Clinical mutations in the TERT and TERC genes coding for telomerase components induced oxidative stress, DNA damage at telomeres and cell apoptosis besides decreased telomerase activity

Telomeres are nucleoprotein structures at the end of chromosomes that maintain their integrity. Mutations in genes coding for proteins involved in telomere protection and elongation produce diseases such as dyskeratosis congenita or idiopathic pulmonary fibrosis known as telomeropathies. These diseases are characterized by premature telomere shortening, increased DNA damage and oxidative stress. Genetic diagnosis of telomeropathy patients has identified mutations in the genes TERT and TERC coding for telomerase components but the functional consequences of many of these mutations still have to be experimentally demonstrated. The activity of twelve TERT and five TERC mutants, five of them identified in Spanish patients, has been analyzed. TERT and TERC mutants were expressed in VA-13 human cells that express low telomerase levels and the activity induced was analyzed. The production of reactive oxygen species, DNA oxidation and TRF2 association at telomeres, DNA damage response and cell apoptosis were determined. Most mutations presented decreased telomerase activity, as compared to wild-type TERT and TERC. In addition, the expression of several TERT and TERC mutants induced oxidative stress, DNA oxidation, DNA damage, decreased recruitment of the shelterin component TRF2 to telomeres and increased apoptosis. These observations might indicate that the increase in DNA damage and oxidative stress observed in cells from telomeropathy patients is dependent on their TERT or TERC mutations. Therefore, analysis of the effect of TERT and TERC mutations of unknown function on DNA damage and oxidative stress could be of great utility to determine the possible pathogenicity of these variants.

Psychological factors are associated with pain extent in patients with carpal tunnel syndrome

INTRODUCTION

Widespread pain may be related to psychosocial aspects in several musculoskeletal conditions, but the literature on carpal tunnel syndrome (CTS) is scarce.

OBJECTIVE

To determine the relationship between pain extent and psychological factors (catastrophizing, kinesiophobia, anxiety symptoms, and depression) in people with CTS.

METHODS

A cross-sectional study was conducted. The independent variables were: pain intensity, disability (QuickDASH), duration of symptoms, anxiety and depressive symptoms, catastrophizing, and kinesiophobia. The main outcome was: pain extent (% of total area and categories "pain within the median nerve-innervated territory" versus "extra-median nerve pain"). Correlation analysis was performed using Spearman's correlation coefficient. A linear regression model and binary logistic regression (both with forward selection) were performed to determine the main predictors of pain extent.

RESULTS

Forty-eight participants were included. A moderate positive correlation was found between catastrophizing (r = 0.455; p = 0.024) and disability (r = 0.448; p = 0.024) with total pain extent area. Regression models indicated that catastrophizing explained 22% of the variance in the pain extent (β = 0.003; 95% CI: 0.002-0.005), while kinesiophobia was the variable that best explained the distribution of pain in the extra-median territory (R2 Nagelkerke = 0.182). Null or weak correlations were found for the rest of the associations.

CONCLUSION

Catastrophizing and kinesiophobia were the main indicators of pain extent in people with CTS. Clinicians are advised to use specific questionnaires to check for the presence of catastrophizing or kinesiophobia in people with CTS and wider pain extension.

Pain Control Beliefs Predict Premature Withdrawal From the Labor Market in Workers With Persistent Pain: Prospective Cohort Study With 11-Year Register Follow-up

While a range of work-related psychosocial factors has been associated with various pain disorders and early retirement, less is known about pain cognitions and their influence on premature exit from the labor market. Therefore, as a primary objective, this study investigates associations between pain control beliefs and risk of disability pension among Danish eldercare workers. In 2005, 2257 female eldercare workers with low-back and/or neck/shoulder pain>90 days within the previous 12 months, replied to a survey and were followed for 11 years in a national register of social transfer payments. Using Cox regression, we estimated the risk of disability pension during follow-up from experiencing different levels of "pain control" and "pain influence," controlling for pain intensity and other relevant confounders. In the fully adjusted model for pain control with "high" as reference, hazard ratios of 1.30 (95% CI 1.03-1.64) and 2.09 (95% CI 1.45-3.01) are observed for "moderate" and "low," respectively, while the metric of pain influence shows hazard ratios of 1.43 (95% CI 1.11-1.87) and 2.10 (1.53-2.89), respectively. Pain control beliefs are associated with disability pension among eldercare workers with persistent pain. These results highlight the importance of evaluating not only bodily manifestations of pain, but also individual pain-related cognitions that may influence the experience of pain. PERSPECTIVE: This article addresses the complex experience of pain within an organizational context. We introduce the metrics of "pain control" and "pain influence" among workers with persistent pain, showing that the psychometric properties of these measures are prospectively associated with premature exit from the labor market.

Effects of resistance training on patients with End-Stage Renal Disease: an umbrella review with meta-analysis of the pooled findings

OBJECTIVES

This umbrella review aimed to review the effects of resistance training on patients with end-stage renal disease and assess the methodological quality of the available literature.

METHODS

An umbrella review and meta-meta-analysis was performed. A systematic search was conducted until May 2022. Article selection, quality assessment, and risk of bias assessment were performed by two independent reviewers. The meta-meta-analyses were performed with a random-effects model and the summary statistics were presented in the form of a forest plot with a weighted compilation of all standardized mean differences and corresponding 95% confidence interval. Twenty-four reviews were eventually included. The protocol was registered in the international registry PROSPERO (CRD42022321702).

RESULTS

Resistance training showed positive effects on functional capacity (g = 0.614), aerobic capacity (g = 0.587), health-related quality of life (g = 0.429), and peak force (g = 0.621). Fifteen of the included studies (63%) presented low risk of bias, and the remaining studies (37%) showed unclear risk of bias.

