Трансоральная тиреоид- и паратиреоидэктомия: серия наблюдений

ЩИТОВИДНОЙ ЖЕЛЕЗЫ БОЛЕЗНИПАРАЩИТОВИДНЫХ ЖЕЛЕЗ БОЛЕЗНИОКОЛОЩИТОВИДНЫХ ЖЕЛЕЗ БОЛЕЗНИЭНДОКРИННЫЕ ХИРУРГИЧЕСКИЕ ОПЕРАЦИИХИРУРГИЯ ЭНДОКРИННЫХ ЖЕЛЕЗТИРЕОИДЭКТОМИЯЭНДОСКОПИЧЕСКАЯ ТЕХНИКАПАРАТИРЕОИДЭКТОМИЯОКОЛОЩИТОВИДНОЙ ЖЕЛЕЗЫ УДАЛЕНИЕТРАНСОРАЛЬНЫЙ ДОСТУПТРАНСОРАЛЬНАЯ ХИРУРГИЯ ШЕИДЕРМАТОЛОГИЧЕСКИЙ ИНДЕКСКАЧЕСТВО ЖИЗНИЦель. Представить результаты собственной серии трансоральных операций у пациентов с заболеваниями щитовидной и околощитовидных желез. Материал и методы. Трансоральная операция выполнена 20 женщинам и 1 мужчине. Все пациенты оперированы по поводу первичного заболевания и соответствовали критериям отбора на основании ультразвукового и цитологического исследований, гормонального фона, соматического статуса. Показаниями к операции в 17 случаях явился узловой зоб, в 2 случаях – диффузный токсический зоб, в 2 случаях – первичный гиперпаратиреоз, аденома околощитовидной железы. Хирургическая техника включала в себя трехпортовый доступ в нижнем своде преддверия рта и газовый способ поддержания рабочей полости. Для операции использовались стандартные лапароскопические инструменты и ультразвуковое энергетическое устройство. В послеоперационном периоде пациенты прошли тест по субъективной оценке эстетического результата операции с использованием опросника дерматологического индекса качества жизни. Результаты. Тиреоидэктомия выполнена 4 пациентам, 15 пациентам – гемитиреоидэктомия и 2 пациентам – паратиреоидэктомия. У одной пациентки трансоральная паратиреоидэктомия выполнена в составе симультанной операции по поводу синдрома множественной эндокринной неоплазии 1 типа. У двух пациентов после операции верифицирован папиллярный рак T1N0M0. Среднее время операции составило 196,1 мин (диапазон 110 – 300 мин). Средняя кровопотеря 39,5 мл (диапазон 10 – 300 мл). На девятой по счету операции потребовалась конверсия вследствие неконтролируемого кровотечения. В одном случае отмечен преходящий парез возвратного гортанного нерва, в одном случае гематома. После операции медиана и среднее значение дерматологического индекса качества жизни составили 1 (0; 4) и 2,05 соответственно, что свидетельствует о незначительном влиянии на качество жизни. Заключение. Трансоральная эндоскопическая операция на щитовидной и околощитовидных железах перспективна в отношении оптимального выбора у пациентов, желающих избежать рубца на шее.Objective. To present the results of the author’s own series of transoral operations in patients with pathology of the thyroid and parathyroid glands. Methods. Transoral surgery was performed in women (n=20) and man (n=1). All patients were operated on for the primary disease and met the selection criteria based on ultrasound and cytological examinations, hormonal levels, and somatic status. Indications for surgery were: nodular goiter in 17 cases, diffuse toxic goiter – in 2 cases, parathyroid adenoma – in 2 cases. The surgical technique included a three-port approach in the lower fornix of the vestibule of the mouth and a gas technique for maintaining the working cavity. Standard laparoscopic instruments and an energy based ultrasonic device were used for the operation. In the postoperative period, patients underwent a test for subjective assessment of the aesthetic result of the operation using the survey of the dermatology life quality index. Results. Thyroidectomy was performed in 4 patients, hemithyroidectomy – in 15 patients and parathyroidectomy – in 2 patients. In one patient, transoralparathyroidectomy was performed as a part of a simultaneous operation for multiple endocrine neoplasia type 1 syndrome. Papillary cancer T1N0M0 was verified in two patients after surgery. The mean operation time was 196.1 min (range 110 – 300 min). Average blood loss – 39.5 ml (range 10 – 300 ml). The nineth operation required the conversion due to severe bleeding. In one case, the temporary recurrent laryngeal nerve (RLN) injury was reported, in one case – hematoma. After surgery, the median and average values of the dermatology life quality index were 1 (IQR 0-4) and 2.05, respectively, which indicates an insignificant effect on the quality of life. Conclusion. Transoral endoscopic surgery on the thyroid and parathyroid glands would be the promising optimal choice in patients to avoid scarring on the neck

