The importance of chronic cardiopulmonary exercise in the development of oxidative stress in patients under chronic periodic hemodialysis

INTRODUCTION: Chronic Kidney Disease (CKD) affects 8-16% of the adult population. End Stage Renal Disease (ESRD) is related to 87% to hemodialysis (HD). ESRD patients under HD experience intense changes of redox status and systemic inflammation.AIM: This study aimed at investigating the efficacy of a 6-month intradialytic cardiopulmonary exercise training program on Redox Status (RS), inflammation, physical, functional performance and quality of life in patients with ESRD. MATERIAL AND METHOD: Twenty four HD patients were included in the study. Patients were assigned randomly to either an intradialytic Training (bedside cycling) Group (TG, N=12) or a Control Group (CG, N=12). TG was participating in the cardiopulmonary exercise program thrice/week during the HD session for 6 months while CG was just performing the HD session. Duration and intensity of the exercise was increasing gradually during the period of 6 months according to the tolerance of each patient. Anthropometrics [Body Mass (BM) and Height, Body Mass Index (BMI), body composition], physical performance (VO2peak), functional capacity [North Staffordshire Royal Infirmary (NSRI) walk test, Sit-to-Stand-60 (STS-60) test, quality of life (Short Form-36 /SF-36) as well as RS [thiobarbituric acid reactive substances (TBARS), protein carbonyls (PC), reduced (GSH) and oxidized (GSSG) glutathione, GSH/GSSG, total antioxidant capacity (TAC), catalase activity (CAT)] and high-sensitivity C-reactive protein (hs-CRP) were assessed at baseline and after the 6-month intervention. RESULTS: Twenty patients (10 in each group) completed the 6 month cardiopulmonary exercise training program. Peak oxygen consumption (VO2peak) increased by 15,3% only in TG (p<0.05). Performance in NSRI, STS-60 improved by 7,69% (p<0.05) and 12,56 (p<0.05) respectively only in TG, while quality of life (SF-36) appeared statistically important significance by 4% in TG. Exercise training reduced TBARS (by 42,95%) (p<0.05), PC (by 43,19%) (p<0.05) and hs-CRP (by 14,9%) (p<0.05) and elevated GSH (by 51,93%), (p<0.05), GSH/GSSG ratio (by 51,13%) (p<0.05), TAC (by 59,47%) (p<0.05) and CAT (by 15,07%) (p<0.05). CONCLUSION: These findings suggest that engagement in chronic intradialytic cardiovascular exercise alters RS, reduces inflammation and improves performance in patients with ESRD.ΕΙΣΑΓΩΓΗ: Η Χρόνια Νεφρική Νόσος (ΧΝΝ), υπολογίζεται ότι προσβάλλει το 8-16% του ενήλικου πληθυσμού. Η Τελικού Σταδίου Χρόνια Νεφρική Νόσος (ΤΣΧΝΝ), σχετίζεται σε ποσοστό 87% με την αιμοκάθαρση. Οι ασθενείς με ΤΣΧΝΝ υπό αιμοκάθαρση βιώνουν έντονες μεταβολές της οξειδοαναγωγικής κατάστασης και συστηματική φλεγμονή. ΣΚΟΠΟΣ: Σκοπός της παρούσας μελέτης είναι να διερευνήσει την αποτελεσματικότητα ενός προγράμματος καρδιοαναπνευστικής άσκησης διάρκειας 6 μηνών το οποίο εκτελείται κατά τη διάρκεια της αιμοκάθαρσης, ως προς τις μεταβολές της οξειδοαναγωγικής κατάστασης και της φλεγμονής, καθώς επίσης και ως προς την επίδραση στη φυσική, λειτουργική κατάσταση και στην ποιότητα ζωής των συγκεκριμένων ασθενών. ΥΛΙΚΟ ΚΑΙ ΜΕΘΟΔΟΣ: Είκοσι τέσσερις ασθενείς με ΤΣΧΝΝ υπό αιμοκάθαρση, συμπεριλήφθηκαν στη μελέτη. Οι συμμετέχοντες εντάχθηκαν τυχαιοποιημένα σε μία από τις δύο ομάδες: Α) Ομάδα Παρέμβασης (ΟΠ, Ν = 12) και Β) Ομάδα ελέγχου (ΟΕ, Ν = 12). Η ΟΠ συμμετείχε στο πρόγραμμα καρδιοαναπνευστικής προπόνησης, με συχνότητα 3 προπονήσεις ανά εβδομάδα, για 6 μήνες, κατά τη διάρκεια των συνεδριών αιμοκάθαρσης. Η ένταση και η διάρκεια των προπονήσεων αυξάνονταν προοδευτικά στο διάστημα της 6μηνης παρέμβασης, σύμφωνα με την ανοχή του κάθε ασθενή στην άσκηση. Η ΟΕ συμμετείχε μόνο στις συνεδρίες αιμοκάθαρσής Πριν και μετά την 6μηνη παρέμβαση όλοι οι συμμετέχοντες υποβλήθηκαν σε αξιολόγηση των ανθρωπομετρικών χαρακτηριστικών (ΣΒ, ύψος, ΔΜΣ, σύσταση σώματος), της φυσικής κατάστασης (VO2peak), της λειτουργικής ικανότητας (δοκιμασίες NSRI και STS-60) και της ποιότητας ζωής (SF-36). Επίσης υποβλήθηκαν σε αιμοληψία για την αξιολόγηση δεικτών οξειδωτικού στρες (TBARS,PC), φλεγμονής (hs-CRP) και της αντιοξειδωτικής ικανότητας (CAT, GSH, GSSG, λόγος GSH/GSSG, TAC). ΑΠΟΤΕΛΕΣΜΑΤΑ: Από το σύνολο των ασθενών οι 20 τελικά (10 από κάθε ομάδα) ολοκλήρωσαν την 6μηνη προπονητική παρέμβαση. Μετά από αυτήν παρατηρήθηκε αύξηση της VO2peak στην ΟΠ κατά 15,3% (p<0,05), βελτίωση της λειτουργικής ικανότητας επίσης στην ΟΠ μέσω των δοκιμασιών NSRI κατά 7,69%, (p<0,05) και STS-60 κατά 12,56%, (p<0,05), ενώ ως προς την ποιότητα ζωής (SF-36) παρατηρήθηκε στατιστικά σημαντικά αύξηση κατά 4% στην ΟΠ. Αναφορικά με τους δείκτες οξειδοαναγωγικής κατάστασης, η άσκηση επέφερε μείωση των TBARS κατά 42,95%, (p<0,05), των PC κατά 43,19%, (p<0,05) και του δείκτη φλεγμονής hs-CRP κατά 14,9%, (p<0,05), ενώ η GSH παρουσίασε αύξηση κατά 51,93%, (p<0,05), όπως επίσης και ο λόγος GSH/GSSG κατά 51,13%, (p<0,05), η TAC αυξήθηκε κατά 59,47%, (p<0,05) επίσης στην ίδια ομάδα ενώ τέλος και η CAT παρουσίασε αύξηση μετά την άσκηση κατά 15,07%, (p<0,05).ΣΥΜΠΕΡΑΣΜΑΤΑ : Σύμφωνα με τα παραπάνω ευρήματα, η χρόνια καρδιοαναπνευστική άσκηση κατά τη διάρκεια της αιμοκάθαρσης φαίνεται ότι επιδρά θετικά στην οξειδοαναγωγική κατάσταση των ασθενών, μειώνει τη φλεγμονή και βελτιώνει τη φυσική και λειτουργική κατάσταση των ασθενών με υπό αιμοκάθαρση ΤΣΧΝΝ

