Yoram Epstein

(1) Background: Cardiac rehabilitation often emphasizes aerobic capacity while overlooking the importance of muscle strength. This study evaluated the impact of an enhanced remote strength training program (RCR-ST) on cardiac rehabilitation. (2) Methods: In this randomized prospective study (RCT registration number SMC-9080-22), 50 patients starting cardiac rehabilitation were assessed for muscle strength, aerobic capacity, and self-reported outcomes at baseline and after 16 weeks. Participants were divided into two groups: the RCR-ST group received a targeted resistance training program via a mobile app and smartwatch, while the control group received standard care with general resistance training advice. (3) Results: The RCR-ST group demonstrated significant improvements in muscle endurance, notably in leg extension and chest press exercises, with increases of 92% compared to 25% and 92% compared to 13% in the control group, respectively. Functional assessments (5-STS and TUG tests) also showed marked improvements in agility, coordination, and balance. Both groups improved in cardiorespiratory fitness, similarly. The RCR-ST group reported enhanced physical health and showed increased engagement, as evidenced by more frequent use of the mobile app and longer participation in the rehabilitation program (p < 0.05). (4) Conclusions: Incorporating a focused strength training regimen in remote cardiac rehabilitation significantly improves muscle endurance and patient engagement. The RCR-ST program presents a promising approach for optimizing patient outcomes by addressing a crucial gap in traditional rehabilitation protocols that primarily focus on aerobic training.

Exposure to high ambient temperature is a stressor that influences both biological and behavioral functions and has been previously shown to have an extensive impact on brain structure and function. Physiological, cellular and behavioral responses to heat-stress (HS) (40–41 °C, 2 h) were evaluated in adult male Sprague-Dawley rats. The effect of HS exposure before predator-scent stress (PSS) exposure (i.e., HS preconditioning) was examined. Finally, a possible mechanism of HS-preconditioning to PSS was investigated. Immunohistochemical analyses of chosen cellular markers were performed in the hippocampus and in the hypothalamic paraventricular nucleus (PVN). Plasma corticosterone levels were evaluated, and the behavioral assessment included the elevated plus-maze (EPM) and the acoustic startle response (ASR) paradigms. Endogenous levels of heat shock protein (HSP)-70 were manipulated using an amino acid (L-glutamine) and a pharmacological agent (Doxazosin). A single exposure to an acute HS resulted in decreased body mass (BM), increased body temperature and increased corticosterone levels. Additionally, extensive cellular, but not behavioral changes were noted. HS-preconditioning provided behavioral resiliency to anxiety-like behavior associated with PSS, possibly through the induction of HSP-70. Targeting of HSP-70 is an attractive strategy for stress-related psychopathology treatment.

Stress fractures (SF) are one of the most common and potentially serious overuse injuries. Purpose: This study aimed to develop a computational biomechanical model of strain in human tibial bone that will facilitate better understanding of the pathophysiology of SF. Methods: The MRI of a healthy, young male was used for full anatomical segmentation of the calf tissues, which considered hard–soft tissues biomechanical interactions. From the undeformed coronal MR images, the geometry of bones, muscles, connecting ligaments, and fat were reconstructed in three dimensions and meshed to a finite element model. A force that simulated walking was applied on the tibial plateaus. The model was then analyzed for strains in the tibia under various conditions: unloaded walking, walking with a load equivalent to 30% of bodyweight, and walking under conditions of muscular fatigue. In addition, the effect of tibia robustness on strain was analyzed. Results: The model showed that the tibia is mostly loaded by compression, with maximal strains detected in the distal anterior surface: 1241 and 384 microstrain, compressive and tensile, respectively. Load carriage resulted in ~30% increase in maximal effective strains. Muscle fatigue has a complex effect; fatigued calf muscles (soleus) reduced the maximal effective strains up to 9%, but fatigued thigh muscles increased those strains by up to 3%. It had also been shown that a slender tibia is substantially prone to higher maximal effective strains compared with an average (22% higher) or robust tibia (39% higher). Conclusions: Thigh muscle fatigue, load carriage, and a slender tibia were detected as factors that may contribute to the development of SF. The methodology presented here is a novel tool for investigating the pathophysiology of SF.

Bclavian artery caused by the shoulder straps. Purpose This study aimed to evaluate the changes in the upper extremity hemodynamic and neural function and to assess how they are associated with brachial plexus tissue deformation during heavy load carriage. Methods Ten young healthy adults carried for 45 min a backpack load (40% of their body weight) while standing freely, followed by 15 min of recovery (unloaded). Index-finger microvascular flow and sensorimotor function were measured before and after carrying the load, and after recovery. The following sensorimotor functions were measured: light touch thresholds by the index finger and little finger, forearm thermal sensation thresholds, and gross motor function. In addition, marksmanship accuracy, as an indication for fine motor function, was tested. Results Load carriage resulted in an average decrease of ~40% in microvascular flow and a significant decrement in light touch sensation (P < 0.05), but not in thermal sensation and gross motor functions. An increase in the light touch threshold was highly correlated with a reduced index-finger microvascular blood flow (r = 0.79, P = 0.007). These physiological effects were associated with a functional 34% decrement in the accuracy of target acquisition. Conclusion Heavy load carriage resulted in impaired light touch sensitivity and fine motor function, which were associated with reduced finger microvascular blood flow....

A common and unfortunate cause for heat stroke-related deaths in children is entrapment in closed vehicles. The aim of this study was to analyze the pathological consequences of such grave events. Autopsy reports of all children that were brought to a national forensic medicine center after being found dead in closed vehicles over a 21-year period (1995–2015) were reviewed. Data extracted were the circumstances of the events, child age, sex, height and weight, time, date and duration of entrapment, and environmental temperatures at the time of entrapment and the autopsy findings. Eight deceased children were brought to the forensic medicine center for autopsy, and seven families consented to the procedure. Autopsy findings included diffuse petechiae and hemorrhages of serosal membranes (n = 7/7) and lung congestion (n = 3/7). Conclusion: Typical autopsy findings following classical heat stroke in children include diffuse petechiae and hemorrhages and lung involvement. These findings are similar to those reported in adults that had died following exertional heat stroke—a very different mechanism of heat accumulation. Prevention of future events can possibly be obtained by public education on the rapid heating of closed vehicles, the vulnerability of children to heat, and the caregiver role in child entrapment. What is Known: • A common and unfortunate cause for heat stroke-related deaths in children is entrapment in closed vehicles. The pathological consequences of such grave events have not been previously reported. What is New: • This study is the first to describe autopsy findings from children who were found dead in parked cars. • Autopsy findings included diffuse petechiae hemorrhages of serosal membranes and lung congestion. • These findings are identical to those seen in adults following exertional heat stroke.