CONCLUSION

Resistance training in patients undergoing hemodialysis is an intervention that shows positive results regarding physical and functional outcomes. The quality level of the literature is inconclusive, but the included studies present low risk of bias.

Dynamic balance and explosive strength appears to better explain single leg hop test results among young elite female basketball athletes

To analyze the impact of balance, lower-limb explosive strength and anthropometric variables on the result of the hop test in young elite female basketball athletes. Ninety young elite female basketball athletes (13-17 years), without current or recent lower-limb injury, were assessed in the off-season period of July 2021. Single leg hop test, countermovement jump, Y balance test and anthropometric outcomes were assessed. A correlation study and a regression model were performed to investigate the influence of such outcomes and the value of their participation on the hop test results. It was found a low-to-moderate correlation effect size for both countermovement jump (distance and power flight) and Y balance test values (except interlimb outcomes) with the single leg hop test results. Anthropometric outcomes did not show significant correlation (p > 0.05). Regression model revealed that for right hop test, countermovement jump values exhibited an adjusted determination coefficient of 0.408, (β = 0.249, p = 0.013), For left hop test, again the countermovement jump values (β = 0.229, p = 0.025), and left Y balance test values (β = 0.331, p = 0.011) jointly obtained an adjusted determination coefficient of 0.263 significant predictive value for countermovement jump outcomes in both right (β = 0.249, p = 0.013; β = 0.301; p = 0.031) and left leg (β = 0.229, p = 0.025; β = 0.365, p = 0.040), as well as certain Y balance outcomes values. Explosive strength, and dynamic balance although to a lesser extent, appear to be the most relevant physical-functional factors influencing the single leg hop test results among young elite female basketball athletes. These findings may a serve as a basis to implement targeted interventions, such as plyometric and balance training, for an enhancement on functional rehabilitation and reducing the risk of injury related to the hop test results.

Duration and intensity of occupational lifting and risk of long-term sickness absence: Prospective cohort study with register follow-up among 45 000 workers

OBJECTIVE

This study aimed to investigate the prospective association of lifting duration and lifting load with the risk of long-term sickness absence (LTSA).

METHODS

We followed manual workers with occupational lifting (N=45 346) from the Work Environment and Health in Denmark Study (2012-2018) for two years in a high-quality national register on social transfer payments (DREAM). Cox regressions with model-assisted weights were employed to estimate the risk of LTSA from lifting duration and loads.

RESULTS

During follow-up, 9.6% of the workers had an episode of LTSA. Compared to workers with seldom lifting (reference), workers lifting ½ and ¾ of the workday had increased risk of LTSA [hazard ratios (HR) of 1.36 [95% confidence interval (CI) 1.20-1.56] and 1.22 (95% CI 1.07-1.39)], respectively. Lifting load showed a positive exposure-response association with LTSA (trend test, P<0.01), with HR for lifting 5-15, 16-29, and ≥30 kg at 1.11 (95% CI 1.02-1.22), 1.17 (95% CI 1.03-1.34), and 1.29 (95% CI 1.11-1.50), respectively. Age-stratified analyses showed increased risk of LTSA among workers ≥50 years with a high proportion of work-related lifting compared to their younger counterparts.

CONCLUSIONS

Occupational lifting for ½ the workday increased the risk of LTSA, while higher occupational lifting load exacerbated this risk in an exposure-response manner. The study underscores the importance of reducing both lifting duration and loads for prevention of LTSA at the workplace, especially among older workers.

Neuromuscular and acute symptoms responses to progressive elastic resistance exercise in patients with chronic obstructive pulmonary disease: Cross-sectional study

Background

Quadriceps muscle training is a key part in the rehabilitation of chronic obstructive pulmonary disease (COPD) patients. However, exercise intensity prescription and progression with the typically used elastic bands is challenging. We aimed to evaluate neuromuscular, acute symptoms and cardiorespiratory responses (heart rate and dyspnea) during progressive elastic resistance exercise in patients with COPD.

Methods

Fourteen patients diagnosed with moderate-very severe COPD performed knee extensions at different elastic resistance levels (i.e., colors). The neuromuscular activity was recorded using surface electromyography for the rectus femoris, vastus lateralis and vastus medialis, together with rate of perceived exertion, perceived quadriceps fatigue, dyspnea, oxygen saturation and heart rate.

Results

For the vastus lateralis and rectus femoris, increase of muscle activity was evident from a two-level increment when using the red color. For the vastus medialis, there were no muscle activity progressions. Dyspnea, quadriceps fatigue and especially rate of perceived exertion increased in a dose-response fashion and were correlated with the resistance level and muscle activity at the three muscles.

Conclusion

Heavy elastic resistance exercise is feasible in COPD patients without excessive dyspnea and a stable cardiorespiratory response. In general, at least two elastic resistance increments are needed to enhance muscle activity for the vastus lateralis and rectus femoris, while there is no increase for the vastus medialis. These results may help to individualize exercise dosing during elastic resistance training in patients with COPD.

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.

Musculoskeletal pain intensity in different body regions and risk of disability pension among female eldercare workers: prospective cohort study with 11-year register follow-up

Background

Musculoskeletal pain is a risk factor for leaving the labour market temporarily and permanently. While the presence of multi-site pain increases the risk of disability pension, we lack detailed knowledge about pain intensity as a risk factor. This study investigated the association between musculoskeletal pain intensity in different body regions and risk of future disability pension among eldercare workers.

Methods

Eight thousand seven hundred thirty-one female eldercare workers replied to a questionnaire on work and health in 2005 and were followed for 11 years in the Danish Register for Evaluation of Marginalization. Time-to-event analyses estimated hazard ratios (HR) for disability pension from pain intensities (0–9 numeric rating scale (NRS)) in the low-back, neck/shoulders, and knees during the previous 3 months. Analyses were mutually adjusted for pain regions, age, education, lifestyle, psychosocial work factors, and physical exertion at work.

