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Palacio M, Mottola MF. Activity Restriction and Hospitalization in Pregnancy: Can Bed-Rest Exercise Prevent Deconditioning? A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1454. [PMID: 36674214 PMCID: PMC9859130 DOI: 10.3390/ijerph20021454] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/16/2022] [Accepted: 01/10/2023] [Indexed: 06/17/2023]
Abstract
Evidence suggests that exercise during pregnancy is beneficial to both parent and fetus. However, there are high-risk pregnancy conditions that may warrant hospitalization. In our narrative review, we first describe the clinical implications for activity restriction in pregnancy, the effects of hospitalization, and the impact of bed rest on non-pregnant individuals. We provide examples of a 30 min bed-rest exercise program for hospitalized pregnant patients using the principal of suggested frequency, intensity, time (duration) of activity, and type of activity (FITT) using a resistance tool while in bed. If the individual is able to ambulate, we recommend short walks around the ward. Every minute counts and activity should be incorporated into a program at least 3 times per week, or every day if possible. As in all exercise programs, motivation and accountability are essential. Flexibility in timing of the exercise intervention is important due to the scheduling of medical assessments that may occur throughout the day for these hospitalized patients. Evidence suggests that by improving physical and emotional health through a bed-rest exercise program during a hospitalized pregnancy may help the individual resume demanding daily activity in the postpartum period and improve quality of life once birth has occurred. More research is necessary to improve the health of those individuals who are hospitalized during pregnancy, with follow up and support into the postpartum period.
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Affiliation(s)
- Montse Palacio
- Senior Consultant, Maternal-Fetal Medicine, Hospital Clínic Barcelona (BCNatal Fetal Medicine Research Center), Universitat de Barcelona, 08028 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi I Sunyer, 08036 Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBERER), 08001 Barcelona, Spain
| | - Michelle F. Mottola
- R. Samuel McLaughlin Foundation-Exercise and Pregnancy Laboratory, School of Kinesiology, Faculty of Health Sciences, Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Children’s Health Research Institute, The University of Western Ontario, London, ON N6A 3K7, Canada
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Proactive Swallowing Rehabilitation in Patients with Recurrent Oral Cancer Receiving Salvage Treatment: Long-Term Swallowing-Related Outcomes. Dysphagia 2022; 38:954-964. [PMID: 36127448 DOI: 10.1007/s00455-022-10521-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 09/11/2022] [Indexed: 11/03/2022]
Abstract
The present study aimed to evaluate the impact of proactive swallowing rehabilitation on swallowing function and quality of life in patients with recurrent oral cancer in the first 2 years after salvage treatment. Consecutive adult patients with recurrent oral cancer who received salvage surgery and free flap reconstruction were recruited prospectively, to whom proactive swallowing rehabilitation was provided. Body weight (BW); fiberoptic endoscopic evaluation of swallowing (FEES), functional oral intake scale (FOIS), and diet level; 10-item eating assessment tool (EAT-10), and MD Anderson Dysphagia Inventory (MDADI); and adherence at baseline, 1, 3, 6, 12, 18 and 24 months were evaluated. A total of 50 patients were included during May 2018 to July 2020. Compared to the baseline, significant deterioration in BW, FOIS, and MDADI was noted at one month. However, a trend of recovery was observed in BW and FOIS from one month, and in MDADI from three months. All patients were free of tube feeding at 18-24 months and tolerated diet with special preparations or compensation. Safe swallowing could be achieved in approximately 80% participants after 12 months of diet modification or compensatory maneuvers. Proactive swallowing therapy was feasible in patients with recurrent oral cancer receiving salvage treatment. Although this patient population might have pre-existing dysphagia from previous treatments, rehabilitation could facilitate safe per oral intake and maintain adequate nutrition with adaptive maneuvers or compensatory strategies. Patients who underwent proactive swallowing rehabilitation had better recovery in the functional oral intake level.
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Extracellular polysaccharides purified (Polycan) from Aureobasidium pullulans SM‑2001 improves pathophysiology of dystrophin-deficient mdx mice. Mol Cell Toxicol 2022. [DOI: 10.1007/s13273-022-00245-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Abstract
Background
Duchenne muscular dystrophy is a hereditary muscular disease involving degeneration (i.e. atrophy and loss of muscle fibres) of skeletal muscles, including the diaphragm, and progressively severe functional decline. A previous study shows Polycan, a type of β-glucan derived from the black yeast Aureobasidium pullulans (SM-2001), promotes osteogenicity and bone loss, and possesses anti-inflammatory activity to induce inflammatory cytokines in human immune and cancer cells.
Objective
In this study, we evaluated changes in exercise load behaviour measurements and changes in muscle-related physiological indicators following oral administration of Polycan in mdx mice, an experimental animal model of Duchenne muscular dystrophy.
Result
In mdx mice, Polycan prevented weight loss and thickness of skeletal muscle. In addition, by monitoring increases in running time of mice on treadmills and performing a grip strength test, we confirmed reduced muscle function was recovered to some extent after administering Polycan to mdx mice. In addition, we confirmed that Polycan significantly altered mRNA expression in a concentration-dependent manner, whereby myogenic transcription factors (MyoD, Myf5 and Myogenin) increased and FoxO3α, MuRF1 and Atrogin-1 decreased. We aimed to investigate the mechanism of action in Polycan on energy metabolism of p-AMPK, SIRT1 and PGC1α with apoptosis expression levels as factors related to signalling pathways. Expression ratios of cleaved-caspase-3/caspase-3 and Bax/Bcl-2 in the Polycan extract-administered group increased compared with the control group.
Conclusion
These results demonstrate that Polycan can improve and protect muscle atrophy by preventing apoptosis via pathway regulation related to myogenic transcription factors and energy metabolism in mdx mice.
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Molecular Mechanisms of Muscle Fatigue. Int J Mol Sci 2021; 22:ijms222111587. [PMID: 34769017 PMCID: PMC8584022 DOI: 10.3390/ijms222111587] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 10/23/2021] [Accepted: 10/25/2021] [Indexed: 12/15/2022] Open
Abstract
Muscle fatigue (MF) declines the capacity of muscles to complete a task over time at a constant load. MF is usually short-lasting, reversible, and is experienced as a feeling of tiredness or lack of energy. The leading causes of short-lasting fatigue are related to overtraining, undertraining/deconditioning, or physical injury. Conversely, MF can be persistent and more serious when associated with pathological states or following chronic exposure to certain medication or toxic composites. In conjunction with chronic fatigue, the muscle feels floppy, and the force generated by muscles is always low, causing the individual to feel frail constantly. The leading cause underpinning the development of chronic fatigue is related to muscle wasting mediated by aging, immobilization, insulin resistance (through high-fat dietary intake or pharmacologically mediated Peroxisome Proliferator-Activated Receptor (PPAR) agonism), diseases associated with systemic inflammation (arthritis, sepsis, infections, trauma, cardiovascular and respiratory disorders (heart failure, chronic obstructive pulmonary disease (COPD))), chronic kidney failure, muscle dystrophies, muscle myopathies, multiple sclerosis, and, more recently, coronavirus disease 2019 (COVID-19). The primary outcome of displaying chronic muscle fatigue is a poor quality of life. This type of fatigue represents a significant daily challenge for those affected and for the national health authorities through the financial burden attached to patient support. Although the origin of chronic fatigue is multifactorial, the MF in illness conditions is intrinsically linked to the occurrence of muscle loss. The sequence of events leading to chronic fatigue can be schematically denoted as: trigger (genetic or pathological) -> molecular outcome within the muscle cell -> muscle wasting -> loss of muscle function -> occurrence of chronic muscle fatigue. The present review will only highlight and discuss current knowledge on the molecular mechanisms that contribute to the upregulation of muscle wasting, thereby helping us understand how we could prevent or treat this debilitating condition.
