Energy Expenditure Validation of an Exergame Platform: Ring Fit Adventure Use in Adults with Overweight and Obesity.

Objective: This study aims at comparing the energy expenditure (EE) and heart rate (HR) data from Ring Fit Adventure (RFA) with those from indirect calorimetry (COSMED) and a heart rate monitor (Polar FT7). A secondary goal is to evaluate self-reported enjoyment and perceived effort levels. Materials and Methods: Thirty participants (age = 21.8 ± 2.2; body mass index = 31.8 ± 4.4) were recruited for two laboratory visits. The first visit involved baseline measurements. In the second visit, participants performed a 55-minute ad libitum exercise session with the RFA in adventure mode with moderate difficulty. During this session, EE, HR, perceived effort, and enjoyment of physical activity were recorded. Results: Although no statistically significant overestimation of EE was found between the RFA and the metabolic cart, two-way analysis of variance results show a main effect of condition (RFA vs. Polar FT7) on HR (122.8 ± 20.1 bpm and 129.0 ± 18.6 bpm; P = 0.007; ᶯp2 = 0.235). Based on comprehensive statistical evaluations, including the mean absolute percent error, intraclass correlations, typical error of measurement, and limits of agreement, the data suggest that the RFA provides reliable estimates for EE and HR. Overall, participants enjoyed the game considerably (71.3 ± 5.9/80 arbitrary units), and their reported perceived exertion was low. Conclusion: This study underscores that the RFA values are relatively accurate and precise, and thus it can be safely suggested for individuals with overweight and obesity to adopt an active lifestyle.

All-Arthroscopic Management of Locked Posterior Shoulder Dislocation: Reduction Under Direct Visualization and Treatment of Intra-articular Pathologies.

Locked posterior shoulder dislocation (LPSD) is a rare condition often overlooked. In most cases, the humeral head remains stuck behind the glenoid, causing an impression fracture in 40% to 90% of LPSD cases, known as a reverse Hill-Sachs lesion. The condition also affects the posterior capsulolabral complex and leads to the formation of scar tissue under the coracoid and subscapularis tendon, making it challenging to reduce without surgery. Although open treatment has been successful, it does not address the posterior capsulolabral complex. Arthroscopic-assisted reduction provides a more detailed view and better exposure to the posterior structures. This article details a reproducible arthroscopic surgical technique for treating the locked dislocation and all intra-articular pathology in a single-stage procedure for patients with less than 25% reverse Hill-Sachs bone loss.

Manejo racional de las neuropatías diabéticas: consenso multidisciplinario de expertos / Rational management of the diabetic neuropathies: a multidisciplinary expert group consensus

Resumen: La diabetes mellitus, un padecimiento crónico y progresivo, ocupó el tercer lugar en defunciones durante el período comprendido de enero a junio de 2021 en México. Su complicación crónica más frecuente es la neuropatía diabética que tiene un impacto importante en el sistema nervioso. En la Ciudad de México se reunió un grupo multidisciplinario de expertos para establecer un algoritmo de tratamiento que considere los aspectos sintomáticos y etiopatogénicos de la neuropatía diabética. Se utilizó un método Delphi en tiempo real con dos rondas de preguntas interactivas. La implementación del algoritmo propuesto permitirá abordar de manera integral al paciente diabético con neuropatía dolorosa y no dolorosa, tanto en el terreno de los síntomas como en la etiopatogenia. Este abordaje brinda la oportunidad de mejorar la calidad de vida y lograr la reinserción a la vida familiar y laboral. El panel de expertos recomienda al ácido tióctico como tratamiento etiopatogénico de primera línea en la neuropatía diabética.

Abstract: Diabetes mellitus, a chronic and progressive condition, was the third most common cause of death in Mexico between January and June 2021. Its most frequent chronic complication is diabetic neuropathy, which has a major impact on the nervous system. A multidisciplinary group of experts met in Mexico City to establish a treatment algorithm considering the symptomatic and etiopathogenic aspects of diabetic neuropathy. A real-time Delphi method with two rounds of interative questions was used. The implementation of the proposed algorithm will allow a comprehensive approach to the diabetic patient with painful and non-painful neuropathy, both in terms of symptoms and etiopathogenesis. This approach provides the opportunity to improve quality of life and achieve reintegration into family and work life. The expert panel recommends thioctic acid as the first line etiopathogenic treatment for diabetic neuropathy.