Results

During 11-year follow-up, 1035 (11.9%) of the eldercare workers received disability pension. For all body regions among all eldercare workers, dose-response associations were observed between higher pain intensity and risk of disability pension (p < 0.001). The risk for disability pension was increased when reporting “very high” pain levels (≥7 points on the 0–9 NRS) in the low-back (HR 2.19, 95% CI 1.70–2.82), neck/shoulders (HR 2.34, 95% CI 1.88–2.92), and knees (HR 1.89, 95% CI 1.44–2.47). Population attributable risks (PAR) were 15.5, 23.2, and 9.6% for pain > 2 on NRS in the low-back, neck/shoulders, and knees, respectively, indicating that 15.5, 23.2, and 9.6% fewer eldercare workers would likely receive disability pension if the pain intensity was reduced to 2 or less. For workers ≤45 years and > 45 years, PAR was highest for neck/shoulder pain (27.6%) and low-back pain (18.8%), respectively.

Conclusions

The present study found positive dose-response associations between pain intensity in the low-back, neck/shoulders, and knees, and risk of disability pension during 11-year follow-up. Moderate to very high levels of musculoskeletal pain in eldercare workers should, therefore, be considered an early warning sign of involuntary premature exit from the labour market. These findings underscore the importance of preventing, managing, and reducing musculoskeletal pain to ensure a long and healthy working life.

Quality Analysis of YouTube Videos Presenting Shoulder Exercises after Breast Cancer Surgery

<b><i>Background:</i></b> The prolonged immobilization suggested after breast cancer (BC) surgery causes morbidity. Patients search the Internet, especially social networks, for recommended exercises. <b><i>Objective:</i></b> The aim of this observational study was to assess the quality of YouTube videos, accessible for any patient, about exercises after BC surgery. <b><i>Methods:</i></b> A systematic search was performed on YouTube. One hundred and fifty videos were selected and analyzed. Two statistical analyses were conducted based on machine-learning techniques. Videos were classified as “Relevant” and “Non-Relevant” using principal component analysis models. Popularity was evaluated by Video Power Index (VPI), informational quality and accuracy were measured using the DISCERN Scale and Global Quality Scale (GQS). Scoring criteria for exercises were established according to the exercises recommended by the Oncology Section of the American Physical Therapy Association (APTA). Interobserver agreement and individual correlations were statistically examined. <b><i>Results:</i></b> DISCERN scored a mean of 50.97 (standard deviation [SD] 19.19). HONcode scored 78.30 (11.02) and GQS scored 3.49 (0.74). Average number of views was 53,963 (SD 67,376), mean duration was 9:42 min (9:15), mean days online was 2,158 (922), mean view ratio was 27.14 (30.24), mean likes was 245 (320.5), mean dislikes was 13.4 (14.2), and mean VPI was 93.48 (5.42). <b><i>Conclusion:</i></b> The quality of YouTube videos of recommended exercises post-BC surgery is high and can be a translational activity to improve patients’ behavior. Health institutions and NGOs, with higher popularity levels than academic institutions, should consider this information when implementing new policies focused on video quality which can contribute to adaptive behavior in patients.

Is hard physical work in the early working life associated with back pain later in life? A cross-sectional study among 5700 older workers

OBJECTIVES

Physically demanding work increases the risk of developing musculoskeletal disorders during working life, with low back pain (LBP) as the most prevalent and debilitating musculoskeletal disorder worldwide. However, a lack of knowledge exists about the role of early working years on musculoskeletal health later in life. This study investigated whether an exposure-response association exists between physical demands in early working life and risk of LBP in later working life.

DESIGN

Cross-sectional study.

SETTING, PARTICIPANTS AND OUTCOME MEASURE

In the SeniorWorkingLife study, 5909 wage earners aged ≥50 years with currently sedentary work replied to a questionnaire survey in 2018 about physical work demands during their first working years (exposure) and current LBP (outcome). Associations between physical work demands in the early working years and current LBP were modelled using general linear models controlling for various confounders, combined with model-assisted weights based on national registers.

RESULTS

Hard physical work during early working life was associated with more intense LBP later in life among senior workers with currently sedentary jobs. In the fully adjusted model, workers with 'standing/walking work with lifting/carrying' and 'heavy or fast work that is physically strenuous' during the first years of working life reported higher LBP intensity than those with sedentary work during their first working years (0.2 (95% CI, 0.0 to 0.4) and 0.6 (95% CI, 0.4 to 0.9), respectively).

CONCLUSION

Work involving lifting/carrying or work that is physically strenuous in early life is associated with higher intensity of LBP among older workers with currently sedentary employment. These findings suggest that early working life may have an impact on later working years and underscore the necessity for careful introduction and instruction to the working environment for retaining musculoskeletal health and prolonging working life.

TRIAL REGISTRATION NUMBER

NCT03634410.

Hand strengthening exercises in chronic stroke patients: Dose-response evaluation using electromyography

STUDY DESIGN

Cross-sectional.

PURPOSE OF THE STUDY

This study evaluates finger flexion and extension strengthening exercises using elastic resistance in chronic stroke patients.

METHODS

Eighteen stroke patients (mean age: 56.8 ± 7.6 years) with hemiparesis performed 3 consecutive repetitions of finger flexion and extension, using 3 different elastic resistance levels (easy, moderate, and hard). Surface electromyography was recorded from the flexor digitorum superficialis (FDS) and extensor digitorum (ED) muscles and normalized to the maximal electromyography of the non-paretic arm.

