RESUMEN
The primary aim of this study was to determine whether supplementation with calcium ß-hydroxy-ß-methylbutyrate (HMB) and vitamin D3 (D) would enhance muscle function and strength in older adults. Older adults over 60 years of age with insufficient circulating 25-hydroxy-vitamin D (25OH-D) levels were enrolled in a double-blinded controlled 12-month study. Study participants were randomly assigned to treatments consisting of: (a) Control + no exercise, (b) HMB+D + no exercise, (c) Control + exercise, and (d) HMB+D + exercise. The study evaluated 117 participants via multiple measurements over the 12 months that included body composition, strength, functionality, and questionnaires. HMB+D had a significant benefit on lean body mass within the nonexercise group at 6 months (0.44 ± 0.27 kg, HMB+D vs -0.33 ± 0.28 kg, control, p < .05). In nonexercisers, improvement in knee extension peak torque (60°/s) was significantly greater in HMB+D-supplemented participants than in the nonsupplemented group (p = .04) at 3 months, 10.9 ± 5.7 Nm and -5.2 ± 5.9 Nm, respectively. A composite functional index, integrating changes in handgrip, Get Up, and Get Up and Go measurements, was developed. HMB+D + no exercise resulted in significant increases in the functional index compared with those observed in the control + no exercise group at 3 (p = .03), 6 (p = .04), and 12 months (p = .04). Supplementation with HMB+D did not further improve the functional index within the exercising group. This study demonstrated the potential of HMB and vitamin D3 supplementation to enhance muscle strength and physical functionality in older adults, even in individuals not engaged in an exercise training program.
Asunto(s)
Calcio/administración & dosificación , Fuerza Muscular/efectos de los fármacos , Entrenamiento de Fuerza , Valeratos/administración & dosificación , Vitamina D/administración & dosificación , Anciano , Composición Corporal , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y CuestionariosRESUMEN
Controversy still exists regarding the best clinical assessment test for chondromalacia patellae (CMP). Our study aims to evaluate the specificity and sensitivity of a novel clinical test for CMP, the "Patella Slide Test" (PST) against the findings of magnetic resonance imaging (MRI) and arthroscopy. We included 221 consecutive patients planned for elective knee arthroscopic surgery. An MRI scan of the symptomatic knee was performed prior to surgery. On the day of surgery, each patient was examined using the PST followed by a knee arthroscopy to assess the quality of the chondral surfaces of the patellofemoral joint. The MRI and PST results were compared against the arthroscopic findings that served as the gold standard. The PST (0.89) was statistically more sensitive than MRI (0.67) in diagnosing CMP. The PST (0.89) also had a greater negative predictive value (NPV) than MRI (0.74). However, MRI (0.94) was more specific than the PST (0.85). The differences in accuracy and positive predictive value of the PST versus MRI were not statically significant. In conclusion, the PST shows high sensitivity and has a greater NPV than MRI as a clinical test for diagnosing CMP.
Asunto(s)
Artroscopía , Condromalacia de la Rótula/diagnóstico , Imagen por Resonancia Magnética , Examen Físico , Adulto , Condromalacia de la Rótula/cirugía , Diagnóstico Diferencial , Femenino , Humanos , MasculinoRESUMEN
BACKGROUND: Psychologic factors are associated with pain and disability in patients with chronic shoulder pain. Recent research regarding the association of affective psychologic factors (emotions) with patients' pain and disability outcome after surgery disagrees; and the relationship between cognitive psychologic factors (thoughts and beliefs) and outcome after surgery is unknown. QUESTIONS/PURPOSES: (1) Are there identifiable clusters (based on psychologic functioning measures) in patients undergoing shoulder surgery? (2) Is poorer psychologic functioning associated with worse outcome (American Shoulder and Elbow Surgeons [ASES] score) after shoulder surgery? METHODS: This prospective cohort study investigated patients undergoing shoulder surgery for rotator cuff-related shoulder pain or rotator cuff tear by one of six surgeons between January 2014 and July 2015. Inclusion criteria were patients undergoing surgery for rotator cuff repair with or without subacromial decompression and arthroscopic subacromial decompression only. Of 153 patients who were recruited and consented to participate in the study, 16 withdrew before data collection, leaving 137 who underwent surgery and were included in analyses. Of these, 124 (46 of 124 [37%] female; median age, 54 years [range, 21-79 years]) had a complete set of four psychologic measures before surgery: Depression, Anxiety and Stress Scale; Pain Catastrophizing Scale; Pain Self-Efficacy Questionnaire; and Tampa Scale for