The effect of a home-based coaching program on heart rate variability in subacute stroke patients: a randomized controlled trial.

Autonomic imbalance in stroke is characterized by increased sympathetic activity and reduced vagal nerve activity. Physical activity could be a strategy to counteract autonomic control impairments after a stroke. The aim of the study was to evaluate the effect on heart rate variability of a 6-month coaching program in a home setting in subacute stroke patients. Eighty-four stroke patients participated in the study. They were randomly assigned to the experimental group or the control group. The intervention was a coaching program, consisting of physical activity, home visits and a weekly phone call. Patients were evaluated after hospital discharge (T0) and at the end of the 6-month period (T1). Heart rate variability measures were recorded in the supine and orthostatic positions. Time and frequency domain values were treated using Kubios. Distance on 6 minutes walking test (6MWT), Barthel and motricity index and modified functional ambulation categories were evaluated. No effects were found on time and frequency domain values in the supine and orthostatic positions in either group. Walking distance on 6MWT increased significantly between T0 and T1 in experimental group (377 ± 141-448 ± 140 m; P < 0.02) with no effects in control group (373.6 ± 150.6-394.6 ± 176.4 m). No other functional effects were found. A coaching program in a home setting had no effect on heart rate variability, probably due to time of recovery and exercise intensity. Future research is needed to understand the lack of changes in heart rate variability by physical activity in subacute stroke patients.

Procalcitonin concentration in the emergency department predicts 30-day mortality in COVID-19 better than the lymphocyte count, the neutrophil-tolymphocyte ratio, or the C-reactive protein level. / Procalcitonina es superior a recuento linfocitario, índice neutrófilo/linfocito y proteína C reactiva para la predicción de mortalidad a 30 días de pacientes con COVID-19 en el servicio de urgencias.

OBJECTIVES: Although many demographic and clinical predictors of mortality have been studied in relation to COVID-19, little has been reported about the prognostic utility of inflammatory biomarkers. MATERIAL AND METHODS: Retrospective cohort study. All patients with laboratory-confirmed COVID-19 treated in a hospital emergency department were included consecutively if baseline measurements of the following biomarkers were on record: lymphocyte counts, neutrophil-to-lymphocyte ratio NRL, and C-reactive protein (CRP) and procalcitonin (PCT) levels. We analyzed associations between the biomarkers and all-cause 30-day mortality using Cox regression models and dose-response curves. RESULTS: We included 896 patients, 151 (17%) of whom died within 30 days. The median (interquartile range) age was 63 (51-78) years, and 494 (55%) were men. NLR, CRP and PCT levels at ED presentation were higher, while lymphocyte counts were lower, in patients who died compared to those who survived (P .001). The areas under the receiver operating characteristic curves revealed the PCT concentration (0.79; 95% CI, 0.75-0.83) to be a better predictor of 30-day mortality than the lymphocyte count (0.70; 95% CI, 0.65-0.74; P .001), the NLR (0.74; 95% CI, 0.69-0.78; P = .03), or the CRP level (0.72; 95% CI, 0.68-0.76; P .001). The proposed PCT concentration decision points for use in emergency department case management were 0.06 ng/L (negative) and 0.72 ng/L (positive). These cutoffs helped classify risk in 357 patients (40%). Multivariable analysis demonstrated that the PCT concentration had the strongest association with mortality. CONCLUSION: PCT concentration in the emergency department predicts all-cause 30-day mortality in patients with COVID-19 better than other inflammatory biomarkers.