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The natural history of weight and swallowing outcomes in oropharyngeal cancer patients following radiation or concurrent chemoradiation therapy. Support Care Cancer 2020; 29:1597-1607. [PMID: 32740893 DOI: 10.1007/s00520-020-05628-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 07/10/2020] [Indexed: 01/25/2023]
Abstract
PURPOSE Patients treated for oropharyngeal cancer (OPC) are at increased risk for functional decline due to cancer-related impairments and treatment toxicities, often leading to recommendations for enteral nutritional support. This study investigated the natural history of weight and swallowing outcomes in patients with and without feeding tube (FT) placement. METHODS Data were collected from electronic medical records of OPC patients treated with (chemo)radiotherapy at a single regional cancer center between January 2013 and December 2015. Weight measurements, Functional Oral Intake Scale (FOIS) scores, Performance Status Scale for Head and Neck Cancer (PSS-HN) normalcy of diet scores, and M.D. Anderson Dysphagia Inventory (MDADI) composite scores were gathered at baseline and at 3-, 6-, and 12-months post-treatment. Patients were grouped based on FT placement and change over time was assessed using linear mixed effects analysis. RESULTS Of 122 eligible patients, 38 (31.1%) received a FT (FT group). Compared with baseline, weight decreased significantly at 3 and 6 months in both groups and at 12 months for patients without a FT (NFT group). Swallowing-related quality of life (QoL) decreased significantly at 3 and 6 months only in the NFT group. CONCLUSION OPC patients experience clinically relevant decreases in weight and swallowing-related QoL in the first-year post-treatment irrespective of FT placement. These findings will contribute to improved patient monitoring and communication within the clinical setting which may ultimately lead to better outcomes for those with OPC.
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Changes of bite force and occlusal contacts in the retention phase of orthodontic treatment: A controlled clinical trial. Am J Orthod Dentofacial Orthop 2017; 152:767-777. [PMID: 29173856 DOI: 10.1016/j.ajodo.2017.03.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 03/01/2017] [Accepted: 03/01/2017] [Indexed: 11/22/2022]
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Kizilarslanoglu MC, Kuyumcu ME, Yesil Y, Halil M. Sarcopenia in critically ill patients. J Anesth 2016; 30:884-90. [PMID: 27376823 DOI: 10.1007/s00540-016-2211-4] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 06/26/2016] [Indexed: 12/25/2022]
Abstract
Sarcopenia occurring as a primary consequence of aging and secondary due to certain medical problems including chronic disease, malnutrition and inactivity is a progressive generalized loss of skeletal muscle mass, strength and function. The prevalence of sarcopenia increases with aging (approximately 5-13 % in the sixth and seventh decades). However, data showing the prevalence and clinical outcomes of sarcopenia in intensive care units (ICUs) are limited. A similar condition to sarcopenia in the ICU, called ICU-acquired weakness (ICU-AW), has been reported more frequently. Here, we aim to examine the importance of sarcopenia, especially ICU-AW, in ICU patients via related articles in Medline.
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Affiliation(s)
- Muhammet C Kizilarslanoglu
- Division of Geriatrics, Department of Internal Medicine, Hacettepe University School of Medicine, 06100, Ankara, Turkey.
| | - Mehmet E Kuyumcu
- Division of Geriatrics, Department of Internal Medicine, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | - Yusuf Yesil
- Division of Geriatrics, Department of Internal Medicine, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | - Meltem Halil
- Division of Geriatrics, Department of Internal Medicine, Hacettepe University School of Medicine, 06100, Ankara, Turkey
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Jolley SE, Bunnell AE, Hough CL. ICU-Acquired Weakness. Chest 2016; 150:1129-1140. [PMID: 27063347 DOI: 10.1016/j.chest.2016.03.045] [Citation(s) in RCA: 200] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 03/09/2016] [Accepted: 03/24/2016] [Indexed: 12/17/2022] Open
Abstract
Survivorship after critical illness is an increasingly important health-care concern as ICU use continues to increase while ICU mortality is decreasing. Survivors of critical illness experience marked disability and impairments in physical and cognitive function that persist for years after their initial ICU stay. Newfound impairment is associated with increased health-care costs and use, reductions in health-related quality of life, and prolonged unemployment. Weakness, critical illness neuropathy and/or myopathy, and muscle atrophy are common in patients who are critically ill, with up to 80% of patients admitted to the ICU developing some form of neuromuscular dysfunction. ICU-acquired weakness (ICUAW) is associated with longer durations of mechanical ventilation and hospitalization, along with greater functional impairment for survivors. Although there is increasing recognition of ICUAW as a clinical entity, significant knowledge gaps exist concerning identifying patients at high risk for its development and understanding its role in long-term outcomes after critical illness. This review addresses the epidemiologic and pathophysiologic aspects of ICUAW; highlights the diagnostic challenges associated with its diagnosis in patients who are critically ill; and proposes, to our knowledge, a novel strategy for identifying ICUAW.
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Affiliation(s)
- Sarah E Jolley
- Section of Pulmonary/Critical Care Medicine and Allergy/Immunology, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Aaron E Bunnell
- Department of Rehabilitation Medicine, Harborview Medical Center, University of Washington, Seattle, WA
| | - Catherine L Hough
- Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, WA.
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Abstract
Sedation is a necessary component of care for the critically ill. Oversedation, however, is associated with immediate complications and long-term problems, termed post-intensive care unit syndrome. It also contributes to unnecessary costs of care. This article describes the physical, functional, psychiatric, and cognitive complications of oversedation, and multiple research-based strategies that minimize complications.
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Affiliation(s)
- Jan Foster
- Nursing Inquiry & Intervention, Inc, The Woodlands, TX 77381, USA.
