Measurements on the external load acting on aquatic resistance fins during flexion/extension movements using a robotic joint.

Aquatic resistance training has been proven to be beneficial to many people, in particular those struggling with degenerative joint diseases or recovering from other musculoskeletal issues as the reaction forces acting on the joints become lower, but without compromising the cardiovascular and neuromuscular benefit of the movement. Little has been written on the load produced by or measurements of the devices used in aquatic resistance training. Therefore, uncertainties exist regarding details of how much load can be applied onto the foot when performing the movements and how to quantify progression. In this study, an instrumented robotic arm was designed, built, and used to measure the load acting on the three different types of fins during a simulated flexion/extension movement of a knee. The angular velocities of the knee ranged from 25°/s to 150°/s, which represent the physiological range of in vivo movements. The results demonstrated that the load followed a second-order polynomial with the angular velocities. The load is therefore a function of the angular velocity, the surface area of the fins, and the location of the fins away from the joint center rotation. We modeled the progression of speeds at maximal voluntary movements based on previous studies. The maximum loads measured between 11 kg and 13 kg in extension and 6 kg and 9 kg in flexion at 150°/s rotational velocity.

Angiotensin II AT2 Receptors Contribute to Regulate the Sympathoadrenal and Hormonal Reaction to Stress Stimuli.

Angiotensin II, through AT1 receptor stimulation, mediates multiple cardiovascular, metabolic, and behavioral functions including the response to stressors. Conversely, the function of Angiotensin II AT2 receptors has not been totally clarified. In adult rodents, AT2 receptor distribution is very limited but it is particularly high in the adrenal medulla. Recent results strongly indicate that AT2 receptors contribute to the regulation of the response to stress stimuli. This occurs in association with AT1 receptors, both receptor types reciprocally influencing their expression and therefore their function. AT2 receptors appear to influence the response to many types of stressors and in all components of the hypothalamic-pituitary-adrenal axis. The molecular mechanisms involved in AT2 receptor activation, the complex interactions with AT1 receptors, and additional factors participating in the control of AT2 receptor regulation and activity in response to stressors are only partially understood. Further research is necessary to close this knowledge gap and to clarify whether AT2 receptor activation may carry the potential of a major translational advance.

Beneficial effects of Angiotensin II receptor blockers in brain disorders.

A canonical brain Renin-Angiotensin System (RAS), like the canonical peripheral RAS, has long been proposed as a major regulator of brain function. Because of methodological limitations, however, this system is in urgent need of critical revision. The Angiotensin II AT1 receptors have been confirmed as key factors in the regulation of brain function, and AT1 receptor over activity has been established as a major and early injury factor in the development of many brain diseases. Consequently, Angiotensin Receptor Blockers (ARBs), compounds widely used to treat cardiovascular and metabolic disorders, are excellent candidates for repurposing for the treatment of brain disorders. This review will discuss some of the reasons why revisiting brain RAS is a pressing necessity, will present evidence for a participation of AT1 receptor over activity in the development of major brain disorders, and will present definite evidence of ARBs neuroprotective effects. The review will focus on the beneficial effects of ARB therapy in stroke, neurodegenerative disorders including Alzheimer's and Parkinson's diseases, traumatic brain injury, radiation- induced brain damage, stress and mood disorders.

Reallocating sedentary time to moderate-to-vigorous physical activity but not to light-intensity physical activity is effective to reduce adiposity among youths: a systematic review and meta-analysis.

The aim of the study was to summarize the evidence of the effects of reallocating time spent in sedentary behaviours in different activity intensities on youth's adiposity. Five databases were searched. Studies that reported the effects of replacing sedentary behaviour with light-intensity physical activity (LIPA) and/or moderate-to-vigorous physical activity (MVPA) on at least one adiposity parameter. The estimated regression coefficients (ß) and 95% CIs were combined and meta-analysed. Data from 7,351 youths and five studies were analysed. Pooled analysis from cross-sectional studies shows that replacing sedentary time with LIPA showed no significant associations with any adiposity-related outcomes. Replacing sedentary time with MVPA was statistically associated with total body fat percentage (ß = -2.512; p = 0.003), but not with body mass index or waist circumference. In subgroup analysis, the greatest magnitude of association was observed from studies where 60 min of sedentary behaviour was reallocated to 60 min of MVPA (ß = -4.535; p < 0.001). Our results highlight the importance of promoting MVPA, which may improve body composition phenotypes in young people. This information can be used to develop more effective lifestyle interventions.

