Effort syndrome: hyperventilation and reduction of anaerobic threshold

Effort syndrome is an entity in danger of being subsumed into "chronic fatigue syndrome" and lost to sight. Its distinctive feature is the reduction of the anaerobic threshold for work by depletion of the body's alkaline buffering systems through hyperventilation. This article describes the history and clinical features of effort syndrome and reports a study in which capnography is used to identify the anaerobic threshold by registering the respiratory response to the onset of metabolic acidosis. The patients' thresholds are low, and provide a goal for rehabilitation. In other forms of chronic fatigue syndrome, the pathogenesis and logic of therapy are unclear.     

Lactate kinetics and individual anaerobic threshold

Exercise with stepwise increasing work loads until exhaustion leads to a curvilinear increase of lactate in blood and typical lactate kinetics in the post-exercise period. Lactate kinetics in blood during exercise and recovery results from diffusion along gradients between muscle and blood and simultaneous elimination. Therefore, a general diffusion-elimination model is presented from which maximal rate of elimination (Em), individual anaerobic threshold (IAT), gradient between muscle and blood (deltaC-deltaCEm), muscle volume working above the IAT (Vm), individual membrane constant (Mc), quantity of lactate accounting for lactate gradient (Agrad), and whole body lactate (Anet) can be obtained. For demonstration purpose, this model was applied to a highly trained athlete. In this example, all constants and variables mentioned above as well as an equation reflecting individual lactate kinetics were calculated. Furthermore, the IAT was determined in 61 athletes participating in different events. In general, it can be demonstrated that with increasing aerobic capacity the lactate concentration at the IAT decreases. The lactate concentration at the IAT varies interindividually within broad limits, thus emphasizing the need for individual assessment.     

Clinical study of anaerobic respiratory infection

Interleukin-2 (IL-2) therapy is dose limited by a severe vascular leak with resulting systemic and pulmonary toxicity. Although recognized as a mediator of septic shock and vascular leak, the relative role of IL-1 in IL-2 toxicity is unclear. We evaluated the effect of IL-1 receptor antagonist (IL-1ra) on IL-2 lethality, pulmonary vascular leak, and treatment of pulmonary metastases in a murine model. In vivo induction of mRNA for IL-1 alpha was evaluated in liver by Northern blots after 0, 5, 8, and 11 doses of IL-2 in C3H/HEN mice. The expression index for the IL-1 alpha gene increased from 0.16 to 0.74 after 5 doses of IL-2, and further increased to 1.04 after 11 doses of IL-2. C3H/HEN mice (n = 56) were randomized to receive phosphate-buffered saline (PBS), IL-1ra high dose (HD), or IL-1ra low dose (LD) by continuous subcutaneous infusion via Alzet mini-pumps. The biologic effectiveness of the dose and administration of IL-1ra was determined by the ability to block IL-1-induced IL-6 production in vivo. Mean serum IL-6 levels 3 hr after intraperitoneal IL-1 alpha (10 micrograms/kg) were: PBS, 3730 +/- 526 (mean +/- SEM pg/ml); IL-1ra (LD), 1156 +/- 398; and IL-1ra (HD), 594 +/- 30 (P < 0.01, IL-1ra HD or LD vs PBS). Pulmonary vascular leak was measured by iv I125 albumin after 8 doses of IL-2 (100,000 U ip q 8 hr).(ABSTRACT TRUNCATED AT 250 WORDS)     

Is the intracellular pH threshold an anaerobic threshold from the view point of intracellular events?: a brief review

Intracellular biochemical changes could be monitored noninvasivery and continuously by using nuclear magnetic resonance (NMR). In about the last decade, intracellular behavior of phosphorus compounds and pH during muscle contraction in man have been studied by 31P nuclear magnetic resonance spectroscopy (31P-MRS). During incremental load, lactic acidosis was followed by a decline in intracellular pH. 31P-MRS studies has been definitely proved that this change in intracellular pH shows the threshold behavior. Some reports discussed the intracellular pH threshold (pHT) as an anaerobic threshold (AT) from the view point of intracellular events. However, our studies revealed that pHT did not reflect the onset of lactate production. In this article, studies of intracellular pH of working muscle were reviewed in relation to an anaerobic threshold.     

