Preliminary approach for the surface electromyographical evaluation of the oral phase of swallowing

Journal of Oral Rehabilitation, EarlyView.


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Correlation between the median particle size of chewed frankfurter sausage and almonds during masticatory performance test

Journal of Oral Rehabilitation, EarlyView.


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Comments on: “Nordic Walking for the Management of People With Parkinson Disease: A Systematic Review”

Cugusi et al [1] recently conducted a systematic review to evaluate the effects of Nordic walking on motor and nonmotor symptoms, functional performance, and quality of life in people with Parkinson disease. Investigating the effect of physical activity and exercise may help to better understand the impact of these interventions on physical and mental health in patients with Parkinson disease. I wish to comment on some procedures and findings in this review.

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Copyright Page

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Information for Authors

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Refractory Knee Osteoarthritis: Adipose-Derived Stromal Cells Versus Bone Marrow Aspiration Concentrate

A 56-year-old woman presents to the clinic with a long history of right knee pain. The pain began insidiously 4 years prior and she reports a slow progression in pain and decrease in her function. She has been treated with oral analgesics and anti-inflammatories. In addition, she is currently enrolled in her third round of physical therapy. Last year she had an intra-articular corticosteroid injection, which gave her about 6 weeks of relief. Following this, she underwent a series of 3 hyaluronic acid injections (SupartzFX) that she completed 3 months ago.

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Reply to comment on: “Nordic Walking for the Management of People with Parkinson Disease: A Systematic Review”

We are pleased to respond to the letter by Dr Mohammad Alwardat, who raised some issues about the methodology and conclusions of our recent publication, titled "Nordic Walking for the Management of People With Parkinson Disease: A Systematic Review" [1]. We believe that there may have been some misinterpretation on Dr Alwardat's part, and by this reply we wish to clarify any concern to Dr Alwardat's and to PM&R readers' satisfaction.

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Re: Sainani K. Interpreting “null” results

Professor Sainani starts her article [1] by stating that the notion that a lack of statistical significance (P > .05) constitutes proof of no effect is a common misconception in statistics. She thereafter uses logical reasoning and illustrative examples to explain to the reader why this is a misconception, and finally winds up with some very useful recommendations on how to interpret statistical test results when P > .05.

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Reply

I appreciate Hannerz et al's careful read of my article (1). My intent was to point out that the concern that one may have made a Type II error due to low statistical power does not apply in this arm of the flow diagram (a Type II error, by definition, can only occur if one fails to find significance). I did not mean to imply that statistical power was necessarily sufficient or high. Thank you for pointing out this error.

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Editorial Board

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Spanish Translated Abstracts

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Academy News – May PM&R

As the primary medical society for the specialty of PM&R, your Academy is focused on moving the specialty and you forward. Our mission is to lead the advancement of physiatry's impact throughout health care. Your Academy will ensure that:

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Table of Contents

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A Lumbosacral Plexopathy Compressed by Huge Uterine Myoma

No abstract available

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Feasibility and Reliability of Functional Muscle Tests in Lung Transplant Recipients

Objective This study investigates the feasibility, reliability, and correlations of recommended functional tests in lung transplant recipients shortly after surgery. Design This is an observational study. Methods Fifty patients (28 females) performed well-standardized maximum isometric back extension in a sitting position, handgrip strength, and Biering-Sørensen endurance tests shortly before discharge from the acute hospital, shortly thereafter, and 2 mos later after subacute rehabilitation. Results Back extension testing was well feasible, but only two thirds of the patients could perform the Biering-Sørensen test at baseline and they experienced a greater number of minor but no major adverse events. Absolute reliability measures and the intraclass correlation coefficients were excellent for the strength (0.97–0.98 [0.95–0.99]) and good for the endurance tests (0.69 [0.26–0.87]). Handgrip revealed high correlation with back strength (≥0.75) but not with Biering-Sørensen scores. Conclusions Well-controlled maximum back strength testing is feasible and reliable, and the scores are highly correlated with grip strength in lung transplant recipients shortly before hospital discharge. The Biering-Sørensen test should be limited to patients without dominant weakness and/or fear. Future research should investigate whether grip instead of back extension strength can safely be used for proper exercise prescription.

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Are Corticosteroid Injections Safe to Inject into Knees With Osteoarthritis?: What Are the Long-term Effects?

No abstract available

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Rehabilitation Outcomes in Spinal Abscess Patients With and Without a History of Intravenous Substance Abuse

Objective The aim of the study was to compare functional outcomes of acute inpatient rehabilitation for spinal epidural abscess patients with and without history of intravenous substance abuse. Design This is a retrospective case series study in freestanding rehabilitation hospital. Methods Charts of 28 spinal epidural abscess patients admitted from January 2012 to September 2015: 13 with intravenous substance abuse and 15 without intravenous substance abuse were reviewed. Both groups received standard-of-care rehabilitation. Statistical analyses of Functional Independence Measure scores were conducted using individual 2 (substance use) × 2 (rehabilitation status) repeated measures analysis of variance. Functional outcomes were defined by total Functional Independence Measure scores as well as motor and cognitive subsets. Length of stay and morphine equivalents were also compared. Results There were no significant differences between the two groups. There was a significant main effect of treatment on total Functional Independence Measure scores (P

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Comparing Corticosteroid Preparation and Dose in the Improvement of Shoulder Function and Pain: A Randomized, Single-Blind Pilot Study

Introduction Shoulder pain may arise from inflammation of the bursa separating the supraspinatus tendon from the coracoacromial ligament and acromion. The optimal treatment dose and preparation of intrabursal corticosteroid injection are unknown. Methods This single-blinded equivalence study recruited 62 subjects randomizing them to one of following four arms: methylprednisolone 20 mg, methylprednisolone 40 mg, triamcinolone acetonide 20 mg, or triamcinolone acetonide 40 mg. QuickDASH, subject-reported pain, and adverse events were recorded in time of injection, 3 days later, 3 wks later, and 6 wks later. Primary outcome was QuickDASH improvements 6 wks after injection. Results All four groups were equally matched regarding age, sex, ethnicity, and site injected. Six weeks after injection, no statistically significant changes were noted in QuickDASH improvement (as compared with time of injection) among the four arms. There were no statistically significant differences at 6 wks regarding improvement in pain. There were no statistically significant differences noted in adverse events among the four arms. Conclusions Neither dose nor preparation of injectable corticosteroid influences magnitude of improvement in function or pain experienced. Although this study provides clinically relevant insight regarding corticosteroid dose and type when managing shoulder pain, the modest sample size may limit the conclusions that can be made about efficacy and adverse effects.

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Lean Mass and Functional Recovery in Men With Hip Fracture: A Short-Term Prospective Pilot Study

Objective The aim of the study was to assess the capability of different definitions of low appendicular lean mass (aLM) to predict the short-term functional recovery in men with hip fracture. Design We investigated 80 of 95 men with hip fracture admitted consecutively to a rehabilitation hospital. Body composition was assessed by dual-energy x-ray absorptiometry. Functional recovery after inpatient rehabilitation was evaluated using Barthel Index scores. Results The patients with aLM above the cutoff value of 19.75 kg indicated by the Foundation for the National Institutes of Health (FNIH) had significantly higher Barthel Index scores than those with aLM below the cutoff value (P = 0.002). Patients' categorization according to the same threshold (aLM = 19.75 kg) was significantly associated with a Barthel Index score of 85 or higher after adjustment for age, cognitive impairment, hip fracture type, co-morbidities, and medications (odds ratio = 7.17, 95% confidence interval = 1.43–35.94, P = 0.017). Conversely, patients' categorization according to neither Baumgartner's cutoff value (7.26 kg/m2) for aLM/height2 nor Foundation for the National Institutes of Health cutoff value (0.789) for aLM divided by body mass index was significantly associated with the Barthel Index scores. Conclusions Categorization according to the Foundation for the National Institutes of Health threshold for aLM, but not to the Foundation for the National Institutes of Health threshold for aLM/body mass index or Baumgartner's threshold for aLM/height2, was associated with the short-term recovery in activities of daily living after a hip fracture in men.

