Efeitos da suplementação com hidroximetilbutirato na sarcopenia em idosos sem exercício físico: revisão sistemática da literatura / Effects of hydroxymethylbutyrate supplementation on sarcopenia in non-exercising older adults: a systematic literature review / Efectos de la suplementación con hidroximetilbutirato sobre la sarcopenia en ancianos sin ejercicio físico: una revisión sistemática de la literatura

Observa-se um aumento percentual da população de idosos, e a prevalência de comorbidades específicas dessa população gera impactos sociais e nos gastos em saúde. Entre essas comorbidades, identifica-se a sarcopenia, relacionada a declínio funcional, incapacidade física e redução da qualidade de vida. Assim, tornam-se importantes estudos que avaliem a melhoria da força muscular com ênfase no processo de envelhecimento. Considerando a limitação física encontrada em parte dessa população, surgem evidências que avaliaram o efeito independente de suplementos nutricionais em marcadores de sarcopenia, força muscular e funcionalidade. Esta revisão sistemática tem como objetivo avaliar o efeito do hidroximetilbutirato (HMB) na sarcopenia em idosos na ausência de exercício físico. Foi feita uma revisão sistemática de estudos randomizados publicados em inglês, português ou espanhol, entre 2004 e 2021, avaliando o efeito do HMB em marcadores de sarcopenia em idosos. O estudo foi conduzido utilizando Medline, Cochrane, Cinahl, Lilacs e Periódicos Capes. A pesquisa inicial encontrou um total de 201 artigos. A análise final incluiu quatro artigos com amostra de 958 pacientes idosos sarcopênicos. Variabilidade significativa foi encontrada nas definições de sarcopenia, nos métodos utilizados para avaliar o efeito da intervenção e na composição do suplemento nutricional utilizado. Resultados estatisticamente significantes em relação à preservação de massa magra foram encontrados, sem benefício associado de marcadores de força muscular e funcionalidade. A suplementação com HMB, apesar de controlar a perda de massa magra em idosos, não foi capaz de gerar aumento de força muscular e marcadores de funcionalidade.

The population of older adults has shown a percentage increase worldwide, and the prevalence of comorbidities specific to this population generates social impacts and affects health expenditures. Among these comorbidities is sarcopenia, a condition related to functional decline, physical disability, and reduced quality of life. Hence the importance of evaluation studies on muscle strength improvement with emphasis on the aging process. Considering the physical limitations found in part of this population, recent clinical research evaluated the independent effect of nutritional supplements on sarcopenia markers, muscle strength, and functionality. This systematic literature review seeks to evaluate the effect of hydroxymethibultyrate (HMB) on sarcopenia in non-exercising older adults. Bibliographic search on randomized studies published between 2004 and 2021 in English, Portuguese, or Spanish evaluating the effect of HMB on sarcopenia markers was conducted on the MEDLINE, Cochrane, CINAHL, LILACS and CAPES databases. Of the 201 articles identified, only four were included in the review, totaling a sample of 958 sarcopenic aged patients. Results showed significant variability regarding the definitions of sarcopenia, the methods used to assess intervention effects, and the composition of the nutritional supplement used. Lean mass preservation presented statistically significant results, with no associated benefits of muscle strength and functionality markers. Despite decreasing the loss of lean mass in the aged, HMB supplementation was not able to increase muscle strength and functionality markers.

Dado el aumento porcentual de la población anciana, existe una prevalencia de comorbilidades específicas en esta población que generan impactos sociales y gastos en salud. Entre estas comorbilidades se identifica la sarcopenia, relacionada con deterioro funcional, discapacidad física y reducción de la calidad de vida. Así, cobran importancia los estudios que evalúan la mejora de la fuerza muscular con énfasis en el proceso de envejecimiento. Considerando la limitación física encontrada en parte de esta población, aparece evidencia que evalúa el efecto independiente de los suplementos nutricionales sobre los marcadores de sarcopenia, la fuerza muscular y la funcionalidad. Esta revisión sistemática tiene como objetivo evaluar el efecto del hidroximetiletibultirato (HMB) sobre la sarcopenia en ancianos en ausencia de ejercicio físico. Se realizó una revisión sistemática de estudios aleatorizados, publicados entre 2004 y 2021 en inglés, portugués o español y que evaluaron el efecto del HMB en marcadores de sarcopenia en adultos mayores. Se utilizaron las bases de datos Medline, Cochrane, Cinahl, Lilacs y Capes. La búsqueda inicial encontró un total de 201 artículos. El análisis final incluyó cuatro artículos con una muestra de 958 pacientes ancianos sarcopénicos. Se encontró una variabilidad significativa en las definiciones de sarcopenia, los métodos utilizados para evaluar el efecto de la intervención y la composición del suplemento nutricional utilizado. Hubo resultados estadísticamente significativos en cuanto a la preservación de la masa magra, sin beneficio asociado de los marcadores de fuerza muscular y funcionalidad. La suplementación con HMB, si bien disminuye la pérdida de masa magra en los ancianos, no fue capaz de generar un aumento de los marcadores de fuerza y funcionalidad muscular.

