Previous cycling does not affect running efficiency during a triathlon world cup competition

AIM

The most strategic part of a triathlon is the cycle-run transition. However, all the studies about this situation have been carried out in laboratory conditions and there is a need to perform this kind of study during competition, when the triathletes are highly motivated and the effort is maximum.1 Therefore, the aims of the present study were: 1) to determine the effect of prior 40-km cycling on the 10-km running kinematics during a Triathlon World Cup competition, and 2) to examine the possible differences between males and females.

METHODS

Ten men and ten women, selected among the first ten competitors at the end of the cycling part at Madrid 2006 BG Triathlon World Cup, were enrolled in the study. The kinematic analysis was carried out using a photogrammetric technique (DLT algorithms) in the saggital plane (2D).

RESULTS

There are significant differences (P<0.05) in men's stride length and velocity between the first and the last lap. Also, significant differences (P<0.05) were found between men and women in many of the variables analyzed.

CONCLUSIONS

The previous cycling does not affect the subsequent running efficiency during a elite triathlon competition. On the other hand, the running technique profile during a triathlon competition is very different between men and women.

[Quality of neurological care in the emergency services: a study from the community-hospital]

INTRODUCTION

The medical conditions shared by hospital emergency services and community-hospital neurology clinics (CHNC) have not been described, and the quality of the medical care received in these conditions has not been evaluated in our environment.

METHODS

Over a 2 month period, those patients presenting at any of the seven CHNC in a Health Care Area 1 of Madrid due to previously attended medical conditions in the emergency services were systematically registered. The area neurologists of the CHNC collected administrative and clinical variables and made a judgment on the medical care (primary outcome measure) and diagnoses (secondary outcome measure) received.

RESULTS

A total of 181 patients were included (mean age: 58 years; 60% women). The inclusion rate was one patient per working day, and 31% of patients were visited out of the established quota number of patients for the clinic. The most frequent reasons for visiting the emergency room were: headache (20%), focal neurological syndrome (16%) and loss of consciousness (14%). The most frequent diagnoses at the CHNC were: primary headache (19 %), stroke (11%) and epilepsy (9 %). Emergency care was deemed correct in 56 % of patients. When the patients with intervention were compared to those with no intervention, participation of the neurology service in the emergency room was associated to a greater percentage of correct diagnoses (59% vs. 41%; p=0.019) and care (69% vs. 47%; p=0.003).

CONCLUSIONS

The medical conditions shared with the emergency services represent a small but relevant proportion of the patients assisted in the CHNC. Some of these conditions (primary headaches, syncopes) should be canalized into primary health care. Others (epilepsy) require a circuit between emergency room and CNNC, but the appointment system should be adapted. The intervention of a neurologist in the emergency room raises the quality of the care.

Physical demands of top-class soccer assistant refereeing during high-standard matches

This study examined the physical demands experienced by top-class assistant referees during high-standard football matches. Computerized match analyses and heart rate recordings were performed on 18 international assistant referees during the FIFA Confederations Cup 2005. Total distance covered averaged 5752+/-554 m, of which 34% was covered at a high-intensity (>13 km.h (-1)). Sidewards movements represented 30% of total match distance. Both total distance (r=0.67; P<0.01) and high-intensity activities (r=0.52; P<0.05) were related to the displacements of the ball in the same match. The distance covered by high-speed running in this tournament was 255% greater (P<0.001) than that covered during the under-17 World Championship 2003. Mean heart rate during the game was 140+/-11 b.min (-1) (78+/-4% HR (max)). Mean heart rate during a 5-min interval of the match was related in part (r=0.31; P<0.001) to the amount of high-intensity activities performed within the same match-period. The results of this study show that the physical demands imposed on assistant referees are influenced by the movements of the ball and the standard of the competition.

Estimation of Cognitive Plasticity in Old Adults Using Dynamic Assessment Techniques

In recent years, research has provided extensive data concerning the use, utility, and appropriateness of dynamic assessment techniques as a way of determining cognitive plasticity in old adults. Current research in this area is focused on three principle lines of investigation: (a) determining neurological correlates of cognitive plasticity evaluated through dynamic assessment techniques; (b) establishing the diagnostic utility of such procedures; and (c) analyzing age-related limits with regard to quantity and domains of plasticity. In this context, the present study was undertaken using a sample of 274 older adults, who were evaluated through two dynamic assessment techniques and one cognitive functioning screening test over a period of 3 consecutive years. Results show differences in plasticity related to both age and cognitive status. The study also demonstrates the capacity of plasticity to predict maintenance and decline in a follow-up period of 3 years.

