Activity behaviors in lean and morbidly obese pregnant women.

Interventions to increase physical activity in pregnancy are challenging for morbidly obese women. Targeting sedentary behaviors may be a suitable alternative to increase energy expenditure. We aimed to determine total energy expenditure, and energy expended in sedentary activities in morbidly obese and lean pregnant women. We administered the Pregnancy Physical Activity Questionnaire (nonobjective) and the Actical accelerometer (objective) to morbidly obese (BMI ≥ 40 kg/m²) and lean (BMI ≤ 25 Kg/m²) pregnant women recruited in early (<24 weeks), and late (≥24 weeks) gestation. Data are mean (SD). Morbidly obese pregnant women reported expending significantly more energy per day in early (n = 140 vs 109; 3198.4 (1847.1) vs 1972.3 (10284.8) Kcal/d, P < .0001) and late (n = 104 vs 64; 3078.2 (1356.5) vs 1947.5 (652.0) Kcal/d, P < .0001) pregnancy, and expended significantly more energy in sedentary activities, in early (816.1 (423.5) vs 540.1 (244.9) Kcal/d, P < .0001) and late (881.6 (455.4) vs 581.1 (248.5) Kcal/d, P < .0001) pregnancy, than lean pregnant women. No differences were observed in the proportion of energy expended sedentary between lean and morbidly obese pregnant women. The greater total energy expenditure in morbidly obese pregnant women was corroborated by Actical accelerometer in early (n = 14 per group, obese 1167.7 (313.6) Kcal; lean 781.1 (210.1) Kcal, P < .05), and in late (n = 14 per group, obese 1223.6 (351.5) Kcal; lean 893.7 (175.9) Kcal, P < .05) pregnancy. In conclusion, non-objective and objective measures showed morbidly obese pregnant women expended more energy per day than lean pregnant. Further studies are needed to determine whether sedentary behaviors are a suitable target for intervention in morbidly obese pregnancy.

Responsiveness of muscle size and strength to physical training in very elderly people: a systematic review.

The purpose of this review was to determine whether very elderly muscle (>75 years) hypertrophies in response to physical training. The databases MEDLINE; EMBASE; CINAHL Plus and SPORTDiscus were systematically literature searched with reference lists of all included studies and relevant reviews. Controlled trials (inactive elderly control group) involving healthy elderly participants over 75 years participating in an intervention complying with an established definition of physical training were included. Data extraction and quality assessment were performed using the PEDro scale. Data analysis was performed on muscle size and strength using RevMan (software version 5.1). Four studies were included of which four of four measured changes in gross muscle size. Training induced increases in muscle size from 1.5%-15.6% were reported in three of four studies, and one of four studies reported a decrease in muscle size (3%). The greatest gain in muscle mass was observed in a study of whole body vibration training. Meta-analysis of three studies found an increase of thigh muscle cross-sectional area (mean difference 2.31 cm(2) or 0.2%, 95% confidence interval (CI): 0.62 to 4.00; P = 0.008) and muscle strength (standardized mean difference 1.04, 95% CI: 0.65 to 1.43; P < 0.001). Physical training when delivered as resistance training has the ability to elicit hypertrophy and increase muscle strength in very elderly muscle.

Simple pressure bandage technique for free skin grafts.

We applied sterile packed cellulose sponges in the dehydrated state as a pressure dressing from skin grafts by using the classic "tie-over" technique. At the end of the procedure, the sponges were hydrated, and provided flat, even pressure to a localized area. By using this simple technique, we obtained 26 of 27 successful free skin grafts with flat apposition.

Physical fitness training for stroke patients.

BACKGROUND: Stroke patients have impaired physical fitness and this may exacerbate their disability. It is not known whether improving physical fitness after stroke reduces disability. OBJECTIVES: The primary aims of the review were to establish whether physical fitness training reduces death, dependence and disability after stroke. The secondary aims of the review included an investigation of the effects of fitness training on secondary outcome measures (including, physical fitness, mobility, physical function, health and quality of life, mood and the incidence of adverse events). SEARCH STRATEGY: We searched the Cochrane Stroke Group Trials Register (June 2003). In addition, the following electronic databases were searched: Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2002 Issue 4), MEDLINE (1966 to December 2002), EMBASE (1980 to December 2002), CINAHL (1982 to December 2002), SPORTDiscus (1949 to December 2002), Science Citation Index Expanded (1981 to December 2002), Web of Science Proceedings (1982 to December 2002), Physiotherapy Evidence Database (December 2002), REHABDATA (1956 to December 2002) and Index to UK Theses (1970 to December 2002). We hand searched relevant journals and conference proceedings and screened reference lists. To identify unpublished and ongoing trials we searched trials directories and contacted experts in the field. SELECTION CRITERIA: Randomised controlled trials were included when an intervention represented a clear attempt to improve either muscle strength and/or cardiorespiratory fitness, and whose control groups comprised either usual care or a non-exercise intervention. DATA COLLECTION AND ANALYSIS: Data from eligible studies were independently extracted by two reviewers. The primary outcome measures were death, disability and dependence. The lack of common outcome measures prevented some of the intended analysis. MAIN RESULTS: A total of twelve trials were included in the review. No trials reported death and dependence data. Two small trials reporting disability showed no evidence of benefit. The remaining available secondary outcome data suggest that cardiorespiratory training improves walking ability (mobility). Observed benefits appear to be associated with specific or 'task-related' training. REVIEWER'S CONCLUSIONS: There are few data available to guide clinical practice at present with regard to fitness training interventions after stroke. More general research is needed to explore the efficacy and feasibility of training, particularly soon after stroke. In addition more specific studies are required to explore the effect of content and type of training. Further research will require careful planning to address a number of issues peculiar to this type of intervention.

Subcutaneous-based triangular skin flaps.

Subcutaneous-based triangular skin flaps that have no skin attachments are discussed as a useful method for closing round defects in the medial and lateral canthal regions when adjacent skin is inadequate.

The "corncrib" repair of senile entropion.

A new method of senile entropion repair has been described. The method corrects the entropion by affecting those conditions which create an entropion: enophthalmos, lid laxity, preseptal orbicularis movement, and retractor weakness. A 3.4% recurrence rate in 58 lids followed an average 17 months was found. This procedure is simple and applicable to all senile entropion patients.

The effectiveness of the pigtail probe method of repairing canalicular lacerations.

The pigtail probe method of repairing canalicular lacerations is a widely used technique, however its long-range effectiveness has never been documented. By evaluating statistical data on 51 canalicular lacerations, and then examining 30 patients who had been repaired by the pigtail probe we were able to conclude that: a left inferior canalicular laceration, in a young male, following assault is the most common presentation; that this method objectively yields a 36.6% patency rate with a 10% incidence of iatrogenic damage to the uninvolved side; that 73.3% of the failures remained asymptomatic; secondary to keratitis sicca, a functioning conjunctival canalicular fistula, or the patent remaining canaliculus; and that the inferior canaliculus appears to be symptomatically more important than the superior canaliculus. It is suggested that all canalicular lacerations be repaired, but that the pigtail probe method be abandoned.