OBJETIVO: Existen múltiples variables demográficas y clínicas predictivas de mortalidad en pacientes con COVID-19. Sin embargo, hay menos información sobre el valor pronóstico de los biomarcadores inflamatorios. METODO: Estudio de cohorte retrospectivo. Se incluyeron de forma consecutiva todos los pacientes con COVID-19, confirmado por laboratorio, atendidos en un servicio de urgencias hospitalario (SUH) y con valor basal de los siguientes biomarcadores: recuento linfocitario, índice neutrófilo/linfocito (INL), proteína C reactiva (PCR) y procalcitonina (PCT). La relación entre los biomarcadores y la mortalidad total a 30 días se analizó mediante una regresión de Cox y gráficos de dosis-respuesta. RESULTADOS: Se incluyeron 896 pacientes, 151 (17%) fallecieron en los primeros 30 días. La mediana de edad fue de 63 años (51-78) y 494 (55%) eran hombres. El valor de INL, PCR y PCT fue mayor, mientras que el recuento linfocitario fue menor, en los pacientes que fallecieron respecto a los que sobrevivieron (p 0,001). La PCT fue superior al recuento linfocitario, INL y PCR en la predicción de mortalidad a 30 días (ABC 0,79 [IC 95%: 0,75-0,83] vs 0,70 [IC 95%: 0,65-0,74], p 0,001; 0,74 [IC 95%: 0,69-0,78], p = 0,03; y 0,72 [IC 95%: 0,68-0,76], p 0,001). Los puntos de decisión de PCT propuestos, 0,06 ng/l para exclusión y 0,72 ng/l para inclusión de muerte a 30 días, podrían facilitar la toma de decisiones en urgencias. Hubo 357 pacientes (40%) con valores de PCT en estas categorías. El análisis multivariable mostró una mayor asociación con la mortalidad para PCT que en los otros biomarcadores estudiados. CONCLUSIONES: PCT es el biomarcador con mejor capacidad para predecir mortalidad a 30 días por cualquier causa en pacientes con COVID-19 valorados en un SUH.

Error Propagation in Microwave Soil Moisture and Vegetation Optical Depth Retrievals.

Satellite soil moisture and vegetation optical depth [(VOD); related to the total vegetation water mass per unit area] are increasingly being used to study water relations in the soil-plant continuum across the globe. However, soil moisture and VOD are typically jointly estimated, where errors in the optimization approach can cause compensation between both variables and confound such studies. It is thus critical to quantify how satellite microwave measurement errors propagate into soil moisture and VOD. Such a study is especially important for VOD given limited investigations of whether VOD reflects in situ plant physiology. Furthermore, despite new approaches that constrain (or regularize) VOD dynamics to reduce soil moisture errors, there is limited study of whether regularization reduces VOD errors without obscuring true vegetation temporal dynamics. Here, we find that, across the globe, VOD is less robust to measurement error (more difficult for optimization methods to find the true solution) than soil moisture in their joint estimation. However, a moderate degree of regularization (via time-constrained VOD) reduces errors in VOD to a greater degree than soil moisture and reduces spurious soil moisture-VOD coupling. Furthermore, despite constraining VOD time dynamics, regularized VOD variations on subweekly scales are both closer to simulated true VOD time series and have global VOD post-rainfall responses with reduced error signatures compared to VOD retrievals without regularization. Ultimately, we recommend moderately regularized VOD for use in large scale studies of soil-plant water relations because it suppresses noise and spurious soil moisture-VOD coupling without removing the physical signal.

Effect of individualized coaching at home on walking capacity in subacute stroke patients: A randomized controlled trial (Ticaa'dom).