Abdominal Cocoon Syndrome: Two Cases of an Anatomical Abnormality

Introduction. Idiopathic sclerosing encapsulating peritonitis or abdominal cocoon syndrome (ACS) is a rare anatomical deformity characterized by the partial or complete encasement of the small intestine with fibrotic peritoneum. 193 cases have been described worldwide. The aim of this study is to present two cases of ACS successfully treated at the Surgical Clinic of the Agios Dimitrios General Hospital in Thessaloniki, Greece. Presentation of Cases. Two men (55 and 54 years old) presented to the emergency department complaining of abdominal pain, distension, constipation, nausea, and vomiting. Neither of these patients had any previous operations. The computed tomography scan of the first patient showed considerable distension of the small bowel, suggestive of internal herniation. The second case showed distention of the jejunum with no obvious cause. Both patients underwent emergency surgery. Intraoperatively, it was found that a fibrous membrane had completely covered the small intestine of the first patient and the jejunum and part of the large intestine of the second patient. Adhesiolysis and partial excision of the membrane were performed in both cases. Discussion. ACS is a rare cause of small bowel obstruction. Although conservative management with immunosuppressants and steroids has been described, surgical treatment is the gold standard. Conclusion. Preoperative clinical suspicion of this disease can help determine the diagnosis and protect surgeons from intraoperative “surprises”

