基于胸部CT分析基线骨骼肌含量对ICU患者预后的影响

目的 探讨危重患者入ICU时基线骨骼肌含量与病情危重程度及预后的相关性。方法 纳入在ICU治疗时间≥48 h的危重患者79例,测量其入ICU时胸部CT第七胸椎（T7）水平横断面胸肌面积（PMA）,分析PMA与90 d病死率、90 d内生存率、28 d内非ICU生存日数、28 d内无机械通气生存日数、ICU病死率、院内病死率等指标的相关性。结果 在校正性别、危重症营养风险评分、 Charlson共病指数、血红蛋白等因素后,基线PMA较大患者90 d病死率更低,90 d内生存率更高,28 d内非ICU生存日数更多,院内病死率也更低,与基线PMA较小患者比较差异均具有统计学意义（P均< 0.05）。结论 危重患者入ICU时的基线骨骼肌含量可用于预测病情严重程度、需要体外生命支持和ICU治疗的时间和临床预后。     

Effects of Kinesio tape application to trunk isokinetic strength in female participants

ABSTRACT

The purpose of this study is to analyse the effects of KT on trunk strength with respect to different angular speeds when applied to the trunks of healthy women. Forty healthy female participants were randomly distributed into two groups: the placebo group (PG) in which placebo KT was applied and the experimental group (EG). Participants’ trunk concentric flexion and extension muscle strength were measured using an isokinetic dynamometer in two different angular speeds (60°/s ? 180°/s). In both PG and EG groups, there was no significant difference measured immediately after taping at the two angular speed values. In the measurements taken 48 h later, as regards PG trunk flexion, extension muscle strength increased significantly (p = 0.0001) at 60°/sc. angular speed while, for the EG only, the strength of trunk extension muscle increased significantly (p = 0.002). It was observed, that to ensure an increase in strength, waiting for a certain length of time was required. Lower angular speeds and short-term applied KT improved the strength of the trunk extension muscle.     

负荷渐增式训练对老年小鼠骨骼肌卫星细胞AMPK磷酸化的影响

目的 探讨负荷渐增式训练对老年小鼠骨骼肌卫星细胞腺苷酸活化蛋白激酶（AMP-activated protein kinase，AMPK）磷酸化的影响。方法 实验小鼠分为 3 组：青年对照组（YC组，n=12）、老年对照组（OC组，n=12）与老年运动组（OT组，n=12）。OT组进行负荷渐增式训练，流式细胞分选技术分离CD45-/CD31-/Sca1-/VCAM(CD106)+细胞群体，分选细胞通过desmin、Myod肌原性染色以及成肌分化诱导培养进行肌卫星细胞鉴定，免疫组化结合Western blotting方法检测肌卫星细胞p-AMPK水平。结果 YC组骨骼肌卫星细胞AMPK及p-AMPK表达水平显著高于OC组（P<0.05）；OT组与OC组AMPK表达无明显变化（Ｐ>0.05），而OT组p-AMPK表达水平显著高于OC组（P<0.05）。结论 负荷渐增式训练可促进老年小鼠骨骼肌卫星细胞AMPK磷酸化，改善老年小鼠骨骼肌能量代谢。     

Genioglossus muscle advancement: A modification of the conventional technique

Obstructive sleep apnoea syndrome (OSAS) is a pathophysiologic condition associated with fragmented sleep and arousals caused by nocturnal mechanical obstruction of the upper airway. This results in behavioural derangements, such as excessive daytime sleepiness and fatigue, and pathophysiologic derangements that cause morbidities and mortality including hypertension, arrhythmias, myocardial infarction, stroke and sudden death.The genioglossus advancement is a proven technique for the treatment of mild to moderate obstructive sleep apnoea syndrome by relieving airway obstruction at the hypopharyngeal level.In this article, we report a modification of the conventional genioglossus advancement described by Riley and Powell. The modification we describe replaces the bone segment at the mandibular basal bone rather than at the mid area of the symphysis. This means a linear movement that allows a greater advancement and avoids the rotation of the genioglossus muscle. Through this article we will describe the advantages of the surgical technique such as greater effectiveness, stability, more pleasing aesthetic outcome and the reduction of potential complications.     

