Energy cost of walking with hip joint impairment

The energy cost of walking was measured in 12 patients (age 39-73 years) with hip joint impairment and 10 healthy controls during unassisted walking (2-6 km\ub7h -1) on a level treadmill surface and on a 5% incline. The energy cost of locomotion in most patients increased up to 50% and 70% during level-surface and uphill walking, respectively. This difference between patients and controls was probably due to the increased external mechanical work. The energy cost of walking, although related to pain experienced during walking but not hip joint range of motion or to joint status evaluated radiographically, provides an additional variable when defining the conditions of disability and functional impairment individuals with this pathological condition

Partial persistence of exercise-induced myocardial angiogenesis following 4-week detraining in the rat

Enhanced angiogenesis, or capillary growth, has a prominent role among the various beneficial effects of exercise training on the myocardium. The aim of the present study is to assess if training-induced increases in capillarity and vascularization persist after 4 weeks of detraining. Adult male rats were trained to run on a treadmill for 10 weeks at approximately 60% VO(2max), which did not induce cardiac hypertrophy, but increased (P < 0.05) the soleus/body weight ratio, left ventricle capillarity and von Willebrand-positive cell density (n = 6). In another group of animals (n = 6) subjected to training followed by 4-week detraining, the soleus/body weight ratio returned to normal, with only partial reversal of left ventricle capillarity and von Willebrand-positive cell density. Markers of angiogenesis (VEGF, KDR/VEGF-R2 and HIF-1alpha mRNA, studied by real-time RT-PCR) were upregulated at the end of training, and returned to baseline value after detraining. Electron microscopy highlighted some morphological features in trained hearts (endothelial cell sprouting and bridges and pericyte detachment), suggestive of endothelial cell proliferation and capillary growth that were absent in untrained and detrained hearts. We conclude that the training-induced increase in cardiac capillarity and vascularization are retained for some time upon cessation of the training program even in the absence of angiogenic stimuli

Remote preconditioning in normal and hypertrophic rat hearts

<p>Abstract</p> <p>Background</p> <p>The aim of our study was to investigate whether remote preconditioning (RPC) improves myocardial function after ischemia/reperfusion injury in both normal and hypertrophic isolated rat hearts. This is the first time in world literature that cardioprotection by RPC in hypertrophic myocardium is investigated.</p> <p>Methods</p> <p>Four groups of 7 male Wistar rats each, were used: Normal control, normal preconditioned, hypertrophic control and hypertrophic preconditioned groups. Moderate cardiac hypertrophy was induced by fludrocortisone acetate and salt administration for 30 days. Remote preconditioning of the rat heart was achieved by 20 minutes transient right hind limb ischemia and 10 minutes reperfusion of the anaesthetized animal. Isolated Langendorff-perfused animal hearts were then subjected to 30 minutes of global ischemia and reperfusion for 60 minutes. Contractile function and heart rhythm were monitored. Preconditioned groups were compared to control groups.</p> <p>Results</p> <p>Left ventricular developed pressure (LVDP) and the product LVDP × heart rate (HR) were significantly higher in the hypertrophic preconditioned group than the hypertrophic control group while left ventricular end diastolic pressure (LVEDP) and severe arrhythmia episodes did not differ. Variances between the normal heart groups were not significantly different except for the values of the LVEDP in the beginning of reperfusion.</p> <p>Conclusions</p> <p>Remote preconditioning seems to protect myocardial contractile function in hypertrophic myocardium, while it has no beneficial effect in normal myocardium.</p

Why do we treat adolescent idiopathic scoliosis? What we want to obtain and to avoid for our patients. SOSORT 2005 Consensus paper

BACKGROUND: Medicine is a scientific art: once science is not clear, choices are made according to individual and collective beliefs that should be better understood. This is particularly true in a field like adolescent idiopathic scoliosis, where currently does not exist definitive scientific evidence on the efficacy either of conservative or of surgical treatments. AIM OF THE STUDY: To verify the philosophical choices on the final outcome of a group of people believing and engaged in a conservative treatment of idiopathic scoliosis. METHODS: We performed a multifaceted study that included a bibliometric analysis, a questionnaire, and a careful Consensus reaching procedure between experts in the conservative treatment of scoliosis (SOSORT members). RESULTS: The Consensus reaching procedure has shown to be useful: answers changed in a statistically significant way, and 9 new outcome criteria were included. The most important final outcomes were considered Aesthetics (100%), Quality of life and Disability (more than 90%), while more than 80% of preferences went to Back Pain, Psychological well-being, Progression in adulthood, Breathing function, Scoliosis Cobb degrees (radiographic lateral flexion), Needs of further treatments in adulthood. DISCUSSION: In the literature prevail outcome criteria driven by the contingent treatment needs or the possibility to have measurement systems (even if it seems that usual clinical and radiographic methods are given much more importance than more complex Disability or Quality of Life instruments). SOSORT members give importance to a wide range of outcome criteria, in which clinical and radiographic issues have the lowest importance. CONCLUSION: We treat our patients for what they need for their future (Breathing function, Needs of further treatments in adulthood, Progression in adulthood), and their present too (Aesthetics, Disability, Quality of life). Technical matters, such as rib hump or radiographic lateral alignment and rotation, but not lateral flexion, are secondary outcomes and only instrumental to previously reported primary outcomes. We advocate a multidimensional, comprehensive evaluation of scoliosis patients, to gather all necessary data for a complete therapeutic approach, that goes beyond x-rays to reach the person and the family