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Letter to the Editor on “Effects of Antigravity Treadmill Training on Gait, Balance, and Fall Risk in Children With Diplegic Cerebral Palsy”

No abstract available

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Comparison Between Effectiveness of Ultrasound-Guided Corticosteroid Injection Above Versus Below the Median Nerve in Mild to Moderate Carpal Tunnel Syndrome: A Randomized Controlled Trial

Objective In this study, the clinical effectiveness of ultrasound-guided corticosteroid injection "above" versus "below" the median nerve for treatment of patients with mild to moderate carpal tunnel syndrome was compared. Design This prospective randomized double-blind clinical trial included 44 patients with mild to moderate carpal tunnel syndrome. The subjects were randomly assigned to two groups to receive ultrasound-guided injection of 40 mg of triamcinolone either "above" or "below" the involved median nerve. Outcome measures were the Boston Carpal Tunnel Questionnaire, visual analog scale, electrophysiological tests, and ultrasonographic measurement of the median nerve cross-sectional area at baseline, 6, and 12 wks after the injection. Results All outcome measures improved significantly in both groups at 6 wks after intervention, and these improvements were persevered up to 12 wks of follow-up (all P values

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Automated Mechanical Peripheral Stimulation Improves Gait Parameters in Subjects With Parkinson Disease and Freezing of Gait: A Randomized Clinical Trial

Objective This study aimed to assess spatiotemporal gait parameters and range of motion of lower limbs in subjects with Parkinson disease (PD) and freezing of gait, treated with automated mechanical peripheral stimulation (AMPS) or AMPS SHAM (placebo). Design This randomized clinical trial included 30 subjects allocated into two groups: AMPS (15 subjects with PD) and AMPS SHAM (15 subjects with PD). Fourteen age-matched healthy subjects were also included as a reference group. Both PD groups received the treatment twice a week during 4 weeks. Automated mechanical peripheral stimulation was applied using a commercial medical device (Gondola) and consisted of mechanical pressure in four areas of feet. For AMPS SHAM group, a subliminal stimulus was delivered. Gait analysis were measured before, after the first, after the fourth, and after the eighth sessions. Results We did not find significant differences between AMPS and AMPS SHAM groups either for spatiotemporal gait parameters or for range of motion of lower limbs. However, within-group analysis showed that AMPS group significantly improved spatiotemporal gait parameters and hip rotation range of motion throughout the treatment period. The AMPS SHAM group did not show any improvement. Conclusions Automated mechanical peripheral stimulation therapy induces improvements in spatiotemporal parameters and hip rotation range of motion of subjects with PD and freezing of gait. To Claim CME Credits Complete the self-assessment activity and evaluation online at https://ift.tt/1l80W45 CME Objectives Upon completion of this article, the reader should be able to: (1) Understand the impact of reduced plantar sensitivity on gait in individuals with Parkinson disease; (2) Identify the improvements on spatiotemporal gait parameters in subjects with Parkinson disease and freezing of gait after automated mechanical peripheral stimulation therapy; and (3) Recommend the use of new strategies of plantar stimulus for gait disorders of subjects with Parkinson disease. Level Advanced Accreditation The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

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Effects of Mat Pilates on Physical Functional Performance of Older Adults: A Meta-analysis of Randomized Controlled Trials

Objective The present meta-analysis aimed to examine evidence from randomized controlled trials to determine the effects of mat Pilates on measures of physical functional performance in the older population. Design A search was conducted in the MEDLINE/PubMed, Scopus, Scielo, and PEDro databases between February and March 2017. Only randomized controlled trials that were written in English, included subjects aged 60 yrs who used mat Pilates exercises, included a comparison (control) group, and reported performance-based measures of physical function (balance, flexibility, muscle strength, and cardiorespiratory fitness) were included. The methodological quality of the studies was analyzed according to the PEDro scale and the best-evidence synthesis. The meta-analysis was conducted with the Review Manager 5.3 software. Results The search retrieved 518 articles, nine of which fulfilled the inclusion criteria. High methodological quality was found in five of these studies. Meta-analysis indicated a large effect of mat Pilates on dynamic balance (standardized mean difference = 1.10, 95% confidence interval = 0.29–1.90), muscle strength (standardized mean difference = 1.13, 95% confidence interval = 0.30–1.96), flexibility (standardized mean difference = 1.22, 95% confidence interval = 0.39–2.04), and cardiorespiratory fitness (standardized mean difference = 1.48, 95% confidence interval = 0.42–2.54) of elderly subjects. Conclusions There is evidence that mat Pilates improves dynamic balance, lower limb strength, hip and lower back flexibility, and cardiovascular endurance in elderly individuals. Furthermore, high-quality studies are necessary to clarify the effects of mat Pilates on other physical functional measurements among older adults.

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Preliminary Use of the Physical and Neurological Examination of Subtle Signs for Detecting Subtle Motor Signs in Adolescents With Sport-Related Concussion

Sensitive examination tools are needed to optimize evaluation after sports-related concussion. The Physical and Neurological Examination of Subtle Signs was preliminarily examined for sensitivity to motor changes in a pilot cohort of adolescents aged 13–17 yrs with sports-related concussion. A total of 15 adolescents (5 female adolescents) with sports-related concussion were evaluated up to three times: within 2 wks of injury, approximately 1 mo later (mean, 35 days between visits), and for those not recovered at the second visit, again after clinical recovery (mean, 70 days between the first and last visits for all participants). Comparison data were acquired from 20 age- and sex-matched healthy control athletes with no history of concussion who were evaluated twice (mean, 32 days apart). Main effects of group, time, and interaction effects were evaluated with an analysis of covariance, which controlled for socioeconomic status, times tested, and days between testing sessions. Adolescents with concussion had poorer Physical and Neurological Examination of Subtle Signs performance than controls did at all time points. Performance improved between visits within the concussion group, with no change within the control group. These findings suggest that the Physical and Neurological Examination of Subtle Signs merits additional study in larger cohorts and in combination with other markers of injury to facilitate an enhanced understanding of sports-related concussion and recovery.

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Inability to Perform the Repeated Chair Stand Task Predicts Fall-Related Injury in Older Primary Care Patients

Objective The aim of the study was to examine whether the chair stand component of the Short Physical Performance Battery predicts fall-related injury among older adult primary care patients. Design A 2-yr longitudinal cohort study of 430 Boston-area primary care patients aged ≥65 yrs screened to be at risk for mobility decline was conducted. The three components of the Short Physical Performance Battery (balance time, gait speed, and chair stand time) were measured at baseline. Participants reported incidence of fall-related injuries quarterly for 2 yrs. Complementary log-log discrete time hazard models were constructed to examine the hazard of fall-related injury across Short Physical Performance Battery scores, adjusting for age, sex, race, Digit Symbol Substitution Test score, and fall history. Results Participants were 68% female and 83% white, with a mean (SD) age of 76.6 (7.0). A total of 137 (32%) reported a fall-related injury during the follow-up period. Overall, inability to perform the chair stand task was a significant predictor of fall-related injury (hazard ratio = 2.11, 95% confidence interval = 1.23–3.62, P = 0.01). Total Short Physical Performance Battery score, gait component score, and balance component score were not predictive of fall-related injury. Conclusions Inability to perform the repeated chair stand task was associated with increased hazard of an injurious fall for 2 yrs among a cohort of older adult primary care patients.

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Posture-Dependent Dysphagia After Botulinum Toxin Type A Injection at Sternocleidomastoid in a Patient With Athetoid Cerebral Palsy

Cervical dystonia is a common issue in patients with athetoid cerebral palsy. Botulinum toxin injection to dystonic cervical muscles is a well-recognized treatment option, but it is known to be associated with dysphagia. Previously reported cases of dysphagia after botulinum toxin injection to the sternocleidomastoid muscle were related to the regional spread of toxin to the pharyngeal muscles. We report a unique case of posture-dependent dysphagia due to preactivation of the suprahyoid and infrahyoid muscles to compensate for impaired head stabilization by the weakened sternocleidomastoid muscle while swallowing. This case suggests a possible mechanism of dysphagia in patients with athetoid cerebral palsy.

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Mechanical Traction for Lumbar Radicular Pain: Supine or Prone? A Randomized Controlled Trial

Objective The aim of the study was to compare the effects of mechanical lumbar traction either in the supine or in the prone position with conventional physical therapy (PT) in patients with chronic low back pain and lumbosacral nerve root involvement in terms of disability, pain, and mobility. Design Participants (N = 125) were randomly assigned to receive 15 sessions of PT with additional mechanical lumbar traction either in the supine position (supine traction group) or in the prone position (prone traction group) or only PT without traction (PT only group). Patients were assessed at baseline and at the end of the PT sessions in terms of disability, pain, and mobility. Disability was assessed using the modified Oswesty Disability Index; pain was assessed using a visual analog scale, and lumbar mobility was assessed using the modified lumbar Schober test. Results One hundred eighteen patients completed the trial. All groups improved significantly in the Oswesty Disability Index, visual analog scale, and modified lumbar Schober test (P

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Poststroke Headache: An Underdiagnosed Entity?

No abstract available

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Premorbid Activity Limitation Stages Are Associated With Posthospitalization Discharge Disposition

Objective Activity of daily living stages and instrumental activity of daily living stage have demonstrated associations with mortality and health service use among older adults. This cohort study aims to assess the associations of premorbid activity limitation stages with acute hospital discharge disposition among community-dwelling older adults. Design Study participants were Medicare beneficiaries aged 65 yrs or older who enrolled in the Medicare Current Beneficiary Survey between 2001 and 2009. Associations of premorbid stages with discharge dispositions were estimated with multinomial logistic regression models adjusted for covariates. Results The proportions of elderly Medicare patients discharged to home with self-care, home with services, postacute care facilities, and other dispositions were 59%, 15%, 19%, and 7%, respectively. The following adjusted relative risk ratios and 95% confidence intervals of postacute care facilities versus home with self-care discharge increased with higher premorbid activity limitation stages (except nonfitting stage III): 1.7 (1.5–2.0), 2.4 (2.0–2.9), 2.4 (1.9–3.0), and 2.5 (1.6–4.1) for activity of daily living stages I–IV; a similar pattern was found for instrumental activity of daily living stages. The adjusted relative risk ratios of discharge to home with services also increased with higher premorbid activity limitation stages compared with no limitation. Conclusions Routinely assessed activity limitation stages predict posthospitalization discharge disposition among older adults and may be used to anticipate postacute care and services use by elderly Medicare beneficiaries.

