Impact of vertical positioning on lung aeration among mechanically ventilated intensive care unit patients: a randomized crossover clinical trial / Impacto do posicionamento vertical na aeração pulmonar em pacientes de unidades de terapia intensiva ventilados mecanicamente: um estudo clínico transversal randomizado

ABSTRACT Objective: To assess the impact of different vertical positions on lung aeration in patients receiving invasive mechanical ventilation. Methods: An open-label randomized crossover clinical trial was conducted between January and July 2020. Adults receiving invasive mechanical ventilation for > 24 hours and < 7 days with hemodynamic, respiratory and neurological stability were randomly assigned at a 1:1 ratio to the sitting position followed by passive orthostasis condition or the passive orthostasis followed by the sitting position condition. The primary outcome was lung aeration assessed using the lung ultrasound score (score ranges from 0 [better] to 36 [worse]). Results: A total of 186 subjects were screened; of these subjects, 19 were enrolled (57.8% male; mean age, 73.2 years). All participants were assigned to receive at least one verticalization protocol. Passive orthostasis resulted in mean lung ultrasound scores that did not differ significantly from the sitting position (11.0 versus 13.7; mean difference, -2.7; [95%CI -6.1 to 0.71; p = 0.11). Adverse events occurred in three subjects in the passive orthostasis group and in one in the sitting position group (p = 0.99). Conclusion: This analysis did not find significant differences in lung aeration between the sitting and passive orthostasis groups. A randomized crossover clinical trial assessing the impact of vertical positioning on lung aeration in patients receiving invasive mechanical ventilation is feasible. Unfortunately, the study was interrupted due to the need to treat COVID-19 patients. ClinicalTrials.gov registry: NCT04176445

RESUMO Objetivo: Avaliar o impacto de diferentes posicionamentos verticais na aeração pulmonar em pacientes em ventilação mecânica invasiva. Métodos: Trata-se de ensaio clínico aberto, randomizado e transversal, realizado entre janeiro e julho de 2020. Adultos em ventilação mecânica invasiva por mais de 24 horas e menos de 7 dias com estabilidade hemodinâmica, respiratória e neurológica foram distribuídos aleatoriamente em uma proporção de 1:1 à postura sentada seguida da condição de ortostatismo passivo ou o ortostatismo passivo seguido de postura sentada. O desfecho primário foi a aeração pulmonar avaliada pelo lung ultrasound score. O escore varia de zero (melhor) a 36 (pior). Resultados: Foram selecionados 186 indivíduos; destes, 19 foram incluídos (57,8% do sexo masculino; média idade de 73,2 anos). Todos os participantes foram selecionados para receber pelo menos um protocolo de verticalização. O ortostatismo passivo resultou em escores médios de aeração pulmonar por ultrassonografia que não diferiram significativamente da postura sentada (11,0 versus 13,7; diferença média, -2,7; IC95% -6,1 a 0,71; p = 0,11). Ocorreram eventos adversos em três indivíduos no grupo ortostatismo passivo e em um no grupo postura sentada (p = 0,99). Conclusão: Esta análise não encontrou diferenças significativas na aeração pulmonar entre os grupos ortostatismo passivo e postura sentada. É factível conduzir um estudo clínico transversal randomizado para avaliar o impacto do posicionamento vertical na aeração pulmonar em pacientes em ventilação mecânica invasiva. Infelizmente, o estudo foi interrompido devido à necessidade de tratar pacientes com COVID-19. Registro ClinicalTrials.gov: NCT04176445

Caracterización del asma grave no controlada en adultos mayores de 60 años

Introducción: Los pacientes mayores de 60 años suelen tener un asma más grave, menos controlada y peor función pulmonar que los jóvenes. Objetivo: Caracterizar a los pacientes mayores de 60 años con asma grave no controlada. Métodos: Se realizó un estudio observacional descriptivo, prospectivo y transversal en el Hospital Neumológico Benéfico Jurídico en el período comprendido entre enero del 2020 y enero del 2021. Resultados: Edad predominante 60-69 años (76,5 %). Mujeres (61,8 %). Antecedentes familiares de asma o alergia (64,7 %). Asma de larga evolución (85,3 %). Asma asociada a obesidad y mal control (55,9 %). Reversibilidad del VEF1 (volumen espiratorio forzado en el primer segundo) después de la aplicación del broncodilatador (26,5 %). Adherencia al tratamiento (61,8 %). El riesgo futuro de resultados adversos fue bajo en el 58,8 %, es el principal factor, el mal control actual en el 100 %. Conclusiones: El asma grave no controlada en mayores de 60 años es más frecuente en el sexo femenino, los pacientes suelen tener antecedentes familiares de asma o alergia, presentar asma de larga evolución, obesidad asociada al mal control, disminución de la reversibilidad del VEF1 con la aplicación del broncodilatador, mala adherencia al tratamiento y el mal control actual como riesgo futuro de la enfermedad.

