Effect of range of motion in heavy load squatting on muscle and tendon adaptations.

Manipulating joint range of motion during squat training may have differential effects on adaptations to strength training with implications for sports and rehabilitation. Consequently, the purpose of this study was to compare the effects of squat training with a short vs. a long range of motion. Male students (n = 17) were randomly assigned to 12 weeks of progressive squat training (repetition matched, repetition maximum sets) performed as either a) deep squat (0-120° of knee flexion); n = 8 (DS) or (b) shallow squat (0-60 of knee flexion); n = 9 (SS). Strength (1 RM and isometric strength), jump performance, muscle architecture and cross-sectional area (CSA) of the thigh muscles, as well as CSA and collagen synthesis in the patellar tendon, were assessed before and after the intervention. The DS group increased 1 RM in both the SS and DS with ~20 ± 3 %, while the SS group achieved a 36 ± 4 % increase in the SS, and 9 ± 2 % in the DS (P < 0.05). However, the main finding was that DS training resulted in superior increases in front thigh muscle CSA (4-7 %) compared to SS training, whereas no differences were observed in patellar tendon CSA. In parallel with the larger increase in front thigh muscle CSA, a superior increase in isometric knee extension strength at 75° (6 ± 2 %) and 105° (8 ± 1 %) knee flexion, and squat-jump performance (15 ± 3 %) were observed in the DS group compared to the SS group. Training deep squats elicited favourable adaptations on knee extensor muscle size and function compared to training shallow squats.

Partial liver ischemia is followed by metabolic changes in the normally perfused part of the liver during reperfusion.

BACKGROUND: Temporary vascular in- and outflow occlusion is an effective technique for bleeding control during liver resection. However, occlusion can result in ischemia/reperfusion (I/R) injury to the liver. The aim of this study in a porcine model was to investigate the effect of in- and outflow occlusion of part of the liver on the metabolism of the normally perfused parenchyma of the same liver measured by microdialysis. METHODS: Eight pigs underwent laparotomy. A microdialysis catheter was inserted into in the left and right part of the liver, respectively. Microdialysis samples were collected every 30 min. Occlusion of the left part of the liver was achieved for 60 min, followed by 5 h of reperfusion. Samples were analyzed for glucose, lactate, pyruvate and glycerol. Blood samples were drawn to determine standard liver and biochemical parameters. RESULTS: Comparing the ischemic part of the liver with the normally perfused part, significant differences in the levels of lactate, pyruvate and glycerol were found. During reperfusion, similar and continuous decreases below baseline levels were observed for lactate and pyruvate in both the ischemic and normally perfused part of the liver. No significant changes in liver parameters or blood glucose levels were seen. CONCLUSIONS: Partial ischemia of the liver is without effects on metabolism in the normally perfused part. Metabolic changes in the ischemic part of the liver were reversible. However, partial liver ischemia was followed by similar continuous decreases in lactate and pyruvate levels in the whole liver, even though the ischemic insult was not detectable in transaminase levels.

Does rapid intraoperative parathyroid hormone analysis predict cure in patients undergoing surgery for primary hyperparathyroidism? A prospective study.

BACKGROUND AND AIMS: Preoperative 99mTc-sestamibi scintigraphy is used by many surgeons to identify the anatomical location of pathological parathyroid glands in patients undergoing surgical treatment for hyperparathyroidism. However, false negative results do occur. It has been suggested that intraoperative parathyroid hormone (PTH) analysis may enhance the possibility of performing successful focused, unilateral neck surgery in these patients. This study aimed to evaluate whether an adequate fall in intraoperative parathyroid hormone values predicts the removal of all hyperfunctioning parathyroid tissue and postoperative normocalcemia. MATERIAL AND METHODS: One hundred consecutive patients undergoing surgery for hyperparathyroidism had preoperative 99mTc-sestamibi scintigraphy and intraoperative parathyroid hormone (PTH) analysis. A fall in intraoperative PTH value by more than 50% of baseline value ended the procedure. This prospective study presents the clinical and biochemical results. RESULTS: The overall sensitivity of the 99mTc-sestamib scintigraphy was 88% and for single adenomas 95%. The scintigraphy failed to detect the correct pathology in all cases with multiglandular disease (7 patients). A fall in intraoperative PTH value by more than 50% of baseline value was achieved in all patients. The combination of intraoperative PTH analysis and 99mTc-sestamibi scintigraphy enabled us to limit the operation to a focused, unilateral operation in 87 of the 100 patients. All patients were normocalcemic postoperatively. CONCLUSIONS: A fall in intraoperative PTH value more than 50 % of baseline value seems to predict postoperative normocalcemia and the removal of all hyperfunctioning parathyroid tissue. Bilateral neck exploration is avoided in the majority of patients.

