RESUMEN
Obesity and overweight, frequently caused by a lack of exercise, are associated with many metabolic diseases, such as hypertension, diabetes, and dyslipidemia. Aerobic exercise effectively increases the high-density lipoproteins-cholesterol (HDL-C) levels and alleviates the triglyceride (TG) levels. The consumption of Cuban policosanol (Raydel®) is also effective in enhancing the HDL-C quantity and HDL functionality to treat dyslipidemia and hypertension. On the other hand, no study has examined the effects of a combination of high-intensity exercise and policosanol consumption in obese subjects to improve metabolic disorders. In the current study, 17 obese subjects (average BMI 30.1 ± 1.1 kg/m2, eight male and nine female) were recruited to participate in a program combining exercise and policosanol (20 mg) consumption for 12 weeks. After completion, their BMI, waist circumference, total fat mass, systolic blood pressure (SBP), and diastolic blood pressure (DBP) reduced significantly up to around -15%, -13%, -33%, -11%, and -13%, respectively. In the serum lipid profile, at Week 12, a significant reduction was observed in the total cholesterol (TC) and triglyceride (TG) levels, up to -17% and -54% from the baseline, respectively. The serum HDL-C was elevated by approximately +12% from the baseline, as well as the percentage of HDL-C in TC, and HDL-C/TC (%), was enhanced by up to +32% at Week 12. The serum coenzyme Q10 (CoQ10) level was increased 1.2-fold from the baseline in all participants at Week 12. In particular, the male participants exhibited a 1.4-fold increase from the baseline. The larger rise in serum CoQ10 was correlated with the larger increase in the serum HDL-C (r = 0.621, p = 0.018). The hepatic function parameters were improved; the serum γ-glutamyl transferase decreased at Week 12 by up to -55% (p < 0.007), while the aspartate aminotransferase and alanine transaminase levels diminished within the normal range. In the lipoprotein level, the extent of oxidation and glycation were reduced significantly with the reduction in TG content. The antioxidant abilities of HDL, such as paraoxonase (PON) and ferric ion reduction ability (FRA), were enhanced significantly by up to 1.8-fold and 1.6-fold at Week 12. The particle size and number of HDL were elevated up to +10% during the 12 weeks, with a remarkable decline in the TG content, glycation extent, and oxidation. The improvements in HDL quality and functionality were linked to the higher survivability of adult zebrafish and their embryos, under the co-presence of carboxymethyllysine (CML), a pro-inflammatory molecule known to cause acute death. In conclusion, 12 weeks of Cuban policosanol (Raydel®, 20 mg) consumption with high-intensity exercise displayed a significant improvement in blood pressure, body fat mass, blood lipid profile without liver damage, CoQ10 metabolism, and renal impairment.
RESUMEN
BACKGROUND: This study evaluated outcomes and complications with endoscopic carpal tunnel release performed with local anesthesia only versus local anesthesia with sedation. The authors hypothesized that patient outcomes and satisfaction would be equivalent in both groups irrespective of anesthesia type. METHODS: One hundred fifty-four consecutive patients undergoing endoscopic carpal tunnel release with local anesthesia either with or without sedation were prospectively enrolled in a study of satisfaction and outcomes. Patients were surveyed preoperatively and at 2 weeks and 3 months postoperatively to evaluate satisfaction, symptoms, complications, and disability using the 11-question Disabilities of the Arm, Shoulder, and Hand questionnaire survey; the Levine-Katz carpal tunnel survey; and a customized Likert scale. RESULTS: The hypothesis was upheld. Patients reported high levels of satisfaction (96 percent in the local anesthesia group and 93 percent in the local anesthesia with sedation group at 3 weeks). Disability, pain, and symptom scores did not differ significantly between groups at either postoperative time point. After surgery, patients in the sedation group recalled more mean preoperative anxiety (four of 10 versus 2.03 of 10 at 3 months). If they were to undergo surgery again, patients in the sedation group were likely to desire either sedation (68 percent) or general anesthesia (29 percent), whereas patients in the local anesthesia-only group were likely to wish for similar local-only anesthesia (78 percent). There were no reoperations or epinephrine-related complications in either group. CONCLUSIONS: Patients undergoing endoscopic carpal tunnel release with the local anesthesia or local anesthesia plus sedation experience similar levels of satisfaction and outcomes. Both methods of anesthesia provide excellent results and allow surgeons and patients to choose freely between the two anesthetic techniques.
Asunto(s)
Anestesia Local/métodos , Síndrome del Túnel Carpiano/cirugía , Sedación Profunda/métodos , Neuroendoscopía/métodos , Procedimientos Quirúrgicos Ambulatorios/métodos , Anestésicos Locales , Femenino , Humanos , Hipnóticos y Sedantes , Lidocaína , Masculino , Persona de Mediana Edad , Prioridad del Paciente , PropofolRESUMEN
PURPOSE: Volar plating of distal radius fractures using an approach through the flexor carpi radialis (FCR) sheath is commonplace. The palmar cutaneous branch of the median nerve (PCB) is considered to run in a position adjacent to, but outside, the ulnar FCR sheath. Anatomic studies have not identified anatomic abnormalities relevant to volar plating. The purpose of this study was to determine the frequency of anomalous PCB branches entering the FCR sheath during volar plating. METHODS: This observational study involved 10 attending hand surgeons during a 7-month period (July 2015-January 2016). Surgeons assessed, documented, and reported any PCB anomalies that were encountered during volar plating through a trans-FCR approach. RESULTS: There were 182 volar plates applied that made up the study group. There were 10 cases (5.5%) of anomalous PCBs entering the FCR sheath. In 4 cases, the PCB pierced the radial FCR sheath proximally, crossed beneath the tendon, and traveled distally on the ulnar side. In 4 other cases, the PCB entered the FCR sheath proximally on the ulnar or central aspect of the sheath and remained within the sheath, staying along the ulnar or dorsal side of the tendon. In 1 case, the PCB pierced the ulnar distal aspect of the sheath and split into 2 branches. In 1 case, the PCB ran within the sheath along the radial aspect of the FCR. CONCLUSIONS: Anomalies in the course of the PCB are more common than often considered. These variants are at risk during volar surgical approaches to the wrist that proceed through the FCR sheath. CLINICAL RELEVANCE: Although dissecting along the radial side of the FCR sheath may protect the PCB in most cases, care must be taken to identify anomalous branches (if present) and protect them during surgery.