Short-term effects of two different recovery strategies on muscle contractile properties in healthy active men: A randomised cross-over study.

The aim of this study was to compare the immediate effects of cold-water immersion (CWI) and hot-water immersion (HWI) versus passive resting after a fatigue-induced bout of exercise on the muscle contractile properties of the Vastus Medialis (VM). We conducted a randomised cross-over study involving 28 healthy active men where muscle contractile properties of the VM wer recorded using Tensiomyography (TMG) before and after CWI, HWI or passive resting and up to one-hour post-application. The main outcomes obtained were muscle displacement and velocity of deformation according to limb size (Dmr and Vdr). Our results showed a significant effect of time (F(3.9,405) =32.439; p <0.001; η2p =0.29) and the interaction between time and temperature (F(7.9,405) =5.814; p <0.001; η2p=0.13) on Dmr but no for temperature alone (F(2,81) =2.013; p =0.14; η2p=0.04) while for Vdr, both time (F(5.2,486) =23.068; p <0.001 η2p = 0.22) and temperature (F(2,81) =4.219; p = 0.018; η2p= 0.09) as well as the interaction (F(10.4,486) =7.784; p <0.001; η2p =0.16) were found significant. Compared to CWI, HWI increased Dmr post-application and Vdr both post-application as well as 15 and 45' thereafter. These findings suggest that applying HWI could be a valid alternative to CWI to promote muscle recovery.

BALF cytokines in different phenotypes of chronic lung allograft dysfunction in lung transplant patients.

The long-term success of lung transplantation (LT) is limited by chronic lung allograft dysfunction (CLAD). Different phenotypes of CLAD have been described, such as bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome (RAS). The purpose of this study was to investigate the levels of cytokines and chemokines in bronchoalveolar lavage fluid (BALF) as markers of these CLAD phenotypes. BALF was collected from 51 recipients who underwent (bilateral and unilateral) LT. The study population was divided into three groups: stable (ST), BOS, and RAS. Levels of interleukin (IL)-4, IL-5, IL-6, IL-10, IL-13, tumor necrosis factor alpha (TNF-α), interferon-gamma (IFN-γ), and granulocyte-macrophage colony-stimulating factor (GM-CSF) were measured using the multiplex technology. BALF neutrophilia medians were higher in BOS (38%) and RAS (30%) than in ST (8%) (P=.008; P=.012). Regarding BALF cytokines, BOS and RAS patients showed higher levels of INF-γ than ST (P=.02; P=.008). Only IL-5 presented significant differences between BOS and RAS (P=.001). BALF neutrophilia is as a marker for both CLAD phenotypes, BOS and RAS, and IL-5 seems to be a potential biomarker for the RAS phenotype.

Assessment of nutritional status by dual X-Ray absorptiometry in women with rheumatoid arthritis: A case-control study.

Rheumatoid arthritis (RA) has been related to an impairment of the nutritional status. Body mass index (BMI) has been used but questions arise about how to properly evaluate nutritional status in RA patients. Few studies have evaluated it by dual-energy X-ray absorptiometry.In women with RA, to analyze:Case-control study including 89 women with RA. The control group was composed by 100 patients affected by non-inflammatory rheumatic disorders. Study variables included age, RA duration, history, activity and disability, and in relation to nutritional status: BMI, serum albumin (ALB), whole body DXA assessment, and skeletal muscle index (SMI).Mean age of patients was 62 ±â€Š8 years, mean duration of RA was 14 ±â€Š9 years, mean disease activity score (DAS28) was 3.7 ±â€Š1.4 and mean Health Assessment Questionnaire was 0.88 ±â€Š0.77. BMI was 27.43 ±â€Š5.16 Kg/m in patients and 27.78 ±â€Š3.98 Kg/m in controls (P: ns). ALB was within normal range in all patients.By whole body DXA, RA patients presented a statistically significant lower lean mass in all locations and lower fat mass in limbs than controls. Patients had a redistribution of fat mass to trunk. Lean mass directly correlated with fat mass.Neither BMI nor ALB correlated with DXA parameters.BMI, appendicular lean mass and SMI correlated inversely with disease duration. Trunk lean mass correlated inversely, and fat mass directly, with RA disability parameters.RA patients fulfilled criteria of sarcopenia in 44% of cases versus 19% of controls (P <.001). In RA patients, regarding SMI, BMI showed a high specificity to detect sarcopenia (94% of the patients with low BMI had sarcopenia) but low sensitivity (47% of the patients with normal BMI or overweight had sarcopenia).RA patients have an impairment of nutritional status associated to disease duration that looks like sarcopenia and that is not predicted by BMI.

