COPD as an independent risk factor for osteoporosis and fractures.

Fractures are common in individuals with COPD and occur at higher bone mass values than expected. COPD appears to be an important risk factor for bone fragility. INTRODUCTION: Patients with chronic obstructive pulmonary disease (COPD) have an increased risk of osteoporosis and fractures, but screening and prophylactic measures to prevent both disorders are often neglected in this population. This case-control study assessed the prevalence of osteopenia, osteoporosis, and fractures in patients with COPD, and identified potential risk factors for fractures in this population. METHODS: Overall, 91 patients with COPD (COPD group; COPDG) and 81 age- and sex-matched controls (control group; CG) were assessed with bone mineral density (BMD), thoracic/lumbar spine radiographs, and serum PTH and 25-hydroxyvitamin D (25[OH]D) levels. The occurrence of prior fractures was retrieved from clinical history. RESULTS: The prevalence of total fractures in the COPDG was 57.1% (odds of fracture 4.7 times greater compared with the CG), and the femoral neck T-score emerged as the best predictor of fractures. Compared with the CG, the COPDG had lower spine and femoral BMD (p ≤ 0.01) and 25(OH)D levels (p = 0.01) and 2.6 times greater odds of osteoporosis. Among men, vertebral fractures were more prevalent in the COPDG versus CG (25.9% vs. 6.5%, respectively, p = 0.01). The odds of fracture increased with femoral neck T-scores ≤ - 2.7 in the CG and ≤ - 0.6 in the COPDG. CONCLUSION: These results add robust evidence to an increased odds of osteoporosis and fractures in COPD. Fractures in the COPDG occurred at higher BMD values than expected, suggesting that COPD may be an independent marker of fracture risk, reinforcing a need for regular osteoporosis screening with BMD measurement and prophylaxis of fractures in patients with this disorder.

Proto-oncogenic isoform A2 of eukaryotic translation elongation factor eEF1 is a target of miR-663 and miR-744.

BACKGROUND: Eukaryotic translation elongation factor 1A2 (eEF1A2) is a known proto-oncogene. We proposed that stimulation of the eEF1A2 expression in cancer tissues is caused by the loss of miRNA-mediated control. METHODS: Impact of miRNAs on eEF1A2 at the mRNA and protein levels was examined by qPCR and western blot, respectively. Dual-luciferase assay was applied to examine the influence of miRNAs on 3'-UTR of EEF1A2. To detect miRNA-binding sites, mutations into the 3'-UTR of EEF1A2 mRNA were introduced by the overlap extension PCR. RESULTS: miR-663 and miR-744 inhibited the expression of luciferase gene attached to the 3'-UTR of EEF1A2 up to 20% and 50%, respectively. In MCF7 cells, overexpression of miR-663 and miR-744 reduced the EEF1A2 mRNA level by 30% and 50%. Analogous effects were also observed at the eEF1A2 protein level. In resveratrol-treated MCF7 cells the upregulation of mir-663 and mir-744 was accompanied by downregulation of EEF1A2 mRNA. Both miRNAs were able to inhibit the proliferation of MCF7 cells. CONCLUSION: miR-663 and miR-744 mediate inhibition of the proto-oncogene eEF1A2 expression that results in retardation of the MCF7 cancer cells proliferation. Antitumour effect of resveratrol may include stimulation of the miR-663 and miR-744 expression.

Laparoscopic ventral hernia repair: does IPOM plus allow to increase the indications in larger defects?

PURPOSE: The laparoscopic ventral hernia repair (LVHR) may have a limit of effectiveness, especially in defects greater than 80 cm2, with a higher recurrence rate which contraindicates this technique. The purpose of this study is to analyze the indication of LVHR determining and comparing the recurrence rate according to defect size in two series. METHODS: We analyzed all patients who underwent LVHR between 2007 and 2017. Patients were divided according to the ring size: < o ≥ 80 cm2 into group one (G1) and group two (G2) respectively. In both groups, all three techniques were used: intraperitoneal onlay mesh (IPOM), IPOM with closure of the defect (IPOM plus), and IPOM plus + anterior videoscopic component separation (AVCS). RESULTS: A total of 258 patients underwent LVHR. Mean recurrence rate was 13% in G1 and 24% in G2. A statistically significant difference was found when comparing the IPOM technique among both groups, with a higher recurrence rate when ring size was ≥ 80 cm2 (p < 0.5). However, when comparing recurrence rate in IPOM plus and IPOM plus + AVCS between both groups, no significant differences were observed, yielding a p of 0.51 and 0.63, respectively. CONCLUSION: The IPOM technique has shown a limit of effectiveness in large ventral hernia defects. The combination of techniques (ring closure and AVCS) may be useful to expand the indication for this surgery to larger defects and to reduce the recurrence rate. Prospective randomized studies are required to confirm this trend.