Introduction: Patients older than 60 years tend to have more severe, less controlled asthma and worse lung function than younger people. Objective: To characterize patients older than 60 years with severe uncontrolled asthma. Methods: A descriptive, prospective and cross-sectional observational study was carried out at Benéfico Jurídico Pneumological Hospital from January 2020 to January 2021. Results: The age group 60-69 years (76.5%) predominated. Women also predominated (61.8%), as well as family history of asthma or allergy (64.7%), and long-standing asthma (85.3%). Asthma associated with obesity and poor control was 55.9%. The reversibility of the forced expiratory volume in the first second (FEV1) after the application of the bronchodilator was 26.5%. The adherence to treatment was 61.8%. The future risk of adverse results was low (58.8%), which is the main factor, the current poor control in 100%. Conclusions: Severe uncontrolled asthma in people over 60 years of age is more frequent in women, patients usually have family history of asthma or allergy, there is long-term asthma. It was observed that obesity is associated with poor control, the decreased FEV1 reversibility with the application of the bronchodilator, poor adherence to treatment and poor current control as a future risk of the disease.

Effect of using a spine mat on sagittal spinal alignment in children / 体力科学

Recently, poor posture (hyperkyphosis) has become a problem among children. This study investigated the effectiveness of an intervention (a spine mat) by measuring spinal alignment before and after the intervention in elementary school students. The study included 83 elementary school students. For the intervention, each participant was placed in a supine position on a bed and a spine mat was inserted ensuring that it adhered to the thoracic spine. The primary outcome variables included the thoracic kyphosis angle (TKA), upper thoracic angle, lower thoracic angle, lumbar lordosis angle (LLA), and sacral anteversion angle (SAA) measured in the standing and sitting positions using Spinal Mouse® before and after the intervention. Based on this evaluation, we assigned the participants to two groups: hyperkyphosis (n=25) and non-hyperkyphosis (n=58). Significant differences were observed between the pre-test and post-test TKA in the hyperkyphosis group in the standing position (pre-test: 45.3±4.5° and post-test: 40.8±9.0°, P<0.05). In the non-hyperkyphosis group, significant differences were observed between the pre-test and post-test LLA and SAA in the standing position. However, no significant difference was observed between the pre-test and post-test spinal alignment in the sitting position in both groups. The results of this study indicated that using a spine mat in elementary school children resulted in decreased TKA in the standing position only in the hyperkyphosis group, which exhibited a TKA of 40° or more after the intervention.

12-lead electrocardiogram for orthostatic hypertension in children and its clinical significance / 中国基层医药

Objective:To investigate the 12-lead electrocardiogram findings and their clinical significance in children with orthostatic hypertension (OHT), providing evidence for clinical diagnosis and treatment of OTH.Methods:Thirty-four children with OHT who received diagnosis and treatment in the Zhuji Second People's Hospital from January 2017 to December 2019 were included in the OHT group. An additional 34 healthy children who concurrently received routine physical examination were included in the control group. Both groups of children underwent a 12-lead electrocardiogram in lying and standing positions. The changes in ST-segment and T-wave amplitudes in the lying position relative to the standing position were compared between the two groups.Results:The changes in T-wave amplitude of leads II, V 5, and V 6 in the OHT group were (0.07 ± 0.11) mV, (0.13 ± 0.12) mV, and (0.14 ± 0.11) mV, respectively, which were significantly higher than those in the control group [(0.02 ± 0.07) mV, (0.05 ± 0.06) mV, (0.03 ± 0.04) mV, t = 2.24, 3.48, 5.48, P = 0.029, 0.001, < 0.001). There were no significant differences in the changes in T-wave amplitude of other leads between the two groups (all P > 0.05). There was no significant difference in change in ST-segment amplitude on 12-lead electrocardiogram images between the two groups (all P > 0.05). The area under the curve of the changes in T-wave amplitude of leads II and V 5 in predicting OHT in children was 0.596 and 0.672 respectively, the sensitivity was 64.71% and 55.88%, respectively, and the specificity was 70.59% and 61.76%, respectively. The changes in T-wave amplitude of leads II and V 5 had low efficacy in predicting OHT in children. The area under the curve of the change in T-wave amplitude of lead V 6 in predicting OHT in children was 0.738, and the sensitivity and specificity were 76.47% and 67.65%, respectively. The change in T-wave amplitude of lead V 6 had moderate efficacy for predicting OHT in children. Conclusion:The changes in T-wave amplitude of lead V 6 on the electrocardiogram image taken in the lying position relative to the standing position are of certain value in predicting OHT in children. The 12-lead electrocardiogram can provide important evidence for clinical prediction and diagnosis of OHT in children.