Is high-intensity interval training more effective on improving cardiometabolic risk and aerobic capacity than other forms of exercise in overweight and obese youth? A meta-analysis.

BACKGROUND: The scientific interest in high-intensity interval training (HIIT) has greatly increased during recent years. OBJECTIVE: The objective of this meta-analysis was to determine the effectiveness of HIIT interventions on cardio-metabolic risk factors and aerobic capacity in overweight and obese youth, in comparison with other forms of exercise. DATA SOURCES: A computerized search was made using seven databases. STUDY ELIGIBILITY CRITERIA: The analysis was restricted to studies that examined the effect of HIIT interventions on cardio-metabolic and/or aerobic capacity in pediatric obesity (6-17 years old). PARTICIPANTS AND INTERVENTIONS: Nine studies using HIIT interventions were selected (n = 274). STUDY APPRAISAL AND SYNTHESIS METHODS: Standarized mean difference (SMD) and 95% confidence intervals were calculated. The DerSimonian-Laird approach was used. RESULTS: HIIT interventions (4-12 week duration) produced larger decreases in systolic blood pressure (SMD = 0.39; -3.63 mmHg) and greater increases in maximum oxygen uptake (SMD = 0.59; 1.92 ml/kg/min) than other forms of exercise. Also, type of comparison exercise group and duration of study were moderators. CONCLUSIONS: HIIT could be considered a more effective and time-efficient intervention for improving blood pressure and aerobic capacity levels in obese youth in comparison to other types of exercise. © 2016 World Obesity.

Bilateral first branchial cleft anomaly with evidence of a genetic aetiology.

Anomalies of the first branchial cleft (FBC) are uncommon, and recognizing them can be difficult. Although present at birth, many cases do not become evident until later in childhood or adolescence, with an initial clinical presentation in adulthood being encountered only rarely. Typically, FBC anomalies present as a unilateral cyst, sinus, or fistula associated with the external auditory canal, or with swelling or an inflammatory opening in the peri-auricular/parotid area. They are commonly misdiagnosed and are often treated inadequately before being excised completely. A 40-year-old woman presented to the maxillofacial outpatient clinic with an episode of bilateral pre-auricular tumefaction, initially diagnosed as temporomandibular dysfunction syndrome. This was associated with bilateral pre-auricular pain that increased with mandibular movements. In relation to the patient's history, and given the bilateral presence of a pre-auricular pit, a diagnosis of FBC anomaly was made. Further investigation showed a related asymptomatic history in five other cases across four generations of the same family. The authors describe here the case, the diagnostic methodology, and the wide local excision technique used for removal of the branchial sinus.

Prospective double-blind clinical trial evaluating the effectiveness of Bromelain in the third molar extraction postoperative period.

OBJECTIVES: To evaluate the anti-inflammatory and analgesic effect of Bromelain (pineapple extract) administered orally in the postoperative after extraction of impacted lower molars. STUDY DESIGN: This is a prospective, placebo-controlled, unicentric, double-blind study; the sample size was 34 patients. The pre and postoperative outcomes, evaluated on the third (D3) and eighth day (D8), included inflamtion, pain and oral aperture, as well as the need for analgesics. One group received Bromelain 150mg per day for three days and 100mg on days 4 to 7. The other group received placebo in the same dosage. All outcomes werrecorded quantitatively and analyzed with the Mann-Whitney U test for independent samples. RESULTS: Although there were no statistically significant differences between the treatment groups, a trend towards less inflammation and improved oral aperture was observed in the group that received Bromelain, compared to the group that received placebo. This trend can be attributed completely to random reasons, since there is no statistical difference in the results. CONCLUSIONS: Further studies are necessary to analyze different administration patterns and doses of Bromelain for the use in the postoperative of impacted third molars.

Prediction of correlates of daily physical activity in Spanish children aged 8-9 years.