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Oliveira PDD, Gomes CRDG, Oliveira RFD, Pires-Oliveira DADA, Bertolini SMMG. Histomorphometric alterations of muscle soleus provoked by drawn out immobilization: experimental study with wistar lineage rats. FISIOTERAPIA EM MOVIMENTO 2015. [DOI: 10.1590/0103-5150.028.002.ao09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective This study has as objective to analyze the effect of joint immobilization of the soleus muscle of posterior members of rats on morphometric profile view, at periods of 21 and 45 days. Materials and methods Ten male Rattus novergicus albinus, Wistar variety, were used, separated into two groups (group I and II), of 5 animals each, with the first group submitted to immobilization for 21 days and the second for 45 days. The experiment control was acquired from the right contralateral member of each animal. The immobilization of the left posterior member was done by adapted orthesis. The morphometric analysis of soleus was by non-serial cross sections, 8μm thick. Results From the obtained images, the muscle fibers areas were analyzed, including the form of the fibers, comparing with the control group. In both the periods of immobilization cross sections of staple fibres had reduction of the section area, front to the comparison to its respective member has controlled, with significant important (p < 0.0001), especially it enters the experimental groups of 21 and 45 days. Conclusion It can be concluded that immobilization to articulate of rats per 21 and 45 days modifies the section area more transversa of staple fibres of the sóleo muscle and deleterious effect of more significant the cellular components for drawn out periods.
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Hutcheson KA, Bhayani MK, Beadle BM, Gold KA, Shinn EH, Lai SY, Lewin J. Eat and exercise during radiotherapy or chemoradiotherapy for pharyngeal cancers: use it or lose it. JAMA Otolaryngol Head Neck Surg 2014; 139:1127-34. [PMID: 24051544 DOI: 10.1001/jamaoto.2013.4715] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
IMPORTANCE Data support proactive swallowing therapy during radiotherapy (RT) or chemoradiotherapy (CRT) for pharyngeal cancers. The benefits of adherence to a regimen of swallowing exercises and maintaining oral intake throughout treatment are reported, but independent effects are unclear. OBJECTIVE To evaluate the independent effects of maintaining oral intake throughout radiotherapy and adherence to preventive swallowing exercise. DESIGN Retrospective observational study. SETTING The University of Texas MD Anderson Cancer Center, Houston. PATIENTS The study included 497 patients treated with definitive RT or CRT for pharyngeal cancer (458 oropharynx, 39 hypopharynx) between 2002 and 2008. MAIN OUTCOMES AND MEASURES Swallowing-related end points were final diet after RT or CRT and duration of gastrostomy dependence. Primary independent variables included oral intake status at the end of RT or CRT (no oral intake, partial oral intake, or full oral intake) and adherence to a swallowing exercise regimen. Multiple linear regression and ordered logistic regression models were analyzed. RESULTS At the conclusion of RT or CRT, 131 patients (26%) had no oral intake and 74% maintained oral intake (167 partial [34%], 199 full [40%]). Fifty-eight percent (286 of 497) reported adherence to swallowing exercises. Maintenance of oral intake during RT or CRT and swallowing exercise adherence were independently associated with better long-term diet after RT or CRT (P = .045 and P < .001, respectively) and shorter duration of gastrostomy dependence (P < .001 and P = .007, respectively) in models adjusted for tumor and treatment burden. CONCLUSIONS AND RELEVANCE The data indicate independent, positive associations of maintenance of oral intake throughout RT or CRT and swallowing exercise adherence with long-term swallowing outcomes. Patients who either eat or exercise fare better than those who do neither. Patients who both eat and exercise have the highest rate of return to a regular diet and shortest duration of gastrostomy dependence.
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Affiliation(s)
- Katherine A Hutcheson
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston
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Brooks NE, Cadena SM, Cloutier G, Vega-López S, Roubenoff R, Castaneda-Sceppa C. Influence of exercise on the metabolic profile caused by 28 days of bed rest with energy deficit and amino acid supplementation in healthy men. Int J Med Sci 2014; 11:1248-57. [PMID: 25317071 PMCID: PMC4196126 DOI: 10.7150/ijms.9694] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 08/27/2014] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE Muscle loss and metabolic changes occur with disuse [i.e. bed rest (BR)]. We hypothesized that BR would lead to a metabolically unhealthy profile defined by: increased circulating tumor necrosis factor (TNF)-α, decreased circulating insulin-like-growth-factor (IGF)-1, decreased HDL-cholesterol, and decreased muscle density (MD; measured by mid-thigh computerized tomography). METHODS We investigated the metabolic profile after 28 days of BR with 8 ± 6% energy deficit in male individuals (30-55 years) randomized to resistance exercise with amino acid supplementation (RT, n=24) or amino acid supplementation alone (EAA, n=7). Upper and lower body exercises were performed in the horizontal position. Blood samples were taken at baseline, after 28 days of BR and 14 days of recovery. RESULTS We found a shift toward a metabolically unfavourable profile after BR [compared to baseline (BLN)] in both groups as shown by decreased HDL-cholesterol levels (EAA: BLN: 39 ± 4 vs. BR: 32 ± 2 mg/dL, RT: BLN: 39 ± 1 vs. BR: 32 ± 1 mg/dL; p<0.001) and Low MD (EAA: BLN: 27 ± 4 vs. BR: 22 ± 3 cm(2), RT: BLN: 28 ± 2 vs. BR: 23 ± 2 cm(2); p<0.001). A healthier metabolic profile was maintained with exercise, including NormalMD (EAA: BLN: 124 ± 6 vs. BR: 110 ± 5 cm(2), RT: BLN: 132 ± 3 vs. BR: 131 ± 4 cm(2); p<0.001, time-by-group); although, exercise did not completely alleviate the unfavourable metabolic changes seen with BR. Interestingly, both groups had increased plasma IGF-1 levels (EAA: BLN:168 ± 22 vs. BR 213 ± 20 ng/mL, RT: BLN:180 ± 10 vs. BR: 219 ± 13 ng/mL; p<0.001) and neither group showed TNFα changes (p>0.05). CONCLUSIONS We conclude that RT can be incorporated to potentially offset the metabolic complications of BR.
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Affiliation(s)
- Naomi E Brooks
- 1. Health & Exercise Sciences, University of Stirling, Stirling, Scotland UK
| | - Samuel M Cadena
- 2. Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston MA
| | - Gregory Cloutier
- 3. Bouve College of Health Sciences, Northeastern University, Boston MA
| | - Sonia Vega-López
- 4. School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ
| | - Ronenn Roubenoff
- 5. Friedman School of Nutrition Science and Policy, Tufts University, Boston MA
| | - Carmen Castaneda-Sceppa
- 3. Bouve College of Health Sciences, Northeastern University, Boston MA ; 5. Friedman School of Nutrition Science and Policy, Tufts University, Boston MA
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Volpini MM, Frangella VS. Nutritional assessment of institutionalized elderly. EINSTEIN-SAO PAULO 2013; 11:32-40. [PMID: 23579741 PMCID: PMC4872965 DOI: 10.1590/s1679-45082013000100007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 11/12/2012] [Indexed: 11/22/2022] Open
Abstract
Objective: To define the nutritional profile of institutionalized elderly individuals. Methods: Comparative correlation and quantitative field study conducted in a Long-Stay Institution in Sao Paulo (SP), Brazil, between December 2010 and January 2012. To define nutritional diagnosis, data were collected from patient files, such as body mass index, circumferences, triceps skinfold, muscle area of the arm, thickness of the adductor pollicis, handgrip strength, and biochemical test results. The anthropometric variables were presented as mean, standard deviation, and percentages, and were grouped by gender and stratified by age. The level of statistical significance was p<0.05. Results: One hundred and two elderly individuals were selected, and 84 were females. Excess weight was the most common anthropometric diagnosis in men (n=11; 61%), with the detection of protein depletion in those aged 70 years, and possible cases of sarcopenic obesity. All women were in good health conditions (n=84; 100%). However, in 27% (n=23) of them, protein depletion was evident. Conclusion: More anthropometric studies are necessary which would allow a definition of local reference standards, stratified by gender and age group. The difference between populations and factors, such as inclusion and exclusion criteria, and methodological characteristics, limit the use of international standards, interfering in the reliability of the nutritional diagnosis.