A randomised controlled trial of postal versus interviewer administration of a questionnaire measuring satisfaction with, and use of, services received in the year before death.

STUDY OBJECTIVES: To develop a short form of an interview schedule used successfully in previous national surveys of care for the dying, and to investigate the effect of administering it by post on response rate, response bias and on the nature of responses to questions. DESIGN: Randomised controlled trial. SETTING: An inner London health authority. PARTICIPANTS: Informants (person registering death) of random sample of cancer deaths between June 1995 and July 1996. MAIN RESULTS: The shortened questionnaire (VOICES) has 158 questions. Response rate did not differ significantly between postal and interview groups (interview; 56% (69 of 123), postal: 52% (161 of 308). Responders in the two groups did not differ in terms of their sociodemographic characteristics. Postal questionnaires had significantly more missing data, particularly on questions about service provision and satisfaction with services. Responses to questions differed between the groups on 11 of 158 questions. Interview group respondents were more likely to give top ranking responses to questions on service satisfaction and symptom control. CONCLUSIONS: Postal questionnaires are an acceptable alternative to interviews in retrospective post-bereavement surveys of care for the dying, at least in terms of response rate and response bias. However, the increased costs of interview surveys need to be balanced against the fact that postal questionnaires result in more missing data, and possibly less reliable answers to some questions. Caution is needed in combining results from the two data collection methods as interview respondents gave more positive answers to some questions.

Visual laser coagulation of the prostate using intraurethral gel anesthesia and light intravenous analgesia and sedation.

Twenty-eight patients with symptomatic bladder outlet obstruction secondary to benign prostatic hyperplasia were treated as outpatients by visual laser coagulation of the prostate using only intraurethral gel anesthesia and light intravenous sedation and analgesia. No premedication was administered. Laser coagulation was performed with the Myriadlase side-firing fiber using a standard Sharplan neodymium: YAG laser source at 40 W power setting, and 650 (516-1000) J/g of prostate tissue was delivered. Patient acceptance was favorable. All remained relaxed, cooperative, and without pain during the procedure. None of the patients required any further anesthesia. There was no significant change in blood pressure, pulse rate, or peripheral oxygen saturation measurements during the procedure. Any patient who feels comfortable with a diagnostic cystoscopy being performed using intraurethral gel anesthesia should find this anesthesia protocol acceptable for laser coagulation of the prostate.

Absence of activation of proteolytic enzymes by extracorporeal shock waves.

The mechanism of tissue damage by extracorporeal shock wave lithotripsy has not been clarified, but proteolytic enzymes are known to play an important role in tissue breakdown in response to other types of injury. Screening tests for activation of the proteolytic enzymes kallikrein, plasmin, trypsins 1 and 2, and granulocyte elastase therefore were performed for 4 to 5 hours in 14 dogs after unilateral treatment with 1500 or 2000 extracorporeal shock waves under anesthesia and vigorous hydration. We also studied the activity of the proenzymes prekallikrein, plasminogen, and prothrombin and three plasma protease inhibitors (kallikrein inhibitor, antiplasmin, and antithrombin III). Blood from both renal veins (treated and control kidneys) and the aorta and tissue samples of the injured renal parenchyma and corresponding areas of the control kidneys revealed no proteolytic enzyme activation by the shock waves and no decline in the activities of proenzymes and enzymes inhibitors. Significant proteolysis does not seem to play a part in the tissue injury induced by extracorporeal shock wave lithotripsy.

Gas-containing renal stones treated with percutaneous nephrolithotomy: case report.

