Effects of whole-body vibration applied to lower extremity muscles during decline bench press exercise.

OBJECTIVES: To evaluate the effects of whole-body vibration (WBV) on skeletal muscle activity and power performance of the upper body during decline bench press exercise at different loads. METHODS: Forty-seven healthy young and active male students volunteered. Each performed dynamic decline bench press repetitions with and without WBV (50 Hz, 2.2 mm) applied through a hamstring bridge exercise at three different loads of their 1-repetition maximum (1RM): 30%, 50%, and 70% 1RM. Muscle activity of the triceps brachii (TB), biceps brachii (BB), pectoralis major (PM), and biceps femoris (BF) was measured with surface electromyography electrodes and kinetic parameters of the repetitions were measured with a rotary encoder. RESULTS: WBV increased peak power (PP) output during the 70% 1RM condition (p<0.01). Muscle activity was increased with WBV in the TB and BF muscles at all loads (p<0.05). There were no effects of WBV on BB or PM muscles. CONCLUSION: WBV applied through a hamstring bridge exercise increases TB muscle activity during a decline bench press and this augmentation contributes to an increased peak power at higher loads and increased peak acceleration at lower loads.

The addition of synchronous whole-body vibration to battling rope exercise increases skeletal muscle activity.

OBJECTIVES: To evaluate the effects of performing battling rope exercise with and without the addition of whole-body vibration (WBV) on muscle activity of the leg, trunk, and upper body. METHODS: Twenty-eight recreationally active university students completed 20-s of battling rope undulation for 6 separate conditions: 1) alternating arm motion no WBV -Alt_NoWBV; 2) alternating arm motion 30 Hz low amplitude WBV -Alt_30 Hz-L; 3) alternating arm motion 50 Hz high amplitude -Alt_50 Hz-H; 4) double arm motion no WBV -Double_NoWBV; 5) double arm motion 30Hz low amplitude WBV -Double_30Hz-L; 6) double arm motion 50 'Hz high amplitude -Double_50 Hz-H. Electromyography (EMG) was measured for the gastrocnemius medialis (GM), vastus medialis oblique (VMO), vastus lateralis (VL), rectus abdominis (RA), multifidus (MF), biceps brachii (BB), and triceps brachii (TB) muscles. RESULTS: The double arm motion during undulation resulted in greater (p<0.05) muscle activity in the VMO, VL, RA, and MF muscles while the GM was more active during the alternating arm motion. WBV at 50Hz increased EMG in all muscles measured vs NoWBV and the 30 Hz condition. CONCLUSION: These results are the first to demonstrate that the exercise stimulus of performing battling rope exercise can be augmented by completing the exercise while being exposed to WBV from a ground-based platform.

A comparison of different vibration exercise techniques on neuromuscular performance.

The first purpose of this study was to determine the effects of whole-body vibration (WBV) exercise during an isometric hand-grip exercise. The second purpose was to evaluate whether more than one vibratory focus would evoke an increase in the effects evoked by only one vibratory focus. The present study investigated whether WBV exposure during 10 repetitions of a handgrip dynamometer while standing on a WBV platform. Twenty-eight recreationally active university students completed 3 different test conditions, in random order: 1) grip dynamometer exercise with superimposed WBV and contralateral arm vibration (WBV+AV); 2) superimposed arm vibration only (AV); 3) grip dynamometer exercise without vibration (Control). The hand grip strength was slightly higher in the WBV condition as compared to the Control and AV conditions (1.1% and 3.6%, p>0.05, respectively). A main effect of the EMGrms of extensor digitorum muscle (ED) was observed indicating that the WBV+AV condition produced a lower co-activation of ED during a flexor digital task than the Control and AV (p<0.05) conditions. The application of WBV+AV may acutely increase muscle coordination and decreases the coactivation of ED. Furthermore, the muscle EMGrms showed increases in activation near the vibratory focus in both upper- and lower-body.

Acute unilateral leg vibration exercise improves contralateral neuromuscular performance.

