Yoram Epstein

Plasma antioxidant status and cell injury after severe physical exercise

Strenuous exercise leads to an increase in metabolic rate, increased production of reactive oxygen species, and compromised antioxidant defense systems. To study the effects of oxidative stress during strenuous exercise, a homogeneous group of 31 male subjects participated in a 6-month, 5 days/week training schedule involving two extreme marches of 50 km and 80 km at sea level, separated by 2 weeks of regular training. Each participant carried 35 kg of extra weight. Blood samples were drawn imediately before and after each march. Twenty-nine subjects completed the 50-km march, and only 16 completed the 80-km march. Plasma levels of reduced ascorbic acid, total ascorbate, and dehydroascorbate did not undergo significant changes during either march. However, the 50- and 80-km marches led to 25% and 37% increases, respectively, in plasma levels of uric acid; due presumably to increases in the metabolic rate and consequent pyrimidine nucleotide metabolism. Both marches led to ≈10-fold increase leakage of creatine phosphokinase into the plasma. Likewise, plasma levels of aspartate transaminase, a characteristic marker of liver injury, increased ≈4-fold. Plasma levels of bilirubin, creatine, urea, and glucose also increased. Plasma protein carbonyl content, a marker of protein oxidative damage, decreased significantly during each march. These results are discussed with respect to the consideration that elevation of the respiration rate during exercise leads to production of more reactive oxygen species than the antioxidant systems can scavenge. Plausible explanations for leakage of molecules into the plasma are discussed.

Exertional heat stroke : a case series

UNLABELLED Exertional heat stroke (EHS) is a state of extreme hyperthermia that occurs when excess heat that is generated by muscular exercise exceeds the bodys ability to dissipate it at the same rate. EHS is thought to coincide with previously healthy, highly motivated, and relatively untrained individuals exerting in hot environments for long periods. PURPOSE To establish this notion, the present study was aimed to follow the trends in the incidence of EHS in the period 1988-1996. METHODS During these years, 150 cases of male soldiers (age = 20+/-3 yr) were reported to our institute as suffering from heat illnesses. According to the files, 82 cases were definitely diagnosed as EHS. RESULTS More than 50% of the cases occurred during the first 6 months in service. Most of the cases occurred during the summer season (June-September), but 30% of the cases occurred during the spring. EHS was not related to time in the day. Many cases occurred during the night or early morning, even under mild heat load. Forty percent of the cases occurred during very short activities, and about 60% occurred already during the first 2 h of exercise. The results were discussed in view of the regulations which prevail in the Israeli army. CONCLUSIONS It seems that almost all EHS cases occurred when regulations were not strictly followed.

Comparison of thermoregulatory responses to exercise in dry heat among prepubertal boys young adults and older males

The purpose of this investigation was to compare the thermoregulatory responses during exercise in a hot climate among three age categories. Eight prepubertal (PP), eight young adult (Y) and eight elderly (O) male subjects cycled at an intensity of 50 ± 1% of their maximum oxygen uptake for 85 min (three 20 min bouts with three 7 min rest periods) in hot and dry conditions (41 ± 0.67°C, 21 ± 1% relative humidity). During the exercise‐in‐heat protocol, rectal temperature (Tre) skin temperatures (Tsk), heart rate (HR), , RER, sweat rate, and the number of heat activated sweat glands (HASG) were determined. Despite highest and lowest end‐exposure Tre in the Y and O groups, respectively, the rise in rectal temperature (accounting for differences in baseline Tre) was similar in all age groups. Changes in body heat storage (ΔS), both absolute and relative to body mass, were highest in the Y and O groups and lowest in the PP group. While end‐session as well as changes in mean skin temperature were similar in all three age groups, HR (absolute and percentage of maximum) was significantly lower for the O compared with the PP and Y groups. Total body as well as per body surface sweating rate was significantly lower for the PP group, while body mass‐related net metabolic heat production ((M−W) kg−1) and heat gained from the environment were highest in the PP and lowest in the O group. Since mass‐related evaporative cooling (Esk kg−1) and sweating efficiency (Esk/Msw kg−1) were highest in the PP and lowest in the O group, the mass‐dependent heat stored in the body (ΔS kg−1) was lowest in the PP (1.87 ± 0.03 W kg−1) and highest in Y and O groups (2.19 ± 0.08 and 1.97 ± 0.11 W kg−1, respectively). Furthermore, it was calculated that while the O group required only 4.1 ± 0.5 W of heat energy to raise their body core temperature by 1°C, and the Y group needed 6.9 ± 0.9 W (1°C)−1, the PP group required as much as 12.3 ± 0.7 W to heat up their body core temperature by 1°C. These results suggest that in conditions similar to those imposed during this study, age and age‐related characteristics affect the overall rate of heat gain as well as the mechanisms through which this heat is being dissipated. While prepubertal boys seem to be the most efficient thermoregulators, the elderly subjects appear to be the least efficient thermoregulators.