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Ultrasonography Imaging for the Diagnosis and Guided Injection of Plantaris Tendon Strain in a Patient With Tennis Leg

No abstract available

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Genome-Wide Search for Quantitative Trait Loci Controlling Important Plant and Flower Traits in Petunia Using an Interspecific Recombinant Inbred Population of Petunia axillaris and Petunia exserta

A major bottleneck in plant breeding has been the much limited genetic base and much reduced genetic diversity in domesticated, cultivated germplasm. Identification and utilization of favorable gene loci or alleles from wild or progenitor species can serve as an effective approach to increasing genetic diversity and breaking this bottleneck in plant breeding. This study was conducted to identify quantitative trait loci (QTL) in wild or progenitor petunia species that can be used to improve important horticultural traits in garden petunia. An F₇ recombinant inbred population derived between Petunia axillaris and P. exserta was phenotyped for plant height, plant spread, plant size, flower counts, flower diameter, flower length, and days to anthesis, in Florida in two consecutive years. Transgressive segregation was observed for all seven traits in both years. The broad-sense heritability estimates for the traits ranged from 0.20 (days to anthesis) to 0.62 (flower length). A genome-wide genetic linkage map consisting 368 single nucleotide polymorphism bins and extending over 277 cM was searched to identify QTL for these traits. Nineteen QTL were identified and localized to five linkage groups. Eleven of the loci were identified consistently in both years; several loci explained up to 34.0% and 24.1% of the phenotypic variance for flower length and flower diameter, respectively. Multiple loci controlling different traits are co-localized in four intervals in four linkage groups. These intervals contain desirable alleles that can be introgressed into commercial petunia germplasm to expand the genetic base and improve plant performance and flower characteristics in petunia.

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A Genomic Region Containing REC8 and RNF212B Is Associated with Individual Recombination Rate Variation in a Wild Population of Red Deer (Cervus elaphus)

Recombination is a fundamental feature of sexual reproduction, ensuring proper disjunction, preventing mutation accumulation and generating new allelic combinations upon which selection can act. However it is also mutagenic, and breaks up favourable allelic combinations previously built up by selection. Identifying the genetic drivers of recombination rate variation is a key step in understanding the causes and consequences of this variation, how loci associated with recombination are evolving and how they affect the potential of a population to respond to selection. However, to date, few studies have examined the genetic architecture of recombination rate variation in natural populations. Here, we use pedigree data from ~2,600 individuals genotyped at ~38,000 SNPs to investigate the genetic architecture of individual autosomal recombination rate in a wild population of red deer (Cervus elaphus). Female red deer exhibited a higher mean and phenotypic variance in autosomal crossover counts (ACC). Animal models fitting genomic relatedness matrices showed that ACC was heritable in females (h² = 0.12) but not in males. A regional heritability mapping approach showed that almost all heritable variation in female ACC was explained by a genomic region on deer linkage group 12 containing the candidate loci REC8 and RNF212B, with an additional region on linkage group 32 containing TOP2B approaching genome-wide significance. The REC8/RNF212B region and its paralogue RNF212 have been associated with recombination in cattle, mice, humans and sheep. Our findings suggest that mammalian recombination rates have a relatively conserved genetic architecture in both domesticated and wild systems, and provide a foundation for understanding the association between recombination loci and individual fitness within this population.

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A Targeted RNAi Screen Reveals Drosophila Female-Sterile Genes That Control the Size of Germline Stem Cell Niche During Development

Adult stem cells maintain tissue homeostasis. This unique capability largely depends on the stem cell niche, a specialized microenvironment, which preserves stem cell identity through physical contacts and secreted factors. In many cancers, latent tumor cell niches are thought to house stem cells and aid tumor initiation. However, in developing tissue and cancer it is unclear how the niche is established. The well-characterized germline stem cells (GSCs) and niches in the Drosophila melanogaster ovary provide an excellent model to address this fundamental issue. As such, we conducted a small-scale RNAi screen of 560 individually expressed UAS-RNAi lines with targets implicated in female fertility. RNAi was expressed in the soma of larval gonads, and screening for reduced egg production and abnormal ovarian morphology was performed in adults. Twenty candidates that affect ovarian development were identified and subsequently knocked down in the soma only during niche formation. Feminization factors (Transformer, Sex lethal, and Virilizer), a histone methyltransferase (Enhancer of Zeste), a transcriptional machinery component (Enhancer of yellow 1), a chromatin remodeling complex member (Enhancer of yellow 3) and a chromosome passenger complex constituent (Incenp) were identified as potentially functioning in the control of niche size. The identification of these molecules highlights specific molecular events that are critical for niche formation and will provide a basis for future studies to fully understand the mechanisms of GSC recruitment and maintenance.

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New Reference Values for Cardiopulmonary Exercise Testing in Children

Introduction Cardiopulmonary exercise testing is an essential tool to assess cardiorespiratory fitness (CRF) in children. There is a paucity of adequate pediatric reference values that are independent of body size and pubertal stage. The purpose of this study is to provide Z score equations for several maximal and submaximal CRF parameters derived from a prospectively recruited sample of healthy children. Methods In this cross-sectional multicenter study, we prospectively recruited 228 healthy children 12 to 17 yr old in local schools. We performed a symptom-limited cardiopulmonary exercise testing progressive ramp protocol on an electronically braked cycle ergometer. Eighteen CRF parameters were analyzed. We tested several regression models to obtain prediction curves that minimized residual association with age, body size, and pubertal stage. Both the predicted mean and the predicted SD were modeled to account for heteroscedasticity. Results We identified nonlinear association of CRF parameters with body size and significant heteroscedasticity. To normalize CRF parameters, the use of a single body size variable was not sufficient. We therefore used multivariable models with various combination of height, corrected body mass, and age. Final prediction models yielded adjusted CRF parameters that were independent of age, sex, body mass, height, body mass index, and Tanner stages. Conclusions We present Z score equations for several CRF parameters derived from a healthy pediatric population. These reference values provide updated predicted means and range of normality that are independent of sex and body size. Further testing is needed to assess if these reference values increase sensitivity and specificity to identify abnormal cardiorespiratory response in children with chronic diseases.

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Video-Recorded Direct Observation: A Step Forward for Physical Activity Measurement

No abstract available

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Novel Methods for Reporting of Exercise Dose and Adherence: An Exploratory Analysis

Purpose The purpose of this study was to explore whether methods adapted from oncology pharmacological trials have utility in reporting adherence (tolerability) of exercise treatment in cancer. Methods Using a retrospective analysis of a randomized trial, 25 prostate cancer patients received an aerobic training regimen of 72 supervised treadmill walking sessions delivered thrice weekly between 55% and 100% of exercise capacity for 24 consecutive weeks. Treatment adherence (tolerability) was assessed using conventional (lost to follow-up and attendance) and exploratory (e.g., permanent discontinuation, dose modification, and relative dose intensity) outcomes. Results The mean total cumulative "planned" and "completed" dose was 200.7 ± 47.6 and 153.8 ± 68.8 MET·h, respectively, equating to a mean relative dose intensity of 77% ± 24%. Two patients (8%) were lost to follow-up, and mean attendance was 79%. A total of 6 (24%) of 25 patients permanently discontinued aerobic training before week 24. Aerobic training was interrupted (missing ≥3 consecutive sessions) or dose reduced in a total of 11 (44%) and 24 (96%) patients, respectively; a total 185 (10%) of 1800 training sessions required dose reduction owing to both health-related (all nonserious) and non–health-related adverse events. Eighteen (72%) patients required at least one session to be terminated early; a total of 59 (3%) sessions required early termination. Conclusions Novel methods for the conduct and reporting of exercise treatment adherence and tolerability may provide important information beyond conventional metrics in patients with cancer.

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Exercise Thresholds on Trial: Are They Really Equivalent?

Purpose The interchangeable use of whole-body exercise thresholds and breakpoints (BP) in the local oxygenation response, as measured via near-infrared spectroscopy, has recently been questioned in scientific literature. Therefore, the present study aimed to longitudinally investigate the interrelationship of four commonly used exercise thresholds: critical power (CP), the respiratory compensation point (RCP), and BP in muscle (m[HHb]BP) and brain (c[O2Hb]BP) oxygenation. Methods Nine male participants (21.8 ± 1.2 yr) completed 6 wk of cycling interval training. Before and after this intervention period, subjects performed a ramp incremental exercise protocol to determine RCP, m[HHb]BP, and c[O2Hb]BP and four constant work rate (WR) tests to calculate CP. Results WR associated with CP, RCP, m[HHB]BP, and c[O2Hb]BP increased by 7.7% ± 4.2%, 13.6% ± 9.0%, 9.8% ± 5.7%, and 11.3% ± 11.1%, respectively. CP was lower (pre: 260 ± 32 W, post: 280 ± 41 W; P 0.05). Conclusions Results of the present study strongly question true equivalence of CP, RCP, m[HHb]BP, and c[O2Hb]BP during ramp incremental exercise. Therefore, these exercise thresholds should not be used interchangeably.

