Principles of surgical resection in hilar cholangiocarcinoma

The aim of this article is to describe the surgical techniques for the treatment of hilar cholangiocarcinoma (HC). Resection with microscopically negative margin (R0) is the only way to cure patients with HC. Today, resection of the caudate lobe and part of segment IV, combined with a right or left hepatectomy, bile duct resection, lymphadenectomy of the hepatic hilum and sometimes vascular resection, is the standard surgical procedure for HC. Intraoperative frozen-section examination of proximal and distal biliary margins is necessary to confirm the suitability of resection. Although lymphadenectomy probably has little direct effect on survival, inaccurate staging information may influence post resection treatment recommendations. Aggressive venous and arterial resections should be undertaken in selected cases to achieve a R0 resection. The concept of "no-touch proposed" in 1999 by Neuhaus et al combine an extended right hepatectomy with systematic portal vein resection and caudate lobectomy avoiding hilar dissection and possible intraoperative microscopic dissemination of cancer cells. More recently minor liver resections have been proposed for treatment of HC. As the hilar bifurcation of the bile ducts is near to liver segments IV, V and I, adequate liver resection of these segments together with the bile ducts can result in cure

The efficacy of resistance training in hypoxia to enhance strength and muscle growth: A systematic review and meta-analysis.

Recent studies have reported that resistance training in hypoxia (RTH) may augment muscle size and strength development. However, consensus on the effects of RTH via systematic review and meta-analysis is not yet available. This work aimed to systematically review studies which have investigated using RTH versus normoxic resistance training (NRT) to improve muscular size and strength, and to perform a meta-analysis to determine the effect of RTH on these adaptive parameters. Searches were conducted in PubMed, Web of Science and the Cochrane Library from database inception until 17 June 2017 for original articles assessing the effects of RTH on muscle size and strength versus NRT. The effects on outcomes were expressed as standardized mean differences (SMD). Nine studies (158 participants) reported on the effects of RTH versus NRT for muscle cross-sectional area (CSA) (n = 4) or strength (n = 6). RTH significantly increased CSA (SMD = 0.70, 95% confidence intervals (CI) 0.05, 1.35; p = .04) and strength (SMD = 1.88; 95% CI = 1.20, 2.56; p < .00001). However, RTH did not produce significant change in CSA (SMD = 0.24, 95% CI -0.19, 0.68, p = .27) or strength (SMD = 0.20; 95% CI = -0.27, 0.78; p = .23) when compared to NRT. Although RTH improved muscle size and strength, this protocol did not provide significant benefit over resistance training in normoxia. Nevertheless, this paper identified marked differences in methodologies for implementing RTH, and future research using standardized protocols is therefore warranted.Actividad Física y Deport

Effects of multicomponent training on lean and bone mass in postmenopausal and older women: a systematic review.

OBJECTIVE: The purpose of this systematic review was to update and examine to what extent multicomponent training interventions could improve lean and bone mass at different anatomical regions of the body in postmenopausal and older women. METHODS: A computerized literature search was performed in the following online databases: PubMed MEDLINE, Cochrane, and Web of Knowledge. The search was performed to include articles up until February 2017. The methodological quality of selected studies was evaluated using the Cochrane risk of bias tool. RESULTS: Fifteen studies met the inclusion criteria. Studies examining the effects of combined training methods in postmenopausal and older women showed contrasting results, possibly due to the wide range of the participants' age, the evaluation of different regions, and the varying characteristics of the training methods between studies. Overall, it appears that exercise modes that combine resistance, weight-bearing training, and impact-aerobic activities can increase or prevent muscle and skeletal mass loss during the ageing process in women. CONCLUSIONS: Further studies are needed to identify the optimal multicomponent training protocols, specifically the training loads that will improve lean and bone mass at different anatomical locations, in postmenopausal and older women.Actividad Física y Deport

