Motor Imagery and Pain Processing in Patients With Entrapment Neuropathies: A Cross-sectional Study.

OBJECTIVES: (1) To assess the ability to generate both kinesthetic and visual motor imagery in participants with carpal tunnel syndrome (CTS), compared with asymptomatic participants. (2) To assess the influence of psychophysiological and functional variables in the motor imagery process. METHODS: Twenty patients with unilateral CTS and 18 pain-free individuals were recruited. An observational case-control study with a nonprobability sample was conducted to assess visual and kinesthetic movement imagery ability and psychophysiological variables in patients with CTS compared with asymptomatic participants in a control group. The trial was conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology statement. RESULTS: CTS patients have more difficulties in generating visual motor images compared with asymptomatic individuals ( t =-2.099; P <0.05; d=0.70). They need more time to complete the mental tasks (visual t =-2.424; P <0.05 and kinesthetic t =-2.200; P <0.05). A negative correlation was found between the ability to imagine and functional deficits ( r =-0.569; P =0.021) for the kinesthetic subscale and temporal summation ( r =-0.515; P <0.5). A positive correlation was found between pain pressure threshold homolateral (homolateral) and time to generate the visual mental images ( r =0.537; P <0.05). DISCUSSION: CTS patients have greater difficulty generating motor images than asymptomatic individuals. Patients also spend more time during mental tasks. CTS patients present a relationship between temporal summation and the capacity to generate kinesthetic images. In addition, the CST patients presented a correlation between chronometry mental tasking and mechanical hyperalgesia.

Hospital Readmissions of Discharged Patients with COVID-19.

OBJECTIVE: To analyse the rate of occurrence and the clinical variables associated with readmission of patients who had previously been discharged after admission for COVID-19. SETTING: University hospital in Madrid (Spain). PARTICIPANTS: Sixty-one patients (74% male) who presented COVID-19 were readmitted during the 3 weeks after discharge from hospital. INTERVENTIONS: Nested case-control study paired (1:1 ratio) by age, sex and period of admission. OUTCOME MEASURES: Rate of readmission rate of patients discharged after suffering COVID-19 and identification of the clinical variables associated with it. RESULTS: Out of 1368 patients who were discharged during the study period, 61 patients (4.4%) were readmitted. Immunocompromised patients (N=10.2%) were at increased risk for readmission (p=0.04). There was also a trend towards a higher probability of readmission in hypertensive patients (p=0.07). Cases had had a shorter hospital stay and a higher prevalence of fever during the 48 hours prior to discharge. There were no significant differences in oxygen levels measured at admission and discharge by pulse oximetry intra-subject or between the groups. Neutrophil-to-lymphocyte ratio at hospital admission tended to be higher in cases than in controls (p=0.06). Neither glucocorticoids nor anticoagulants prescribed at hospital discharge were associated with a lower readmission rate. Patients who were readmitted due to a thrombotic event (8 patients, 13.1%) presented a higher level of D-dimer at discharge of initial admission. CONCLUSION: The rate of readmission after discharge from hospital for COVID-19 was low. Immunocompromised patients and those presenting with fever during the 48 hours prior to discharge were at greater risk of readmission to hospital.

Validation of an Automated and Adjustable Blood Pressure System for Use with a Public Health Station.

OBJECTIVE: A new automated and adjustable blood pressure (BP) system has been developed to improve the accuracy of BP measurements on public-use health stations. This self-fitting BP system includes a mechanical cuff that wraps down to the user's arm prior to bladder inflation. The purpose of this study was to validate the adaptable BP system (ABPS) using the current standards from the Association for the Advancement of Medical Instrumentation (AAMI). METHODS: The AAMI/ISO 81060:2013 standards for clinical validation of non-invasive automated arterial BP measurement devices were followed precisely using the same arm sequential method. For each participant, BP was measured over multiple trials by trained observers alternating a reference sphygmomanometer with the ABPS. All study requirements were met with 85 qualifying participants, each with 3 valid paired determinations. RESULTS: The mean difference between ABPS BP and reference BP using all 255 paired determinations was -2.4 ± 7.7 mmHg for systolic and 1.7 ± 5.7 mmHg for diastolic. The standard deviation of the averaged paired determinations per participant was 6.3 mmHg for systolic and 5.2 mmHg for diastolic. Arm circumference measurements had a mean error of -2.1 ± 2.4 cm (R2 = 0.87). A new prediction model for arm circumference was validated using a holdout dataset (R2 = 0.94). CONCLUSION: The results of the study confirm that the ABPS met all benchmarks established by the AAMI. The device accurately measures BP across a wide range of arm circumferences (24-44 cm) and is suitable for use by individuals to self-monitor BP.

