Efectos de un programa de ejercicio intradiálisis en pacientes con enfermedad renal crónica

El objetivo de este estudio fue comprobar el grado de cumplimiento y analizar el efecto de un programa intradiálisis de ejercicio físico sobre la condición física y salud del paciente con enfermedad renal crónica (ERC) que recibe hemodiálisis. Estudio de intervención con dos periodos de 14 semanas, uno sin intervención de ejercicio y otro con intervención, combinando trabajo de resistencia aeróbica y fuerza, en sesiones de 60 minutos, 3 días/semana. La condición física se evaluó a través de la capacidad de fuerza máxima de prensión manual, fuerza resistencia en extremidades inferiores y capacidad cardiorrespiratoria. El 62% de los pacientes cumplieron el 75% del programa. Durante el periodo sin ejercicio intradiálisis se observó una disminución significativa de la condición física, que se frenó durante el periodo con intervención de ejercicio. El programa de ejercicio intradiálisis es importante para frenar la pérdida de condición física ocasionada por la ERC.

The recycling endosome protein RAB-10 promotes autophagic flux and localization of the transmembrane protein ATG-9

Macroautophagy/autophagy involves the formation of an autophagosome, a double-membrane vesicle that delivers sequestered cytoplasmic cargo to lysosomes for degradation and recycling. Closely related, endocytosis mediates the sorting and transport of cargo throughout the cell, and both processes are important for cellular homeostasis. However, how endocytic proteins functionally intersect with autophagy is not clear. Mutations in the DAF-2/insulin-like IGF-1 (INSR) receptor at the permissive temperature result in a small increase in GFP::LGG-1 foci, i.e. autophagosomes, but a large increase at the nonpermissive temperature, allowing us to control the level of autophagy. In a RNAi screen for endocytic genes that alter the expression of GFP::LGG-1 in daf-2 mutants, we identified RAB-10, a small GTPase that regulates basolateral endocytosis. Loss of rab-10 in daf-2 mutants results in more GFP::LGG-1-positive foci at the permissive, but less GFP::LGG-1 or SQST-1::GFP foci at the nonpermissive temperature. As previously reported, loss of rab-10 alone resulted in an increase of GFP:LGG-1 foci. Exposure of rab-10 mutant animals to chloroquine, a known inhibitor of autophagic flux, failed to increase the number of GFP::LGG-1 foci. Moreover, colocalization between LMP-1::tagRFP and GFP::LGG-1 (the lysosome and autophagosome reporters) was decreased in daf-2; rab-10 dauers at the nonpermissive temperature. Intriguingly, RAB-10 was required to maintain the normal size of GFP::ATG-9-positive structures in daf-2 mutants at both the permissive and nonpermissive temperature. Finally, we found that RAB-10 GTPase cycling was required to control the size of GFP::ATG-9 foci. Collectively, our data support a model where rab-10 controls autophagic flux by regulating autophagosome formation and maturation.

Physical Activity Is Associated with Attention Capacity in Adolescents

OBJECTIVE

To assess the relationships among physical activity, measured objectively, and attention capacity in European adolescents.

STUDY DESIGN

The study included 273 adolescents, aged 12.5-17.5 years, who participated in the Healthy Lifestyle in Europe by Nutrition in Adolescence Study. Participants wore a uniaxial accelerometer for 7 days to measure physical activity. The d2 Test of Attention was administered to assess attention capacity. Multivariate analyses were used to study the association of attention capacity with each measure of physical activity. Receiver operating characteristic analysis was performed to determine thresholds that best discriminate between low and good attention capacity.

RESULTS

After controlling for potential confounding variables (age, sex, body mass index, parental educational level, fat mass, aerobic fitness, and center), adolescents' attention capacity test performances were significantly and positively associated with longer time spent in moderate or moderate-to-vigorous physical activity (MVPA) in free-living conditions (P < .05). Receiver operating characteristic curve analyses revealed that the physical activity thresholds that best discriminated between low/good attention capacities were ≥41 min·day(-1) for moderate, ≥12 min·day(-1) for vigorous, and ≥58 min·day(-1) for MVPA.

CONCLUSION

These findings suggest that promoting MVPA may be have a beneficial effect on attention capacity, an important component of cognition, in adolescents.