Listening to Fast-Tempo Music Improves Physical Performance in Recreational Swimmers.

Purpose: To determine whether swimming while listening to fast (140 bpm) or moderate tempo (120 bpm) music enhances physical performance compared to a non-music condition. Methods: Sixteen healthy university students (21.5 ± 2.3 years) with a minimum of one year of experience swimming front crawl were recruited. All completed four testing sessions. In the first session, a graded exercise treadmill test was performed to establish baseline fitness. The next three visits were at the swimming pool and participants were asked to swim as far as possible in 12-minutes (i.e., Swimming Cooper Test) under each of three randomly assigned conditions: 120 bpm (M120), 140 bpm (M140) and a non-music condition (NM). Results: No significant differences were found between conditions for either heart rate (p > .05) or rating of perceived exertion (p > .05). However, differences were found on distance covered (p = .014) between M120 (305.7 ± 19.7 m) and M140 (321.2 ± 19.4 m; p = .035), and on stroke frequency (p = .009) between M120 (48.4 ± 1.8) and M140 (51.6 ± 1.9; p = .028). Conclusion: These results suggest that distance covered and the frequency of strokes per minute were greater when participants were exposed to fast tempo music (M140) compared to moderate tempo music (M120) and a non-music condition (NM) in a 12-minute swimming test.

Remote, Whole-Body Interval Training Improves Muscular Endurance and Cardiac Autonomic Control in Young Adults.

High-intensity interval training (HIIT) is an exercise modality acknowledged to maintain physical fitness with more engagement in an active lifestyle compared with other traditional exercise models. Nevertheless, its effects on cardiac control and physical performance in an online-guided setting are not yet clarified. The present work assessed physical fitness and heart rate variability (HRV) before and after an online, home-based HIIT program in college-age students while pandemic lockdowns were in effect. Twenty university students (age: 21.9 ± 2.4 years.) that were solely enrolled in online classes were distributed into three groups: control-CON-(n = 6), 14 min of HIIT-HIIT-14-(n = 8), and 21 min of HIIT-HIIT-21-(n = 6). A maximal push-up test was employed to assess muscular endurance and performance, and resting HRV signals were collected with wireless heart rate monitors and were processed in Kubios HRV Std. (Kubios Oy, Finland). There was an increase in total push-up capacity compared to CON (p < 0.05 HIIT-21 vs. CON; p < 0.001 HIIT-14 vs. CON) after 8 weeks. A significant interaction was observed in high-frequency and low-frequency spectra ratios after the HIIT-21 intervention (p < 0.05). The current work demonstrated that either short- or mid-volume online, whole-body HIIT improves muscle strength, whereas mid-volume HIIT (HIIT-21) was the only intervention that developed a sympathovagal adaptation. This study showed promising results on muscular endurance and cardiac autonomic modulation through whole-body HIIT practice at home.

Association between Body Mass Index with Sugar-Sweetened and Dairy Beverages Consumption in Children from the Mexico-USA Border.

The consumption of sugar-sweetened beverages has been associated with the onset of cardiometabolic diseases. The aim of this study was to describe consumption patterns of sugar-sweetened and dairy beverages and to evaluate their correlation with the body mass index in children residing at the Mexico−USA border. A total of 722 (370 girls, 352 boys) elementary school children aged 9 to 12 years from Tijuana, Mexico, participated in the study. Anthropometric measures were recorded, and a beverage intake questionnaire was completed by the children's parents. Significant age by sex interactions were found on body mass index Z-scores (p < 0.01). Boys showed higher sugar intake (p < 0.05) and total relative energy consumption from sugar (p < 0.05) than girls. The energy consumption from sugar-sweetened and dairy beverages was similar between sexes (p > 0.05). Sugar intake from beverages was higher than the limit recommended by the World Health Organization in boys (66%) and girls (44%). A high frequency of consumption of sugar-sweetened beverages and similar intake of dairy beverages were found in children from the Mexico−USA border. The high consumption of sugar exceeds international recommendations and should be carefully monitored.

