Lower limb vasodilatory capacity is not reduced in patients with moderate COPD

We compared exercise capacity (peak O₂ uptake; V̇O_2peak) and lower limb vasodilatory capacity in 9 patients with moderate COPD (FEV₁ 52.7 ± 7.6% predicted) and 9 age-matched healthy control subjects. V̇O_2peak was measured via open circuit spirometry during incremental cycling. Calf blood flow (CBF) measurements were obtained at rest and after 5 minutes of ischemia using venous occlusion plethysmography. While V̇O_2peak was significantly lower in the COPD patients (15.8 ± 3.5 mL·kg⁻¹·min⁻¹) compared with the control group (25.2 ± 3.5 mL·kg⁻¹·min⁻¹), there were no significant differences between groups in peak CBF or peak calf conductance measured 7 seconds post-ischemia. V̇O_2peak was significantly correlated with peak CBF and peak conductance in the control group, whereas no significant relationship was found between these variables in the COPD group. However, the rate of decay in blood flow following ischemia was significantly slower (p < 0.05) for the COPD group (−0.036 ± 0.005 mL·100 mL⁻¹·min⁻¹·s⁻¹) when compared with controls (−0.048 ± 0.015 mL·100 mL⁻¹·min⁻¹·s⁻¹). The results suggest that the lower peak exercise capacity in patients with moderate COPD is not related to a loss in leg vasodilatory capacity.     

Primary bone grafting with pedicled flap cover for dorsal combined injuries of the digits

Twenty digits in 15 patients with dorsal combined tissue loss were treated by radical debridement, primary non-vascularised iliac crest bone graft and immediate lower abdominal flap cover between 1996 and 2006. The average length of the bone grafts was 3.3 (range 2.5-5) cm. No extensor tendon reconstruction was carried out. The flaps were divided at 3 weeks without delay. Permissible thinning of the flap was done at the time of division of flaps. No secondary procedure was done. All patients were retrospectively reviewed and X-rays obtained. Radiological union was achieved in 18 of 20 digits. One bone graft was removed because of infection. One bridging bone graft united with the distal phalanx but had a painless non-union with the proximal phalanx. There were no flap complications. Bone graft length resorptions of 20% and 15% occurred in two terminal bone grafts. We recommend this protocol as a solution to this challenging problem.     

Caffeine improves supramaximal cycling but not the rate of anaerobic energy release

The purpose of this study was to determine if improved supramaximal exercise performance in trained cyclists following caffeine ingestion was associated with enhanced O₂ uptake ( [(V)\dot]\textO₂ \dot{V}{\text{O}}_{2} kinetics), increased anaerobic energy provision (accumulated O₂—AO₂—deficit), or a reduction in the accumulation of metabolites (for example, K⁺) associated with muscular fatigue. Six highly trained male cyclists ( [(V)\dot]\textO₂ \dot{V}{\text{O}}_{2} peak 68 ± 8 mL kg⁻¹ min⁻¹) performed supramaximal (120% [(V)\dot]\textO₂ \dot{V}{\text{O}}_{2} peak) exercise bouts to exhaustion on an electronically braked cycle ergometer, following double-blind and randomized ingestion of caffeine/placebo (5 mg kg⁻¹). Time to exhaustion (TE), [(V)\dot]\textO₂ \dot{V}{\text{O}}_{2} kinetics, AO₂ deficit, blood lactate (La⁻), plasma potassium (K⁺), caffeine and paraxanthine concentrations were measured. Caffeine ingestion elicited significant increases in TE (14.8%, p < 0.01) and AO₂ deficit (6.5%, p < 0.05). In contrast, no changes were observed in AO₂ deficit at isotime, [(V)\dot]\textO₂ \dot{V}{\text{O}}_{2} kinetics, blood [La⁻] at exhaustion or peak [K⁺] following caffeine ingestion. However, [K⁺] was significantly reduced (13.4%, p < 0.01) during warm-up cycling immediately prior to the onset of the supramaximal bout for the caffeine trials, compared with placebo. It appears that caffeine ingestion is beneficial to supramaximal cycling performance in highly trained men. The reduced plasma [K⁺] during submaximal warm-up cycling may prolong the time taken to reach critical [K⁺] at exhaustion, thus delaying fatigue. Considering caffeine ingestion did not change [(V)\dot]\textO₂ \dot{V}{\text{O}}_{2} kinetics or isotime AO₂ deficit, increases in absolute AO₂ deficit may be a consequence of prolonged TE, rather than causal.     