Physical performance of elite and subelite spanish female futsal players

The aim of this study was to determine the parameters distinguishing top female futsal players from lower level players. Twenty-seven female futsal players participated in the study, composed of professional first division (elite; n = 15) players and semi-professional second division players (sub-elite; n = 14). Active and passive straight leg raise tests, isokinetic strength of the knee extensor and flexor muscles at 60° · s-1 angular velocity, squat and counter movement jumps, 30 m sprint, 30 m agility, repeated sprint ability test and maximum ball speed during shooting were measured. The elite players were more agile and kicked harder than sub-elite players in maximum ball speed during the shooting test (P ≤ 0.05). However, no significant differences between teams were observed in active and passive hamstring flexibility, jumping ability, repeated sprint ability test, 30 m sprint time, H/Q ratio and absolute and relative torque from 60° · s-1 angular velocity. Based on these findings we conclude that agility and maximum ball speed during shooting may be important determinant factors of Spanish female futsal actions and could distinguish ability at high-level games.Actividad Física y Deport

Effectiveness of Resistance Circuit-Based Training for Maximum Oxygen Uptake and Upper-Body One-Repetition Maximum Improvements: A Systematic Review and Meta-Analysis.

BACKGROUND: It is well known that concurrent increases in both maximal strength and aerobic capacity are associated with improvements in sports performance as well as overall health. One of the most popular training methods used for achieving these objectives is resistance circuit-based training. OBJECTIVE: The objective of the present systematic review with a meta-analysis was to evaluate published studies that have investigated the effects of resistance circuit-based training on maximum oxygen uptake and one-repetition maximum of the upper-body strength (bench press exercise) in healthy adults. METHODS: The following electronic databases were searched from January to June 2016: PubMed, Web of Science and Cochrane. Studies were included if they met the following criteria: (1) examined healthy adults aged between 18 and 65 years; (2) met the characteristics of resistance circuit-based training; and (3) analysed the outcome variables of maximum oxygen uptake using a gas analyser and/or one-repetition maximum bench press. RESULTS: Of the 100 articles found from the database search and after all duplicates were removed, eight articles were analysed for maximum oxygen uptake. Of 118 healthy adults who performed resistance circuit-based training, maximum oxygen uptake was evaluated before and after the training programme. Additionally, from the 308 articles found for one-repetition maximum, eight articles were analysed. The bench press one-repetition maximum load, of 237 healthy adults who performed resistance circuit-based training, was evaluated before and after the training programme. Significant increases in maximum oxygen uptake and one-repetition maximum bench press were observed following resistance circuit-based training. Additionally, significant differences in maximum oxygen uptake and one-repetition maximum bench press were found between the resistance circuit-based training and control groups. CONCLUSIONS: The meta-analysis showed that resistance circuit-based training, independent of the protocol used in the studies, is effective in increasing maximum oxygen uptake and one-repetition maximum bench press in healthy adults. However, its effect appears to be larger depending on the population and training characteristics. For large effects in maximum oxygen uptake, the programme should include ~14-30 sessions for ~6-12 weeks, with each session lasting at least ~20-30 min, at intensities between ~60 and 90% one-repetition maximum. For large effects in one-repetition maximum bench press, the data indicate that intensity should be ~30-60% one-repetition maximum, with sessions lasting at least ~22.5-60 min. However, the lower participant's baseline fitness level may explain the lighter optimal loads used in the circuit training studies where greater strength gains were reported.Actividad Física y Deport

Extra-anatomic aortic bypass for the treatment of a mycotic pseudoaneurysm after liver transplantation for hilar cholangiocarcinoma

Liver transplantation (LT) after neoadjuvant chemoradiotherapy in patients with unresectable hilar cholangiocarcinoma (HC) is an accepted treatment strategy [1]. Neoadjuvant therapy is associated with an increased risk of arterial and portal complications after LT [1,2]. In most cases, radiation therapy makes the use of the native hepatic artery inadvisable, and an aortic anastomosis is needed, either with or without a graft [2]. The development of a mycotic pseudoaneurysm after LT is a rare complication that is associated with a high incidence of graft failure and mortality. Radiotherapy, local infections and the use of grafts are known risk factors for the development of a mycotic pseudoaneurysm, which is always challenging to manage [3]

Biochemical responses and physical performance during high-intensity resistance circuit training in hypoxia and normoxia