Short-Term High-Intensity Circuit Training Does Not Modify Resting Heart Rate Variability in Adults during the COVID-19 Confinement.

BACKGROUND/OBJECTIVE: The quarantine caused by the COVID-19 pandemic increased sedentary behavior, psychological stress, and sleep disturbances in the population favoring the installation of alterations in the cardiovascular system. In this sense, physical exercise has widely been suggested as an efficient treatment to improve health. The current study determined the impact of short-term high-intensity circuit training (HICT) on resting heart rate variability (HRV) in adults. METHODS: Nine healthy participants (age: 31.9 ± 4.4 yr.) performed 36 HICT sessions (3 times per day; 3 days per week) and four participants (age: 29.5 ± 1.7 yr.) were assigned to a control group. The HICT consisted of 12 min of whole-body exercises performed during a workout. Twenty-four hours before and after the exercise program, HRV parameters were recorded. RESULTS: The heart rate exercise during the last session trended to be lower when compared with the first HICT session (p = 0.07, d = 0.39, 95% CI = -13.50, 0.72). The interval training did not modify the HRV time (Mean NN, SDNN, RMSSD, NN50, pNN50) and frequency (LF, HF, LF/HF ratio, total power) domain parameters. CONCLUSION: Thirty-six HICT sessions did not provide enough stimuli to modify the resting HRV in adults during social isolation elicited by the COVID-19 pandemic. However, the data suggested that exercise protocol did not induce cardio-vagal adaptations.

Impact of Spirulina maxima Intake and Exercise (SIE) on Metabolic and Fitness Parameters in Sedentary Older Adults with Excessive Body Mass: Study Protocol of a Randomized Controlled Trial.

Life expectancy has increased unprecedentedly in recent decades, benefiting the longevity of the world's population. The most frequent pathological conditions presented in this age group include excessive body fat, frailty, and hypercholesterolemia. These pathological characteristics condition general health and autonomy in adults to carry out their usual activities. In this sense, the search for a healthy lifestyle is necessary, consisting in a healthy diet that includes supplementation with nutraceuticals and the daily practice of physical activity. This study protocol aims to evaluate the independent and synergistic effect of 12 weeks of Spirulina maxima intake (5 g/day), with or without an exercise program on metabolic and fitness parameters of 52 sedentary older adults with excessive body mass in a double-blind, randomized, crossover, controlled trial design. The main findings from this trial will provide novel evidence for future interventions designed for the elderly population and the result will be disseminated through peer-reviewed journals and international meetings. ClinicalTrials.gov identification number: NCT04658875 (Effect of Spirulina maxima and Exercise on General Fitness and Blood Lipids in Older Adults).

Hemodynamic Adaptations Induced by Short-Term Run Interval Training in College Students.

Perceived lack of time is one of the most often cited barriers to exercise participation. High intensity interval training has become a popular training modality that incorporates intervals of maximal and low-intensity exercise with a time commitment usually shorter than 30 min. The purpose of this study was to examine the effects of short-term run interval training (RIT) on body composition (BC) and cardiorespiratory responses in undergraduate college students. Nineteen males (21.5 ± 1.6 years) were randomly assigned to a non-exercise control (CON, n = 10) or RIT (n = 9). Baseline measurements of systolic and diastolic blood pressure, resting heart rate (HRrest), double product (DP) and BC were obtained from both groups. VO2max and running speed associated with VO2peak (sVO2peak) were then measured. RIT consisted of three running treadmill sessions per week over 4 weeks (intervals at 100% sVO2peak, recovery periods at 40% sVO2peak). There were no differences in post-training BC or VO2max between groups (p > 0.05). HRrest (p = 0.006) and DP (p ≤ 0.001) were lower in the RIT group compared to CON at completion of the study. RIT lowered HRrest and DP in the absence of appreciable BC and VO2max changes. Thereby, RIT could be an alternative model of training to diminish health-related risk factors in undergraduate college students.