Higher levels of physical fitness are associated with a reduced risk of suffering sarcopenic obesity and better perceived health among the elderly: the EXERNET multi-center study

OBJECTIVE

To evaluate the associations between physical fitness levels, health related quality of life (HRQoL) and sarcopenic obesity (SO) and to analyze the usefulness of several physical fitness tests as a screening tool for detecting elderly people with an increased risk of suffering SO.

DESIGN

Cross-sectional analysis of a population-based sample.

SETTING

Non-institutionalized Spanish elderly participating in the EXERNET multi-centre study.

PARTICIPANTS

2747 elderly subjects aged 65 and older.

MEASUREMENTS

Body weight, height and body mass index were evaluated in each subject. Body composition was measured by bioelectrical impedance. Four SO groups were created based on percentage of body fat and relative muscle mass; 1) normal group, 2) sarcopenic group, 3) obesity group and 4) SO group. Physical fitness was evaluated using 8 tests (balance, lower and upper body strength, lower and upper body flexibility, agility, walking speed and aerobic capacity). Three tertiles were created for each test based on the calculated scores. HRQoL was assessed using the EuroQol visual analogue scale.

RESULTS

Participants with SO showed lower physical fitness levels compared with normal subjects. Better balance, agility, and aerobic capacity were associated to a lower risk of suffering SO in the fittest men (odds ratio < 0.30). In women, better balance, walking speed, and aerobic capacity were associated to a lower risk of suffering SO in the fittest women (odds ratio < 0.21) Superior perceived health was associated with better physical fitness performance.

CONCLUSIONS

Higher levels of physical fitness were associated with a reduced risk of suffering SO and better perceived health among elderly. SO elderly people have lower physical functional levels than healthy counterparts.

Sedentarism, active lifestyle and sport: Impact on health and obesity prevention

The benefits of regular physical activity have been known since ancient Greek. But in the last Century the scientific knowledge around this topic has progressed enormously, starting with the early studies of JN Morris and RS Paffenberger, who demonstrated that physical activity at work reduced incidence of cardiovascular disease and mortality. In the Harvard alumni study, the lowest risk was associated with a weekly output of 1000 to 2000 kcal performing vigorous activities. Further studies in all age groups have supported these findings and have added that even moderate levels of physical activity provide considerable benefits to health, including lower prevalence of overweight and obesity at all ages. Metabolic fat oxidation rate is highest at exercise intensities between 45 and 65% of VO2max. This means that people must be active regularly and force physiological mechanisms at certain intensities. All this body of evidence has contributed to current WHO physical activity recommendations of 150 min/week of moderate to vigorous physical activity (MVPA) in adults and elderly, and 60 min/day of MVPA in children and adolescents, with additional strength training, apart from adopting an active lifestyle. In the last 50 years, occupational physical activity has been reduced for about 120 kcal/day, and sedentarism has emerged as an additional risk factor to physical inactivity. Even if less than 60 min of TV time in adults have been related to lower average BMI, there is still a need for research to determine the appropriate dose of exercise in combination with sedentary behaviours and other activities in the context of our modern lifestyle in order to prevent obesity at all ages. As public health measures have failed to stop the obesity epidemic in the last 3 decades, there is clearly a need to change the paradigm. The inclusion of sport scientists, physical education teachers and other professionals in the multidisciplinary team which should be responsible for drawing the road map to prevent the increase of the obesity epidemic effectively is a "must" from our point of view.

Physical strength is associated with Mini-Mental State Examination scores in Spanish institutionalized elderly

AIM

The present cross-sectional study aimed at assessing muscle strength of hands, the dominant arm and legs in Spanish institutionalized elderly people according to sex, age and cognitive status.

METHODS

A total of 153 elderly subjects (102 females, 51 males, mean age 83.6 ± 6.8 years) living in the region of Madrid were measured for handgrip strength (kg) with a Takei TKK 5101 digital dynamometer (range 5-100 kg, precision 0.1 kg), and arm and leg endurance strength (repetitions) according to the Rikli and Jones tests. Cognitive status was determined with the Mini-Mental State Examination (MMSE).