Relationship between physical fitness and phase angle based on bioelectrical impedance analysis in 6-year-old children / 体力科学

Phase angle, calculated as the arc-tangent of the reactance-to-resistance ratio in bioelectrical impedance analysis, represents skeletal muscle quality, and is suggested to be an indicator of sports ability and physical fitness. However, it is unclear whether phase angle is related to physical fitness in early childhood in Japanese subjects. The purpose of this study was to examine the cross-sectional relationship between physical fitness and bioelectrical impedance analysis-based phase angle in 6-year-old Japanese children. The subjects were 85 kindergarten students who participated in a physical fitness test and body composition assessment in 2017, 2018 or 2019, in the third year of kindergarten. Fitness tests included grip strength, standing long jump, and 25 m run. A multi-frequency composition analyzer was used for body composition analysis, and the phase angle of the left half of the body was acquired at 50 kHz. Statistical analysis was performed using a general linear model to calculate the regression coefficient of phase angle for physical fitness. Phase angle correlated significantly with the standing long jump and 25 m run. The regression coefficient (±standard error) of phase angle in the standing long jump in the fully adjusted model was 5.098 ±2.264 (p<0.05), and that in the 25 m run was -0.179 ±0.088 (p<0.05). There was no significant correlation between phase angle and grip strength. These results suggest that phase angle based on bioelectrical impedance analysis might be related to lower limb muscle function and running ability in 6-year-old Japanese children.

Evaluación de la frecuencia cardiaca durante la bipedestación activa inicial en pacientes que padecen síncope vasovagal / Evaluation of the heart rate during initial active standing in patients with vasovagal syncope

Introducción: El síncope vasovagal es la causa más frecuente de pérdida breve de la conciencia, en su etiopatogenia se reporta una disfunción autonómica que puede ponerse de manifiesto en la bipedestación activa inmediata. Objetivo: Comparar la dinámica de los cambios de la frecuencia cardíaca durante la bipedestación activa inmediata, de pacientes que padecen síncope vasovagal y sujetos controles. Métodos: Se evaluaron 132 sujetos supuestamente sanos (grupo A) entre 18 y 25 años y 156 pacientes con síncopes vasovagales; fueron divididos por su respuesta ante la bipedestación prolongada, negativa 111 (grupo B) y positiva 45 (grupo C). Se registró la actividad electrocardiográfica en decúbito supino y al inicio de la bipedestación activa, se obtuvo las secuencias de intervalos RR. Se comparó la frecuencia cardíaca en los 3 grupos, con 22 indicadores (posicionales, temporales, ordinales y relacionales, promedio y de la velocidad de los cambios). Resultados: No hubo diferencias en los indicadores promedio, sin embargo, algunos que evalúan la velocidad del cambio inicial, fueron significativamente menores en el grupo A comparado con B y C (p < 0,05), mientras que los que evalúan la velocidad de recuperación, fueron significativamente menores en el grupo C comparado con A y B. Conclusión: La dinámica de los cambios de frecuencia, permitió encontrar indicadores que pueden considerarse posibles predictores de una respuesta cardiovascular inadecuada en pacientes con síncope vasovagal(AU)

Introduction: Vasovagal syncope is the most frequent cause of brief loss of consciousness, in its etiopathogenesis an autonomic dysfunction is reported that can be manifested in immediate active standing. Objective: To compare the dynamics of heart rate changes during immediate active standing of patients suffering from vasovagal syncope with control subjects. Methods: 132 supposedly healthy subjects (group A) between 18 and 25 years old and 156 patients with vasovagal syncope were evaluated, which were divided by their response to prolonged standing, negative 111 (group B) and positive 45 (group C). Electrocardiographic activity was recorded in the supine position and at the beginning of active standing, the sequences of RR intervals were obtained. The heart rate was compared in the 3 groups, using 22 indicators (positional, temporal, ordinal and relational, average and of the speed of changes). Results: Differences were not found in the average indicators in the analyzed period, however, some that evaluate the speed of the initial change were significantly lower in group A compared to B and C (p < 0.05), while others that evaluate the speed recovery rates were significantly lower in group C compared to A and B. This allows to characterize, compare and differentiate the groups studied during the complex and rapid interactions that occur in the change of position. Conclusion: The dynamic of frequency changes, allowed to find indicators, which can be considered as possible predictors of an inadequate cardiovascular response in patients with vasovagal syncope(AU)

Image quality of digital radiography versus neoimaging software technique in imaging of the spine and lower extremities in a standing position / 中国基层医药

Objective:To investigate the image quality of digital radiography (DR) versus neoimaging (NE) technique in imaging of the spine and lower extremities in a standing position. Methods:The clinical data of 163 patients who underwent DR of the thoracolumbar spine and full-length lower extremities in a staining position in June to December 2019 in Taizhou Hospital of Zhejiang Province were retrospectively analyzed. Conventional DR images were designated as pre-processing images. NE software technique-processed images were designated as post-processing images. The image quality between the two techniques were compared.Results:Grade I image quality was observed in 91.41% (149/163) of DR images, and grade II image quality in 8.59% (14/163) of DR images. Grade I image quality was found in 93.87% (153/163) of NE software-treated images, and grade II image quality in 6.14% (10/163) NE software-treated images. There was significant difference in image quality between before and after NE software processing ( χ2 = 10.220, P = 0.001). Conclusion:NE software technique can seamlessly splice conventional DR images of the spine and low extremities in a standing position without being limited by equipment. Thus, high-quality images can be obtained to meet the requirement of clinical diagnosis. This study is innovative.