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Casey CM. The study of activity in older ICU patients: an integrative review. J Gerontol Nurs 2013; 39:12-25; quiz 26-7. [PMID: 23758116 DOI: 10.3928/00989134-20130603-02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 05/09/2013] [Indexed: 12/25/2022]
Abstract
The purpose of this study was to review relevant literature on activity of older critically ill patients, including activity interventions conducted in this population, with a focus on activity measurement and technology. Literature published between 1996 and 2012 was reviewed using keywords older adults, inactivity, mobility, progressive mobility, rehabilitation, ambulation, early mobilization, ICU (intensive care unit), and accelerometry using CINAHL, MEDLINE, and the Cochrane Database of Systematic Reviews. Previous relevant research is discussed and includes intervention and nonintervention studies. Although studies have demonstrated the benefits of early mobilization in the ICU setting, this research has not focused on the high-risk older adult ICU population, nor has it addressed how best to quantify these clinical activities. Current technologies, such as accelerometry, may assist in measuring patient activity and in mobilizing high-risk patients during acute, critical illness.
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Affiliation(s)
- Colleen M Casey
- Oregon Health & Science University, Portland, OR 97239, USA.
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15
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Ye F, Mathur S, Liu M, Borst SE, Walter GA, Sweeney HL, Vandenborne K. Overexpression of insulin-like growth factor-1 attenuates skeletal muscle damage and accelerates muscle regeneration and functional recovery after disuse. Exp Physiol 2013; 98:1038-52. [PMID: 23291913 DOI: 10.1113/expphysiol.2012.070722] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Skeletal muscle is a highly dynamic tissue that responds to endogenous and external stimuli, including alterations in mechanical loading and growth factors. In particular, the antigravity soleus muscle experiences significant muscle atrophy during disuse and extensive muscle damage upon reloading. Given that insulin-like growth factor-1 (IGF-1) has been implicated as a central regulator of muscle repair and modulation of muscle size, we examined the effect of virally mediated overexpression of IGF-1 on the soleus muscle following hindlimb cast immobilization and upon reloading. Recombinant IGF-1 cDNA virus was injected into one of the posterior hindlimbs of the mice, while the contralateral limb was injected with saline (control). At 20 weeks of age, both hindlimbs were immobilized for 2 weeks to induce muscle atrophy in the soleus and ankle plantarflexor muscle group. Subsequently, the mice were allowed to reambulate, and muscle damage and recovery were monitored over a period of 2-21 days. The primary finding of this study was that IGF-1 overexpression attenuated reloading-induced muscle damage in the soleus muscle, and accelerated muscle regeneration and force recovery. Muscle T2 assessed by magnetic resonance imaging, a non-specific marker of muscle damage, was significantly lower in IGF-1-injected compared with contralateral soleus muscles at 2 and 5 days reambulation (P<0.05). The reduced prevalence of muscle damage in IGF-1-injected soleus muscles was confirmed on histology, with a lower fractional area of abnormal muscle tissue in IGF-1-injected muscles at 2 days reambulation (33.2±3.3 versus 54.1±3.6%, P<0.05). Evidence of the effect of IGF-1 on muscle regeneration included timely increases in the number of central nuclei (21% at 5 days reambulation), paired-box transcription factor 7 (36% at 5 days), embryonic myosin (37% at 10 days) and elevated MyoD mRNA (7-fold at 2 days) in IGF-1-injected limbs (P<0.05). These findings demonstrate a potential role of IGF-1 in protecting unloaded skeletal muscles from damage and accelerating muscle repair and regeneration.
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Affiliation(s)
- Fan Ye
- Department of Physical Therapy, PO Box 100154, Room 1142, PHHP Building, University of Florida, Gainesville, FL 32610, USA
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Lee S, Shin J, Hong Y, Lee M, Kim K, Lee SR, Chang KT, Hong Y. Beneficial effects of melatonin on stroke-induced muscle atrophy in focal cerebral ischemic rats. Lab Anim Res 2012; 28:47-54. [PMID: 22474474 PMCID: PMC3315192 DOI: 10.5625/lar.2012.28.1.47] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 02/27/2012] [Accepted: 03/02/2012] [Indexed: 12/26/2022] Open
Abstract
MUSCLE ATROPHY IS THE RESULT OF TWO OPPOSING CONDITIONS THAT CAN BE FOUND IN PATHOLOGICAL OR DISEASED MUSCLES: an imbalance in protein synthesis and degradation mechanisms. Thus, we investigated whether exogenous melatonin could regulate muscle components in stroke-induced muscle atrophy in rats. Comparing muscle phenotypes, we found that long-term melatonin administration could influence muscle mass. Muscle atrophy-related genes, including muscle atrophy F-box (MAFbx) and muscle ring finger 1 (MuRF1) were significantly down-regulated in melatonin-administered rats in the gastrocnemius. However, only MAFbx at the mRNA level was attenuated in the soleus of melatonin-administered rats. Insulin-like growth factor-1 receptor (IGF-1R) was significantly over-expressed in melatonin-administered rats in both the gastrocnemius and soleus muscles. Comparing myosin heavy chain (MHC) components, in the gastrocnemius, expression of both slow- and fast-type isoforms were significantly enhanced in melatonin-administered rats. These results suggest that long-term exogenous melatonin-administration may have a prophylactic effect on muscle atrophy through the MuRF1/MAFbx signaling pathway, as well as a potential therapeutic effect on muscle atrophy through the IGF-1-mediated hypertrophic signaling pathway in a stroke animal model.