Testing an AAC system that transforms pictograms into natural language with persons with cerebral palsy.

In this article, we describe a compansion system that transforms the telegraphic language that comes from the use of pictogram-based augmentative and alternative communication (AAC) into natural language. The system was tested with four participants with severe cerebral palsy and ranging degrees of linguistic competence and intellectual disabilities. Participants had used pictogram-based AAC at least for the past 30 years each and presented a stable linguistic profile. During tests, which consisted of a total of 40 sessions, participants were able to learn new linguistic skills, such as the use of basic verb tenses, while using the compansion system, which proved a source of motivation. The system can be adapted to the linguistic competence of each person and required no learning curve during tests when none of its special features, like gender, number, verb tense, or sentence type modifiers, were used. Furthermore, qualitative and quantitative results showed a mean communication rate increase of 41.59%, compared to the same communication device without the compansion system, and an overall improvement in the communication experience when the output is in natural language. Tests were conducted in Catalan and Spanish.

Lung transplantation in systemic sclerosis: A single center cohort study.

OBJECTIVE: Lung transplantation (LT) has been proposed as a treatment for advanced interstitial lung disease (ILD) and/or pulmonary hypertension (PH) associated to systemic sclerosis (SSc) but few studies have been reported. The aim of this study was to describe the clinical features, complications and survival of a single-center cohort of patients with SSc that underwent LT and to compare their survival with a group of non-SSc transplanted patients. METHODS: Fifteen patients with SSc were transplanted between May 2005 and April 2015. Standard international criteria were used to determine eligibility for LT. The severity of gastroesophageal involvement was not considered as a major contraindication if symptoms were under control. RESULTS: Eight (53.3%) patients had diffuse cutaneous SSc. Eleven (73%) underwent bilateral LT. The main indication for LT was ILD, with or associated PH in 4 cases. Acute cellular rejection and infections were the most frequent complications. Functional lung tests tended to keep stable after transplantation. Median survival was 2.4 years (Q1-Q3: 0.7-3.7 years). We did not find differences in survival between patients transplanted with SSc versus those transplanted due to non-SSc ILD or PH. SSc complications were scarce with no patient developing PH after LT. CONCLUSIONS: LT was an effective treatment for advanced ILD and/or PH associated to SSc in our study. Gastroesophageal reflux was not a limitation for LT in SSc in this study. Complications and survival did not differ from non-SSc patients undergoing LT.

Influence of early neurological complications on clinical outcome following lung transplant.

BACKGROUND: Neurological complications after lung transplantation are common. The full spectrum of neurological complications and their impact on clinical outcomes has not been extensively studied. METHODS: We investigated the neurological incidence of complications, categorized according to whether they affected the central, peripheral or autonomic nervous systems, in a series of 109 patients undergoing lung transplantation at our center between January 1 2013 and December 31 2014. RESULTS: Fifty-one patients (46.8%) presented at least one neurological complication. Critical illness polyneuropathy-myopathy (31 cases) and phrenic nerve injury (26 cases) were the two most prevalent complications. These two neuromuscular complications lengthened hospital stays by a median period of 35.5 and 32.5 days respectively. However, neurological complications did not affect patients' survival. CONCLUSIONS: The real incidence of neurological complications among lung transplant recipients is probably underestimated. They usually appear in the first two months after surgery. Despite not affecting mortality, they do affect the mean length of hospital stay, and especially the time spent in the Intensive Care Unit. We found no risk factor for neurological complications except for long operating times, ischemic time and need for transfusion. It is necessary to develop programs for the prevention and early recognition of these complications, and the prevention of their precipitant and risk factors.

