Risk factors of recurrent secondary hyperparathyroidism after adequate primary surgical treatment.

Background: Secondary hyperparathyroidism (SHPT) is a common condition in patients with end-stage renal disease (ESRD) who are on dialysis. Parathyroidectomy is a treatment for patients when medical therapy has failed. Recurrence may occur and is indicated for further surgery in the era of improved quality of care for ESRD patients. Methods: We identified, 1060 patients undergoing parathyroidectomy from January, 2011 to June, 2020. After excluding patients without regular check-up at our institute, primary hyperparathyroidism, or malignancy, 504 patients were enrolled. Sixty-two patients (12.3%, 62/504) were then excluded due to persistent SHPT even after the first parathyroidectomy. We aimed to identify risk factors for recurrent SHPT after the first surgery. Results: During the study period, 20% of patients who underwent parathyroidectomy at our institute (in, 2019) was due to recurrence after a previous parathyroidectomy. There were 442 patients eligible for analysis of recurrence after excluding patients with the persistent disease (n = 62). While 44 patients (9.95%) had recurrence, 398 patients did not. Significant risk factors for recurrent SHPT within 5 years after the first parathyroidectomy, including dialysis start time to first operation time < 3 years (p = 0.046), postoperative PTH >106.5 pg/mL (p < 0.001), and postoperative phosphorus> 5.9 mg/dL (p = 0.016), were identified by multivariate analysis. Conclusions: The starting time of dialysis to first operation time < 3 years in the patients with dialysis, postoperative PTH> 106.5 pg/mL, and postoperative phosphorus> 5.9 mg/dL tended to have a higher risk for recurrent SHPT within 5 years after primary treatment.

Effects of Protein-Rich Nutritional Composition Supplementation on Sarcopenia Indices and Physical Activity during Resistance Exercise Training in Older Women with Knee Osteoarthritis.

Older adults with knee osteoarthritis (KOA) are at high risk of sarcopenia. Protein-rich nutritional composition supplementation (PS) combined with resistance exercise training (RET) improves muscle gains and facilitates physical activity in older adults. However, whether PS augments the effects of RET on muscle mass and PA in patients with KOA remains unclear. Therefore, this study identified the effects of PS on sarcopenic indices and PA in older women with KOA subjected to an RET program. Eligible older women aged 60-85 years and diagnosed as having KOA were randomly assigned to either the experimental group (EG) or the control group (CG). Both groups performed RET twice a week for 12 weeks. The EG received additional PS during this period. Outcome measures included appendicular lean mass index, walking speed, physical activity, and scores on the Western Ontario and McMaster Universities Osteoarthritis Index-WOMAC). All measures were tested at baseline and after intervention. With participant characteristics and baseline scores as covariates, analysis of variance was performed to identify between-group differences in changes in all outcome measures after intervention. Statistical significance was defined as p < 0.05. Compared with the CG, the EG achieved greater changes in appendicular lean mass index (adjusted mean difference (aMD) = 0.19 kg/m2, p < 0.01), physical activity (aMD = 30.0 MET-hour/week, p < 0.001), walking speed (aMD = 0.09 m/s, p < 0.05), and WOMAC global function (aMD = -8.21, p < 0.001) after intervention. In conclusion, PS exerted augmentative effects on sarcopenic indices, physical activity, and perceived global WOMAC score in older women with KOA through 12 weeks of RET.

12-Week Inspiratory Muscle Training Improves Respiratory Muscle Strength in Adult Patients with Stable Asthma: A Randomized Controlled Trial.

This study aims to investigate and compare the effects of conventional breathing exercises and an inspiratory muscle training intervention on clinical symptoms in asthma patients. Sixty asthma patients (40-65 years old) were randomly assigned to either the conventional breathing exercises (BTE) or inspiratory muscle training (IMT) group for a 12-week intervention period. Outcome measurements were performed before and after the intervention, including the spirometry data, maximal inspiratory and expiratory pressures (PImax and PEmax), asthma control test, asthma control questionnaire, six-minute walk test, and three-day physical activity log, were recorded. PImax expressed as % of predicted value controlled for age and gender in healthy subjects (% predicted) increased by 16.92% (82.45% to 99.38%, p < 0.05) in the BTE group and by 29.84% (71.19% to 101.03%, p < 0.05) in the IMT group. Except for forced vital capacity, which was reduced in the BTE group, all other measured variables improved in both groups, and no statistically significant between-group differences were found. IMT appears to be more effective than breathing exercise intervention in promoting improvements in respiratory muscle strength. IMT may act as an alternative to conventional breathing exercises for middle-aged and elderly asthma patients.