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Affiliation(s)
- Seunghoon Lee
- Department of Rehabilitation Science in Interdisciplinary PhD Program, Graduate School of Inje University, Gimhae, Korea
| | - Jinhee Shin
- Department of Physical Therapy, College of Biomedical Science & Engineering, Inje University, Gimhae, Korea
| | - Yunkyung Hong
- Department of Rehabilitation Science in Interdisciplinary PhD Program, Graduate School of Inje University, Gimhae, Korea
| | - Minkyung Lee
- Department of Rehabilitation Science in Interdisciplinary PhD Program, Graduate School of Inje University, Gimhae, Korea
| | - Koo Kim
- Department of Physical Therapy, College of Biomedical Science & Engineering, Inje University, Gimhae, Korea
| | - Sang-Rae Lee
- National Primate Research Center, Korea Research Institute of Bioscience and Biotechnology, Ochang, Korea
| | - Kyu-Tae Chang
- National Primate Research Center, Korea Research Institute of Bioscience and Biotechnology, Ochang, Korea
| | - Yonggeun Hong
- Department of Rehabilitation Science in Interdisciplinary PhD Program, Graduate School of Inje University, Gimhae, Korea
- Department of Physical Therapy, College of Biomedical Science & Engineering, Inje University, Gimhae, Korea
- National Primate Research Center, Korea Research Institute of Bioscience and Biotechnology, Ochang, Korea
- Cardiovascular & Metabolic Disease Center, College of Biomedical Science & Engineering, Inje University, Gimhae, Korea
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Seene T, Kaasik P, Riso EM. Review on aging, unloading and reloading: Changes in skeletal muscle quantity and quality. Arch Gerontol Geriatr 2012; 54:374-80. [DOI: 10.1016/j.archger.2011.05.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 05/04/2011] [Accepted: 05/05/2011] [Indexed: 11/29/2022]
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Norrenberg M, Vincent JL. Rééducation motrice dans le cadre d’un séjour en réanimation. MEDECINE INTENSIVE REANIMATION 2011. [DOI: 10.1007/s13546-011-0320-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Brun CR, Shoemaker JK, Bocking A, Hammond JA, Poole M, Mottola MF. Bed-rest exercise, activity restriction, and high-risk pregnancies: a feasibility study. Appl Physiol Nutr Metab 2011; 36:577-82. [DOI: 10.1139/h11-036] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This feasibility study investigated the response of maternal heart rate, blood pressure, and uterine contractions to a 30-min bed-rest exercise session (while listening to music) in hospitalized women with varying diagnoses of high-risk pregnancy. Eleven antenatal women who were hospitalized for activity restriction were assigned randomly to either a bed-rest exercise and music group (n = 6) or a bed-rest and music group (n = 5) that involved no exercise. The key findings were that there were no changes in maternal blood pressure or in the number of uterine contractions following the exercise intervention. A supervised bed-rest exercise intervention may, therefore, provide minimal risks and help alleviate the physiological effects of hospital activity restriction.
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Affiliation(s)
- Chantale R. Brun
- R. Samuel McLaughlin Foundation-Exercise and Pregnancy Laboratory, University of Western Ontario, London, ON, Canada
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
- School of Kinesiology and Recreation, Université de Moncton, Moncton, NB E1A 3E9, Canada
| | - J. Kevin Shoemaker
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
| | - Alan Bocking
- St. Joseph’s Health Care London, London, ON, Canada
- Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Jo-Anne Hammond
- R. Samuel McLaughlin Foundation-Exercise and Pregnancy Laboratory, University of Western Ontario, London, ON, Canada
- Department of Family Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
- St. Joseph’s Health Care London, London, ON, Canada
| | - Monica Poole
- St. Joseph’s Health Care London, London, ON, Canada
| | - Michelle F. Mottola
- R. Samuel McLaughlin Foundation-Exercise and Pregnancy Laboratory, University of Western Ontario, London, ON, Canada
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
- Department of Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
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20
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Kim Y, Choe MA. [Effect of decreased locomotor activity on hindlimb muscles in a rat model of Parkinson's disease]. J Korean Acad Nurs 2010; 40:580-8. [PMID: 20820125 DOI: 10.4040/jkan.2010.40.4.580] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE The purpose of this study was to examine effects of decreased locomotor activity on mass, Type I and II fiber cross-sectional areas of ipsilateral and contralateral hindlimb muscles 21 days after establishing the Parkinson's disease rat model. METHODS The rat model was established by direct injection of 6-hydroxydopamine (6-OHDA, 50 microg) into the left substantia nigra after stereotaxic surgery. Adult male Sprague-Dawley rats were assigned to one of two groups; the Parkinson's disease group (PD; n=17) and a sham group (S; n=8). Locomotor activity was assessed before and 21 days after the experiment. At 22 days after establishing the rat model, all rats were anesthetized and soleus and plantaris muscles were dissected from both ipsilateral and contralateral sides. The brain was dissected to identify dopaminergic neuronal death of substantia nigra in the PD group. RESULTS The PD group at 21 days after establishing the Parkinson's disease rat model showed significant decrease in locomotor activity compared with the S group. Weights and Type I and II fiber cross-sectional areas of the contralateral soleus muscle of the PD group were significantly lower than those of the S group. CONCLUSION Contralateral soleus muscle atrophy occurs 21 days after establishing the Parkinson's disease rat model.
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Critical illness neuromyopathy and muscle weakness in patients in the intensive care unit. AACN Adv Crit Care 2009; 20:243-53. [PMID: 19638746 DOI: 10.1097/nci.0b013e3181ac2551] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Neuromuscular complications of critical illness are common and can be severe and persistent in some patients. Neuromyopathy from critical illness and disuse atrophy from prolonged immobility contribute to muscle weakness acquired while in the intensive care unit. Although various risk factors (eg, severity of illness, corticosteroids, neuromuscular blocking agents) have been implicated in critical illness neuromyopathy (CINM), the evidence supporting these associations is inconsistent. Hyperglycemia may be an important risk factor for CINM, with tight glycemic control through intensive insulin therapy reducing the incidence of CINM. Early mobility in the intensive care unit may minimize disuse atrophy and possibly CINM, through exercise training and its anti-inflammatory effects. Although emerging data have demonstrated the safety, feasibility, and benefit of early mobility in critically ill patients, randomized controlled trials are needed to thoroughly evaluate its potential benefits on patients' muscle strength, physical function, and quality of life. Future studies are needed to elucidate the multiple mechanisms by which immobility, CINM, and other aspects of critical illness lead to muscle loss and neuromuscular dysfunction.
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22
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Norman H, Zackrisson H, Hedström Y, Andersson P, Nordquist J, Eriksson LI, Libelius R, Larsson L. Myofibrillar protein and gene expression in acute quadriplegic myopathy. J Neurol Sci 2009; 285:28-38. [PMID: 19501843 DOI: 10.1016/j.jns.2009.04.041] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Revised: 04/17/2009] [Accepted: 04/21/2009] [Indexed: 10/20/2022]
Abstract
The dramatic muscle wasting, preferential loss of myosin and impaired muscle function in intensive care unit (ICU) patients with acute quadriplegic myopathy (AQM) have traditionally been suggested to be the result of proteolysis via specific proteolytic pathways. In this study we aim to investigate the mechanisms underlying the preferential loss of thick vs. thin filament proteins and the reassembly of the sarcomere during the recovery process in muscle samples from ICU patients with AQM. Quantitative and qualitative analyses of myofibrillar protein and mRNA expression were analyzed using SDS-PAGE, confocal microscopy, histochemistry and real-time PCR. The present results demonstrate that the transcriptional regulation of myofibrillar protein synthesis plays an important role in the loss of contractile proteins, as well as the recovery of protein levels during clinical improvement, myosin in particular, presumably in concert with proteolytic pathways, but the mechanisms are specific to the different thick and thin filament proteins studied.