International longitudinal registry of patients with atrial fibrillation and treated with rivaroxaban: RIVaroxaban Evaluation in Real life setting (RIVER)

Background Real-world data on non-vitamin K oral anticoagulants (NOACs) are essential in determining whether evidence from randomised controlled clinical trials translate into meaningful clinical benefits for patients in everyday practice. RIVER (RIVaroxaban Evaluation in Real life setting) is an ongoing international, prospective registry of patients with newly diagnosed non-valvular atrial fibrillation (NVAF) and at least one investigator-determined risk factor for stroke who received rivaroxaban as an initial treatment for the prevention of thromboembolic stroke. The aim of this paper is to describe the design of the RIVER registry and baseline characteristics of patients with newly diagnosed NVAF who received rivaroxaban as an initial treatment. Methods and results Between January 2014 and June 2017, RIVER investigators recruited 5072 patients at 309 centres in 17 countries. The aim was to enroll consecutive patients at sites where rivaroxaban was already routinely prescribed for stroke prevention. Each patient is being followed up prospectively for a minimum of 2-years. The registry will capture data on the rate and nature of all thromboembolic events (stroke / systemic embolism), bleeding complications, all-cause mortality and other major cardiovascular events as they occur. Data quality is assured through a combination of remote electronic monitoring and onsite monitoring (including source data verification in 10% of cases). Patients were mostly enrolled by cardiologists (n = 3776, 74.6%), by internal medicine specialists 14.2% (n = 718) and by primary care/general practice physicians 8.2% (n = 417). The mean (SD) age of the population was 69.5 (11.0) years, 44.3% were women. Mean (SD) CHADS2 score was 1.9 (1.2) and CHA2DS2-VASc scores was 3.2 (1.6). Almost all patients (98.5%) were prescribed with once daily dose of rivaroxaban, most commonly 20 mg (76.5%) and 15 mg (20.0%) as their initial treatment; 17.9% of patients received concomitant antiplatelet therapy. Most patients enrolled in RIVER met the recommended threshold for AC therapy (86.6% for 2012 ESC Guidelines, and 79.8% of patients according to 2016 ESC Guidelines). Conclusions The RIVER prospective registry will expand our knowledge of how rivaroxaban is prescribed in everyday practice and whether evidence from clinical trials can be translated to the broader cross-section of patients in the real world

2011 SOSORT guidelines: Orthopaedic and Rehabilitation treatment of idiopathic scoliosis during growth

<p>Abstract</p> <p>Background</p> <p>The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT), that produced its first Guidelines in 2005, felt the need to revise them and increase their scientific quality. The aim is to offer to all professionals and their patients an evidence-based updated review of the actual evidence on conservative treatment of idiopathic scoliosis (CTIS).</p> <p>Methods</p> <p>All types of professionals (specialty physicians, and allied health professionals) engaged in CTIS have been involved together with a methodologist and a patient representative. A review of all the relevant literature and of the existing Guidelines have been performed. Documents, recommendations, and practical approach flow charts have been developed according to a Delphi procedure. A methodological and practical review has been made, and a final Consensus Session was held during the 2011 Barcelona SOSORT Meeting.</p> <p>Results</p> <p>The contents of the document are: methodology; generalities on idiopathic scoliosis; approach to CTIS in different patients, with practical flow-charts; literature review and recommendations on assessment, bracing, physiotherapy, Physiotherapeutic Specific Exercises (PSE) and other CTIS. Sixty-five recommendations have been given, divided in the following topics: Bracing (20 recommendations), PSE to prevent scoliosis progression during growth (8), PSE during brace treatment and surgical therapy (5), Other conservative treatments (3), Respiratory function and exercises (3), Sports activities (6), Assessment (20). No recommendations reached a Strength of Evidence level I; 2 were level II; 7 level III; and 20 level IV; through the Consensus procedure 26 reached level V and 10 level VI. The Strength of Recommendations was Grade A for 13, B for 49 and C for 3; none had grade D.</p> <p>Conclusion</p> <p>These Guidelines have been a big effort of SOSORT to paint the actual situation of CTIS, starting from the evidence, and filling all the gray areas using a scientific method. According to results, it is possible to understand the lack of research in general on CTIS. SOSORT invites researchers to join, and clinicians to develop good research strategies to allow in the future to support or refute these recommendations according to new and stronger evidence.</p

