A nurse-led home-based exercise program for patients with chronic kidney disease.

BACKGROUND: Exercise programs in patients with kidney disease improve functional capacity and health-related quality of life, but the implementation of exercise programs in nephrology services is not an easy task. AIM: To evaluate the effectiveness of a home-based exercise program in patients with chronic kidney disease (CKD) stages 4-5 (with or without dialysis). METHODS: A 12-week prospective observational cohort design study was carried out with patients with renal failure who undertook a home-based exercise program. Registered data included: (a) biochemical parameters; (b) functional capacity tests, that is, short physical performance battery, sit to stand to sit 10, and 6-min walking test; (c) handgrip strength; (d) health-related quality of life; (e) satisfaction; and (f) adherence. The quantitative variables were expressed by means and standard deviation, and qualitative variables, by percentage. The comparison of quantitative data between baseline and at 12 weeks of the same group was carried out using the Wilcoxon test for nonparametric-related variables and the chi-square test for categorical variables using contingency tables. RESULTS: Fifty-three patients were included (mean age = 67.4 years). The functional capacity tests showed a significant improvement in the short physical performance battery (8.3 ± 2.8 vs. 9.5 ± 2.6 points), the sit to stand to sit 10 (35.8 ± 17.7 vs. 31.8 ± 15.3 s), and the 6-min walking test (355.0 ± 106.1 vs. 386.4 ± 113.6 meters), mainly in CKD stage 5. There were no significant differences in handgrip and health-related quality of life. Regarding the degree of program satisfaction, 70% of the patients were very satisfied with being able to participate in the program, and 64% considered that they had more strength after completing the home-based exercise program. LINKING EVIDENCE TO ACTION: The implementation of a home-based exercise program results in improved functional capacity in patients with CKD stage 5. Moreover, this exercise program is safe, and patients were satisfied.

Home-based exercise programs in patients with chronic kidney disease: A systematic review and META-analysis.

BACKGROUND: Intradialysis exercise programs in renal patients result in improved functional capacity, muscle strength, symptoms of depression, and health-related quality of life. Home-based exercise programs are an alternative to overcome logistical and human resource problems. However, the implementation of these programs is not an easy task and there is a lack of knowledge regarding the benefits associated with home-based exercise programs. AIM: To determine whether home-based exercise programs improve functional capacity, health-related quality of life, muscle strength, and symptoms of depression among patients with stage III-V chronic kidney disease. METHODS: A systematic review and meta-analyses following PRISMA guidelines were utilized. Relevant articles were collected and independently assessed for their inclusion eligibility. Effects of home-based exercise were summarized by the standardized mean differences and represented by forest plots (Review Manager 5.4). RESULTS: Eight studies were included, none of which reported any adverse effects. The intervention was usually aerobic, 76% of these programs lasted 3-6 months, and exercise adherence was 60-87.5%. Four studies measured health-related quality of life and found significant improvements in several subscales. Regarding functional capacity, five studies used the six-minute walking test (44.9 meters; 95% CI [30.45, 59.30]; p ≤ .001), three studies used the sit-to-stand-to-sit test (-0.45 seconds; 95% CI [-0.46, -0.26]; p ≤ .001), and two studies used the timed up-and-go test (-0.76 seconds; 95% CI [-1.38, -0.15]; p ≤ .001) and the handgrip strength test (1.16 kg; 95% CI [-2.88, 5.20]; p ≤ .001). LINKING EVIDENCE TO ACTION: Home-based exercise programs are beneficial to renal patients. These interventions are safe and effective to improve health-related quality of life and functional capacity and reduce symptoms of depression among patients with chronic kidney disease.

Genetic and Molecular Interactions between HΔCT, a Novel Allele of the Notch Antagonist Hairless, and the Histone Chaperone Asf1 in Drosophila melanogaster.

Cellular differentiation relies on the highly conserved Notch signaling pathway. Notch activity induces gene expression changes that are highly sensitive to chromatin landscape. We address Notch gene regulation using Drosophila as a model, focusing on the genetic and molecular interactions between the Notch antagonist Hairless and the histone chaperone Asf1. Earlier work implied that Asf1 promotes the silencing of Notch target genes via Hairless (H). Here, we generate a novel HΔCT allele by genome engineering. Phenotypically, HΔCT behaves as a Hairless gain of function allele in several developmental contexts, indicating that the conserved CT domain of H has an attenuator role under native biological contexts. Using several independent methods to assay protein-protein interactions, we define the sequences of the CT domain that are involved in Hairless-Asf1 binding. Based on previous models, where Asf1 promotes Notch repression via Hairless, a loss of Asf1 binding should reduce Hairless repressive activity. However, tissue-specific Asf1 overexpression phenotypes are increased, not rescued, in the HΔCT background. Counterintuitively, Hairless protein binding mitigates the repressive activity of Asf1 in the context of eye development. These findings highlight the complex connections of Notch repressors and chromatin modulators during Notch target-gene regulation and open the avenue for further investigations.

Impact of measurement timing on reproducibility of testing among haemodialysis patients.