Biomechanical Comparison of Two-Point and Three-Point Fixation for Treating SandersⅢ Calcaneal Fracture / 医用生物力学

Objective To analyze the biomechanical feasibility of two-point fixation by distal radius plate for the treatment of SandersⅢ calcaneal fractures. Methods The three-dimensional (3D) finite element musculoskeletal foot model was established based on CT and MRI images, which comprised bones, muscles, plantar fascia, ligaments and soft tissues. After validation, the SandersⅢ calcaneal fracture models fixed by distal radial plate (two-point fixation) and calcaneal plate (three-point fixation) were established, so as to compare the biomechanical characteristics of two calcaneal models. Results The maximum stress of the two-point fixation and three-point fixation model was 324.70 and 407.90 MPa, respectively. The maximum displacements of the two models were 2.498 and 2.541 mm, respectively. There was no significant difference in the posterior articular surface displacement between the two models. In both models, the Bohler’s angle and Gissane’s angle were within the normal range. Conclusions The two-point fixation by distal radial plate can satisfy the biomechanical stability of calcaneal fracture treatment. Compared with traditional steel plate, the two-point fixation shows the advantage of smaller surgical trauma, more uniform overall stress distribution, early weight-bearing rehabilitation after surgery, which is a novel treatment recommended for treating calcaneal fractures.

Effect of temporary school closure due to COVID-19 on musculoskeletal function in elementary school children / Journal of Rural Medicine

Objective: In 2020, coronavirus disease-2019 (COVID-19) became the cause of a pandemic. In response, the Japan Sports Agency issued warnings about secondary damage to health, such as the threat to physical and mental well-being due to the lack of exercise in this situation. In this study, we report on cross-sectional and longitudinal examinations of standing trunk flexion to evaluate how temporary long-term school closures affected musculoskeletal function in elementary school students.Patients and Methods: All children in one public elementary school in T-city during the school years 2019 and 2020 were included in this study. A digital forward flexion meter was used to measure standing trunk flexion.Results: In this study, 284 (284/289: 98.3%) and 266 (266/274: 97.1%) children in school years 2020 and 2019, respectively, were found to have valid data for cross-sectional analysis. The standing trunk flexion did not show significant differences between grades or sexes. In the longitudinal analysis, the results of the comparison of standing trunk flexion in children for two consecutive years revealed significant differences only between grades 3 and 4 (P<0.05) and between girls in grades 3 and 4 (P<0.01), but no significant differences in other grades or among boys or girls were observed.Conclusion: Initially, we expected that there would be a difference in the results of functional assessment using standing trunk flexion depending on the period of absence from school. However, the results of this study showed no significant changes in standing trunk flexion. Moreover, since children’s musculoskeletal functions may be affected by various factors during the COVID-19 pandemic, they should be carefully monitored in the future.

Two-staged hybrid ablation versus thoracoscopic epicardial ablation for long-standing persistent atrial fibrillation: Mid-long term result of a randomized controlled trial / 中国胸心血管外科临床杂志

@#Objective    To evaluate the efficacy of hybrid ablation through compared with thoracoscopic epicardial ablation. Methods    In this study, 108 patients with all long-standing persistent atrial fibrillation (LSPAF) received thoracoscopic epicardial ablation (TEA) after enrollment. There were 82 males and 26 females at age of 56.5±9.4 years. After blanking-period, patients off antiarrhythmic therapy with sinus rhythm were divided into a hybrid ablation (HA) group (50 patients) and a TEA group (58 patients). Only patients in the HA group received catheter ablation after randomization subsequently. In at least two-year observation period, cardiovascular risk factors were observed in all groups’ patients. Results    The mean follow-up duration was 17.3-41.8 (26.9±6.1) months and there was no significant difference between two groups [8.2-40.6 (27.5±5.7) months in the HA group and 17.3-41.8 (26.4±6.7) months in the TEA group]. The off antiarrhythmic agents (AADs) sinus rhythm rate was significantly higher in the HA group than that in the TEA group at the time of postoperative 6, 12, 24 and 36 months ［96.0%, 90.0%, 83.7%, 83.7% versus 79.3%, 75.9%, 67.3%, 63.1%, HR=0.415 (95%CI 0.206-0.923)]. Conclusion    We can conclude that the efficacy of two-staged hybrid ablation for LSPAF is superior to thoracoscopic epicardial ablation alone. Patients can obtain benefit from a supplemental radiofrequency catheter ablation after blanking-period of surgical ablation, instead of those without a supplemental ablation.