PURPOSE: The aim of this study was to analyze the effect of hypoxia on metabolic and acid-base balance, blood oxygenation, electrolyte, and half-squat performance variables during high-resistance circuit (HRC) training. METHODS: Twelve resistance-trained subjects participated in this study. After a 6RM testing session, participants performed three randomized trials of HRC: normoxia (NORM: FiO2 = 0.21), moderate hypoxia (MH: FiO2 = 0.16), or high hypoxia (HH: FiO2 = 0.13), separated by 72 h of recovery in normoxic conditions. HRC consisted of two blocks of three exercises (Block 1: bench press, deadlift and elbow flexion; Block 2: half-squat, triceps extension, and ankle extension). Each exercise was performed at 6RM. Rest periods lasted for 35 s between exercises, 3 min between sets, and 5 min between blocks. Peak and mean force and power were determined during half-squat. Metabolic, acid-base balance, blood oxygenation and electrolyte variables, arterial oxygen saturation (SaO2), and rating of perceived exertion (RPE) were measured following each block. RESULTS: During the first set, peak force and power were significantly lower in HH than MH and NORM; whereas in the second set, mean and peak force and power were significantly lower in HH than NORM. At the end of the HRC training session, blood lactate and RPE in HH were significantly higher than in MH and NORM. SaO2, pH, HCO3-, and pO2 values were significantly lower in all hypoxic conditions than in NORM. CONCLUSION: These results indicate that simulated hypoxia during HRC exercise reduce blood oxygenation, pH, and HCO3-, and increased blood lactate ultimately decreasing muscular performance.Actividad Física y Deport

Acute Physiological and Performance Responses to High-Intensity Resistance Circuit Training in Hypoxic and Normoxic Conditions.

The aim of this study was to analyze physical performance and physiological variables during high-intensity resistance circuit training (HRC) with the addition of 2 levels (moderate and high) of systemic hypoxia. Twelve resistance-trained young male subjects participated in the study. After a 6 repetition maximum testing session, participants performed 3 randomized trials of HRC: normoxia (NORM: fraction of inspired oxygen [FiO2] = 0.21; ∼0 m altitude), moderate hypoxia (MH: FiO2 = 0.16; ∼2.100 m altitude), or high hypoxia (HH: FiO2 = 0.13; ∼3.800 m altitude), as controlled by a hypoxic generator. Bench press force, heart rate and heart rate variability, rating of perceived exertion, resting metabolic rate, energy cost, and countermovement jump were assessed in each session. Heart rate variability in HH was significantly lower (standard deviation of all normal NN intervals [intervals between two "normal" beats] = 111.9 vs. 86.7 milliseconds; standard deviation of the difference between consecutive NN intervals = 19.5 vs. 17.0 milliseconds; p ≤ 0.05) in comparison with NORM. There were significant differences in rating of perceived exertion between NORM and HH (11.6 vs. 13.8 points). Peak and mean force on the bench press were significantly lower (p ≤ 0.05) in HH when compared with MH (peak: 725 vs. 488 N; mean: 574 vs. 373 N). Energy cost was significantly higher (p ≤ 0.01) in both hypoxic conditions compared with NORM (NORM: 10.4; MH: 11.7; HH: 13.3 kJ·min). There were no differences between conditions in heart rate and countermovement jump variables. These results indicate that hypoxic stimuli during HRC exercise alter physical performance and physiological variables and affect how strenuous the exercise is perceived to be. High-intensity resistance circuit training in hypoxia increases the stress on the performance and physiological responses, and these differences must be taken into account to avoid an excessive overload.Actividad Física y Deport

Muscle damage and inflammation biomarkers after two ultraendurance mountain races of different distances: 54 km vs 111km