The aims of the study were (a) to examine the associations between the daily physical activity (PA) of 8- to 9-year-old children and their parents, and (b) to examine what effect the child's daily PA has on its cardiorespiratory fitness (CRF), body mass index (BMI), and health-related quality of life (HRQoL). The sample consisted of 1021 persons [351 children (8.73 ± 0.69 years in age) and 670 parents]. Pedometers were used to evaluate PA in parents and their children over the course of 4 days (Thursday-Sunday), with the instructions on how to wear the pedometers for 24 h a day. Also evaluated were height, weight, BMI, CRF (via the maximal multistage 20-m shuttle run test), and HRQoL (via the EQ-5D-Y questionnaire). Associations between these variables were studied using path model techniques. The father's PA predicts his child's daily PA. This in turn predicts the child's lower BMI, CRF, and perceived quality of life. The findings suggest that the role model of a physically active father positively influences the child's PA habits, and hence that the family environment can have an important part to play in promoting health.

Fallo multiorgánico en paciente con fungemia por Saprochaete capitata / Multi-organ failure in a patient with fungaemia due to Saprochaete capitata

Antecedentes. El aumento significativo de las infecciones fúngicas sistémicas es debido fundamentalmente al incremento de pacientes inmunodeprimidos. La morbimortalidad de estas infecciones es muy alta, lo que unido a los elevados costes de hospitalización que generan las convierten en una entidad de gran trascendencia en nuestra práctica hospitalaria. Saprochaete capitata es un hongo raro que causa infecciones invasivas habitualmente en pacientes inmunocomprometidos y para el que además no existe un consenso en la pauta terapéutica. Caso clínico. Presentamos un caso de infección diseminada por este hongo en una paciente intensamente inmunodeprimida, que fallece como consecuencia de un fallo multiorgánico a pesar de las medidas de soporte vital tomadas y del inicio de antibioterapia de amplio espectro. Conclusiones. Es de vital importancia iniciar el tratamiento antibiótico lo antes posible, así como la realización de cultivos de vigilancia y seguimiento para la búsqueda de hongos en los enfermos neutropénicos (AU)

Effects of exercise on resting blood pressure in obese children: a meta-analysis of randomized controlled trials.

The purpose of this meta-analysis was to examine the evidence for the effectiveness of exercise interventions on the resting blood pressure (systolic and diastolic) of obese children. A computerized search was made of seven databases using keywords. Effect sizes (ES) and 95% confidence intervals were calculated, and the heterogeneity of the studies was estimated using Cochran's Q-statistic applied to the effect size means. Nine randomized controlled trial (RCT) studies were selected for review as satisfying the inclusion criteria (n = 205 exercise, 205 control). The main cumulative evidence indicates that the exercise programmes with a frequency of three sessions weekly lasting longer than 60 min had a moderate effect on systolic blood pressure (ES = -0.46, I(2) = 27%), and programmes of under 12 weeks with more than three sessions weekly were beneficial in terms of reduction of diastolic blood pressure (ES = -0.35, I(2) = 78%).

[Multi-organ failure in a patient with fungaemia due to Saprochaete capitata]. / Fallo multiorgánico en paciente con fungemia por Saprochaete capitata.

BACKGROUND: The significant increase in systemic fungal infections is mainly due to the increase in immunocompromised patients. The high morbimortality of these infections, along with the high hospitalization costs they generate, makes them a problem of great importance in our hospital practice. Saprochaete capitata is a rare fungus that causes invasive infections, usually in immunocompromised patients, and for which there is still no consensus on the treatment regimen to be used. CASE REPORT: We present a case of disseminated infection by this fungus in a heavily immunosuppressed patient, who died as a result of multiple organ failure despite the life support measures taken and the wide spectrum antibiotics. CONCLUSIONS: It is vital to begin the antibiotic treatment as soon as possible, as well as the monitoring and follow-up cultures to test for fungi in neutropenic patients.

Maternal deprivation in rats is associated with corticotrophin-releasing hormone (CRH) promoter hypomethylation and enhances CRH transcriptional responses to stress in adulthood.