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Affiliation(s)
- Holly Norman
- Department of Clinical Neurophysiology, Uppsala University, Sweden
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23
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Hwang YH, Choe MA. [Study on the changes in limb circumferences and muscle areas of critically ill patients using ventilators]. J Korean Acad Nurs 2009; 38:874-80. [PMID: 19122489 DOI: 10.4040/jkan.2008.38.6.874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE The purpose of this study was to identify muscle atrophy in critically ill patients on ventilators. A comparison was made between limb circumferences and muscle areas on the day of admission to an intensive care unit (ICU) and on the 8th day after admission. METHODS The data were collected from 30 critically ill patients using ventilators at S hospital ICU in Seoul during the period from October 2005 to April 2006. Limb circumferences and skinfold thickness were measured on the day of admission and on the 8th day after admission to the ICU. Limb circumferences and skinfold thickness were measured on the right mid-arm, right mid-thigh, and right mid-calf using a measuring tape and a skinfold calipers. Limb muscle areas were calculated by an equation after measuring limb circumferences and skinfold thickness. The data were analyzed by paired t-test and independent t-test. RESULTS 1) Mid-arm circumference, mid-thigh circumference and mid-calf circumference on the 8th day after admission to the ICU were significantly less than those on the day of admission to the ICU, 2) Mid-arm muscle area, mid-thigh muscle area and mid-calf muscle area on the 8th day after admission to the ICU were significantly less than those on the day of admission to the ICU, 3) Steroid and vecuronium medication didn't affect changes in limb circumferences (mid-arm, mid-thigh, mid-calf) and muscle areas (mid-arm, mid-thigh, mid-calf) on the 8th day after admission to the ICU compared to the day of admission. CONCLUSION Limb muscle atrophy may occur on the 8th day after admission to the ICU in critically ill patients using ventilator.
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Affiliation(s)
- Young-Hui Hwang
- Department of Nursing, Seoul National University, Seoul, Korea.
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Grosset JF, Onambele-Pearson G. Effect of foot and ankle immobilization on leg and thigh muscles' volume and morphology: a case study using magnetic resonance imaging. Anat Rec (Hoboken) 2009; 291:1673-83. [PMID: 18951503 DOI: 10.1002/ar.20759] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Our aim was to determine the time course of any changes in muscle volume and shape in the lower limbs following immobilization. A healthy young woman (29 years) had suffered a fracture of the fifth metatarsal of the right foot. MRI scanning of her right thigh and calf muscles had been performed 1 month before the injury (Pre) during a scan initially planned as a teaching tool, 2 days following a 4-week immobilization period (Post), and after a 2-month recovery period (Post+2). The results show muscle volume decrements in the triceps surae (TS), quadriceps (Quad), and hamstring (Ham) of 21.9%, 24.1%, and 6.5%, respectively, between the Pre and Post measurements. At Post+2, the Quad and TS muscle volumes were still 5.2% and 9.5% lower, compared with the Pre data. The Ham muscle volume, however, was 2.7% greater than at the Pre phase. Following recovery, the increase in individual TS muscles volume was limited to both proximal and medial (with respect to the knee joint) segments of the muscles. These results indicate very substantial and rapid losses in muscle volumes, both proximally and distally to the immobilization site. The results also show that recovery is far from complete up to 2 months post cast removal. The results have implications for the requirements for rehabilitation for orthopedic patients.
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Affiliation(s)
- Jean-François Grosset
- Department of Exercise and Sport Sciences, Manchester Metropolitan University, Alsager ST7 2HL, UK.
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Hershey J, Robbins C, Nelson O, Lin D. Minimal Seasonal Alterations in the Skeletal Muscle of Captive Brown Bears. Physiol Biochem Zool 2008; 81:138-47. [DOI: 10.1086/524391] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Chingui LJ, Braquinho RP, Severi MTM, Silva CAD. Comportamento quimiometabólico do músculo sóleo na fase aguda da imobilização articular. FISIOTERAPIA E PESQUISA 2008. [DOI: 10.1590/s1809-29502008000200014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
O objetivo foi avaliar o perfil fisiológico do músculo sóleo na fase aguda da imobilização articular na posição de 90o. Ratos Wistar foram divididos em 4 grupos (n=6 cada): controle (C), imobilizado por 1 (Im1), 2 (Im2) e 3 dias (Im3). Após o período experimental, o músculo sóleo foi retirado e foram mensurados: o peso muscular, o índice de hidratação, a concentração de glicogênio e a concentração de DNA/proteínas totais. Os dados foram submetidos a análise estatística, com nível de significância fixado em p<0,05. No primeiro dia não houve alterações nas reservas glicogênicas, sendo observada redução progressiva das reservas: 53% no segundo dia e 65% no terceiro dia de imobilização. O peso muscular sofreu redução de 28,57% apenas no terceiro dia; o índice de hidratação aumentou 6,44% no segundo e 8,58% no terceiro dia. As concentrações de DNA tiveram elevação de 43,18% no primeiro dia, 59,09% no segundo e 75% no terceiro. Quanto à concentração de proteínas totais, houve elevação de 45,9% no primeiro dia, 32,25% no segundo e 58,95% no terceiro dia. Os resultados sugerem que a hipotrofia muscular é um processo desencadeado precocemente, envolvendo alterações quimiofisiológicas que são deflagradas na fase aguda da imobilização.
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Stahn A, Terblanche E, Strobel G. Modeling upper and lower limb muscle volume by bioelectrical impedance analysis. J Appl Physiol (1985) 2007; 103:1428-35. [PMID: 17626831 DOI: 10.1152/japplphysiol.01163.2006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Most studies employing bioelectrical impedance analysis (BIA) for estimating appendicular skeletal muscle mass using descriptive BIA models rely on statistical rather than biophysical principles. The aim of the present study was to evaluate the feasibility of estimating arm and leg muscle volume (MV) based on multiple bioimpedance measurements and using a recently proposed mathematical model and to compare this technique to conventional segmental BIA at high and low frequencies. MV of the arm and leg, respectively, was determined in 15 young, healthy, active men [age 22 ± 2 (SD) yr, total body fat 15.6 ± 5.1%] by magnetic resonance imaging (MRI) and BIA using a conventional and new bioimpedance model. MRI-determined MV for leg and arm was 6,268 ± 1,099 and 1,173 ± 172 cm3, respectively. Estimated MV by the new BIA model [leg: 6,294 ± 1,155 cm3 (50 kHz), 6,278 ± 1,103 cm3 (500 kHz); arm: 1,216 ± 172 cm3 (50 kHz), 1,155 ± 157 cm3 (500 kHz)] was not statistically different from MRI-determined MV (leg: P= 0.958; arm: P= 0.188). The new BIA model was superior to conventional BIA and performed best at 500 kHz for estimating leg MV as indicated by the lower relative total error [new: 3.6% (500 kHz), 5.2% (50 kHz); conventional: 7.6% (500 kHz) and 8.3% (50 kHz)]. In contrast, the new BIA model, both at 50 and 500 kHz, did not improve the accuracy for estimating arm MV [new: 10.8% (500 kHz), 10.6% (50 kHz); conventional: 11.8% (500 kHz), 11.4% (50 kHz)]. It was concluded that modeling of multiple BIA measurements has advantages for the determination of lower limb muscle volume in healthy, active adult men.