Small-Bowel Obstruction Secondary to Ileal Trichobezoar in a Patient with Rapunzel Syndrome.

Bezoars are conglomerations of undigested foreign material retained in the gastrointestinal tract. Trichobezoar is a compact conglomeration of swallowed hair and constitutes less than 6% of all bezoars. Their most frequent location is in the stomach but they may extend through the pylorus into the small bowel. This condition is known as Rapunzel syndrome. Many patients may remain asymptomatic or present a mild form of the disease characterized by abdominal pain, early satiety, nausea, and vomiting. Complications may manifest as gastric outlet obstruction or bleeding, and intestinal obstruction. A 15-year-old female patient presented with clinical findings of intestinal obstruction. The patient suffered from depressive and anxiety disorders and trichotillomania, although trichophagy could not be assured. Alopecia circumscripta and irregular hair length on the scalp were identified. A computed tomography (CT) scan showed two images highly suggestive of trichobezoars, one in the stomach and the second one causing obstruction at the ileocecal valve. At laparotomy, both a mobile gastric trichobezoar with a tail extending to the duodenum and a trichobezoar causing obstruction at the ileocecal valve were removed. The postoperative course was uneventful. The passage of a detached trichobezoar fragment in a patient with Rapunzel syndrome may cause intestinal obstruction. CT is the preferred image modality for the evaluation of suspected trichobezoars in order to characterize their size and locations, the presence and level of obstruction, and complications such as ischemia or perforation. A case of small-bowel obstruction secondary to ileal trichobezoar in a patient with Rapunzel syndrome is herein reported.

Entrenamiento de resistencia muscular en jóvenes universitarios ¿método de oclusión vascular o tradicional? / Resistance training in college students ¿vascular occlusion training or traditional method?

El objetivo del estudio fue determinar si existen diferencias significativas en la circunferencia del brazo y en el número de repeticiones realizadas en base a dos métodos de entrenamiento: oclusión vascular y tradicional. Se reclutaron ocho sujetos a los cuales, de manera aleatoria, se les asignó el método de oclusión vascular (OVbi) para un brazo y el entrenamiento tradicional (ETmi) para el otro. Se realizó un pretest en el cual se midió la circunferencia del brazo y la cantidad de repeticiones que pudieran realizar con una carga equivalente al 9% de la masa corporal. Después de cuatro semanas de tratamiento (tres sesiones por semana) se realizó el postest. Los resultados no encontraron interacción significativa en la circunferencia del brazo (p = 0.164) ni en la cantidad de repeticiones (p = 0.390), sin embargo, si se encontraron diferencias en la cantidad de repeticiones realizadas entre el pretest y postest (p = 0.048). Estos resultados demuestran que, independientemente del tratamiento (OVbi y ETmi), los sujetos aumentaron el número de repeticiones realizadas, en pocas palabras, un entrenamiento a baja intensidad con oclusión vascular durante cuatro semanas es igual de efectivo a un entrenamiento tradicional de moderada intensidad.

The purpose of the study was to determine the effect of vascular occlusion (VO) and traditional resistance training (TRT) methods on arm circumference and number of repetitions to exhaustion. Eight participants were randomly assigned to VO in one arm and TRT on the other. Before and after four weeks of training performed three times per week, measurements were obtained on arm circumference and number of repetitions with a workload equivalent to 9% of body mass. No significant treatment by measurements interactions were found on arm circumference (p = 0.164) and number of repetitions to exhaustion (p = 0.390). Regardless of the training method, participants improved number of repetition to exhaustion following the intervention (p = 0.048). In conclusion, four weeks of VO is as effective as TRT for improving arm muscular performance to exhaustion.

Spontaneous Rupture of Hepatocellular Carcinoma in a Young Patient with Fatal Outcome.