Antagonism of pheromone response of Ostrinia nubilalis males and implications on behavior in the laboratory and in the field.

The antagonistic effect on the pheromone response and catabolism of male European corn borers, Ostrinia nubilalis, by several trifluoromethyl ketones is reported. (Z)-11-Tetradecenyl trifluoromethyl ketone (Z11-14:TFMK), the most closely related analogue of the main component of the pheromone, elicits a remarkable disruptive effect on close approach and source contact of males flying to a source baited with mixtures of the pheromone and the antagonist in 5:1 and 10:1 ratios. In this experiment, the male displayed an erratic flight track with frequent counter turns and intersections with the plume. In the field, the TFMK significantly lowered the number of males caught when mixed with the pheromone in a 10:1 ratio in comparison with the natural attractant. The compound was also a good inhibitor of the antennal esterase of the insect with a IC(50) value of 0.28 muM. The homologous (Z)-10-tridecenyl trifluoromethyl ketone, with one carbon less in the chain, also elicited an antagonistic effect in the wind tunnel, but in the field, the results were not conclusive. The effect induced was lower than the one displayed by Z11-14:TFMK including the activity as the esterase inhibitor (IC(50) value of 7.55 muM). The saturated tetradecyl trifluoromethyl ketone, tetradecyltrifluoropyruvamide, and (Z)-11-2-thiatetradecenyl trifluoromethyl ketone resulted completely inactive. The results obtained in conjunction to the previously shown low toxicity to mice by related trifluoromethyl ketones provide new important data for the putative utilization of these chemicals as new pest control agents.

Influence of right ventricular function on the development of primary graft dysfunction after lung transplantation.

BACKGROUND: Primary graft dysfunction (PGD) remains a significant cause of lung transplant postoperative morbidity and mortality. The underlying mechanisms of PGD development are not completely understood. This study analyzed the effect of right ventricular function (RVF) on PGD development. METHODS: A retrospective analysis of a prospectively assessed cohort was performed at a single institution between July 2010 and June 2013. The primary outcome was development of PGD grade 3 (PGD3). Conventional echocardiographic parameters and speckle-tracking echocardiography, performed during the pre-transplant evaluation phase up to 1 year before surgery, were used to assess preoperative RVF. RESULTS: Included were 120 lung transplant recipients (LTr). Systolic pulmonary arterial pressure (48 ± 20 vs 41 ± 18 mm Hg; p = 0.048) and ischemia time (349 ± 73 vs 306 ± 92 minutes; p < 0.01) were higher in LTr who developed PGD3. Patients who developed PGD3 had better RVF estimated by basal free wall longitudinal strain (BLS; -24% ± 9% vs -20% ± 6%; p = 0.039) but had a longer intensive care unit length of stay and mechanical ventilation and higher 6-month mortality. BLS ≥ -21.5% was the cutoff that best identified patients developing PGD3 (area under the receiver operating characteristic curve, 0.70; 95% confidence interval, 0.54-0.85; p = 0.020). In the multivariate analysis, a BLS ≥ -21.5% was an independent risk factor for PGD3 development (odds ratio, 4.56; 95% confidence interval, 1.20-17.38; p = 0.026), even after adjusting for potential confounding. CONCLUSIONS: A better RVF, as measured by BLS, is a risk factor for severe PGD. Careful preoperative RVF assessment using speckle-tracking echocardiography may identify LTrs with the highest risk of developing PGD.

Acute and chronic pleural complications in lung transplantation.