Intususcepción ileocólica en el adulto como presentación de un linfoma no Hodgkin de intestino delgado / Ileocolic Intussusception in Adults due to Small-Bowel Non-Hodgkin's Lymphoma

La intususcepción intestinal, definida como la penetración de un segmento intestinal en otro adyacente, es una causa infrecuente de obstrucción intestinal en el adulto. El objetivo de este trabajo es presentar el caso de un paciente adulto con intususcepción ileocólica como presentación de un linfoma no Hodgkin de intestino delgado. Este paciente presenta una causa poco frecuente de intususcepción intestinal. Dada lo inespecífico de la clínica, el diagnóstico etiológico suele ser intraoperatorio, precisando resección de la lesión causante y, en el caso de nuestro paciente, quimioterapia adyuvante(AU)

Intestinal intussusception, defined as penetration of an intestinal segment into an adjacent, is a rare cause of intestinal obstruction in adults. The aim of this paper is to present the case of an adult patient with ileocolic intussusception as presenting a non-Hodgkin lymphoma of the small intestine. This patient has a rare cause of intestinal intussusception. Because of its non-specific clinical, etiologic diagnosis is usually intraoperative, requiring resection of the culprit lesion and, in the case of our patient, adjuvant chemotherapy(AU)

Reliability of maximal voluntary muscle strength and power testing in older men.

BACKGROUND: Maximal voluntary muscle strength (MVMS) and leg power are important measures of physical function in older adults. We hypothesized that performing these measures twice within 7-10 days would demonstrate a >5% increase due to learning and familiarization of the testing procedures. METHODS: Data were collected from three studies in older adult men (60-87 years) and were divided into two cohorts defined by study site and type of exercise equipment. MVMS was assessed in 116 participants using the one-repetition maximum method at two separate study visits for the chest press, latissimus pull-down, leg press, leg flexion, and leg extension exercises along with unilateral leg extension power. RESULTS: Test-retest scores were not different and did not exceed 0.8 +/- 9.0% in Cohort 1 or 2.3 +/- 9.8% in Cohort 2, except for leg extension, which improved by 6.6 +/- 14.4% (p <.009) and 3.4 +/- 6.8% (p <.016), respectively. Repeat tests were closely correlated with initial tests (all p <.001). Pearson correlation coefficients ranged from 0.74 for leg extension power to 0.96 for leg press. Coefficients of variation were <10% (4.2%-9.0%) for all exercises except for leg extension power, which was 15.5%. CONCLUSIONS: Our findings demonstrated that test-retest measures of MVMS and power in older adult men do not differ by more than 2.3% except for leg extension, and have relatively low coefficients of variation using data collected from three studies. Moreover, these findings were similar between two study sites using different equipment, which further supports the reliability of MVMS and power testing in older adult men.

Longitudinal change in coronary heart disease risk factors in older runners.

BACKGROUND: it is currently not clear how coronary heart disease (CHD) risk factors change over time in chronic exercisers. Therefore, the purpose of this study is to describe the longitudinal change in CHD risk factors in chronically endurance-trained men and women, and to determine the exercise and nutritional factors associated with those respective changes. METHODS AND RESULTS: ninety-one middle-aged runners (56 male, 35 female) were tested on two occasions approximately 10 years apart (aged 50.8 +/- 8.0 versus 60.0 +/- 7.9 years at respective visits). Body composition, VO2max, blood pressure (BP) and blood chemistries were measured, and the subjects' self-reported training and nutritional history. Data were analysed by factorial analysis of variance (ANOVA) and multivariate step-wise regression. Among the entire sample, training volume decreased (61.1 +/- 28.2 versus 44.7 +/- 24.6 km/week, P<0.05) but nutritional variables did not change. Body fat (16.9 +/- 5.3% for men versus 21.1 +/- 5.3% for women, P<0.05), blood lipids, blood glucose and systolic and diastolic BP all changed negatively over the study duration. These changes occurred similarly in both genders and irrespective of menstrual and hormone replacement status among the women. Lastly, the changes in CHD risk factors were not predicted by change in exercise or nutritional patterns. CONCLUSIONS: despite the maintenance of significant volumes of exercise and the absence of changes in diet, most CHD risk factors demonstrated unfavourable changes over 10 years in chronic men and women runners. However, the absolute values for most CHD risk factors remained better than those reported for sedentary peers of comparable age.