Heat and cold therapy reduce pain in patients with delayed onset muscle soreness: A systematic review and meta-analysis of 32 randomized controlled trials

ObjectiveThe aim of this review and meta-analysis was to evaluate the effect of heat and cold therapy on the treatment of delayed onset muscle soreness (DOMS).MethodsWe followed our protocol that was registered in PROSPERO with ID CRD42020170632. A systematic review and meta-analysis of randomized controlled trials (RCT) was conducted. Nine databases were searched up to December 2020. Data was extracted from the retained studies and underwent methodological quality assessment and meta-analysis.ResultsA total of 32 RCTs involving 1098 patients were included. Meta-analysis showed that, the application of cold therapy within 1 h after exercise could reduce the pain of DOMS patients within 24 h (≤24 h) after exercise (SMD -0.57,95%CI -0.89 to −0.25, P = 0.0005) and had no obvious effect within more than 24 h (>24 h) (P = 0.05). In cold therapies, cold water immersion (SMD -0.48, 95%CI -0.84 to −0.13, P = 0.008) and other cold therapies (SMD -0.68, 95%CI -1.28 to −0.08, P = 0.03) had the significant effects within 24 h. Heat treatment could reduce the pain of patients. It had obvious effects on the pain within 24 h (SMD -1.17, 95%CI -2.62 to −0.09, P = 0.03) and over 24 h (SMD -0.82, 95%CI -1.38 to −0.26, P = 0.004). Hot pack effect was the most obvious, which reduced the pain within 24 h (SMD -2.31, 95%CI -4.33 to −0.29, P = 0.03) and over 24 h (SMD -1.78, 95%CI -2.97 to −0.59, P = 0.003). Other thermal therapies were not statistically significant (P > 0.05). Both cold and heat showed effect in reducing pain of patients, however there was no significant difference between cold and heat group (P = 0.16).ConclusionsThe current evidence indicated that the application of cold and heat therapy within 1 h after exercise could effectively reduce the pain degree of DOMS patients for 24 h cold water immersion and hot pack therapy, which had the best effect, could promote the recovery of DOMS patients. But more high-quality studies are needed to confirm whether cold or heat therapy work better.     

Repair of Left Ventricular Assist Device Driveline Damage Directly at the Transcutaneous Exit Site

With increasing support duration of cardiac assist devices, transcutaneous drivelines remain a weak point of the therapy. First, they can be an entry point for infections, and second, cable lesions and even electrical failures due to material fatigue and eventual carelessness can occur. We report a case of a damaged outer sheath of a ventricular assist device driveline cable directly at the exit site, where the standard repair procedure with self‐fusing tape may lead to biocompatibility problems and irritation of the entrance through the skin. Therefore, a new procedure was developed using a special sleeve expander tool and a highly expandable latex tubing to stabilize the defect in a flexible and biocompatible manner. A patient experienced a fracture of the outer sheath of a HeartWare HVAD driveline directly at the skin entrance (approximately 15 mm long, 5 mm distal from the skin). The metal strands and the electrical functionality were yet not affected, therefore, a pump exchange was not indicated. After considering several conventional solutions for repair as not applicable, a new approach was developed: a sleeve expander tool was applied, which allowed radial stretching of the latex tubing. After preparations of the tool and the cable site, the pump was briefly disconnected, the tubing was moved over the connector and was released at the site of fracture. The problem could be solved by keeping the cable's flexibility and without additional risks to the skin. Within a still ongoing (5‐month) follow‐up, the skin entrance returned to perfect condition and no further intervention was necessary. In conclusion, this method allows a quick stabilization and repair of damaged driveline isolations even near the exit site, resulting in a biocompatible surface and consistent flexibility of the cable.     