Spontaneous rupture of hepatocellular carcinoma (HCC) is a potentially life-threatening complication. Diagnosis may be difficult, particularly in the absence of known liver cirrhosis or tumor. A 20-year-old male patient presented with progressive abdominal pain and shock. His past medical history was uneventful. Anemia, acute renal failure, and abnormal liver function test were demonstrated. Mild hepatomegaly, perihepatic and flank fluid, and multiple hypodense liver lesions suggestive of intrahepatic metastases or multifocal HCC were revealed by computed tomography. Two actively bleeding liver tumors and multiple tumors in a noncirrhotic liver were found. Hemostatic suture and perihepatic packing were performed. The patient remained in critical condition, with a fatal outcome 48 h later. Histopathologic analysis reported HCC and absence of cirrhotic changes. HCC spontaneous rupture incidence is reported between 2.3 and 26%. Median age is 65 years. No liver cirrhosis is found in one-third of patients, with a median age of 51 years. Sudden onset of abdominal pain and shock is observed in the majority of cases. An accurate preoperative diagnosis improves to 75% with ultrasound and computed tomography. Besides hemodynamic stabilization, there is no general agreement on the best treatment option. Transarterial embolization, surgical perihepatic packing, suture plication, and hepatic artery ligation are useful methods of hemostasis in unstable patients. Mortality has been reported from 16.5 to 100%. The histopathologic finding of HCC in a noncirrhotic liver represents a less frequent presentation. A case of spontaneous rupture of HCC carcinoma and a noncirrhotic liver in a young patient is herein reported.

Refinando el tempo de la música para un efecto ergogénico durante el ejercicio de ciclismo estacionario 1 / Refining music tempo for an ergogenic effect on stationary cycling exercise

Resumen Aburto-Corona, J. y Aragón-Vargas, L.F. (2017). Refinando el tempo de la música para un efecto ergogénico durante el ejercicio de ciclismo estacionario. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 15(2), 13-25. El efecto de la música durante el ejercicio ha sido estudiado desde muchas perspectivas, pero los resultados no han sido del todo claros, probablemente por la falta apropiada de control en la investigación. El propósito de este estudio fue medir el rendimiento físico en bicicleta estacionaria en un ambiente caluroso, en condiciones cuidadosamente controladas, modificando solo el tempo de la música. Diez estudiantes físicamente activos, con 24.5±3.6 años de edad (promedio ± desviación estándar), escogieron su música favorita para hacer ejercicio y realizaron una prueba de máximo esfuerzo en bicicleta. Durante las siguientes visitas al laboratorio, los participantes pedalearon a una cadencia de su preferencia y contra una resistencia constante (70% de la carga máxima) dentro de un cuarto de clima controlado (28.6±0.5°C y 65±3%FC), por 30 minutos en tres días diferentes, sin música (NM), con música tempo medio (MT-120ppm) o música tempo rápido (FT-140ppm) en orden aleatorio. Se registró el esfuerzo percibido (EP), la frecuencia cardíaca (FC) y el trabajo realizado (TR). No se encontró diferencia significativa entre condiciones en EP (4.47±1.52; 4.22±1.5; 3.83±2.06u.a. para NM, MT y FT, respectivamente, p=.162) ni FC (142.4±24.53; 142.6±24.37; 142.9±18.36lpm para NM, MT y FT, respectivamente, p=.994). Sin embargo, sí se encontraron diferencias en TR (43.4±19.02; 46.1±20.34; 47.1±20.97kJ para NM, MT y FT, respectivamente, p=.009); el análisis post-hoc demostró que esas diferencias en TR eran entre FT y NM. Al utilizar música del agrado de cada persona durante el ejercicio, los participantes mejoraron el rendimiento físico solo con tempo rápido de 140ppm.