BACKGROUND: The gains in walking capacity achieved during rehabilitation often plateau, or are lost, when the patient returns home. Moreover, maintaining or increasing the patient's daily physical activity level after a stroke remains challenging. We aimed to evaluate the effectiveness of a six-month individualized coaching program at home on walking capacity, as evaluated by the six-minute walk test in subacute stroke patients. METHODS: Stroke patients in the physical medicine and rehabilitation service participated in a monocentric observer blinded randomized controlled trial with two groups, intervention versus usual care control. The inclusion criteria were: age≥18 years, first ischemic or hemorrhagic stroke, and stroke within<6 months. Participants were randomly assigned (blocks of variable size) to an intervention group (EG) receiving individualized coaching on physical activity, or to a control group (CG) receiving standard care. The six-month program was composed of monitored physical activity, home visits and a weekly phone call. Participants were evaluated after hospital discharge (T0), at the end of the six-month program (T1) and six months later(follow-up; T2). The primary outcome was the walking distance performance, as evaluated with the six-minute walk test at T1. RESULTS: Eighty-three participants (age: 61y [IQR=22]; time post-stroke: 2.4 month [IQR=1.7]; Barthel index: 100[IQR=5]) were included in the study: (EG, n=41; CG, n=42). The difference between the two groups was not significant at T1(418m [IQR=165] for the EG and 389m [IQR=188] for the CG; P=0.168) and at T2(425m [IQR=121] for the EG vs. 382m [IQR=219] for the CG; P=0.208). CONCLUSION: Our study shows no difference in the six-minute walk test between the two groups of subacute stroke patients after 6 months of the individualized coaching program, combining home visits, feedback on daily performance and weekly telephone calls. http://ClinicalTrials.gov (NCT01822938).

Categorías diagnósticas y resultados a corto plazo en los pacientes con sospecha de COVID-19 atendidos en un servicio de urgencias / Diagnostic groups and short-term outcomes in suspected COVID-19 cases treated in an emergency department

OBJETIVO: EL objetivo principal fue describir el perfil clínico y la mortalidad a los 30 días de diferentes categorías diagnósticas en los casos de COVID-19 atendidos en un servicio de urgencias (SU). MÉTODO: Análisis secundario del registro COVID-19_URG-HCSC. Se seleccionaron los casos sospechosos de COVID-19 atendidos en un SU de Madrid desde el 28 de febrero hasta el 31 de marzo de 2020. La muestra se dividió: 1) sospecha con PCR no realizada (S/PCR NR); 2) sospecha con PCR negativa (S/PCR-); 3) sospecha con PCR positiva (S/PCR+); 4) alta sospecha con PCR negativa o no realizada (AS/PCR- o NR); y 5) alta sospecha con PCR positiva (AS/PCR+). Se recogieron variables clínicas, radiológicas y microbiológicas del episodio de urgencias. La variable de resultado principal fue la mortalidad por cualquier causa a los 30 días. Las variables secundarias fueron el ingreso y la gravedad del episodio. RESULTADOS: Se incluyeron 1.993 pacientes; 17,2% S/PCR NR, 11,4% S/PCR-, 22,1% S/PCR+, 11,7% AS/PCR- o NR y 37,6% AS/PCR+. Se hallaron diferencias estadísticamente significativas respecto a las variables demográficas, comorbilidad, clínicas, radiográficas, analíticas y terapéuticas y de resultados a corto plazo en función las categorías diagnósticas. La mortalidad global a los 30 días fue de un 11,5%, 56,5% casos fueron hospitalizados y 19,6% casos sufrieron un episodio grave. Las categorías de AS y de S/PCR+ tuvieron un incremento del riesgo ajustado de mortalidad a los 30 días y de sufrir un episodio grave durante el ingreso hospitalario respecto a S/PCR-. En relación al ingreso, solo las categorías de AS tuvieron un incremento del riesgo ajustado de hospitalización respecto a la categoría de S/PCR-. CONCLUSIONES: Existen diferentes categorías diagnósticas de la enfermedad COVID-19 en función del perfil clínico y microbiológico que tienen correlato con el pronóstico a 30 días