Acute effects of breaking up prolonged sitting on fatigue and cognition: a pilot study.

OBJECTIVES: To compare the acute effects of uninterrupted sitting with sitting interrupted by brief bouts of light-intensity walking on self-reported fatigue, cognition, neuroendocrine biomarkers and cardiometabolic risk markers in overweight/obese adults. DESIGN: Randomised two-condition crossover trial. SETTING: Laboratory study conducted in Melbourne, Australia. PARTICIPANTS: 19 overweight/obese adults (45-75 years). INTERVENTIONS: After an initial 2 h period seated, participants consumed a meal-replacement beverage and completed (on 2 days separated by a 6-day washout period) each condition over the next 5 h: uninterrupted sitting (sedentary condition) or sitting with 3 min bouts of light-intensity walking every 30 min (active condition). PRIMARY OUTCOME MEASURES: Self-reported fatigue, executive function and episodic memory at 0 h, 4 h and 7 h. SECONDARY OUTCOME MEASURES: Neuroendocrine biomarkers and cardiometabolic risk markers (blood collections at 0 h, 4 h and 7 h, blood pressure and heart rate measured hourly and interstitial glucose measured using a continuous glucose monitoring system). RESULTS: During the active condition, fatigue levels were lower at 4 h (-13.32 (95% CI -23.48 to -3.16)) and at 7 h (-10.73 (95% CI -20.89 to -0.58)) compared to the sedentary condition. Heart rate was higher at 4 h (4.47 (95% CI 8.37 to 0.58)) and at 7 h (4.32 (95% CI 8.21 to 0.42)) during the active condition compared to the sedentary condition. There were no significant differences between conditions by time for other variables. In the sedentary condition, changes in fatigue scores over time correlated with a decrease in heart rate and plasma dihydroxyphenylalanine (DOPA) and an increase in plasma dihydroxyphenylglycol (DHPG). CONCLUSIONS: Interrupting prolonged sitting with light-intensity walking breaks may be an effective fatigue countermeasure acutely. Fatigue levels corresponded with the heart rate and neuroendocrine biomarker changes in uninterrupted sitting in this pilot study. Further research is needed to identify potential implications, particularly for the occupational health context. TRIAL REGISTRATION NUMBER: ACTRN12613000137796; Results

Is short sleep bad for the brain? Brain structure and cognitive function in short sleepers

Many sleep less than recommended without experiencing daytime tiredness. According to prevailing views, short sleep increases risk of lower brain health and cognitive function. Chronic mild sleep deprivation could cause undetected sleep debt, negatively affecting cognitive function and brain health. However, it is possible that some have less sleep need and are more resistant to negative effects of sleep loss. We investigated this question using a combined cross-sectional and longitudinal sample of 47,029 participants (age 20-89 years) with measures of self-reported sleep, including 51,295 MRIs of the brain and cognitive tests. 701 participants who reported to sleep < 6 hours did not experience daytime tiredness or sleep problems. These short sleepers showed significantly larger regional brain volumes than both short sleepers with daytime tiredness and sleep problems (n = 1619) and participants sleeping the recommended 7-8 hours (n = 3754). However, both groups of short sleepers showed slightly lower general cognitive function, 0.16 and 0.19 standard deviations, respectively. Analyses using acelerometer-estimated sleep duration confirmed the findings, and the associations remained after controlling for body mass index, depression symptoms, income and education. The results suggest that some people can cope with less sleep without obvious negative consequences for brain morphometry, in line with a view on sleep need as individualized. Tiredness and sleep problems seem to be more relevant for brain structural differences than sleep duration per se. However, the slightly lower performance on tests of general cognitive function warrants closer examination by experimental designs in natural settings