Accurate evaluation of physical function in patients undergoing haemodialysis is crucial in the analysis of the impact of exercise programs in this population. The aim of this study was to evaluate the reproducibility of several physical functional tests, depending on the timing of their implementation (before the HD session vs. non-HD days). This is a prospective, non-experimental, descriptive study. Thirty patients in haemodialysis were evaluated twice, 1 week apart. The test session was performed before the haemodialysis session started and a retest was performed in non-dialysis day. The testing battery included the short physical performance battery, sit-to-stand tests, 6 min walk test, one-leg stand test, timed up and go, and handgrip strength with and without forearm support. The intra-rater reproducibility was determined by the intraclass correlation coefficients and the agreement was assessed by Bland-Altman analysis. The intraclass correlation coefficients values ranged from 0.86 to 0.96, so that all tests showed good to very good relative reliability. The mean differences between trials of sit to stand 10 and 60, timed up and go and all the handgrip tests were close to zero, indicating no systematic differences between trials. Large range of values between trials was observed for the 6 min walk test, gait speed, one-leg stand test and short physical performance battery, indicating a systematic bias for these four tests. In conclusion,  the sit to stand 10 and 60, timed up and go and handgrip tests had good to excellent test-retest reliability in measuring physical function in different dialysis days of patients undertaking haemodialysis. The minimal detectable change values are provided for this population. Bias were found for the 6 min walk test, gait speed, Short physical performance battery or one-leg stand test when the testing day changed.

Clinical grade ACE2 as a universal agent to block SARS-CoV-2 variants.

The recent emergence of multiple SARS-CoV-2 variants has caused considerable concern due to both reduced vaccine efficacy and escape from neutralizing antibody therapeutics. It is, therefore, paramount to develop therapeutic strategies that inhibit all known and future SARS-CoV-2 variants. Here, we report that all SARS-CoV-2 variants analyzed, including variants of concern (VOC) Alpha, Beta, Gamma, Delta, and Omicron, exhibit enhanced binding affinity to clinical grade and phase 2 tested recombinant human soluble ACE2 (APN01). Importantly, soluble ACE2 neutralized infection of VeroE6 cells and human lung epithelial cells by all current VOC strains with markedly enhanced potency when compared to reference SARS-CoV-2 isolates. Effective inhibition of infections with SARS-CoV-2 variants was validated and confirmed in two independent laboratories. These data show that SARS-CoV-2 variants that have emerged around the world, including current VOC and several variants of interest, can be inhibited by soluble ACE2, providing proof of principle of a pan-SARS-CoV-2 therapeutic.

The Relationship between Physical Activity Levels and Functional Capacity in Patients with Advanced Chronic Kidney Disease.

The purpose of this study is to assess whether the functional capacity of patients with chronic kidney disease stage V (CKD-5D) is different depending on their physical activity levels. We also compared functional capacity, quality of life, and symptoms of depression depending on treatment modalities (HD vs. PD). A Cross-sectional study included 52 patients (35HD and 17PD; males 61.5%, mean age 71 years). The main measurements were physical activity level using the Human Activity Profile questionnaire (HAP), muscle strength, functional capacity, health-related quality of life (HRQoL), and depressive symptomatology. The functional tests and physical activity levels correlated significantly. Participants on HD with low physical activity levels were older (*p ≤ .039) and had worst physical function (*p ≤ .01). The HAP is a useful tool to detect subjects with low functional capacity; there were no differences between the therapy modalities in terms of functional capacity, HRQoL, or depressive symptomatology.

Clinical grade ACE2 as a universal agent to block SARS-CoV-2 variants.

The recent emergence of multiple SARS-CoV-2 variants has caused considerable concern due to reduced vaccine efficacy and escape from neutralizing antibody therapeutics. It is therefore paramount to develop therapeutic strategies that inhibit all known and future SARS-CoV-2 variants. Here we report that all SARS-CoV-2 variants analyzed, including variants of concern (VOC) Alpha, Beta, Gamma, and Delta, exhibit enhanced binding affinity to clinical grade and phase 2 tested recombinant human soluble ACE2 (APN01). Importantly, soluble ACE2 neutralized infection of VeroE6 cells and human lung epithelial cells by multiple VOC strains with markedly enhanced potency when compared to reference SARS-CoV-2 isolates. Effective inhibition of infections with SARS-CoV-2 variants was validated and confirmed in two independent laboratories. These data show that SARS-CoV-2 variants that have emerged around the world, including current VOC and several variants of interest, can be inhibited by soluble ACE2, providing proof of principle of a pan-SARS-CoV-2 therapeutic.

Test-retest reliability and minimal detectable change scores for the short physical performance battery, one-legged standing test and timed up and go test in patients undergoing hemodialysis.

Functional tests are commonly used for chronic kidney disease (CKD) patients undergoing hemodialysis (HD). However, the relative and absolute reliability of such physical performance-outcome assessments must first be determined in specific patient cohorts. The aims of this study were to assess the relative and the absolute reliability of the Short Physical Performance Battery (SPPB), One-Legged Stance Test (OLST), and Timed Up and Go (TUG) test, as well as the minimal detectable change (MDC) scores for these tests in CKD patients receiving HD. Seventy-one end-stage CKD patients receiving HD therapy, aged between 21 and 90 years, participated in the study. The patients completed two testing sessions one to two weeks apart and performed by the same examiner, comprising the following tests: the SPPB (n = 65), OLST (n = 62), and TUG test (n = 66). High intraclass correlation coefficients (≥0.90) were found for all the tests, suggesting that their relative reliability is excellent. The MDC scores for the 90% confidence intervals were as follows: 1.7 points for the SPPB, 11.3 seconds for the OLST, and 2.9 seconds for the TUG test. The reliability of the SPPB, OLST, and TUG test for this sample were all considered to be acceptable. The MDC data generated by these tests can be used to monitor meaningful changes in the functional capacity of the daily living-related activity of CKD patients on HD.

Identification and regulation of novel PPAR-gamma splice variants in human THP-1 macrophages.