Fatal exertional heat stroke: A case series

Background:Exertional heat stroke (EHS) is one of the most serious conditions that occur when excess heat, generated by muscular exercise, exceeds the body’s heat-dissipation rate. The consequent elevated body core temperature causes damage to the body’s tissues, resulting in a characteristic multiorgan syndrome, which is occasionally fatal. Methods:We analyzed the fatal EHS cases that occurred in the Israeli Defence Forces during the last decade according to Minard’s paradigm for evaluation of EHS predisposing factors, aiming to characterize the common features and unique circumstances leading to fatality. Results:Accumulation of predisposing factors, particularly those concerning training regulations, coupled with inappropriate treatment at site, were found to be strong predictors of a grave prognosis. Analysis of the pathologic findings of the fatal EHS cases on autopsy revealed a possible association between the duration and length of exercise prior to EHS occurrence and the extent of pathologic findings. Conclusions:Strict adherence to existing training regulations may prevent further heat stroke fatalities.

Heat stroke : a review of cooling methods.

The prognosis of heat stroke in patients is directly related to the degree of hyperthermia and its duration. Therefore, the most important feature in the treatment of heat stroke is rapid cooling. Several cooling methods have been presented in the literature including immersion in water at different temperatures, evaporative cooling, ice pack application, pharmacological treatment and invasive techniques. This article describes the various cooling techniques in terms of efficacy, availability, adverse effects and mortality rate. Data suggest that cooling should be initiated immediately at time of collapse and should be based on feasible field measures including ice or tepid water (1–16°C), which are readily available. In the emergency department, management should be matched to the patient’s age and medical background and include immersion in ice water (1–5°C) or evaporative cooling.

Biocompatibility of the Ex-PRESS Miniature Glaucoma Drainage Implant

PurposeBased on lessons learned from earlier attempts, a novel miniature glaucoma implant, Ex-PRESS, was developed in 1998. The current study summarizes the histopathologic evaluation of this device implanted in the eyes of rabbits. MethodsThe device was implanted into the anterior chamber at the corneoscleral junction in 1 eye each of 8 white New Zealand rabbits, while the contralateral eye served as control. Three and 6 months after implantation, the rabbits were killed and their eyes were enucleated and processed histologically, leaving the device in situ when sectioning. ResultsThree and 6 months postoperatively, the local tissue reaction typically consisted of an enveloping, thin, mature, fibrotic capsule (thickness <0.04 mm), devoid of inflammatory cells. This capsule surrounded approximately 25% of the implant surface area present in the sections. The lumina of the devices were devoid of inflammatory exudates or other obstructions in all specimens examined, suggesting free flow of fluid. ConclusionsThe implantation of the Ex-PRESS miniature glaucoma shunt resulted in minimal capsular reaction. Considering the high reactivity of the rabbit eye, it is possible that this implant will induce a smaller cellular inflammatory reaction in the human eye.

Increase in rat intestinal permeability to endotoxin during hyperthermia

SummaryVictims of heat stroke exhibit several clinical features which are also encountered in endotoxaemia. In order to investigate these similarities hyperthermic rats were used to explore the possibility that high body temperature results in increased permeability of intestinal wall to endotoxin. 125I endotoxin was introduced into intestinal segments taken from non-heat exposed rats. The segments were then incubated at 37‡ C or 45‡ C. Intestinal segments from heat stressed rats were similarly prepared and incubated at 37‡ C. Leakage of endotoxin from segments taken from heat stressed rats was three times greater than from those from non-heat stressed rats, as were the segments from non-heat stressed rats which were incubated at 45‡ C. These results indicate that the intestinal membrane is damaged by heat and that an increase in outward leakage of microbial endotoxins from the gut then occurs. This might contribute to the pathophysiological picture of heatstroke.

External load can alter the energy cost of prolonged exercise

SummaryThe present study was undertaken to examine the energy cost of prolonged walking while carrying a backpack load. Six trained subjects were tested while walking for 120 min on a treadmill at a speed of 1.25 m · s−1 and 5% elevation with a well fitted backpack load of 25 and 40 kg alternately. Carrying 40 kg elicited a significantly higher (p<0.01) enery cost than 25 kg. Furthermore, whereas carrying 25 kg resulted in a constant energy cost, 40 kg yielded a highly significant (p<0.05) increase in energy cost over time. The study implies that increase in load causes physical fatigue, once work intensity is higher than 50% maximal work capacity. This is probably due to altered locomotion biomechanics which in turn lead to the increase in energy cost. Finally, the prediction model which estimates energy cost while carrying loads should be used with some caution when applied to heavy loads and long duration of exercise, since it might underestimate the acutal enery cost.

The energy cost of walking and running with and without a backpack load

SummaryThe effect of a backpack load (20 kg) on oxygen consumption while walking and running at different speeds was investigated. Fifteen males walked and ran (with and without load) up a 5% sloped treadmill at 6.4, 7.2, 8.0, 9.6, and 11.2 km/h (4, 4.5, 5, 6, and 7 mph). While walking