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Affiliation(s)
- Alexander Stahn
- Department of Sport Science, Stellenbosch University, Private Bag X1, 7602 Stellenbosch, South Africa.
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Winocur E, Davidov I, Gazit E, Brosh T, Vardimon AD. Centric slide, bite force and muscle tenderness changes over 6 months following fixed orthodontic treatment. Angle Orthod 2007; 77:254-9. [PMID: 17319759 DOI: 10.2319/0003-3219(2007)077[0254:csbfam]2.0.co;2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2005] [Accepted: 04/01/2006] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The postorthodontic change of the masticatory muscles was evaluated using three parameters: maximal voluntary bite force (MVBF), slide in centric (difference between maximal intercuspation and retruded contact position), and muscle sensitivity to palpation. MATERIALS AND METHODS MVBF was measured with a custom-made rubber tube bite force device, centric slide with a digital caliper, and sensitivity to palpation of the masseter and temporalis muscles (scale 0-3) during application of standardized digital force (10 N). Data were collected at four time points: T0, before bracket removal; T1, immediately after bracket removal; T2, after 3 months of retention; and T3, after 6 months of retention. Patients (n = 41; 22 females, 19 males; mean age 17.4 +/- 5.4 years) were examined from T0 to T1 and from T1 to T2. Of these, 28 (15 females, 13 males) were followed at T3. RESULTS Immediately after bracket removal (T0 to T1), MVBF increased significantly by 15%. Another significant increase (15.5%) was found 3 months posttreatment (T1-T2), and almost no increase (2%) at 6 months (T2-T3). The slide in centric remained within normal values during the three time points. A decline in sensitivity to palpation from T1 to T3 was found for both masseter and temporalis muscles. CONCLUSIONS Neuromuscular adaptability begins within several minutes after bracket removal. A second stage of muscular adaptation occurs within 3 months of retention. These findings suggest that muscular adjustment occurs within a short period after orthodontic treatment.
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Affiliation(s)
- Ephraim Winocur
- Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Israel.
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Giannoglou GD, Chatzizisis YS, Misirli G. The syndrome of rhabdomyolysis: Pathophysiology and diagnosis. Eur J Intern Med 2007; 18:90-100. [PMID: 17338959 DOI: 10.1016/j.ejim.2006.09.020] [Citation(s) in RCA: 178] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2006] [Accepted: 09/26/2006] [Indexed: 12/18/2022]
Abstract
Rhabdomyolysis is defined as a pathological condition of skeletal muscle cell damage leading to the release of toxic intracellular material into the blood circulation. Its major causes include trauma, ischemia, drugs, toxins, metabolic disorders, and infections. The pathophysiological hallmark of the syndrome is an increase in intracellular free ionized calcium due to either cellular energy depletion, or direct plasma membrane rupture. The increased intracellular calcium activates several proteases, intensifies skeletal muscle cell contractility, induces mitochondrial dysfunction, and increases the production of reactive oxygen species, ultimately resulting in skeletal muscle cell death. Clinically, the syndrome presents with severe muscular pain, weakness and myoglobinuria. Increased myoglobin and creatine phosphokinase as a consequence of muscular cell death are the major laboratory findings, which, in combination with the clinical presentation, lead the clinician to the final diagnosis of the syndrome.
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Affiliation(s)
- George D Giannoglou
- AHEPA University Hospital, Aristotle University Medical School, 1 St. Kiriakidi Street, 54636, Thessaloniki, Greece
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Abstract
Bed rest is a commonly prescribed activity restriction among patients in the ICU. Although bed rest may promote rest, recovery and safety, inactivity related to bed rest also may lead to complications and adverse outcomes. The biological mechanisms that lead to immediate and long-term sequelae from bed rest have not been elucidated. It may be the inflammatory factors common to critical illness combined with bed rest lead to a positive feedback loop, contributing to inflammatory disequilibrium. This disequilibrium has a profound affect on muscles. Muscle decay has serious and long-term adverse outcomes on survivors of critical illness. Mobility therapy may improve inflammatory disequilibrium and preserve muscles, leading to improved functional outcome. Investigations in the laboratory, in healthy people and among patients with systemic inflammatory disease, suggest that activity does not exacerbate inflammation. Clinically, exercise is beneficial to patients with various chronic inflammatory diseases. Further study is needed to best understand the role, duration, and frequency of activity in promoting recovery for critically ill patients.
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Affiliation(s)
- Chris Winkelman
- Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA.
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Boonyarom O, Inui K. Atrophy and hypertrophy of skeletal muscles: structural and functional aspects. Acta Physiol (Oxf) 2006; 188:77-89. [PMID: 16948795 DOI: 10.1111/j.1748-1716.2006.01613.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This review summarizes current information on structural and functional changes that occur during muscle atrophy and hypertrophy. Most published studies consider an increase in total mass of a muscle as hypertrophy, whereas a decrease in total mass of a muscle is referred to as atrophy. In hypertrophy, the rate of synthesis is much higher than the rate of degradation of muscle contractile proteins, leading to an increase in the size or volume of an organ due to enlargement of existing cells. When a muscle remains in disuse for a long period, the rate of degradation of contractile proteins becomes greater than the rate of replacement, resulting in muscle atrophy. This defect may occur as a result of lack of nutrition, loss of nerve supply, micro-gravity, ageing, systemic disease, prolonged immobilization or disuse. An understanding of the specific modifications that occur during muscle atrophy and hypertrophy may facilitate the development of novel techniques, as well as new therapies for affected muscles.
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Affiliation(s)
- O Boonyarom
- Department of Physical Therapy, Naresuan University, Phitsanulok, Thailand.
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Abstract
Critically ill patients require sedation to reduce anxiety, agitation, and achieve therapeutic goals. Over-sedation in combination with multiple causes for extreme muscle weakness, however, interferes with recovery from critical illness. This article describes contributing factors and explores methods of preventing over-sedation and related sequelae.
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Affiliation(s)
- Jan Foster
- College of Nursing, Texas Woman's University, Houston, TX 77030, USA.
