A cross-over evaluation of different methods and devices to measure blood pressure in type 1 diabetic patients with nephropathy

BACKGROUND: In type 1 diabetic patients with nephropathy, tight blood pressure control has been shown to prevent the progression of the disease. Up until now, self-monitoring, ambulatory and office blood pressure values have not been compared in these patients. Thus, we have evaluated blood pressure values obtained in the office by a physician and at home by self-monitoring with those measured under ambulatory conditions in these patients. Additionally, for blood pressure self-monitoring, three different devices (the sphygmomanometer, upper-arm oscillometer and wrist oscillometer) were compared. METHODS: Twenty-one treated hypertensive type 1 diabetic patients [age 45+/-9 years, duration of diabetes 33+/-12 years (mean+/-SD)] with overt diabetic nephropathy participated in this study. At both baseline and the end of the study, daytime ambulatory blood pressure measurement was performed. Office blood pressure was measured at baseline. Additionally, all the patients measured their blood pressure over a 3-week period using each of the three different devices, in random order, for 1 week. RESULTS: The mean office blood pressure values (135+/-21/85+/-12mmHg) were higher than both the ambulatory (131+/-23/80+/-12, P<0.05) and self-monitoring values (130+/-14/78+/-10; P<0.05 for systolic and P<0.02 for diastolic values). The difference between the ambulatory and self-monitoring values were not statistically significant. Diastolic blood pressure values measured with the oscillometric wrist device showed a trend towards higher values when compared to those measured with the sphygmomanometer and with the oscillometric upper-arm device (P=0.065 for diastolic values). CONCLUSION: Office blood pressure measurements may over-estimate blood pressure in patients with type 1 diabetes and diabetic nephropathy. Because the oscillometric wrist device tends to over-estimate diastolic values, upper-arm devices should be preferred for blood pressure self-monitoring in these patients.     

Effects of somatostatin on hepatic bile formation

Somatostatin is a peptide that has anticholeretic properties in the dog. The purpose of the present work was to investigate if somatostatin is an anticholeretic agent in humans also. The effects of intravenous infusion of somatostatin on hepatic bile flow and biliary electrolytes and secretion of biliary lipids were studied in 7 patients with complete biliary drainage who had been operated on for choledocholithiasis. Somatostatin, 250 microgram/h, was found to decrease the hepatic bile secretion by approximately 30%. The peptide also reduced the outputs of bile acids, cholesterol, and phospholipids and the outputs of sodium, potassium, and chloride. The concentrations of the biliary lipids were not significantly changed. Somatostatin inhibited the erythritol clearance in the 2 patients studied by approximately 25%. The present study thus provides evidence that somatostatin inhibits bile formation in humans. It appears as if the reduction in bile production is mainly due to decreased canalicular bile flow. It is possible that this effect of somatostatin is attributable to inhibition of bile acid synthesis or of transport-secretion of bile acids, or both.     

Shoulder Rotational Strength Profiles of Danish National Level Badminton Players

BackgroundIncreased age has been shown to be associated with weaker external rotators and stronger internal rotators of the shoulder in pitchers and tennis players. Whether this age-associated change is present in elite badminton players is unknown.PurposeTo compare the internal and external rotation strength of the shoulder in adolescent and adult elite badminton players.Study designCross-sectional.MethodsThirty-one adolescent (12 females aged 16.8 ± 1.6 years and 19 males aged 17.1 ± 1.6 years) and 29 adult (10 females aged 25 ± 2.9 years and 19 males aged 26.2 ± 4.6 years) national level badminton players were tested pre-seasonally for external rotation (ER) and internal rotation (IR) isometric muscle strength bilaterally, using a hand-held dynamometer. Within-group ER to IR strength ratios were calculated (ER/IR×100%).ResultsThe adolescents had stronger shoulder ER than the adults on both sides (p < 0.05). The adult males tended to have stronger IR of the dominant shoulder than the adolescent males (p = 0.071). In the dominant shoulders, the strength ratios for adult females and males were 77% and 78%, respectively, while the same ratio for adolescent females and males were 85% and 99%, respectively. In the non-dominant shoulders, the ER/IR strength ratios for adult females and males were 90% and 87%, respectively, while the ratios for adolescent females and males were 116% and 102%, respectively.ConclusionThis study is the first to demonstrate that in shoulder injury-free national team badminton players, adolescents have stronger shoulder ER than adults on both sides. Therefore, increased age appears to be associated with weaker shoulder ER muscles in elite badminton players.Level of evidence3b.     

Effects of contract‐relax vs static stretching on stretch‐induced strength loss and length–tension relationship

The purpose of this study was to determine the acute effects of contract‐relax stretching (CRS) vs static stretching (SS) on strength loss and the length‐tension relationship. We hypothesized that there would be a greater muscle length‐specific effect of CRS vs SS. Isometric hamstring strength was measured in 20 healthy people at four knee joint angles (90°, 70°, 50°, 30°) before and after stretching. One leg received SS, the contralateral received CRS. Both stretching techniques resulted in significant strength loss, which was most apparent at short muscle lengths [SS: P = 0.025; stretching × angle P < 0.001; 11.7% at 90° P < 0.01; 5.6% at 70° nonsignificant (ns); 1.3% at 50° ns; ?3.7% at 30° ns. CRS: P < 0.001; stretching × angle P < 0.001; 17.7% at 90°, 13.4% at 70°, 11.4% at 50°, all P < 0.01, 4.3% at 30° ns]. The overall stretch‐induced strength loss was greater (P = 0.015) after CRS (11.7%) vs SS (3.7%). The muscle length effect on strength loss was not different between CRS and SS (stretching × angle × stretching technique P = 0.43). Contrary to the hypothesis, CRS did not result in a greater shift in the length–tension relationship, and in fact, resulted in greater overall strength loss compared with SS. These results support the use of SS for stretching the hamstrings.     

Predictors of signs and symptoms of temporomandibular disorders: a 20-year follow-up study from childhood to adulthood

The aim of this study was to find possible predictors of signs and symptoms of temporomandibular disorders (TMD) in a long-term perspective. Baseline questionnaire and clinical examinations focusing on function and dysfunction of the masticatory system were performed in a sample of 402 subjects 7, 11, and 15 years old. After 20 years, 320 subjects (80% of the original sample) completed a similar questionnaire as at baseline. From the oldest age group, now aged 35 years, 100 subjects (74% of the original sample) also attended a clinical examination. Three variables from the 20-year follow-up were chosen as dependent variables in logistic regression analyses, with independent variables selected from the baseline examinations. Three variables at baseline were significant predictors for reported TMJ clicking at the 20-year follow-up, tooth wear index being the strongest (odds ratio = 4.3). Reported TMJ clicking at the start was the only significant predictor for TMD symptoms without clicking 20 years later (odds ratio = 2.3). The third logistic regression model, using the Helkimo Clinical Dysfunction Score as dependent variable, resulted in four significant predictors from the baseline examinations (bruxism, oral parafunctions, TMJ clicking, and deep bite). The results indicated that some signs and symptoms might predict TMD signs and symptoms in a long-term perspective. However, it cannot be concluded from this study whether these symptoms recorded in childhood - oral parafunction, tooth wear, TMJ clicking, and deep bite - can be used for predicting manifest TMD in adult age.