No phenotypic or genotypic evidence for a link between sleep duration and brain atrophy

Short sleep is held to cause poorer brain health, but is short sleep associated with higher rates of brain structural decline? Analysing 8,153 longitudinal MRIs from 3,893 healthy adults, we found no evidence for an association between sleep duration and brain atrophy. In contrast, cross-sectional analyses (51,295 observations) showed inverse U-shaped relationships, where a duration of 6.5 (95% confidence interval, (5.7, 7.3)) hours was associated with the thickest cortex and largest volumes relative to intracranial volume. This fits converging evidence from research on mortality, health and cognition that points to roughly seven hours being associated with good health. Genome-wide association analyses suggested that genes associated with longer sleep for below-average sleepers were linked to shorter sleep for above-average sleepers. Mendelian randomization did not yield evidence for causal impacts of sleep on brain structure. The combined results challenge the notion that habitual short sleep causes brain atrophy, suggesting that normal brains promote adequate sleep duration—which is shorter than current recommendations

Copenhagen consensus statement 2019: physical activity and ageing

From 19th to 22nd November 2018, 26 researchers representing nine countries and a variety of academic disciplines met in Snekkersten, Denmark, to reach evidence-based consensus about physical activity and older adults. It was recognised that the term ‘older adults’ represents a highly heterogeneous population. It encompasses those that remain highly active and healthy throughout the life-course with a high intrinsic capacity to the very old and frail with low intrinsic capacity. The consensus is drawn from a wide range of research methodologies within epidemiology, medicine, physiology, neuroscience, psychology and sociology, recognising the strength and limitations of each of the methods. Much of the evidence presented in the statements is based on longitudinal associations from observational and randomised controlled intervention studies, as well as quantitative and qualitative social studies in relatively healthy community-dwelling older adults. Nevertheless, we also considered research with frail older adults and those with age-associated neurodegenerative diseases, such as Alzheimer’s and Parkinson’s disease, and in a few cases molecular and cellular outcome measures from animal studies. The consensus statements distinguish between physical activity and exercise. Physical activity is used as an umbrella term that includes both structured and unstructured forms of leisure, transport, domestic and work-related activities. Physical activity entails body movement that increases energy expenditure relative to rest, and is often characterised in terms of intensity from light, to moderate to vigorous. Exercise is defined as a subset of structured physical activities that are more specifically designed to improve cardiorespiratory fitness, cognitive function, flexibility balance, strength and/or power. This statement presents the consensus on the effects of physical activity on older adults’ fitness, health, cognitive functioning, functional capacity, engagement, motivation, psychological well-being and social inclusion. It also covers the consensus on physical activity implementation strategies. While it is recognised that adverse events can occur during exercise, the risk can be minimised by carefully choosing the type of activity undertaken and by consultation with the individual’s physician when warranted, for example, when the individual is frail, has a number of co-morbidities, or has exercise-related symptoms, such as chest pain, heart arrhythmia or dizziness. The consensus was obtained through an iterative process that began with the presentation of the state-of-the-science in each domain, followed by group and plenary discussions. Ultimately, the participants reached agreement on the 30-item consensus statements

A Paleolithic Diet with and without Combined Aerobic and Resistance Exercise Increases Functional Brain Responses and Hippocampal Volume in Subjects with Type 2 Diabetes