MASSIMA POTENZA ANAEROBICA ALATTACIDA E MASSE MUSCOLARI IN SCIATORI DI LIVELLO NAZIONALE

The role of muscle mass of the lower limbs in developing explosive leg strength (extensor muscles) has been investigated in 79 male athletes of the Italian national alpine skiing team. Muscle mass was assessed as thigh and calf cross section area and explosive strength was measured as: a) maximal anaerobic power according to Margaria (running at top speed up a staircase) and Davies and Rennie tests (standing vertical jump of both feet from force platform) and b) displacement of the center of gravity (vertical jump, Sargent test). The muscle mass as well as explosive leg strength was about 10% higher in down-hill and special and giant slalom than in other groups. A linear correlation between thigh or calf muscle mass and explosive leg strength was not observed. However, multiple correlations between both thigh and calf cross section areas were statistically correlated with the explosive leg strength

Cardiac output and cardiac load during isometric exercise in man

Cardiac output, heart rate, arterial pressure and indirect left ventricular oxygen consumption have been measured in three subjects during isometric contractions (50 - 170 kg) of the plantar flexors until fatigue was reached and during walking on a treadmill. Cardiac output was linearly related to V(O2) for both exercises. However, for the same V(O2) Q was four times higher during isometric effort than during walking. In the last 15 s of static tasks, HR was linearly increasing to V(O2) and AP reached values of 160 and 125 Torr (systolic and diastolic, respectively) independently of V(O2). For comparable V(O2) in static and isotonic exercises myocardial O2 uptake was doubled during isometric rather than during the isotonic exercise

Kinetics of heart rate increase with exercise in different athletes

The kinetics of heart rate (HR) increase in man at the beginning of muscular exercise follow a biexponential function whose fast and slow components seem to depend on neurogenic (0-2 min) and/or chemical stimuli (1-5 min of exercise). The feasibility of this model and the different roles played by the two components have been analyzed in endurance (EA) and sprinter (SA) athletes and in sedentary controls (SC) during bicycle exercise of different intensities at 0.15-0.90 of the maximal aerobic power, V\u307(O2) max, range. It appears that: 1) in EA group, characterized by both high V\u307(O2) max and fraction of slow twitch muscle fibers, the fast component alone is responsible for the HR increase up to a work load of about 0.6 V\u307(O2) max. In SA and SC the corresponding value is 0.5 and 0.3 V\u307(O2) max respectively; 2) the half-time values of the fast and slow exponential functions are in the range of 3-15 sec and, if any, of 35-100 sec respectively, independent of work intensity and athletic characteristics. The different training history seems therefore to affect differently the mode of the heart control elicited by muscular exercise

Effects of stretching on maximal anaerobic power : the roles of active and passive warm-ups

The purpose of the study was to provide practical suggestions on the effect of stretching on the maximal anaerobic power preceded by active or passive warm-up. To this aim, 15 relatively fit male subjects (age 23 +/- 0.2 years, height 177 +/- 2 cm, body mass 74 +/- 2 kg; [mean +/- SE]) randomly performed a series of squat jumps (SJ) and countermovement jumps (CMJ). Jumps were preceded alternatively by: i) passive stretching of lower limbs muscles; ii) active warm-up (AWU); iii) passive warm up (PWU); and iv) the joining of stretching with either active warm-up (AWU+S) or passive warm-up (PWU+S). In control conditions (C) only jumps were required. For the 2 jumps the flight time (Ft), the peak force (Pf), and the maximal power (Wpmax) were calculated. It resulted that Ft, Pf, and Wmax values were significantly higher: i) after AWU than after PWU and PWU+S in CMJ; and ii) in AWU as compared to those of other protocols of SJ. Stretching did not negatively affect the maximal anaerobic power, per se, but seems to inhibit the effect of AWU.The results suggested that AWU seemed to increase vertical jump performance when compared to PWU, presumably due to an increase in metabolic activity as a consequence of AWU, which did not occur in PWU, despite the same skin temperature. Passive stretching alone seemed not to negatively influence vertical jump performance, whereas, if added after AWU, could reduce the power output