Physical load imposed on soccer players during small-sided training games

AIM

The aim of this study was to examine the kinematical, physiological and technical load imposed on soccer players during three typical small-sided 3-a-side training games carried out in an artificial grass 33x20 m surface.

METHODS

Kinematic analysis was carried out with a bidimensional photogrammetric video system. Heart rate was recorded at 5 s intervals using Polar Accurex Plus heart rate monitors and expressed in relation to individual maximal heart rate (HR(max)). Technical parameters were registered using a specifically designed notation sheet.

RESULTS

The overall intensity of these three small-sided games was superior than the experienced during competitive matches. Distance covered (747-749 vs 638 m) and mean heart rate (173 vs 166 b x min(-1)) were higher (P<0.05) in the drills without goalkeepers. The inclusion of goalkeepers reduced the tempo of the game as players performed less (P<0.05) high-intensity running and increased (P<0.05) low-intensity activities. Time spent exercising at intensities between 76-85% HR(max) was lower (P<0.05) in the game without goals, whereas the presence of goalkeepers reduced (P<0.05) activities performed exceeding 86% HR(max).

CONCLUSION

The results of this study suggest that small-sided games can be used effectively to develop the specific endurance capacity of football players. The integration of these drills by coaches during the regular training schedule can help replicating the demands experienced during real match-play.

Utility of a low-iodide diet in (131)I whole body scanning of patients with differentiated thyroid cancer

INTRODUCTION

(131)I whole body scanning (WBS) is useful in the follow-up of patients with differentiated thyroid carcinoma (DTC). The need to follow a low-iodide diet (LID) to optimize WBS is widely recognized but there are few reports that justify this practice. The aim of this study was to assess levels of urinary iodide in patients who underwent WBS in our service and the possible impact of some changes to the diet on these levels.

PATIENTS AND METHOD

Between January 2004 and December 2005, we measured iodide levels in 12-h urine samples by paired-ion-reversed-phase HPLC with electrochemical detection (sensitivity, 0.1 μg/dl) in 371 patients with DTC referred to our service for ablation or follow-up. The patients were divided into 2 groups: patients on hormone withdrawal and strict LID (group A) and those on hormone withdrawal and generic LID (group B). Urinary iodide excretion below 10 μg/dl was considered low. Data were analyzed by ANOVA and χ(2) tests.

RESULTS

The mean±standard deviation urinary iodide excretion was 4.3±3 μg/dl in group A and 5.8±3.2 μg/dl in group B. The mean urinary iodide excretion in A group was significantly lower than that in group B (p<0.05).

CONCLUSIONS

Following a strict LID significantly decreased urinary iodide excretion in patients undergoing WBS.

Clinicopathological correlations of Bcl-xL and Bax expression in differentiated thyroid carcinoma

OBJECTIVE

The Bcl-2 family proteins are essential mediators in the apoptotic process. Our aim was to investigate whether anti-apoptotic Bcl-xL and pro-apoptotic Bax were over-expressed in a large series of differentiated thyroid carcinomas (DTC) and to study their association with tumour presentation at diagnosis and prognosis.

DESIGN AND PATIENTS

We examined the immunohistochemical expression of Bcl-xL and Bax in benign nodular thyroid disease (BNTD) and DTC and their association with clinicopathological parameters. Thyroid tissue samples were collected from an unselected series of patients undergoing surgical resection for DTC (n = 74) or BNTD (n = 15).

RESULTS

Among DTC cases, expression of Bcl-xL was found to be high in 43.2% and low or absent in 56.8%. Expression of Bax was high in 75.7% and low or absent in 24.3%. Non-neoplastic thyroid tissue was largely unstained for both proteins. Among BNTD cases, expression of Bcl-xL was high in 13.3% and low or absent in 86.6%. Expression of Bax was high in 14.3% and low or absent in 86.6%. A significant association was found between Bcl-xL expression and the presence of high-risk histological subtype (P < 0.05), and regional lymph node (P < 0.01) and distant metastases (P < 0.01). The association between high Bcl-xL expression levels and a longer time of persistent disease after radioiodine ablation was also significant (P < 0.01). Bcl-xL expression was confirmed as an independent prognostic factor for persistent disease in DTC (relative risk, 2.5; 95% confidence interval, 1.1-5.9; P < 0.05).

