Very High-Resolution Ultrasound of the Distal Median Nerve

Objective: A very high-resolution (70 MHz) ultrasound device (VHRUS) has recently been approved for use in humans. The aim of this study was to use VHRUS to collect data on healthy subjects to propose some reference values for the digital branches of the median nerves of the hand. Methods: A VHRUS with 70 MHz linear array transducer was used to measure the cross sectional area of the median nerve at the wrist (CSAw) and digital branches (CSAf), largest and smallest fascicles, the fascicles number (Nfasc), the fascicle density (FD), the flattening ratio (FR) and CSAw/CSAf. Results: Data from 20 healthy subjects were obtained for both hands. The median nerve at the wrist and digital branches were properly identified without anatomical alterations. No differences were found between the right and the left hand. In the dominant hand, CSAw was 9.35 mm2 (4.57-12.35) and Nfasc was 24 (18-38). FD and FR were respectively 2.94 (2.47-4.91) and 2.74 (1.70-4.90). Conclusion: VHRUS technology can visualize the median nerves at the wrist, their internal structure and their small branches at the fingers, providing both a qualitative and quantitative assessment. Results from this study provide preliminary reference values in a young healthy sample. Significance: Most conventional ultrasound devices are not able to properly visualize the distal branches of the median nerve. In contrast, VHRUS allows to detect and measure smaller structures of the nerve, assisting in clinical practice

Climate Change and Building Renovation: Effects on Energy Consumption and Internal Comfort in a Social Housing Building in Northern Italy

Climate change is becoming a crucial factor to consider within human activities and the building sector is particularly influenced by aspects of internal comfort and energy. In Italy, great attention has been paid to the energy refurbishment of buildings. However, such interventions are mostly focused on reducing heating energy consumption, thus neglecting summer season performance. Moreover, climate change is barely considered during the design phase. This issue is addressed in this work which analyzes some of the most common refurbishment interventions applied to a social housing building in Trieste, while also considering internal comfort during the summer season. A dynamic analysis of the building-plant system is carried out using EnergyPlus. Fanger, UTCI and the adaptive comfort models were used to represent internal health, while three TRY data sets were generated using two GCM–RCM projections to evaluate the influence of climate change. The results show that both building insulation and climatic change affect heating consumption reaching a 70% reduction. However, building insulation does not greatly affect internal comfort, although different models show different behavior to protect against external temperatures. On the contrary, climatic change influences the percentage of hours of discomfort, with a 20% increase for all of the models. The final consideration is that people’s internal health should always be considered when carrying out refurbishment activities

Muscle Asymmetries in the Lower Limbs of Male Soccer Players: Preliminary Findings on the Association between Countermovement Jump and Tensiomyography

Strength and power asymmetries have been observed in different sports, including soccer. Such asymmetries, as well as the bilateral deficit (BLD), can be assessed during different tasks, static or dynamic, and with different methods and devices, in order to detect the possible different aspects, as well as the association with physical performance and injuries. The aim of this study was to investigate the association between muscle asymmetries and BLD during a countermovement jump (CMJ), and tensiomyography (TMG) parameters and asymmetries, in the lower limbs of male soccer players. A total of 23 male soccer players (18 ± 4 years) were recruited. Bilateral and unilateral CMJs were performed, and peak power (W) and height (cm) were obtained. TMG was performed on different muscles of the lower limbs, and lateral and functional symmetries were obtained. Playing position and history of injuries were collected. CMJ inter-limb symmetry was found to significantly correlate with biceps femoris (r = 0.574, p = 0.004) and soleus (r = 0.437, p = 0.037) lateral symmetry. Players in central roles presented significantly worse functional symmetry scores of the knee than defense players (−17.5%, 95% CI −31.2–−3.9; p = 0.10). Participants reporting a history of injury at the ankle were characterized by significantly lower functional symmetry in both the dominant (43%, 39.5–48.0 vs. 74.5%, 46.5–89.3, p = 0.019) and non-dominant (45%, 42.5–46.0 vs. 81.0%, 45.8–90.3, p = 0.024) ankle. Findings from this preliminary study suggest an association between lower-limb muscle asymmetries during a dynamic task, such as jumping, and muscle contractile properties evaluated with TMG; moreover, functional asymmetries may be present after ankle injuries. Future studies in larger samples should evaluate the presence of such asymmetries as predictors or characteristics of different muscular and joint injuries