RESULTS

The values for men and women were, respectively: 23.5 ± 7.3 kg and 11.6 ± 4.6 kg (right handgrip), 22.0 ± 7.8 kg and 10.7 ± 4.8 kg (left handgrip), 13 ± 5 and 10 ± 5 repetitions (arm strength), 8 ± 5 and 5 ± 4 repetitions (legs strength), and 21 ± 6 and 17 ± 7 (MMSE score). All parameters were significantly higher for men (P ≤ 0.01), but strength decline with age was less pronounced in women. In all MMSE groups, lower strength was associated with lower cognitive status.

CONCLUSIONS

Strength values were lower in older subjects in both sexes; this difference was higher in men than in women. Higher strength values were associated with better cognitive status, which was the most influencing variable, even more than sex and age.

Exercise dose and diabetes risk in overweight and obese children: a randomized controlled trial

CONTEXT

Pediatric studies have shown that aerobic exercise reduces metabolic risk, but dose-response information is not available.

OBJECTIVES

To test the effect of different doses of aerobic training on insulin resistance, fatness, visceral fat, and fitness in overweight, sedentary children and to test moderation by sex and race.

DESIGN, SETTING, AND PARTICIPANTS

Randomized controlled efficacy trial conducted from 2003 through 2007 in which 222 overweight or obese sedentary children (mean age, 9.4 years; 42% male; 58% black) were recruited from 15 public schools in the Augusta, Georgia, area.

INTERVENTION

Children were randomly assigned to low-dose (20 min/d; n = 71) or high-dose (40 min/d; n = 73) aerobic training (5 d/wk; mean duration, 13 [SD, 1.6] weeks) or a control condition (usual physical activity; n = 78).

MAIN OUTCOME MEASURES

The prespecified primary outcomes were postintervention type 2 diabetes risk assessed by insulin area under the curve (AUC) from an oral glucose tolerance test, aerobic fitness (peak oxygen consumption [VO2]), percent body fat via dual-energy x-ray absorptiometry, and visceral fat via magnetic resonance, analyzed by intention to treat.

RESULTS

The study had 94% retention (n = 209). Most children (85%) were obese. At baseline, mean body mass index was 26 (SD, 4.4). Reductions in insulin AUC were larger in the high-dose group (adjusted mean difference, -3.56 [95% CI, -6.26 to -0.85] × 10(3) μU/mL; P = .01) and the low-dose group (adjusted mean difference, -2.96 [95% CI, -5.69 to -0.22] × 10(3) μU/mL; P = .03) than the control group. Dose-response trends were also observed for body fat (adjusted mean difference, -1.4% [95% CI, -2.2% to -0.7%]; P < .001 and -0.8% [95% CI, -1.6% to -0.07%]; P = .03) and visceral fat (adjusted mean difference, -3.9 cm3 [95% CI, -6.0 to -1.7 cm3]; P < .001 and -2.8 cm3 [95% CI, -4.9 to -0.6 cm3]; P = .01) in the high- and low-dose vs control groups, respectively. Effects in the high- and low-dose groups vs control were similar for fitness (adjusted mean difference in peak VO2, 2.4 [95% CI, 0.4-4.5] mL/kg/min; P = .02 and 2.4 [95% CI, 0.3-4.5] mL/kg/min; P = .03, respectively). High- vs low-dose group effects were similar for these outcomes. There was no moderation by sex or race.

CONCLUSION

In this trial, after 13 weeks, 20 or 40 min/d of aerobic training improved fitness and demonstrated dose-response benefits for insulin resistance and general and visceral adiposity in sedentary overweight or obese children, regardless of sex or race.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00108901.

[Polymedication in institutionalized elderly and its effect on vitamin B12, folate, and homocysteine levels]

AIM

To determine drug consumption in institutionalized elderly living in the Region of Madrid (Spain) and to assess the relationship between drug intake and biochemical parameters for vitamin B12 (Cobalamin and Holotranscobalamin), serum folate (SF) and homocysteine (Hcy).

METHODS

167 subjects (32% men), mean age 83 ± 7 years, were classified according to biochemical parameter levels (in or out of reference range) and drugs were classified according to ATC system. The relationship between drug intake and biochemical levels was studied by means of the Fisher exact test.