OBJECTIVE: The primary objective was to describe the clinical characteristics and 30-day mortality rates in emergency department patients with coronavirus disease 2019 (COVID-19) in different diagnostic groupings. METHODS: Secondary analysis of the COVID-19 registry compiled by the emergency department of Hospital Clínico San Carlos in Madrid, Spain. We selected suspected COVID-19 cases treated in the emergency department between February 28 and March 31, 2020. The cases were grouped as follows: 1) suspected, no polymerase chain reaction (PCR) test (S/no-PCR); 2) suspected, negative PCR (S/PCR-); 3) suspected, positive PCR (S/PCR+); 4) highly suspected, no PCR, or negative PCR (HS/no or PCR-); and 5) highly suspected, positive PCR (HS/PCR+). We collected clinical, radiologic, and microbiologic data related to the emergency visit. The main outcome was 30-day all-cause mortality. Secondary outcomes were hospitalization and clinical severity of the episode. RESULTS: A total of 1993 cases (90.9%) were included as follows: S/no-PCR, 17.2%; S/PCR-, 11.4%; S/PCR+, 22.1%; HS/no PCR or PCR-, 11.7%; and HS/PCR+, 37.6%. Short-term outcomes differed significantly in the different groups according to demographic characteristics; comorbidity and clinical, radiographic, analytical, and therapeutic variables. Thirty-day mortality was 11.5% (56.5% in hospitalized cases and 19.6% in cases classified as severe). The 2 HS categories and the S/PCR+ category had a greater adjusted risk for 30-day mortality and for having a clinically severe episode during hospitalization in comparison with S/PCR- cases. Only the 2 HS categories showed greater risk for hospitalization than the S/PCR- cases

Clinical presentation and outcome across age categories among patients with COVID-19 admitted to a Spanish Emergency Department.

PURPOSE: To determine the differences by age-dependent categories in the clinical profile, presentation, management, and short-term outcomes of patients with laboratory-confirmed COVID-19 admitted to a Spanish Emergency Department (ED). METHODS: Secondary analysis of COVID-19_URG-HCSC registry. We included all consecutive patients with laboratory-confirmed COVID-19 admitted to the ED of the University Hospital Clinico San Carlos (Madrid, Spain). The population was divided into six age groups. Demographic, baseline and acute clinical data, and in-hospital and 30-day outcomes were collected. RESULTS: 1379 confirmed COVID-19 cases (mean age 62 (SD 18) years old; 53.5% male) were included (18.1% < 45 years; 17.8% 45-54 years; 17.9% 55-64 years; 17.2% 65-74 years; 17.0% 75-84 years; and 11.9% ≥ 85 years). A statistically significant association was found between demographic, comorbidity, clinical, radiographic, analytical, and therapeutic variables and short-term results according to age-dependent categories. There were less COVID-specific symptoms and more atypical symptoms among older people. Age was a prognostic factor for hospital admission (aOR = 1.04; 95% CI 1.02-1.05) and in-hospital (aOR = 1.08; 95% CI 1.05-1.10) and 30-day mortality (aOR = 1.07; 95% CI 1.04-1.09), and was associated with not being admitted to intensive care (aOR = 0.95; 95% CI 0.93-0.98). CONCLUSIONS: Older age is associated with less COVID-specific symptoms and more atypical symptoms, and poor short-term outcomes. Age has independent prognostic value and may help in shared decision-making in patients with confirmed COVID-19 infection.

Diagnostic groups and short-term outcomes in suspected COVID-19 cases treated in an emergency department. / Categorías diagnósticas y resultados a corto plazo en los pacientes con sospecha de COVID-19 atendidos en un servicio de urgencias.

OBJECTIVES: The primary objective was to describe the clinical characteristics and 30-day mortality rates in emergency department patients with coronavirus disease 2019 (COVID-19) in different diagnostic groupings. MATERIAL AND METHODS: Secondary analysis of the COVID-19 registry compiled by the emergency department of Hospital Clínico San Carlos in Madrid, Spain. We selected suspected COVID-19 cases treated in the emergency department between February 28 and March 31, 2020. The cases were grouped as follows: 1) suspected, no polymerase chain reaction (PCR) test (S/no-PCR); 2) suspected, negative PCR (S/PCR-); 3) suspected, positive PCR (S/PCR+); 4) highly suspected, no PCR, or negative PCR (HS/no or PCR-); and 5) highly suspected, positive PCR (HS/PCR+). We collected clinical, radiologic, and microbiologic data related to the emergency visit. The main outcome was 30-day all-cause mortality. Secondary outcomes were hospitalization and clinical severity of the episode. RESULTS: A total of 1993 cases (90.9%) were included as follows: S/no-PCR, 17.2%; S/PCR-, 11.4%; S/PCR+, 22.1%; HS/no PCR or PCR-, 11.7%; and HS/PCR+, 37.6%. Short-term outcomes differed significantly in the different groups according to demographic characteristics; comorbidity and clinical, radiographic, analytical, and therapeutic variables. Thirty-day mortality was 11.5% (56.5% in hospitalized cases and 19.6% in cases classified as severe). The 2 HS categories and the S/PCR+ category had a greater adjusted risk for 30-day mortality and for having a clinically severe episode during hospitalization in comparison with S/PCR- cases. Only the 2 HS categories showed greater risk for hospitalization than the S/PCR- cases. CONCLUSION: COVID-19 diagnostic groups differ according to clinical and laboratory characteristics, and the differences are associated with the 30-day prognosis.