RESULTS

Maximal grip strength was 39.2 (standard deviation: 12.5) and 7.8 kg (standard deviation: 9.4) in the nonparetic and paretic hand, respectively. For the paretic hand, muscle activity was higher during finger flexion exercise than during finger extension exercise for both ED (30% [95% confidence interval {CI}: 19-40] vs 15% [95% CI: 5-25] and FDS (37% [95% CI: 27-48] vs 24% [95% CI: 13-35]). For the musculature of both the FDS and ED, no dose-response association was observed for resistance and muscle activity during the flexion exercise (P > .05).

CONCLUSION

The finger flexion exercise showed higher muscle activity in both the flexor and extensor musculature of the forearm than the finger extension exercise. Furthermore, greater resistance did not result in higher muscle activity during the finger flexion exercise. The present results suggest that the finger flexion exercise should be the preferred strengthening exercise to achieve high levels of muscle activity in both flexor and extensor forearm muscles in chronic stroke patients. The finger extension exercise may be performed with emphasis on improving neuromuscular control.

LEVEL OF EVIDENCE

4b.

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.

Association of Stress and Musculoskeletal Pain With Poor Sleep: Cross-Sectional Study Among 3,600 Hospital Workers

Background: While acute stress and pain are part of our inherent survival mechanisms, persistent stress and pain can negatively impact health and well-being. This may also lead to poor sleep and thus a lack of recovery. This study investigated the influence of stress and musculoskeletal pain on sleep quality. Methods: A total of 3,593 Danish hospital workers replied to a questionnaire about work and health. Pain intensity was evaluated using subjective values as an average of 9 body parts. Stress was assessed using the full version of Cohen's Perceived Stress scale. Sleep quality was rated using 3 questions on sleep characteristics. Associations between stress and pain (mutually adjusted predictors) and sleep (outcome) were modeled using binary logistic regression controlling for gender, age, education, BMI and smoking. Results: The risk ratio of moderate stress (compared to no/low stress) on poor sleep was 1.27 (CI 1.26-1.29), whereas the risk ratio of high stress on poor sleep was 1.87 (CI 1.83-1.91). Similarly, for pain, the risk ratio of moderate pain (compared to no/low pain) on poor sleep was 1.18 (95% CI 1.16-1.19), whereas the risk ratio of a high pain score on poor sleep was 1.48 (95% CI 1.44-1.52). Conclusion: This study demonstrates that both stress and musculoskeletal pain are associated with poor sleep among hospital workers. Hospital management should consider implementing strategies for preventing stress and musculoskeletal pain to improve the overall health and workability among hospital workers.

Attentional Focus and Grip Width Influences on Bench Press Resistance Training

This study evaluated the influence of different attentional foci for varied grip widths in the bench press. Eighteen resistance-trained men were familiarized with the procedure and performed a one-repetition maximum (1RM) test during Session 1. In Session 2, they used three different standardized grip widths (100%, 150%, and 200% of biacromial width distance) in random order at 50% of 1RM while also engaged in three different attention focus conditions (external focus on the bench press, internal focus on pectoralis major muscles, and internal focus on triceps brachii muscles). Surface electromyography (EMG) signals were recorded from the triceps brachii and pectoralis major, and peak EMG of the filtered signals were normalized to maximum EMG of each muscle. Both grip width and focus influenced the muscle activity level, but there were no significant interactions between these variables. Exploratory analyses suggested that an internal focus may slightly (4%-6%) increase pectoralis major activity at wider grip widths and triceps brachii activity at narrower grip widths, but this should be confirmed or rejected in a study with a larger sample size or through a meta-analysis of research to date.

Combined resistance and endurance training at a moderate-to-high intensity improves physical condition and quality of life in liver transplant patients

Although currently moderate and high intensity concurrent physical exercise is prescribed in populations with special needs due to its greater effect on physical condition and health-related quality of life (HRQOL), there are no data in the liver transplantation (LT) setting. The aim of this study is to evaluate changes in maximal strength, aerobic capacity, body composition, liver function, and HRQOL in LT patients after a moderate-to-high intensity combined resistance-endurance training. Six months after LT, 54 patients were randomized into 2 groups: intervention group (IG) and control group (CG). A total of 50 patients completed the study with repeat testing at 6 and 12 months after LT. The IG completed a 6-month exercise training program, consisting of exercising 2 days for 24 weeks in the hospital facilities, whereas the CG followed usual care recommendations. Patients completed a 5-multijoint exercise circuit with elastic bands involving the major muscle groups. The effects of the concurrent training program on maximal oxygen consumption, overall and regional maximal strength, body composition, liver function, and HRQOL were analyzed. The IG showed a significant improvement (P < 0.05) in outcome measurements compared with the CG in aerobic capacity, hip extension, elbow flexion, overall maximal strength, physical functioning, and vitality of HRQOL, whereas no changes were observed in body composition and liver function tests. In conclusion, this is the first study that combines supervised resistance and aerobic training performed at moderate-to-high intensity in LT recipients. It results in significant improvements in aerobic capacity, maximal strength, and HRQOL. Liver Transplantation 23 1273-1281 2017 AASLD.

High-intensity preoperative training improves physical and functional recovery in the early post-operative periods after total knee arthroplasty: a randomized controlled trial

PURPOSE

The benefits of preoperative training programmes compared with alternative treatment are unclear. The purpose of this study was to evaluate the effectiveness of a high-intensity preoperative resistance training programme in patients waiting for total knee arthroplasty (TKA).

METHODS

Forty-four subjects (7 men, 37 women) scheduled for unilateral TKA for osteoarthritis (OA) during 2014 participated in this randomized controlled trial. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Physical Functioning Scale of the Short Form-36 questionnaire (SF-36), a 10-cm visual analogue scale (VAS), isometric knee flexion, isometric knee extension, isometric hip abduction, active knee range of motion and functional tasks (Timed Up and Go test and Stair ascent-descent test) were assessed at 8 weeks before surgery (T1), after 8 weeks of training (T2), 1 month after TKA (T3) and finally 3 months after TKA (T4). The intervention group completed an 8-week training programme 3 days per week prior to surgery.