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Nieszkowska A, Combes A, Luyt CE, Ksibi H, Trouillet JL, Gibert C, Chastre J. Impact of tracheotomy on sedative administration, sedation level, and comfort of mechanically ventilated intensive care unit patients*. Crit Care Med 2005; 33:2527-33. [PMID: 16276177 DOI: 10.1097/01.ccm.0000186898.58709.aa] [Citation(s) in RCA: 172] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To assess the impact of tracheotomy on sedative administration, sedation level, and autonomy of mechanically-ventilated intensive care unit (ICU) patients. DESIGN, SETTING, AND PATIENTS In this observational study, the charts of all consecutive patients undergoing mechanical ventilation requiring tracheotomy over a 14-month period in our 18-bed tertiary care ICU were reviewed retrospectively. Patients' sedation levels (according to the Riker's 7-level sedation-agitation score) and intravenous (fentanyl and midazolam) and oral (clorazepate and haloperidol) sedative administration were measured daily during the 7 days before and after tracheotomy. We also recorded patients for whom chair positioning and oral alimentation became possible in the days following tracheotomy. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Tracheotomy was performed on 72 (23.1%) of the 312 patients undergoing mechanical ventilation for > or = 48 hrs. After tracheotomy, median (25th, 75th percentiles) fentanyl and midazolam administration decreased from 866 (191, 1672) to 71 (3, 426) microg/(patient.day) and from 44 (16, 128) to 7 (1, 42) mg/(patient.day) (p < .001), respectively. Concomitant median time spent heavily sedated decreased from 7 (3, 17) to 1 (0, 6) hrs/day (p < .001), with no increase in agitation time. During the 7 days following tracheotomy, partial oral alimentation became possible for 35 patients (48.6%) and out-of-bed positioning became possible for 16 patients (22.2%). CONCLUSION On the basis of these observations, we conclude that tracheotomized mechanically ventilated ICU patients required less intravenous sedative administration, spent less time heavily sedated, and achieved more autonomy earlier.
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Affiliation(s)
- Ania Nieszkowska
- Service de Réanimation Médicale, Hôpital Pitié-Salpêtrière, Paris, France
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Abstract
Although therapeutic activity prevents functional decline and reduces mortality, little is known about typical levels of activity among intensive care unit (ICU) patients. This report of a preliminary study describes typical therapeutic activity and compares the use of two measures of activity in a small sample of chronically critically ill adults. Type, frequency, and duration of therapeutic activity were measured simultaneously with direct observation and actigraphy. The only consistent activity documented was turning (frequency: 3 turns/8 hours; duration: mean average of 11 minutes). Analysis demonstrated acceptable agreement between the two measures of activity for both frequency and duration of therapeutic but not for type of activity. Congruence between measures for duration of activity was also supported. This study provides information for investigators and practitioners who are interested in measuring or implementing therapeutic activity in selected critically ill adults.
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Affiliation(s)
- Chris Winkelman
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA.
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Desaphy JF, Pierno S, Liantonio A, De Luca A, Didonna MP, Frigeri A, Nicchia GP, Svelto M, Camerino C, Zallone A, Camerino DC. Recovery of the soleus muscle after short- and long-term disuse induced by hindlimb unloading: effects on the electrical properties and myosin heavy chain profile. Neurobiol Dis 2005; 18:356-65. [PMID: 15686964 DOI: 10.1016/j.nbd.2004.09.016] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2004] [Revised: 09/18/2004] [Accepted: 09/29/2004] [Indexed: 11/22/2022] Open
Abstract
The hindlimb unloading (HU) rat is a model of muscle disuse characterized by atrophy and slow-to-fast phenotype transition of the postural muscles, such as the soleus. We previously found that the resting sarcolemmal chloride conductance (gCl) that is typically lower in slow-twitch myofibers than in fast ones increased in soleus fibers following 1 to 3 weeks of HU in accord with the slow-to-fast transition of myosin heavy chain (MHC) isoforms. Nevertheless, the gCl already raised after a 3-day HU, whereas no change in MHC expression was detected. The present work evaluates the ability of soleus muscle to recover on return to normal load after a short (3 days) or long (2 weeks) disuse period. The changes observed after a 2-week HU were slowly reversible, since 3-4 weeks of reloading were needed to completely recover gCl, fiber diameter, MHC expression pattern, as well as the mechanical threshold Rheobase, an index of calcium homeostasis. After 3-day HU, the gCl increased homogeneously in most of the soleus muscle fibers and gCl recovery was rapidly completed after 4-day reloading. These results suggest different induction mechanisms for gCl augmentation after the short and long HU periods, as well as a possible role for gCl in the slow muscle adaptation to disuse.
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Affiliation(s)
- Jean-François Desaphy
- Unit of Pharmacology, Department of Pharmaco-Biology, Faculty of Pharmacy, University of Bari, Bari, I-70125 Italy
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Liu MJ, Li JX, Lee KM, Qin L, Chan KM. Oxidative stress after muscle damage from immobilization and remobilization occurs locally and systemically. Clin Orthop Relat Res 2005:246-50. [PMID: 15864060 DOI: 10.1097/01.blo.0000150464.29883.ca] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Higher oxidative stress reportedly plays a key role in muscle damage caused by immobilization and subsequent remobilization. However, we have no clear understanding regarding oxidative stress during immobilization and remobilization. The purpose of this study was to clarify the characteristics of oxidative stress by measuring oxidative stress locally and systemically. Twenty-three New Zealand White rabbits were used in this study. Blood samples were collected on Days 1, 3, 7, 14, and 21 of immobilization, and Days 1, 2, 3, and 4 of remobilization. The soleus muscles in immobilized and nonimmobilized limbs were harvested on Day 21 of immobilization and Day 7 or Day 14 of remobilization. Muscle wet weight was determined as the indicator of muscle atrophy. The levels of lipid peroxidation and glutathione in plasma and soleus muscles were measured. Immobilization and remobilization induced an increase in the lipid peroxidation levels and a decrease in glutathione levels in muscle and blood. These findings suggest that oxidative stress occurs locally and systemically, lasts throughout the immobilization period, but peaks at the early phase of remobilization.
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Affiliation(s)
- Ming Ju Liu
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Hong Kong, China
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Abstract
Muscle dysfunction leads to activity intolerance, prolonged hospitalization, and additional days of mechanical ventilation. The etiology of muscle dysfunction in the critically ill patient is multifactoral. Inactivity and inflammation, common phenomena to patients in the intensive care unit, are associated with myopathy and muscle dysfunction. Cytokines are small biological active molecules that regulate inflammation and have a direct effect on muscle wasting. The purpose of this article is to describe selected cytokines (ie, interleukin-1, interleukin-6, interleukin-10, and tumor necrosis factor), explain their role in muscle dysfunction, and explore the role of therapeutic activity as a moderator of muscle dysfunction and cytokine-mediated muscle damage.
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Affiliation(s)
- Chris Winkelman
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, Ohio, USA.
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Sigmon HD, Varricchio C, Grady PA. Genetics and Beyond—Its Interface With Nursing Research. Res Theory Nurs Pract 2003; 17:363-9. [PMID: 14960002 DOI: 10.1891/rtnp.17.4.363.53197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Hilary D Sigmon
- Center for Scientific Review, Division of Biologic Basis of Disease, Bethesda, MD 20892, USA.
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