Autonomic dysfunction in post-COVID patients with and witfhout neurological symptoms: a prospective multidomain observational study

The autonomic nervous system (ANS) can be affected by COVID-19, and dysautonomia may be a possible complication in post-COVID individuals. Orthostatic hypotension (OH) and postural tachycardia syndrome (POTS) have been suggested to be common after SARS-CoV-2 infection, but other components of ANS function may be also impaired. The Composite Autonomic Symptom Scale 31 (COMPASS-31) questionnaire is a simple and validated tool to assess dysautonomic symptoms. The aim of the present study was to administer the COMPASS-31 questionnaire to a sample of post-COVID patients with and without neurological complaints. Participants were recruited among the post-COVID ambulatory services for follow-up evaluation between 4 weeks and 9 months from COVID-19 symptoms onset. Participants were asked to complete the COMPASS-31 questionnaire referring to the period after COVID-19 disease. Heart rate and blood pressure were manually taken during an active stand test for OH and POTS diagnosis. One-hundred and eighty participants were included in the analysis (70.6% females, 51\u2009\ub1\u200913 years), and OH was found in 13.8% of the subjects. Median COMPASS-31 score was 17.6 (6.9\u201331.4), with the most affected domains being orthostatic intolerance, sudomotor, gastrointestinal and pupillomotor dysfunction. A higher COMPASS-31 score was found in those with neurological symptoms (p\u2009<\u20090.01), due to more severe orthostatic intolerance symptoms (p\u2009<\u20090.01), although gastrointestinal (p\u2009<\u20090.01), urinary (p\u2009<\u20090.01), and pupillomotor (p\u2009<\u20090.01) domains were more represented in the non-neurological symptoms group. This study confirms the importance of monitoring ANS symptoms as a possible complication of COVID-19 disease that may persist in the post-acute period

Sex differences in hydration status among adolescent elite soccer players

Hydration of athletes may affect performance and health status likely with differences among sexes. We studied the impact of sex on hydration behaviour in adolescent athletes. Hydration status and urine markers were investigated in 7 female and 7 male elite 16 years-old soccer players in temperate climate (21-24°C). Participants consumed water ad libitum during the first training session (LIB), whereas in the second session (HYD) they drunk a water amount matching 70% of sweat loss from the LIB session. Post-training performances were evaluated by Yo-Yo intermittent recovery level 1 (IR1) test and countermovement jump (CMJ). Body mass values were recorded and urine samples were collected before and after each experimental session. Males drunk a double amount of water in HYD (1.19±0.21 kg) compared to LIB (0.62±0.19 kg; p=0.001; ES=2.88), resulting in a lower percentage body mass loss (HYD -0.95±0.63% versus LIB -1.59±0.33%; p=0.044; ES=-1.35); total distance of Yo-Yo IR1 was higher, albeit not significantly, in HYD (2953±779 m) than in LIB (2103±939 m); CMJ performance was unchanged. In females, water drunk, body mass, Yo-Yo IR1 and CMJ did not vary in HYD versus LIB sessions. In adolescent males a 70% sweat replacement personalized hydration regimen reduced body mass loss and tended to improve performance, whereas in females ad libitum water drinking allowed to maintain hydration status (<1% body mass loss). Our results suggest that coaches and athletes themselves should consider a personalized hydration regimen for adolescent male soccer players, whereas ad libitum drinking seems suitable for females

Cerebral hypoperfusion in post-COVID-19 cognitively impaired subjects revealed by arterial spin labeling MRI

Cognitive impairment is one of the most prevalent symptoms of post Severe Acute Respiratory Syndrome COronaVirus 2 (SARS-CoV-2) state, which is known as Long COVID. Advanced neuroimaging techniques may contribute to a better understanding of the pathophysiological brain changes and the underlying mechanisms in post-COVID-19 subjects. We aimed at investigating regional cerebral perfusion alterations in post-COVID-19 subjects who reported a subjective cognitive impairment after a mild SARS-CoV-2 infection, using a non-invasive Arterial Spin Labeling (ASL) MRI technique and analysis. Using MRI-ASL image processing, we investigated the brain perfusion alterations in 24 patients (53.0 ± 14.5 years, 15F/9M) with persistent cognitive complaints in the post COVID-19 period. Voxelwise and region-of-interest analyses were performed to identify statistically significant differences in cerebral blood flow (CBF) maps between post-COVID-19 patients, and age and sex matched healthy controls (54.8 ± 9.1 years, 13F/9M). The results showed a significant hypoperfusion in a widespread cerebral network in the post-COVID-19 group, predominantly affecting the frontal cortex, as well as the parietal and temporal cortex, as identified by a non-parametric permutation testing (p < 0.05, FWE-corrected with TFCE). The hypoperfusion areas identified in the right hemisphere regions were more extensive. These findings support the hypothesis of a large network dysfunction in post-COVID subjects with cognitive complaints. The non-invasive nature of the ASL-MRI method may play an important role in the monitoring and prognosis of post-COVID-19 subjects