OBJECTIVES: To examine the post-exercise cross-transfer effects of acute whole body vibration (WBV). METHODS: Seventeen healthy male volunteers (20.8 ± 1.2 y) performed three unilateral vibration conditions in a randomized order: 1) WBV-50 Hz [high amplitude]; 2) WBV-30 Hz [low amplitude]; and 3) a control no WBV condition (Sham) applied to the dominant leg. Each condition involved maximal voluntary isometric contractions (MVC) followed by three leg press explosive repetitions (40% MVC) with non-dominant and dominant legs; which were conducted prior to and post vibration (immediately; 2 min and 5 min). Surface electromygraphy (sEMG) of the vastus lateralis (VL) and medial gastrocnemius (MG) were measured throughout each condition. RESULTS: A condition x leg x time interaction effect was detected (p=0.001) where 50 Hz-High in the stimulated leg enhanced mean velocity at post-2 min compared to 30 Hz-Low and Sham, remaining elevated at post-5 min. Similarly, 50 Hz-High in the non-stimulated leg increased mean velocity at post-immediately and post-2 min compared to 30 Hz-Low and Sham. There were no changes in sEMG of VL and GM in the stimulated and non-stimulated post-conditions. CONCLUSION: WBV (50 Hz) can augment cross-transfer in neuromuscular performance. WBV could provide an alternate method of unilateral training to promote cross education explosive strength.

Adalimumab (tumor necrosis factor-blocker) reduces the expression of glial fibrillary acidic protein immunoreactivity increased by exogenous tumor necrosis factor alpha in an organotypic culture of porcine neuroretina.

PURPOSE: To determine if exogenous addition of tumor necrosis factor alpha (TNFα) exacerbates retinal reactive gliosis in an organotypic culture of porcine neuroretina and to evaluate if concomitant adalimumab, a TNF-blocker, diminishes it. METHODS: Porcine retinal explants from 20 eyeballs were cultured. Cultures with 100 pg/ml TNFα, 10 µg/ml adalimumab, 100 pg/ml TNFα plus 10 µg/ml adalimumab, or controls without additives were maintained for 9 days. Freshly detached retinas were processed in parallel. TNFα levels in control culture supernatants were quantified with enzyme-linked immunosorbent assay. Cryostat sections were doubly immunostained for glial fibrillary acidic protein (GFAP), a marker for reactive gliosis, and cellular retinaldehyde-binding protein (CRALBP), a marker for Müller cells. Sections were also labeled with the isolectin IB4, a label for microglia/macrophages. RESULTS: TNFα in control culture supernatants was detected only at day 1. Compared to the fresh neuroretinal samples, upregulation of GFAP and downregulation of CRALBP occurred during the 9 days of culture. Exogenous TNFα stimulated glial cells to upregulate GFAP and downregulate CRALBP immunoreactivity. TNFα-treated cultures also initiated the growth of gliotic membranes and underwent retinal disorganization. Adalimumab inhibited the spontaneous increases in GFAP and maintained CRALBP. In combination with TNFα, adalimumab reduced GFAP expression and conserved CRALBP, with only slight retinal disorganization. No appreciable changes in IB4 labeling were observed under the different culture conditions. CONCLUSIONS: In cultured porcine neuroretina, spontaneous reactive gliosis and retinal disorganization were exacerbated by exogenous TNFα. Adalimumab reduced spontaneous changes and those induced by TNFα. Therefore, inhibiting TNFα may represent a novel approach to controlling retinal fibrosis observed in some human diseases.

Cerebral glucose metabolism after portacaval shunting in the rat. Patterns of metabolism and implications for the pathogenesis of hepatic encephalopathy.