RESULTS

Isometric knee flexion, isometric hip abduction, VAS, WOMAC, ROM extension and flexion and all the functional assessments were greater for the intervention group at T2, T3 and T4, whereas isometric knee extension was greater for this group at T2 and T4 compared with control.

CONCLUSION

The present study supports the use of preoperative training in end-stage OA patients to improve early postoperative outcomes. High-intensity strength training during the preoperative period reduces pain and improves lower limb muscle strength, ROM and functional task performance before surgery, resulting in a reduced length of stay at the hospital and a faster physical and functional recovery after TKA. The present training programme can be used by specialists to speed up recovery after TKA.

LEVEL OF EVIDENCE

I.

Trunk muscle activity during different variations of the supine plank exercise

BACKGROUND

Exercises providing neuromuscular challenges of the spinal muscles are desired for core stability, which is important for workers with heavy manual labour as well as people recovering from back pain.

PURPOSE

This study evaluated whether using a suspended modality increases trunk muscle activity during unilateral or bilateral isometric supine planks.

DESIGN

Cross-sectional.

METHODS

Twenty university students participated in this cross-sectional study. Each subject performed four different conditions: bilateral stable supine plank, unilateral stable supine plank, bilateral suspended supine plank and unilateral suspended supine plank. Surface electromyography (EMG) signals were recorded for the upper rectus abdominis (UP ABS), lower rectus abdominis (LOW ABS), external oblique (OBLIQ) and lumbar erector spinae (LUMB). Peak EMG of the filtered signals were normalized to the maximum voluntary isometric contraction (MVIC).

RESULTS

No differences between exercises were found for UP ABS, LOW ABS and OBLIQ muscle activity. The unilateral suspended supine plank provided the highest LUMB activity (20% of MVIC) whiles the bilateral stable supine plank provided the lowest activity (11% of MVIC).

CONCLUSIONS

The combination of unilateral variations with a suspended support provides the greatest LUMB muscle activity, while using these variations separately only provides advantages when compared with regular planks.

Bench press and push-up at comparable levels of muscle activity results in similar strength gains

Electromyography (EMG) exercise evaluation is commonly used to measure the intensity of muscle contraction. Although researchers assume that biomechanically comparable resistance exercises with similar high EMG levels will produce similar strength gains over the long term, no studies have actually corroborated this hypothesis. This study evaluated EMG levels during 6 repetition maximum (6RM) bench press and push-up, and subsequently performed a 5-week training period where subjects were randomly divided into 3 groups (i.e., 6RM bench press group, 6RM elastic band push-up group, or control group) to evaluate muscle strength gains. Thirty university students with advanced resistance training experience participated in the 2-part study. During the training period, exercises were performed using the same loads and variables that were used during the EMG data collection. At baseline, EMG amplitude showed no significant difference between 6RM bench press and band push-up. Significant differences among the groups were found for percent change (Δ) between pretest and posttest for 6RM (p = 0.017) and for 1 repetition maximum (1RM) (p < 0.001). Six repetition maximum bench press group and 6RM elastic band push-up group improved their 1RM and 6RM (Δ ranging from 13.65 to 22.21) tests significantly with similar gains, whereas control group remains unchanged. Thus, when the EMG values are comparable and the same conditions are reproduced, the aforementioned exercises can provide similar muscle strength gains.

CORE MUSCLE ACTIVITY DURING THE CLEAN AND JERK LIFT WITH BARBELL VERSUS SANDBAGS AND WATER BAGS

PURPOSE/BACKGROUND

While the traditional clean and jerk maneuver implies simultaneous participation of a large number of muscle groups, the use of this exercise with some variations to enhance core muscle activity remains uninvestigated. The purpose of this study was to compare the muscle activity during clean and jerk lift when performed with a barbell, sandbag and a water bag at same absolute load.

STUDY DESIGN

Descriptive, repeated-measures study.

METHODS

Twenty-one young fit male university students (age: 25 ± 2.66 years; height: 180.71 ± 5.42 cm; body mass: 80.32 ± 9.8 kg; body fat percentage: 12.41 ± 3.56 %) participated. Surface electromyographic (EMG) signals were recorded from the anterior deltoid (AD), external oblique (OBLIQ), lumbar erector spinae (LUMB), and gluteus medius (GM) and were expressed as a percentage of the maximum voluntary isometric contraction (MVIC).

RESULTS

There were no significantly significant differences for AD muscle activity between conditions, whereas muscle activation values for OBLIQ (60%MVIC), GM (29%MVIC) and LUMB (85%MVIC) were significantly higher during the water bag power clean and jerk maneuver when compared with the other conditions.

CONCLUSIONS

The clean and jerk is an exercise that may be used to enhance core muscle activity. Performing the maneuver with water bags resulted in higher core muscle activity compared with sandbag and standard barbell versions.

LEVEL OF EVIDENCE

3.