Exposure to stress during early development causes long-lasting alterations in behaviour and hypothalamic pituitary adrenal (HPA) axis activity, including increased expression of corticotrophin-releasing hormone (CRH). To determine whether early-life stress causes epigenetic changes in the CRH promoter leading to increased CRH transcription, 8-week old female and male rats, subjected to maternal deprivation (MD) between days 2 and 13 post-birth, were studied for HPA axis responses to stress and CRH promoter methylation in the hypothalamic paraventricular nucleus (PVN) and central nucleus of the amygdala (CeA). Plasma corticosterone and PVN CRH heteronuclear (hn)RNA responses to acute restraint stress were higher in MD rats of both sexes. DNA methylation analysis of the CRH promoter revealed a significantly lower percentage of methylation in two CpGs preceding (CpG1) and inside (CpG2) the cyclic AMP-response element (CRE) at -230 bp in the CRH promoter in the PVN but not the CeA of MD rats. Gel-shift assays, using nuclear proteins from forskolin-treated hypothalamic 4B cells and CRH promoter CRE oligonucleotides, unmethylated or methylated at CpG1, revealed a strong band that was supershifted by phospho-cAMP response element-binding antibody. This band was 50% weaker using oligonucleotides methylated at CpG2 (intra-CRE), or methylated at both CpG1 and CpG2. These findings demonstrate that HPA axis hypersensitivity caused by neonatal stress causes long-lasting enhanced CRH transcriptional activity in the PVN of both sexes. Hypomethylation of the CRH promoter CRE, a region critical for CRH transcriptional activation, could serve as a mechanism for the increased transcriptional responses to stress observed in MD rats.

Association of the intronic polymorphism rs891512 (G24943A) of the endothelial nitric oxide synthase gene with hypertension in Chilean type 2 diabetes patients.

We investigated two single nucleotide polymorphisms of the NOS3 gene in type 2 diabetic patients (n=93) and healthy non-diabetic controls (n=76) and their relationship with smoking habits, body mass index, hypertension and dyslipidemia. Results showed that eNOS polymorphism rs891512 (G24943A) is associated with hypertension in Chilean individuals (p<0.05).

Effects of exercise on functional aerobic capacity in lower limb osteoarthritis: a systematic review.

Osteoarthritis (OA) is a degenerative joint disease. The reduced aerobic capacity of patients with lower limb osteoarthritis affects their independence in performing everyday activities. The purpose of this systematic review was to summarize evidence for the effectiveness and structure of exercise programs on functional aerobic capacity (ability to perform activities of daily living that require sustained aerobic metabolism) in patients with hip and knee osteoarthritis. A computerized search was made of seven databases. Effect sizes (ES) and 95% confidence intervals (CI) were calculated, and the heterogeneity of the studies was assessed using Cochran's Q statistic applied to the ES means. The 20 studies that satisfied the inclusion criteria were selected for analysis. These studies were grouped into five categories according to the characteristics of the exercise program: land-based interventions (strength programs, tai chi, aerobic programs, mixed exercise programs) and aquatic intervention (hydrotherapy). The functional aerobic capacity improved in tai chi programs (ES=0.66; 95% CI, 0.23-1.09), aerobic programs (ES=0.90; 95% CI, 0.70-1.10), and mixed programs (ES=0.47; 95% CI, -0.38-0.39). The conclusions were: (i) despite recommendations for the use of exercise programs for aerobic fitness in patients with hip and knee osteoarthritis, few randomized clinical trials have been conducted; (ii) the structure of the exercise programs (program content and duration, and session frequency and duration) is very heterogeneous; (iii) overall, exercise programs based on tai chi, aerobic, and mixed exercise seem to give better results than hydrotherapy programs, but without the differences being altogether clear.

Exercise in fibromyalgia and related inflammatory disorders: known effects and unknown chances.