BACKGROUND: Lung transplant recipients may have pleural complications. However, the influence of these complications on the prognosis is not well known. METHODS: We analyzed pleural complications and clinical and radiologic data from 100 patients who underwent lung transplantation in a general hospital in a 9-year period. Pre-operative evaluation, surgical protocol, immunosuppressive regimen, and follow-up were carried out systematically. Chest computerized tomography (CT) was performed at 3 and 12 months after transplantation. RESULTS: All patients had early post-operative pleural effusion ipsilateral to the graft, which required drainage for a mean of 19.3 days (range, 5-52 days). Thirty-four patients had 43 acute pleural complications: 15 hemothoraxes, 10 persistent air leaks, 8 pneumothoraxes, 7 transient air leaks, and 3 empyemas. Multivariate analysis showed hemothorax and persistent air leak were associated with increased post-operative mortality (p = 0.024, p = 0.011, respectively). Post-operative mortality was not associated with any pre-transplant variable. Chest CT findings at 3 months revealed > or =1 pleural alteration in 58 of 70 patients (83%): 34 post-operative residual ipsilateral pleural effusions; 36 pleural thickenings; and 3 residual pneumothoraxes, 1 with a coexisting bronchial dehiscence. Chest CT at 12 months showed pleural alterations in 50 of 58 patients (86%): pleural thickening in 48, calcification in 4, and residual pleural effusion in 4. CONCLUSIONS: Pleural complications are common in lung transplant recipients. Hemothorax and persistent air leak are associated with increased post-operative mortality. Chest CT showed pleural alterations in most patients 12 months after transplantation.

Temporal arteritis and polymyalgia rheumatica in north-eastern Spain: clinical spectrum and relationship over a 15 year period.

OBJECTIVE: To examine the clinical spectrum of polymyalgia rheumatica (PMR) and temporal arteritis (TA) and their relationship over a period of 15 years in an area of north-eastern Spain. METHODS: We undertook a descriptive study of an unselected population of 163 patients with PMR and/or TA diagnosed from 1985 to 1999. RESULTS: Of the 163 patients included, 90 had isolated PMR, 41 had PMR associated with TA, and 32 had isolated TA. The clinical spectrum of both conditions in our area was similar to that reported in other populations, including a marked female predominance. However, in our series, no patient developed permanent blindness or other major ischemic complications. PMR was observed in 56% of patients with TA. Conversely, 7% of patients originally suffering from PMR without clinical evidence of arteritis at presentation developed later symptoms of TA, and there were no predictive features for this. Interestingly, none of these patients suffered visual loss or other ischemic complications. The low risk of major complications in these cases does not support the need for systematic arterial biopsy in all patients with symptoms of PMR alone. On comparing patients with isolated TA with patients with PMR associated with TA, no differences were observed, thus discarding the possibility that the second constitutes a distinct and independent subgroup of TA. In contrast, when comparing patients with isolated PMR with patients with PMR associated with TA, we found significant differences between both the groups, with greater abnormality of clinical and laboratory markers of inflammation in patients with PMR associated with TA. These differences seem to reflect a greater degree of systemic inflammation linked to the presence of TA. CONCLUSION: In our area, TA appears nowadays as a benign disease which infrequently presents blindness or other major complications. Our experience confirms that even after a good clinical response with normalization of a high ESR in PMR, the patient is at risk for clinical development of TA. Finally, our study also shows that isolated TA and PMR associated with TA seem to be the same condition, different from isolated PMR.

[Mechanisms of cytostasis and metastasis]. / Mecanismos de citostasis y metástasis.

TGFbeta signaling controls a plethora of cellular responses in human development and disease. Recent cellular, biochemical, and structural studies have revealed significant insight into the mechanisms of the activation of TGFbeta receptors, the receptor-mediated activation of Smad transcription factors, the Smad-mediated regulation of target gene expression, and the negative control of the cell cycle by these signals. Loss of TGFbeta cytostatic responsiveness and gain of metastastic activity are common alterations of this pathway in cancer. The analysis of these normal and altered states is providing new insights into physiology, pathology and therapy.

[Lung transplantation in pulmonary fibrosis and other interstitial lung diseases]. / Trasplante pulmonar en la fibrosis pulmonar idiopática y otras enfermedades pulmonares intersticiales.

