Background and Purpose: Previous work demonstrates that older adults have a lower response in the middle cerebral artery velocity (MCAv) to an acute bout of moderate intensity exercise when compared to young adults. However, no information exists regarding MCAv response to exercise post-stroke. We tested whether MCAv response to an acute bout of moderate intensity exercise differed between participants 3 months post-stroke and an age-and sex-matched control group of older adults (CON). A secondary objective was to compare MCAv response between the stroke and non-stroke affected MCAv. Methods: Using transcranial Doppler ultrasound, we recorded MCAv during a 90-second baseline (BL) followed by a 6-minute moderate intensity exercise bout using a recumbent stepper. Heart rate (HR), end tidal CO2 (PETCO2) and beat-to-beat mean arterial blood pressure (MAP) were additional variables of interest. The MCAv response measures included: BL, peak response amplitude (Amp), time delay (TD), and time constant (τ). Results: The Amp was significantly lower in the stroke affected MCAv compared to CON (p < 0.01) and in the non-affected MCAv and compared to CON (p = 0.03). No between-group differences were found between TD and τ. No significant differences were found during exercise for PETCO2, and MAP while HR was lower in participants with stroke. (p < 0.01). Within the group of participants with stroke, no differences were found between the stroke-affected and non-stroke affected side for any measures. Discussion and Conclusions: Resolution of the dynamic response profile has the potential to increase our understanding of the cerebrovascular control mechanisms and test cerebrovascular response to physical therapy driven interventions such as exercise. Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1).

Despite its necessity for understanding healthy brain aging, the influence of exercise intensity on cerebrovascular kinetics is currently unknown. We, therefore characterized middle cerebral artery blood flow velocity (MCAv) kinetics associated with two exercise intensities: low and moderate. We hypothesized that increasing exercise intensity would increase the MCAv amplitude response (Amp) and that age and estimated fitness (VȮ2max) would be related to Amp. Baseline (BL) values were collected for 90-seconds followed by a 6-minute exercise bout. Heart rate, end-tidal CO 2 , mean arterial pressure and MCAv were recorded throughout. MCAv kinetics were described by Amp, time delay (TD) and time constant (τ). Sixty-four adults completed the study. Amp was greater during moderate compared to low exercise intensity (p<0.001) while no difference was observed in either TD (p=0.65) or τ (p=0.47). Amp was negatively associated with age (p<0.01) and positively correlated with estimated VȮ2max (p<0.01). Although Amp declines with age, maintaining higher VȮ2max may benefit the cerebrovascular response to exercise.

SummaryA double-blind, randomised study was conducted to compare the efficacy and safety of a combination of pefloxacin and metronidazole versus doxycycline and metronidazole in patients with pelvic inflamma tory disease (PID). The clinical diagnosis had to be confirmed by laparoscopy before patients were includ ed. Of the 74 patients who fulfilled the clinical criteria for PID, laparoscopy confirmed the diagnosis in only 40 patients (54%). The microorganism most frequently found as causative pathogen was Chlamydia trachomatis. Both treatment groups showed a good response to the study-medication. At discharge 9 patients in the pefloxacin group (45%) were cured and 10 patients (50%) had improved. In the doxycycline group 7 patients (35%) were cured and 10 patients (50%) had improved. Obviously pefloxacin/metroni dazole and doxycycline/metronidazole are equally effective in the treatment of PID.