Ileal impaction resolution in a horse with colic via a standing right flank laparotomy ˗ case report / [Laparotomia de equino em estação para resolução de compactação de íleo ˗ relato de caso]

This report describes a horse presenting ileal impaction that went through a right flank laparotomy procedure while standing. The decision to use this technique was made under the influence of several factors: the patient exhibited a calm temperament and demonstrated responsiveness to the analgesic treatment for pain control; the abdominal lesion was amenable to correction by a standing right flank approach. Also, the owner reported financial problems. Ileal obstruction was relieved successfully, and the horse recovery was satisfactory. This case highlights that, in specific cases of colic syndrome, the use of surgical procedures in the standing position might be a viable option and promote fast recovery.(AU)

Este relato de caso descreve um equino com compactação de íleo corrigida por laparotomia em estação pelo flanco direito. A decisão dessa abordagem foi influenciada por vários fatores: o paciente exibiu um temperamento calmo e demonstrou responsividade ao tratamento analgésico para controle da dor; a afecção intestinal em questão foi passível de correção pela abordagem pelo flanco direito em estação; e o proprietário relatou limitações financeiras. A desobstrução ileal foi realizada com sucesso e o cavalo apresentou recuperação satisfatória. Este caso destaca que, em casos específicos da síndrome de cólica, o uso de um procedimento em estação pode ser uma abordagem viável e promover uma rápida recuperação.(AU)

A Prevalência da Hipotensão Ortostática e a Distribuição da Variação Pressórica no Estudo Longitudinal da Saúde do Adulto / Prevalence of Orthostatic Hypotension and the Distribution of Pressure Variation in the Longitudinal Study of Adult Health

Resumo Fundamento A hipotensão ortostática (HO) tem sido negligenciada na clínica não havendo estudos sobre sua prevalência na população brasileira. Objetivo Determinar a prevalência de HO e a variação da pressão arterial (PA) após manobra postural no Estudo Longitudinal da Saúde do Adulto. Métodos No presente estudo descritivo da linha de base (N = 14.833 indivíduos, 35-74 anos), os participantes ficavam deitados por 20 minutos e então levantavam ativamente, com a medida da PA em supino e aos 2, 3, e 5 minutos de ortostase. A HO foi definida por queda ≥ 20 mmHg na PA sistólica e/ou queda ≥ 10 mmHg na PA diastólica aos 3 minutos, sendo determinada a sua prevalência com intervalo de confiança de 95% (IC95%). A distribuição da variação da PA após a manobra postural foi determinada numa subamostra (N = 8.011) após remoção de participantes com morbidade cardiovascular e/ou diabetes. Resultados A prevalência de HO foi de 2,0% (IC95%: 1,8 - 2,3), crescente com a idade. Se o critério for a mesma queda pressórica em qualquer das medidas, a prevalência aumenta para 4,3% (IC95%: 4,0 - 4,7). Em presença de HO houve relato de sintomas (tontura, escotomas, náuseas, etc.) em 19,7% dos participantes (IC95%: 15,6 - 24,6) e em apenas 1,4% (IC95%: 1,2 - 1,6) dos sem HO. Os escores-Z −2 das variações da PA antes e após manobra postural na subamostra foram de −14,1 mmHg na PA sistólica e −5,4 mmHg na diastólica. Conclusão A prevalência de HO varia em função do momento da aferição da PA. Os pontos de corte atuais podem subestimar a ocorrência de HO na população. (Arq Bras Cardiol. 2020; 114(6):1040-1048)

Abstract Background Orthostatic hypotension (OH) has been neglected in clinical practice, and there are no studies on its prevalence in the Brazilian population. Objective To determine the prevalence of OH and blood pressure (BP) changes after the postural change maneuver in participants of the Longitudinal Study of Adult Health. Methods In this descriptive study of baseline data (N = 14,833 adults, ages 35 - 74 years), participants remained lying down for 20 minutes and subsequently stood up actively. BP measurements were taken while the participants were supine and at 2, 3, and 5 minutes after standing. OH was defined as a reduction of ≥ 20 mmHg in systolic BP and/or a reduction of ≥ 10 mmHg in diastolic BP at 3 minutes, and its prevalence was determined with a 95% confidence interval (CI). The distribution of BP variation after the postural change maneuver was determined in a subsample (N = 8,011) obtained by removing patients with cardiovascular morbidity and/or diabetes. Results The prevalence of OH was 2.0% (95% CI: 1.8 - 2.3), increasing with age. If the criterion applied were a BP reduction during any measurement, the prevalence would increase to 4.3% (95% CI: 4.0 - 4.7). Symptoms (dizziness, scotoma, nausea, etc.) were reported by 19.7% of participants (95% CI: 15.6 - 24.6) with OH and 1.4% (95% CI: 1.2 - 1.6) of participants without OH. The −2 Z-scores of BP variation before and after the postural change maneuver in the subsample were −14.1 mmHg for systolic BP and −5.4 mmHg for diastolic BP. Conclusion Prevalence of OH varies depending on when BP is measured. Current cutoff points may underestimate the actual occurrence of OH in the population. (Arq Bras Cardiol. 2020; 114(6):1040-1048)

Short term effect of yoga asana - An adjunct therapy to conventional treatment in frozen shoulder