The regional cerebral metabolic rate for glucose was measured in normal and portacaval shunted rats and the effects of unilateral carotid infusions of "threshold" amounts of ammonia were assessed. 8 wk after shunting the glucose metabolic rate was increased in all 20 brain regions sampled. Effects on subcortical and phylogenetically older regions of the brain were most pronounced with a 74% increase observed in the reticular formation at the collicular level. Increases in the cerebral cortex ranged from 12 to 18%. Unilateral infusions of ammonia did not affect behavior but altered the electroencephalogram and selectively increased the glucose metabolic rate in the thalamus, hypothalamus, and substantia nigra in half of the animals, a pattern similar to that seen after a portacaval shunt, suggesting hyperammonemia as the cause of postshunt increases in glucose metabolism. Visual inspection of autoradiograms, computed correlation coefficients relating interregional metabolism, and principal component analysis suggest that normal cerebral metabolic and functional interrelationships are altered by shunting. Ammonia stimulation of the hypothalamic satiety centers may suppress appetite and lead to cachexia. Reductions in the ammonia detoxification capacity of skeletal muscle may increase the probability of developing future episodes of hyperammonemia, perpetuating the process. Direct effects of ammonia on specific brain centers such as the dorsomedial hypothalamus and reticular activating system may combine with global disruptions of cerebral metabolic-functional relationships to produce the protean manifestations of portal-systemic encephalopathy.

Comprehensive analysis of venom from the scorpion Centruroides tecomanus reveals compounds with antimicrobial, cytotoxic, and insecticidal activities.

Centruroides tecomanus is a medically important scorpion of the state of Colima (Mexico). This communication reports the identification of venom components of this scorpion with biological activity over insects/crickets (Acheta domestica), crustaceans/fresh water shrimps (Cambarellus montezumae), and mammalians/mice (Mus musculus, strain CD1). It also describes the pharmacological effects on cell lines in culture (L5178Y cells, HeLa cells, HuTu cells and Jurkat E6-1 cells), as well as on several types of bacteria (see below). The soluble venom of this scorpion was fractionated by high-performance liquid chromatography (HPLC) and collected separately in twelve independent fractions collected over 60 min run (5 min time apart each other). The HPLC components of fraction VII were lethal to all three species used for assay. The IVth fraction had a toxic effect on freshwater shrimps. In this species, fractions VI, VII and VIII were all lethal. For crickets, fractions V and VI were toxic and fraction VII was lethal. In mouse, the lethal components were found in fraction VII, whereas fraction VIII was toxic, but not lethal, at the doses assayed. The molecular weight of peptides from the various group of fractions were identified by mass spectrometry determination. Components lethal to mice showed molecular weights from 7013 to 7487 Da. Two peptides were obtained in homogeneous form and shown to be lethal to the three species of animal used for assay. The soluble venom tested on L5178Y cell line survival was shown to be cytotoxic, at 10-100 µg/mL concentration, when compared to control murine splenocytes (p = 0.007). The soluble venom applied to Hela, Hutu and Jurkat cell lines did not show cytotoxic effects at these concentrations. On the contrary, it seems to have a proliferative effect. However the HPLC fractions I, III, VI and XII do have a cytotoxic effect on Jurkat E06-1 cells in culture at 200 µg/mL concentration. The antimicrobial activity of the venom fractions on Staphylococcus aureus (gram-positive), Escherichia coli, Pseudomonas aeruginosa y Salmonella spp (gram-negative) was measured, using the liquid inhibition growth system. The four strains of bacteria used were susceptible to fractions III and IV, affecting all four bacterial strains at concentrations below 5 µg/mL.

Trichofolliculoma of the eyelid.

The clinical and histological features of 2 cases of trichofolliculoma of the eyelid are described. One case presented the typical wool-like wisp of immature hairs and was easily diagnosed clinically. The other one was mistaken for a basalioma. In both cases the histological structure was diagnostic for trichofolliculoma.

[Study of hypercholesterolemia among the child population of Valdemoro]. / Estudio de la hipercolesterolemia en la población infantil de Valdemoro.

We studied 99 children with ages ranging from 0 to 14 years, randomly selected from the census of Valdemoro (Madrid) and stratified by sex and age. The clinical records of all the children were completed and the levels of total serum cholesterol were assessed. The average cholesterol level for the total sample was 159 +/- 31 mg/dl (m +/- sd). Twenty-six children (26.3%) had values above 175 mg/dl [75th percentile of the Lipid Research Clinics Program(LRCP)], with no significant differences between the values of such percentile in both studies. Ten per cent of the children showed cholesterolemias greater than 200 mg/dl. The average cholesterol level in children whose mothers had high education levels was 125 +/- 16 mg/dl (m +/- sd), versus 161 +/- 21 mg/dl (m +/- sd); p = 0.005; (CI 95% of the difference 12 to 62 mg/dl) in children whose mothers had low-medium education levels. Cholesterol in children with family history of hypercholesterolemia (HC) showed a non-significant trend towards higher levels than in children without such antecedents (164 mg/dl vs 155 mg/dl; p = 0.19; NS). Neither the differences were significant when comparing children with or without family history of early cardiovascular disease (ECDV) (162 md/dl vs 158 md/dl; p = 0.49). Using both familiar antecedents as misleading method, just 72% of the children were diagnosed of HC (cholesterol greater than 175 md/dl). The absence of both antecedents (negative VP) would discard the presence of HC in 83% of the children in such situation (CI 95%, 67% to 92%).

