Kinematic and neuromuscular measures of intensity during drop jumps in female volleyball players

The aim of this study was to assess drop jump (DJ) performance variables (jump height, contact time, and reactive strength index) concomitant to surface electromyography (sEMG) of lower limb muscles during DJs from different drop heights (intensities). The eccentric and concentric phase sEMG from the gastrocnemius medialis, biceps femoris, and vastus medialis muscles were assessed during all tests, with sEMG activity normalized to maximal voluntary isometric contraction (MVIC). In a cross-sectional, study, 10 amateur female volleyball players (age 22.1 ± 1.8 years; body mass 72.9 ± 15.2 kg; height 1.70 ± 0.08 m) completed DJs from six heights [15-90 cm (DJ15 to DJ90)]. During DJs there was no jump-target box to rebound on to. Results of one-way analysis of variance (ANOVA) showed that the jump height, contact time, and reactive strength index were not significantly ( \u3e 0.05) different between drop heights. Mean biceps femoris eccentric and concentric sEMG ranged from 27 to 50%, although without significant differences between drop heights. Mean gastrocnemius medialis eccentric and concentric sEMG remained relatively constant (∼60-80% MVIC) across DJs heights, although eccentric values reached 90-120% MVIC from DJ75 to DJ90. Mean variations of ∼50-100% MVIC for eccentric and ∼50-70% MVIC for concentric sEMG activations were observed in the vastus medialis across DJs heights. The biceps femoris eccentric/concentric sEMG ratio during DJ45 (i.e., 1.0) was lower ( = 0.03) compared to the ratio observed after DJ90 (i.e., 3.2). The gastrocnemius medialis and vastus medialis eccentric/concentric sEMG ratio were not significantly different between drop heights. In conclusion, jumping performance and most neuromuscular markers were not sensitive to DJ height (intensity) in amateur female volleyball athletes

El impacto de la detección de disfunción endotelial en la aterosclerosis: estudio mediante tomografía por emisión de positrones

El endotelio juega un papel importante en la regulación del líquido intracelular, la permeabilidad vascular, en la modulación del tono vascular focal y la angiogénesis. La disfunción endotelial se manifiesta por la pérdida de la capacidad del endotelio de modular el comportamiento fisiológico del lecho vascular y actualmente se considera un marcador pronóstico de la enfermedad arterial coronaria. La relevancia de estudiar la disfunción endotelial radica en que ésta se ha observado en diversas patologías como diabetes mellitas (DM), dislipidemia, hipertensión arterial sistémica, tabaquismo o en enfermedades inmunológicas como síndrome antifosfolípido y lupus eritematoso sistémico. La Tomografía por Emisión de Positrones (PET) es un método no invasivo que permite cuantificar en términos absolutos el flujo miocárdico en reposo, esfuerzo y durante la estimulación adrenérgica, siendo considerado en la actualidad el estándar de oro para valorar la función endotelial. Por lo tanto el PET es una herramienta diagnóstica muy útil en identificar a los pacientes con disfunción endotelial y en evaluar la respuesta a la terapia administrada en enfermedades que se acompañen de ésta. Permitiendo un control óptimo y prevención de eventos adversos de estas enfermedades

Efecto del tratamiento combinado con metformina/glimepirida sobre la función endotelial en pacientes con diabetes mellitus tipo 2 evaluados mediante PET

El objetivo de este estudio fue evaluar el efecto que tiene el tratamiento con metformina y el tratamiento combinado con metformina/glimepirida en la función endotelial. Se estudiaron 16 pacientes con diagnóstico reciente de Diabetes Mellitus tipo 2 (DM2), que no tuvieran tratamiento farmacológico; se compararon con 15 controles sanos. En todos los pacientes se realizaron dos estudios de Tomografia por Emisión de Positrones (TEP) (al inicio y tras ocho semanas de tratamiento) con 13N-amoniaco de tres fases: reposo, prueba de respuesta presora al frío (CPT, por sus siglas en inglés) y fase de estrés con adenosina. Se cuantificó el flujo coronario (FC) en reposo, durante la CPT y la fase de estrés. Los valores se corrigieran para el doble producto (RPP, por sus siglas en inglés). Con los valores corregidos se calcularon índices de la función endotelial: el índice de vasodilatación endotelio-dependiente (IVED), el porcentaje de cambio del FC (%ΔFC) y la reserva de flujo coronario (RFC). De acuerdo con lo resultados, los pacientes diabéticos sufrieron disfunción endotelial. Después del tratamiento, el grupo que recibió la combinación de glimepirida/metformina mejoró significativamente en cuanto a la función endotelial