Type 2 diabetes is associated with impaired episodic memory functions and increased risk of different dementing disorders. Diet and exercise may potentially reverse these impairments. In this study, sedentary individuals with type 2 diabetes treated by lifestyle ± metformin were randomized to a Paleolithic diet (PD, n = 12) with and without high intensity exercise (PDEX, n = 12) for 12 weeks. Episodic memory function, associated functional brain responses and hippocampal gray matter volume was measured by magnetic resonance imaging. A matched, but not randomized, non-interventional group was included as a reference (n = 6). The PD included a high intake of unsaturated fatty acids and protein, and excluded the intake of dairy products, grains, refined sugar and salt. The exercise intervention consisted of 180 min of supervised aerobic and resistance exercise per week. Both interventions induced a significant weight loss, improved insulin sensitivity and increased peak oxygen uptake without any significant group differences. Furthermore, both interventions were associated with increased functional brain responses within the right anterior hippocampus, right inferior occipital gyrus and increased volume of the right posterior hippocampus. There were no changes in memory performance. We conclude that life-style modification may improve neuronal plasticity in brain areas linked to cognitive function in type 2 diabetes. Putative long-term effects on cognitive functions including decreased risk of dementing disorders await further studies. Clinical trials registration number: Clinicaltrials. gov NCT01513798

Development and Feasibility of a Regulated, Supramaximal High-Intensity Training Program Adapted for Older Individuals

Background: High-intensity training (HIT) with extremely short intervals (designated here as supramaximal HIT) is a time-efficient training method for health and performance. However, a protocol for regulation and control of intensity is missing, impeding implementation in various groups, such as older individuals. Methods: This study presents the development and characteristics of a novel training protocol with regulated and controlled supramaximal intervals adapted for older people. Using both quantitative and qualitative analyses, we explored the feasibility of the program, performed in a group training setting, with physically active older individuals (aged 65–75, n = 7; five women). The developed supramaximal HIT program consisted of 10 × 6 s cycle sprint intervals with ∼1 min of active recovery with the following key characteristics: (1) an individual target power output was reached and maintained during all intervals and regulated and expressed as the percentage of the estimated maximum mean power output for the duration of the interval (i.e., 6 s); (2) pedaling cadence was standardized for all participants, while resistance was individualized; and (3) the protocol enabled controlled and systematic adjustments of training intensity following standardized escalation criteria. Aim: Our aim was to test the feasibility of a novel training regimen with regulated and controlled supramaximal HIT, adapted for older people. The feasibility criteria for the program were to support participants in reaching a supramaximal intensity (i.e., power output &gt; 100% of estimated VO2 max), avoid inducing a negative affective response, and have participants perceive it as feasible and acceptable. Results: All feasibility criteria were met. The standardized escalation procedure provided safe escalation of training load up to a supramaximal intensity (around three times the power output at estimated VO2 max). The participants never reported negative affective responses, and they perceived the program as fun and feasible. Conclusion: This novel program offers a usable methodology for further studies on supramaximal HIT among older individuals with different levels of physical capacity. Future research should explore the effects of the program in various populations of older people and their experiences and long-term adherence compared with other forms of training

Effekter av konditionsträning periodiserad utifrån menstruationscykeln hos idrottande kvinnor