[Modifications in intact parathyroid hormone, total serum calcium, and ionized calcium levels in the surgery of primary hyperparathyroidism for single adenoma]. / Modificaciones de paratirina intacta, calcio sérico total y calcio ionizado en la cirugía por hiperparatiroidismo primario por adenoma único.

INTRODUCTION: We evaluated total serum calcium (TSC) and ionized calcium (IC) and their correlation with intraoperative intact parathyroid hormone (iPTH) in the surgery of primary hyperparathyroidism in patients with a single adenoma. MATERIAL AND METHOD: We performed a prospective, blind trial with determination of iPHT, TSC and IC in a cohort of surgical patients (n = 279; 244 were valid for the study) who underwent surgery in the Department of Surgery, Hospital de Cruces, between October 1999 and April 2006. Total calcium, ionic calcium and iPTH were measured in the outpatient department, on admission and intraoperatively (at anesthesia induction and every 5 minutes after surgical excision). RESULTS: Levels of calcium and iPTH were corrected in 234 (95.9%) patients. iPTH decreased from abnormal preoperative values of 294.43 +/- 286.38 pg/ml to 97.89 +/- 121.01 mg/dl (minute 5), 58.58 +/- 58.37 pg/ml (minute 10), 44.62 +/- 54.77 pg/ml (minute 15), and 38.42 +/- 51.72 pg/ml (minute 20). TSC decreased from preoperative values of 10.93 +/- 1.04 mg/dl to 10.2 +/- 0.97 mg/dl (minute 5), 10.17 +/- 1.00 mg/dl (minute 10), 10.12 +/- 0.98 mg/ml (minute 15), and 10.09 +/- 1.03 mg/ml (minute 20). The results for ionized calcium were as follows: 4.90 +/- 0.63 mg/dl at induction, 4.84 +/- 0.61 mg/dl (minute 5), 4.84 +/- 0.66 mg/dl (minute 10), 4.82 +/- 0.63 mg/dl (minute 15), and 4.82 +/- 0.63 mg/dl (minute 20). Frozen samples were conclusive for parathyroid tissue (19.56 +/- 15.3 after excision). CONCLUSIONS: Intraoperative total calcium levels may help to predict adequate elimination of parathyroid tissue in primary hyperparathyroidism when intraoperative iPTH is not available. Ionized calcium levels did not show the same decrease.

Modificaciones de paratirina intacta, calcio sérico total y calcio ionizado en la cirugía por hiperparatiroidismo primario por adenoma único / Modifications in intact parathyroid hormone, total serum calcium, and ionized calcium levels in the surgery of primary hyperparathyroidism for single adenoma