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Health Benefits of an Innovative Exercise Program for Mitochondrial Disorders

Purpose We determined the effects of an innovative 8-wk exercise intervention (aerobic, resistance, and inspiratory muscle training) for patients with mitochondrial disease. Methods Several end points were assessed in 12 patients (19–59 yr, 4 women) at pretraining, posttraining, and after 4-wk detraining: aerobic power, muscle strength/power and maximal inspiratory pressure (main end points), ability to perform activities of daily living, body composition, quality of life, and blood myokines (secondary end points). Results The program was safe, with patients' adherence being 94% ± 5%. A significant time effect was found for virtually all main end points (P ≤ 0.004), indicating a training improvement. Similar findings (P ≤ 0.003) were found for activities of daily living tests, total/trunk/leg lean mass, total fat mass, femoral fracture risk, and general health perception. No differences were found for blood myokines, except for an acute exertional increase in interleukin 8 at posttraining/detraining (P = 0.002) and in fatty acid binding protein 3 at detraining (P = 0.002). Conclusions An intervention including novel exercises for mitochondrial disease patients (e.g., inspiratory muscle training) produced benefits in numerous indicators of physical capacity and induced a previously unreported shift toward a healthier body composition phenotype.

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Equity in Physical Activity is a Misguided Goal

No abstract available

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Strength Training Effects on Muscular Regeneration after ACL Reconstruction

Purpose Protracted quadriceps muscle atrophy is observed after anterior cruciate ligament reconstruction (ACL-R). The aim of this study was to assess if quadriceps strength training with eccentric overload (CON/ECC+) is more efficient to induce muscle regeneration after ACL-R than conventional concentric/eccentric (CON/ECC) strength training. Methods Biopsies from the vastus lateralis muscle were obtained from 37 recreational athletes after 12 wk of regular rehabilitation after ACL-R and again after 12 wk with twice a week of either conventional CON/ECC (n = 16) or CON/ECC+ (n = 21) one-legged supervised leg-press training. Immunohistochemical analyses were used to determine satellite cell (SC) number (Pax7+); activated SC number (Pax7+/MyoD+); fibers expressing myosin heavy-chain (MHC) I and II, MHC neonatal, and fiber cross-sectional area. Magnetic resonance imaging was performed to measure quadriceps cross-sectional area and isokinetic testing for the measurement of quadriceps strength. Results CON/ECC+ induced a significantly (P = 0.002) greater increase in quadriceps cross-sectional area than did CON/ECC. There also was a significant increase in the fiber cross-sectional areas of all fiber types and in quadriceps strength, but without significant difference between training groups. Only CON/ECC+ training led to a significant (P

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No Effect of Muscle Stretching within a Full, Dynamic Warm-up on Athletic Performance

Purpose This study aimed to examine the effects of static and dynamic stretching routines performed as part of a comprehensive warm-up on flexibility and sprint running, jumping, and change of direction tests in team sport athletes. Methods A randomized, controlled, crossover study design with experimenter blinding was conducted. On separate days, 20 male team sport athletes completed a comprehensive warm-up routine. After a low-intensity warm-up, a 5-s static stretch (5S), a 30-s static stretch (30S; 3 × 10-s stretches), a 5-repetition (per muscle group) dynamic stretch (DYN), or a no-stretch (NS) protocol was completed; stretches were done on seven lower body and two upper body regions. This was followed by test-specific practice progressing to maximum intensity. A comprehensive test battery assessing intervention effect expectations as well as flexibility, vertical jump, sprint running, and change of direction outcomes was then completed in a random order. Results There were no effects of stretch condition on test performances. Before the study, 18/20 participants nominated DYN as the most likely to improve performance and 15/20 nominated NS as least likely. Immediately before testing, NS was rated less "effective" (4.0 ± 2.2 on a 10-point scale) than 5S, 30S, and DYN (5.3–6.4). Nonetheless, these ratings were not related to test performances. Conclusion Participants felt they were more likely to perform well when stretching was performed as part of the warm-up, irrespective of stretch type. However, no effect of muscle stretching was observed on flexibility and physical function compared with no stretching. On the basis of the current evidence, the inclusion of short durations of either static or dynamic stretching is unlikely to affect sprint running, jumping, or change of direction performance when performed as part of a comprehensive physical preparation routine.

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Efficacy of Tandem Gait to Identify Impaired Postural Control after Concussion

Purpose The purpose was to evaluate tandem gait (TG), Balance Error Scoring System (BESS), and modified Balance Error Scoring System (mBESS) performance acutely after concussion in collegiate student-athletes. In addition, we sought to evaluate the psychometric properties of TG, including minimal detectable change (MDC), sensitivity, and specificity. Methods Seventy-six National Collegiate Athletic Association student-athletes performed TG and BESS tests: 38 acutely after concussion and 38 controls. Participants were tested at baseline (time 1) and again acutely after concussion, or the following year for controls (time 2). Ten controls, tested simultaneously by two researchers, established a TG interrater minimal detectable change. A 2 × 2 mixed-design ANOVA compared each outcome variable. An receiver operating characteristic curve analysis was used to evaluate sensitivity, specificity, and area under the curve (AUC). Result There was a significant interaction (F = 8.757, P = 0.004) for TG whereby the concussion group was slower after concussion (10.59 ± 1.53 vs 11.80 ± 2.67 s), whereas there was no difference for controls (10.13 ± 1.72 vs 9.93 ± 1.85 s). There was no significant interaction for BESS (F = 0.235, P = 0.630) or mBESS (F = 0.007, P = 0.935). TG had a sensitivity of 0.632, a specificity of 0.605, and an AUC of 0.704. BESS had a sensitivity of 0.447, a specificity of 0.500, and an AUC of 0.508. mBESS had a sensitivity of 0.474, a specificity of 0.632, and an AUC of 0.535. Conclusions Participants completed TG significantly slower after concussion, whereas no change across time was detected for controls. In contrast, BESS and mBESS performances were similar at both testing times in both groups. Our AUC analysis was acceptable for TG, but a failure for both BESS and mBESS; thus, TG may be a useful alternative for clinicians conducting postconcussion postural control assessments.

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Active and Inactive Leg Hemodynamics during Sequential Single-Leg Interval Cycling

Introduction Leg order during sequential single-leg cycling (i.e., exercising both legs independently within a single session) may affect local muscular responses potentially influencing adaptations. This study examined the cardiovascular and skeletal muscle hemodynamic responses during double-leg and sequential single-leg cycling. Methods Ten young healthy adults (28 ± 6 yr) completed six 1-min double-leg intervals interspersed with 1 min of passive recovery and, on a separate occasion, 12 (six with one leg followed by six with the other leg) 1-min single-leg intervals interspersed with 1 min of passive recovery. Oxygen consumption, heart rate, blood pressure, muscle oxygenation, muscle blood volume, and power output were measured throughout each session. Results Oxygen consumption, heart rate, and power output were not different between sets of single-leg intervals, but the average of both sets was lower than the double-leg intervals. Mean arterial pressure was higher during double-leg compared with sequential single-leg intervals (115 ± 9 vs 104 ± 9 mm Hg, P

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Exercise Protects against Cancer-induced Cardiac Cachexia

Cancer has been shown to negatively stimulate autophagy, leading to a decline in cardiac function. Although exercise is cardioprotective, its influence over autophagy-mediated tumor growth and cardiac function are not well defined. Purpose This study aimed to determine the effect of exercise on tumor morphology and cardiac function. Methods Fisher 344 rats (n = 28) were assigned to one of four groups: 1) sedentary non-tumor bearing (SED), 2) sedentary tumor bearing (SED + T), 3) wheel run non-tumor bearing (WR), or 4) wheel run tumor bearing (WR + T). Rats remained sedentary or exercised for 6 wk. At week 4, rats in tumor groups were inoculated with MatBIII tumor cells. At week 6, cardiac function was measured. Results SED + T animals exhibited significantly lower left ventricular developed pressure when compared with SED, WR, and WR + T (P

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Beyond Cut Points: Accelerometer Metrics that Capture the Physical Activity Profile

Purpose Commonly used physical activity metrics tell us little about the intensity distribution across the activity profile. The purpose of this paper is to introduce a metric, the intensity gradient, which can be used in combination with average acceleration (overall activity level) to fully describe the activity profile. Methods A total of 1669 adolescent girls (sample 1) and 295 adults with type 2 diabetes (sample 2) wore a GENEActiv accelerometer on their nondominant wrist for up to 7 d. Body mass index and percent body fat were assessed in both samples and physical function (grip strength, Short Physical Performance Battery, and sit-to-stand repetitions) in sample 2. Physical activity metrics were as follows: average acceleration (AccelAV); the intensity gradient (IntensityGRAD from the log–log regression line: 25-mg intensity bins [x]/time accumulated in each bin [y]); total moderate-to-vigorous physical activity (MVPA); and bouted MVPA (sample 2 only). Results Correlations between AccelAV and IntensityGRAD (r = 0.39–0.51) were similar to correlations between AccelAV and bouted MVPA (r = 0.48) and substantially lower than between AccelAV and total MVPA (r ≥ 0.93). IntensityGRAD was negatively associated with body fatness in sample 1 (P

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Effects of Different Exercise Modes on Arterial Stiffness and Nitric Oxide Synthesis

