Anthony W. Bachmann

Markers for monitoring overtraining and recovery

Physiological and mood state parameters were monitored during a 6-month swimming season in an attempt to determine markers of overtraining and recovery. Fourteen elite male and female swimmers were tested early-, mid-, and late-season and shortly before and after major competition. Training details and subjective ratings of well-being were compiled by the athletes in daily logs. Three swimmers were classified as stale based upon performance deterioration and prolonged, high fatigue levels. Staleness scores were calculated for each athlete using performance change from early- to late-season and daily fatigue ratings for the season. Regression analysis revealed a battery of well-being ratings which predicted staleness scores, accounting for 76% of the variance. The late-season stress ratings and plasma catecholamine levels at rest predicted staleness scores, accounting for 85% of the variance. During tapering, well-being ratings predicted improvement in competitive performance, accounting for 72% of the variance of the improvement in race times from previous best times. It was concluded that self-reported ratings of well-being may provide an efficient means of monitoring both overtraining and recovery; plasma catecholamine levels at rest may provide an additional objective tool for diagnosis.

Glucocorticoid receptor polymorphisms and post-traumatic stress disorder.

Post-traumatic stress disorder (PTSD) is reported in some studies to be associated with increased glucocorticoid (GC) sensitivity. Two common glucocorticoid receptor (GR) polymorphisms (N363S and BclI) appear to contribute to the population variance in GC sensitivity. There is some evidence that there may be a genetic predisposition to PTSD. Hence we studied 118 Vietnam war veterans with PTSD for (i) GR polymorphisms, particularly the N363S and the BclI polymorphisms which are thought to be GC sensitising, and (ii) two measures of GC sensitivity, the low-dose 0.25 mg dexamethasone suppression test (LD-DST) and the dermal vasoconstrictor assay (DVVA). The DST and GR polymorphisms were also performed in 42 combat exposed Vietnam war veterans without PTSD. Basal plasma cortisol levels were not significantly different in PTSD (399.5+/-19.2 nmol/L, N=75) and controls (348.6+/-23.0 nmol/L, N=33) and the LD-DST resulted in similar cortisol suppression in both groups (45.6+/-3.2 vs. 40.8+/-4.1%). The cortisol suppression in PTSD patients does not correlate with Clinician Administered PTSD Scores (CAPS), however there was a significant association between the BclI GG genotype and low basal cortisol levels in PTSD (P=0.048). The response to the DVVA was similar to controls (945+/-122, N=106 vs. 730+/-236, N=28, P=0.42). PTSD patients with the GG genotype, however, tended to be more responsive to DVVA and in this group the DVVA correlated with higher CAPS scores. The only exon 2 GR polymorphisms detected were the R23K and N363S. Heterozygosity for the N363S variant in PTSD, at 5.1% was not more prevalent than in other population studies of the N363S polymorphism in Caucasians (6.0-14.8%). The GG genotype of the BclI polymorphism found to be associated with increased GC sensitivity in many studies showed a tendency towards increased response with DVVA and correlated with higher CAPS scores. In conclusion, the N363S and BclI GR polymorphisms were not more frequent in PTSD patients than controls and reported population frequencies. Our PTSD group did not display GC hypersensitivity, as measured by the LD-DST and DVVA. In a subset of PTSD patients with the BclI GG genotype, CAPS scores and basal cortisol levels were negatively correlated.