Physical activity in patients with Type 1 diabetes: carbohydrate requirements for exercise and hydration strategies

INTRODUCTION: Maintaining homeostasis can be particularly complicated in diabetic individuals, especially during physical activity. Glucose is the primary metabolic fuel, and T1DM individuals have to adapt their therapy and diet in order to reduce the risk of glycemic perturbations, such as hypoglycemia or hyperglycemia. Fluid balance is relevant to preserve physical and cognitive performance, and elevated blood glucose levels are likely to increase fluid losses in urine. METHODS: Four studies will be presented combining T1DM, exercise, and hydration science. ECRES algorithm has been proposed to estimate the proper amount of carbohydrate (CHO) for exercise in diabetic individuals. In the first part of this thesis, ECRES algorithm was compared with individual strategies during a 24x1-h relay run; then it was compared with a reference method (REF) during moderate intensity walk on a treadmill. Hydration during training was investigated using a survey in both healthy and T1DM athletes, querying about their individual characteristics, sport characteristics, therapy (in T1DM individuals), and fluid intake behaviour. RESULTS: ECRES was found to suggest an amount of CHO similar to the amount actually consumed by T1DM when they were free to decide their own strategy (median, 38 and 30 g respectively, p = NS). Preliminary results from the validation study suggest that glycemic responses during exercise may be similar when estimated using ECRES or REF to estimate CHO needs. The hydration survey in healthy Italian athletes indicated that fluid intake during training was smaller than the volume suggested by international guidelines, and it is primarily influence by the number of pauses to drink, training duration, and coaches\u2019 encouragement to drink. From preliminary results in T1DM individuals, fluid intake seems to be similar to healthy individuals, despite almost 1/4 of the sample reported to start the training with blood glucose above 180 mg/dL (10.0 mMol). CONCLUSIONS: Results from this thesis support the validity of ECRES algorithm in estimating the proper amount of CHO to prevent glycemic imbalances during exercise. Fluid balance is currently underrated in T1DM, despite its effects on performance and health: specific guidelines should be developed for diabetic athletes considering their behaviours and fluid requirements

Enteral Nutrition and Hydration in Patients with Acute Stroke: Efficacy of an Automatic Pump System for Water Administration and Flushes&mdash;A Pilot Study

Background: Enteral nutrition is often prescribed in acute stroke to meet energy and fluid needs in patients with dysphagia. Tubes clogging represent a common complication of enteral formula delivery, requiring substitution and influencing nutrition administration. Frequent water flushes are recommended as one of the most effective procedures to prevent tube occlusion, but it might be time demanding and not consistently performed by the healthcare staff. This study aimed to assess the efficacy of an automatic flush pump, compared to a manual flush system, to prevent tubes&rsquo; occlusions in acute-stroke patients, as this might affect nutrition and hydration. Methods: Gastrointestinal symptoms, nutrition and hydration biomarkers were also monitored to determine the different devices&rsquo; safety. Sixty-two patients were included in the study and allocated to the &ldquo;manual&rdquo; or &ldquo;automatic&rdquo; flushes device. Results: The mean duration of data collection was 7 &plusmn; 2 days. Tube occlusions occurred in 22.6% of the patients in the &ldquo;manual&rdquo; group, whereas only one tube clogging was reported in the &ldquo;automatic&rdquo; group (p = 0.023). No significant differences between groups were reported for constipation and diarrhea frequency nor nutrition and hydration status. When the nurses were asked to simulate manual flush administration at the same frequency of the automatic device, they were able to meet the recommendations only 10% of the time. Conclusion: This preliminary study suggests the efficacy of automatic flush systems to prevent enteral tube clogging, without affecting health status compared to standard manual flush systems