CONCLUSIONS

Immunohistochemical expression of Bcl-xL might be a valuable tool in the prediction of tumour aggressiveness in DTC.

Changes in mucosal fatty acid profile in inflammatorybowel disease and in experimental colitis: a common response to bowel inflammation

BACKGROUND AND AIMS

Plasma polyunsaturated fatty acid profile in patients with inflammatory bowel disease is abnormal. We aimed to assess the mucosal fatty acid pattern in patients with ulcerative colitis and Crohn's disease, and in rats with trinitrobenzene-sulfonic acid (TNB) induced colitis.

METHODS

Fatty acids were measured in colonic mucosa of patients with ulcerative colitis (n = 30), Crohn's disease (n = 21), and healthy controls (n = 13). Likewise, they were assessed in the colonic mucosa of rats with TNB- and sham-colitis.

RESULTS

There was an increase of the end-products (C22:5n3, C22:6n3, C20:4n6, C22:5n6) and a decrease of the precursors (C18:3n3, C18:2n6) of both n3 and n6 polyunsaturated fatty acids in the mucosa of active ulcerative colitis and TNB-colitis. Also, high values of saturated (C16:0, C18:0) and low values of monounsaturated fatty acids (C18:1n9) were observed. Furthermore, the mucosa of active Crohn's disease showed substantial changes in saturated, monounsaturated and essential fatty acids, but not in polyunsaturated fatty acids. Mucosa of patients with inactive disease showed intermediate fatty acid values between the mucosa of active patients and healthy controls.

CONCLUSIONS

Colonic inflammation causes a characteristic modification of the mucosal fatty acid profile which appears to be common to different aetiologies and seems to be related to the degree of inflammation.

Influence of ultraviolet radiation on UVR-absorbing compounds in freshwater algal biofilms and Scenedesmus vacuolatus cultures

There is considerable concern about increasing levels of solar ultraviolet radiation (UVR) and the potential harmful effects of UVR on living organisms. Microcosm studies were conducted with algal biofilms and Scenedesmus vacuolatus cultures to examine the effects of increased UVR on freshwater algae. Because algae have evolved various strategies to minimize the potential damage induced by UVR, the sensitivity of an UVR ratio was evaluated using absorbance characteristics of algal extracts to short- and long-term responses of algae to UVR exposure. The effects of UVR on the photosynthetic activity of periphyton also were determined by fluorometry. Results showed various patterns: (1) a short-term decrease in the UVR ratio between UVR-absorbing compounds and chlorophyll-a that reflect damage from UVR, and (2) a long-term increase in the UVR ratio as communities change their photosystems by increasing UVR absorbance capabilities, and thereby cell protection. Results include (1) validation of the UVR ratio, (2) allowing assessment of different UVR exposure-induced effects to algae, and (3) providing mechanistic information on cellular strategies used by algae to reduce UVR-induced damages.

More about the developing of invisible lipstick-contaminated lipmarks on human skin: the usefulness of fluorescent dyes

At the present time fingerprints are one of the simplest, and most reliable means of identification. Increasingly, crime scene investigators look for palm, foot, ear or lip prints. With regard to lip prints, the use, very common today, of protective or permanent lipsticks allow the production an invisible lipmark (or invisible lipstick-contaminated lipmark) which is possible to develop. Some results have already been published about developers useful for different kinds of surfaces (both porous and non-porous) as well as those which are more efficient in case of old or recent prints. The latest studies are about the developing on human skin, and they prove the usefulness of lysochromes (specifically Sudan Black) for the develop of recent invisible lipstick-contaminated lipmarks on corpse skin. This study attempts to determine the efficiency of fluorescent reagents to develop invisible lipstick-contaminated lipmark on human skin. Results show that REDescent Fluorescent Latent Prints Powder is effective for obtaining recent invisible lipstick-contaminated lip mark on the skin of deceased.