Fibromyalgia (FM) is characterised by chronic widespread pain and allodynia (pain from stimuli which are not normally painful with pain that may occur other than in the area stimulated) of more than 3 months duration. The current hypothesis of the aetiology of FM includes inflammatory and neuroendocrine disorders. The biophysiology of this syndrome, however; remains still widely elusive, and there are no formally approved therapies. Non-pharmacological interventions in FM patients include habitual exercise programs which improve physical function and quality of life of patients and may even reduce pain. However the mechanisms through which exercise benefits FM symptoms needs to be elucidated. In this article we firstly review the main topics and characteristics of the FM syndrome, while focusing our attention on the inflammatory hypothesis of FM, as well as on the beneficial effects of habitual exercise as a co-therapy for FM patients. In this context, the latest developments in research on anti-inflammatory effects of exercise are also reviewed and discussed. To find out what is known about the connection between benefits of exercise for FM and anti-inflammatory effects of exercise, we carried out a PubMed search using the term "fibromyalgia" and "exercise" together with "inflammation", and no more than ten published articles were found (six of them reviews), which are also discussed. In the second part of the article we present a pilot investigation on a group of 14 female FM patients with a diagnosis of FM by a rheumatologist. They took part in a pool-aquatic program in warm water over a period of fourth months (three weekly 60-min sessions). Circulating inflammatory (IL-1beta, IL-2, IFNgamma, TNFalpha, IL-8, IL-6, IL-4, IL-10 and CRP) and neuroendocrine (NA and cortisol) markers were determined. FM patients showed higher circulating levels of IL-8, IFNgamma and CRP as well as cortisol and NA than age-matched healthy control women. After the exercise program, a significant decrease in IL-8, IFNgamma, and CRP were found, in parallel with a decrease in circulating concentrations of cortisol and increased levels of NA. The results confirm an elevated "inflammatory status" in the FM syndrome and strengthen the hypothesis that the benefits of exercise in FM patients are mediated, at least in part, by its anti-inflammatory effects. A better regulation of the cytokine-HPA axis feedback may be also involved.

Angiotensin II AT(1) receptor blockade selectively enhances brain AT(2) receptor expression, and abolishes the cold-restraint stress-induced increase in tyrosine hydroxylase mRNA in the locus coeruleus of spontaneously hypertensive rats.

Spontaneously hypertensive rats, a stress-sensitive strain, were pretreated orally for 14 days with the AT(1) receptor antagonist candesartan before submission to 2 h of cold-restraint stress. In non-treated rats, stress decreased AT(1) receptor binding in the median eminence and basolateral amygdala, increased AT(2) receptor binding in the medial subnucleus of the inferior olive, decreased AT(2) binding in the ventrolateral thalamic nucleus and increased tyrosine hydroxylase mRNA level in the locus coeruleus. In non-stressed rats, AT(1) receptor blockade reduced AT(1) receptor binding in all areas studied and enhanced AT(2) receptor binding in the medial subnucleus of the inferior olive. Candesartan pretreatment produced a similar decrease in brain AT(1) binding after stress, and prevented the stress-induced AT(2) receptor binding decrease in the ventrolateral thalamic nucleus. In the locus coeruleus and adrenal medulla, AT(1) blockade abolished the stress-induced increase in tyrosine hydroxylase mRNA level. Our results demonstrate that oral administration of candesartan effectively blocked brain AT(1) receptors, selectively increased central AT(2) receptor expression and prevented the stress-induced central stimulation of tyrosine hydroxylase transcription. The present results support a role of brain AT(1) and AT(2) receptors in the regulation of the stress response, and the hypothesis that AT(1) receptor antagonists may be considered as potential therapeutic compounds in stress related disorders in addition to their anti-hypertensive properties.

In vivo administration of doxazosin in rats highly decreases serum circulating levels of testosterone through a mechanism involving the testicular renin-angiotensin system.

Men are at greater risk of cardiovascular and renal diseases than women. Several hypertensive rat models also exhibit gender differences in blood pressure. Although the mechanisms responsible for these gender differences are not clear, androgens have been shown to promote hypertension. Testosterone is produced by Leydig cells under the regulation of catecholamines acting through both alpha- and beta-adrenoceptors. Some investigators have postulated a putative role of angiotensin II (Ang II) in modulating the action of gonadotropin in Leydig cells, inhibiting testosterone production. In the present work, we analysed the potential mechanism by which the testicular renin-angiotensin system (RAS) decreases the serum circulating levels of testosterone after the in vivo administration of the long-acting selective alpha(1)-adrenergic receptor antagonist doxazosin. RAS was analysed through assessment of the activity of its proteolytic regulatory enzymes. We can conclude that the testicular testosterone production, at least in rat, is regulated by catecholamines through a mechanism involving alpha(1)-adrenergic receptors and RAS, with a putative role for Ang III. Because doxazosin is usually used as a pharmacological therapy in the treatment of hypertension and benign prostatic hyperplasia, our results could also indicate that its benefits are due, at least in part, to decreased serum circulating levels of testosterone.

Modelling diseases: the allergens of Olea europaea pollen.