We have previously identified four novel isoforms of PPAR-gamma transcripts in monkey macrophages (J. Zhou, K.M. Wilson, J.D. Medh, Genetic analysis of four novel peroxisome proliferator receptor-gamma splice variants in monkey macrophages. Biochem. Biophys. Res. Commun., 293 (2002) 274-283). The purpose of this study was to ascertain that these isoforms are also present in humans. Specific primers were designed to amplify individual isoform transcripts. The presence of PPAR-gamma4, PPAR-gamma5, and PPAR-gamma7 transcripts in human THP-1 macrophages was confirmed by RT-PCR and sequencing. A transcript corresponding to PPAR-gamma6 was not detected. The presence of novel full-length transcripts and protein was also ascertained by Northern and Western blot analysis. Treatment of THP-1 cells with 15-deoxy-Delta12,14-prostaglandin J2 (15d-PGJ2) resulted in more than 20% induction in the expression of PPAR-gamma5 and PPAR-gamma7 transcripts by both Northern blot analysis and RT-PCR. Another PPAR-gamma ligand, troglitazone, induced expression of only PPAR-gamma5. Both ligands inhibited the expression of PPAR-gamma1 and PPAR-gamma2. Additionally, 15d-PGJ2 and troglitazone increased the level of apolipoprotein E transcript by 60% but decreased lipoprotein lipase expression by 15% in THP-1 cells. The differential regulation of PPAR-gamma transcripts suggests that each transcript isoform may contribute to macrophage function.

The presence of donor liver granuloma requiring further workup to rule out parasitic disease.

A shortage of donor organs is a major limitation to liver transplantation. Expansion of donor pool criteria to include patients with schistosomiasis diagnosed on liver biopsy might allow the allocation of more transplant livers. Schistosomiasis is a chronic parasitic disease affecting millions in endemic areas including sub-Sahara Africa that might lead to the development of granulomas as a response to the parasite's ova and might cause chronic liver disease and portal hypertension. Due to increased mobility globally, schistosomiasis may be encountered in non-endemic areas. Currently, the usage of donor livers with known Schistosomiasis is not universally defined.

Resultados de un programa de ejercicio físico domiciliario en pacientes con enfermedad renal / Results of a home physical exercise program in patients with kidney disease

INTRODUCCIÓN: Cada vez es más frecuente la literatura que nos muestra los beneficios de los programas de ejercicio físico para mejorar la capacidad funcional y la calidad de vida relacionada con la salud de los pacientes con enfermedad renal crónica. Sin embargo, la implementación de estos programas no es una tarea fácil. OBJETIVO: Evaluar la efectividad de un programa de ejercicio físico domiciliario sobre la fuerza de agarre de las manos, capacidad funcional y calidad de vida en pacientes con enfermedad renal crónica avanzada en estadíos 4-5. MATERIAL Y MÉTODO: Estudio prospectivo experimental. Los pacientes realizaron un programa completo de ejercicio domiciliario de 3 sesiones semanales durante 12 semanas. Principales datos analizados: dinamometría manual (HG) y la prueba Short Physical Performance Battery (SPPB) y calidad de vida mediante el Euroqol 5D. RESULTADOS: 62 pacientes incluidos. 34 eran hombres con una edad media 67,4±14,9 años. La velocidad de la marcha en 4 metros aumentó en 0,18 m/s (IC95%: 0,08-0,28). Los resultados del SPPB aumentaron en 1,4 puntos (IC95%: 0,6-2,2 puntos). No se observan cambios significativos ni en la dinamometría manual (de 26,1Kg a 26,4Kg) ni en la calidad de vida relacionada con la salud (de 67,8 a 71,3 puntos). CONCLUSIÓN: Un programa de ejercicio físico domiciliario de 12 semanas de duración fue seguro y mejoró la capacidad funcional de los pacientes en enfermedad renal crónica avanzada en estadíos 4-5

INTRODUCTION: Scientific evidence is greater on the benefits of physical exercise programs to improve functional capacity and health-related quality of life of patients with chronic kidney disease. However, implementing these programs is not an easy task. OBJECTIVE: To evaluate the effectiveness of a home physical exercise program on hand grip strength, functional capacity and quality of life in patients with advanced chronic kidney disease in stages 4-5. MATERIAL AND METHOD: Prospective experimental study. The patients performed a complete home exercise program of 3 weekly sessions for 12 weeks. The main data analyzed were manual dynamometry, the Short Physical Performance Battery (SPPB) test, and the EuroQoL 5D questionnaire to assess quality of life. RESULTS: Sixty-two patients were included, 34 men and with a mean age of 67.4±14.9 years. The 4-meter gait speed increased by 0.18 m/s (95%CI: 0.08-0.28). The SPPB results increased by 1.4 points (95%CI: 0.6-2.2 points). No significant changes were observed either in manual dynamometry (from 26.1 to 26.4Kg) or in health-related quality of life (from 67.8 to 71.3 points). CONCLUSION: A 12-week home physical exercise program was safe and improved the functional capacity of patients with advanced chronic kidney disease in stages 4-5

Benefits of a low intensity exercise programme during haemodialysis sessions in elderly patients.