OBJETIVO: El objetivo principal fue describir el perfil clínico y la mortalidad a los 30 días de diferentes categorías diagnósticas en los casos de COVID-19 atendidos en un servicio de urgencias (SU). METODO: Análisis secundario del registro COVID-19_URG-HCSC. Se seleccionaron los casos sospechosos de COVID-19 atendidos en un SU de Madrid desde el 28 de febrero hasta el 31 de marzo de 2020. La muestra se dividió: 1) sospecha con PCR no realizada (S/PCR NR); 2) sospecha con PCR negativa (S/PCR­); 3) sospecha con PCR positiva (S/ PCR+); 4) alta sospecha con PCR negativa o no realizada (AS/PCR­ o NR); y 5) alta sospecha con PCR positiva (AS/ PCR+). Se recogieron variables clínicas, radiológicas y microbiológicas del episodio de urgencias. La variable de resultado principal fue la mortalidad por cualquier causa a los 30 días. Las variables secundarias fueron el ingreso y la gravedad del episodio. RESULTADOS: Se incluyeron 1.993 pacientes; 17,2% S/PCR NR, 11,4% S/PCR­, 22,1% S/PCR+, 11,7% AS/PCR­ o NR y 37,6% AS/PCR+. Se hallaron diferencias estadísticamente significativas respecto a las variables demográficas, comorbilidad, clínicas, radiográficas, analíticas y terapéuticas y de resultados a corto plazo en función las categorías diagnósticas. La mortalidad global a los 30 días fue de un 11,5%, 56,5% casos fueron hospitalizados y 19,6% casos sufrieron un episodio grave. Las categorías de AS y de S/PCR+ tuvieron un incremento del riesgo ajustado de mortalidad a los 30 días y de sufrir un episodio grave durante el ingreso hospitalario respecto a S/PCR­. En relación al ingreso, solo las categorías de AS tuvieron un incremento del riesgo ajustado de hospitalización respecto a la categoría de S/PCR­. CONCLUSIONES: Existen diferentes categorías diagnósticas de la enfermedad COVID-19 en función del perfil clínico y microbiológico que tienen correlato con el pronóstico a 30 días.

Validity of the Actigraph GT3x and influence of the sensor positioning for the assessment of active energy expenditure during four activities of daily living in stroke subjects.

OBJECTIVE:: To explore the validity of the Actigraph and the influence of the placement of the sensor when estimating the active energy expenditure in four common daily activities (transfers, manual task, walking in overground and walking up and down stairs) in stroke survivors. DESIGN:: Cross-sectional study. SETTING:: Department of Physical Medicine and Rehabilitation. SUBJECTS:: A total of 46 subjects affected with stroke sequelae were wearing the Actigraph on three different locations-ankle, hip and wrist on the non-affected side-and performed four tasks: transfers, manual task, walking on flat ground and walking up and down stairs. MAIN MEASURES:: The values of active energy expenditure estimated by the Actigraph were compared to those measured by a portable breathing gas exchange analyzer Metamax3B. The accuracy and agreement between Actigraph and Metamax values were analyzed with mean bias, root mean square error, correlation coefficient and Bland-Altman plots for each task and each sensor location. RESULTS:: The mean bias between the Metamax and Actigraph placed on wrist, hip and ankle were, respectively, MD = 1.16 kcal (%MD = 3%), MD =-20.44 kcal (%MD =-58%) and MD = 17.64 kcal (%MD = 50%). The agreement with the Metamax was poor in general regardless of the sensor location and type of task ( r = 0.12-0.58). CONCLUSION:: This study found large differences and a poor agreement between the active energy expenditure as measured by the Actigraph and the Metamax according to the location of the sensor and the type of task performed by the subject.