Nocturnal evolution of respiratory effort in obstructive sleep apnoea syndrome: influence on arousal threshold

It has been recently described that the overnight increase in maximal end-apnoeic oesophageal pressure (P(oes,max)), considered as an index of the arousal threshold to occlusion, mostly contributes to apnoea lengthening during the night. However, the rise in apnoea duration could also be caused by changes in hypoxaemia, chemosensitivity and upper airway resistance. To better define the relative contributions of each of these factors, we examined the recordings of nine patients. Before apnoea, the mean pulmonary resistance at peak inspiratory flow (RPIF) was computed. During apnoea, all swings in oesophageal pressure (P(oes)) were measured to define the P(oes,max), the increase from the minimum to the maximum (deltaP(oes)), the rate of increase in P(oes) (RP(oes)) and the P(oes) at the first occluded breath (P(oes,1)). A gradual and significant increase in apnoea duration (p=0.02), P(oes,max) (p=0.02) and deltaP(oes) (p=0.006) was present across the night without any changes in oxygen saturation, RPIF, and P(oes,1). The slope of increase in P(oes,max), apnoea duration and deltaP(oes) was correlated with the apnoea/hypopnoea index. We conclude that in obstructive sleep apnoea, the nocturnal rise in apnoea duration is attributable more to an increase in the arousal threshold related to apnoea recurrence than to changes in chemosensitivity and upper airway resistance.     

Identification of the anaerobic threshold using double product in patients with coronary artery disease

This study compared the ventilatory threshold with the double-product break point in 104 patients with cardiovascular disease during ramp treadmill testing. The high correlation (r = 0.81) between the double-product break point and the ventilatory threshold, even in patients taking beta blockers, suggests the former method is a viable noninvasive alternative for identifying the anaerobic threshold in patients with cardiovascular disease, particularly when expired gas analysis is not appropriate or available.     

Functional relevance of anaerobic metabolism in the isolated respiratory network of newborn rats

Respiratory (C3-C5) activity and extracellular K+, pH and Ca2+ (aKe, pHe, [Ca]e, respectively) in the ventral respiratory group (VRG) were measured in vitro. In brainstem-spinal cord preparations from 0- to 1-day-old rats, lowering of bath glucose content from 30 to 10 mM for 1 h did not affect aKe or rhythmic activity. In preparations from 2- to 3-day-old animals, however, an aKe rise by about 1 mM and disturbance of rhythm occurred after a delay of 50 min. Glucose-free saline resulted, after about 30 min, in reversible blockade of respiratory rhythm and an aKe rise by more than 8 mM, whereas pHe remained unaffected. Exposure to anoxia for 30 min after 1 h of pre-incubation in 10 mM glucose led to a progressive rise of aKe, and a fall of [Ca]e. The concomitant suppression of rhythm was irreversible in preparations from 2- to 3-day-old animals. Similar effects on aKe and [Ca]e and irreversible blockade of rhythm were revealed during anoxia in glucose-free solution, or by addition of 2-5 mM iodoacetate to oxygenated or hypoxic solutions. Iodoacetate led to a slow increase of pHe by more than 0.2 pH units, which was accelerated by anoxia. Our findings show that normal respiratory network functions in the en bloc medulla, in particular from rats older than 1 day, depend on high bath glucose levels, necessary for effective utilization of anaerobic metabolism.     

Effect of training program based on anaerobic threshold in the early phase after acute myocardial infarction

We devised a new physical training program on the basis of anaerobic threshold for rehabilitation in the early phase of acute myocardial infarction. Forty-four patients were divided into two groups, control and training. We measured the left ventricular ejection fraction using nuclear stethoscopy during the treadmill test and calculating radioactive cardiac output. In the training group, anaerobic threshold and exercise time to the anaerobic threshold point were significantly increased, and stroke volume at rest measured by the dye dilution method increased significantly. Radioactive cardiac output during exercise also increased after the exercise therapy. These results indicate that the rehabilitation program consisting of physical training based on the anaerobic threshold is effective.     

Susceptibility testing interpretive criteria for levofloxacin when testing respiratory pathogens, Haemophilus influenzae and Moraxella catarrhalis