BACKGROUND: Elderly patients on haemodialysis (HD) are a steadily increasing group. They show a high complexity, dependency and comorbidity. Multiple benefits from exercise in HD patients have been reported; however, they have not been specifically evaluated in an elderly population. OBJECTIVE: To assess the effect of an adapted low intensity intradialytic exercise programme on muscle strength, functional capacity and health-related quality of life in our elderly patients (> 80 years) on HD. MATERIAL AND METHODS: HD patients were non-randomly assigned to an exercise training group (E) or a control group (C) in a 12-week single-centre prospective study. E included a combined exercise programme using balls, weights, elastic bands and cycle movements in the first 2 hours of HD sessions. C group patients received standard HD care. Endpoints were: 1) main biochemical data; 2) maximum quadriceps length strength (MQLS) and hand-grip (HG); 3) functional capacity tests: "Sit to stand to sit" (STS10) and "six-minutes walking test" (6MWT); 4) Beck Depressive Inventory (BDI); and 5) Health-related quality of life questionnaire: EuroQol-5D (EQ-5D). RESULTS: A total of 22 patients were included (50% men). Mean age was 83.2 years; patients had received HD for 44.1 month. Charlson index was 9.5. Main aetiology was diabetes mellitus (36.4%). Eleven patients were assigned to E group and 11 to C group. No related adverse effects were observed. At the end of the study, E group showed an overall improvement in tests (*P<.05): MQLS 10.5 ± 7.6 vs. 12.9 ± 10.1 kg, HG* 16.6 ± 8.7 vs. 18.2 ± 8.9 kg, STS10* 29.9 ± 10.6 vs. 25 ± 7.87 sec, 6MWT* 14.6%, 234.4 vs. 274.7 m, BDI* 14.4 ± 11.5 vs. 11.7 ± 10.8 and EQ-5D 49 ± 19.1 vs. 59.5 ± 20.3. No similar changes were observed in C group. Significant differences between groups were also found for HG, MQLS, STS10, 6MWT, BDI and EQ-5D. No significant changes were found in biochemical and anthropometric data, antidepressant treatment or suitable dialysis parameters at the end of the study. CONCLUSIONS: 1) An adapted low intensity exercise programme improved muscle strength, functional capacity and health-related quality of life in our elderly patients on HD. 2) Our results highlight the benefits from exercise in HD patients even in this elderly population. 3) In elderly patients on HD, it is worth considering an adapted low intensity intradialytic exercise programme as a part of a comprehensive care.

Efficacy of neuromuscular electrostimulation intervention to improve physical function in haemodialysis patients.

BACKGROUND: Haemodialysis (HD) patients are characterised by muscle wasting, decreased physical function and poor quality of life. The objective was to analyse the effect of an intradialysis NMES training programme in muscular strength, functional capacity and quality of life in our HD patients. MATERIAL: HD patients were assigned to NMES (ESG) or control group (CG) in a 12-week single-centre prospective study. Transversal quadriceps muscular area, maximum length quadriceps strength (MLQS), handgrip, sit-to-stand-to-sit 10 test (STS10), "6-min walking test" (6MWT); EuroQol-5D health-related quality of life (EQ-5D) questionnaire, subjective global assessment (SGA) and NMES symptoms questionnaires (SQ) were completed. RESULTS: Thirty-eight patients (54 % men). Mean age 69.7 years. 32.1 months on HD, 23 ESG and 15 in CG. In contrast with CG, ESG significantly (*p < 0.05) improved MLQS* (10.2 6.7 vs. 13.1 8.1 kg), STS10* (41 18.7 vs. 37.2 23.9 s), 6MWT* (12 %, 280.5 vs. 312.4 m) and EQ-5D score* (52.7 vs. 65.5) at the end of the study. However, lower SQ score* (8.5 vs. 5.8 sympt./patient) in ESG was observed, mainly due to muscular pain* (2.2 vs. 1.2), cramps* (1.6 vs. 1.2), numbness* (1.7 vs. 1.1) or stinging* (1.5 vs. 1.1). In ESG, 44 and 72 % referred better wellness sensation and physical condition in SGA, respectively. CONCLUSIONS: Intradialytic NMES of both quadriceps improved muscular strength, functional capacity and quality of life in our HD patients. With the obtained results, NMES constitutes a novel therapeutic alternative to improve the deteriorated physical condition and quality of life of these patients.

Striatal 6-hydroxydopamine induces apoptosis of nigral neurons in the adult rat.

The massive dopaminergic neuronal loss that occurs in Parkinson's disease shows features of apoptosis. In the current study we have characterised the neuronal death in an animal model of Parkinson's disease. 6-Hydroxydopamine infused in the striatum of adult rats induced progressive loss of dopamine neurons, identified as tyrosine hydroxylase immunoreactive profiles, in the ipsilateral substantia nigra starting at day 5 post-lesion (32%). Silver staining revealed the presence of apoptotic profiles with neuronal morphology in the substantia nigra ipsilateral to the intrastriatal 6-hydroxydopamine injection. These apoptotic nuclei were first observed at day 6 post-lesion, peaked between days 7 and 10 and then abruptly declined. The apoptotic morphology of 6-hydroxydopamine-induced neuronal death was confirmed by electron microscopic studies. These data show that intrastriatal 6-hydroxydopamine-induced dopaminergic neuronal death in the adult rat is apoptotic and supports the use of this lesion protocol as an animal model of Parkinson's disease.

Evaluación de la fiabilidad en instrumentos de valoración funcional en pacientes en hemodiálisis / Evaluation of reliability in functional assessment tools in patients on hemodialysis

Introducción: Cada vez es más frecuente promocionar programas de ejercicio físico en pacientes en hemodiálisis. Se puede valorar la condición física de estos pacientes y el resultado de dichos programas con diferentes pruebas funcionales. Objetivo: Valorar la fiabilidad en términos de concordancia interobservador de las mediciones de capacidad funcional y fuerza muscular en pacientes en hemodiálisis. Material y Método: 30 pacientes en hemodiálisis realizaron una batería de pruebas funcionales en dos fases: Short Physical Performance Battery, equilibrio estático monopodal, Timed Up and Go, Test Sit-to-stand-To-Sit-5, Sit-to-stand-To-Sit-10, Sit-to-stand-To-Sit-60, fuerza de tríceps sural, 6 minutos marcha y dinamometría de la mano. Resultados: El índice de correlación intraclase para la fiabilidad interobservador fue para el test Sit-to-stand-To-Sit-5: 0,779; velocidad en 4 metros: 0,820; puntuación total Short Physical Performance Battery: 0,807; Sit-to-stand-To-Sit-10: 0,908; Sit-to-stand-To-Sit-60: 0,865; 6 minutos marcha: 0,897; Equilibrio monopodal: 0,925; Timed Up and Go: 0,918; Fuerza de tríceps sural derecho: 0,702; Fuerza de tríceps sural izquierdo: 0,995; dinamometría mano derecha con apoyo: 0,952; dinamometría mano izquierda con apoyo: 0,897; dinamometría mano derecha sin apoyo: 0,973; dinamometría mano izquierda con apoyo: 0,964. Conclusiones: La fiabilidad interobservador en la mayoría de las pruebas es alta, por lo que se puede aceptar que la valoración del estado funcional del paciente y de los resultados de los programas destinados a promocionar el ejercicio lo lleven a cabo diferentes observadores experimentados, lo que facilitaría el seguimiento de los pacientes

