Whole body vibration compared to conventional physiotherapy in patients with gonarthrosis: a protocol for a randomized, controlled study

<p>Abstract</p> <p>Background</p> <p>Osteoarthritis (OA) is the most common degenerative arthropathy. Load-bearing joints such as knee and hip are more often affected than spine or hands. The prevalence of gonarthrosis is generally higher than that of coxarthrosis.</p> <p>Because no cure for OA exists, the main emphasis of therapy is analgesic treatment through either mobility or medication. Non-pharmacologic treatment is the first step, followed by the addition of analgesic medication, and ultimately by surgery.</p> <p>The goal of non-pharmacologic and non-invasive therapy is to improve neuromuscular function, which in turn both prevents formation of and delays progression of OA. A modification of conventional physiotherapy, whole body vibration has been successfully employed for several years. Since its introduction, this therapy is in wide use at our facility not only for gonarthrosis, but also coxarthrosis and other diseases leading to muscular imbalance.</p> <p>Methods/Design</p> <p>This study is a randomized, therapy-controlled trial in a primary care setting at a university hospital. Patients presenting to our outpatient clinic with initial symptoms of gonarthrosis will be assessed against inclusion and exclusion criteria. After patient consent, 6 weeks of treatment will ensue. During the six weeks of treatment, patients will receive one of two treatments, conventional physiotherapy or whole-body-vibration exercises of one hour three times a week. Follow-up examinations will be performed immediately after treatment and after another 6 and 20 weeks, for a total study duration of 6 months. 20 patients will be included in each therapy group.</p> <p>Outcome measurements will include objective analysis of motion and ambulation as well as examinations of balance and isokinetic force. The Western Ontario and McMaster Universities Arthritis Index and SF-12 scores, the patients' overall status, and clinical examinations of the affected joint will be carried out.</p> <p>Discussion</p> <p>As new physiotherapy techniques develop for the treatment of OA, it is important to investigate the effectiveness of competing strategies. With this study, not only patient-based scores, but also objective assessments will be used to quantify patient-derived benefits of therapy.</p> <p>Trial registration</p> <p>Deutsches Register Klinischer Studien (DRKS) DRKS00000415</p> <p>Clinicaltrials.gov NCT01037972</p> <p>EudraCT 2009-017617-29</p

Brief cognitive assessment in a UK population sample – distributional properties and the relationship between the MMSE and an extended mental state examination

BACKGROUND: Despite the MMSE's known flaws, it is still used extensively as both a screening instrument for dementia and a population measure of cognitive ability. The aim of this paper is to provide data on the distribution of MMSE scores in a representative sample from the UK population and to compare it with an extended cognitive assessment (EMSE) which covers a wider range of cognitive domains and provides a wider range of difficulty levels. METHODS: The MMSE and the EMSE were administered to over 12,000 participants at the screening stage of the MRC Cognitive Function and Ageing Study (MRC CFAS). MRC CFAS is a multi-centre population-based study in England and Wales with respondents aged 65 years and older. RESULTS: Normative values on the MMSE and EMSE are presented by age group, sex and level of education. There are very large differences between age groups, with smaller differences seen between the sexes and by level of education. The EMSE extends the scores at the high end of the ability range, but is no better than the MMSE at differentiating between dementia and non-dementia. CONCLUSION: Population-derived norms are valuable for comparing an individual's score to the score that would be expected among the general population, given the individual's specific demographic characteristics

Molecular Refinement of Clinical Staging in Hepatocellular Carcinoma Patients Evaluated for Potentially Curative Therapies

Abstract: Aim: VEGF and AFP mRNA determinations in the blood are promising prognostic factors for patients with HCC. This study explores their potential prognostic synergy in a cohort of HCC patients evaluated for potentially curative therapies. Methods: One hundred twenty-four patients with a diagnosis of HCC were prospectively enrolled in the study. Inclusion criteria were: (a) histological diagnosis of HCC and assessment of tumour grade and (b) determination of AFP mRNA status and VEGF levels in the blood before therapy. Results: At baseline evaluation, 40% of the study group had AFP mRNA in the blood (AFP mRNA positive), and 35% had VEGF > 23 pg ml(-1) (VEGF positive). Surgery was performed in 58 patients (47%), 54 (43%) had tumour ablation, and 12 had chemoembolisation (10%). Median follow-up and survival of the study group were 19 and 26 months (range, 1 to 60), respectively. The association of AFP mRNA and VEGF proved to be prognostically more accurate than their single use in discriminating the risk of death (ROC curve analysis) and survival probability (Cox analysis). In particular, we identified 3 main molecular stages (p < 0,0001): both negative (3-year survival = 63%), one positive (3-year survival = 40%), both positive (3-year survival = 16%). Multivariate analysis identified BCLC staging, surgery, and molecular staging as the most significant survival variables. Conclusions: The preoperative determination of AFP mRNA status and VEGF may potentially refine the prognostic evaluation of HCC patients and improve the selection process for potentially curative therapies

Single- and multiple-set resistance training improves skeletal and respiratory muscle strength&nbsp;in elderly women