The Supraclavicular Artery Island Flap for Pharynx Reconstruction

The supraclavicular artery island flap (SCAIF) is a reliable, easy-to-harvest and versatile fasciocutaneous flap that can be used for pharynx reconstruction. Instead of free flaps, it requires no microsurgical technique, reduced operating time and postoperative care, making it an ideal option, especially during the COVID-19 pandemic. The primary aim of our study was to present two cases of a total laryngectomy and reconstruction with the SCAIF during the pandemic. The secondary aim was to review the literature concerning surgical techniques, complications and contradictions of the SCAIF for pharynx reconstruction. A literature search was performed using the PubMed, ScienceDirect, Wiley Online Library, Google Scholar, Scopus and Cochrane Library databases, using MeSH terms: larynx AND reconstruction AND flap. Ten full-text articles comprising 92 patients with 93 supraclavicular flaps were included. The patch graft, pharyngeal interposition graft, tubularization or “U”-shaped SCAIF were the main surgical techniques. Pharyngocutaneous fistula was the most frequent postoperative complication, especially in patients with previous radiotherapy, but just 19% of patients required secondary intervention. The lack of donor-site morbidity, low flap loss rates and stenosis rates favored this reconstructive option. This review underlined that the SCAIF has comparable results with other reconstructive options, consolidating this flap in the workhorse of pharynx reconstruction

Carcinosarcoma of the Pancreas: How a Common Blood Disorder Can Hide an Extremely Rare Tumour

Context Sarcomas represent a relatively rare malignancy. Primary sarcomas of the pancreas represent an extremely rare pathology. Case report We report a case of primary pancreatic carcinoma that presented with anaemia. The patient underwent a Kausch-Whipple operation, and, 16 months after the operation, the patient is disease free. Conclusion This unique case describes an extremely rare gastrointestinal tumour that was found during the patient's anaemia assessment.Image: Gastro-duodenoscopy demonstrating a tumor at the ampulla of Vater

Protein ingestion preserves proteasome activity during intense aseptic inflammation and facilitates skeletal muscle recovery in humans

The ubiquitin–proteasome system (UPS) is the main cellular proteolytic system responsible for the degradation of normal and abnormal (e.g. oxidised) proteins. Under catabolic conditions characterised by chronic inflammation, the UPS is activated resulting in proteolysis, muscle wasting and impaired muscle function. Milk proteins provide sulphur-containing amino acid and have been proposed to affect muscle inflammation. However, the response of the UPS to aseptic inflammation and protein supplementation is largely unknown. The aim of this study was to investigate how milk protein supplementation affects UPS activity and skeletal muscle function under conditions of aseptic injury induced by intense, eccentric exercise. In a double-blind, cross-over, repeated measures design, eleven men received either placebo (PLA) or milk protein concentrate (PRO, 4×20 g on exercise day and 20 g/d for the following 8 days), following an acute bout of eccentric exercise (twenty sets of fifteen eccentric contractions at 30°/s) on an isokinetic dynamometer. In each trial, muscle biopsies were obtained from the vastus lateralis muscle at baseline, as well as at 2 and 8 d post exercise, whereas blood samples were collected before exercise and at 6 h, 1 d, 2 d and 8 d post exercise. Muscle strength and soreness were assessed before exercise, 6 h post exercise and then daily for 8 consecutive days. PRO preserved chymotrypsin-like activity and attenuated the decrease of strength, facilitating its recovery. PRO also prevented the increase of NF-κB phosphorylation and HSP70 expression throughout recovery. We conclude that milk PRO supplementation following exercise-induced muscle trauma preserves proteasome activity and attenuates strength decline during the pro-inflammatory phase

Protein ingestion preserves proteasome activity during intense aseptic inflammation and facilitates skeletal muscle recovery in humans