This study analyzes the influence of the IgE response to certain olive pollen allergens in the modulation of the different clinical phenotypes of allergic disease and their relationship with the level of exposure to pollen and genetic factors. Patients from high-exposure areas had a complex IgE antibody response to allergens of Olea euroapea, which included 3 or more allergens in 75% of cases. The majority allergens were Ole e 1, Ole e 2 (profilin), Ole e 7 (lipid transporting protein), Ole e 9 (glucanase), and Ole e 10. The existence of the antigen HLA-DR2 (15) led to a higher risk of sensitization to Ole e 10 and a greater trend towards the development of severe asthma, which increased in the presence of an anti-profilin IgE. Thirty percent of patients suffering from pollinosis simultaneously presented allergy to vegetable foods. Anti-Ole e 7 IgE was significantly associated with fruit anaphylaxis and anti-profilin IgE was detected in 90% of patients with oral syndrome. Finally, we analyzed the role of glucanase and Ole e 10 as causes of the pollen-latex-fruit syndrome.

Influence of a medium-impact aquaerobic program on health-related quality of life and fitness level in healthy adult females.

AIM: The aim of the study was to examine the influence of a medium-impact aquaerobic program on the health-related quality of life (HRQoL) and health-related fitness (HRF) level of middle-aged healthy female subjects. METHODS: Twenty apparently healthy women (mean age: 43.1 [standard deviation: 9.7] years) participated in the study. Criteria for inclusion were absence of diagnosed illnesses, as well and signs and symptoms of disease as evaluated by the Physical Activity Readiness Questionnaire. Participants carried out a medium-impact aquaerobic exercise program consisting of 2 weekly sessions of 60 min during 8 months. Before and after the exercise program, HRQoL was assessed by the 36-item short form health survey (SF-36) questionnaire, and HRF was measured using a simplified version of the AFISAL-INEFC HRF test battery. RESULTS: Following the exercise program, an increase in all domains of HRQoL, except general health and role-emotional, was observed. Total body mass and body fat percentage decreased, and estimated aerobic power increased. CONCLUSION: Completion of a medium-impact aquaerobic program (2 weekly sessions of 60 min during 8 months) improves HRQoL in most domains, particularly bodily pain and vitality, and shows to be among the most effective programs for improving perceived quality of life. Moreover, this exercise program proved to have a positive influence on the body composition and functional capacity of the subjects, being effective in reducing fat body mass and improving cardiorespiratory function.

Concordancia interobservadores en la interpretación en forma ciega de cintigrafía de ventilación perfusión en pacientes con sospecha clínica de tromboembolismo pulmonar / Interobserver concordance in the interpretation of ventilation-perfusion scintigraphy in patients with clinically suspected pulmonary embolism

La pesquisa adecuada del tromboembolismo pulmonar (TEP) tiene importancia en el manejo terapéutico y en el pronóstico de los pacientes. El cintigrama de ventilación y perfusión (VQ) es un método bien establecido en la evaluación de esta patología. La concordancia interobservador puede ser bastante variable y debieran minimizarse las discordancias dentro de un mismo grupo. Objetivo: Conocer la concordancia entre observadores formados en nuestro centro y correlacionarlos con el informe oficial emitido con los antecedentes clínicos y radiológicos. Método: Se analizaron retrospectivamente 401 estudios de 382 pacientes con sospecha de TEP de diferente probabilidad clínica, informados por 6 observadores independientes con distinta experiencia. Se realizó lectura en forma ciega informando como alta, baja o intermedia probabilidad de TEP, basado en la experiencia individual y en criterios PIOPED modificados. Se aplicó kappa ponderado. Resultados: En los informes existió 27.2 por ciento de alta probabilidad de TEP, 5.5 por ciento fueron intermedia o indeterminada y 67.3 por ciento de baja probabilidad, casi normal o normal. La concordancia entre los observadores varió entre 72.6 y 86 por ciento con variación de índice kappa entre 0.582 y 0.743. La correlación con el informe emitido varió entre 74.3 y 81.8 por ciento y (k: 0.582 y 0.675). Hubo mayor concordancia entre los observadores con mayor experiencia. Conclusión: En nuestro centro existe una excelente concordancia interobservador con buenos índices kappa en la interpretación ciega de los VQ solicitados por TEP. Este ejercicio además, sirvió como entrenamiento práctico para los residentes del centro.