Cardio-respiratory and electromyographic responses to ergometer and on-water rowing in elite rowers

The aim of this study was to compare muscle activation and cardio-respiratory response during ergometer and on-water rowing. Nine internationally competitive rowers (five Olympic Games medal winners, age 25.6 ± 4.8 years) were requested to perform a 1,000 m race simulation test in the two conditions. Surface electromyographic (sEMG) signals from trapezius superior (TRS), latissimus dorsi (LD), biceps brachii (BB), rectus femoris (RF), vastus medialis (VAM), vastus lateralis (VAL), biceps femoris (BF) and tibialis anterior (TA) muscles were recorded continuously during the tests together with other cardio-respiratory parameters: heart rate (HR), ventilation (V_E), oxygen consumption $ \left(\dot{V}{\text{O}}_{2}\right) $ . On-water, subjects covered the same distance in a longer time (218.4 ± 3.8 s vs. 178.1 ± 5.6 s during ergometer test). TRS, LD, BB, RF, VAM and VAL muscle activation on-water was lower than off-water during the rowing race. $ \dot{V}{\text{O}}_{2} $ and V_E responses were similar between the two conditions even if the time to complete the 1,000 m race simulation test was higher on-water. The results indicate that for most of the analyzed muscles EMG activation on the ergometer is higher than on-water with the maximal activity at the beginning of the on-water test due reasonably to overcome the forces opposing the forward motion, while the ergometer task elicited increasing muscle activation over time. The present data may be considered by coaches when choosing a rowing ergometer in substitution for the training on-water or when relying on the indoor tests to select the crew.     

Dimensional changes following alveolar ridge preservation in the posterior area using bovine-derived xenografts and collagen membrane compared to spontaneous healing: a 6-month randomized controlled clinical trial

Clinical Oral Investigations - To assess dimensional changes following alveolar ridge preservation using bovine-derived xenograft with 10% collagen and collagen membrane compared to ridge...     

Locally-advanced prostate cancer in the elderly: should we revisit our treatment paradigms?

Prostate cancer (PCa) represents the most common malignancy in adult males with an estimated number of 280 000 newly diagnosed cases only in the United States in 2015.1 Due to the introduction of PSA in clinical practice, the majority of the patients are currently diagnosed with organ-confined and sometimes indolent disease. However, a nonnegligible proportion of individuals are still diagnosed with locally-advanced tumors. In their recently published article, Bekelman et al.2 focused on elderly patients with locally-advanced PCa in the attempt to determine the best treatment approach in this patient category, and concluded that, even in these individuals, androgen deprivation therapy (ADT) plus radiotherapy (RT) may confer a survival benefit relative to ADT alone. The importance of the current article resides in the fact that it focuses on a patient population that has not been, or has been only scarcely, included in previous studies on the same topic.The survival benefit of RT plus ADT versus ADT alone in patients with locally-advanced PCa has been recently demonstrated by two randomized controlled trials (RCTs).3,4 Specifically, Widmark et al. recruited 875 patients from 47 Scandinavian centers who were randomized to receive either ADT or ADT plus RT.3 Inclusion criteria for this study were age ≤75 and a life expectancy ≥10 years. According to this trial, the 10-year cancer-specific mortality rate was 23.9% in the ADT group relative to 11.9% in the ADT plus RT group. The same study demonstrated a slightly higher, but still acceptable, proportion of urinary, rectal and sexual problems in the latter group of patients. Similarly, Warde et al.4 evaluated the outcomes of 1205 individuals randomly assigned to be treated either with ADT or with ADT plus RT. Patients aged ≤80 years and with an Eastern Cooperative Oncology Group performance status between 0 and 2 were included. At 7 years, an 8% overall survival benefit was observed in the ADT plus RT group relative to patients receiving ADT alone. As in the previous study, gastrointestinal toxicities were most frequent in the ADT plus RT group.While both of these RCTs represent well-designed and well-conducted studies supporting the effectiveness of ADT plus RT in locally-advanced PCa, their strict inclusion criteria may limit the applicability of their findings to the general population. To overcome this issue and provide further evidences supporting the role of ADT plus RT in patients with high-risk PCa, Bekelman et al.2 used a population-based (SEER-Medicare) dataset to extrapolate three different groups of patients with locally-advanced PCa diagnosed between 1995 and 2007: (1) the RCT cohort (n = 12.924), consisting of patients selected according to the same inclusion criteria defined by the two previously cited studies; (2) the elderly cohort (n = 14.340), consisting of men aged between 76 and 85 years with locally-advanced PCa; (3) the screen-detected cohort (n = 4277), consisting of patients aged between 65 and 85 years with high-risk clinically undetectable disease. Besides standard survival analysis, the authors also adopted two statistical methodologies, namely the propensity score approach and instrumental variable analysis in order to adjust for possible confounders. In all of the three scenarios (unadjusted, propensity-score and instrumental variable adjusted), ADT plus RT resulted in a significant increase both in cancer-specific and overall mortality rates as compared to ADT alone. Interestingly, the survival benefit was observed not only in the RCT cohort, but also in the elderly and in the screen-detected ones. In consequence, this study provides evidences to expand the indications for ADT plus RT also to these patients. This is even more important when considering that, despite the potential survival benefits, older patients with locally-advanced PCa are less likely to receive local therapies relative to their younger counterparts.5However, while the population-based nature of this study may support the generalizability of its findings, it also represents a potential limitation that should be taken into account when interpreting the results. As correctly stated by the authors, several important data, such as total PSA and radiation dose/field, were missing. The retrospective nature of the dataset along with the risk of a misclassification bias also represents a limitation. In addition, no information was provided regarding the toxicities of ADT plus RT versus ADT alone and whether differences in the rate of side effects existed between the three groups. Finally, the oncological outcomes and morbidities of ADT plus RT in locally-advanced PCa should also be compared to those of radical prostatectomy with or without adjuvant RT, especially in carefully selected patients with a life expectancy ≥10 years.In conclusion, the study by Bekelman et al.2 adds important evidences regarding the oncological effectiveness of ADT plus RT relative to ADT alone in locally-advanced PCa even in older individuals. However, the clinical applicability of their findings should be further corroborated by prospective randomized trials focusing on this patient category.     