Introduction: It is increasingly common to promote physical exercise programs in hemodialysis patients. The physical condition of patients and the result of these programs with different functional tests can be assessed. Objective: To assess the reliability in terms of interobserver reliability of functional capacity and muscle strength measurements in hemodialysis patients. Material and Method: 30 patients on hemodialysis performed several functional tests in two phases: Short Physical Performance Battery, static monopodal equilibrium, Timed Up and Go, Test Sit-to-stand-To-Sit-5, Sit-to-stand-To-Sit-10, Sit-to-stand-To-Sit-60, strength of triceps sural, 6 minutes walking and dynamometry of the hand. Results: The intraclass correlation coefficient for interobserver reliability was for the Sit-to-stand-To-Sit-5 test: 0.779; speed in 4 meters: 0.820; Total score Short Physical Performance Battery: 0.807; Sit-to-stand-To-Sit-10: 0.908; Sit-to-stand-To-Sit-60: 0.865; 6 minutes march: 0.897; Monopodal equilibrium: 0.925; Timed Up and Go: 0.918; Right triceps sural force: 0.702; Left triceps sural force: 0.995; Right hand dynamometry with support: 0.952; Left hand dynamometry with support: 0.897; right hand dynamometry without support: 0.973; left hand dynamometry with support: 0.964. Conclusions: The interobserver reliability, in most tests is high, so it can be accepted that the assessment of the patient’s functional status and the results of the programs designed to promote the exercise is carried out by different experienced observers, which would facilitate the follow-up of patients

Percepción de los profesionales sanitarios sobre la gravedad de las úlceras por presión como evento adverso / Perception of health professionals on the severity of pressure ulcers as an adverse event

Introducción: La seguridad de los pacientes representa una prioridad del sistema de salud y un principio fundamental de la atención sanitaria. Las úlceras por presión, evitables en un alto porcentaje, son consideradas el primer evento adverso relacionado con los cuidados de enfermería. Objetivos: Conocer la percepción de los distintos profesionales sanitarios sobre la gravedad de las úlceras por presión como evento adverso. Metodología: Se realizó un estudio descriptivo transversal en enero de 2016 a personal sanitario de diferentes centros de trabajo, principalmente de España y Andorra. Se administró una encuesta online desarrollada por los investigadores ad hoc para la recogida de datos con variables sociodemográficas, experiencia y ámbito de trabajo y los diferentes ítems en los que se pretendía conocer su opinión sobre la importancia de tres efectos adversos: úlceras por presión, caídas y flebitis. Resultados: Participaron 459 profesionales: un 71,24% enfermeras, un 14,81% médicos y un 13,95% técnicos en cuidados auxiliares en enfermería. El 87,7% consideró las úlceras por presión como un evento adverso grave, y las enfermeras fueron el colectivo que consideró este efecto como más grave. Para la prevención de estas lesiones, el 97,8% afirmaron la evidencia de su evitabilidad. No se observó asociación sobre la importancia y consecuencias de las úlceras por presión como evento adverso entre las variables profesión y opinión. Conclusiones: Los encuestados consideraron las úlceras por presión como el evento adverso más grave entre los cuidados de enfermería y consideraron, además, que se pueden prevenir (AU)

Introduction: Patient safety in the healthcare system is a priority and a fundamental principle of health care. Pressure ulcers, which in most cases are avoidable, are considered the first adverse event related to nursing care. Objectives: To understand the observations of different healthcare professionals on the severity of pressure ulcers as an adverse event. Methods: A descriptive, cross-sectional study was carried out in January 2016 amongst healthcare personnel from different workplaces, mainly in Spain and Andorra. An online survey was administered by the ad hoc investigators for the collection of data with socio-demographic variables, experience and scope of work and the different items in which it was intended to know their opinion on the importance of three adverse effects: pressure ulcers, falls and phlebitis. Results: 459 professionals participated: 71.24% nurses, 14.81% doctors and 13.95% nursing assistant. 87.7% considered pressure ulcers as a serious adverse event, with nurses being the group that considered this effect as more serious. For the prevention of these injuries, 97.8% affirmed the evidence of their avoidability. No association was observed on the importance and consequences of pressure ulcers as an adverse event, between the profession and opinion variables. Conclusions: Respondents considered pressure ulcers to be the most serious adverse event among nursing care and considered, moreover, that they can be prevented (AU)

Resultado de un programa adaptado de ejercicio físico en pacientes ancianos en hemodiálisis / Effects of an adapted physical activity program in elderly haemodialysis patients