Purpose Aerobic training (AT) and high-intensity intermittent training (HIIT) reduce arterial stiffness, whereas resistance training (RT) induces deterioration of or no change in arterial stiffness. However, the molecular mechanism of these effects of different exercise modes remains unclear. This study aimed to clarify the difference of different exercise effects on endothelial nitric oxide synthase (eNOS) signaling pathway and arterial stiffness in rats and humans. Methods In the animal study, forty 10-wk-old male Sprague–Dawley rats were randomly divided into four groups: sedentary control (CON), AT (treadmill running, 60 min at 30 m·min−1, 5 d·wk−1 for 8 wk), RT (ladder climbing, 8–10 sets per day, 3 d·wk−1 for 8 wk), and HIIT (14 repeats of 20-s swimming session with 10-s pause between sessions, 4 d·wk−1 for 6 wk from 12-wk-old) groups (n = 10 in each group). In the human study, we confirmed the effects of 6-wk HIIT and 8-wk AT interventions on central arterial stiffness and plasma nitrite/nitrate level in untrained healthy young men in randomized controlled trial (HIIT, AT, and CON; n = 7 in each group). Results In the animal study, the effect on aortic pulse wave velocity (PWV), as an index of central arterial stiffness, after HIIT was the same as the decrease in aortic PWV and increase in arterial eNOS/Akt phosphorylation after AT, which was not changed by RT. A negative correlation between aortic PWV and eNOS phosphorylation was observed (r = −0.38, P

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Complications in Foot and Ankle Surgery: Management Strategies

No abstract available

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Residual Force Enhancement Is Preserved for Conditions of Reduced Contractile Force

Introduction The isometric muscle force attained after active stretch is greater than that attained in a purely isometric contraction. This property is referred to as residual force enhancement (RFE). Because RFE is thought to be caused by a titin-based passive force, it should be preserved in reduced contractile force states. Therefore, we evaluated the magnitude of RFE in normal and reduced contractile force states. Methods Skinned fibers of rabbit psoas and soleus (N = 60) were used in all experiments. Reduced contractile force states were induced (i) by using a low Ca2+ concentration (N = 30), (ii) by adding 20 mM butanedione monoxime (N = 15), and (iii) by lowering the pH level (N = 15). Force enhancement and reference isometric tests were conducted for each condition. In the force enhancement tests, fibers were actively stretched from an average sarcomere length of 2.4 to 3.0 μm. The isometric force attained 15 s after the end of stretching was used for analysis. In the isometric reference tests, fibers were activated isometrically at an average sarcomere length of 3.0 μm, and the force at steady state was used for analysis. The absolute and relative magnitudes of RFE were calculated. Results The absolute RFE was the same for the normal and reduced contractile force states. Because the isometric reference force was smaller in the reduced contractile force states, the relative RFE was greater in the reduced contractile force than the normal states for all conditions. Conclusion RFE was preserved in the reduced contractile force states.

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Exercise Effects on Adipose Tissue Postprandial Lipolysis and Blood Flow in Children

Poor suppression of lipolysis and blunted increase in blood flow after meal ingestion in obese adults may indicate resistance to the antilipolytic action of insulin. Exercise may be used to normalize lipolytic responses to food intake by increasing insulin sensitivity. Purpose To determine if acute bouts of aerobic exercise and/or excise training alter lipolytic and blood flow responses to food intake in lean (LN) and obese (OB) children. Methods Sixty-five children (9–11 yr) were randomized into acute exercise (EX: 16 LN and 28 OB) or control (CON: 9 LN and 12 OB) groups that exercised (EX), or rested (CON) between standardized breakfast and lunch. Microdialysis probes were inserted into the subcutaneous abdominal adipose tissue to monitor interstitial glycerol (lipolysis) and blood flow. Changes in interstitial glycerol and nutritive flow were calculated from dialysate samples before and after each meal. A subgroup (OB = 15 and LN = 9) from the acute exercise group underwent 16 wk of aerobic exercise training. Results Poor suppression of lipolysis and a blunted increase in adipose tissue nutritive blood flow in response to breakfast was associated with BMI percentile (r = 0.3, P

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Physical Inactivity from Youth to Adulthood and Risk of Impaired Glucose Metabolism

Introduction Physical activity (PA) is important in the prevention and treatment of impaired glucose metabolism. However, association of physical inactivity during the transition between childhood and adulthood with glucose metabolism is unknown. Therefore, we studied the association of persistent physical inactivity since childhood with glucose metabolism in adulthood. Methods Data were drawn from the ongoing, Cardiovascular Risk in Young Finns Study with repeated follow-ups between 1980 and 2011 (baseline age, 3–18 yr; n = 3596). Impaired glucose metabolism was defined as having impaired fasting glucose (6.1–6.9 mmol·L−1) or type 2 diabetes in adulthood. Leisure-time PA habits were repeatedly collected with a standardized questionnaire and expressed as a PA Index. Using PA Index, four groups were formed (n = 2000): 1) persistently low PA, 2) decreasingly active, 3) increasingly active, and 4) persistently active subjects. Poisson regression model was used to examine the association between PA groups and impaired glucose metabolism. Results The proportion of the sample with impaired glucose metabolism was 16.1% in individuals with persistently low PA, 14.5% in decreasingly active, 6.8% in increasingly active, and 11.1% in persistently active. Compared with individuals with persistently low PA, age and sex-adjusted risk for impaired glucose metabolism were lower in those who increased PA (relative risk [RR], 0.47; 95% confidence interval [CI], 0.29–0.76) and in those who were persistently active (RR, 0.70; 95% CI, 0.51–0.97), but similar in those who decreased PA (RR, 0.93; 95% CI, 0.66–1.36). Conclusions Persistently physically inactive lifestyle from youth to adulthood is associated with increased risk of impaired glucose metabolism in adulthood. Importantly, a moderate increase in PA lowered the risk. The results highlight the importance of avoiding physically inactive lifestyle at all stages of life.

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Effects of Acute Salbutamol Intake on Peripheral and Central Fatigue in Trained Men

Purpose Ergogenic effect in physically active subjects has been reported after acute salbutamol (SAL) intake. β2-Agonists have potential stimulant effects within the central nervous system that could be involved in this ergogenic effect. We hypothesized that acute SAL intake would induce changes in cerebral responses during exercise, with significant improvement in cerebral oxygenation and voluntary activation (VA) contributing to an increase in muscle performance. Methods Fourteen trained male subjects (25 ± 5 yr) performed repeated isometric knee extensions until task failure (TF) after 4 mg (oral) SAL, 800 μg (inhaled) SAL, or placebo intake. VA, corticospinal excitability, and inhibition assessed by transcranial magnetic stimulation and changes in hemoglobin concentrations assessed by near-infrared spectroscopy were measured before and during the fatiguing task. Results SAL had no significant effect both at rest and during exercise on prefrontal cortex oxygenation (e.g., changes in oxyhemoglobin concentration at TF: 11.4 ± 11.1 (4 mg SAL) vs 10.4 ± 10.6 (800 μg SAL) vs 10.8 ± 8.1 μmol (placebo); P = 0.314) and neuromuscular function (e.g., VA measured by TMS at TF: 90.2% ± 6.6% vs 92.6% ± 5.0% vs 90.1% ± 7.0%; P = 0.760). SAL had no effect on the number of contractions until TF (95 ± 51 vs 100 ± 52 vs 93 ± 47; P = 0.629). Conclusions These results indicate that acute SAL intake had no effect on central and peripheral mechanisms of neuromuscular fatigue and did not improve quadriceps endurance.

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Community-level Sports Group Participation and Older Individuals’ Depressive Symptoms

Purpose Community-level group participation is a structural aspect of social capital that may have a contextual influence on an individual's health. Herein, we sought to investigate a contextual relationship between community-level prevalence of sports group participation and depressive symptoms in older individuals. Methods We used data from the 2010 Japan Gerontological Evaluation Study, a population-based, cross-sectional study of individuals 65 yr or older without long-term care needs in Japan. Overall, 74,681 participants in 516 communities were analyzed. Depressive symptoms were diagnosed as a 15-item Geriatric Depression Scale score of ≥5. Participation in a sports group 1 d·month−1 or more often was defined as "participation." For this study, we applied two-level multilevel Poisson regression analysis stratified by sex, calculated prevalence ratios (PR), and 95% confidence intervals (CI). Results Overall, 17,420 individuals (23.3%) had depressive symptoms, and 16,915 (22.6%) participated in a sports group. Higher prevalence of community-level sports group participation had a statistically significant relationship with a lower likelihood of depressive symptoms (male: PR, 0.89 (95% CI, 0.85–0.92); female: PR, 0.96 (95% CI, 0.92–0.99), estimated by 10% of participation proportion) after adjusting for individual-level sports group participation, age, diseases, family form, alcohol, smoking, education, equivalent income, and population density. We found statistically significant cross-level interaction terms in male participants only (PR, 0.86; 95% CI, 0.77–0.95). Conclusions We found a contextual preventive relationship between community-level sports group participation and depressive symptoms in older individuals. Therefore, promoting sports groups in a community may be effective as a population-based strategy for the prevention of depression in older individuals. Furthermore, the benefit may favor male sports group participants.