Inspiratory Muscle Training Potentiates the Beneficial Effects of Proportional Assisted Ventilation on Exertional Dyspnea and Exercise Tolerance in COPD: A Proof-of-Concept Randomized and Controlled Trial

Abstract

During pulmonary rehabilitation, a subset of subjects with COPD requires adjunct therapy to achieve high-intensity training. Both noninvasive ventilation (NIV) and inspiratory muscle training (IMT) are available to assist these subjects. We aimed to prime the respiratory muscles before NIV with IMT, anticipating additive effects for maximal exercise tolerance (T _lim) and dyspnea/leg fatigue relief throughout the exercise as primary outcomes. Changes in the respiratory pattern were secondary outcomes. COPD subjects performed a total of four identical constant work rate tests on a cycle ergometer at 75% of maximum work rate, under control ventilation (SHAM, 4?cm H₂O) or proportional assisted ventilation (PAV, individually adjusted), before and after 10 sessions of high-intensity IMT (three times/week) during 30?days. Two-way RM ANOVA with appropriate corrections were performed. Final analysis in nine subjects showed improved T _lim (Δ = 111?s) and lower minute-ventilation (Δ = 4?L^.min^?1) at exhaustion, when comparing the IMT effects within the PAV modality (p?=?0.001 and p?=?0.036, respectively) and improved T _lim for PAV vs. SHAM (PAV main-effect, p?=?0.001; IMT main-effect, p?=?0.006; PAV vs. IMT interaction, p?=?0.034). In addition, IMT?+?PAV association, compared to PAV alone, resulted in lower respiratory frequency (IMT main-effect, p?=?0.009; time main-effect, p?<?0.0001; IMT vs. time interaction, p?=?0.242) and lower inspiratory time related to duty cycle (IMT main-effect, p?=?0.018; time main-effect, p?=?0.0001; IMT vs. time interaction, p?=?0.004) throughout exercise. The addition of IMT prior to a PAV-supported aerobic bout potentiates exercise tolerance and dyspnea relief and induces favourable changes in ventilatory pattern in severe COPD during high-intensity training (Brazilian Registry of Clinical Trials, number RBR-6n3dzz).     

Maximal calf circumference reflects calf muscle mass measured using magnetic resonance imaging

BackgroundCalf circumference (CC) has been used as a surrogate for calf muscle mass, which facilitates venous blood return to the heart through active skeletal muscle. However, the correlation between CC and calf muscle mass has not been extensively examined. This study aimed to examine the relationship between CC and calf muscle mass considering differences in sex and physique in elderly individuals.MethodsA total of 124 community-dwelling elderly individuals ≥60 years of age (61 men, mean [±SD] age 74.3 ± 5.7 years) were enrolled. Maximal CC was measured using a tape measure with the subject supine. The cross-sectional area of skeletal muscle tissues was measured using magnetic resonance imaging from the point of greatest calf circumference to 5 cm proximal and distal. Calf muscle mass was calculated by multiplying the area of each slice by slice thickness (5 mm).ResultsCC was strongly correlated with calf muscle mass in male and female subjects (male: r = 0.908, P < 0.001; female: r = 0.892, P < 0.001). Multiple regression analysis revealed that CC and body mass index (BMI) were independent associate factors of calf muscle mass. The following estimation formulae were derived: (male) calf muscle mass (cm³) = 47.82 × CC (cm)−12.50 × BMI (kg/m²) −732.80; (female) calf muscle mass (cm³) = 32.23 × CC (cm) −4.85 × BMI (kg/m²) −429.94.ConclusionsA strong correlation was found between CC and calf muscle mass according to magnetic resonance imaging. Sex differences and BMI should be considered for accurate estimation of calf muscle mass using CC.