Introducción: Los pacientes ancianos constituyen un grupo en continuo crecimiento en los programas de hemodiálisis. Éstos se caracterizan por su elevada complejidad, dependencia y comorbilidad asociada. Múltiples beneficios del ejercicio físico en los pacientes en hemodiálisis han sido descritos; si bien no han sido completamente evaluados en la población anciana en hemodiálisis. Objetivos: Analizar el efecto de un programa adaptado de ejercicio físico intradiálisis sobre la fuerza muscular, la capacidad funcional, la sintomatología depresiva y la calidad de vida en nuestros pacientes ancianos (>75 años) en hemodiálisis. Material y métodos: Estudio prospectivo de 12 semanas de duración. 11 pacientes incluidos (36.4% hombres). Edad media 83.9 años y 37.2 meses en hemodiá- lisis. Charlson medio: 9.7. Principal etiología: Diabetes Mellitus (45.5%), No filiada (27.3%), hipertensión (9.1%). Los pacientes incluidos realizaron un programa de ejercicio físico adaptado mediante pelotas medicinales, pesas, bandas elásticas y cicloergómetros en las primeras dos horas de hemodiálisis. Analizamos: 1.-Parámetros bioquímicos. 2. Datos musculares: Fuerza extensión máxima cuádriceps y hand-grip. 3.-Tests Test funcionales: “Sit to stand to sit" y “six-minutes walking test”. 4.- Sintomatología depresiva: Inventario Beck. 5.-Calidad de Vida: EuroQol-5D. Resultados: De forma global, se observó una mejoría en las pruebas realizadas (*p<0.05): Fuerza extensión máxima del cuádriceps (10.5 ± 7.6 vs 12.9 ± 10 kg), hand-grip* (16.6 ± 8.7 vs 18.2 ± 8.9 kg), Sit to stand to sit 10* (29.9 ± 10.6 vs 25 ± 7.8 seg), six-minutes walking test* (22.6%, 234.4 vs 286.8 m), inventario de Beck* (14.4 ± 11.5 vs 11.7 ± 10.8) y EuroQol-5D (49.1 ± 19.1 vs 59.5 ± 20.3, p=0.064) al finalizar el estudio. Del mismo modo, no observamos cambios relevantes en los datos bioquímicos y antropométricos durante el estudio. Conclusiones: 1.-El programa adaptado de ejercicio físico intradiálisis mejoró la fuerza muscular, la capacidad funcional y la calidad de vida de nuestros pacientes ancianos en hemodiálisis. 2.- Aún en población anciana, nuestros resultados realzan los beneficios del ejercicio físico en los pacientes en hemodiálisis. 3.-Ante un paciente anciano en hemodiálisis, merece la pena considerar la realización de ejercicio físico adaptado intradiálisis como una parte más del cuidado integral en hemodiálisis (AU)

Introduction: Elderly patients are a group continuously growing in haemodialysis programs. They are characterized by their high complexity, dependency and associated comorbidity. Multiple benefits of physical activities in haemodialysis patients have been described; although they have not been fully evaluated in the elderly haemodialysis population. Objectives: To analyse the effect of an intradialytic adapted physical activity program on muscle strength, functional capacity, depressive symptoms and quality of life in our elderly patients (> 75 years) on haemodialysis. Methods: A prospective study of 12 weeks. 11 patients were included (36.4% male). Mean age of 83.9 years and haemodialysis vintage of 37.2 months. Mean Charlson index of 9.7. Main aetiologies: Diabetes Mellitus (45.5%), Not drafted (27.3%), hypertension (9.1%). Included patients performed a tailored physical exercise program using medicine balls, weights, elastic bands and ergometer in the first two hours of dialysis. We analyse: 1.-Biochemical parameters. 2.-Muscular Data: Maximum quadriceps extension strength and maximum handgrip strength. 3.-Functional tests: “Sit to stand to sit" and “six-minutes walking test”. 4.-Depressive symptomatology: Beck Depression Inventory. 5.-Quality of Life: EuroQol-5D. Results: Overall, an improvement was observed in tests (*p<0.05): Maximum quadriceps extension strength (10.5 ± 7.6 vs. 12.9 ±10 kg), hand-grip* (16.6 ± 8.7 vs. 18.2 ± 8.9 kg) Sit to stand to sit 10* (29.9 ± 10.6 vs. 25 ± 7.8 sec), Six-minute walking test* (22.6%, 234.4 vs. 286.8 m), Beck Depression Inventory* (14.4 ± 11.5 vs. 11.7 ± 10.8) and EuroQol-5D (49.1 ± 19.1 vs. 59.5 ± 20.3, p = 0.064) at study end. Similarly, we observed no significant changes in biochemical and anthropometric data during the study. Conclusions: 1. Intradialytic adapted physical activity program improved muscle strength, functional capacity and quality of life in elderly haemodialysis patients. 2. Our results highlight the benefits of exercise in elderly haemodialysis patients. 3. It is worth considering conducting intradialytic adapted physical exercises as just another part of comprehensive care in haemodialysis (AU)

Electroestimulación neuromuscular intradiálisis, fuerza muscular, capacidad funcional y composición corporal / Intradialysis neuromuscular electro stimulation muscle strength, functional capacity and body composition