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Physiological Responses to Overdressing and Exercise-Heat Stress in Trained Runners

Heat acclimation is the best strategy to improve performance in a hot environment. Many athletes seeking the benefits of heat acclimation lack access to a hot environment for exercise and, thus, rely on overdressing to simulate environmental heat stress. It is currently unknown whether this approach produces the requisite thermoregulatory strain necessary for heat acclimation in trained men and women. Purpose To compare physiological and cellular responses to exercise in a hot environment (HOT; 40°C, 30% RH) with minimal clothing (clo = 0.87) and in a temperate environment (CLO; 15°C, 50% RH) with overdressing (clo = 1.89) in both men and women. Methods HR, rectal temperature (Tre), mean skin temperature (Tsk), sweating rate (SR), and extracellular heat shock protein (eHSP)72 were measured in 13 (7 males, 6 females) well-trained runners (V˙O2max: 58.7 ± 10.7 mL·kg−1·min−1) in response to ~60 min of treadmill running at 50%–60% V˙O2max in HOT and CLO. Results Tre increased in both conditions, but the increase was greater in HOT (ΔTre HOT: 2.6°C ± 0.1°C; CLO 2.0°C ± 0.1°C; P = 0.0003). SR was also higher in HOT (1.41 ± 0.1 L h−1; CLO: 1.16 ± 0.1 L·h−1; P = 0.0001). eHSP72 increased in HOT (% change: 59% ± 11%; P = 0.03) but not in CLO (6% ± 2%; P = 0.31). Mean Tsk and HR were not different between HOT and CLO in men but were higher in HOT for women. Conclusion These data support the idea that overdressing during exercise in a temperate environment may produce the high Tre, Tsk, HR, and SR necessary for adaptation, but these responses do not match those in hot, dry environments. It is possible that greater exercise stimulus, warmer environment, or more clothing may be required to allow for a similar level of acclimation.

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Prestimulus delta and theta contributions to equiprobable Go/NoGo processing in healthy ageing

Publication date: Available online 15 May 2018
Source:International Journal of Psychophysiology
Author(s): Frances M. De Blasio, Robert J. Barry
Ongoing EEG activity contributes to ERP outcomes of stimulus processing, and each of these measures is known to undergo (sometimes significant) age-related change. Variation in their relationship across the life-span may thus elucidate mechanisms of normal and pathological ageing. This study assessed the relationships between low-frequency EEG prestimulus brain states, the ERP, and behavioural outcomes in a simple equiprobable auditory Go/NoGo paradigm, comparing these for 20 young (Mage = 20.4 years) and 20 healthy older (Mage = 68.2 years) adults. Prestimulus delta and theta amplitudes were separately assessed; these were each dominant across the midline region, and reduced in the older adults. For each band, (within-subjects) trials were sorted into ten increasing prestimulus EEG levels for which separate ERPs were derived. The set of ten ERPs for each band-sort was then quantified by PCA, independently for each group (young, older adults). Four components were primarily assessed (P1, N1-1, P2/N2b complex, and P3), with each showing age-related change. Mean RT was comparable, but intra-individual RT variability increased in older adults. Prestimulus delta and theta each generally modulated component positivity, indicating broad influence on task processing. Prestimulus delta was primarily associated with the early sensory processes, and theta more with the later stimulus-specific processes; prestimulus theta also inversely modulated intra-individual RT variability across the groups. These prestimulus EEG–ERP dynamics were consistent between the young and older adults in each band for all components except the P2/N2b, suggesting that across the lifespan, Go/NoGo categorisation is differentially affected by prestimulus delta and theta.



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Operative technique in robotic pancreaticoduodenectomy (RPD) at University of Illinois at Chicago (UIC): 17 steps standardized technique

Abstract

Background

Minimally invasive pancreaticoduodenectomy (MIPD) was introduced in the attempt to improve the outcomes of the open approach. Laparoscopic pancreaticoduodenectomy (LPD) was first reported by Gagner and Pomp (Surg Endosc 8:408–410, 1994). Unfortunately, due to its complexity and technical demand, LPD never reached widespread popularity. Since it was first performed by P. C. Giulianotti in 2001, Robotic PD (RPD) has been gaining ground among surgeons. MIPD is included as a surgical option in the latest NCCN Guidelines. However, lack of surgical standardization, however, has limited the reproducibility of MIPD and made the acquisition of the technique by other surgeons difficult. We provide an accurate description of our standardized step-by-step RDP technique.

Methods

We took advantage of our 15-year long experience and > 150 cases performed to provide a step-by-step guidance of our RPD standardized technique. The description includes practical "tips and tricks" to facilitate the learning curve and assist with the teaching/evaluation process.

Results

17 surgical steps were identified as key components of the RPD procedure. The steps reflect the subdivision of the RPD into several parts which help to understand a strategy that takes into accounts specific anatomical landmarks and the demands of the robotic platform.

Conclusions

Standardization is a key element of the learning curve of RPD. It can potentially provide consistent, reproducible results that can be more easily evaluated. Despite promising results, full acceptance of RPD as the 'gold standard' is still work in progress. Randomized-controlled trials with the application of a standardized technique are necessary to better define the role of RPD.

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Intraoperative conversion does not affect the oncological outcomes of minimally invasive esophagectomy for treatment of esophageal cancer

Abstract

Background

The aim of this study is to summarize the causes and implications of intraoperative conversion from minimally invasive esophagectomy (MIE) to open thoracotomy, and to evaluate the effect on long-term survival.

Methods

There were 293 thoracoscopic esophagectomies for esophageal squamous cell carcinoma (ESCC) of the thoracic esophagus performed by the authors from September 2009 to August 2015. Totally, 257 patients were enrolled in this study. These patients were divided into two groups (those underwent complete MIE and those converted to open thoracotomy) and then compared. A standardized preoperative evaluation, as well as a postoperative method of following at a regular frequency were adopted for all of these patients. The clinicopathologic characteristics and the perioperative variables were retrospectively analyzed. Univariate and multivariate analyses were performed to identify prognostic factors. And the Kaplan–Meier method was used to compare survival differences.

Results

There were 231 patients (89.9%) underwent successful thoracoscopic esophagectomy (Group 1), and 26 cases (10.1%) required conversion to open procedure (Group 2). The majority of conversion (73.1%, 19/26) occurred in the initial 100 cases. No significant difference in background or clinicopathologic factors between the two groups was observed, but patients in Group 2 had significantly longer operative time and more operative blood loss. Among the 26 patients of Group 2, there were nine cases that need emergent conversion for various reasons. And the most common cause for emergent conversion was intraoperative bleeding. Univariate and multivariate analyses all demonstrated that intraoperative conversion did not significantly influence the overall or recurrence-free survival of these patients.

Conclusions

Univariate analysis and multivariate Cox proportional hazard regression analysis indicated that intraoperative conversion did not significantly influence the OS and RFS rate of these patients. Our results demonstrated that the intraoperative conversion did not affect the long-term survival of patients underwent MIE for ESCC.

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Robotic-assisted laparoscopic groin hernia repair: observational case-control study on the operative time during the learning curve

Abstract

Background

Robotic groin hernia repair (r-TAPP) is demonstrating rapid adoption in the US. Barriers in Europe include: low availability of robotic systems to general surgeons, cost of robotic instruments, and the perception of longer operative time.

Methods

Patients undergoing r-TAPP in our start-up period were prospectively entered in the EuraHS database and compared to laparoscopic TAPP (l-TAPP) performed by the same surgeon within the context of two other prospective studies. Operations were performed with the daVinci Xi robot and the primary endpoint was skin-to-skin operative time.

Results

Following proctoring in September 2016 by US surgeons, 50 r-TAPP (34 unilateral and 16 bilateral) procedures have been performed up to January 2017. Mean operative time for unilateral r-TAPP was 54 min, with a decrease from 63 min for the first tertile to 44 min for the third tertile. For unilateral l-TAPP, the mean operative time was 45 min. Mean operative time for bilateral r-TAPP was 78 min, with a decrease from 90 min for the first half to 68 min for the second half. For bilateral l-TAPP, the mean operative time was 61 min. There were no intraoperative complications and no conversions to conventional laparoscopy or open surgery. The operation was performed as an outpatient in 67% of cases. Urinary retention requiring urinary catheterization was the only early postoperative complication noted in 5 patients (10.2%). At 4 week follow-up, 7 patients (14.3%) had an asymptomatic seroma, but no other complications were seen.

Conclusion

Robotic TAPP was associated with a rapid reduction in operative time during our learning curve and afterwards the operative time to perform a robotic TAPP equals the operative time to perform a laparoscopic TAPP, both for unilateral and for bilateral groin hernia repairs. No complications related to the introduction of robotic-assisted laparoscopic groin hernia repair were observed.

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Perioperative outcomes and anesthetic considerations of robotic bariatric surgery in a propensity-matched cohort of super obese and super-super obese patients

Abstract

Background

The use of the robotic platform has not been well established in patients with super obesity (SO; body mass index, BMI ≥ 50) and super-super obesity (SSO, BMI ≥ 60). We aimed to determine safety and feasibility of robotic bariatric surgery in this cohort.

Methods

Review of a prospectively maintained database was performed of consecutive patients undergoing robotic bariatric surgery between 2015 and 2017. Propensity score analysis with 1:2 nearest neighbor matching was performed to control for baseline characteristics and procedure type.

Results

A propensity-matched cohort of 47 SO patients (median BMI 55.3, range 50.1–92.5) and 94 morbidly obese (MO; median BMI 41.8, range 35.1–48.8) patients were analyzed. After matching, there were no difference in baseline characteristics including age, American Society of Anesthesiologists (ASA) score, or preoperative comorbidities. Most patients in each group underwent sleeve gastrectomy (81% of SO patients versus 76% of MO patients) or Roux-en-Y gastric bypass (13% vs. 18%, respectively), p = 0.66. There were no differences in operative time, intraoperative complications, postoperative complications, or re-admissions between groups. Length of stay was slightly longer in the MO group (2.2 days, IQR 1.8–3.2 vs. 1.8 days, IQR 1.2–2.7; p = 0.01). A subset of SSO patients (n = 11, median BMI 67, range 60–92) was analyzed; there was no increase in operation time, and zero intraoperative complications, conversions to open, or postoperative complications in this subset.