We present a rare case of E. coli emphysematous pyelonephritis with sepsis. The radiologic presentation consisted of multiple radiolucent gas-filled, free-floating uric acid calculi in a hydronephrotic renal pelvis. The infection was treated by intravenous fluids and antibiotics and percutaneous nephrostomy drainage. The patient was rendered stone free by percutaneous nephrolithotomy and ultrasound lithotripsy.

Measurement of sound emission by endoscopic lithotripters: an in vitro study and theoretical estimation of risk of hearing loss in a fetus.

BACKGROUND: There is concern about applying intraureteral lithotripsy in pregnant patients, as the sound created by the equipment may damage fetal hearing. MATERIALS AND METHODS: The sound intensities produced by electrokinetic, pneumomechanic, holmium laser, ultrasound, and electrohydraulic intraluminal lithotripters were measured in an in vitro model. RESULTS: The purely mechanical modalities (electrokinetic and pneumomechanic) generated lower peak pressures than the other devices. Theoretical calculations were performed based on the fact that in vivo, the sound path and the fetal middle ear cavities are filled with fluid. Calculated pressure levels that give displacement amplitudes of the tympanic membrane, the ossicles, and the basilar membrane comparable to hearing loss risk criteria for airborne impulsive noise are greater than measured for all of the lithotripters. The fluid-filled middle ear thus seems to give the fetus protection against sound. The fluid also improves the symmetry of the cochlea structure, reducing the influence of direct bone transmission. CONCLUSIONS: The peak pressure of the sound emitted by lithotripsy in the ureter during pregnancy is unlikely to be harmful to fetal hearing. Other risk factors, such as the form of the sound waves and the pulse duration were not evaluated. The theoretical assessments are simplified, and one should be careful about drawing conclusions from theoretical considerations and calculations alone.

Age is not the crucial factor in determining how the palliative care needs of people who die from cancer differ from those of people who die from other causes.

A belief that the hospice philosophy is particularly applicable to younger people may account in part for the continued focus of palliative care on cancer patients, as it has been argued that age is the crucial factor in determining how cancer and non-cancer patients differ. We conducted a secondary analysis of the data from a UK population-based retrospective survey, the Regional Study of Care for the Dying, to critically examine this proposition. The sample comprised 2062 cancer and 1471 non-cancer deaths. On average cancer patients were younger. However, at all ages non-cancer and cancer patients differed significantly with, for example, different patterns of dependency and symptomatology. The cause of death--rather than age--is therefore the principal difference between cancer and non-cancer patients. The debate within palliative care on whether and how to provide services for non-cancer patients must move beyond a focus on group differences such as age between these and cancer patients and focus instead on understanding the varying problems non-cancer patients experience, and addressing how best to organize palliative care services to meet the individual needs of these patients.

Ethnic variations in overweight and obesity among children over time: findings from analyses of the Health Surveys for England 1998-2009.

BACKGROUND: The increase in the prevalence of obesity among children and adolescents in England since the mid-1990s has been dramatic. Cross-sectional evidence suggests ethnic variations in childhood obesity prevalence. OBJECTIVES: The objective of the study was to examine whether and how ethnic variations in childhood overweight/obesity have changed over time, and are affected by socioeconomic factors. METHOD: This study uses logistic regression to analyse ethnic differences in the relative likelihood of being at or above the age- and gender-specific thresholds for overweight and obesity developed by the International Obesity Task Force among children aged between 2 and 15 from 11 ethnic groups included in the Health Surveys for England between 1998 and 2009, adjusting for age, gender, year of data collection and equivalized household income. We separately analyse the likelihood of being at or above the thresholds for overweight (but below those for obesity) and obesity. RESULTS: Trends in overweight/obesity over time among ethnic minority groups do not follow those of white English children. Black African children had higher rates of overweight and obesity, which appear to have peaked, and black Caribbean children had higher rates of obesity than other groups examined, which appear to continue rising. These differences were not explained by socioeconomic variations between groups. CONCLUSION: Policies are required that encourage healthy lifestyles among ethnic minority young people, while engaging with the complexities associated with these choices during childhood and adolescence.

Growing seasons of Nordic mountain birch in northernmost Europe as indicated by long-term field studies and analyses of satellite images.

