Handgrip strength and respiratory disease mortality: Longitudinal analyses from SHARE

BACKGROUND

While the association between handgrip strength and all-cause mortality is more deeply explored, no previous studies have been specifically focused on handgrip strength and respiratory disease mortality. The purpose of the study was to investigate the association between handgrip strength and respiratory disease mortality in a large representative sample.

METHODS

Individuals aged 50 or over from 27 European countries and Israel participated in this longitudinal study. Data on handgrip strength and all-cause and respiratory disease mortality were retrieved from the Survey of Health, Ageing and Retirement in Europe (SHARE) waves 1, 2, 4, 5, 6 and 7. We estimated the sub hazard ratios (SHRs) for respiratory disease mortality using a Fine-Gray sub-distribution method with both time-varying exposure and covariates and mortality due to other causes as competing risk. Furthermore, we assessed dose-response associations of handgrip strength (modelled as a continuous exposure) with respiratory disease mortality using restricted cubic splines and estimated hazard ratios (HRs).

RESULTS

We included 60,883 men and 74,904 women with a mean age of 63.6 (SD 9.7) years at study entry. During a median (interquartile range) of 7.4 years of follow-up 565 (0.4%) participants died due to respiratory diseases. The increase of 1 single kg of handgrip strength showed a 6% incidence reduction on respiratory disease mortality (SHR, 0.94; 95%CI, 0.92-0.96) after adjusting for potential confounders. Furthermore, each kg increase of handgrip strength reduced respiratory disease mortality risk in a dose-response fashion and a significant threshold for values of 41 kg (HR, 0.49; 95%CI, 0.26-0.92) and higher was identified.

CONCLUSIONS

Higher handgrip strength is associated with lower mortality due to respiratory disease. Intervention studies are needed to determine whether strength training in respiratory disease patients can prevent premature mortality.

Are Moderate and Vigorous Leisure-Time Physical Activity Associated With Musculoskeletal Pain? A Cross-Sectional Study Among 981 Physical Therapists

PURPOSE

Musculoskeletal pain (MP) is common among workers, especially for health-care professionals. Paradoxically, many of those rehabilitating patients for pain-that is, physical therapists (PTs)-also have pain. Adequate levels of physical activity are recommended for cardiovascular and musculoskeletal health. However, the association between physical activity and MP among PTs remains unknown. This study aims to determine the association between moderate and vigorous leisure-time physical activity levels and MP in PTs.

DESIGN

Cross-sectional study.

SETTING

Workplace.

PARTICIPANTS

Nine hundred eighty-one PTs.

MEASURES

Data on MP and leisure-time physical activity were collected using an online survey.

ANALYSIS

The odds for having lower level of MP as a function of physical activity were estimated using binary logistic regression controlled for various confounders.

RESULTS

Performing ≥75 min/week of vigorous leisure-time physical activity increased the odds of experiencing lower levels of neck-shoulder pain (odds ratio = 1.43, 95% confidence interval, 1.05-1.94). No association was found neither between vigorous nor between moderate leisure-time physical activity and MP in the arm-hand or back.

CONCLUSION

Performing ≥75 min/week of vigorous leisure-time physical activity is associated with lower levels of MP in neck and shoulders among PTs. No associations were found between vigorous or moderate leisure-time physical activity and MP in arm-hand and back.

[Analysis of left ventricular diastolic function using magnetic resonance imaging]

Heart failure is not always due to an alteration in systolic function, and a diastolic dysfunction could explain many cases of heart failure with a normal systolic function. Diastolic function depends on the left ventricular filling capacity to ensure a normal stroke volume. It is routinely measured with transthoracic echocardiography, as it is an easily accessible non-invasive test. The MRI, using flow sequences, shows good agreement with the echocardiography, analysing the diastolic function in a practical way, by the flow into the mitral valve and pulmonary veins. In this sense, the analysis of diastolic function should be added as part of a routine cardiac MR examination.

[Analysis of left ventricular diastolic function using magnetic resonance imaging]

Heart failure is not always due to an alteration in systolic function, and a diastolic dysfunction could explain many cases of heart failure with a normal systolic function. Diastolic function depends on the left ventricular filling capacity to ensure a normal stroke volume. It is routinely measured with transthoracic echocardiography, as it is an easily accessible non-invasive test. The MRI, using flow sequences, shows good agreement with the echocardiography, analysing the diastolic function in a practical way, by the flow into the mitral valve and pulmonary veins. In this sense, the analysis of diastolic function should be added as part of a routine cardiac MR examination.

Nodular pulmonary amyloidosis in a patient with rheumatoid arthritis

We describe a 67-year-old white woman with a long-standing active rheumatoid arthritis who refused treatment. Chest roentgenograms performed in 2000 revealed a pulmonary nodule in the mid-left lung. Progression of the nodule was followed annually by computerized tomography (CT). In the last CT in 2002, we observed multiple nodules in both lungs in the absence of lymph gland involvement. The patient was operated by video-thoracoscopy to resect one of the pulmonary nodules. Pathological examination of the excised tissue revealed amyloid A-type (AA) amyloidosis. Although pulmonary amyloidosis is rare in patients with systemic AA amyloidosis, we recommend that this possibility be considered when confronted with a patient with these characteristics.