Cognitive plasticity as a modulating variable on the effects of memory training in elderly persons

Cognitive plasticity is a topic of interest since it allows us to analyse the potential cognitive modifiability of a person. Previous research has demonstrated the existence of plasticity in old age [Baltes, P. B. (1987). Theoretical propositions of life-span developmental psychology: On the dynamics between growth and decline. Developmental Psychology, 23(5), 611-626] regardless of presence or absence of cognitive deterioration [Calero, M. D., & Navarro, E. (2004). Relationship between plasticity, mild cognitive impairment and cognitive decline. Archives of Clinical Neuropsychology, 19, 653-660]. In this context, the present study was designed to analyse the presence of plasticity in elderly persons who seemed to present cognitive deterioration, and to explore the relation between cognitive plasticity and the results obtained from a memory training programme. One hundred and thirty-three elderly persons participated in the study and were evaluated by means of a cognitive plasticity test (Position test) and various tests for measuring the effects of the training. Part of the elderly population received the memory training, whose effects were measured immediately after the training and again after 9 months. The results demonstrate that the programme significantly improves cognitive performance, while plasticity is shown to be an important modulating variable on the improvement achieved.

Elenoside increases intestinal motility

AIM: To study the effects of elenoside, an arylnaph-thalene lignan from Justicia hyssopifolia, on gastro-intestinal motility in vivo and in vitro in rats.

METHODS: Routine in vivo experimental assessments were catharsis index, water percentage of boluses, intestinal transit, and codeine antagonism. The groups included were vehicle control (propylene glycol-ethanol-plant oil-tween 80), elenoside (i.p. 25 and 50 mg/kg), cisapride (i.p. 10 mg/kg), and codeine phosphate (intragastric route, 50 mg/kg). In vitro approaches used isolated rat intestinal tissues (duodenum, jejunum, and ileum). The effects of elenoside at concentrations of 3.2 x 10^-4, 6.4 x 10^-4 and 1.2 x 10^-3 mol/L, and cisapride at 10^-6 mol/L were investigated.

RESULTS: Elenoside in vivo produced an increase in the catharsis index and water percentage of boluses and in the percentage of distance traveled by a suspension of activated charcoal. Codeine phosphate antagonized the effect of 25 mg/kg of elenoside. In vitro, elenoside in duodenum, jejunum and ileum produced an initial decrease in the contraction force followed by an increase. Elenoside resulted in decreased intestinal frequency in duodenum, jejunum, and ileum. The in vitro and in vivo effects of elenoside were similar to those produced by cisapride.

CONCLUSION: Elenoside is a lignan with an action similar to that of purgative and prokinetics drugs. Elenoside, could be an alternative to cisapride in treatment of gastrointestinal diseases as well as a preventive therapy for the undesirable gastrointestinal effects produced by opioids used for mild to moderate pain.

Use of Real-Time Quantitative Polymerase Chain Reaction to Monitor the Evolution of Brucella melitensis DNA Load During Therapy and Post-Therapy Follow-Up in Patients with Brucellosis

BACKGROUND

We performed quantitative real-time polymerase chain reaction (Q-PCR) to monitor the evolution of Brucella melitensis DNA load from initial diagnosis through post-therapy follow-up in patients with brucellosis.

METHODS

On the basis of real-time fluorometric quantification of PCR products, we used the ultra-rapid LightCycler system (Roche Diagnostics). We collected 180 peripheral blood samples from 18 patients with brucellosis. Analysis of bacterial DNA loads was performed for 2 groups: 11 patients who did not experience relapse and 7 patients who experienced relapse in the follow-up phase.

RESULTS

Q-PCR was 100% specific for B. melitensis and showed an analytical sensitivity of 15 fg. Sensitivity of Q-PCR for both initial infections and relapses was 100%. There were no statistically significant differences between groups with respect to bacterial DNA load from initial diagnosis to the end of post-treatment follow-up (P > .05). Evolution of the bacterial DNA load throughout the treatment phase was similar among patients who relapsed and did not relapse. Despite positive response to treatment and a sharp decrease in bacterial DNA load after initiating therapy, the results of Q-PCR on finalizing treatment for 50% of the patients (7 from the relapse group and 2 from the nonrelapse group) were low-level positive. At the conclusion of follow-up, almost 40% of the patients (4 from the relapse group and 3 from the nonrelapse group), most of them asymptomatic, still maintained low bacterial DNA loads.

CONCLUSIONS

Using Q-PCR techniques, we consistently detected B. melitensis DNA in the blood samples of patients with brucellosis throughout treatment and follow-up, despite apparent recovery from infection. These findings may have diagnostic, pathogenic, and therapeutic implications.