Hormonal, immunological, and hematological responses to intensified training in elite swimmers

The purpose of this study was to compare the responses of selected hormonal, immunological, and hematological variables in athletes showing symptoms of overreaching with these variables in well-trained athletes during intensified training. Training volume was progressively increased over 4 wk in 24 elite swimmers (8 male, 16 female); symptoms of overreaching were identified in eight swimmers based on decrements in swim performance, persistent high ratings of fatigue, and comments in log books indicating poor adaptation to the increased training. Urinary excretion of norepinephrine was significantly lower (P < 0.05, post hoc analysis) in overreached (OR) compared with well-trained (WT) swimmers throughout the 4 wk. There were no significant differences between OR and WT swimmers for other variables including: concentrations of plasma norepinephrine, cortisol, and testosterone, and the testosterone/cortisol ratio; peripheral blood leukocyte and differential counts, neutrophil/lymphocyte ratio, and CD4/CD8 cell ratio; serum ferritin and blood hemoglobin concentrations, erythrocyte number, hematocrit, and mean red cell volume (MCV). MCV increased significantly over the 4 wk in both groups, suggesting increased red blood cell turnover. These data show that, of the 16 hormonal, immunological, and hematological variables measured, urinary norepinephrine excretion appears to be the only one to distinguish OR from WT swimmers during short-term intensified training. Low urinary norepinephrine excretion was observed 2 to 4 wk before the appearance of symptoms of overreaching, suggesting the possibility that neuroendocrine changes may precede, and possibly contribute to, development of the overreaching/overtraining syndromes.

Hormonal Responses of Elite Swimmers to Overtraining

Fourteen elite swimmers had measurements of stress hormones taken at five points during a 6-month season: early-, mid- and late-season, during tapering for National Trials, and 1-3 d after the Trials. Training details and subjective ratings of fatigue were recorded daily in log books. Plasma norepinephrine and epinephrine concentrations were significantly correlated with swim training volume (r = 0.37 and 0.33, respectively, P < 0.05 for each). No significant differences were seen in norepinephrine or cortisol concentrations at the five sampling times. Epinephrine levels were significantly lower (P < 0.05) after competition compared with values early in the season and shortly before competition. Symptoms of the overtraining syndrome were identified in three of the swimmers, based on performance decrements and high, prolonged levels of fatigue. In these three swimmers, norepinephrine levels tended to be higher than those of the other swimmers from mid-season onward and were significantly higher (P < 0.01) during tapering. If these findings can be confirmed in larger numbers and different types of athletes, norepinephrine level may provide a useful marker of the overtraining syndrome.

Identification of BMP and Activin Membrane-Bound Inhibitor (BAMBI) as a Potent Negative Regulator of Adipogenesis and Modulator of Autocrine/Paracrine Adipogenic Factors

Adipose tissue dysfunction underpins the association of obesity with type 2 diabetes. Adipogenesis is required for the maintenance of adipose tissue function. It involves the commitment and subsequent differentiation of preadipocytes and is coordinated by autocrine, paracrine, and endocrine factors. We previously reported that fibroblast growth factor-1 (FGF-1) primes primary human preadipocytes and Simpson Golabi Behmel syndrome (SGBS) preadipocytes and increases adipogenesis through a cascade involving extracellular signal–related kinase 1/2 (ERK1/2). Here, we aimed to use the FGF-1 system to identify novel adipogenic regulators. Expression profiling revealed bone morphogenetic protein (BMP) and activin membrane-bound inhibitor (BAMBI) as a putative FGF-1 effector. BAMBI is a transmembrane protein and modulator of paracrine factors that regulate adipogenesis, including transforming growth factor (TGF) superfamily members (TGF-β and BMP) and Wnt. Functional investigations established BAMBI as a negative regulator of adipogenesis and modulator of the anti- and proadipogenic effects of Wnt3a, TGF-β1, and BMP-4. Further studies showed that BAMBI expression levels are decreased in a mouse model of diet-induced obesity. Collectively, these findings establish BAMBI as a novel, negative regulator of adipogenesis that can act as a nexus to integrate multiple paracrine signals to coordinate adipogenesis. Alterations in BAMBI may play a role in the (patho)physiology of obesity, and manipulation of BAMBI may present a novel therapeutic approach to improve adipose tissue function.

Increased plasma noradrenaline during low dose adrenaline infusion in resting man and during sympathetic stimulation.