Background: The available treatments for frozen shoulder yield variable results. Physical therapy andanalgesics are considered as the first-line treatment for this disorder, but the effects are not uniform.There is some evidence to support that alternative medicine may have a role in its management.Objective(s): This study was designed to examine the short-term effects of yoga therapy in patients withfrozen shoulder of mild to moderate severity.Materials and methods: A prospective randomized controlled trial was conducted on patients with frozenshoulder between 30 and 60 years of age. They were divided into two groups: yoga (Y) and control (NY).A set of Asana exercises called “Standing Group of Asana” was practiced by the yoga group in addition tothe conventional therapy as received by the control group. The patients were reviewed at 1, 2 and 4weeks. The pain and functional assessment were done at baseline and at each review using the ShoulderPain and Disability Index (SPADI).Results: There were 16 male and 20 female participants in the Y group, and 15 males and 21 females inthe NY group. There was no statistically significant difference in age, sex, and pre-treatment SPADI scorebetween the groups. At the end of the four weeks, the SPADI pain scores in the Y and NY group were20.47 and 20.14, respectively (p ¼ 0.666). The SPADI disability scores in the Y and NY group were 20.4 and19.7, respectively (p ¼ 0.599). Overall SPADI scores were 40.67 and 40.03 in the Y and NY group,respectively (p ¼ 0.736). Both groups had a significant reduction in SPADI pain and disability scores.However, there was no significant difference between the groups in terms of SPADI scores.Conclusion: The effect of the Standing Group of Asana has no added advantage relative to standard frozenshoulder treatment when practiced for one month.© 2019 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Publishing Services byElsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Clinical characteristics, residual beta-cell function and pancreatic auto-antibodies in Thai people with long-standing type 1 diabetes mellitus / Journal of the ASEAN Federation of Endocrine Societies

@#Objectives. To describe the characteristics of long-standing T1DM in Thai patients and assess residual beta-cell function with status of pancreatic autoantibodies. Methodology. This is a cross-sectional study of Thai subjects with T1DM and disease duration ≥ 25 years seen at the Theptarin Hospital. Random plasma C-peptide and pancreatic auto-antibodies (Anti-GAD, Anti-IA2, and Anti-ZnT8) were measured. Patients who developed complications were compared with those who remained free of complications. Results. A total of 20 patients (males 65%, mean age 49.4±12.0 years, BMI 22.5±3.1 kg/m2, A1C 7.9±1.6%) with diabetes duration of 31.9±5.1 years were studied. Half of the participants remained free from any diabetic complications while the proportions reporting retinopathy, nephropathy, and neuropathy were 40%, 30%, and 15%, respectively. HDL cholesterol was significantly higher and triglyceride concentration significantly lower in patients who were free from diabetic nephropathy but not in those who were free from other complications. The prevalence rates of anti-GAD, anti- IA2, and anti-ZnT8 were 65%, 20%, and 10%, respectively. None of the patients who tested negative for both anti-GAD and anti-IA2 was positive for anti-ZnT8. Residual beta-cell function based on detectable random plasma C-peptide (≥ 0.1 ng/mL) and MMTT was found in only 3 patients (15%). There was no relationship between residual beta-cell function and protective effects of diabetic complications. Conclusion. Endogenous insulin secretion persists in some patients with long-standing T1DM and half of longstanding T1DM in Thai patients showed no diabetic complications. HDL cholesterol was significantly higher and triglyceride concentration significantly lower in patients who were free from diabetic nephropathy

Imaging changes in spinal-pelvic sagittal alignment in sitting and standing positions in degenerative lumbar spondylolisthesis patients / 中国组织工程研究

BACKGROUND: Spinal-pelvic sagittal alignment is important for the diagnosis and treatment of degenerative lumbar spondylolisthesis. However, the current study of the spine-pelvic sagittal alignment in patients with degenerative lumbar spondylolisthesis is limited to the standing position. There is no relevant report on the spine-pelvic sagittal alignment under the sitting position. OBJECTIVE: To analyze imaging data of sitting-standing spine-pelvic sagittal alignment in patients with degenerative lumbar spondylolisthesis, and to determine the sagittal alignment of spine change in degenerative lumbar spondylolisthesis patients from standing position to sitting position. METHODS: Totally 44 patients with degenerative lumbar spondylolisthesis (12 males, 32 females; age, 50-84 years) were enrolled from Tianjin Hospital from March to September 2019. All patients took X-rays of the spine in standing and sitting positions. Through the hospital image archiving and communication system, spinal and pelvic parameters were measured, including pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, thoracic kyphosis, and sagittal vertical axis. The parameters were compared between standing posture and sitting posture. By using Pearson’s correlation test, differences of relationship between spinal and pelvic parameters in standing versus sitting position were discussed. This study was approved by the Ethics Committee of Tianjin Hospital. RESULTS AND CONCLUSION: (1) When moving from standing to sitting position, in 44 degenerative lumbar spondylolisthesis patients, pelvic tilt increased [(21.3±10.1)°, (34.0±10.4)°, P 0.05). (2) Whether standing or sitting position, lumbar lordosis was correlated with other parameters (P 0.05), but lumbar lordosis was also correlated with sagittal vertical axis (P < 0.05). (3) When the degenerative lumbar spondylolisthesis patients change from standing position to sitting position, the sagittal configuration of spine pelvis shows that the pelvis rotates back around the bilateral femoral heads; the pelvis shows a backward leaning state; the physiological curvature of lumbar spine becomes shallow; and the sagittal balance axis of spine moves forward.