Anisakis/Ascaris IgE ratio improves specificity for the diagnosis of Anisakis simplex sensitization in travellers and immigrants.

Anisakis simplex is a fish parasite responsible for human infection and is able to induce IgE-mediated reactions with several clinical manifestations. Laboratory diagnosis of Anisakis allergy is based on the detection of specific IgE using parasite whole antigen. Unfortunately, these diagnostic tools detect cross-reactivities with other nematodes and micro-organisms leading to low specificity of the diagnostic tests. The aim of this retrospective study was to assess the diagnostic value of specific IgE to Anisakis for diagnosis of A. simplex-sensitization in native Spanish residents (IMM, n=766) and subjects coming from tropical and sub-tropical geographic areas (TRO, n=233). Since Ascaris is the human parasite most closely related to Anisakis, specific IgE to Ascaris was also determined to assess Anisakis cross-reaction with other nematodes and the diagnostic value of Anisakis/Ascaris IgE ratio for Anisakis allergy was examined. IMM and TRO groups showed similar specific IgE to Anisakis levels, while TRO had higher levels of specific IgE to Ascaris than IMM group (p=0.001). ROC curve analysis determined that an Anisakis specific IgE threshold of 0.71 kU/L yielded 93% and 82% specificities in IMM and TRO groups, respectively. A cut-off value ≥4.4 for Anisakis/Ascaris IgE ratio increased specificity to 95% for samples having IgE to Ascaris ≥0.35. In conclusion, the ratio of specific IgE to Anisakis and Ascaris improved remarkably the specificity and this parameter easily obtained from the commercially available system could be useful in the diagnosis of hypersensitivity to A. simplex.

[Family physician attitudes towards insulinization in type II diabetics]. / Actitudes de los médicos de familia ante la insulinización de diabéticos tipo 2.

AIM: To determine the attitudes of Toledo Health Area family physicians about starting insulinization in type 2 diabetic patients. MATERIALS AND METHODS: Descriptive, cross-sectional study. A self-completed questionnaire was given to 353 family physicians of the Toledo Health Area, asking about socio-demographic and occupational data, and including the Spanish version of the Diabetes Attitude Scale (DAS-3sp) questionnaire to evaluate attitudes and motivations related to diabetes. RESULTS: A total of 66 responses were received, of which 50.8% were from females. Mean age (±standard deviation) was 49.97±7.40. Results of the different DAS-3sp subscales (values from 1 to 5) were: S1 (need for special training): 4.52±0.38; S2 (seriousness of type2 diabetes): 4.18±0.42; S3 (value of tight control): 4.15±0.39; S4 (psychosocial impact of diabetes): 3.79±0.48; and S5 (need for patient autonomy): 3.72±0.55. No statistically significant differences were obtained with the four first subscales with sex, specialized training, being a resident tutor, type of contract or clinical setting. There were statistically significant differences in S5 compared with sex (3.90±0,60 in men vs 3.54±0.45 in women; t=2.701; P=.009) and with being a resident tutor (3.99±0.58 vs 3.64±0.52 in non-tutors; t=2.188; P=.033). CONCLUSIONS: The attitudes regarding starting insulin treatment in type2 diabetic patients are positives among Toledo Health Area family physicians, specially in the clinical aspects, but they are lower in the psychosocial impact and patient autonomy.

[Morbidity and costs in complete thyroidectomies. Improvement in Value of the Process by a change in the management]. / Morbilidad y costes en las tiroidectomías totales. Mejora del Valor del Proceso mediante el cambio de gestión.