Odilon Abrahin,1&ndash;3 Rejane P Rodrigues,1&ndash;3 Vanderson C Nascimento,3 Marzo E Da Silva-Grigoletto,1,4 Evitom C Sousa,3 Anderson C Mar&ccedil;al1,2 1Department of Physical Education, Federal University of Sergipe, Sergipe, Brazil; 2Center of Research in Intracellular Signaling, Department of Morphology, Federal University of&nbsp;Sergipe, Sergipe, Brazil; 3Laboratory of Resistance Exercise and Health, Sports Department, University of Par&aacute; State, Belem, Brazil; 4Scientific Sport, Sergipe, Brazil Introduction: Aging involves a progressive reduction of respiratory muscle strength as well as muscle strength. Purpose: Compare the effects of resistance training volume on the maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), functional performance, and muscle strength in elderly women. Methods: Thirty elderly women were randomly assigned to a group performing either single sets (1-SET) or three sets (3-SET) of exercises. The sit-to-stand test, MIP, MEP, and muscle strength were assessed before and after 24 training sessions. Progressive resistance training was performed two times per week for a total of 8&ndash;12 repetitions, using the main muscle groups of the upper and lower limbs. Results: The main results showed that the participants significantly increased their MEP (P&lt;0.05; 1-SET: 34.6%; 3-SET: 35.8%) and MIP (P&lt;0.05; 1-SET: 13.7%; 3-SET: 11.2%). Both groups also improved in the sit-to-stand test (P&lt;0.05; 1-SET: 10.6%; 3-SET: 17.1%). After 24 training sessions, muscle strength also significantly increased (P&lt;0.0001; 40%&ndash;80%) in both groups. An intergroup comparison did not show any statistically significant differences between the groups in any of the parameters analyzed. Conclusion: Single- and multiple-set resistance training programs increased MIP, MEP, muscle strength, and sit-to-stand test performance in elderly women after 24 sessions of training. In conclusion, our results suggested that elderly women who are not in the habit of physical activity may start with single-set resistance training programs as a short-term strategy for the maintenance of health. Keywords: resistance exercise, maximum inspiratory pressure, maximum expiratory pressure, elderl

Respostas metabólicas à suplementação com frutose em exercício de força de membros inferiores Metabolic responses to fructose supplementation in strength exercise of lower limbs

A frutose, por seu metabolismo independente da insulina, realiza significativas alterações no metabolismo hepático, promovendo um entorno metabólico favorável ao metabolismo tanto da glicose como dos lipídios, durante o exercício. Essa condição tem sido bastante estudada em exercício de endurance; no entanto, nenhum estudo sobre a suplementação com frutose no exercício de força (EF) foi encontrado. O objetivo do presente estudo foi avaliar os efeitos agudos da adição de frutose a um suplemento de glicose sobre o metabolismo de lipídios em EF. Vinte homens treinados ingeriram suplemento de glicose (G) ou glicose mais frutose (G+F), 15 minutos antes de realizar exercício de força (10 séries de 10 repetições). Os sujeitos foram testados em ordem randômica em um desenho cruzado e com uma semana de intervalo em duas condições experimentais: EF+(G) e EF+(G+F). A análise dos resultados mostrou que os valores de triglicérides durante o exercício foram maiores (p < 0,05) quando os sujeitos foram suplementados com G+F do que quando suplementados apenas com G. Ao final do exercício, os valores de ácidos graxos livres foram maiores quando os sujeitos foram suplementados G+F (p < 0,05). A glicemia foi menor durante o exercício e maior na recuperação (p < 0,05) para essa condição. O comportamento da insulina não diferiu entre os experimentos durante o exercício de força (p > 0,05), mas foi maior em G+F que em G (p < 0,05) durante a recuperação. A percepção subjetiva de esforço (PSE) foi menor (p < 0,05) para a suplementação com G+F do que com G. Em conclusão, a suplementação com G+F afeta positivamente o metabolismo de lipídios durante o exercício de força e favorece seu metabolismo imediatamente após o esforço, proporcionando condição metabólica que reflete em uma condição que afeta favoravelmente a PSE.<br>Due to its insulin-independent metabolism, fructose promotes significant changes in liver metabolism, promoting a metabolic surrounding favorable to the glucose as well as lipids metabolism during the exercise. This condition has been widely studied in endurance exercises; however, none study about fructose supplementation in strength exercise (SE) was found. This study aimed to assess the acute effects of the fructose addition to a glucose supplement on lipid metabolism in strength exercise. Twenty trained male subjects ingested a glucose (G) or glucose plus fuctose (G+F) supplement, 15 minutes before practicing a strength exercise (10 sets of 10 repetitions). The subjects were tested randomly in a crossover design and with a week of pause in two experimental conditions: SE+(G) and SE+(G+F). The analysis of the results showed that values of triglycerides during the exercise were higher (p < 0.05) when the subjects were supplemented with G+F than when they were supplemented only with G. By the end of the exercise the values of free fatty acid were higher when in G+F (p < 0.05). Glycemia was lower during the exercise and higher in the recovery (p < 0.05) in this condition. Insulin values did not differ among the experiments during strength exercises (p > 0.05), but they were higher in G+F than in G (p < 0.05) during recovery. Perceived exertion (PE) was lower (p < 0.05) in G+F than in G. It can be concluded that the G+F supplementation positively affects the lipid metabolism during the strength exercise and favors its metabolism immediately after the effort, promoting a metabolic condition that reflects on a condition that favorably affects the PE