The ubiquitin-proteasome system (UPS) is the main cellular proteolytic system responsible for the degradation of normal and abnormal (e.g. oxidised) proteins. Under catabolic conditions characterised by chronic inflammation, the UPS is activated resulting in proteolysis, muscle wasting and impaired muscle function. Milk proteins provide sulphur-containing amino acid and have been proposed to affect muscle inflammation. However, the response of the UPS to aseptic inflammation and protein supplementation is largely unknown. The aim of this study was to investigate how milk protein supplementation affects UPS activity and skeletal muscle function under conditions of aseptic injury induced by intense, eccentric exercise. In a double-blind, cross-over, repeated measures design, eleven men received either placebo (PLA) or milk protein concentrate (PRO, 4 x 20 g on exercise day and 20 g/d for the following 8 days), following an acute bout of eccentric exercise (twenty sets of fifteen eccentric contractions at 30 degrees/s) on an isokinetic dynamometer. In each trial, muscle biopsies were obtained from the vastus lateralis muscle at baseline, as well as at 2 and 8 d post exercise, whereas blood samples were collected before exercise and at 6 h, 1 d, 2 d and 8 d post exercise. Muscle strength and soreness were assessed before exercise, 6 h post exercise and then daily for 8 consecutive days. PRO preserved chymotrypsin-like activity and attenuated the decrease of strength, facilitating its recovery. PRO also prevented the increase of NF-kappa B phosphorylation and HSP70 expression throughout recovery. We conclude that milk PRO supplementation following exercise-induced muscle trauma preserves proteasome activity and attenuates strength decline during the pro-inflammatory phase

Protein ingestion preserves proteasome activity during intense aseptic inflammation and facilitates skeletal muscle recovery in humans

The ubiquitin–proteasome system (UPS) is the main cellular proteolytic system responsible for the degradation of normal and abnormal (e.g. oxidised) proteins. Under catabolic conditions characterised by chronic inflammation, the UPS is activated resulting in proteolysis, muscle wasting and impaired muscle function. Milk proteins provide sulphur-containing amino acid and have been proposed to affect muscle inflammation. However, the response of the UPS to aseptic inflammation and protein supplementation is largely unknown. The aim of this study was to investigate how milk protein supplementation affects UPS activity and skeletal muscle function under conditions of aseptic injury induced by intense, eccentric exercise. In a double-blind, cross-over, repeated measures design, eleven men received either placebo (PLA) or milk protein concentrate (PRO, 4×20 g on exercise day and 20 g/d for the following 8 days), following an acute bout of eccentric exercise (twenty sets of fifteen eccentric contractions at 30°/s) on an isokinetic dynamometer. In each trial, muscle biopsies were obtained from the vastus lateralis muscle at baseline, as well as at 2 and 8 d post exercise, whereas blood samples were collected before exercise and at 6 h, 1 d, 2 d and 8 d post exercise. Muscle strength and soreness were assessed before exercise, 6 h post exercise and then daily for 8 consecutive days. PRO preserved chymotrypsin-like activity and attenuated the decrease of strength, facilitating its recovery. PRO also prevented the increase of NF-κB phosphorylation and HSP70 expression throughout recovery. We conclude that milk PRO supplementation following exercise-induced muscle trauma preserves proteasome activity and attenuates strength decline during the pro-inflammatory phase

Post-Game High Protein Intake May Improve Recovery of Football-Specific Performance during a Congested Game Fixture: Results from the PRO-FOOTBALL Study

The effects of protein supplementation on performance recovery and inflammatory responses during a simulated one-week in-season microcycle with two games (G1, G2) performed three days apart were examined. Twenty football players participated in two trials, receiving either milk protein concentrate (1.15 and 0.26 g/kg on game and training days, respectively) (PRO) or an energy-matched placebo (1.37 and 0.31 g/kg of carbohydrate on game and training days, respectively) (PLA) according to a randomized, repeated-measures, crossover, double-blind design. Each trial included two games and four daily practices. Speed, jump height, isokinetic peak torque, and muscle soreness of knee flexors (KF) and extensors (KE) were measured before G1 and daily thereafter for six days. Blood was drawn before G1 and daily thereafter. Football-specific locomotor activity and heart rate were monitored using GPS technology during games and practices. The two games resulted in reduced speed (by 3&ndash;17%), strength of knee flexors (by 12&ndash;23%), and jumping performance (by 3&ndash;10%) throughout recovery, in both trials. Average heart rate and total distance covered during games remained unchanged in PRO but not in PLA. Moreover, PRO resulted in a change of smaller magnitude in high-intensity running at the end of G2 (75&ndash;90 min vs. 0&ndash;15 min) compared to PLA (P = 0.012). KE concentric strength demonstrated a more prolonged decline in PLA (days 1 and 2 after G1, P = 0.014&ndash;0.018; days 1, 2 and 3 after G2, P = 0.016&ndash;0.037) compared to PRO (days 1 after G1, P = 0.013; days 1 and 2 after G2, P = 0.014&ndash;0.033) following both games. KF eccentric strength decreased throughout recovery after G1 (PLA: P=0.001&ndash;0.047&mdash;PRO: P =0.004&ndash;0.22) in both trials, whereas after G2 it declined throughout recovery in PLA (P = 0.000&ndash;0.013) but only during the first two days (P = 0.000&ndash;0.014) in PRO. No treatment effect was observed for delayed onset of muscle soreness, leukocyte counts, and creatine kinase activity. PRO resulted in a faster recovery of protein and lipid peroxidation markers after both games. Reduced glutathione demonstrated a more short-lived reduction after G2 in PRO compared to PLA. In summary, these results provide evidence that protein feeding may more efficiently restore football-specific performance and strength and provide antioxidant protection during a congested game fixture