Core Muscle Activity, Exercise Preference, and Perceived Exertion during Core Exercise with Elastic Resistance versus Machine

Objectives. To investigate core muscle activity, exercise preferences, and perceived exertion during two selected core exercises performed with elastic resistance versus a conventional training machine. Methods. 17 untrained men aged 26-67 years participated in surface electromyography (EMG) measurements of five core muscles during torso-twists performed from left to right with elastic resistance and in the machine, respectively. The order of the exercises was randomized and each exercise consisted of 3 repetitions performed at a 10 RM load. EMG amplitude was normalized (nEMG) to maximum voluntary isometric contraction (MVC). Results. A higher right erector spinae activity in the elastic exercise compared with the machine exercise (50% [95% CI 36-64] versus 32% [95% CI 18-46] nEMG) was found. By contrast, the machine exercise, compared with the elastic exercise, showed higher left external oblique activity (77% [95% CI 64-90] versus 54% [95% CI 40-67] nEMG). For the rectus abdominis, right external oblique, and left erector spinae muscles there were no significant differences. Furthermore, 76% preferred the torso-twist with elastic resistance over the machine exercise. Perceived exertion (Borg CR10) was not significantly different between machine (5.8 [95% CI 4.88-6.72]) and elastic exercise (5.7 [95% CI 4.81-6.59]). Conclusion. Torso-twists using elastic resistance showed higher activity of the erector spinae, whereas torso-twist in the machine resulted in higher activity of the external oblique. For the remaining core muscles the two training modalities induced similar muscular activation. In spite of similar perceived exertion the majority of the participants preferred the exercise using elastic resistance.

Muscle activation during push-ups performed under stable and unstable conditions

Background/Objective

The purpose of this study was to analyze muscle activation when performing push-ups under different stability conditions.

Methods

Physically fit young male university students (N = 30) performed five push-ups under stable conditions (on the floor) and using four unstable devices (wobble board, stability disc, fitness dome, and the TRX Suspension Trainer). The push-up speed was controlled using a metronome, and the testing order was randomized. The average amplitudes of the electromyographic (EMG) root mean square of the anterior deltoid (DELT), serratus anterior (SERRA), lumbar multifidus (LUMB), and rectus femoris (FEM) were recorded. The electromyographic signals were normalized to the maximum voluntary isometric contraction (MVIC).

Results

No significant differences were found for the DELT [F(4,112) = 1.978; p = 0.130] among the conditions. However, statistically significant differences were found among the different conditions for the SERRA [F(4,60) = 17.649; p < 0.001], LUMB [F(4,76) = 12.334; p < 0.001], and FEM [F(4,104) = 24.676; p < 0.001] muscle activation. The suspended device was the only condition that elicited higher LUMB and FEM activation compared to the other conditions. Push-ups performed on the floor showed lower SERRA activation than those performed with all unstable devices.

Conclusion

Not all unstable devices enhance muscle activation compared to traditional push-ups.

Dose-response association between leisure time physical activity and work ability: Cross-sectional study among 3000 workers

INTRODUCTION

Regular physical activity is important for longevity and health, but knowledge about the optimal dose of physical activity for maintaining good work ability is unknown. This study investigates the association between intensity and duration of physical activity during leisure time and work ability in relation to physical demands of the job.

METHODS

From the 2010 round of the Danish Work Environment Cohort Study, currently employed wage earners with physically demanding work (n = 2952) replied to questions about work, lifestyle and health. Excellent (100 points), very good (75 points), good (50 points), fair (25 points) and poor (0 points) work ability in relation to the physical demands of the job was experienced by 18%, 40%, 30%, 10% and 2% of the respondents, respectively.

RESULTS

General linear models that controlled for gender, age, physical and psychosocial work factors, lifestyle and chronic disease showed that the duration of high-intensity physical activity during leisure was positively associated with work ability, in a dose-response fashion (p < 0.001). Those performing ⩾ 5 hours of high-intensity physical activity per week had on average 8 points higher work ability than those not performing such activities. The duration of low-intensity leisure-time physical activity was not associated with work ability (p = 0.5668).

CONCLUSIONS

The duration of high-intensity physical activity during leisure time is associated in a dose-response fashion with work ability, in workers with physically demanding jobs.

Core muscle activity in a series of balance exercises with different stability conditions

Literature that provides progression models based on core muscle activity and postural manipulations is scarce. The purpose of this study was to investigate the core muscle activity in a series of balance exercises with different stability levels and additional elastic resistance. A descriptive study of electromyography (EMG) was performed with forty-four healthy subjects that completed 12 exercises in a random order. Exercises were performed unipedally or bipedally with or without elastic tubing as resistance on various unstable (uncontrolled multiaxial and uniaxial movement) and stable surfaces. Surface EMG on the lumbar multífidus spinae (LM), thoracic multífidus spinae (TM), lumbar erector spinae (LE), thoracic erector spinae (TE) and gluteus maximus (GM), on the dominant side of the body were collected to quantify the amount of muscle activity and were expressed as a % of the maximum voluntary isometric contraction (MVIC). Significant differences (p<.001) were found between exercises. The three unipedal standing exercises with additional elastic resistance generated the greatest EMG values, ranging from 19% MVIC to 30% MVIC. Postural manipulations with additional elastic resistance and/or unstable devices increase core muscle activity. An adequate exercise progression based on global core EMG could start with seated positions, progressing to bipedal standing stance (i.e., from either multiaxial or stable surface to uniaxial surface). Following this, unipedal standing positions may be performed (i.e., from either multiaxial or stable surface to uniaxial surface) and finally, elastic resistance must be added in order to increase EMG levels (i.e., from stable surface progressing to any of the used unstable surfaces).

The validity and reliability of a new instrumented device for measuring ankle dorsiflexion range of motion

PURPOSE/BACKGROUND

A restriction in ankle dorsiflexion range of motion (ROM) has been linked to several clinical manifestations such as metatarsalgia, heel pain, nerve entrapment, ankle joint equinus, patellar and ankle injuries. The purpose of the present study was to examine the validity and reliability of the Leg Motion system for measuring ankle dorsiflexion ROM.

STUDY DESIGN

Descriptive repeated-measures study.

METHODS

Twenty-six healthy male university students were recruited to test the reliability of the Leg Motion system, which is a portable tool used for assessment of ankle dorsiflexion during the weight-bearing lunge test. The participants were tested two times separated by two weeks and measurements were performed at the same time of the day by the same single rater. To test the validity of the Leg Motion system, other maximal ankle dorsiflexion ROM assessments (goniometer, inclinometer and measuring tape) were measured in a single session (i.e., the first test session) during the weight-bearing lunge position using a standard goniometer, a digital inclinometer and a measuring tape measure with the ability to measure to the nearest 0.1 cm.

