University of South Wales

The cold pressor test (CPT) is a clinical stress test commonly used to evoke acute pressor and respiratory responses, accompanied by increased sympathetic nerve activity. Cerebral blood flow (CBF) is well-preserved during CPT despite elevated arterial blood pressure (ABP), but the underlying mechanisms remain unclear. We hypothesized that dynamic cerebral autoregulation (dCA) contributes to this CBF preservation, preventing overperfusion under stress-induced hypertension. Thirty-seven healthy volunteers performed CPT for 3 min, while ABP, middle cerebral artery mean velocity (MCA Vmean), and end-tidal carbon dioxide partial pressure (PETCO2) were measured. CPT significantly increased ABP (p < 0.001) and decreased PETCO2 (p = 0.032), whereas MCA Vmean remained unchanged (p = 0.976), resulting in a significant decrease in cerebrovascular conductance index (CVCi) (p < 0.001). The CPT-induced relative change in CVCi was significantly associated with the low-frequency (LF) phase (p < 0.001). Notably, the CPT-induced decrease in PETCO2 was significantly associated with the decreases in MCA Vmean (p < 0.001) and in %CVCi (p = 0.009). These findings suggest that dynamic cerebral autoregulation, as well as the respiratory response (change in PETCO2), plays a key role in maintaining CBF during CPT-induced elevations in ABP. Furthermore, individual differences in dCA and respiratory responses may account for variability in cerebrovascular responses to acute pressor stimuli.

This paper explores potential lasting solutions to the crisis of internal displacement in Afghanistan as identified by Internally Displace People (IDPs) in the country. The arguments are based on interviews with IDPs, Afghanistan’s government officials as well as local and international humanitarian aid providers. Empirical findings indicates that while war had been the main cause of internal displacement in Afghanistan, drought, natural disasters, and a lack of income-generating opportunities also contributed to this complex problem. This situation has caused loss of dignity, poverty and suffering among IDPs across the country. Although various phases of the long Afghan war had caused internal displacement over the past four and a half decades, failure to find lasting solutions to displacement contributed to continued displacement, suffering and to war. We argue that local and international responses to the IDPs problem in Afghanistan have been inadequate, uncoordinated, focused on ‘short-termism’, and have lacked a long-term vision. We conclude that lasting solutions to the crisis require a combination of sustainable peace, inclusive state institutions, strong political will from the international community and from Afghanistan’s ruling authorities as well as targeted development aid. Such efforts must support the dignified return of IDPs and their reintegration into their places of origin, or their permanent settlement in the communities where they currently live.

Spinous process fractures of the cervical spine are generally considered stable injuries, particularly when they resemble the classic clay-shoveler’s fracture, which typically results from indirect traction forces. However, in certain traumatic settings, these fractures may serve as markers of underlying spinal instability.We report the case of a 93-year-old woman who sustained a fall following a syncopal episode, striking her head on furniture. On initial evaluation, she was neurologically intact, and computed tomography (CT) of the head and cervical spine revealed no clear fracture or dislocation. Within 24 hours, she developed progressive quadriparesis.Repeat CT demonstrated a subtle C6 spinous process fracture with posterior facet joint subluxation and anterior displacement of C5 on C6. Magnetic resonance imaging (MRI) revealed a C5-C6 fracture-dislocation with marked anterolisthesis and significant ligamentous injury. The patient underwent spinal traction followed by anterior cervical discectomy, fusion, and plating, resulting in substantial neurological improvement.This case highlights that even subtle spinous process fractures may indicate serious underlying injury. Unlike isolated clay-shoveler’s fractures, trauma-associated spinous process fractures should prompt further evaluation, particularly with MRI, in patients presenting with delayed or evolving neurological deficits. Early recognition of ligamentous instability is essential to prevent secondary deterioration and optimize clinical outcomes.

Kenyan athletes have dominated competitive middle- and long-distance running for more than half a century, a phenomenon suggested to be attributable, at least in part, to superior running economy. Given that lower-leg anthropometry is an important determinant of running economy, a key contributor to the athletic performance of Kenyan runners is thought to be slender lower legs. Running economy and lower-leg anthropometrics, including relative lower-leg length and mean lower-leg thickness, were measured in adult middle- to long-distance runners, including 12 Kenyan elite and 29 sub-elite runners, and 20 Danish elite and 37 sub-elite runners. Additionally, 46 untrained Kenyan and 30 untrained Danish adolescents were included. Among adult runners, the oxygen cost of running was 33.61mLkg-0.75km-1 lower in Kenyans compared with Danes [95% confidence interval (CI): 18.63, 48.59; p < 0.0001] and increased by 2.20mLkg-0.75km-1 per centimetre squared increase in lower-leg cross-sectional area (95% CI: 1.03, 3.37; p = 0.0005). In untrained adolescents, the oxygen cost of running was 44.82mLkg-0.75km-1 lower (95% CI: 21.99, 67.64; p = 0.0002) and increased by 1.75mLkg-0.75km-1 per centimetre squared increase in lower-leg cross-sectional area (95% CI: 0.18, 3.32; p = 0.0294). Slender lower legs are favourably associated with superior running economy and might contribute to the dominance of Kenyan athletes in competitive middle- to long-distance running.