The aims of this study were 1) to describe the effects of a 54 km and 111 km ultra-endurance mountain race on the biomarkers of muscle damage and inflammation, 2) to compare the effects between the two races regarding the biomarkers of muscle damage and inflammation. Sixteen ultra-endurance amateur runners volunteered to participate in this study. Ten runners completed a 54 km race (Group 1; age: 27.0 ± 5.7; height: 179.5 ± 5.8 cm; and body mass: 77.3 ± 10.7 kg) and six completed a 111 km race (Group 2; age: 30.5 ± 8.0; height: 179.4 ± 5.5 cm; and body mass: 76.2 ± 9.4 kg). Blood samples were taken at five different points during the investigation, 24 h before the race, immediately post-race, and again at 24, 48, and 72 h after the race. There were increases in leukocyte (Group 1: p ≤ .001, ES = 2.8; Group 2: p = .001, ES = 3.5) and platelet concentrations (Group 1: p ≤ .001, ES = 2.3; Group 2: p = .02, ES = 1.7) post-races. Significant inter-race differences were also observed in leukocyte at 72 h (Group 1: 5.5 ± 0.9, Group 2: 4.2 ± 0.9, p = .012, ES = 1.5). Erythrocytes, hematocrit and hemoglobin concentration decreased after 54 km and 111 km races at 24, 48 and 72 h (p ≤.001, ES = 2.0–3.18). Serum uric acid concentration increased after the 54 km race (pre = 4.9 ± 1.2 – post = 7.3 ± 1.0 8 mg/dl; p ≤ .001, ES = 2.4), and also the 111 km race (pre = 5.3 ± 0.9 – post = 6.7 ± 0.8 mg/dl; p < .008, ES = 2.2). GPT, GOT and LDH had changed by the end of the races (p < .05) and differences between the groups were observed in GOT post-race (p = .008, ES = 1.7) 24 h (p = .004, ES = 1.8), 48 h (p = .007, ES = 1.6), and 72 h (p = .02, ES = 1.4) and also in LDH at 24, 48, 72 h. Serum creatinine decreased post-race in Group 1 (pre = 1.1 ± 0.1 – post = 1.4 ± 0.2 mg/dl; p = .001, ES = 1.5) and Group 2 (pre = 1.2 ± 0.1, post = 1.5 ± 0.2; p = .002, ES = 3.3) along with CK and myoglobin. In addition, values did not return to baseline levels after 72 h in Group 2 for C-reactive protein, myoglobin, and CK. Differences between the races were also observed post-race in Troponin I (Group 1 = 0.06 ± 0.05, 111 km = 0.02 ± 0.01 μg/l, p = .047, ES = 1.1) and C-reactive protein post-race (Group 2 = 2.5 ± 1.6, 111 km = 18.2 ± 6.4 mg/l, p ≤ .001, ES = 4.4) at 24 and 48 h. The athletes had increased concentrations of markers associated with damage, inflammation, muscle injury and cardiac damage after the races. Furthermore, athletes who completed the greater distance (111 km) had higher concentrations of the markers associated with muscle damage and muscle inflammation which remained changed for a period of 72 h. However, the participants of the ‘shorter race’ showed higher values associated with cardiac damage. Consequently, athletes who take part in these kinds of races should wait at least 72 h before training with high load.Actividad Física y Deport

The Effect of Whole-Body Vibration Training on Lean Mass in Postmenopausal Women: A systematic review and meta-analysis

Objective: The purpose of the present systematic review and meta-analysis was to evaluate published, randomized controlled trials that investigated the effects of whole-body vibration training (WBVT) on lean mass in postmenopausal women. Methods: The following electronic databases were searched from September to October 2015: PubMed, Web of Science, and Cochrane. Two different authors tabulated, independently, the selected indices in identical predetermined forms. The methodological quality of all randomized trial studies was evaluated according to the modified PEDro scale. In each trial, the effect size of the intervention was calculated by the difference between pre- and postintervention lean mass in WBVT postmenopausal women. For controlled trials, the effect size of the WBVT was also calculated by the difference in lean mass after the WBVT and in control participants. Results: Of the 189 articles found from the database search and all duplicates removed, 5 articles were analyzed. The lean mass of 112 postmenopausal women who performed either WBVT or a control protocol was evaluated. The methodological quality of the trials was high, where the mean score was 8 out of a possible 10 points. No significant improvements in lean mass with WBVT were found in postmenopausal women. In addition, there was no significant difference in lean mass between WBVT and control postmenopausal women. Conclusions: This meta-analysis demonstrated that WBVT alone may not be a sufficient stimulus to increase lean mass in postmenopausal women. Thus, additional complimentary training methods with WBVT are needed to increase muscle size in women with lower hormonal responses.Actividad Física y Deport