Refining Music Tempo For An Ergogenic Effect On Stationary Cycling Exercise1 / Refinando o tempo da música para um efeito ergogênico no exercício do ciclismo ergomêtrico

Abstract Aburto-Corona, J. & Aragón-Vargas, L.F. (2017). Refining music tempo for an ergogenic effect on stationary cycling exercise. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 15(2), 1-12. The effect of music on exercise performance has been studied from many perspectives, but the results have not been as clear as expected, probably due to a lack of appropriate controls. The purpose of this study was to measure stationary cycling performance in a warm environment under carefully controlled conditions, modifying only the presence of music and its tempo. Ten physically active students, 24.5 ±3.6 years (mean±SD) selected their favorite exercise music and performed a maximum cycling test. During subsequent visits to the laboratory, they pedaled at their preferred speed against a constant resistance (70% of maximum) in an environmentally controlled chamber (28.6±0.5 °C db and 65±3% rh) for 30 min, on three different days, without music (NM), medium tempo music (MT-120 bpm) or fast tempo music (FT-140 bpm), in random order. Perceived exertion (PE), heart rate (HR) and total work performed (W) were recorded. There was no significant difference among conditions for PE (4.47±1.52; 4.22±1.5; 3.83±2.06 a.u. for NM, MT and FT, respectively, p=.162) or HR (142.4±24.53; 142.6±24.37; 142.9±18.36 bpm for NM, MT and FT, respectively, p=.994), but W was different (43.4±19.02; 46.1±20.34; 47.1±20.97, kJ for NM, MT and FT, respectively, p=.009); post-hoc analysis showed that the W difference was only between FT and NM. Using individually selected preferred music in a carefully controlled environment, participants improved their spontaneous cycling performance only when the music had a fast tempo of 140 bpm.

Resumo Aburto-Corona, J. & Aragón-Vargas, L.F. (2017). Refinando o tempo da música para um efeito ergogênico no exercício do ciclismo ergométrico. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 15(2), 1-12. O efeito da música durante o exercício tem sido estudado desde muitas perspectivas, mas os resultados não tem sido totalmente claros, provavelmente pela falta apropriada de controle na pesquisa. O propósito deste estudo foi medir o rendimento físico em uma bicicleta ergométrica em um ambiente quente, em condições cuidadosamente controladas, modificando apenas o tempo da música. Dez estudantes fisicamente ativos, 24.5±3.6 anos de idade (média ± desvio padrão), escolheram sua música favorita para fazer exercício e realizaram uma prova de máximo esforço na bicicleta. Durante as seguintes visitas ao laboratório, os participantes mantiveram uma cadência de sua preferência e uma resistência constante (70% da carga máxima) dentro de uma sala de clima controlado (28.6±0.5°C e 65±3%HR) por 30 minutos em três dias diferentes, sem música (NM), com música de ritmo moderado (MT-120bpm) ou música de ritmo rápido (FT-140bpm) em ordem aleatória. Foi registrado o esforço percebido (PE), a frequência cardíaca (HR) e o trabalho realizado (W). Não se encontrou diferença significativa entre condições PE (4.47±1.52; 4.22±1.5; 3.83±2.06u.a. para NM, MT e FT, respectivamente, p=.162) nem HR (142.4±24.53; 142.6±24.37; 142.9±18.36bpm para NM, MT e FT, respectivamente, p=.994). Porém, sim foram encontradas diferenças em W (43.4±19.02; 46.1±20.34; 47.1±20.97kJ para NM, MT e FT, respectivamente, p=.009); a análise post-hoc demonstrou que essas diferenças em W eram entre FT e NM. Ao utilizar música que cada pessoa gosta de ouvir enquanto se exercita em um ambiente cuidadosamente controlado, os participantes melhoraram o rendimento físico somente com ritmo rápido de 140bpm.

Ascites Module for Third-Year Medical Students: Group-Based Learning Workshop on the Diagnosis, Workup, and Management of Ascites.

INTRODUCTION: As medical students transition from didactic courses to clinical rotations, they will frequently encounter patients with cirrhosis and ascites. It is paramount that they have a firm foundation of how to diagnose ascites and perform a proper diagnostic workup in order to understand the etiology and therefore the proper management. This module is designed as a group-based, interactive learning workshop for those transitioning students. METHODS: The session begins with the students obtaining a pertinent history of a standardized patient case. The students are then divided into four groups and rotate through four stations: physical examination, diagnostic studies, paracentesis, and ascitic fluid analysis. Each station is designed for up to 10-12 students and typically lasts 20 minutes. After all of the students have rotated through each station, they reconvene to review ascites management, case conclusions, and summary. The total time allocated for this module is 125 minutes for 40-48 students. RESULTS: Postmodule evaluations by the students showed a high level of satisfaction and improvement in the students' fund of knowledge and clinical skills. Evaluations completed by the students after each workshop revealed more than 95% either agreeing or strongly agreeing with the learning objectives being clear, the learning materials being effective, overall satisfaction with the learning material and teaching, and having a better understanding of the evaluation, diagnosis, and management of ascites. DISCUSSION: Through this team-based interactive module, students obtain clinical and hands-on experience that better prepares them for their clinical rotations.