Does Prolonged Standing at Work Among Teachers Associated With Musculoskeletal Disorders (MSDs)?

@#In order to accomplish a wide range of duties and responsibilities that may be done under unpleasant working conditions, prolonged standing posture is common with school teachers. Nevertheless, standing upright for a long time or otherwise regarded as prolonged standing frequently contributes to body pain and discomfort, muscle fatigue and even health problems such as musculoskeletal disorders (MSDs). The aim of this paper is to review MSDs arising from prolonged standing and spread information on existing ergonomic and non-ergonomic interventions to alleviate prolonged standing discomfort. Systematic review on prolonged standing school teachers with specific keywords were recognized to discover the appropriate studies and information in a systematic search. The informations in this review may be helpful to guide teacher, school management and researchers to implement the suitable interventions in order to minimise the health issue due to MSDs among school teachers.

Influences on the Functional Behavior of Great Arteries during Orthostasis / Gravidade Influencia o Comportamento Funcional das Grandes Artérias Durante a Ortostase

Abstract Background: Arterial compliance reduction has been associated with aging and hypertension in supine position. However, the dynamic effects of orthostatism on aortic distensibility has not been defined. Objective: We sought to determine the orthostatic influence and the interference of age, blood pressure (BP) and heart rate (HR) on the great arteries during gravitational stress. Methods: Ninety-three healthy volunteers (age 42 ± 16 years). Carotid-femoral pulse wave velocity (PWV) assumed as aortic stiffness was assessed in supine position (basal phase), during tilt test (TT) (orthostatic phase) and after return to supine position (recovery phase). Simultaneously with PWV acquisition, measures of BP and HR rate were recorded. Results: PWV during TT increased significantly compared to the basal and recovery phases (11.7 ± 2.5 m/s vs. 10.1 ± 2.3 m/s and 9.5 ± 2.0 m/s). Systolic BP (r = 0.55, r = 0.46 and r = 0.39) and age (r = 0.59, r = 0.63 and r = 0.39) correlated with PWV in all phases. The significance level for all tests was established as α = 0.05. Conclusion: We conclude that there is a permanent increase in PWV during orthostatic position that was returned to basal level at the recovery phase. This dynamic pattern of PWV response, during postural changes, can be explained by an increase in hydrostatic pressure at the level of abdominal aorta which with smaller radius and an increased elastic modulus, propagates the pulse in a faster way. Considering that it could increase central pulse reflection during the orthostatic position, we speculate that this mechanism may play a role in the overall adaptation of humans to gravitational stress.

Resumo Fundamento: A redução da complacência arterial tem sido associada ao envelhecimento e à hipertensão na postura supina. Entretanto, os efeitos dinâmicos do ortostatismo na distensibilidade aórtica não foram definidos. Objetivo: Determinar a influência ortostática e a interferência da idade, pressão arterial (PA) e frequência cardíaca (FC) sobre as grandes artérias durante o estresse gravitacional. Métodos: Noventa e três voluntários saudáveis (idade de 42 ± 16 anos). A velocidade da onda de pulso carotídeo-femoral (VOP), assumida como rigidez aórtica, foi avaliada na posição supina (fase basal) durante o teste de inclinação (TT) (fase ortostática) e após o retorno à posição supina (fase de recuperação). Simultaneamente à aquisição da PWV, registrou-se as medidas de PA e FC. Resultados: A VOP durante o TT aumentou significativamente em comparação com as fases basal e de recuperação (11,7 ± 2,5 m/s vs. 10,1 ± 2,3 m/se 9,5 ± 2,0 m/s). PA sistólica (r = 0,55, r = 0,46 e r = 0,39) e idade (r = 0,59, r = 0,63 e r = 0,39) correlacionaram-se com a VOP em todas as fases. O nível de significância para todos os testes foi estabelecido como = 0,05. Conclusão: Observou-se um aumento permanente da VOP durante a postura ortostática, que retornou ao nível basal na fase de recuperação. Esse padrão dinâmico de resposta da VOP, durante as alterações posturais, pode ser explicado pelo aumento da pressão hidrostática no nível da aorta abdominal que, com raio menor e aumento do módulo de elasticidade, propaga o pulso de maneira mais rápida. Considerando-se que poderia aumentar a reflexão do pulso central durante a posição ortostática, podemos especular que esse mecanismo pode desempenhar um papel na adaptação global do humano ao estresse gravitacional.