Introducción. Evaluamos el calcio total en suero (CTS) y el calcio ionizado (CI) y su correlación con la paratirina intacta (iPTH) intraoperatoria en la cirugía del hiperparatiroidismo primario seleccionando los casos que correspondieron a adenoma único. Material y método. Ensayo prospectivo, determinando (iPTH, CTS y CI) y con enmascaramiento en una cohorte de pacientes quirúrgicos (n = 279; 244 válidos para el estudio) que fueron intervenidos en el Departamento de Cirugía del Hospital de Cruces (octubre de 1999 a abril de 2006). Se valoró: CTS, CI e iPTH medida en consulta, en admisión e intraoperatoriamente: inducción anestésica, y cada 5 min tras la exéresis quirúrgica. Resultados. Se logró corregir las concentraciones de calcio e iPTH en 234 (95,9%) pacientes. La iPTH descendió de valores patológicos preoperatorios 294,43 ± 286,38 pg/ml a 97,89 ± 121,01 mg/dl (minuto 5), 58,58 ± 58,37 pg/ml (minuto 10), 44,62 ± 54,77 pg/ml (minuto 15) y 38,42 ± 51,72 pg/ml (minuto 20). El CTS descendió de valores preoperatorios: 10,93 ± 1,04 mg/dl a 10,2 ± 0,97 mg/dl (minuto 5), 10,17 ± 1,00 mg/dl (minuto 10), 10,12 ± 0,98 mg/ml (minuto 15) y 10,09 ± 1,03 mg/ml (minuto 20). El CI ofreció los siguientes resultados: de 4,90 ± 0,63 mg/dl en tiempo de inducción a 4,84 ± 0,61 mg/dl (minuto 5), 4,84 ± 0,66 mg/dl (minuto 10), 4,82 ± 0,63 mg/dl (minuto 15) y 4,82 ± 0,63 mg/dl (minuto 20). Las muestras congeladas fueron concluyentes para tejido paratiroideo (19,56 ± 15,3 tras la exéresis). Conclusiones. La determinación intraoperatoria de CT puede ser de ayuda para predecir la eliminación adecuada de tejido paratiroideo en el hiperparatiroidismo primario cuando no sea posible la determinación intraoperatoria de iPTH. El CI no muestra la misma pauta de descenso (AU)

Introduction. We evaluated total serum calcium (TSC) and ionized calcium (IC) and their correlation with intraoperative intact parathyroid hormone (iPTH) in the surgery of primary hyperparathyroidism in patients with a single adenoma. Material and method. We performed a prospective, blind trial with determination of iPHT, TSC and IC in a cohort of surgical patients (n = 279; 244 were valid for the study) who underwent surgery in the Department of Surgery, Hospital de Cruces, between October 1999 and April 2006. Total calcium, ionic calcium and iPTH were measured in the outpatient department, on admission and intraoperatively (at anesthesia induction and every 5 minutes after surgical excision). Results. Levels of calcium and iPTH were corrected in 234 (95.9%) patients. iPTH decreased from abnormal preoperative values of 294.43 ± 286.38 pg/ml to 97.89 ± 121.01 mg/dl (minute 5), 58.58 ± 58.37 pg/ml (minute 10), 44.62 ± 54.77 pg/ml (minute 15), and 38.42 ± 51.72 pg/ml (minute 20). TSC decreased from preoperative values of 10.93 ± 1.04 mg/dl to 10.2 ± 0.97 mg/dl (minute 5), 10.17 ± 1.00 mg/dl (minute 10), 10.12 ± 0.98 mg/ml (minute 15), and 10.09 ± 1.03 mg/ml (minute 20).The results for ionized calcium were as follows: 4.90 ± 0.63 mg/dl at induction, 4.84 ± 0.61 mg/dl (minute 5), 4.84 ± 0.66 mg/dl (minute 10), 4.82 ± 0.63 mg/dl (minute 15), and 4.82 ± 0.63 mg/dl (minute 20). Frozen samples were conclusive for parathyroid tissue (19.56 ± 15.3 after excision). Conclusions. Intraoperative total calcium levels may help to predict adequate elimination of parathyroid tissue in primary hyperparathyroidism when intraoperative iPTH is not available. Ionized calcium levels did not show the same decrease (AU)

Chronic exercise and skeletal muscle power in older men.

We sought to determine the effects of age and chronic exercise on muscle power in older males. We examined 32 older males 60-74 years of age and grouped as sedentary (CON, n = 11), chronic endurance trained (ET, n = 10), and chronic endurance trained + resistance training (ET + RT, n = 11). Exercise history was obtained by questionnaire. Absolute strength and power measures were obtained by the one-repetition maximum method. Relative strength and power were determined by dividing the absolute measure by the muscle mass involved in the exercise. Total and regional muscle mass was measured by DXA. Absolute and relative leg power were not significantly different among the 3 groups. In contrast, absolute leg press strength was greater in ET + RT compared with CON, and relative leg press strength was greater in ET and ET + RT compared with CON. Chronic running combined with resistance training may therefore enhance absolute and relative muscle strength in older adults, but does not influence muscle power. Endurance exercise may inhibit the ability of resistance exercise to positively influence skeletal muscle power.

