Asbestos exposure and tuberculous pleurisy as developmental causes of progressive unilateral upper-lung field pulmonary fibrosis radiologically consistent with pleuroparenchymal fibroelastosis

BackgroundUnilateral upper-lung field pulmonary fibrosis (upper-PF), which is radiologically consistent with pleuroparenchymal fibroelastosis, develops after thoracic surgery. In most patients with unilateral upper-PF, aberrant intra-/extra thoracic air commonly emerges and an autopsy shows chronic pleuritis, which indicates that pleural involvement is associated with upper-PF development. If so, there may be patients with unilateral upper-PF who have a history of pleural involvement, including tuberculous pleurisy (TP) or asbestos exposure (AE). This study aimed to examine this supposition.MethodsWe examined the radiological reports of all consecutive patients from 2012 to 2018 to investigate whether there were patients having unilateral upper-PF and a history of TP or AE.ResultsEight patients were included in the study. Five patients had a history of TP, and the remaining three had that of AE. All patients were men and had respiratory symptoms, and seven patients presented with restrictive ventilatory impairment. The interval between TP or last AE and upper-PF development was long, with a median of over 20 years. The upper-PF lesion was commonly located in the right lung, and aberrant intrathoracic air was observed in five patients during their clinical course. Additionally, the upper-PF lesion transformed into a cystic lesion in six patients, which resulted in Aspergillus infection in two patients. The prognosis was poor, with a median overall survival of 38 months.ConclusionsUnilateral upper-PF developed even in patients with a history of pleural involvement. Our results indicate that pleural involvement plays an important role in the development of unilateral upper-PF.     

Therapeutic effectiveness of a single exercise session combined with Walk Aide functional electrical stimulation in post-stroke patients:a crossover design study

A growing body of evidence has suggested that the imbalance of epigenetic markers and oxidative stress appears to be involved in the pathophysiology and progression of stroke. Thus, strategies that modulate these biomarkers might be considered targets for neuroprotection and novel therapeutic opportunities for these patients. Physical exercise has been reported to induce changes in these epigenetic markers and improve clinical outcomes in different populations. However, little is reported on this in post-stroke patients. The purpose of this study was to investigate the effect of a single exercise session with Walk Aide functional electrical stimulation(FES) on cognitive performance, clinical functional parameters, oxidative stress and epigenetic modulation in post-stroke individuals. In this crossover design study, 12 post-stroke individuals aged 54–72 years of either sexes were included and subjected to a single session of exercise(45 minutes) without Walk Aide functional electrical stimulation(EXE alone group), followed by another single session of exercise(45 minutes) with Walk Aide functional electrical stimulation(EXE + FES group). The clinical functional outcome measures, cognitive performance and blood collections for biomarker measurements were assessed pre-and post-intervention. After intervention, higher Berg Balance Scale scores were obtained in the EXE + FES group than in the EXE alone group. There was no significant difference in the Timed Up and Go test results post-intervention between EXE alone and EXE + FES groups. After intervention, a better cognitive performance was found in both groups compared with before the intervention. After intervention, the Timed Up and Go test scores were higher in the EXE + FES group than in the EXE alone group. In addition, the intervention induced lower levels of lipid peroxidation. After intervention, carbonyl level was lower, superoxide dismutase activity and superoxide dismutase/catalase activity ratio were higher in the EXE + FES group, compared with the EXE group alone. In each group, both histone deacetylase(HDAC2) and histone acetyltransferase activities were increased after intervention compared with before the intervention. These findings suggest that a single exercise session with Walk Aide FES is more effective on balance ability and cognitive performance compared with conventional exercise alone in post-stroke patients. This is likely to be related to the regulation of oxidative stress markers. The present study was approved by the Research Ethics Committee of the Methodist University Center-IPA(approval No. 2.423.376) on December 7, 2017 and registered in the Brazilian Registry of Clinical Trials—Re BEC(RBR-9 phj2 q) on February 11, 2019.     

早期康复护理和功能锻炼在骨创伤患者术后的应用效果

目的探究早期康复护理和功能锻炼应用于骨创伤患者术后效果。方法选取2018年1月—12月本院收治的60例骨创伤手术患者,随机分成观察组与对照组,各组30例。对照组患者接受常规护理,观察组患者实施术后康复护理及功能锻炼。对比两组护理效果。结果观察组的骨折愈合时长与住院时长都短于对照组,差异有统计学意义(P<0.05)。干预6个月后的,观察组的焦虑评分、抑郁评分、疼痛评分以及总分都优于对照组,差异有统计学意义(P<0.05)。结论针对骨创伤手术患者,应用术后康复护理与功能锻炼,可以有效加快患者骨折愈合速度,减轻患者的关节疼痛,促进尽快恢复关节功能,效果突出,推动患者尽早恢复健康。     

The adolescent athlete's heart; A miniature adult or grown-up child?