Kinesiophobia. The existence of clusters of people with different profiles of affective and cognitive factors was investigated using latent class analysis, which grouped people according to their pattern of scores on the four psychologic measures. Resultant clusters were profiled on potential confounding variables. The ASES score was measured before surgery and 3 and 12 months after surgery. Linear mixed models assessed the association between psychologic cluster membership before surgery and trajectories of ASES score over time adjusting for potential confounding variables. RESULTS: Two clusters were identified: one cluster (84 of 124 [68%]) had lower scores indicating better psychologic functioning and a second cluster (40 of 124 [32%]) had higher scores indicating poorer psychologic functioning. Accounting for all variables, the cluster with poorer psychologic functioning was found to be independently associated with worse ASES score at all time points (regression coefficient for ASES: before surgery -9 [95% confidence interval {CI}, -16 to -2], p = 0.011); 3 months after surgery -15 [95% CI, -23 to -8], p < 0.001); and 12 months after surgery -9 [95% CI, -17 to -1], p = 0.023). However, both clusters showed improvement in ASES score from before to 12 months after surgery, and there was no difference in the amount of improvement between clusters (regression coefficient for ASES: cluster with poorer psychologic function 31 [95% CI, 26-36], p < 0.001); cluster with better psychologic function 31 [95% CI, 23-39], p < 0.001). CONCLUSIONS: Patients who scored poorly on a range of psychologic measures before shoulder surgery displayed worse ASES scores at 3 and 12 months after surgery. Screening of psychologic factors before surgery is recommended to identify patients with poor psychologic function. Such patients may warrant additional behavioral or psychologic management before proceeding to surgery. However, further research is needed to determine the optimal management for patients with poorer psychologic function to improve pain and disability levels before and after surgery. LEVEL OF EVIDENCE: Level II, therapeutic study.
Asunto(s)
Emociones , Percepción del Dolor , Lesiones del Manguito de los Rotadores/cirugía , Articulación del Hombro/cirugía , Dolor de Hombro/cirugía , Adulto , Anciano , Evaluación de la Discapacidad , Femenino , Humanos , Estudios Longitudinales , Masculino , Salud Mental , Persona de Mediana Edad , Dimensión del Dolor , Estudios Prospectivos , Recuperación de la Función , Medición de Riesgo , Factores de Riesgo , Lesiones del Manguito de los Rotadores/diagnóstico , Lesiones del Manguito de los Rotadores/fisiopatología , Lesiones del Manguito de los Rotadores/psicología , Articulación del Hombro/fisiopatología , Dolor de Hombro/diagnóstico , Dolor de Hombro/fisiopatología , Dolor de Hombro/psicología , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
Lung carcinoid tumours constitute approximately 1-2% of all pulmonary tumours. They are derived from enterochromaffin cells, which are also known as 'Kulchitsky cells' and generally have indolent growth and development patterns. Carcinoid tumours are categorized as typical or atypical, depending on the number of mitoses per high power field and the presence of necrosis. In terms of management, surgical resection has been recognized to be the standard treatment for pulmonary carcinoid tumours. To our knowledge, the da Vinci system and robotic surgery have not been applied in sleeve lobectomies and bronchoplasty for the removal of carcinoid tumours in the United Kingdom. Therefore, we present a case of a sleeve lobectomy with bronchoplasty procedure for the removal of a carcinoid tumour located in the left lower lobe of the patient. The bronchus was repaired using a V-lock suture & Prolene sutures with the surgery performed using the da Vinci robotic surgical system.
RESUMEN
Peripheral biomarkers for dementia are few and far between. Despite research into blood plasma/serum biomarkers for dementia diagnostics, there is a lack of information on erythrocytes and their vast proteomes as potential biomarkers. This review identifies a number of relevant and potentially promising erythrocyte biomarkers for various subtypes of dementia. These include erythrocyte morphology, oxidative stress, and erythrocyte membrane proteins such as the glucose transporter (GLUT-1), amyloid-ß, IgG, Hsp90, calpain-1, and band 3 protein. Of those proteins identified Hsp90, amyloid-ß, calpain-1 and band 3 show the most promise as pre-clinical biomarkers. However, the most intriguing aspect of erythrocytes is their changed morphology in dementia. The altered morphology not only could be used as a diagnostic biomarker but may be crucial in early pathogenesis of the disease. Further work must be done to establish the pathological connection between the periphery and central disease processes.