Home-based physical activity incentive and education program in subacute phase of stroke recovery (Ticaa'dom): study protocol for a randomized controlled trial.

BACKGROUND: Stroke causes functional decline, psychological disorders and cognitive impairments that affect activities of daily living and quality of life. Although physical activity (PA) is beneficial in stroke recovery, PA recommendations are rarely met after hospital discharge. There is presently no standard strategy for monitoring and inciting PA at home during the subacute phase of stroke recovery. The main aim of this study is to evaluate the effects of a home-based physical activity incentive and education program (Ticaa'dom) on functional capacity in subacute stroke patients. METHODS: This study is a comparative prospective, observer-blinded, monocentric, parallel, randomized controlled clinical trial. This study will include 84 patients: 42 patients in the home-based physical activity incentive group (HB-PAI) and 42 in the control group (CG). The intervention group will follow the HB-PAI program over 6 months: their PA will be monitored with an accelerometer during the day at home while they record their subjective perception of PA on a chart; they will observe a weekly telephone call and a home visit every three weeks. The CG will receive traditional medical care over 12 months. The main study outcome will be the distance on a 6-minute walk test. Secondary outcomes will include measurements of lower limb strength, independence level, body composition, cardiac analysis, fatigue and depression state. DISCUSSION: The results of this trial will demonstrate the value of implementing the Ticaa'dom program during the subacute phase of stroke recovery. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01822938 . Registered on 25 March 2013.

Función endotelial y lipemia postprandial en adultos con presencia de criterios asociados a síndrome metabólico: efecto del estado nutricional / Endothelial function and postprandial lipemia in adults presenting criteria associated to metabolic syndrome: effect of nutritional state

Resumen Introducción : La lipemia postprandial se caracteriza por un aumento de las lipoproteínas ricas en triglicéridos y varios trabajos lo describen como un factor que determina la salud metabólica de un individuo. El objetivo del estudio fue cuantificar la contribución del sobrepeso en la magnitud de la lipemia postprandial en 33 sujetos con criterios asociados al síndrome metabólico (n = 20, sobrepeso y n = 13 eutróficos, 66% hombres, edad media 31,2 ± 7,6 años). Métodos: Estudio descriptivo y transversal. Se midió la vasodilatación mediada por el flujo, la velocidad de onda del pulso, el perfil lipídico, el cociente Log triglicéridos/lipoproteínas de alta densidad, la glucosa y la presión arterial tras una ingesta estándar alta en lípidos (79% Kcal/grasa). Se calculó el Z-score de riesgo cardiovascular a partir de la suma de los residuos tipificados (Z) de las variables bioquímicas. El estado de lipemia se midió en ayuno (0 min.) y a los (60, 120, 180, y 240 minutos) postprandiales. Resultados: El valor basal de la vasodilatación mediada por el flujo y la velocidad de onda del pulso fue de 6,9 ± 5,9% y 7,0 ± 0,8 m/s, respectivamente. Se identificó que la lipemia postprandial reducía la vasodilatación mediada por el flujo en 19,2% a los 60 minutos (5,9 ± 1,5%) y a los 240 minutos (3,7 ± 1,2%) (p = 0,04), respectivamente. Este hallazgo se acompañó con un aumento en la velocidad de onda del pulso (p < 0,05). Al dividir los sujetos en dos grupos según el índice de masa corporal, los participantes en sobrepeso muestran cifras más elevadas en el Zscore de riesgo cardiovascular, la velocidad de onda del pulso, el Log triglicéridos/lipoproteínas de alta densidad y el Δ-velocidad de onda del pulso, (p < 0,001). Conclusión: Este estudio demuestra que los sujetos clasificados en sobrepeso y que presentan criterios asociados al síndrome metabólico, muestran un perfil cardiometabólico asociado con un mayor riesgo cardiovascular, tras una ingesta alta en grasas.