Introducción: La capacidad funcional disminuida y la importante atrofia muscular caracterizan a los pacientes en hemodiálisis (HD). El ejercicio físico intradiálisis y recientemente la electroestimulación neuromuscular (EMS), representan dos serias opciones terapéuticas para mejorar esta deteriorada condición física. Actualmente, no existen estudios publicados sobre el papel de la EMS y la composición corporal en los pacientes en HD. Objetivo: Analizar que efecto produce un programa de EMS sobre la fuerza muscular, capacidad funcional, parámetros nutricionales y composición corporal en nuestros pacientes en HD. Material y Métodos: Estudio unicéntrico, prospectivo de 12 semanas de duración. Los pacientes incluidos realizaron un programa adaptativo de EMS en ambos cuádriceps intradiálisis mediante el dispositivo Compex R Theta 500i. Analizamos: 1.- Parámetros nutricionales (Albumina, pre albúmina, triglicéridos, colesterol total y fracciones, ferritina y Proteína C reactiva). 2.- Datos musculares: Composición muscular cuadriceps, Fuerza extensión máxima cuádriceps (FEMQ) y handgrip (HG) brazo dominante. 3.- Test funcionales: “Sit to stand to sit” (STS10) y “six- minutes walking test” (6MWT). 4.- Composición corporal mediante biompedancia electrica (BIA). Resultados: 13 pacientes incluidos: (69.2% hombres). Edad media: 65.7 años y 33.9 meses en HD. I.Charlson medio 9.1. La principal etiología de la ERC fue la DM ( 38.5%). Al final del estudio se observó una mejoría en (*p<0.05): FEMQ* ( 11.7±7.1 vs 13.4±7.4 Kg), STS10 (39.3±15.5 vs 35.8±13.7 seg), 6MWT* (9.9%, 293.2 vs 325.2 m). En relación a la composición corporal, se observó únicamente un aumento significativo del área muscular (AMQ*: 128.6 ± 30.2 vs 144.6 ± 22.4 cm2) y una disminución del área grasa (AGQ*: 76.5 ± 26.9 vs 62.1 ± 20.1 cm2) a nivel quadricipital, sin cambios en el resto de datos analizados (% grasa abdominal, peso graso, peso magro, agua corporal total). No se objetivaron cambios relevantes en los parámetros nutricionales y de adecuación dialítica. Conclusiones: 1.- La electroestimulación neuromuscular intradialísis mejoró la fuerza muscular, la capacidad funcional y la composición muscular del cuadriceps de nuestros pacientes en HD. 2.- Nuestros resultados remarcan el carácter local de la electroes-timulación neuromuscular, dada la ausencia de cambios relevantes en el resto de los parámetros nutricionales y datos corporales analizados. 3.- No obstante, son necesarios futuros estudios mejor diseñados, de cara a discernir si la electroestimulación neuromuscular podría ser una nueva alternativa terapéutica para evitar la atrofia muscular y el deterioro progresivo de la condición física de éstos pacientes (AU)

Background: The reduced functional capacity and significant muscle atrophy characterized patients on hemodialysis. Intradialytic exercise and recently neuromuscular electrostimulation (EMS) represent two serious therapeutical options to improve the deteriorated physical condition. Until date, there are no published studies about the role of EMS and body composition in HD patients. Objectives: Analyze the effect a program of EMS on muscle strength, functional capacity, nutritional parameters and body composition in our HD patients. Methods: A 12 weeks single-center, prospective study. Patients included in the study performed an intradialysis EMS adaptive program in both quadriceps using the Compex R Theta 500i device. We analyzed: 1.- Nutritional parameters (albumin, pre-albumin, triglycerides, total cholesterol and fractions, ferritin and C-reactive protein). 2.- Muscular data: Muscular composition, Maximum length quadriceps strength (MLQS) and “hand-grip” (HG) dominant arm. 3.- Functional capacity test: “Sit to stand to sit” (STS10) and “six- minutes walking test” (6MWT). 4.- Body composition. Results: 13 HD patients included: 69.2 % men. Mean age 65.7 years and 33.9 months on HD. A significant (* p < 0,05) improvement was observed in MLQS* (11.7±7.1 vs 13.4±7.4 Kg), STS10* (39.3±15.5 vs 35.8±13.7 seg), 6MWT* (9.9%, 293.2 vs 325.2 m). There was a signi-ficant increase in the quadriceps muscular area (QMA*: 128.6 ± 30.2 vs 144.6 ± 22.4 cm2) and decrease of fat quadricipital area (FQA*: 76.5 ± 26.9 vs 62.1 ± 20.1 cm2). No significant changes were observed in nutritional parameters, body composition (body fat percentage, lean and fat mass, total body water) or dialysis adecuacy data. Conclusions: 1.- Intradialysis quadriceps EMS improved muscle strength, functional capacity and the quadriceps muscle composition in our HD patients. 2.- Our results underline the local aspects on EMS, given the absence of relevant changes on nutritional parameters and body composition. 3.- Future studies are manadatory in order to establish if EMS could be a new alternative to prevent muscle atrophy and the progressive deterioration of the physical condition of these patients (AU)

Beneficios del ejercicio físico de baja intensidad durante la sesión de hemodiálisis en el paciente anciano / Benefits of a low intensity exercise programme during haemodialysis sessions in elderly patients

Introducción: Los pacientes ancianos constituyen un grupo en continuo crecimiento en los programas de hemodiálisis (HD). Estos se caracterizan por su elevada complejidad, dependencia y comorbilidad asociada. Múltiples beneficios del ejercicio físico en los pacientes en HD han sido descritos, si bien no han sido completamente evaluados en la población anciana. Objetivos: Analizar el efecto de un programa adaptado de ejercicio físico intradiálisis sobre la fuerza muscular, la capacidad funcional y la calidad de vida relacionada con la salud en nuestros pacientes ancianos (>80 años) en HD. Material y métodos: Estudio prospectivo unicéntrico no aleatorizado (12 semanas) con 2 grupos comparativos. El grupo ejercicio (E) incluía un programa de ejercicio físico adaptado mediante pelotas medicinales, pesas, bandas elásticas y cicloergómetros en las primeras 2 h de HD. El grupo control (C) recibía el cuidado habitual en HD. Analizamos: 1) Parámetros bioquímicos. 2) Fuerza de extensión máxima de cuádriceps (FEMQ) y «hand-grip» (HG). 3) Tests de capacidad funcional: «sit to stand to sit» (STS10) y «six-minutes walking test» (6MWT). 4) Sintomatología depresiva: inventario Beck (BDI). 5) Calidad de vida: EuroQol-5D (EQ-5D). Resultados: Un total de 22 pacientes incluidos: 50% hombres. Edad media 83,2 años y 44,1 meses en HD. Charlson medio: 9,5. Principal etiología: DM (36,4%). Un total de 11 pacientes asignados al grupo E y 11 al grupo C. No se observaron efectos adversos relacionados. Al final del estudio, el grupo E presentó de forma global una mejoría en las pruebas realizadas (*p<0,05): FEMQ 10,5±7,6 vs. 12,9±10,1kg; HG* 16,6±8,7 vs. 18,2±8,9kg; STS10* 29,9±10,6 vs. 25±7,87sec; 6MWT* 14,6%, 234,4 vs. 274,7 m; BDI* 14,4±11,5 vs. 11,7±10,8 y EQ-5D 49±19,1 vs. 59,5±20,3. Estos cambios no se observaron en el grupo C al final del estudio. Del mismo modo, el análisis entre grupos mostró una diferencia significativa para HG, FEMQ, STS10, 6MWT, BDI y EQ-5D. No observamos cambios relevantes en los datos bioquímicos ni antropométricos, en la medicación antidepresiva ni en los parámetros de adecuación dialítica a la finalización. Conclusiones: 1) El programa adaptado de ejercicio físico intradiálisis mejoró la fuerza muscular, la capacidad funcional y la calidad de vida relacionada con la salud de nuestros pacientes ancianos en HD. 2) Aun en población anciana, nuestros resultados realzan los beneficios del ejercicio físico en los pacientes en HD. 3) Ante un paciente anciano en HD, merece la pena considerar la realización de ejercicio físico adaptado intradiálisis como una parte más del cuidado integral en HD (AU)