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Enfermedad de Alzheimer/sangre , Eritrocitos/metabolismo , Eritrocitos/patología , Enfermedad de Alzheimer/patología , Animales , Biomarcadores/sangre , HumanosRESUMEN
ß-Hydroxy-ß-methylbutyrate (HMB), a leucine metabolite, has long been supplemented as a Ca salt (Ca-HMB) to increase strength and performance gains with exercise and to reduce recovery time. Recently, the free acid form of HMB (HMB-FA) has become commercially available in capsule form (gelcap). The current study was conducted to compare the bioavailability of HMB using the two commercially available capsule forms of HMB-FA and Ca-HMB. We also compared the pharmacokinetics of each form when administered mixed in water. Ten human subjects (five male and five female) were studied in a randomised crossover design. There was no significant sex by treatment interaction for any of the pharmacokinetic parameters measured. HMB-FA administered in capsules was more efficient than Ca-HMB capsule at HMB delivery with a 37 % increase in plasma clearance rate (74·8 (sem 4·0) v. 54·5 (sem 3·2) ml/min, P<0·0001) and a 76 % increase in peak plasma HMB concentration (270·2 (sem 17·8) v. 153·9 (sem 17·9) µmol/l, P<0·006), which was reached in one-third the time (P<0·009). When HMB-FA and Ca-HMB were administered in water, the differences still favoured HMB-FA, albeit to a lesser degree. Plasma HMB with HMB-FA administered in water was greater during the early phase of absorption (up to 45 min postadministration, P<0·05); this resulted in increased AUC during the first 60 min after administration, when compared with Ca-HMB mixed in water (P<0·03). In conclusion, HMB-FA in capsule form improves clearance rate and availability of HMB compared with Ca-HMB in capsule form.
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Calcio/sangre , Calcio/farmacocinética , Valeratos/sangre , Valeratos/farmacocinética , Adulto , Disponibilidad Biológica , Calcio/administración & dosificación , Estudios Cruzados , Suplementos Dietéticos , Ejercicio Físico , Femenino , Humanos , Masculino , Tasa de Depuración Metabólica , Valeratos/administración & dosificación , Adulto JovenRESUMEN
BACKGROUND: Predictable patterns of periprosthetic fracture have been observed around polished double tapered stems. Finite element studies have suggested that triple-tapered stems cause less cement strain in torsion compared to double-tapered stems. Hence, we hypothesised that the in vitro behaviour of implanted double- and triple-tapered polished stems, like the CPT (Zimmer, Warsaw, USA) or C-Stem (DePuy, Leeds, U.K.) when subjected to pathological torsional loads may cause different patterns of periprosthetic fractures. METHODS: Ten double-tapered stems (CPT) and ten triple-tapered stems (C-Stem) were cemented into synthetic femur bones. A constant axial compression load of 100 N and a torsional pre-load of 0.1 N.m were applied using a biaxial testing machine. The distal femur was then loaded in external rotation at 45 degrees until failure. RESULTS: Seven of the 10 CPT stems fractured at the level of the stem body while fracturing the cement mantle at the same level. In three of ten of the CPT stems and all ten C-Stems, the synthetic bone fractured at the tip of the prosthesis while the cement mantle remained intact. This was significant for the resulting fracture pattern (P=0.001). There was no significant difference between the groups for either torque (P=0.13) or angle at failure (P=0.49). INTERPRETATION: This biomechanical study indicates that the CPT and C-Stem create a different fracture pattern under the same loading condition. The C-Stem (a triple tapered stem) may produce lower strain in torsion to the cement mantle of a cemented THA. However, fractures that do occur may be more difficult to treat than those produced around a stem like the CPT subjected to comparable loading.
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Artroplastia de Reemplazo de Cadera/efectos adversos , Fracturas de Cadera/patología , Prótesis de Cadera/efectos adversos , Fracturas Periprotésicas/patología , Diseño de Prótesis/efectos adversos , Falla de Prótesis/efectos adversos , Cementación , Fracturas de Cadera/etiología , Humanos , Fracturas Periprotésicas/etiología , Torsión Mecánica , Soporte de PesoRESUMEN
We describe a new technique and aim to justify its use in total hip arthroplasty. The incision is short and there is minimal soft tissue dissection: piriformis and most of quadratus femoris remain intact. A meticulous capsular repair is performed. Patients are mobilized without restrictions. One hundred total hip arthroplasties by the standard posterior approach (group 1) were compared with 100 by the less invasive approach (group 2). Minimum follow-up was 2 years. Mean blood loss in group 1 was higher (P < .0001) and inpatient stay longer (P < .0001). There was greater improvement in WOMAC scores for up to 1 year in the less invasive group (P = .027). In conclusion, the less invasive approach is safe and the functional benefits last up to 1 year.