Rasagenthi lehyam (RL) a novel complementary and alternative medicine for prostate cancer

Purpose The use of complementary and alternative medicine (CAM) in cancer has been increasing. The therapeutic modalities which originated from India, viz., Ayurveda and Siddha, have phytotherapy as their fundamental basis and, therefore, produce few side effects. They are among the most ancient medicinal systems and are still being practiced in India and elsewhere, to cure cancer and other diseases. Many Siddha practitioners in the southern parts of India prescribe rasagenthi lehyam (RL) as a drug for cancer. RL contains 38 different botanicals, many of which have been shown to possess therapeutic efficacy, and 8 inorganic compounds, all prepared into a paste in a palm sugar and hens egg base. The efficacy of RL in killing prostate cancer cells in vitro was investigated in this study to determine whether RL could be recommended as a CAM for prostate cancer.Methods In order to scientifically validate the anticancer activity of RL on prostate cancer, a methanolic extract of RL was serially extracted with four organic solvents, and the extracts were tested for clonogenic inhibition and induction of apoptosis in PC-3 prostate cancer cells, with and without irradiation. n-Hexane, ethyl acetate and chloroform extracts of RL effectively killed PC-3 cells.Results The IC₅₀ values of n-hexane, ethyl acetate and chloroform extracts of RL were 3.84 g/ml, 3.68 g/ml and 75 ng/ml, respectively. All three extracts induced apoptosis in PC-3 cells. Further, all the three extracts when combined with radiation, caused enhanced effect on killing of PC-3 cells. Among the three extracts, the chloroform extract showed the most significant radiation-sensitizing effect.Conclusion RL, either in its original formulation prepared under strict quality control or its chloroform extract, could potentially be an alternative medicine for prostate cancer, and also a sensitizing agent in the context of radiation therapy for prostate cancer, as a complementary medicine. A more directed study could lead to the identification of the active principle(s) in the chloroform extract of RL for use in prostate cancer therapy.     

Oxygen uptake kinetics during severe exercise: a comparison between young and older men

This study examined the relationship between the slow component of oxygen uptake (VO2) kinetics and muscle electromyography (EMG) during severe exercise in nine young (21.7+/-0.9 yr) and nine older (71.6+/-0.8 yr) men. Oxygen uptake (VO2) and surface EMG activity of the left vastus lateralis muscle were measured during a 7-min square-wave bout of severe exercise on a cycle ergometer. The absolute amplitude of the VO2 slow component was greater and occurred approximately 60 s earlier in the young compared to older subjects. However, the rate of increase in the slow component, expressed as a percentage of the total VO2 response per unit time, was not different between young and older subjects (young: 4.8+/-0.5%.min(-1); older: 4.9+/-0.6%.min(-1)). The mean power frequency (MPF) of the EMG increased significantly during the slow component phase of exercise by 6.4+/-1.0% in the young and by 5.4+/-0.7% in the older group and this rise was not significantly different between the two groups. These results indicate that normal ageing may not alter the VO2 slow component (measured as the rate of increase in VO2) and that this finding may be related to similar muscle fibre recruitment patterns in the two groups during severe-intensity exercise.     

First Successful Separation of Craniopagus Twins in India—Plastic Surgical Considerations

Separation of total vertical craniopagus with shared venous sinuses poses multiple challenges. Provision of soft-tissue cover to the exposed brains at the time of total separation is one of them, due to the large size of the defect and paucity of local tissues. Staged separation of twins is advised with partial venous and parenchymal disconnection in the first stage and total separation in the second stage. Tissue expanders are inserted in the first stage, and second stage planned to coincide with the period of adequate expansion. In the child being reported, emergency second stage was done due to the deteriorating general condition of the children. Left with inadequate expanded skin, the critical defect in a twin was managed with bilateral trapezius myocutaneous flaps. High ionotropic support of the postoperative period resulted in superficial necrosis of the flap, which was managed by debridement, allograft application and autograft later. Both twins had well-healed wounds by 3 months.