Background: Elderly patients on haemodialysis (HD) are a steadily increasing group. They show a high complexity, dependency and comorbidity. Multiple benefits from exercise in HD patients have been reported; however, they have not been specifically evaluated in an elderly population. Objective: To assess the effect of an adapted low intensity intradialytic exercise programme on muscle strength, functional capacity and health-related quality of life in our elderly patients (> 80 years) on HD. Material and methods: HD patients were non-randomly assigned to an exercise training group (E) or a control group (C) in a 12-week single-centre prospective study. E included a combined exercise programme using balls, weights, elastic bands and cycle movements in the first 2 hours of HD sessions. C group patients received standard HD care. Endpoints were: 1) main biochemical data; 2) maximum quadriceps length strength (MQLS) and hand-grip (HG); 3) functional capacity tests: "Sit to stand to sit" (STS10) and "six-minutes walking test" (6MWT); 4) Beck Depressive Inventory (BDI); and 5) Health-related quality of life questionnaire: EuroQol-5D (EQ-5D). Results: A total of 22 patients were included (50% men). Mean age was 83.2 years; patients had received HD for 44.1 month. Charlson index was 9.5. Main aetiology was diabetes mellitus (36.4%). Eleven patients were assigned to E group and 11 to C group. No related adverse effects were observed. At the end of the study, E group showed an overall improvement in tests (*P<.05): MQLS 10.5 ± 7.6 vs. 12.9 ± 10.1 kg, HG* 16.6 ± 8.7 vs. 18.2 ± 8.9 kg, STS10* 29.9 ± 10.6 vs. 25 ± 7.87 sec, 6MWT* 14.6%, 234.4 vs. 274.7 m, BDI* 14.4 ± 11.5 vs. 11.7 ± 10.8 and EQ-5D 49 ± 19.1 vs. 59.5 ± 20.3. No similar changes were observed in C group. Significant differences between groups were also found for HG, MQLS, STS10, 6MWT, BDI and EQ-5D. No significant changes were found in biochemical and anthropometric data, antidepressant treatment or suitable dialysis parameters at the end of the study. Conclusions: 1) An adapted low intensity exercise rogramme improved muscle strength, functional capacity and health-related quality of life in our elderly patients on HD. 2) Our results highlight the benefits from exercise in HD patients even in this elderly population. 3) In elderly patients on HD, it is worth considering an adapted low intensity intradialytic exercise programme as a part of a comprehensive care (AU)

Effect of the metabotropic glutamate antagonist MPEP on striatal expression of the Homer family proteins in levodopa-treated hemiparkinsonian rats.

RATIONALE: Striatal glutamatergic hyperactivity through the metabotropic receptors and their intracellular signaling pathways is considered critical in the development of levodopa-induced dyskinesias in Parkinson's disease and in experimental parkinsonism. OBJECTIVE: We investigated whether the administration of the metabotropic glutamate antagonist, MPEP, modifies striatal expression of Homer family proteins which are involved in the intracellular mechanisms mediated by these receptors. MATERIALS AND METHODS: Sprague-Dawley rats were unilaterally lesioned in the nigrostriatal pathway with 6-hydroxydopamine (8 microg) and treated with: levodopa (12 mg/kg, i.p.) plus vehicle (n=10) divided in two daily injections; levodopa plus MPEP (1.5 and 3 mg/kg, i.p.; n=6-13) divided in two daily injections; or saline (n=7) for 10 consecutive days. Axial, limb, and orolingual dyskinesias were evaluated. Striatal expression of tyrosine hydroxylase (TH), Homer 1a, 1b/c, and deltaFosB were measured by Western Blot. RESULTS: Animals treated with levodopa showed an increase of dyskinesia score (p<0.01) that was attenuated by the administration of MPEP (p<0.01). In the ipsilateral side of the lesion, striatal TH expression was decreased (p<0.01). No significant differences in striatal Homer 1a or b/c expression were observed between the groups of treatment. Striatal deltaFosB expression increased in the animals treated with levodopa (p<0.05) being attenuated after MPEP administration (p<0.05). MPEP effect was not paralleled by any modification of striatal Homer proteins expression. CONCLUSIONS: These results suggest that Homer protein family is not causally involved in the development of dyskinetic movements induced by levodopa treatment in this animal model of parkinsonism.