Non heart beating donors. Succesfully expanding the donor's pool

OBJECTIVES

Expand the donors pool is one of the most hastening problems among transplant coordination teams all over the world. Our Hospital outlined thirteen years ago a specific policy to increase donors pool with non-heart-beating-donors program.

METHODS

We have developed an specific program, called "code 9" to get donors from "previously healthy" people who die of sudden or unexpected death. Madrid has one of the best emergency medical services all over the world, with response time under eight minutes, and being able to perform all kind of advanced life support maneuvers in situ and during transfer to hospital.

RESULTS

From 1989 we have reported the goodness of the program and the excellence of the organs transplanted. In Madrid, one of the most active communities in Spain in organ donors procurement, 33% of donors comes from this program. Organs and tissues obtained are of same or better quality than those obtained from encephalic death donors.

CONCLUSIONS

Non-heart beating programs are a good option to increase donors pool.

Perforation of the sigmoid colon in a rheumatoid arthritis patient treated with methylprednisolone pulses

We describe a 61 year-old caucasian male diagnosed with rheumatoid arthritis. He was started on methylprednisolone pulses because of a severe flare of symmetric polyarthritis while he was on weekly intramuscular methotrexate and low-dose oral prednisone. After the second pulse of methylprednisolone the patient suddenly developed severe abdominal pain with free air under the right hemidiaphragm in the chest roentgenogram. The emergency surgery revealed the perforation of a colonic diverticulum. We suggest that methylprednisolone pulses should be carefully used in those patients over 50 years of age and/or people with demonstrated or suspected diverticular disease.

A randomized double-blind clinical trial on the effectiveness of helium-neon laser in the prevention of pain, swelling and trismus after removal of impacted third molars

The effect of helium-neon (He-Ne) laser on the prevention of pain, swelling and trismus following the removal of an impacted third molar was studied in 100 patients randomly allocated to receive He-Ne laser, ibuprofen or placebo in a prospective double-blind parallel clinical trial. Trismus was significantly reduced in the He-Ne laser and ibuprofen treatment groups. Pain was significantly less in the ibuprofen group with regard to He-Ne laser and placebo groups. Swelling was the same in the three treatment groups.

Beta-N-acetylglucosaminidase from Aspergillus nidulans which degrades chitin oligomers during autolysis

A hexosaminidase from autolyzed cultures of Aspergillus nidulans was purified 196 fold and characterized as a beta-N-acetylglucosaminidase (EC 3.2.1.30). The enzyme has a MW of 190000, a pI of 4.3, and optimum pH of 5.0 and is unstable at temperatures above 50 degrees C. The enzyme is a glycoprotein with 19.5% sugars, mannose being the principal component. It binds strongly to chitin. The enzyme hydrolyzes different substrates. The Ki with the competitive inhibitor 2-acetamido-2-deoxy-D-gluconolactone was independent of the substrate used. The enzyme was inhibited by Hg2+, Ag+, acetate and other organic anions. The kinetics of hydrolysis of chitin oligosaccharides from 2 to 6 units was studied by HPLC. This enzyme is an exoenzyme which degraded chitin oligomers gradually with the production of N-acetylglucosamine. The hydrolysis of N-N'-diacetylchitobiose was inhibited non-competitively by glucosamine and N-acetylglucosamine. In mixtures of chitin oligosaccharides, the hydrolysis of chitobiose was competitively inhibited by each of the other oligomers.

Endochitinase from Aspergillus nidulans implicated in the autolysis of its cell wall

An endochitinase from centrifuged autolyzed cultures of Aspergillus nidulans has been purified 100 times. The enzyme has Mw 27,000, pI of 4.8 units, pH optimum around 5 pH units. It is unstable at temperature greater than 70 degrees C and does not have a cation requirement. It is inhibited by Hg2+, Cu2+, Ca2+ and Ag+ and it does not have muramidase activity. The enzyme depolymerizes chitin rapidly with production of high molecular weight polysaccharides, and then slowly degrades these with production of N,N'-diacetylchitobiose. The enzyme hydrolyzes N,N',N''-triacetylchitotriose with production of N,N'-diacetylchitobiose and N-acetylglucosamine and this hydrolysis is inhibited by other chitin oligomers and N-acetylglucosamine. This enzyme hydrolyzes in the same way the chitin obtained from the cell wall of Aspergillus nidulans.

[Review of clindamycin]

Clindamycin use in dental infections is reviewed in this article. A broad spectrum against most strains associated to odontostomatological pathology (caries, pulp and periodontal infections) is emphasized, as soon as the high levels in gingival fluid, bone and saliva with clindamycin obtained.