RESULTS

The daily mean drug intake was 5. Psicoleptic and antiacid drugs were the most consumed (both 53%). Cobalamin (median 158.2 pg/mL; 10.7% of individuals), SF (5.3 ng/mL; 52.1%) and holotranscobalamin (11.76 pmoL/L; 7.8%) deficiencies were observed. Hyperhomocysteinaemia (19.4 μmoL/L) was present in 65% of population. Antiaenemic drug intake normalized cobalamin, urologic drug and corticosteroids SF and psicoanaleptics holotranscobalamin levels. Drugs against pulmonar obstruction increased Hcy concentration (all p < 0.05).

CONCLUSION

There is a high prevalence of SF deficiency and hyperhomocysteinaemia in the studied population. The elevated number of drugs taken simultaneously by each subject makes it difficult to analyze which drugs are responsible for those alterations.

Prevalence of sensitization to lipid transfer proteins and profilins in a population of 430 patients in the south of Madrid

BACKGROUND

Lipid transfer proteins (LTPs) and profilins are the most important panallergens in the management of patients who are allergic to pollen and plant food in our area. LTPs are highly stable proteins that can induce systemic symptoms after ingestion. Profilins are labile proteins that are present in pollens and vegetables. Considered markers of several types of pollen sensitization, they are responsible for cross-reactivity between pollens and vegetables. The objective of this study was to assess the frequency of sensitization to LTP and profilin using skin prick tests (SPTs) in patients referred to our allergy unit for any complaint (not only pollen and plant food allergy).

METHODS

The study sample comprised 430 consecutive patients who were evaluated using their medical history and SPTs with pollen, date palm profilin, and peach extract enriched in Pru p 3 (30 g/mL) as an LTP marker.

RESULTS

We found that 52 (12.1%) patients were sensitized to profilin and 53 (12.3%) to LTP. Pollen allergy was diagnosed in 53% and plant food allergy in 11%. In the LTP-sensitized group and the profilin-sensitized group, 37.7% and 34.6% of the patients had plant food allergy, respectively. Thirty-three patients (62.3%) were sensitized to LTP but had no symptoms after eating vegetables.

CONCLUSIONS

To the best of our knowledge, this is the first study to analyze the real rate of sensitization to profilin and LTP in a population sensitized to allergens other than pollens and plant foods. Twelve percent of patients were sensitized to both profilin and LTP. A large proportion of LTP-sensitized patients had no symptoms at the time of the study.

The "healthy lifestyle guide pyramid" for children and adolescents

INTRODUCTION

Increasing evidence demonstrates that risk factors for chronic diseases are established during childhood and adolescence. Consensus about the need to increase prevention efforts makes the adoption of a healthy lifestyle seem desirable from early childhood onwards. After reviewing educational tools for children and adolescents aimed at promoting a healthy lifestyle, it was recognized that there was a need to develop a simple educational tool specifically designed for these age groups.

METHODS

Development of the healthy lifestyle pyramid for children and adolescents.

RESULTS

We propose a three-dimensional, truncated and staggered pyramid with 4 faces and a base, which introduces a completely new concept that goes beyond other published pyramids. Each of the faces is oriented towards achieving a different goal. Two faces (faces 1 and 2) are formulated around achieving a goal on a daily basis (daily food intake, face 1, and daily activities, face 2). Face 3 is an adaptation of the traditional food guide pyramid, adapted to children's energy, nutritional and hydration needs. Face 4 deals with both daily and life-long habits. On the base of the pyramid, there is advice about adequate nutrition alternating with advice about physical activity and sports.

CONCLUSION

The Healthy Lifestyle Pyramid is specifically developed for children and adolescents according to current scientific knowledge and evidence-based data and includes easy-to-follow advice and full colour pictures. Following these guidelines should improve health and reduce risk factors, promoting enjoyable and appropriate development towards adulthood.

Caenorhabditis elegans lin-13, a member of the LIN-35 Rb class of genes involved in vulval development, encodes a protein with zinc fingers and an LXCXE motif

The SynMuv genes appear to be involved in providing a signal that inhibits vulval precursor cells from adopting vulval fates in Caenorhabditis elegans. One group of SynMuv genes, termed class B, includes genes encoding proteins related to the tumor suppressor Rb and RbAp48, a protein that binds Rb. Here, we provide genetic evidence that lin-13 behaves as a class B SynMuv gene. We show that null alleles of lin-13 are temperature sensitive and maternally rescued, resulting in phenotypes ranging in severity from L2 arrest (when both maternal and zygotic activities are removed at 25 degrees ), to sterile Multivulva (when only zygotic activity is removed at 25 degrees ), to sterile non-Multivulva (when both maternal and zygotic activities are removed at 15 degrees ), to wild-type/class B SynMuv (when only zygotic activity is removed at 15 degrees ). We also show that LIN-13 is a nuclear protein that contains multiple zinc fingers and a motif, LXCXE, that has been implicated in Rb binding. These results together suggest a role for LIN-13 in Rb-mediated repression of vulval fates.