Prognostic significance of human pituitary tumor-transforming gene immunohistochemical expression in differentiated thyroid cancer

CONTEXT

Human securin pituitary tumor-transforming gene (hPTTG) is overexpressed in a variety of primary neoplasias, including differentiated thyroid cancer (DTC).

OBJECTIVE

The objective of this study was to examine the immunohistochemical expression of hPTTG in DTC and its association with known prognostic factors.

DESIGN

hPTTG expression was analyzed by immunostaining on paraffin-embedded tissues. Clinical data were used to determine any associations between the expression of hPTTG and prognostic variables of DTC. A median follow-up of 43 months allowed us to analyze the persistence of disease and the response to radioiodine therapy.

SETTING

The study was conducted at a tertiary university hospital.

PATIENTS

Ninety-five patients undergoing surgical resection for DTC (n = 60) or benign nodular thyroid disease (n = 35) were studied.

MAIN OUTCOME MEASURE

The main outcome measure was the association between hPTTG expression and prognostic factors in DTC.

RESULTS

Among DTC cases, 21 (35%) had low and 39 (65%) had high hPTTG immunostaining. Adjacent nonneoplastic thyroid tissue was largely unstained. Among benign nodular thyroid disease cases, immunostaining was detected focally in eight (22.8%). A significant association was found between hPTTG expression and the presence of nodal (P < 0.01) or distant metastases (P < 0.05). A significant association with TNM was also found, because 83.3% of advanced TNM stages showed elevated hPTTG (P < 0.05). The association between hPTTG overexpression and decreased radioiodine uptake during follow-up was also significant (P < 0.05). The expression levels of hPTTG were confirmed as an independent prognostic factor for persistent disease (relative risk, 3.0; 95% confidence interval, 1.1-8.7; P < 0.05).

CONCLUSIONS

Immunohistochemical analysis of hPTTG is of potential value in the determination of tumor aggressiveness in DTC.

Evaluation of the role of RET polymorphisms/haplotypes as modifier loci for MEN 2, and analysis of the correlation with the type of RET mutation in a series of Spanish patients

Multiple endocrine neoplasia type 2 (MEN 2) is an autosomal dominant cancer syndrome, which is divided into three subtypes: MEN 2A, MEN 2B and familial medullary thyroid cancer (FMTC). Approximately 92% of MEN 2 cases are caused by mutations in exons 10, 11, 13-16 of the RET proto-oncogene. There exists inter- and intra-familial phenotypic variability among the MEN 2 families, even when the disease is caused by the same RET mutation, suggesting a role for genetic modifiers, such as polymorphisms/haplotypes. We have sought to determine the frequency and position of RET germline mutations in a cohort of 114 Spanish probands with any sign of MEN 2, and to search for putative modifier loci. Mutational screening of RET revealed 9 different mutations, present in 26 of the 114 probands (22.8%). In addition, distributions of 8 RET polymorphisms and the haplotypes comprising them, were studied in the context of the families positive for RET mutational screening, in order to evaluate them as genetic modifiers. The relationship between RET mutation type and presence of a polymorphism/haplotype was analyzed. The relationship between the presence of pheochromocytoma (PC) and/or hiperparathyroidism (HPT) in carriers of the same RET mutation, and the genotype for the specific variants was also studied. The results derived from those analyses revealed no associations of any variant/haplotype to a specific mutation or to the clinical presentation. Nevertheless, these observations do not permit us to exclude the possible role of other variants in RET or other related genes, in the final presentation of the disease.

Analysis of RET polymorphisms and haplotypes in the context of sporadic medullary thyroid carcinoma

CONTEXT

Little is known about the etiology of sporadic medullary thyroid carcinoma (sMTC). While germline gain-of-function mutations in the RET proto-oncogene cause hereditary MTC, the molecular mechanisms leading to the sporadic forms remain obscure. Our group had evidence about the existence of a low-penetrance susceptibility locus for sMTC in linkage disequilibrium with RET variants S836S/IVS1-126G>T, and probably in 5' with respect to both variants. In this study we sought to identify such locus. On the other hand, because an overrepresentation of G691S/S904S variants in patients with sMTC had been previously reported, we sought to determine if such association was present in our series.