Conclusions

Robotic bariatric surgery can safely be performed on patients with SO or SSO with low perioperative morbidity and no increase in operating time.

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It’s better to be lucky

Abstract

Presidential Address at the 2018 SAGES Annual Meeting Seattle, Washington, April 13, 2018. Working together, there is no limit to what SAGES teams can achieve with innovation, passion, persistence, and a little luck. The speech highlights several SAGES initiatives, and he recognizes their champions.

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Evaluation of VTE prophylaxis and the impact of alternate regimens on post-operative bleeding and thrombotic complications following bariatric procedures

Abstract

Background

Studies examining utilization and impact of venous thromboembolism (VTE) chemoprophylaxis for patients undergoing bariatric surgery are limited. Determination of the optimal prophylactic regimen to minimize complications is crucial.

Methods

The Cerner Health Facts database from 2003 to 2013 was queried using ICD-9 codes to identify patients undergoing laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (RYGB). VTE chemoprophylaxis regimens were divided into pre-operative alone (PreP), post-operative alone (PostP), both pre-operative and post-operative (PPP), or no prophylaxis (NP). Specific chemoprophylaxis agents were compared. Comparisons in inpatient clinical outcomes were based on univariate analysis and multivariable logistic regression when appropriate.

Results

We identified 11,860 patients who underwent LSG and RYGB. 634 (5.35%) had PreP, 4593 (38.73%) had PostP, 2646 (22.31%) had PPP, and 3987 (33.62%) had NP. The overall rates of transfusion, DVT, and PE were 2.48, 0.27, and 0.18%, respectively. Patients without chemoprophylaxis had higher rate of DVT compared to any chemoprophylaxis (0.58 vs 0.11%, p < 0.0001), without any significant difference in PE rate. Patients with pre-operative chemoprophylaxis were more likely to receive transfusion compared to patients with post-operative prophylaxis alone (OR 1.98, 95% CI 1.28–3), without significant difference in having VTE. When examining heparin versus enoxaparin versus mixed regimen in the PostP group, mixed regimen was associated with increased transfusion requirements (p < 0.001).

Conclusions

Bariatric surgical VTE chemoprophylaxis utilization is inconsistent. In this study, post-operative VTE chemoprophylaxis was associated with decreased VTE events compared to NP, while minimizing bleeding compared to PreP. Mixed therapy using heparin and enoxaparin was associated with more bleeding.

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Comparison between laparoscopic and open Hartmann’s reversal: results of a decade-long multicenter retrospective study

Abstract

Background

Hartmann's reversal is a challenging surgical procedure with significant postoperative morbidity rates. Various surgical methods have been suggested to lower the risk of postoperative complications. In this study, we aimed to compare the postoperative results between open and laparoscopic techniques for Hartmann's reversal.

Methods

A retrospective study of all patients who underwent Hartmann's reversal in five centers in central Israel between January 2004 and June 2015 was conducted. Medical charts were reviewed, analyzing preoperative and operative parameters and short-term postoperative outcomes.

Results

260 patients were included in the study. 76 patients were operated laparoscopically with a conversion rate of 26.3% (20 patients). No differences were found between patients operated laparoscopically and those operated in an open technique regarding gender (p = 0.785), age (61.34 vs. 62.64, p = 0.521), body mass index (26.6 vs. 26.2, p = 0.948), Charlson index score (1.79 vs. 1.95, p = 0.667), and cause for Hartmann's procedure (neoplastic vs. non-neoplastic, p = 0.644). No differences were seen in average time from the Hartmann's procedure to reversal (204.89 vs. 213.60 days, p = 0.688) and in overall complication rate (46.4 vs. 46.5%, p = 1). The Clavien–Dindo score for distinguishing between minor (0–2 score, p = 1) and major complications (3–5 score, p = 0.675) failed to demonstrate an advantage to laparoscopy, as well as to average length of stay (10.91 days in the laparoscopic group vs. 11.72 days in the open group, p = 0.529). An analysis based on the intention-to-treat with laparoscopy, including converted cases in the laparoscopic group, showed similar results, including overall complication rate (48.6 vs. 45.6%, p = 0.68) and Clavien–Dindo score in both minor (p = 0.24) and major complications (p = 0.44). Length of stay (10.92 vs. 11.81 days, p = 0.45) was also similar between the two groups.

Conclusion

In this series, a laparoscopic approach to Hartmann's reversal did not offer any short-term advantage when compared to an open surgical approach.

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Technique, safety, and feasibility of EUS-guided radiofrequency ablation in unresectable pancreatic cancer

Abstract

Background and aims

Radiofrequency ablation (RFA) is a well-recognized local ablative technique applied in the treatment of different solid tumors. Intraoperative RFA has been used for non-metastatic unresectable pancreatic ductal adenocarcinoma (PDAC), showing increased overall survival in retrospective studies. A novel RFA probe has recently been developed, allowing RFA under endoscopic ultrasound (EUS) guidance. Aim of the present study was to assess the feasibility and safety of EUS-guided RFA for unresectable PDACs.

Methods

Patients with unresectable non-metastatic PDAC were included in the study following neoadjuvant chemotherapy. EUS-guided RFA was performed using a novel monopolar 18-gauge electrode with a sharp conical 1 cm tip for energy delivery. Pre- and post-procedural clinical and radiological data were prospectively collected.

Results

Ten consecutive patients with unresectable PDAC were enrolled. The procedure was successful in all cases and no major adverse events were observed. A delineated hypodense ablated area within the tumor was observed at the 30-day CT scan in all cases.

Conclusions

EUS-guided RFA is a feasible and safe minimally invasive procedure for patients with unresectable PDAC. Further studies are warranted to demonstrate the impact of EUS-guided RFA on disease progression and overall survival.

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The laparoscopic inguinal and diaphragmatic defect (LIDD) model: a validation study of a novel box trainer model

Abstract

Background

Paediatric laparoscopic procedures are now becoming routine practice. Therefore, there is a need for simulated laparoscopic models to acquire part-procedural competency prior to direct patient contact in a safe learning environment. For this reason, we chose two paediatric conditions; inguinal hernia (IH) and congenital diaphragmatic hernia (CDH), which were combined to create the laparoscopic inguinal and diaphragmatic defect (LIDD) model. Our aim was to assess this novel surgical simulation model by determining its construct and content validity.

Methods

A total of 107 participants completed the validation study: volunteer medical students (novices), surgical trainees (intermediate) and consultant surgeons (experts). Basic demographic data were collected. Subjects were shown a pre-recorded video of both exercises. The assessment exercise involved closing both the simulated inguinal or diaphragmatic hernial orifice. The task was assessed using a novel scoring system with a maximum score of 21 for IH model and 15 for the CDH. The content validity was assessed by a 6-point Likert scale of the expert group.

Results

105/107 participants successfully completed the two exercises. Both aspects of the LIDD model revealed a statistical significance between the scores obtained by the three groups of subjects. Experts scored 20.3/21 for the IH and 14.8/15 for the CDH models which significantly higher than medical students (6.3/21 and 5.3/15; p < 0.05 for both) and trainees (11.2/21 and 9.3/15; p < 0.05 for both). Similarly, trainees performed significantly better than medical students in both models (p < 0.05). Therefore, the LIDD model was found to have a good construct validity. It was, however, unable to differentiate between the various levels of trainees in the intermediate group. Content validity from the experts revealed that there was a high score for the potential of both aspects of LIDD (4.8 and 4.8). There was also a high level of functional fidelity for task completion (4.0 and 4.0).

Conclusions

We have demonstrated both the construct and content validity of the LIDD model for both laparoscopic IH and CDH repair. It was able to successfully differentiate between the expert, trainees and inexperienced laparoscopic surgeons.

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Narrative review on the effect of shockwave treatment for management of upper and lower extremity musculoskeletal conditions

Extracorporeal shockwave therapy (ESWT) is a technology that was first introduced into clinical practice in 1982 for urological conditions. Subsequent clinical applications in musculoskeletal conditions have been described in treatment of plantar fasciopathy, both upper and lower extremity tendinopathies, greater trochanteric pain syndrome, medial tibial stress syndrome, management of non-union fractures, and joint disease including avascular necrosis (AVN). The aim of this review is to summarize the current understanding of treatment of musculoskeletal conditions with ESWT, accounting for differences in treatment protocol and energy levels.

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Insertion and Presence of Fine-wire Intramuscular Electrodes to the Lumbar Paraspinal Muscles Do Not Affect Muscle Performance and Activation during High-exertion Spinal Extension Activities

Low back pain (LBP) is commonly associated with paraspinal muscle dysfunctions. A method to study deep lumbar paraspinal (i.e. multifidus) muscle function and neuromuscular activation pattern is intramuscular electromyography (EMG). Previous studies have shown that the procedure does not significantly impact muscle function during activities involving low-level muscle contractions. However, it is currently unknown how muscular function and activation are affected during high-exertion contractions.