The more active L-isomer, levofloxacin, of the racemic ofloxacin mixture has been under development for therapeutic use. In this study, we evaluated the activity of ofloxacin, levofloxacin, and D-ofloxacin against the fastidious respiratory tract pathogens Haemophilus influenzae and Moraxella catarrhalis. Levofloxacin was two-fold more active than ofloxacin against H. influenzae (MIC90, 0.015 microgram/ml), and D-ofloxacin was least active (MIC90, 1 microgram/ml). For M. catarrhalis the MIC90 values were 0.03 microgram/ml, 0.06 microgram/ml, and 2 micrograms/ml for levofloxacin, ofloxacin, and D-ofloxacin, respectively. For disk diffusion susceptibility testing, Chocolate Mueller-Hinton agar (CMH) was considered preferable to Haemophilus test medium (HTM) because it supported the growth of all of 105 H. influenzae strains whereas five strains failed to grow on HTM. In addition, the margins of the zones of inhibition were more distinct on CMH and the Haemophilus species strains with elevated fluoroquinolone MICs were readily distinguished. The superior growth on CMH was reflected in a reduction of inhibition zone diameters of 2-3 mm relative to the inhibition zone diameters on HTM. The previously proposed interpretive criteria for the 5 microgram disk diffusion susceptibility test (susceptible at > or = 17 mm) results in complete categorical agreement with the reference microdilution broth method for M. catarrhalis on Mueller Hinton agar and for H. influenzae on HTM and CMH. However, the minimum diameter of the zone of inhibition recorded for a member of the dominant population of either species was considerably greater (25 mm) than 17 mm on any of the media tested.     

Cardiorespiratory failure and diabetic autonomic neuropathy: a case report

Advanced autonomic neuropathy in diabetic patients is associated with homeostatic cardiovascular response. Sympathetic compensation diminishes and the organism becomes more susceptible to the depressant effect of certain drugs. The incidence of undesirable cardiovascular effects (bradycardia, hypotension and sudden heart failure) during anesthesia is higher in such patients. We report the case of a woman with diabetes who suffered two episodes of sudden heart failure after brachial plexus block through the axilla, followed one year later by sudden heart failure during general anesthesia for kidney transplantation. The possible contributing mechanisms are described.     

Anaerobic expression of Escherichia coli succinate dehydrogenase: functional replacement of fumarate reductase in the respiratory chain during anaerobic growth

Succinate-ubiquinone oxidoreductase (SQR) from Escherichia coli is expressed maximally during aerobic growth, when it catalyzes the oxidation of succinate to fumarate in the tricarboxylic acid cycle and reduces ubiquinone in the membrane. The enzyme is similar in structure and function to fumarate reductase (menaquinol-fumarate oxidoreductase [QFR]), which participates in anaerobic respiration by E. coli. Fumarate reductase, which is proficient in succinate oxidation, is able to functionally replace SQR in aerobic respiration when conditions are used to allow the expression of the frdABCD operon aerobically. SQR has not previously been shown to be capable of supporting anaerobic growth of E. coli because expression of the enzyme complex is largely repressed by anaerobic conditions. In order to obtain expression of SQR anaerobically, plasmids which utilize the PFRD promoter of the frdABCD operon fused to the sdhCDAB genes to drive expression were constructed. It was found that, under anaerobic growth conditions where fumarate is utilized as the terminal electron acceptor, SQR would function to support anaerobic growth of E. coli. The levels of amplification of SQR and QFR were similar under anaerobic growth conditions. The catalytic properties of SQR isolated from anaerobically grown cells were measured and found to be identical to those of enzyme produced aerobically. The anaerobic expression of SQR gave a greater yield of enzyme complex than was found in the membrane from aerobically grown cells under the conditions tested. In addition, it was found that anaerobic expression of SQR could saturate the capacity of the membrane for incorporation of enzyme complex. As has been seen with the amplified QFR complex, E. coli accommodates the excess SQR produced by increasing the amount of membrane. The excess membrane was found in tubular structures that could be seen in thin-section electron micrographs.     

On-line analysis of anaerobic power and oxygen debt in rectangular-triangular stress testing (author's transl)

The rectangular-triangular bicycle exercise test with on-line analysis of respiratory function and gas exchange is used in the evaluation of physical performance. A programme has been developed for on-line computation of an index of anaerobic power and of oxygen debt. The index of anaerobic power is calculated by subtracting the oxygen uptake exceeding the resting values from the energy demand to sustain a given work load. The oxygen uptake exceeding the resting level during a period of five minutes after the exercise test is added up and the result is taken to represent the index of the oxygen debt. In this presentation of preliminary results it is concluded that the index of anaerobic power and the parameter of anaerobic power (maximal oxygen uptake in symptom-limited stress testing) provide valuable additional information in regard to the physical performance of untrained people, athletes and patients with impaired cardio-pulmonary function in quantitative terms.     