Inflammation plays an essential role in the pathogenesis of cardiovascular diseases (CVDs), and despite advances in treatments, challenges still exist. Recent studies have explored the use of colchicine in reducing the risk of CVDs. Therefore, the present systematic review aimed to evaluate the impact of colchicine in terms of efficacy, safety, and therapeutic role in managing CVD patients. A comprehensive literature search was performed from different electronic databases, such as PubMed, Scopus, and the Cochrane Library, using keywords associated with the aim of the study, using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). Methodological quality assessment was performed using the Cochrane risk of bias-2.0 (RoB-2.0) and the Risk of Bias in Non-Randomized Studies-Intervention (ROBINS-I) tools for randomized controlled trials (RCTs) and non-RCTs, respectively. For the meta-analysis, RevMan 5.4 was used to construct forest plots. Finally, 19 studies were included for qualitative and quantitative analyses. Both male and female patients were included in the studies; however, studies were more skewed toward male patients reported with different types of CVDs, including acute pericarditis, coronary artery disease (CAD), heart failure, and myocardial infarction, and also reported comorbidities, like hypertension (HTN), diabetes, and dyslipidemia. Overall, a low dose of 0.5 mg/daily of colchicine was used. A high adherence rate (>85%) was observed in the studies, with few cases of discontinuation of medications. Numerous studies have reported that colchicine successfully benefits in reducing the inflammatory and other biomarkers, such as C-reactive protein (CRP), Interleukin (IL)-6, and IL-1β. The pooled estimate size for comorbidities, like diabetes, was 0.94, odds ratio (OR) (95% CI, 0.86-1.02, p = 0.13, I2 = 0%). For hypertension and dyslipidemia, it was 1, OR (95% CI, 0.93-1.07, p = 0.95, I2 = 9%) and 0.89, OR (95% CI, 0.66-1.2, p = 0.46, I2 = 0%), respectively. Meanwhile, the overall effect size was 0.97, OR (95% CI, 0.92-1.02, p = 0.29, I2 = 0%). The pooled estimate size for major adverse cardiovascular events (MACEs) and all complications was 0.68, OR (95% CI, 0.36-1.26, p = 0.22, I2 = 47%) and 1.60, OR (95% CI, 1.11-2.31, p = 0.01, I2 = 65%). The overall effect size was 1.26, OR (95% CI, 0.92-1.72, p = 0.16, I2 = 63%). Furthermore, the pooled estimate size for mortality associated with CVDs and all-cause mortality was 0.77, OR (95% CI, 0.56-1.06, p = 0.11, I2 = 17%) and 1.11, OR (95% CI, 0.72-1.71, p = 0.65, I2 = 48%), with the overall effect size of 0.89, OR (95% CI, 0.70-1.12, p = 0.32, I2 = 40%). These outcomes suggest that colchicine offers potential anti-inflammatory benefits in CVD patients, but its clinical impact on outcomes, like MACE and mortality, remains uncertain due to the non-significant difference, warranting further large-scale, high-quality multicenter studies.

The concept of inter-organ cross-talk, central to understanding physiological adaptations to exercise and disease progression, has been significantly advanced by identifying skeletal muscle as an endocrine organ. This article traces the historical quest for an 'exercise factor', beginning with early speculations in the 19th century and culminating in the discovery of interleukin (IL)-6 as the first myokine and exercise factor in 2003. Initially explored through the works of Julius Geppert and Nathan Zuntz, and later Erling Asmussen and Marius Nielsen, as well as Maurice Goldstein and Bengt Saltin, the search focused on substances released during muscle work, which could influence systemic physiological responses. Despite controversies and the challenge of isolating such factors, the concept gained clarity with the identification of IL-6 that is released from contracting skeletal muscles and plays a crucial role in glucose homeostasis and other processes across various organs, comprising a breakthrough that established skeletal muscle as an endocrine organ.