Cardiopulmonary responses to eccentric and concentric resistance exercise in older adults.

BACKGROUND: In older ambulatory persons, exercise strategies that are expected to generate beneficial muscle adaptations with low cardiopulmonary demands are needed. OBJECTIVE: We hypothesised that eccentric resistance exercise would be less demanding on the cardiovascular and pulmonary systems than bouts of concentric resistance exercise. DESIGN: The effects of eccentric and concentric resistance exercise were compared during leg squats at a submaximal intensity known to increase muscle mass. SUBJECTS: 19 Older persons (15 women/four men, age 65 +/- 4 years) and 19 young reference controls (10 women/nine men; age 25 +/- 2 years) were enrolled. METHODS: Participants completed eccentric-only and concentric-only exercise bouts 5-7 days apart. RESULTS: Cardiovascular and pulmonary measures were collected from subjects during bouts consisting of three sequential sets of 10 repetitions at 65% of their voluntary concentric 1-repetition maximum force (68+/-16 kg for older participants and 94 +/- 36 kg for young participants). Peak heart rate (119 +/- 10 versus 155 +/- 16 b.p.m.), systolic blood pressure (129 +/- 18 versus 167 +/- 14 mmHg), cardiac index (7.8 +/- 2.0 versus 9.2 +/- 1.5 l/min/m2) and expired ventilation (20.5 +/- 5.7 versus 29.8 +/- 9.1 l/min) were significantly lower during eccentric than during concentric bouts in the older subjects, respectively (P < 0.001 for all comparisons). Similarly, peak heart rate, systolic blood pressure, cardiac index and expired ventilation were significantly lower during eccentric bouts in the young control subjects. CONCLUSIONS: Eccentric resistance exercise produced less cardiopulmonary demands and may be better suited for older persons with low exercise tolerance and at risk of adverse cardiopulmonary events.

Six-week improvements in muscle mass and strength during androgen therapy in older men.

BACKGROUND: The purpose of our study was to assess the early effects of a potent anabolic androgen on muscle mass and strength, lower extremity power, and functional performance in older men. METHODS: Thirty-two men 72 +/- 6 years of age were randomized to receive oxandrolone (10 mg twice daily) or matching placebo in a 2:1 manner for 12 weeks. Total and appendicular lean body mass (LBM) were assessed by dual-energy x-ray absorptiometry (DEXA). Lower extremity muscle volume was determined by magnetic resonance imaging to validate DEXA changes. RESULTS: Total LBM increased by 2.7 +/- 1.6 kg after 6 weeks with oxandrolone (p <.001), which was greater (p <.001) than the decline in LBM (-0.5 +/- 0.9 kg) with placebo. Appendicular LBM increased by 1.2 +/- 0.9 kg after just 6 weeks with oxandrolone (p <.001), which was greater (p <.001) than the decline in LBM (-0.4 +/- 0.5 kg) with placebo. These changes were >90% of the gains in total and appendicular LBM (3.0 +/- 1.5 kg and 1.3 +/- 0.9 kg, respectively) after 12 weeks. Total thigh and hamstring muscle volume increased by 111 +/- 29 mm(3) (p =.001) and 75 +/- 18 mm(3) (p =.001), respectively, after 12 weeks. Maximal strength increased for the leg press 6.3 +/- 5.6% (p =.003), leg curl 6.7 +/- 8.6% (p =.01), chest press 6.9 +/- 6.5% (p =.001), and latissimus pull-down 4.8 +/- 6.3% (p =.009) with oxandrolone after 6 weeks; these increases were different than those with placebo (p <.001) and were 93%, 96%, 74%, and 94% of the respective gains at week 12. There were no improvements in functional measures. CONCLUSION: Treatment with a potent anabolic androgen may produce significant increases in muscle mass and strength after only 6 weeks in healthy older men. However, such treatment did not improve leg muscle power or walking speed.