BACKGROUND AND OBJECTIVE: Interstitial lung disease (ILD) is the second indication for lung transplantation (LT) after emphysema. The aim of this study is to review the results of LT for ILD in Hospital Vall d'Hebron (Barcelona, Spain). PATIENTS AND METHODS: We retrospectively studied 150 patients, 87 (58%) men, mean age 48 (r: 20-67) years between August 1990 and January 2010. One hundred and four (69%) were single lung transplants (SLT) and 46 (31%) bilateral-lung transplants (BLT). The postoperative diagnoses were: 94 (63%) usual interstitial pneumonia, 23 (15%) nonspecific interstitial pneumonia, 11 (7%) unclassifiable interstitial pneumonia and 15% miscellaneous. We describe the functional results, complications and survival. RESULTS: The actuarial survival was 87, 70 and 53% at one, 3 and 5 years respectively. The most frequent causes of death included early graft dysfunction and development of chronic rejection in the form of bronchiolitis obliterans (BOS). The mean postoperative increase in forced vital capacity and forced expiratory volume in the first second (FEV1) was similar in SLT and BLT. The best FEV1 was reached after 10 (r: 1-36) months. Sixteen percent of patients returned to work. At some point during the evolution, proven acute rejection was diagnosed histologically in 53 (35%) patients. The prevalence of BOS among survivors was 20% per year, 45% at 3 years and 63% at 5 years. CONCLUSIONS: LT is the best treatment option currently available for ILD, in which medical treatment has failed.

Relationship between psoriatic arthritis and moderate-severe psoriasis: analysis of a series of 166 psoriatic arthritis patients selected from a hospital population.

The aim of the study was to assess the prevalence of moderate to severe psoriasis (MS-P) in patients with psoriatic arthritis (PsA) and the relationship between MS-P and other variables related to arthritis. One hundred sixty-six consecutive patients with PsA periodically monitored at a university hospital's PsA unit in northeastern Spain were included in the study. Patients with psoriasis were classified as having MS-P when systemic treatment for skin was required. Clinical criteria for treatment indication was BSA >10 and/or PASI >14 and/or psoriasis affecting a very sensitive area of the body. Demographic and clinical data related to arthritis were assessed, including PsA pattern, age of onset of psoriasis and arthritis, disease activity index, and treatment required over the course of the disease. Moderate-severe psoriasis were more prevalent in women (p = 0.027). One hundred nine patients (65.7%) had psoriatic nail disease, and MS-P was more frequent in these patients (40 (77%) vs. 69 (61%), p = 0.028). Patients with spondyloarthropathy were significantly associated with MS-P (7 (16%) vs. 3 (3%), p = 0.014). No statistical association was observed between severe psoriasis and the age of onset of psoriasis or arthritis, involvement of distal interphalangeal joints, laboratory findings (HLA B27, RF), functional class, or disease activity indices. We report a high prevalence of severe psoriasis among patients with psoriatic arthritis, higher in women and patients with psoriatic nail disease and axial spondyloarthropathy.

Guidelines for the selection of lung transplantation candidates.

The present guidelines have been prepared with the consensus of at least one representative of each of the hospitals with lung transplantation programs in Spain. In addition, prior to their publication, these guidelines have been reviewed by a group of prominent reviewers who are recognized for their professional experience in the field of lung transplantation. Within the following pages, the reader will find the selection criteria for lung transplantation candidates, when and how to remit a patient to a transplantation center and, lastly, when to add the patient to the waiting list. A level of evidence has been identified for the most relevant questions. Our intention is for this document to be a practical guide for pulmonologists who do not directly participate in lung transplantations but who should consider this treatment for their patients. Finally, these guidelines also propose an information form in order to compile in an organized manner the patient data of the potential candidate for lung transplantation, which are relevant in order to be able to make the best decisions possible.

Feasibility, tolerability, and outcomes of nebulized liposomal amphotericin B for Aspergillus infection prevention in lung transplantation.