Sunscreen Use and Sweat Production in Men and Women.

CONTEXT: Sunscreen lotions are important to protect the skin during outdoor exercise, but they may interfere with sweating. OBJECTIVE: To measure the effect of 2 water-resistant sunscreens on local sweat production in men and women exercising in the heat and to compare those effects with the expected inhibition resulting from the use of an antiperspirant. DESIGN: Randomized crossover study. SETTING: Exercise in the heat (ambient temperature = 30.2°C ± 0.4°C dry bulb and 58% ± 4.3% relative humidity) in a controlled-environment laboratory. PATIENTS OR OTHER PARTICIPANTS: Twenty physically active, apparently healthy college students, 10 men (age = 22.5 ± 2.8 years, height = 1.771 ± 0.069 m, mass = 70.2 ± 11.0 kg) and 10 women (age = 22.2 ± 3.2 years, height = 1.625 ± 0.075 m, mass = 57.7 ± 7.9 kg). INTERVENTION(S): With sweat-collection patches applied to their right and left scapular regions, the participants performed 2 exercise sessions on consecutive days. We assigned skin treatments (antiperspirant; organic chemical sun filter, sunscreen A; inorganic physical sun block, sunscreen B; no lotion) randomly to side and session. Participants pedaled at 79% ± 1% of maximum heart rate for 20 minutes in the heat. MAIN OUTCOME MEASURE(S): Scapular localized sweat rate. RESULTS: No baseline, environmental, or exercise condition was different among skin treatments. Scapular localized sweat rate was lower for the antiperspirant treatment (88.3 µL/min·dm 2 ; 95% confidence interval [CI] = 82.0, 94.7 µL/min·dm2) and the inorganic physical sun block (sunscreen B) treatment (99.3 µL/min·dm 2 ; 95% CI = 93.1, 105.5 µL/min·dm2) than for the organic chemical sun filter (sunscreen A) treatment (114.8 µL/min·dm 2 ; 95% CI = 108.8, 120.6 µL/min·dm2) or the no-lotion treatment (122.6 µL/min·dm 2 ; 95% CI = 116.2, 129.0 µL/min·dm2; P < .01). CONCLUSIONS: The inorganic physical sun block, sunscreen B, hindered effective sweating to the same extent as the antiperspirant, whereas the treatment with the organic chemical sun filter, sunscreen A, was not different from the control treatment. At this stage, it is not possible to identify the specific ingredient responsible for the effect.

Gallstone ileus, clinical presentation, diagnostic and treatment approach.

Gallstone ileus is a mechanical intestinal obstruction due to gallstone impaction within the gastrointestinal tract. Less than 1% of cases of intestinal obstruction are derived from this etiology. The symptoms and signs of gallstone ileus are mostly nonspecific. This entity has been observed with a higher frequency among the elderly, the majority of which have concomitant medical illness. Cardiovascular, pulmonary, and metabolic diseases should be considered as they may affect the prognosis. Surgical relief of gastrointestinal obstruction remains the mainstay of operative treatment. The current surgical procedures are: (1) simple enterolithotomy; (2) enterolithotomy, cholecystectomy and fistula closure (one-stage procedure); and (3) enterolithotomy with cholecystectomy performed later (two-stage procedure). Bowel resection is necessary in certain cases after enterolithotomy is performed. Large prospective laparoscopic and endoscopic trials are expected.

Zenker's Diverticulum: Diagnostic Approach and Surgical Management.