Vascular infections: exceeding the threshold

During fiscal year 1988, our hospital infection control practitioner identified a 400% increase in the incidence of vascular surgery nosocomial infections. The six graft and six amputation infections were validated as nosocomial against hospital definitions adopted from the Centers for Disease Control. Our Infection Control Committee mandated an audit of the infected vascular surgery patients using a case/control design to identify and examine associated variables that may need attention. The significant finding was microbial resistance to prophylactic antibiotics used during surgery (p > 0.0001, Fisher's exact). The use of vancomycin as a prophylactic antimicrobial agent for all major vascular cases was recommended to the surgeons.     

Antibiotic resistance in oral/respiratory bacteria

In the last 20 years, changes in world technology have occurred which have allowed for the rapid transport of people, food, and goods. Unfortunately, antibiotic residues and antibiotic-resistant bacteria have been transported as well. Over the past 20 years, the rise in antibiotic-resistant gene carriage in virtually every species of bacteria, not just oral/respiratory bacteria, has been documented. In this review, the main mechanisms of resistance to the important antibiotics used for treatment of disease caused by oral/respiratory bacteria--including beta-lactams, tetracycline, and metronidazole--are discussed in detail. Mechanisms of resistance for macrolides, lincosamides, streptogramins, trimethoprim, sulfonamides, aminoglycosides, and chloramphenicol are also discussed, along with the possible role that mercury resistance may play in the bacterial ecology.     

Pharmaceutical wastewater treatment using an anaerobic/aerobic sequencing batch biofilter

The performance of a sequencing batch biofilter integrating anaerobic/aerobic conditions in one tank to treat a pharmaceutical wastewater effluent was studied. A pilot reactor, packed with a porous volcanic stone (puzzolane) was used in the study. The reactor operated as a sequencing batch biofilter, SBB, with reaction times varying for the anaerobic stage from 8 to 24 h and for the aerobic one from 4 to 12 h. The volume of exchange was from 16 to 88%. The pharmaceutical wastewater contained organic chemicals including phenols and o-nitroaniline, a concentration of organic matter that varied from 28,400 to 72,200 mg/L (as total COD), 280 to 605 mg N-NH4/L. and 430 to 650 mg SST/L. In order to acclimatize the microorganisms to the industrial wastewater, the organic load was increased stepwise from 1 to 7.7 kg COD/m3/d. The adequate time was obtained when the removal efficiency of COD reached 80%, or more. Maximal removal loads, associated to high removal efficiencies (95-97% as COD), varied from 4.6 to 5.7 kg COD/m3/d. Under these conditions color removal was 80% as Pt-Co units. Microtox analysis was performed to the wastewater and to the anaerobic and aerobic stages. It was observed that the aerobic stage was the responsible for wastewater detoxification. Results showed that the anaerobic/aerobic SBB was able to treat efficiently initial concentrations of the raw effluent up to 28,400 mg COD/L.     

Clinical evaluation of the automated COBAS AMPLICOR MTB assay for testing respiratory and nonrespiratory specimens

We evaluated the COBAS AMPLICOR PCR system (Roche Diagnostics) for the routine detection of Mycobacterium tuberculosis complex (MTBC) in clinical specimens. Diagnostic culture, considered as the reference method, was performed with BACTEC, L?wenstein-Jensen, Stonebrink, and Kirchner media. Occasionally MB-Redox, ESP, or MGIT medium was also used. A total of 643 respiratory and 506 nonrespiratory specimens collected from 807 patients were investigated. Of the 95 culture-positive specimens, 80 were COBAS AMPLICOR MTB positive, and of the 1,054 culture-negative specimens, 1,044 were COBAS AMPLICOR MTB negative. After resolving discrepancies by review of the medical history, the overall sensitivity, specificity, and positive and negative predictive values for the COBAS AMPLICOR MTB assay, respectively, were 83.5, 98.8, 86.7, and 98.6% compared to those of diagnostic culture. In smear-positive specimens, the sensitivity of the COBAS AMPLICOR MTB assay was 96%, versus 48% for smear-negative specimens. No significant differences in the test performance between respiratory and nonrespiratory specimens were observed. The overall inhibition rate was less than 2%, excluding stool specimens. The clear advantages of the COBAS AMPLICOR PCR system are standardized procedures and reagents for specimen processing as well as an internal control for reliable monitoring of PCR inhibitors. By simplifying the work flow through a completely automated amplification and amplicon detection procedure, the COBAS AMPLICOR PCR system proved itself as a very useful component for routine diagnostic procedures.