OBJECTIVES: 1) To present the postoperative morbidity of complete thyroidectomies and the results of their clinical management and costs obtained after surgery. 2) To compare the results obtained for the morbidity and costs in the complete thyroidectomy Process, after the management changes introduced by the Endocrine Surgical Unit (ESU). 3) To define whether these changes improve the Value (benefit/cost ratio) of the Process. MATERIAL AND METHODS: Prospective study of cohorts conducted on 529 complete thyroidectomies performed between 1998 and 2011. We present their clinical-pathological characteristics and we compare the clinical and management results obtained after surgery in 2 time periods: 1998-2006 without ESU (group 1, 205 patients) and 2007-2011 with ESU (group 2, 324 patients). The clinical results and the possible benefits are assessed by studying the morbimortality (recurrent lesions, hypocalcaemia [<8 mg/dl], suffocative haematomas and bleeding), and those of management, for the evaluation of the use of operating room time, the average stay and the total cost of the Process. The statistical comparison study was made using Student t test, for the comparison of means and the Chi(2) to compare percentages, accepting P<.05 as significant. RESULTS: The global percentage of transient recurrent dysfunctions (TRD) was 6%, and for definitive recurrent paralysis (DRP) it was 1.5%. Hypocalcaemia, at 24 hours was 54.6%, at one month 7%, at six months 6.2% and that of definitive hypoparathyroidism 1.3%. There were 2.8% of suffocative haematomas and 2% adverse effects. The mean surgical time was 98 minutes, and the average stay was 3.66 days. In the comparison of results of the groups, the ESU improved the TRD index by nearly 7 points (10.2 vs. 3.4%, P=.002), that of DRP by 1.5 (2.4 vs. 0.4%; P=.3) until reaching under 1%. The figures on bleeding at 24 hours (53 vs. 44 cc; P=.002) and 48 hours (23 to 17 cc; P<.001), the rate of haematomas by another 6 points (6.3 vs. 0.6%; P<.001), and that of hypocalcaemia at 24 hours (P=.01). The average stay also improved (4.79 vs. 2.94 days; P<.001), the use of operating room time (reduced by 20 minutes/operation; P<.001), the total cost of the Process, decreasing by more than € 2,000/Process (P<.001), and produced a total savings for the hospital in the period of study of € 665,820. CONCLUSIONS: 1) The global results (post-operative morbidity) of our total thyroidectomies are within the quality standards. 2) The surgical specialisation and the changes introduced by the ESU improved the clinical results (greater benefit) and those of management, cutting down the average stay and the operating room usage time and decreasing costs. 3) The change in management increased the Value of the Process.

[Intraoperative intact parathyroid hormone determination as a predictive factor of hyperparathyroidism resolution]. / La determinación peroperatoria de PTHi como factor predictivo de curación en el hiperparatiroidismo.

INTRODUCTION: The objectives of this study were: a) to evaluate the effectiveness of intraoperative intact parathyroid hormone (PTHi) determination as a marker of hyperparathyroidism resolution; b) to establish the minimum number of blood samples required; and c) to determine whether cervical manipulation increases baseline PTHi levels. PATIENTS AND METHOD: We performed a prospective study in 45 patients. Three intraoperative blood PTHi determinations were performed: at baseline and at 10 and 25 minutes after excising the lesion. To analyze the effects of cervical manipulation, in 19 patients, 2 further determinations were made after 2 minutes of massage on both sides of the neck. A decrease of > 50% in PTHi values between postexeresis samples and the baseline sample (gradient > 50%) was used as diagnostic and therapeutic criteria and normalization of calcemia was used as a criteria for complete resolution. RESULTS: Whenever the lesion causing hyperparathyroidism was extirpated, PTHi levels decreased at 10 and 25 minutes after exeresis. This decrease was predictive of complete resolution when the gradient was > 50. Cervical manipulation (massage) did not increase PTHi values. In patients with complete resolution, blood calcium levels also returned to normal. CONCLUSIONS: 1. Intraoperative PTHi determination with a gradient > 50 is an excellent prognostic marker of resolution. 2. Only 2 PTHi samples are required: one at baseline and another at 10 minutes after exeresis. 3. Preoperative cervical manipulation does not increase PTHi values.