DESIGN

We performed a case-control study analysing a wide spectrum of RET variants in the 5' region of the gene, as well as the variants G691S/S904S. Haplotype distribution were also analyzed. A total of 58 patients with sMTC were included in the study. In addition, 100 unselected, unrelated race-, age-, and gender-matched normal controls were also evaluated.

MAIN OUTCOME

Although the overrepresentation of IVS1-126G>T remains present in our current sMTC series, thus supporting our previous hypothesis, no differences were obtained among cases and controls in the distribution of the variants tested upstream this position. On the other hand, the frequency and distribution of G691S/S904S variants were similar in both groups of study, leading to exclude their role in sMTC in our series.

CONCLUSIONS

These findings would suggest that the major genetic events contributing to the appearance of sMTC may reside in several different RET loci. In this way, we could hypothesize about the existence of at least two sMTC loci, linked to S836S-IVS1-126G>T, or to G691S-S904S, respectively.

Effectiveness assessment of otosclerosis surgery

CONCLUSIONS

The epidemiological characteristics of otosclerosis and its treatment in Andalusia resemble those of other populations with similar socioeconomic levels. Two complementary approaches, such as questionnaires and pure-tone audiometry, are required to assess the effectiveness of otosclerosis surgery (OS) reliably and precisely.

OBJECTIVES

We describe a new method to assess effectiveness in OS. It is based on the results of pure-tone audiometry and a specially designed quality of hearing questionnaire (QHQ). The objectives of the study are: (i) to report the general epidemiologic profile of otosclerosis in Andalusia; (ii) to study the effectiveness of OS in our community using conventional methods; and (iii) to study the outcomes of OS using the QHQ and to compare them to those obtained using conventional methods.

MATERIAL AND METHODS

All 31 hospitals in the public healthcare system of Andalusia were studied. They were graded into four groups using a specially designed grouping system. The data were obtained from the minimum basic dataset. The prevalence of otosclerosis in Andalusia was calculated from the incidence data, the duration of the disease and life expectancy. To assess the effectiveness of OS, 475 clinical records from 15 hospitals representing all 4 groups were analysed. Effectiveness was assessed by conventional methods, using data obtained from pure-tone audiometry, and by using version 1.02 p of the QHQ.

RESULTS

The incidence of clinical otosclerosis was 5.67 patients/100,000 inhabitants/year. The calculated prevalence was 0.287%. The number of cases increased progressively during the study period (p<0.001). The 15-45-year age group was the largest (62.2%) and 68.4% of patients were females. The most frequent type of otosclerosis was estapediovestibularis (fenestral), non-obliterative (91.8%). Only 48 cases (2.3%) of cochlear and 45 (2.2%) of obliterative otosclerosis were reported. The most frequently employed therapeutic procedures were stapedectomy and stapedotomy (75.70%). The average total and preoperative lengths of stay were 3.59 and 1.04 days, respectively. There were significant differences between the different types of otosclerosis. Improvement in the air-bone gap was 15.37+/-1.19 dB (n=164) and the overclosure or operative damage was 0.49+/-0.85 dB (n=164). A gap improvement of 10-40 dB was observed in 61.4% of patients. The > 65 years age group showed the best gap improvement but the largest variability. The quality of hearing measured by the QHQ showed that, in general, a better gap improvement was associated with a higher quality of hearing (Pearson correlation r=0.183; p<0.05). The 15-45-year age group had the worst gap improvement but, in contrast, the better quality of hearing.

Autonomic, endothelial function and the analysis of gait in patients with type 1 and type 2 diabetes

Ten control subjects and 20 subjects with type 1 and type 2 diabetes were examined to compare autonomic, endothelial function and gait characteristics while walking in a linear path and during turns. To measure deviations in gait, timing was recorded from foot sensors worn in the shoes and from accelerometers (2 axis) mounted on the head, shoulder, hips, knees and ankles, bilaterally. The results of the experiments showed that subjects with diabetes took additional steps when walking in a linear path and during turns. They also took significantly more time to walk a given distance (greater than 30%) than control subjects. Accelerometry data also revealed that there was an increase in flexion/extension and lateral movement at the major joints in the body. Joint movements at the hip, knee, ankle and shoulders showed a 50 and 100% increase in movement at the joints during gait for subjects with diabetes compared to control subjects. These findings suggest that individuals with type 1 and type 2 diabetes can have significant problems in both the timing and quality of gait. These impairments are likely secondary to dysfunction of the vestibular, somatosensory and autonomic system in diabetics. Data here showed at least a 50% impairment in local tissue blood flow and autonomic function in subjects in both type 1 and type 2 diabetes compared to control subjects.