Estudio de la función endotelial mediante tomografía por emisión de positrones en pacientes con hipercolesterolemia

La hipercolesterolemia predispone al desarrollo de disfunción endotelial (DE) y la DE precipita la aterogénesis. La DE ocurre temprano en el curso de la aterogénesis y es considerada un marcador pronóstico para el desarrollo de cardiopatía isquémica. Objetivo: Evaluar la función endotelial (FE) mediante tomografía por emisión de positrones (PET) de pacientes asintomáticos con dislipidemia sin antecedente de cardiopatía isquémica ni tratamiento hipolipemiante previo. Material y métodos: Se estudiaron catorce pacientes asintomáticos con diagnóstico reciente (< 6 meses) de dislipidemia mediante un perfil lipídico, glucosa en sangre y un estudio de 13N-amonio PET en tres fases: reposo, prueba presora con frío (CPT) y estrés farmacológico con adenosina. Se evaluó su FE mediante el cálculo de la reserva de flujo coronario (RFC), índice de vasodilatación endotelio-dependiente (IVED) y porcentaje del incremento del flujo coronario en CPT (% Δ FC). Resultados: El 79% de los pacientes tuvieron disfunción endotelial (DE), y todos los valores de los pacientes con dislipidemia fueron menores a los parámetros normales previamente publicados: flujo coronario (FC) en reposo (FCR) 0.44 ± 0.12 vs 0.57 ± 0.147 (p = 0.002), FC en CPT 0.57 ± 0.17 vs 0.88 ± 0.26 (p = 0.001), FC en estrés (FCE) 1.24 ± 0.05 vs 1.81 ± 0.35 (p = 0.005), IVED 1.28 ± 0.25 vs 1.53 ± 0.24 (p 0.017), RFC 2.79 ± 0.94 vs 3.15 ± 0.48 (p 0.198) y % Δ FC 29.08 ± 24.62% vs 53 ± 24.60% (p 0.022). Conclusiones: Los pacientes asintomáticos en etapas tempranas de dislipidemia tienen mayor prevalencia de DE que puede ser identificada mediante 13N-amonio PET

Liver Retransplantation in Patients with HIV-1 Infection: An International Multicenter Cohort Study

Liver retransplantation is performed in HIV-infected patients, although its outcome is not well known. In an international cohort study (eight countries), 37 (6%; 32 coinfected with hepatitis C virus [HCV] and five with hepatitis B virus [HBV]) of 600 HIV-infected patients who had undergone liver transplant were retransplanted. The main indications for retransplantation were vascular complications (35%), primary graft nonfunction (22%), rejection (19%), and HCV recurrence (13%). Overall, 19 patients (51%) died after retransplantation. Survival at 1, 3, and 5 years was 56%, 51%, and 51%, respectively. Among patients with HCV coinfection, HCV RNA replication status at retransplantation was the only significant prognostic factor. Patients with undetectable versus detectable HCV RNA had a survival probability of 80% versus 39% at 1 year and 80% versus 30% at 3 and 5 years (p = 0.025). Recurrence of hepatitis C was the main cause of death in the latter. Patients with HBV coinfection had survival of 80% at 1, 3, and 5 years after retransplantation. HIV infection was adequately controlled with antiretroviral therapy. In conclusion, liver retransplantation is an acceptable option for HIV-infected patients with HBV or HCV coinfection but undetectable HCV RNA. Retransplantation in patients with HCV replication should be reassessed prospectively in the era of new direct antiviral agents

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research