BACKGROUND: Nebulized amphotericin B deoxycholate (n-ABD) is used to prevent Aspergillus infection in lung transplantation. Nebulized liposomal amphotericin B (n-LAB) is another option; however, no clinical data are available on the results of n-LAB for this purpose. METHODS: In an observational study performed in 2 centers to assess the feasibility, tolerability, and outcomes of n-LAB prophylaxis, 104 consecutive patients undergoing prophylaxis with n-LAB were compared with 49 historical controls who received n-ABD. Patient follow-up lasted 12 months. The n-LAB prophylaxis regimen was 25 mg thrice weekly starting on the first post-operative day and continuing to 60 days, 25 mg once weekly from 60 to 180 days, and the same dose once every 2 weeks thereafter. RESULTS: Aspergillus infection developed in 8 of 104 patients (7.7%) with n-LAB prophylaxis (5 colonization, 1 simple tracheobronchitis, 1 ulcerative tracheobronchitis, and 1 invasive pulmonary infection). Ulcerative tracheobronchitis and invasive pulmonary aspergillosis were regarded as invasive disease; hence, the rate of invasive disease was 1.9% (2 patients). The control group had similar rates of Aspergillus infection (10.2%; p = 0.6) and invasive disease (4.1%; p = 0.43). In 3 patients (2.9%), n-LAB was withdrawn due to bronchospasm in 2 and nausea in 1. In the control group, prophylaxis was stopped in 2 patients (4.1%) because of bronchospasm (p = 0.7). CONCLUSIONS: At the dose and frequency described, n-LAB seems effective, safe, and convenient for the prevention of Aspergillus infection in lung transplant patients.

Direcciones futuras en el trasplante pulmonar / Future Directions in Lung Transplant

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[Double-lung transplantation in 15 patients with pulmonary hypertension]. / Trasplante bipulmonar en hipertensión pulmonar. Una serie de 15 pacientes.

BACKGROUND: Pulmonary hypertension is a serious disease that, in its terminal phase, requires lung transplantation. PATIENTS AND METHODS: A retrospective study was undertaken of 15 patients with pulmonary hypertension who underwent lung transplantation between 1994 and 2004. Clinical data recorded before the procedure and during follow-up were reviewed. RESULTS: Pulmonary hypertension was reported as idiopathic in 8 patients (53%) and related to consumption of toxic oil in 2. The remaining causes were documented as chronic peripheral pulmonary embolism, histiocytosis X, venoocclusive disease, scleroderma, and simple corrected congenital heart defect in 1 patient each. The mean values of the hemodynamic variables were 100, 50, and 67 mm Hg for systolic, diastolic, and mean pulmonary artery pressure, respectively; 2.63 L/min for cardiac output; and 20.9 Wood units for total pulmonary resistance. The mean time between diagnosis of pulmonary hypertension and lung transplantation was 5.9 years (range, 0.4-20 y). Seven patients were in functional class III and 8 in functional class IV. The mean 6-minute walk distance was 204 m (range, 0-360 m). Four patients (26%) died during the during the perioperative period and 9 (60%), 7 (46%), and 6 (40%) were still alive at 1, 3, and 5 years, respectively. CONCLUSIONS: Double-lung transplantation is a therapeutic option that, in certain cases, has similar outcomes to those achieved with the most aggressive medical treatment for pulmonary hypertension.

Platelet thromboembolism after lung transplantation.

Lung transplant patients have an increased risk of pulmonary embolism which is often associated with hypercoagulability disorders. We present a case of sudden death resulting from pulmonary intravascular platelet thromboembolism following a single-lung transplant.

Experimental study of visual training effects in shooting initiation.

INTRODUCTION: The present study was conducted to investigate the influence of specific visual training in shooting initiation performance. METHODS: Seventy-one first-year university students were divided randomly into two groups. The experimental group followed a nine-session shooting training program that included technical, physical and psychological components, along with specific visual exercises. The control group followed the same program with one difference: this group received theoretical lectures on psychological training techniques instead of doing visual exercises. Pre- and post-test results were obtained for shooting, concentration, saccades and visual acuity. RESULTS: Statistical analysis indicated significant gains in the four mentioned variables for the experimental group. The control group also showed significant differences in the three first variables but no significant improvement in visual acuity. No significant differences in shooting performance were observed between groups. CONCLUSIONS: The effect of vision training on sports initiation performance is still not clear. It cannot be assumed that the improvement is transferable to the performance of precision shooting at the stage of sports initiation.