Six-week inspiratory resistance training ameliorates endurance performance but does not affect obesity-related metabolic biomarkers in obese adults: A randomized controlled trial.

This investigation examined the effects of a six-week inspiratory resistance training (IRT) on metabolic health biomarkers, pulmonary function, and endurance in obese individuals. Twenty-eight obese adults (BMI > 27 kg/m2 Taiwan obesity criteria) were randomly assigned to either IRT (IRT; N = 16) or sham control (PLA; N = 12). The training parameters (twice/day; 3 days/week; 30 breaths/section; IRT: 55% PImax [maximal inspiratory pressure], PLA: 10% PImax) were identical. The endurance, pulmonary function, and blood lipid profiles were measured before/after intervention. After training, the PImax in IRT was greater than in PLA (+49.6%, p < .001), and the 6-minute walking test (6MWT) performance in IRT was greater than in PLA (+12.9%, p = 0.001). However, there were no differences in pulmonary function (FVC, FEV1, or FEV1/FVC) and lipid profiles between groups. Our results demonstrate that a six-week progressively-programmed IRT was effective to improve endurance capacity and inspiratory muscle strength in obese individuals, whereas the IRT had no effects on pulmonary function, body composition, and blood lipid profiles.

The Effects of Expiratory Muscle Strength Training on Voice and Associated Factors in Medical Professionals With Voice Disorders.

OBJECTIVES: This research used expiratory muscle strength training to explore the factors relevant to medical professionals with voice disorders. The maximal expiratory pressure (MEP) improved, which is measured by the maximal contracting force of expiratory muscles. The expiratory muscle strength increased, which can affect the positive pressure of pulmonary volume, thereby influencing subglottal pressure for speech to change the voice performance and vocal-fold vibration. METHODS: Twenty-nine participants with voice disorders who are working in a hospital and who are using their voice for more than 4 hours per day were recruited. The participants were randomly assigned to either the study group (STU) or the control group (CON). All participants underwent aerodynamics analysis, pulmonary function, MEP, and completed a vocal symptoms questionnaire before and after STU was provided. The interventions in the STU were conducted 3 days per week and involved performing 25 expiratory exercises (five cycles, each comprising five breaths) for 5 weeks. The CON did not receive any intervention. RESULTS: The voiceless /S/ expiratory time, symptom questionnaire scores, and MEP were greater in the STU than in the CON (P < 0.05). However, no statistically significant difference in the results of the pulmonary function was observed between the groups. The STU exhibited a greater percentage change in maximal voiced /Z/ phonation and voiceless /S/ expiratory compared with the CON (P < 0.05). CONCLUSIONS: The participants' voiceless /S/ expiratory time, symptom questionnaire scores, and MEP significantly improved after the intervention. Future studies can increase the number of participants, increase the number of study groups, and examine the effectiveness of long-term treatment.

Green tea extract supplementation does not hamper endurance-training adaptation but improves antioxidant capacity in sedentary men.

The purpose of this study was to investigate the effect of green tea extract (GTE) supplementation combined with endurance training on endurance capacity and performance in sedentary men. Forty untrained men (age: 20 ± 1 years) participated in this study. Subjects were assigned to 1 of 4 treatments: (i) placebo-control (CTRL), (ii) GTE, (iii) endurance training (Ex), and (iv) endurance training with GTE (ExGTE). During the 4-week intervention, exercise training was prescribed as 75% oxygen uptake reserve for three 20-min sessions per week, and either GTE (250 mg/day) or placebo was provided. Endurance capacity, malondialdehyde (MDA), total antioxidant status (TAS), and creatine kinase (CK) were examined. Ex and ExGTE but not GTE improved exhaustive-run time (Ex: +8.2%, p = 0.031; ExGTE: +14.3%, p < 0.001); in addition, Ex and ExGTE significantly increased maximal oxygen uptake by ∼14% (p = 0.041) and ∼17% (p = 0.017) above the values of the CTRL group, respectively. Both Ex and ExGTE significantly decreased the increase of CK by ∼11%-32% below that of CTRL following an exhaustive run (Ex: p = 0.007; ExGTE: p = 0.001). Moreover, TAS levels increased by ∼11% in ExGTE after training (p = 0.040), and GTE, Ex, and ExGTE markedly attenuated exercise-induced MDA production (p = 0.01, p = 0.005, p = 0.011, respectively). In conclusion, this investigation demonstrated that daily ingestion of GTE during endurance training does not impair improvements in endurance capacity. Moreover, endurance training combined with GTE not only increases antioxidant capacity without attenuating endurance training adaptations, but also further attenuates acute exercise-induced CK release.