Abstract Introduction: Postprandial lipemia is characterised by an increase in triglyceride-rich lipoproteins and several studies describe it as a factor that determines metabolic health of an individual. The motivation of the study was to quantify the contribution to overweight in the magnitude of the postprandial lipemia in 33 persons with criteria associated to metabolic syndrome (n = 20 being overweight and n = 13 eutrophic, 66% male, average age 31.2 ± 7.6 years). Methods: Cross-sectional descriptive study. Flow-mediated vasodilation, pulse wave velocity, lipid profile, log of the triglyceride/protein ratio, glucose and blood pressure were measured after high standard intake of lipids (79% Kcal/fat). Z-score for cardiovascular risk was calculated using the sum of typified residues (Z) of biochemical variables. Lipemia state was measured at fasting (0 min) and after 60, 120, 180 and 240 postprandial minutes. Results: Baseline flow-mediated vasodilation and pulse wave velocity values were 6.9 ± 5.9% and 7.0 ± 0.8 m/s, respectively. It was identified that postprandial lipemia reduced flowmediated vasodilation by 19.2% after 60 minutes (5.9 ± 1.5%) and after 240 minutes (3.7 ± 1.2%) (p = 0.04), respectively. This finding was paired with an increase in pulse wave velocity (p < 0.05). When dividing subjects into two groups according to their body mass index, overweight participants show higher Z-score cardiovascular risk values, pulse wave velocity, log of the triglyceride/protein ratio and the Δ pulse wave velocity (p > 0.001). Conclusion: This study reveals that overweight individuals showing criteria associated to metabolic syndrome have a cardiometabolic profile linked to a higher cardiovascular risk, after high intake of lipids.

In vivo tricalcium phosphate, bone morphogenetic protein and autologous bone marrow biomechanical enhancement in vertebral fractures in a porcine model.

PURPOSE: Minimally invasive techniques that introduce cement and bone substitutes inside the fractured vertebral body are a new treatment line with clinically proven efficacy. However, mechanical behaviours between different fillers throughout fracture evolution is yet to be clarified, as many substances are available for introduction into the vertebral body fracture. METHODS: We comparatively studied biomechanical properties of tricalcium phosphate, tricalcium phosphate with bone morphogenetic protein (rhBMP-7) and autologous bone marrow aspirate with rhBMP-7 in vivo to determine what substance is optimal for repairing vertebral lesions in a porcine model. This biomechanical study was carried out with an Instron-type testing machine. Data registered were necessary strength to reach vertebral fracture [Newtons (N)], shortening (millimeters) of the vertebra, energy absorption until vertebral fracture (Joules) and vertebral unit stiffness. RESULTS: For statistical study, we used the SPSS 16 package at a significance level of α = 0.05. In the presentation of the results, mean, standard deviation of mean, median and interquartile range (IQR) were analysed. Mean and standard deviation (SD) of strength in newtons (N) for the vertebral fracture are 756 N (SD = 253) in group 1, 1,500 N (SD = 1598) in group 2 and 1,230 N (SD = 1,598) in group 3. Stiffness after fracture was 229 N (SD = 123) in group 1, 277 N (SD = 135) in group 2 and 404 N (SD = 325) in group 3. CONCLUSIONS: The association of tricalcium phosphate and BMP-7 generates major vertebral resistance to external energy, the cause of such fractures. In such fractures, minor shortening occurs as soon as the vertebral body is fractured. Autologous bone marrow and BMP-7 provides increased biomechanical behavior, and the vertebral body is thus significantly strengthened.