Benefits of cognitive-motor intervention in MCI and mild to moderate Alzheimer disease

OBJECTIVE

To evaluate the efficacy of a cognitive-motor program in patients with early Alzheimer disease (AD) who are treated with a cholinesterase inhibitor (ChEI).

METHODS

Patients with mild cognitive impairment (MCI) (12), mild AD (48), and moderate AD (24) (Global Deterioration Scale stages 3, 4, and 5) were randomized to receive psychosocial support plus cognitive-motor intervention (experimental group) or psychosocial support alone (control group). Cognitive-motor intervention (CMI) consisted of a 1-year structured program of 103 sessions of cognitive exercises, plus social and psychomotor activities. The primary efficacy measure was the cognitive subscale of the AD Assessment Scale (ADAS-cog). Secondary efficacy measures were the Mini-Mental State Examination, the Functional Activities Questionnaire, and the Geriatric Depression Scale. Evaluations were conducted at 1, 3, 6, and 12 months by blinded evaluators.

RESULTS

Patients in the CMI group maintained cognitive status at month 6, whereas patients in the control group had significantly declined at that time. Cognitive response was higher in the patients with fewer years of formal education. In addition, more patients in the experimental group maintained or improved their affective status at month 12 (experimental group, 75%; control group, 47%; p = 0.017).

CONCLUSIONS

A long-term CMI in ChEI-treated early Alzheimer disease patients produced additional mood and cognitive benefits.

A randomized, double-blind study to assess the optimal duration of doxycycline treatment for human brucellosis

BACKGROUND

Human brucellosis is usually treated with a combination of tetracyclines and aminoglycosides. However, the optimal duration of therapy has not been clearly determined.

METHODS

We conducted a prospective, double-blind, randomized, multicenter study comparing treatment with doxycycline (100 mg po b.i.d.) for 30 days (30-day group) with the same dosage of doxycycline for 45 days (45-day group) in patients with brucellosis without endocarditis, spondylitis, or neurobrucellosis. All patients were treated with gentamicin (240 mg im once daily) for the first 7 days. Therapeutic outcome was evaluated by measuring relapse rates and drug safety.

RESULTS

Seventy-three patients were included in each group. During the first 45 days after treatment, the percentage of patients with relapse was significantly higher in the 30-day group than in the 45-day group (12.3% vs. 1.37%; relative risk, 9.00; 95% confidence interval [CI], 1.17-69.2; P=.017). Between day 45 after treatment and 12 months after treatment, no further significant differences were found in relapse rates between groups (9.38% in the 30-day group vs. 11.11% in the 45-day group; relative risk, 0.84; 95% CI, 0.31-2.30; P=.78). Overall, relapses occurred in 15 (20.55%) of 73 patients in the 30-day group and in 9 (12.33%) of 73 patients in the 45-day group (relative risk, 1.67; 95% CI, 0.78-3.56; P=.264). Compliance and adverse effects were comparable in the 2 groups.

CONCLUSIONS

Doxycycline treatment for 45 days significantly decreased early relapse rates among adults with brucellosis without increasing adverse effects.

Luxación volar irreductible aislada de la extremidad distal del cúbito

Las luxaciones de la articulación radiocubital distal se asocian con fracturas del radio. La luxación aislada de la articulación radiocubital distal es rara, suponiendo menos del 0,2% de todas las luxaciones, y se describe terminológicamente por la posición que adopta el cúbito respecto al radio. Radiológicamente pueden pasar desapercibidas por lo que a veces es necesario el uso de la Tomografía Axial Computerizada. Presentamos el caso de un varón de 37 años que sufrió una luxación volar irreductible de la extremidad distal del cúbito. Fue intervenido de urgencia mediante reducción abierta y estabilización con aguja de Kirschner, observando una interposición de los ligamentos radiocubitales dorsales que era lo que impedía la reducción cerrada. A las 6 semanas se retiró la aguja, comenzando con la rehabilitación. Se realizó control radiológico y TAC en pronación y supinación observando una buena congruencia. Clínicamente está asintomático.