Senaste decennierna har det skett en kraftig ökning av kvinnors deltagande inom motions- och elitidrott och det har medfört en jämnare könsfördelning av idrottare. Trots det är kvinnliga deltagare inom idrottsforskning underrepresenterade. Orsaken anses bland annat vara att variationen av könshormoner under menstruationscykeln försvårar standardiseringen vid forskning om träningsupplägg och testning. Det saknas därför vetenskapliga studier kring ytterligare utveckling av träningsmodeller specifikt för kvinnliga idrottare utifrån den kvinnliga fysiologin. Syftet med denna studie var att undersöka effekter av konditionsträning periodiserad utifrån menstruationscykeln hos idrottande kvinnor för att öka kunskapen om mer specifika träningsupplägg för kvinnor. Totalt genomförde 31 kvinnor mellan 18 och 35 år hela studien. Kvinnorna fördelades slumpmässigt i två grupper med varierande träningsfrekvens i relation till sin menstruationscykel. En tredje grupp (kontrollgrupp) fortsatte att träna kondition regelbundet enligt sitt tidigare träningsschema. Kvinnorna tränade under fyra på varandra följande menstruationscykler och deltog i ett test före träningsperioden och ett test efter träningsperioden. Av de två grupper som varierade träningsfrekvens utifrån sin menstruationscykel tränade den ena gruppen kondition fem gånger per vecka under de två första veckorna av menstruationscykeln och kondition en gång per vecka under de sista två veckorna av sin menstruationscykel. Den andra gruppen tränade istället kondition en gång per vecka under de två första veckorna av menstruationscykeln och utförde sedan konditionsträning fem gånger per vecka under de sista två veckorna av sin menstruationscykel. Kontrollgruppen konditionstränade hela tiden tre pass per vecka. Detta resulterade i att varje grupp planerades träna 48 konditionsträningspass under den tid som studien pågick. Deras träning bestod av distanspass samt långa och korta intervallpass. Dessutom bibehöll de sin övriga träning i form av styrketräning, rörlighetsträning och eventuell teknikträning inom sina idrotter. Vid testerna före och efter träningsperioden genomfördes blodprovstagning för allmän hälsokontroll samt för hormonanalys. Båda testerna genomfördes under samma fas av menstruationscykeln. Vid de två testerna genomfördes ett ramptest till utmattning på cykel med kontinuerlig mätning av syreupptag och provtagning av laktat i blod före, under och efter cykeltest. Dessutom fyllde kvinnorna i ett frågeformulär om upplevelsen av träningen samt ett frågeformulär om allmänna måendet för både analys av Profile of Mood States (POMS) och skattning av träningsbelastning. Som resultatparametrar från de två cykeltesterna användes det högst uppnådda syreupptaget respektive syreupptaget då försökspersonen hade 2 och 4 mmol/l laktat i blodet. Dessutom mättes laktatnivåerna tre minuter efter arbete. Från POMS-frågeformuläret användes det sammanfattande värdet global POMS. Resultaten visade att konditionsträningens upplägg förbättrade deltagarnas aeroba kapacitet (mätt som maximalt uppnådd VO2peak ml/kg/min och VO2 ml/kg/min vid 2 och 4 mmol laktat i blodet) i alla tre träningsgrupperna, men någon skillnad mellan grupperna vad gäller storleken på denna ökning hittades inte. Inga signifikanta förändringar av global POMS eller av laktatnivåer tre minuter efter arbete fanns mellan de två testerna före och efter träningsperioden. Slutsatsen av studien är att konditionsträning periodiserad utifrån menstruationscykeln, det vill säga koncentrerad konditionsträning de första två veckorna respektive de sista två veckorna av menstruationscykeln, inte ger extra positiva träningseffekter jämfört med regelbunden konditionsträning som utfördes under hela menstruationscykeln (kontrollgruppen).

Effekter av konditionsträning periodiserad utifrån menstruationscykeln hos idrottande kvinnor

