One Week of Hospitalization Following Elective Hip Surgery Induces Substantial Muscle Atrophy in Older Patients

Objectives

Short successive periods of skeletal muscle disuse have been suggested to substantially contribute to the observed loss of skeletal muscle mass over the life span. Hospitalization of older individuals due to acute illness, injury, or major surgery generally results in a mean hospital stay of 5 to 7 days, during which the level of physical activity is strongly reduced. We hypothesized that hospitalization following elective total hip arthroplasty is accompanied by substantial leg muscle atrophy in older men and women.

Supratentorial ischemic stroke: more than an upper motor neuron disorder.

The primary goal of this study was to identify secondary functional changes in the peripheral motor units of the paretic upper extremity (UE) in patients with severe ischemic stroke and to determine how these changes develop during the first weeks after stroke. An inception cohort of 27 consecutive patients with an acute ischemic supratentorial stroke and an initial UE paralysis was compared with 10 healthy control subjects. The ulnar nerve was electrically stimulated proximal to the wrist and electromyographic recordings were obtained from the abductor digiti minimi muscle. Hemiparetic side mean values of the compound muscle action potential (CMAP) 1 and 3 weeks after stroke were compared with the nonparetic side and with CMAP values obtained from healthy control subjects. The mean CMAP amplitude in patients was significantly lower on the paretic side compared with the nonparetic side and with control subjects. Decrease in CMAP amplitude was observed in more than half of the stroke patients, sometimes as early as 4 days after stroke, and persisted in most cases. Whenever present, it was accompanied by absence of motor recovery at that specific time after stroke. Decreased CMAP amplitude in the abductor digiti minimi muscle can be seen already in the very acute phases after stroke unrelated to peripheral neuropathy, radiculopathy, or plexopathy, and it is accompanied by absence of UMN recovery. This knowledge is important for interpreting electrophysiological data in stroke patients.     

Reflex sympathetic dystrophy of the left hand and motor impairments of the unaffected right hand: impaired central motor processing?

OBJECTIVE: To test whether central motor processing can be impaired in chronic reflex sympathetic dystrophy (RSD). DESIGN: Experimental 2-group analysis. SETTING: Tertiary care center in the Netherlands. PARTICIPANTS: Five patients with stage 3 RSD of the left forearm, free of symptoms and complaints in the right forearm; and 10 healthy control subjects. INTERVENTION: On a digitizer, RSD patients and controls had to draw 3 sequences of graphemes of different complexity with their (unaffected) dominant right hand. The drawing tracks were segmented in time periods between points of velocity minima of the pen tip. MAIN OUTCOME MEASURES: Mean velocity, coefficients of variation of both length and movement time per segment, and mean intersegmental pausing time were calculated for each sequence. RESULTS: A repeated-measures analysis of variance by using the multivariate method yielded a 35% lower mean velocity (F(1,13) = 5.83, P =.031), a 110% larger segment length variability (F(1,13) = 9.72, P =.008) and a 60% larger variability of movement time per segment (F(1,13) = 5.78, P =.032) in RSD patients. No group difference was found for intersegmental pausing time or any interaction effect with the type of task. CONCLUSION: Patients with chronic RSD have a normal ability to preprogram sequential movements of their unaffected hand; but with impaired temporospatial coding and movement execution. We concluded that cortical mechanisms may be involved in motor impairments in patients with chronic RSD.     

Assessment of bioequivalence after subcutaneous and intramuscular administration of urinary gonadotrophins