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Nonoperative Management of a Severe Proximal Rectus Femoris Musculotendinous Injury in a Recreational Athlete: A Case Report

This report describes a severe injury to the proximal rectus femoris (RF) muscle in a 37-year-old recreational athlete. This injury is a relatively rare occurrence in both the general and elite athletic populations. Acute and long-term imaging and functional outcomes are described. This athlete was able to return to full activity without surgical intervention. Follow-up imaging demonstrated gross healing of both complete (or near complete) muscle and tendon tears.

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Systematic Review with Meta-analysis: Change in Liver Stiffness During Anti-viral Therapy in Patients with Hepatitis B

Time-varying impact of anti-viral therapy on liver stiffness in patients with hepatitis B is unclear.

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Cesarean section reduces the risk of early mother-to-child transmission of hepatitis B virus

To evaluate the effects of cesarean section (CS) on the prevention of mother-to-child transmission (MTCT) of hepatitis B virus (HBV) among hepatitis B surface antigen (HBsAg) positive pregnant women.

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Influence of POLG on Radiosensitivity of Nasopharyngeal Carcinoma Cells

Cancer Biotherapy and Radiopharmaceuticals, Volume 33, Issue 4, Page 146-154, May 2018.


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Antitumor Effect of GO-PEG-DOX Complex on EMT-6 Mouse Breast Cancer Cells

Cancer Biotherapy and Radiopharmaceuticals, Volume 33, Issue 4, Page 125-130, May 2018.


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Systematic Review with Meta-analysis: Change in Liver Stiffness During Anti-viral Therapy in Patients with Hepatitis B

Time-varying impact of anti-viral therapy on liver stiffness in patients with hepatitis B is unclear.

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Cesarean section reduces the risk of early mother-to-child transmission of hepatitis B virus

To evaluate the effects of cesarean section (CS) on the prevention of mother-to-child transmission (MTCT) of hepatitis B virus (HBV) among hepatitis B surface antigen (HBsAg) positive pregnant women.

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Influence of POLG on Radiosensitivity of Nasopharyngeal Carcinoma Cells

Cancer Biotherapy and Radiopharmaceuticals, Volume 33, Issue 4, Page 146-154, May 2018.


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Antitumor Effect of GO-PEG-DOX Complex on EMT-6 Mouse Breast Cancer Cells

Cancer Biotherapy and Radiopharmaceuticals, Volume 33, Issue 4, Page 125-130, May 2018.


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Influence of dietary nitrate supplementation on local sweating and cutaneous vascular responses during exercise in a hot environment

Abstract

Purpose

We investigated the influence of inorganic nitrate ( \({\text{NO}}_{3}^{ - }\) ) supplementation on local sweating and cutaneous vascular responses during exercise in hot conditions.

Method

Eight healthy, young subjects were assigned in a randomized, double-blind, crossover design to receive \({\text{NO}}_{3}^{ - }\) -rich beetroot (BR) juice (140 mL/day, containing ~ 8 mmol of \({\text{NO}}_{3}^{ - }\) ) and \({\text{NO}}_{3}^{ - }\) -depleted placebo (PL) juice (140 mL/day, containing ~ 0.003 mmol of \({\text{NO}}_{3}^{ - }\) ) for 3 days. On day 3 of supplementation, subjects cycled at an intensity corresponding to 55% of \(\dot{V}\) O_2max for 30 min in hot conditions (30 °C, 50% relative humidity). Chest and forearm sweat rate (SR) and skin blood flow (SkBF), were measured continuously. Cutaneous vascular conductance (CVC) was calculated by SkBF/mean arterial pressure (MAP).

Results

Prior to exercise, plasma \({\text{NO}}_{3}^{ - }\) (21 ± 6 and 581 ± 161 µM) and nitrite ( \({\text{NO}}_{2}^{ - }\) , 87 ± 28 and 336 ± 156 nM) concentrations were higher after BR compared to PL supplementation (P ≤ 0.011, n = 6). Oesophageal, mean skin, and mean body temperatures during exercise were not different between conditions. In addition, BR supplementation did not affect SR, SkBF, and CVC during exercise. A lower MAP was found after 30 min of exercise following BR supplementation (112 ± 6 and 103 ± 6 mmHg for PL and BR, respectively, P = 0.021).

Conclusion

These results suggest that inorganic \({\text{NO}}_{3}^{ - }\) supplementation, which increases the potential for O₂-independent NO production, does not affect local sweating and cutaneous vascular responses, but attenuates blood pressure in young healthy subjects exercising in a hot environment.

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Webinar: How prehospital stroke management with new endovascular care is helping EMS providers

Stroke is the fifth leading cause of death in the U.S., according to the Centers for Disease Control and Prevention. EMS providers are regularly responding to patients who show warning signs of a stroke, and every second matters when it comes to treating stroke. That's why early detection and prompt care play a crucial role in determining outcomes for stroke patients. In honor of National Stroke Awareness Month, EMS1, Medtronic Neurovascular and the IPSA are holding this special webinar. In this webinar, Dr. Peter Taillac, an emergency physician and an associate professor of surgery, within the division of emergency medicine at the University of Utah Health, will share how new endovascular care is helping EMS providers.

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Treatment of cardial submucosal tumors originating from the muscularis propria layer: submucosal tunneling endoscopic resection versus endoscopic submucosal excavation

Abstract

Background and aims

Submucosal tunneling endoscopic resection (STER) is increasingly used for the treatment of submucosal tumors (SMTs) originating from the muscularis propria layer; however, endoscopic submucosal excavation (ESE) is still performed in many hospitals for its low-skill and experience requirements. This study aimed to compare STER with ESE for cardial SMTs.

Methods

From March 2013 to February 2017, patients with cardial SMTs undergoing STER (n = 47) and ESE (n = 40) were retrospectively assessed. Clinicopathological, endoscopic, and complication data were compared between STER and ESE groups.

Results

The 87 enrolled patients included 31 females and 56 males, aged 48.2 ± 9.8 years. Mean tumor size was 22.0 mm (range 5.0–80.0 mm) as evaluated by pathology. Demographic and lesion features were similar in both groups. Despite similar hospital stay duration and cost, ESE was superior to STER with reduced operation time (34 vs. 46 min, P = 0.013) and less clips required (3 vs. 5, P = 0.000). En bloc resection rates, complete resection rates, hospital stay duration, cost, complications, and hemoglobin levels were similar in both groups. Irregular-shaped SMTs were more likely to achieve piecemeal resection in both STER and ESE groups (all P < 0.05). Meanwhile, the piecemeal resection rate was significantly higher for larger tumors in the STER group.

Conclusion

Compared with ESE, STER does not show overt advantages for cardial SMTs. However, ESE is superior to STER for reduced operation time. Irregular tumor shape seems to be a risk factor for piecemeal resection in both STER and ESE.

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Randomized clinical trial comparing laparoscopic hiatal hernia repair using sutures versus sutures reinforced with non-absorbable mesh

Abstract

Background

Current literature is characterized by a discrepancy between reported symptomatic and radiological recurrent hiatal hernia's following primary repair. Crural augmentation using mesh is suggested to reduce recurrence rates. The aim of this trial is to analyze 1-year outcome of laparoscopic hiatal hernia repair using sutures versus sutures reinforced with non-absorbable mesh.

Methods

Between 2013 and 2016, 72 patients with an objectified hiatal hernia were randomized for primary repair using non-absorbable sutures and sutures reinforced with non-absorbable mesh. Data regarding the incidence of recurrent hiatal hernia, need for endoscopic dilatation or surgical reintervention, postoperative dysphagia and/or reflux symptoms, general health, and use of acid-suppressing medication were analyzed.

Results

72 patients (n = 36 vs. n = 36) were included. One year after primary repair and repair using non-absorbable mesh, there were no differences in the number of recurrent hiatal hernia's demonstrated by barium swallow radiology (n = 4 [11.4%] vs. n = 6 [19.4%], p = 0.370) or upper gastrointestinal endoscopy (n = 5 [14.4%] vs. n = 5 [17.2%], p = 0.746), the number of surgical reinterventions (n = 2 [5.6%] vs. n = 1 [2.8%], p = 1.000), nor in chest pain and heartburn scores, with comparable dysphagia and satisfaction scores. Compared to the preoperative state, both groups demonstrated a comparable and significant reduction in chest pain score and Dakkak dysphagia score.

Conclusions

Use of non-absorbable mesh to reinforce primary hiatal hernia repair results in equal hiatal hernia recurrence and symptomatic outcome compared to repair using sutures alone. During 1-year follow-up, there were no mesh-related complications. Follow-up beyond 1 year needs to demonstrate whether these findings are sustained.

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Webinar: How prehospital stroke management with new endovascular care is helping EMS providers

Stroke is the fifth leading cause of death in the U.S., according to the Centers for Disease Control and Prevention. EMS providers are regularly responding to patients who show warning signs of a stroke, and every second matters when it comes to treating stroke. That's why early detection and prompt care play a crucial role in determining outcomes for stroke patients. In honor of National Stroke Awareness Month, EMS1, Medtronic Neurovascular and the IPSA are holding this special webinar. In this webinar, Dr. Peter Taillac, an emergency physician and an associate professor of surgery, within the division of emergency medicine at the University of Utah Health, will share how new endovascular care is helping EMS providers.

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