RESULTS

Paired t-tests showed the absence of significant differences between right and left limb measurements of dorsiflexion in all tests. Mean values ± standard deviations were as follows: Leg Motion test (left 11.6cm±3.9; right 11.9cm ±4.0), tape measure (left 11.6cm±4.0; right 11.8cm±4.2), goniometer (left 40.6º±5.2; right 40.6º±5.2), and digital inclinometer (left 40.0º±5.8; right 39.9º±5.6). The Leg Motion composite values (i.e., average of the two legs) showed a significant (p<0.05) positive correlation with the tape measure (r=0.99), with the goniometer (r=0.66), and with the digital inclinometer (r=0.72).

CONCLUSIONS

The results of the present study provide evidence to support the use of the Leg Motion system as a valid, portable, and easy to use alternative to the weight-bearing lunge test to assess ankle dorsiflexion ROM in healthy participants.

LEVEL OF EVIDENCE

2b.

Construct and concurrent validation of a new resistance intensity scale for exercise with thera-band® elastic bands

The construct and concurrent validity of the Thera-Band Perceived Exertion Scale for Resistance Exercise with elastic bands (EB) was examined. Twenty subjects performed two separate sets of 15 repetitions of both frontal and lateral raise exercise over two sessions. The criterion variables were myoelectric activity and heart rate. One set was performed with an elastic band grip width that permitted 15 maximum repetitions in the selected exercise, and another set was performed with a grip width 50% more than the 15RM grip. Following the final repetition of each set, active muscle (AM) and overall body (O) ratings of perceived exertion (RPE) were collected from the Thera-Band® resistance exercise scale and the OMNI-Resistance Exercise Scale of perceived exertion with Thera-Band® resistance bands (OMNI-RES EB). Construct validity was established by correlating the RPE from the OMNI-RES EB with the Thera-Band RPE scale using regression analysis. The results showed significant differences (p ≤ 0.05) in myoelectric activity, heart rate, and RPE scores between the low- and high-intensity sets. The intraclass correlation coefficient for active muscles and overall RPE scale scores was 0.67 and 0.58, respectively. There was a positive linear relationship between the RPE from the OMNI-RES EB and the Thera-Band scale. Validity coefficients for the RPE AM were r(2) = 0.87 and ranged from r(2) = 0.76 to 0.85 for the RPE O. Therefore, the Thera-Band Perceived Exertion Scale for Resistance Exercise can be used for monitoring elastic band exercise intensity. This would allow the training dosage to be better controlled within and between sessions. Moreover, the construct and concurrent validity indicates that the OMNI-RES EB measures similar properties of exertion as the Thera-Band RPE scale during elastic resistance exercise. Key pointsThis new resistance intensity scale is an appropriate and valid tool for assessing perceived exertion during strength training with elastic bands.This scale can be used without reducing the accuracy of the dosage prescribed during training/rehabilitation sessions and while carrying out medium and/or long-term periodization programs or therapeutic interventions.Populations with specific physical or physiological needs could have access to an easy-to-use resource that allows them to carry out their training/rehabilitation programs with greater efficacy and without any risk to health.

Test-retest reliability of the Star Excursion Balance Test in primary school children

BACKGROUND

Dynamic balance has been considered a fundamental skill at all ages and is required for normal daily tasks, such as walking, running, or other sports activities. The Star Excursion Balance Test (SEBT) has been widely used in recent years to identify dynamic balance deficits and improvements and to predict the risk of lower extremity injury. However, no study has demonstrated the reliability of the SEBT in children while they are performing the test in a physical education session. Reliability is needed in all measurement tools in order to provide repeatable and consistent data.

OBJECTIVE

To evaluate the reliability of the SEBT in primary school students in the school setting.

METHODS

Twenty-four healthy children with typical development were tested twice, 2 weeks apart. The tests were conducted by the same single rater and were performed during the physical education class. The test was performed under standardized conditions during the 2 testing sessions and was performed by each subject with both limbs in the 3 directions (anterior, posteromedial, and posterolateral). Four practice trials were performed in each direction before selecting 3 additional distances reached. The best value of these 3 additional measured trials was selected. The paired t test was used to ensure the absence of any systematic bias. Intraclass correlation coefficient, standard error of measurement, 95% confidence intervals (CIs), and minimal change values were calculated to assess reliability and measurement error.

RESULTS

The paired t tests revealed no significant differences between test-rest scores. Test-retest reliability for all distances reached was moderate to good.

CONCLUSIONS

Reliability values suggest that the SEBT is suitable for primary school students. However, it may be more practical and feasible during extracurricular sports participation due to the time constraints and difficulties in using the test in the school setting.

Muscle activity levels in upper-body push exercises with different loads and stability conditions

BACKGROUND

Exercises that aim to stimulate muscular hypertrophy and increase neural drive to the muscle fibers should be used during rehabilitation. Thus, it is of interest to identify optimal exercises that efficiently achieve high muscle activation levels.

OBJECTIVE

The purpose of this study was to compare the muscle activation levels during push-up variations (ie, suspended push-ups with/without visual input on different suspension systems, and push-ups on the floor with/without additional elastic resistance) with the bench press exercise and the standing cable press exercise both performed at 50%, 70%, and 85% of the 1-repetition maximum.

METHODS

Young fit male university students (N = 29) performed 3 repetitions in all conditions under the same standardized procedures. Average amplitude of the electromyogram (EMG) root mean square for the rectus abdominis, external oblique, sternocostal head of the pectoralis major, anterior deltoid, long head of the triceps brachii, upper trapezius, anterior serratus, and posterior deltoid was recorded. The EMG signals were normalized to the maximum voluntary isometric contraction. The EMG data were analyzed with repeated-measures analysis of variance with a Bonferroni post hoc.