The systematic development of early age talent in sports academies has led to the professionalization of pediatric sport and the sports physician need to be aware of pediatric cardiological problems. Research into the medical cardiac care and assessment of the pediatric athlete are accumulating, but specific pediatric international guidelines are not available yet and reference data for ECG and echocardiography are incomplete, in particular for the age group <12 years of age. This article is an introduction to the physiological and diagnostics specifics of the pediatric athlete. The focus lies in the differences in presentation and diagnosis between pediatric and adult athletes for the most common pathologies. Reference data for electrical and structural adaptations to intensive exercise are sparse particularly in athletes aged below 12 years old. Training related changes include decrease of resting heart rate, increase of cardiac output, ventricular cavity size, and wall thickness. Cardiac hypertrophy is less pronounced in pediatric athletes, as HR mediated cardiac output increase to endurance exercise is the dominant mechanism in peripubertal children. As in adults, the most pronounced cardiovascular adaptations appear in classical endurance sports like rowing, triathlon, and swimming, but the specifics of pediatric ECG and echocardiographic changes need to be considered.     

Over 55 years of critical power: Fact or artifact?

This report aims to generate an evidence-based debate of the Critical Power (CP), or its analogous Critical Speed (CS), concept. Race times of top Spanish runners were utilized to calculate CS based on three (1500-m to 5000-m; CS_1.5-5km) and four (1500-m to 10000-m; CS_1.5-10km) distance performances. Male running world records from 1000 to 5000-m (CS_1-5km), 1000 to 10,000-m (CS_1-10km), 1000-m to half marathon (CS_{1km-half marathon}), and 1000-m to marathon (CS_1km-marathon) distance races were also utilized for CS calculations. CS_1.5-5km (19.62 km h^?1) and CS_1.5-10km (18.68 km h^?1) were different (p < 0.01), but both approached the average race speed of the longest distance chosen in the model, and were remarkably homogeneous among subjects (97% ±1% and 98% ±1%, respectively). Similar results were obtained using the world records. CS values progressively declined, until reaching a CS_1km-marathon value of 20.77 km h^?1 (10% lower than CS_1-5km). Each CS value approached the average speed of the longest distance chosen in the model (96.4%–99.8%). A power function better fitted the speed-time relationship compared with the standardized hyperbolic function. However, the horizontal asymptote of a power function is zero. This better approaches the classical definition of CP: the power output that can be maintained almost indefinitely without exhaustion. Beyond any sophisticated mathematical calculation, CS corresponds to 95%–99% of the average speed of the longest distance chosen as an exercise trial. CP could be considered a mathematical artifact rather than an important endurance performance marker. In such a case, the consideration of CP as a physiological “gold-standard” should be reevaluated.     

Isokinetic eccentric training is more effective than constant load eccentric training for quadriceps rehabilitation following anterior cruciate ligament reconstruction: a randomized controlled trial

ObjectiveTo compare the effects of conventional (constant load) eccentric training and isokinetic eccentric training on quadriceps muscle mass, strength and functional performance in recreational athletes following anterior cruciate ligament (ACL) reconstruction.MethodsThirty recreational male athletes (25 years old) undergoing ACL reconstruction received a standard rehabilitation program. Volunteers were randomized to conventional group (CG; n = 15) or isokinetic group (IG; n = 15) to be engaged in a 6-week (2 sessions/week) quadriceps eccentric training program at the extensor chair or at the isokinetic dynamometer, respectively. Assessments of quadriceps muscle mass (through magnetic resonance imaging), strength (through isokinetic dynamometry) and self-aware functionality (through questionnaire) were performed before and after the training programs. Single leg hop test performance was assessed only at post-training evaluation.ResultsIG had significantly higher improvements than CG (p < 0.05) for all muscle mass outcomes (+17–23% vs. +5–9%), as well as for isometric (+34% vs. +20%) and eccentric (+85% vs. +23%) peak torques. There was no between-group difference (p > 0.05) for concentric peak torque, Lysholm score, and single leg hop test.ConclusionIsokinetic eccentric training promotes greater responses than conventional eccentric training on quadriceps muscle mass and strength of recreational athletes following ACL reconstruction.     

微信打卡式监督法提高冠心病病人院外康复干预效果的观察

[目的]观察微信打卡式监督法提高冠心病病人院外康复锻炼干预的效果。[方法]将140例冠心病病人按随机数字表法分为观察组、对照组各70例,对照组实施常规冠心病院内护理及出院后电话随访,观察组将随访方式改为微信打卡式监督法,比较干预后两组病人心功能指标、锻炼依从性及满意度。[结果]干预后两组病人心功能指标均得到优化,但观察组优于对照组(P<0.05);干预后观察组病人心血管事件发生率低于对照组(P<0.05),依从性评分及满意度得分均高于对照组(P<0.05)。[结论]微信打卡式监督法在缓解冠心病症状、提高病人依从性与满意度方面均具有积极效应。