Exercises using the upper limbs hyperinflate COPD patients more than exercises using the lower limbs at the same metabolic demand.

BACKGROUND: Lower and upper body exercise are mandatory constituents of a rehabilitation programme for patients with COPD. However, it is not known how much these exercises may induce pulmonary dynamic hyperinflation (DH). OBJECTIVE: To evaluate the DH in patients with COPD exercising the upper and lower parts of the body at the same metabolic demand. METHODS: Sixteen patients aged 63 +/- 13 years and with a FEV1 of 1.5 +/- 0.7 L (41 +/- 11% pred) were studied. Patients initially performed a maximal exercise test with the arms using the diagonal movement technique. The lower limbs were exercised on a treadmill at the same metabolic demand. RESULTS: Inspiratory capacity decreased 222 +/- 158 ml (9.8%) after the upper body exercise (p < 0.0001) and 148 +/- 161 ml (7%) after exercise with the lower body (p = 0.0028) and a difference between the two groups was found (p < 0.05). There was no difference between resting IC before upper and lower limbs exercises (p = 0.8); increase in minute ventilation and in pulmonary ventilation in percentage of maximum voluntary ventilation and reduction of expiratory time were larger in the upper limbs exercise (p < 0.05). Dyspnea as measured by the Borg Scale was higher in the upper body (3.9 +/- 2.2) than in the lower body (2.3 +/- 1.3) at the end of the exercise (p = 0.033). Pulmonary ventilation and inspiratory capacity were correlated (p = 0.0001; r = 0.82). CONCLUSION: Exercise with the upper part of the body causes more DH and dyspnea than exercise with the lower part of the body at the same metabolic demand.

Comprehensive exercise training improves ventilatory muscle function and reduces dyspnea perception in patients with COPD.

BACKGROUND: Comprehensive exercise training (CET) is an efficient strategy to decrease dyspnea perception in chronic obstructive pulmonary disease (COPD) and may result in significant improvement in ventilatory muscles function. Our aim was to evaluate the effects of general exercise training on dyspnea perception and on respiratory muscles strength in COPD patients. METHODS: Consecutive COPD patients were enrolled to complete a CET programme. The patients underwent a routine that included a global warm up, upper and lower limbs endurance exercise as well as stretching and relaxation. Before and after the CET programme, patients completed maximal inspiratory (PImax) and expiratory (PEmax) pressures measurements, maximal incremental test, endurance test, and 6-min walk distance (6MWD). RESULTS: 71 patients (52 male). Mean age 67.6 +/- 8.6 years, FEV1 (%) 44.2 +/- 16.2 and Mahler dyspnea scale 6.4 +/- 1.8. The results before and after the exercise programme were: PImax 64.7 +/- 22.9 vs. 75.5 +/- 23.7 cmH2O (p=0.001), PEmax 110.8 +/- 28.1 vs. 120.4 +/- 28.1 cmH2O (p=0.004), 6MWD 510.6 +/- 90.3 vs. 528.2 +/- 99.7 metres (p=0.88), time of incremental test 672 +/- 135 vs. 856 +/- 226 sec (p<0.0001). Compared with the pre exercise programme, we observed a significant reduction on Borg dyspnea scale (6.1 +/- 2.8 to 3.6 +/- 2.3, p<0.0001) as well as a longer test time (504 +/- 218 to 1.038 +/- 841, p<0.0001) at the end of the endurance test after CET programme. Improvement of PImax correlated negatively with dyspnea perception at iso-time during the endurance test (r = -0.33, p=0.03). CONCLUSIONS: Our results confirm that CET is associated with significant improvement in PImax, PEmax and provide evidence demonstrating that CET reduces dyspnea perception in patients with COPD.

Prediction of hearing recovery in sudden deafness treated with intratympanic steroids.

The present study aims to obtain a probability model allowing prediction of auditory recovery in patients affected by sudden sensorineural hearing loss treated exclusively with intratympanic steroids. A monocentric retrospective chart review of 381 patients has been performed. A Probit model was used to investigate the correlation between the success of treatment (marked or total recovery according to Furuashi's criteria) and the delay between onset of disease and beginning of therapy. The age of patients and audiometric curve shapes were included in the analysis. The results show that delay is negatively correlated with variable success. Considering the entire sample, each day of delay decreases the probability of success by 3%. The prediction model shows that for each day that passes from the onset of the disease the probability of success declines in absence of the medical treatment, hence we conclude that early treatment is strongly recommended.

Postural control in chronic obstructive pulmonary disease: a systematic review.