[Benign tumors of the esophagus. Esophageal leiomyoma]. / Tumores benignos de esófago. Leiomioma esofágico.

Benign neoplasms of the esophagus are rare. The most frequent symptom (75% of the cases) is dysphagia, and a very rare one is dyspnea. When a benign tumor of the esophagus is suspected, a radiological examination is made and the diagnosis confirmed by fibro-esophagoscopy and biopsy. The authors make a summarized review of the benign tumors of the esophagus, and describe a case of esophageal leiomyoma.

[Moderate hypercholesterolemia in children. An index of familial pathology?]. / Hipercolesterolemia moderada en niños. Indice de patología familiar?

Out of 44 children (with 200 mg/dl cholesterol) 22, with constantly high levels of cholesterol were studied. All belong to a children population from Madrid which 95 percentile for cholesterol was 204 mg/dl. Fifty nine subjects, first degree relatives of these 22 children (17 families) plus probands were studied to determine if moderately elevated cholesterol levels during infancy are related to any form of familial lipidic disorder. Serum lipidic levels, anthropometric measurements, dietary habits a history of atherosclerotic cardiovascular disease (ACVD), were evaluated in all these 81 individuals. Hypercholesterolemia was encountered in 13 of the 59 non probands and high triglyceride levels in 6 people. More than one member of the family was to have some form of lipidic disorder in 12 of 17 families (71%) and in 10 the metabolic abnormality was of a type associated with a higher risk to suffer ACVD. Five families had a combined hyperlipidemia of the multiple lipoproteinemic (4 familiar heterozygotic hypercholesterolemia and one hyperlipidemia with a double phenotype II B and V). All family members were apparently healthy and had no knowledge of their underlying lipidic abnormality. In this group of families antecedents of morbi-mortality because of atherosclerosis were more frequent that in group control families. Authors conclude that a moderately elevated serum cholesterol level during infancy may be a marker for various familiar lipidic disorders. Detection in infantile population of serum cholesterol levels 200 mg/dl should prompt us to perform a more complete lipidic evaluation both in children as well as in their families.

[Quality control in carotid surgery. Results from the carotid surgery records in Central region of Spain (1999-2000)]. / Control de calidad en cirugia carotidea. Resultados del registro de cirugia carotidea en Región Centro de España (1999-2000).

OBJECTIVE: Evaluation of technique and results of carotid endarterectomy (CEA) in the central region in Spain and possible differences among the hospitals included. Study of factors predictors of complications. PATIENTS AND METHODS: All CEAs performed in 9 hospitals in the central region in Spain (1999 2000). Registry design by a specific commission and contents selected by consensus. Voluntary participation. Ambispective study. Uni and multivariate statistical analysis (logistic regression). RESULTS: 576 procedures registered. Global mortality: 1.9%. 15 (2.7%) patients died or were severely handicapped. The selection of patients adjusted to expert s recommendations in 98%. Significant differences in technique and results were found among the hospital centres (>0,25). In the multivariate analysis, the risk factors associated with complications were: presence of preoperative symptoms (p= 0.006) small number of annual CEAs (p= 0.01), contralateral occlusion (RR= 4.7, p= 0.02) and use of shunt (RR= 6.1, p= 0.01). CONCLUSIONS: Globally, both the selection of patients and the results obtained adjust to the accepted standards for this type of surgery. The patient s risk profile has had a greater influence on the results than the technique used. The mortality rate has been influenced by the low volume hospitals

[Idiopathic arterial calcification in infancy. A literature review and presentation of one case (author's transl)]. / Enfermedad con calcificaciones arteriales idiopáticas en la infancia. Revisión de la literatura y presentación de un caso.

A 26 days old male newborn, developing cardiac insufficiency followed by death, is reported. Necropsy revealed broadly spread calcifications with severe affectation to the coronary arteries. No justifying cause to those calcifications was found. Literature is reviewed, and the current state of knowledge of this uncommon disease's etiology and pathogeny is questioned.