We examined the effect of carbohydrate (CHO) availability on whole body and skeletal muscle protein utilization at rest, during exercise, and during recovery in humans. Six men cycled at approximately 75% peak O(2) uptake (Vo(2peak)) to exhaustion to reduce body CHO stores and then consumed either a high-CHO (H-CHO; 71 + or - 3% CHO) or low-CHO (L-CHO; 11 + or - 1% CHO) diet for 2 days before the trial in random order. After each dietary intervention, subjects received a primed constant infusion of [1-(13)C]leucine and l-[ring-(2)H(5)]phenylalanine for measurements of the whole body net protein balance and skeletal muscle protein turnover. Muscle, breath, and arterial and venous blood samples were obtained at rest, during 2 h of two-legged kicking exercise at approximately 45% of kicking Vo(2peak), and during 1 h of recovery. Biopsy samples confirmed that the muscle glycogen concentration was lower in the L-CHO group versus the H-CHO group at rest, after exercise, and after recovery. The net leg protein balance was decreased in the L-CHO group compared with at rest and compared with the H-CHO condition, which was primarily due to an increase in protein degradation (area under the curve of the phenylalanine rate of appearance: 1,331 + or - 162 micromol in the L-CHO group vs. 786 + or - 51 micromol in the H-CHO group, P < 0.05) but also due to a decrease in protein synthesis late in exercise. There were no changes during exercise in the rate of appearance compared with rest in the H-CHO group. Whole body leucine oxidation increased above rest in the L-CHO group only and was higher than in the H-CHO group. The whole body net protein balance was reduced in the L-CHO group, largely due to a decrease in whole body protein synthesis. These data extend previous findings by others and demonstrate, using contemporary stable isotope methodology, that CHO availability influences the rates of skeletal muscle and whole body protein synthesis, degradation, and net balance during prolonged exercise in humans.

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There is growing interest in the effect of exogenous ketone body supplementation on exercise responses and performance. The limited studies to date have yielded equivocal data, likely due in part to differences in dosing strategy, increase in blood ketones, and participant training status. Using a randomized, double-blind, counterbalanced design, we examined the effect of ingesting a ketone monoester (KE) supplement (600 mg/kg body mass) or flavour-matched placebo in endurance-trained adults (n=10 males, n=9 females; VO2peak=57±8 ml/kg/min). Participants performed a 30-min cycling bout at ventilatory threshold intensity (71±3% VO2peak), followed 15 min later by a 3 kJ/kg body mass time-trial. KE versus placebo ingestion increased plasma [β-hydroxybutyrate] before exercise (3.9±1.0 vs 0.2±0.3 mM, p<0.0001, dz=3.4), ventilation (77±17 vs 71±15 L/min, p<0.0001, dz=1.3) and heart rate (155±11 vs 150±11 beats/min, p<0.001, dz=1.2) during exercise, and rating of perceived exertion at the end of exercise (15.4±1.6 vs 14.5±1.2, p<0.01, dz=0.85). Plasma [β-hydroxybutyrate] remained higher after KE vs placebo ingestion before the time-trial (3.5±1.0 vs 0.3±0.2 mM, p<0.0001, dz=3.1), but performance was not different (KE: 16:25±2:50 vs placebo: 16:06±2:40 min:s, p=0.20; dz=0.31). We conclude that acute ingestion of a relatively large KE bolus dose increased markers of cardiorespiratory stress during submaximal exercise in endurance-trained participants. Novelty bullets: •Limited studies have yielded equivocal data regarding exercise responses after acute ketone body supplementation. •Using a randomized, double-blind, placebo-controlled, counterbalanced design, we found that ingestion of a large bolus dose of a commercial ketone monoester supplement increased markers of cardiorespiratory stress during cycling at ventilatory threshold intensity in endurance-trained adults.

The sonographic diagnosis of a twin pregnancy complicated by acardius anceps of one fetus, total placenta previa, uterine overdistension, and preterm labor is presented and management is discussed. Attempted selective fetocide is described, but was not successful. Clinical management of severe discordant sonographic dysmorphology is discussed, and diagnostic criteria for sonographic diagnosis of acardia are presented.

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