Zenker's diverticulum (ZD), also known as cricopharyngeal, pharyngoesophageal or hypopharyngeal diverticulum, is a rare condition characterized by an acquired outpouching of the mucosal and submucosal layers originating from the pharyngoesophageal junction. This false and pulsion diverticulum occurs dorsally at the pharyngoesophageal wall between the inferior pharyngeal constrictor and the cricopharyngeus muscle. The pathophysiology of ZD involves altered compliance of the cricopharyngeus muscle and raised intrabolus pressure. Decreased compliance of the upper esophageal sphincter and failure to open completely for effective bolus clearance both lead to an increase in the hypopharyngeal pressure gradient. Different open surgical techniques and transoral endoscopic approaches have been described for the management of ZD, although there is no consensus about the best option. We report the case of a 61-year-old patient with a 7-year history of dysphagia and odynophagia for solid food, which after 2 months progressed to dysphagia for liquids and after 4 months to regurgitation 2-6 h after meals. The patient experienced a 12-kg weight loss. Diagnosis was established by esophagogram, which showed a diverticulum through the posterior pharyngeal wall, suggestive of a ZD. Esophagogastroduodenoscopy showed a pouch with erythematous mucosa. Under general anesthesia, diverticulectomy and myotomy were performed. After an uneventful recovery and adequate oral intake, the patient remains free of symptoms at 4 months of follow-up.

Presentación de un paciente con diagnóstico de fibroma del ligamento redondo hepático / Presentation of a Patient with Liver Round Ligament Fibroma Diagnosis

Los tumores del ligamento redondo del hígado son enfermedades poco frecuentes, con escasos reportes en la literatura mundial. Se presentó una paciente de 22 años con un tumor de ligamento redondo hepático, que cursó sin manifestación clínica y se halló de manera fortuita en una ecografía abdominal. Se realizó, además, laparoscopia y tomografía axial computarizada para precisar el diagnóstico preoperatorio. La cirugía tuvo éxito y la conclusión anatomopatológica fue: fibroma del ligamento redondo. La paciente evolucionó de forma satisfactoria en el postoperatorio, a los dos años de la intervención. Los tumores de esta localización parecieron ser de expresión clínica variable, y su diagnóstico fue posible solo por medio de estudios imagenológicos.

The tumors of the round hepatic ligament are uncommon diseases, with only a few reports around the world literature. A 22-year-old female patient with a tumor of the round hepatic ligament, with no clinical manifestations or lab alterations it presented. The lesion was incidentally detected by abdominal ultrasonography. The laparoscopy and computed tomography helped in making an accurate preoperative diagnosis. The patient was successfully treated with major surgery. The histopathologic results showed a fibroma of the round hepatic ligament. The patient´s postoperative progress was successful. These tumours have a variable clinical presentation, and its diagnosis is mostly make by ultrasound and laparoscopy to corroborate it, as in the case of the patient presented in this study.

Obstructing gangliocytic paraganglioma in the third portion of the duodenum.

Gangliocytic paragangliomas are infrequent tumors almost exclusively found in the second portion of the duodenum. An unusual case of a gangliocytic paraganglioma in the third portion of the duodenum with obstructive symptoms is herein reported. A 16-year-old male patient presented with epigastric pain, postprandial plenitude and reflux. A barium swallow failed to demonstrate abnormalities. Endoscopy showed a pedunculated submucosal tumor, originating at the third duodenal portion and causing partial obstruction. Biopsy was not performed due to the risk of bleeding. CT scan demonstrated a polypoid lesion. Through a transmesocolic approach and an anterior duodenotomy, resection of the tumor was performed. No lymph node or other organ affection was found. Histologic examination revealed a gangliocytic paraganglioma. Immunohistochemical examination was performed. Gangliocytic paragangliomas originating in the third or fourth portion of the duodenum, as in the present case, are extremely rare. Characteristic histologic features including epithelioid cells, spindle-shaped cells and ganglion-like cells were met. The majority of cases manifest with a similar benign behavior. Local resection of the tumor is recommended for these cases. An infrequent case of a gangliocytic paraganglioma located in the third portion of the duodenum, with a less common clinical presentation, is herein reported.