1. Both resting and stimulated (straight‐leg raising and head‐up tilt) levels of arterial and venous plasma noradrenaline were significantly higher during low‐dose adrenaline infusion in five mild hypertensive and four normotensive patients with one adrenal.

Reduced Adrenal Secretory Mass After Unilateral Adrenalectomy for Aldosterone-Producing Adenoma May Explain Unexpected Incidence of Hypotension

In a prospective study of 37 patients who had unilateral adrenalectomy for an aldosterone-producing adenoma, five of 33 (15%) were symptomatically hypotensive after at least 1 year, and eight of 29 (28%) who were observed 3, 6, 12, 18 and 24 months after the operation showed 2-year blood pressures below the fifth percentile for age- and sex-matched controls. Postoperatively, plasma aldosterone was lower, and plasma renin activity higher than in controls, these differences being more marked in the hypotensive group. Pre-operatively elevated atrial natriuretic factor fell to levels lower than in controls. These serial changes in volume-regulatory hormones are consistent with chronic hypovolaemia, due to relative hypoaldosteronism. Plasma cortisol was lower 6 months after the operation and plasma adrenaline levels fell by half. A reduced adrenocortical (aldosterone and cortisol) and adrenomedullary (adrenaline) secretory mass may play a role in the hypotension observed after unilateral adrenalectomy.

PHAEOCHROMOCYTOMAS SECRETING ADRENALINE BUT NOT NORADRENALINE DO NOT CAUSE HYPERTENSION AND REQUIRE PRECISE ADRENALINE MEASUREMENT FOR DIAGNOSIS

1. Urinary noradrenaline (NA) and adrenaline (ADR) determinations are a more sensitive index than plasma measurements for the diagnosis of phaeochromocytoma (phaeo).

Diastolic ventricular interaction in chronic heart failure: Relation to heart rate variability and neurohumoral status

SummaryIt is likely that abnormal baroreflex control mechanisms are at least partially responsible for autonomic dysfunction in chronic heart failure. We recently demonstrated that diastolic ventricular interaction is associated with impaired baroreflex control of vascular resistance in heart failure. We reasoned that by con-straining left ventricular filling, such interaction would decrease baroreflex activity and, thereby, increase sympathetic and decrease parasympathetic outflow. Wehypothesized, therefore, that diastolic ventricular interaction in chronic heart failure patients would be associated with autonomic dysfunction.We used radionuclide ventriculography to measure changes in left and right ventricular end-diastolic volumes during acute volume unloading achieved by—30 mm Hg lower-body negative pressure in 30 patients with chronic heart failure. An increase in left ventricular volume in association with a reduction in right ventricular volume indicates diastolic ventricular interaction (a larger increase indicating a greater degree of interaction). We also measured heart rate variability (n = 23) and resting venous plasma norepinephrine (n = 24), epinephrine (n = 24), and atrial natriuretic peptide (ANP) (n = 14).During lower-body negative pressure, while right ventricular volume decreased in all patients (P < 0.001), left ventricular end-diastolic volume increased (from 152 ± 25 to 157 ± 36ml/m2, P = 0.01). The change in left ventricular volume was positively correlated with resting plasma norepinephrine (P < 0.01) and ANP (P <0.005), and negatively correlated with the standard deviation of normal to normal R-R intervals (P <0.005), the root-mean-square of differences between successive normal to normal R-R intervals (P < 0.05), total power (P < 0.01), low-frequency power (P < 0.01), and high-frequency power (P < 0.05).Diastolic ventricular interaction in patients with chronic heart failure is associated with sympathetic nervous system activation evidenced by increased plasma norepinephrine and reduced heart rate variability.

Hybrid gene or hybrid steroids in the detection and screening for familial hyperaldosteronism type I

1. Early diagnosis of Familial Hyperaldosteronism Qpe I (FH‐I, glucocorticoid‐suppressible hyperaldosteronism) in asymptomatic, affected individuals is essential if death from stroke is to be prevented.