Senaste decennierna har det skett en kraftig ökning av kvinnors deltagande inom motions- och elitidrott och det har medfört en jämnare könsfördelning av idrottare. Trots det är kvinnliga deltagare inom idrottsforskning underrepresenterade. Orsaken anses bland annat vara att variationen av könshormoner under menstruationscykeln försvårar standardiseringen vid forskning om träningsupplägg och testning. Det saknas därför vetenskapliga studier kring ytterligare utveckling av träningsmodeller specifikt för kvinnliga idrottare utifrån den kvinnliga fysiologin. Syftet med denna studie var att undersöka effekter av konditionsträning periodiserad utifrån menstruationscykeln hos idrottande kvinnor för att öka kunskapen om mer specifika träningsupplägg för kvinnor. Totalt genomförde 31 kvinnor mellan 18 och 35 år hela studien. Kvinnorna fördelades slumpmässigt i två grupper med varierande träningsfrekvens i relation till sin menstruationscykel. En tredje grupp (kontrollgrupp) fortsatte att träna kondition regelbundet enligt sitt tidigare träningsschema. Kvinnorna tränade under fyra på varandra följande menstruationscykler och deltog i ett test före träningsperioden och ett test efter träningsperioden. Av de två grupper som varierade träningsfrekvens utifrån sin menstruationscykel tränade den ena gruppen kondition fem gånger per vecka under de två första veckorna av menstruationscykeln och kondition en gång per vecka under de sista två veckorna av sin menstruationscykel. Den andra gruppen tränade istället kondition en gång per vecka under de två första veckorna av menstruationscykeln och utförde sedan konditionsträning fem gånger per vecka under de sista två veckorna av sin menstruationscykel. Kontrollgruppen konditionstränade hela tiden tre pass per vecka. Detta resulterade i att varje grupp planerades träna 48 konditionsträningspass under den tid som studien pågick. Deras träning bestod av distanspass samt långa och korta intervallpass. Dessutom bibehöll de sin övriga träning i form av styrketräning, rörlighetsträning och eventuell teknikträning inom sina idrotter. Vid testerna före och efter träningsperioden genomfördes blodprovstagning för allmän hälsokontroll samt för hormonanalys. Båda testerna genomfördes under samma fas av menstruationscykeln. Vid de två testerna genomfördes ett ramptest till utmattning på cykel med kontinuerlig mätning av syreupptag och provtagning av laktat i blod före, under och efter cykeltest. Dessutom fyllde kvinnorna i ett frågeformulär om upplevelsen av träningen samt ett frågeformulär om allmänna måendet för både analys av Profile of Mood States (POMS) och skattning av träningsbelastning. Som resultatparametrar från de två cykeltesterna användes det högst uppnådda syreupptaget respektive syreupptaget då försökspersonen hade 2 och 4 mmol/l laktat i blodet. Dessutom mättes laktatnivåerna tre minuter efter arbete. Från POMS-frågeformuläret användes det sammanfattande värdet global POMS. Resultaten visade att konditionsträningens upplägg förbättrade deltagarnas aeroba kapacitet (mätt som maximalt uppnådd VO2peak ml/kg/min och VO2 ml/kg/min vid 2 och 4 mmol laktat i blodet) i alla tre träningsgrupperna, men någon skillnad mellan grupperna vad gäller storleken på denna ökning hittades inte. Inga signifikanta förändringar av global POMS eller av laktatnivåer tre minuter efter arbete fanns mellan de två testerna före och efter träningsperioden. Slutsatsen av studien är att konditionsträning periodiserad utifrån menstruationscykeln, det vill säga koncentrerad konditionsträning de första två veckorna respektive de sista två veckorna av menstruationscykeln, inte ger extra positiva träningseffekter jämfört med regelbunden konditionsträning som utfördes under hela menstruationscykeln (kontrollgruppen).

Ancient Mnemonic in New Format : Episodic Memory Training With the Method of Loci in a Smart Phone Application

Objectives: Episodic memory is age-sensitive but can be strengthened by targeted training interventions. The method of loci (MoL) is a classic mnemonic which if successfully implemented greatly improves memory performance. We developed and investigated the effects of a MoL training program implemented in a smart phone application (app) with the aim of studying usage of the application, training effect and its modifiability by age, predictors for MoL proficiency, transfer effects to a face-name memory task, and perceived benefit in everyday memory. Method: A total of 359 adults participated. Instruction and training of the MoL, transfer test (face-name paired associates cued recall task), and surveys were performed in an in-house developed app. Results: The app interested people across the adult life span. Older adults practiced the most, whereas younger and youngold participants showed the highest level of MoL proficiency. Level of proficiency was modulated by amount of practice, but in the oldest participants this effect was less pronounced. Greater self-rated health was associated with higher level of proficiency. No transfer effect was observed. Among those who answered the survey, about half expressed that MoL training had benefitted memory in their everyday life. Discussion: App-based memory training in the MoL can be delivered successfully via an app across the adult life span. Level of performance reached in training is variable but generally high, and mainly influenced by amount of training and age of the participants. Our data suggest plasticity across the life span, but to a lesser degree for adults between 70 and 90 years