[Anesthetic management in unilateral lung transplantation]

OBJECTIVE

To describe and evaluate anesthetic treatment during single lung transplantation (SLT).

PATIENTS AND METHODS

This is a retrospective study of patients undergoing SLT during one year of our program's operation. We describe the surgical technique and method of anesthesia, which consisted in combined general and epidural anesthesia. Systemic and pulmonary arterial pressures, heart rate, arterial and mixed venous oxygen saturation were monitored throughout the procedure, along with inspired and expired gases and airway pressure. The following parameters were recorded for the various phases of surgery: cardiac index (CI), right ventricular ejection fraction (REF) and systemic and pulmonary vascular resistances, arterial and mixed venous blood gas readings.

RESULTS

Eight SLT were performed during the study period and the survival rate was 100%. PaCO2 and pulmonary artery pressure increased at the start of ventilation of a single lung. These values increased again when the pulmonary artery was clamped. During this period, however, CI and REF held steady and venous oxygen saturation decreased only slightly. Cardiopulmonary bypass was therefore never used. The variables returned to normal upon revascularization of the new lung.

CONCLUSIONS

In spite of the small series studied, the excellent results obtained lead us to conclude that our method is appropriate and that SLT is a valid therapeutic alternative for our patients.

Activity, expression and function of a second Drosophila protein kinase A catalytic subunit gene

The DC2 gene was isolated previously on the basis of sequence similarity to DC0, the major Drosophila protein kinase A (PKA) catalytic subunit gene. We show here that the 67-kD Drosophila DC2 protein behaves as a PKA catalytic subunit in vitro. DC2 is transcribed in mesodermal anlagen of early embryos. This expression depends on dorsal but on neither twist nor snail activity. DC2 transcriptional fusions mimic this embryonic expression and are also expressed in subsets of cells in the optic lamina, wing disc and leg discs of third instar larvae. A saturation screen of a small deficiency interval containing DC2 for recessive lethal mutations yielded no DC2 alleles. We therefore isolated new deficiencies to generate deficiency trans-heterozygotes that lacked DC2 activity. These animals were viable and fertile. The absence of DC2 did not affect the viability or phenotype of imaginal disc cells lacking DC0 activity or embryonic hatching of animals with reduced DC0 activity. Furthermore, transgenes expressing DC2 from a DC0 promoter did not efficiently rescue a variety of DC0 mutant phenotypes. These observations indicate that DC2 is not an essential gene and is unlikely to be functionally redundant with DC0, which has multiple unique functions during development.

[Effect of nutrition on the functional capacity of a group of elderly Spaniards]

The present study analyzes the influence of the nutritional status on the functional capability of 11 institutionalized elderly living in Madrid (Spain). Nutritional status was evaluated by dietetic, anthropometric, hematological and biochemical data and functional status was evaluated considering adiposity, strength in hands and legs bent and stretched and flexibility. The most important nutritional problems that conditional functional wastages are obesity, hypercholesterolemia and protein and micronutrient deficiency. The adverse influence of obesity and hypercholesterolemia on the functional capacity of the elderly is shown by the inverse relationship between flexibility and strength in hands and legs with the adiposity degree, with the thickness of skin folds and the cholesterolemia. In reference to the diet's influence, there are positive correlations between food intake and most of the nutrients with hand and legs strength, and there are statistical significances for proteins, iron, zinc, magnesium and pyridoxine, and also for vitamin C, niacin, thiamin, folic acid and vitamin E. For blood values, the mayor correlation exists between functional parameters and iron, ferritin and vitamin C levels. Our results contribute to confirm the influence of nutrition on the functional capacity of the influence of nutrition on the functional capacity of the elderly and manifest the necessity of improving the elderly's diet, to prevent micronutrient deficiency and also the necessity of increasing their physical activity. Both measures will mean an important help for sanitary and functional improvement of the elderly.