Ten years of experience in chronic ulcers and malignant transformation

Malignant degeneration of wounds is rare and often misdiagnosed. Delay in diagnosis may result in a worse prognosis. The aim of this study is to determine the number of skin cancers associated with chronic skin ulcers in our facility over a period of 10 years. Between January 2002 and December 2012, a total of about 1000 patients had consulted with us for chronic wounds, especially of vascular, diabetic and traumatic origin and pressure ulcers. Thirteen skin cancers had been detected: seven squamous cell and five basal cell carcinomas and one melanoma. We highlight how important it is to be aware of the signs suggesting a malignant change and the importance of biopsy at regular intervals during the life cycle of any chronic wound.     

Mapping Antigenic Motifs in the Trypomastigote Small Surface Antigen from Trypanosoma cruzi

The trypomastigote small surface antigen (TSSA) is a mucin-like molecule from Trypanosoma cruzi, the etiological agent of Chagas disease, which displays amino acid polymorphisms in parasite isolates. TSSA expression is restricted to the surface of infective cell-derived trypomastigotes, where it functions as an adhesin and engages surface receptors on the host cell as a prerequisite for parasite internalization. Previous results have established TSSA-CL, the isoform encoded by the CL Brener clone, as an appealing candidate for use in serology-based diagnostics for Chagas disease. Here, we used a combination of peptide- and recombinant protein-based tools to map the antigenic structure of TSSA-CL at maximal resolution. Our results indicate the presence of different partially overlapping B-cell epitopes clustering in the central portion of TSSA-CL, which contains most of the polymorphisms found in parasite isolates. Based on these results, we assessed the serodiagnostic performance of a 21-amino-acid-long peptide that spans TSSA-CL major antigenic determinants, which was similar to the performance of the previously validated glutathione S-transferase (GST)-TSSA-CL fusion molecule. Furthermore, the tools developed for the antigenic characterization of the TSSA antigen were also used to explore other potential diagnostic applications of the anti-TSSA humoral response in Chagasic patients. Overall, our present results provide additional insights into the antigenic structure of TSSA-CL and support this molecule as an excellent target for molecular intervention in Chagas disease.     

Disección submucosa endoscópica, ¿solo para endoscopistas expertos?

Endoscopic submucosal dissection (ESD) can be applied to early gastrointestinal cancers. This technique was developed to achieve radical curative resection and to reduce unnecessary surgical interventions. ESD was designed in eastern countries and is not widely used in the West. Although ESD represents a major therapeutic advance in endoscopy and is performed with curative intent, the complication rate (hemorrhage, perforation) is higher than reported in other techniques, requiring from endoscopists the acquirement of technical skill and experience through a structured and progressive training program to reduce the morbidity associated with this technique and increase its potential benefits. Although there is substantial published evidence on the applications and results of ESD, there are few publications on training in this technique and a standardized training program is lacking. The current article aims to describe the various proposals for training, as well as the basic principles of the technique, its indications, and the results obtained, since theoretical knowledge that would guide endoscopists during the clinical application of ESD is advisable before training begins. Training in an endoscopic technique has a little value without knowledge of the technique's aims, the situations in which it should be applied, and the results that can be expected.