RESULTS AND CONCLUSIONS

Elastic-resisted push-ups induce similar EMG stimulus in the prime movers as the bench press at high loads while also providing a greater core challenge. Suspended push-ups are a highly effective way to stimulate abdominal muscles. Pectoralis major, anterior deltoid, and anterior serratus are highly elicited during more stable pushing conditions, whereas abdominal muscles, triceps brachii, posterior deltoid, and upper trapezius are affected in the opposite manner.

Muscle Activation during Push-Ups with Different Suspension Training Systems

The purpose of this study was to analyze upper extremity and core muscle activation when performing push-ups with different suspension devices. Young fit male university students (n = 29) performed 3 push-ups each with 4 different suspension systems. Push-up speed was controlled using a metronome and testing order was randomized. Average amplitude of the electromyographic root mean square of Triceps Brachii, Upper Trapezius, Anterior Deltoid, Clavicular Pectoralis, Rectus Abdominis, Rectus Femoris, and Lumbar Erector Spinae was recorded. Electromyographic signals were normalized to the maximum voluntary isometric contraction (MVIC). Electromyographic data were analyzed with repeated-measures analysis of variance with a Bonferroni post hoc. Based upon global arithmetic mean of all muscles analyzed, the suspended push-up with a pulley system provided the greatest activity (37.76% of MVIC; p < 0.001). Individually, the suspended push-up with a pulley system also provided the greatest triceps brachii, upper trapezius, rectus femoris and erector lumbar spinae muscle activation. In contrast, more stable conditions seem more appropriate for pectoralis major and anterior deltoid muscles. Independent of the type of design, all suspension systems were especially effective training tools for reaching high levels of rectus abdominis activation. Key PointsCompared with standard push-ups on the floor, suspended push-ups increase core muscle activation.A one-anchor system with a pulley is the best option to increase TRICEP, TRAPS, LUMB and FEM muscle activity.More stable conditions such as the standard push-up or a parallel band system provide greater increases in DELT and PEC muscle activation.A suspended push-up is an effective method to achieve high muscle activity levels in the ABS.

Exercise and ankle sprain injuries: a comprehensive review

Ankle sprains are common in team sports and sports played on courts, and often result in structural and functional alterations that lead to a greater reinjury risk. Specific exercises are often used to promote neuromuscular improvements in the prevention and rehabilitation of ankle injuries. This literature review summarizes the neuromuscular characteristics of common ankle sprains and the effectiveness of exercise as an intervention for improving neuromuscular function and preventing reinjury. Our review found that appropriate exercise prescription can increase static and dynamic balance and decrease injury recurrence. In particular, the addition of dynamic activities in the exercise program can be beneficial because of the anticipatory postural adjustments identified as a key factor in the injury mechanism.

Relationship of immunohistochemical biomarker expression and lymph node involvement in patients undergoing surgical treatment of NSCLC with long-term follow-up

We try to identify the relationship between immunohistochemical marker expression and lymph node involvement in a cohort of 282 patients followed for 5 years after curative resection for NSCLC. In 189 patients (67%), lymph nodes were unaffected while 93 patients (33%) showed nodal involvement. The expression of 15 molecular markers was determined from each patient by tissue-array immunohistochemistry. Univariate analysis indicated significantly higher expression of E-cadherin, γ-catenin, p27, and p53 in patients with lymph node involvement. In those with unaffected nodes, p16 and Rb were expressed. E-cadherin expression was related to a 50% mortality reduction in patients with node involvement (hazard ratio (HR) 0.5; p = 0.017). c-erbB-2 expression was correlated with a 3.4-fold increase in mortality compared to patients without expression of this marker in subjects without node involvement (HR 3.41; p = 0.017). Multivariate analysis identified c-erbB-2 (HR 2.22; p = 0.089) and p27 (HR 1.44; p = 0.019) as prognostics of mortality while Rb (HR 0.74) indicated a good prognosis. The expression of proteins encoded by oncogenes and tumor suppressor genes was different according to lymph node involvement. The increased mortality related to c-erbB-2 expression in patients with unaffected lymph nodes would suggests a need for adjuvant treatment.

Exercise intensity progression for exercises performed on unstable and stable platforms based on ankle muscle activation

Ankle sprains are a common sports injury. The literature focuses on the application of neuromuscular training for the improvement of balance, injury prevention and rehabilitation. However, there is a dearth of knowledge about the appropriate prescription of exercises using unstable platforms and surfaces. The purpose of this study was to devise an ankle rehabilitation or training program with exercise progression based on the extent of muscle activation, employing platforms with different levels of stability and additional resistance. A descriptive study of electromyography (EMG) during ankle exercises was performed with a convenience sample of healthy subjects. Forty-four subjects completed 12 exercises performed in a random order. Exercises were performed unipedally or bipedally with or without elastic tubing as resistance on various unstable (uncontrolled multiaxial and uniaxial movement) and stable surfaces. Surface EMG from the tibialis anterior (TA), peroneus longus (PL) and soleus (SOL) were collected to quantify the amount of muscle activity. Significant differences were found between exercise conditions for PL (p<.001), TA (p=.011), and SOL (p<.001). The greatest EMG activity for all muscles occurred with an upright unipedal stance on a soft stability surface with resistance. The least EMG activity for the TA and SOL were in a seated position and for the PL in an erect bipedal position without resistance. Based on the level of ankle muscle activation, exercises for the ankle should progress from bilateral exercises on exercise balls (lowest intensity), to a unipedal position on a soft surface in combination with elastic tubing (highest intensity) in order to achieve progressively greater ankle muscle activation.

[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.