The phenophases first greening (bud burst) and yellowing of Nordic mountain birch (Betula pubescens ssp.tortuosa, also called B. p. ssp. czerepanovii) were observed at three sites on the Kola Peninsula in northernmost Europe during the period 1964-2003, and at two sites in the trans-boundary Pasvik-Enare region during 1994-2003. The field observations were compared with satellite images based on the GIMMS-NDVI dataset covering 1982-2002 at the start and end of the growing season. A trend for a delay of first greening was observed at only one of the sites (Kandalaksha) over the 40 year period. This fits well with the delayed onset of the growing season for that site based on satellite images. No significant changes in time of greening at the other sites were found with either field observations or satellite analyses throughout the study period. These results differ from the earlier spring generally observed in other parts of Europe in recent decades. In the coldest regions of Europe, e.g. in northern high mountains and the northernmost continental areas, increased precipitation associated with the generally positive North Atlantic Oscillation in the last few decades has often fallen as snow. Increased snow may delay the time of onset of the growing season, although increased temperature generally causes earlier spring phenophases. Autumn yellowing of birch leaves tends towards an earlier date at all sites. Due to both later birch greening and earlier yellowing at the Kandalaksha site, the growing season there has also become significantly shorter during the years observed. The sites showing the most advanced yellowing in the field throughout the study period fit well with areas showing an earlier end of the growing season from satellite images covering 1982-2002. The earlier yellowing is highly correlated with a trend at the sites in autumn for earlier decreasing air temperature over the study period, indicating that this environmental factor is important also for autumn phenophases.

[Surgical treatment of urolithiasis in Norway]. / Kirurgisk behandling av urolithiasis i Norge.

The aim of the study was to investigate treatment strategies for urolithiasis as they are practised in Norway today. A questionnaire was sent to the somatic hospitals in Norway. All surgical treatment of urolithiasis was to be registered over a three month period, from 1 September to 30 November 1992. 78% of the hospitals responded, and 505 patients were included in the survey. Extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy and uretero-renoscopy are well established treatment modalities in all parts of the country. The treatment practice follows the accepted international guidelines and treated at the larger treatment centres.

[Extracorporeal shock wave lithotripsy in urolithiasis. An update]. / Ekstrakorporal sjokkbølgebehandling av urolithiasis. En oppdatering.

The author discusses the present role of extracorporeal shock wave treatment of urolithiasis. The views are based on personal experience and a review of the recent literature. Compared with the original device, second generation lithotriptors have led to almost painless treatment. They are less effective in fragmenting the stones, however, which implies a higher number of repeat treatments. The indications and contraindications for extracorporeal shock wave lithotripsy have remained unchanged over the last years. In principle, stones along the whole upper urinary tract can be treated. The ideal situation is a stone in the kidney pelvis less than 2.5 cm in diameter or an unimpacted stone in the upper or lower ureter, with normal collective system anatomy. The main determinants for treatment outcome are stone burden, number, location and chemical composition, presence of infection, intrarenal anatomy and fluid dynamics. Special situations often need additional treatment with other treatment modalities. Rest fragments, even less than 4 mm, are often of clinical significance within two years of treatment. Bioeffects of extracorporeal shock wave lithotripsy include anatomical and functional alterations. Usually they are resolved within weeks. The relationship between extracorporeal shock wave lithotripsy and new onset hypertension remains unresolved.

Branched renal calculi treated by percutaneous nephrolithotomy and extracorporeal shock waves.

Fifty-four renal staghorn calculi, 26 complete and 28 partial, were treated in 51 patients by percutaneous nephrolithotomy (PCN) in combination with extracorporeal shock wave lithotripsy (ESWL) when necessary. At an average time of observation of 11.1 months, 56% of the renal units were stone free. Twenty-two per cent had residual gravel of less than 2 mm in diameter and 15% contained residuals between 2 and 5 mm in diameter. Seven per cent of the kidneys had significant residual calculi. Additional endourological procedures were required in 13 cases. Complications were minimal and were all conservatively treated. PCN in combination with ESWL is an effective treatment of most branched renal calculi. The methods may be used repeatedly without increasing technical difficulty. The results compare well with open surgery.