The objective was to demonstrate bioequivalence between s.c. and i.m. administration of Humegon (FSH/LH ratio 1:1) and Normegon (FSH/LH ratio 3:1). In two randomized, single-centre, cross-over studies, 18 healthy volunteers on each formulation were assigned to one of the two administration sequences. Subjects were given single doses of one of the above gonadotrophins after endogenous gonadotrophin production had first been suppressed using high-dose oral contraceptive. Subsequently, rate (Cmax, tmax) and extent (AUC) of absorption of follicle stimulating hormone (FSH) and luteinizing hormone (LH) were determined for 14 days. For Cmax and AUC, analysis of variance (ANOVA) was performed on log-transformed data and for tmax ANOVA was performed on ranks. Intramuscular and s.c. injections of Humegon were bioequivalent with respect to the main pharmacokinetic parameters, being AUC and Cmax of FSH absorption. Intramuscular and s.c. injections of Normegon were bioequivalent with respect to the AUC of FSH and not bioequivalent with respect to the Cmax of FSH. For tmax of FSH as well as for most LH variables of both preparations, bioequivalence could not be proven due to the high intra- and interindividual variability and/or concentrations being close to the detection limit. Thus, the main pharmacokinetic FSH variables after i.m. and s.c. administration of Humegon and Normegon were bioequivalent.      

Is postural control associated with mental functioning in the persistent postconcussion syndrome?

OBJECTIVE: To investigate whether balance is associated with mental functioning after mild traumatic brain injury (MTBI). DESIGN: Experimental two-group design. SETTING: Outpatient rehabilitation department. PATIENTS AND OTHER PARTICIPANTS: From a consecutive sample of referred MTBI patients, 15 subjects who complained of imbalance were included (8 men and 7 women, age 35.9+/-8.6yrs). Subjects with detectable neurologic impairments were excluded. Twenty healthy control subjects of the same age group also were tested. MAIN OUTCOME MEASURES: In both groups, a force platform recorded center-of-pressure (CP) fluctuations during standing and weight shifting in different conditions. For the patients, attention and mental speed were assessed with the Symbol-Digit Substitution Test of the Wechsler Adult Intelligence Scale (Dutch version), verbal learning and memory were assessed with the 15-Words Test, and emotional distress was assessed with the Symptom Checklist-90. RESULTS: Compared with controls, patients showed an overall increase of 60% in CP velocity and an overall weight-shifting speed 25% slower (p < .005), indicating static and dynamic postural instability. Only performance on the Symbol-Digit Substitution Test was associated with both static and dynamic balance (p < .02), giving an explained variance of over 40%. CONCLUSION: The results indicate a possible association of balance with cognitive performance but not with emotional well-being after MTBI, suggesting an organic rather than a functional cause of postural instability. Further research is needed to assess the possible clinical implications.     

Antecedents and consequences of work-home interference among medical residents

A cross-sectional field study is reported in which a comprehensive model of work-home interference (WHI) was developed and tested among 166 medical residents of an academic hospital in the Netherlands. It was hypothesized that WHI functions as a critical mediating pathway in the relationship between work and home characteristics on the one hand, and work-related and general psychological health indicators on the other. The results revealed that one home characteristic and three work characteristics put pressure on the interface between the work and home life, that is, (1) having a spouse who works overtime frequently, (2) an unfavorable worktime schedule, (3) a high quantitative workload and (4) a problematic dependency on the superior. The results further showed that WHI was positively associated with emotional exhaustion and depersonalization (i.e. work-related health indicators), as well as with psychosomatic health complaints and sleep deprivation (i.e. general health indicators). More importantly, the results strongly supported our basic hypothesis that WHI mediates the impact of some work and home characteristics on psychological health indicators. This seems to be particularly true for the general health indicators: none of the home and work characteristics just mentioned, had a direct impact on these general indicators, independent of WHI. With respect to the work-related health indicators, particularly depersonalization, the mediating role of WHI was also strong, though less consistent. The theoretical and practical implications of the findings are discussed.     

传染性肺结核患者家庭中儿童结核感染发病及预防的研究

目的　分析传染性肺结核患者家庭中的儿童结核感染和发病情况 ,探讨预防儿童发病的有效方案。方法　对与传染性肺结核患者密切接触的儿童进行X线胸透和做结核菌素试验 ;对结核菌素强阳性者给予预防性治疗。结果　与传染性肺结核患者密切接触的儿童感染率为 88 2 %。规则预防治疗组、不规则预防治疗组和不接受预防治疗组的患病率分别为 :8 3%、4 7 6 %、5 8 8%。结论　与传染性肺结核患者密切接触的儿童属于高危人群 ,给予预防性治疗可减少发病。