UNLABELLED: Patients with chronic obstructive pulmonary disease (COPD) fall frequently, although the risk of falls may seem less important than the respiratory consequences of the disease. Nevertheless, falls are associated to increased mortality, decreased independence and physical activity levels, and worsening of quality of life. The aims of this systematic review was to evaluate information in the literature with regard to whether impaired postural control is more prevalent in COPD patients than in healthy age-matched subjects, and to assess the main characteristics these patients present that contribute to impaired postural control. METHODS: Five databases were searched with no dates or language limits. The MEDLINE, PubMed, EMBASE, Web of Science, and PEDro databases were searched using "balance", "postural control", and "COPD" as keywords. The search strategies were oriented and guided by a health science librarian and were performed on March 27, 2014. The studies included were those that evaluated postural control in COPD patients as their main outcome and scored more than five points on the PEDro scale. Studies supplied by the database search strategy were assessed independently by two blinded researchers. RESULTS: A total of 484 manuscripts were found using the "balance in COPD or postural control in COPD" keywords. Forty-three manuscripts appeared more than once, and 397 did not evaluate postural control in COPD patients as the primary outcome. Thus, only 14 studies had postural control as their primary outcome. Our study examiners found only seven studies that had a PEDro score higher than five points. The examiners' interrater agreement was 76.4%. Six of those studies were accomplished with a control group and one study used their patients as their own controls. The studies were published between 2004 and 2013. CONCLUSION: Patients with COPD present postural control impairment when compared with age-matched healthy controls. Associated factors contributing to impaired postural control were muscle weakness, physical inactivity, elderly age, need for supplemental oxygen, and limited mobility.

Retrograde memory deficits in severe closed-head injury patients.

A battery of tests evaluating different aspects of retrograde memory (autobiographical, public events, semantic knowledge) was administered to a group of 20 patients who had suffered from a severe closed-head injury (CHI) and who had recovered from the post-traumatic amnesia period and to a group of sex-, age- and education-matched normal controls. Results document a high prevalence of retrograde memory deficits among CHI individuals. The deficit involves both autobiographical and public events memories and extends to early acquired basic and cultural knowledge. The severity of the deficit does not vary according to some kind of temporal gradient or according to a presumed hierarchical or modality organization of the semantic system. However, in the domain of basic knowledge it more severely affects information pertaining to living than nonliving categories of objects. With the exception of a more severe deficit in retrieving autobiographical events occurred in the last year before trauma in a subgroup of patients with focal lesions restricted to the right hemisphere as compared to left lesioned patients, no clear relationship emerges between severity of the retrograde memory deficit and locus of focal cerebral lesions as demonstrated by neuroradiological exams.

Subcutaneous phaeohyphomycosis caused by Bipolaris hawaiiensis. A case report.

A case of phaeohyphomycosis caused by Bipolaris hawaiiensis is reported. The patient, an immunocompetent host, presented a verrucous lesion on the first finger of the left foot. Dematiaceous septate hyphae and yeast-like elements were seen in direct and histological examination. The isolated strain was identified on the basis of micro and macromorphological aspects. Treated with electrocoagulation, the lesions healed and presented no relapse after two years follow-up.

Subcutaneous hyalohyphomycosis caused by Acremonium recifei: case report.

We present a case of subcutaneous hyalohyphomycosis due to Acremonium recifei, a species whose habitat is probably the soil, first identified in 1934 by Arêa Leão and Lobo in a case of podal eumycetoma with white-yellowish grains and initially named Cephalosporium recifei. A white immunocompetent female patient from the state of Bahia, Brazil, with a history of traumatic injury to the right hand is reported. The lesions was painless, with edema, inflammation and the presence of fistulae. Seropurulent secretion with the absence of grains was present. Histopathological examination of material stained with hematoxylin-eosin showed hyaline septate hyphae. A culture was positive for Acremonium recifei. Treatment with itraconazole, 200 mg/day, for two months led to a favorable course and cure of the process. We report for the first time in the literature a case of subcutaneous hyalohyphomycosis due to Acremonium recifei in a immunocompetent woman. Treatment with itraconazole 200 mg/day, for two months, resulted in cure.

[Subcutaneous phaeohyphomycose due to Exophiala jeanselmir. Report of 3 cases in patients with a kidney transplant]. / Feo-hifomicose subcutânea por Exophiala jeanselmei. Registro de três casos em transplantados renais.

We report three cases of subcutaneous phaeohyphomycosis due to Exophiala jeanselmei (Langeron) McGinnis et Padhye 1977, in kidney transplant patients. Exophiala jeanselmei is a dematious fungus having also ability to rarely procedure eumycetoma (black grains). According to KWON-CHUNG & BENNETT (1992) such fungus is antigenically very heterogeneous, since so far three serotypes have been identified; each serotype including subgroups. Subcutaneous phaeohyphomycosis is becoming more and more frequent in kidney transplant patients submitted to an immunosuppressive treatment. As Exophiala jeanselmei has already been isolated from the environment it becomes difficult to explain the pathogenicity of these cases by a reactivation of quiescent processes. The authors suggest an occasional fungistatic action of cyclosporine A upon Exophiala jeanselmei.