Evaluación de la capacidad física equilibrio en adultos mayores / Evaluation of Physical Capacity Balance in Older Adults

RESUMEN Fundamento: las alteraciones de la marcha y el equilibrio en la tercera edad son la causa principal de caídas. Son necesarios métodos de valoración válidos y fiables para identificar el riesgo de caídas. Objetivo: determinar las relaciones de algunos indicadores del test escala de equilibrio avanzado de Fullerton y la edad, en adultos mayores. Métodos: se realizó un estudio exploratorio, descriptivo y transversal entre septiembre y diciembre de 2017 en los círculos de abuelos del combinado deportivo 5 del municipio Cienfuegos. Para ello se seleccionaron 115 adultos mayores. Fueron seleccionadas como variables generales: la edad y el sexo. Se tomaron cuatro de los diez incisos que conforman el test de Fullerton. Se aplicaron el coeficiente de correlación de Spearman y el coeficiente Gamma, se trabajó al 95 % de confianza. Los resultados se expusieron mediante el uso de tablas. Resultados: el grupo de edades más representado fue el de 71-75 años (40,9 %), con una prevalencia del sexo masculino (16 %). En la aplicación del test de Fullerton los adultos mayores lograron mantener el equilibrio en bipedestación, en más del 25 % de los casos; pudieron o bien tomar el objeto sin mover los pies o bien mediante un paso; en el control ortostático los valores más altos se concentran en el grupo de 71-75 años (40 %). Conclusiones: predominaron los adultos mayores que lograron mantener el equilibrio en bipedestación con los ojos cerrados, pudieron o bien tomar el objeto sin mover los pies o bien mediante un paso con supervisión, en el control ortostático los valores más altos se concentran en el grupo de 71-75 años.

ABSTRACT Foundation: alterations in gait and balance in the elderly are the main cause of falls. Valid and reliable valuation methods are necessary to identify the risk of falls. Objective: to determine the relationships between some indicators of the Fullerton advanced equilibrium scale test and age in older adults. Methods: a descriptive cross sectional exploratory study was conducted between September and December 2017 in elder Day Care Centers of the Combined Sports Center N0 5 of the Cienfuegos Municipality. For this, 115 elderly adults were selected. The general variables were: age and sex. Four of the ten items that make up the Fullerton test were taken. The Spearman correlation coefficient and the Gamma coefficient were applied, with 95 % confidence. The results were exposed through the use of tables. Results: the most represented age group was 71-75 years (40.9 %), with a prevalence of males (16 %). In the application of the Fullerton test older adults managed to maintain balance in standing, in more than 25 % of cases, could take the object either without moving the feet or by a step, in the orthostatic control the highest values they are concentrated in the group of 71-75 years (40 %). Conclusions: older adults who managed to maintain balance in standing with their eyes closed, could either take the object without moving the feet or through a step with supervision, in the orthostatic control the highest values are concentrated in the group of 71-75 years.

Comparison of cardiac autonomic response in different ABO blood groups of young adults

Background: ABO blood group has been associated with various disease phenotypes, particularly cardiovascular disease. Abnormal autonomic response also plays a role in cardiac morbidity. Increasing attention is being focused on the role of autonomic nervous system in health and disease. The literature lacks data on the association of blood groups and cardiac autonomic function. The aim of the study was to find out the association between different blood groups and cardiovascular autonomic functions in young adults.Methods: 150 healthy young students of MMU aged 18-25 years, divided into four groups based on ABO blood grouping, determined by agglutination test (group A, group B, group O and group AB). Various autonomic function tests done were lying to standing test, Valsalva maneuver, Hand grip test (HGT) and Cold pressor test (CPT).Results: The mean baseline heart rate was significantly higher in group O as compared to group A. No parasympathetic alteration between different ABO blood groups was seen. Blood pressure response to HGT and CPT was not statistically significant between different blood groups.Conclusions: Present study revealed no alteration in cardiac autonomic function with regards to ABO blood grouping in young adults.

Effect of Body Mass Index on Cardiac Autonomic Functional Status in Healthy Young Adults

Introduction: Autonomic nervous system (ANS) is involvedin energy metabolism and regulation of the cardiovascularsystem. Autonomic dysfunction has been suggested tooccur in obese individuals in both adults and children but acomprehensive study of the autonomic status in young adultsis scant. So aim of the study was to evaluate and comparecardiovascular autonomic functions in young adults on thebasis of BMI.Material and methods: 150 healthy young students of MMUaged 18–25 years, divided into four groups based on BMI asper Asian criteria (underweight, normal weight, overweightand obese). Various autonomic function tests done were Lyingto Standing test, Valsalva manoeuvre, Hand grip test (HGT)and Cold pressor test (CPT).Results: The mean baseline SBP and DBP were significantlyhigher in obese subjects followed by overweight, normalweight and under weight. No parasympathetic alterationbetween different BMI groups was seen. Mean values ofresting SBP and DBP were significantly higher and bloodpressure response to HGT and CPT was significantly lower inobese as compared to normal weight subjects.Conclusion: Our study revealed an altered autonomicfunction in the form of impaired sympathetic activity withno parasympathetic modulation in obese young adults. Soweight reduction and moderate intensity aerobic exerciseprogrammes should be incorporated into daily living, whichmay delay or prevent the onset of hypertension.