Effects of L-Carnitine on Oxidative Stress Responses in Patients with Renal Disease

FATOUROS, I. G., I. DOUROUDOS, S. PANAGOUTSOS, P. PASADAKIS, M. G. NIKOLAIDIS, A. CHATZINIKOLAOU, A. SOVATZIDIS, Y. MICHAILIDIS, A. Z. JAMURTAS, D. MANDALIDIS, K. TAXILDARIS, and V. VARGEMEZIS. Effects of L-Carnitine on Oxidative Stress Responses in Patients with Renal Disease. Med. Sci. Sports Exerc., Vol. 42, No. 10, pp. 1809-1818, 2010. Purpose: Hemodialyzed patients demonstrate elevated oxidative stress and reduced functional status. Exercise induces health benefits, but acute exertion up-regulates oxidative stress responses in patients undergoing hemodialysis. Therefore, the aim of the present study was to examine the effect of L-carnitine supplementation on i) exercise performance and ii) blood redox status both at rest and after exercise. Methods: Twelve hemodialysis patients received either L-carnitine (20 mg.kg(-1) i.v.) or placebo in a double-blind, placebo-controlled, counterbalanced, and crossover design for 8 wk. Participants performed an exercise test to exhaustion before and after supplementation. During the test, (V) over dotO(2), respiratory quotient, heart rate, and time to exhaustion were monitored. Blood samples, collected before and after exercise, were analyzed for lactate, malondialdehyde, protein carbonyls, reduced and oxidized glutathione, antioxidant capacity, catalase, and glutathione peroxidase activity. Results: Blood carnitine increased by L-carnitine supplementation proportionately at rest and after exercise. L-carnitine supplementation increased time to fatigue (22%) and decreased postexercise lactate (37%), submaximal heart rate, and respiratory quotient but did not affect (V) over dotO(2peak). L-carnitine supplementation increased reduced/oxidized glutathione (2.7-fold at rest, 4-fold postexercise) and glutathione peroxidase activity (4.5% at rest, 10% postexercise) and decreased malondialdehyde (19% at rest and postexercise) and protein carbonyl (27% at rest, 40% postexercise) concentration. Conclusions: Data suggest that a 2-month L-carnitine supplementation may be effective in attenuating oxidative stress responses, enhancing antioxidant status, and improving performance of patients with end-stage renal disease

The effects of aging, physical training, and a single bout of exercise on mitochondrial protein expression in human skeletal muscle

Aging results in a significant decline in aerobic capacity and impaired mitochondrial function. We have tested the effects of moderate physical activity on aerobic capacity and a single bout of exercise on the expression profile of mitochondrial biogenesis, and fusion and fission related genes in skeletal muscle of human subjects. Physical activity attenuated the aging-associated decline in VO2 max (p&lt;0.05). Aging increased and a single exercise bout decreased the expression of nuclear respiratory factor-1 (NRF1), while the transcription factor A (TFAM) expression showed a strong relationship with VO 2max and increased significantly in the young physically active group. Mitochondrial fission representing FIS1 was induced by regular physical activity, while a bout of exercise decreased fusion-associated gene expression. The expression of polynucleotide phosphorylase (PNPase) changed inversely in young and old groups and decreased with aging. The A2 subunit of cyclic AMP-activated protein kinase (AMPK) was induced by a single bout of exercise in skeletal muscle samples of both young and old subjects (p&lt;0.05). Our data suggest that moderate levels of regular physical activity increases a larger number of mitochondrial biogenesis-related gene expressions in young individuals than in aged subjects. Mitochondrial fission is impaired by aging and could be one of the most sensitive markers of the age-associated decline in the adaptive response to physical activity. © 2012 Elsevier Inc