Effects of β-hydroxy-β-methylbutyrate (hmb) and resistance training on body fat and lipid metabolism signaling pathways

ABSTRACT Excess body fat is a serious problem for increasing the risk of cardiovascular diseases such as obesity, compromising the health and quality of life of the population. In this sense, resistance training (RT) is type of physical exercise which improves body composition by increasing lean mass and reducing fat mass. RT in combination with nutrition (i.e. protein supplementation) is a key intervention to improve body fat metabolism and reducing obesity. Concerning protein supplementation, the β-hydroxy-β-methylbutyrate (HMB) is a metabolite of the branched-chain amino acid leucine that has demonstrated positive effects on body fat reduction. However, the effects of combining HMB supplementation with RT related to adipose tissue metabolic activity are controversial and warrant further investigation. This study analyzed the effects of HMB supplementation associated with RT on body fat concentration and lipid metabolism signaling pathways.

RESUMEN El exceso de grasa corporal es un problema grave que aumenta tu riesgo de enfermedades y problemas de salud, tales como enfermedad cardíaca, diabetes, presión arterial alta y ciertos tipos de cáncer. En este sentido, y dentro del ejercicio físico, el entrenamiento de resistencia (ER) es un tipo de entrenamiento con pesos que mejora la composición corporal aumentando la masa magra y perdiendo masa grasa. El ER asociado con la nutrición (ej. suplementación proteica) es una excelente intervención para mejorar el metabolismo de los lípidos al reducir la grasa corporal. En relación con la suplementación proteica el β-hidroxi-β-metilbutirato (HMB) es un metabolito del aminoácido de cadena ramificada esencial leucina que ha demostrado efectos positivos en la reducción de grasa corporal. Sin embargo, los efectos de la suplementación con HMB asociados con TR relacionados con la actividad metabólica del tejido adiposo son controvertidos y necesita la realización de investigaciones adicionales. Este estudio analizó los efectos de la suplementación con HMB asociados con TR en la concentración de grasa corporal y en las vías de señalización que participan en la regulación del metabolismo de los lípidos.

Management of Malnutrition in Community-Dwelling Older Adults: The Importance of Screening and Interventions to Improve Nutritional and Functional Outcomes

@#The worldwide population is ageing rapidly, and the number of people aged ≥65 years is expected to double by 2050. Prevalence of risk of malnutrition is high among community-dwelling older adults and is associated with adverse health outcomes and higher costs of care. Anorexia of ageing is a major cause, characterized by unintentional loss of appetite and reduced oral intake. Achieving energy, protein and micronutrient requirements is important to maintaining health and functional independence. Older adults require a minimum of 1.0 to 1.2 g/kg body weight/day of protein to maintain muscle health. The only exception to this recommendation is older adults with advanced kidney disease and not on dialysis. Nutritional supplementation, in addition to diet, is often required. Several international guidelines recommend oral nutritional supplements (ONS) and dietary advice for older people with malnutrition. ONS containing β-hydroxy-β-methylbutyrate (HMB) has been shown to improve nutritional and functional outcomes in community-dwelling older adults with or at risk of malnutrition. As such, early screening for malnutrition risk in older adults is an important public health strategy. Such screening enables early identification, intervention and best clinical outcomes. Raising awareness on the importance of nutritional health in older people is key, in order to maintain physical function and independent living for as long as possible, preserve quality of life and reduce burdens of unhealthy ageing on healthcare systems.

Monotypic angiomyolipoma of the nasal cavity: An extremely rare cause of nasal mass with recurrent epistaxis

Monotypic angiomyolipoma is usually found in the kidneys and is composed predominantly of epithelioid cells which show positivity for melanocyte and smooth muscle markers. It can pose a diagnostic challenge due to a range of differential diagnosis. We report the second case of monotypic angiomyolipoma of nasal cavity and first from India in a 54-year-old male who presented with a nasal polyp. Grossly the tumor was well circumscribed and un-encapsulated. Microscopy showed a large number of epithelioid cells mixed with a few spindle cells, varying sized blood vessels, and focal areas of adipose tissue. Immunohistochemistry was positive for smooth muscle actin (SMA) and human melanoma black (HMB-45) stains. It is important to identify this tumor as it can sometimes be mistaken for malignancy and only needs endoscopic resection.

Intravascular and Extravascular Migratory, Metastatic Melanoma of the Great Saphenous Vein

Melanoma blood vessel metastases are very uncommon. Wereport this very rare case of metastatic melanoma along thewall of great saphenous vein (GSV), showing intra and extravascular metastasis. By far only a single case of intravascularmetastatic melanoma (IVMM) of GSV and thirty six cases ofextravascular migratory metastatic melanoma (EVMM) ofGSV have been reported. In our case melanoma cells wereseen both inside and outside of the wall of GSV, and in thedermis. A 60 years old male presented with multiple swellingsupper left thigh since one and a half year. Patient wasoperated. All swellings, along with, part of saphenous vein tillthe knee, and small part of skin were excised under GA.Microscopically, hematoxylin and eosin sections given fromvarious sites showed features of malignant melanoma. Tumorcells were seen in the dermis, and the lumen, as well asoutside the wall of saphenous vein, but not in the epidermis.Only very few melanocytic granules were seen in a singlearea of a section. On Immunohistochemistry –, MarkersHMB45, S100 and Vimentin are strong immunoreactive. CKPAN was focal immunoreactive.In our case the melanoma spread along the wall of the GSV.This pericytic angiotropism of melanoma cells, also showingsigns of intravasation, which suggests that melanomacells may migrate along the external surface of vessels, amechanism termed ‘EVMM and also by invading the bloodvessels ‘IVMM’.

Comparative study on levonorgestrel intrauterine system and oral progestogen in women with heavy menstrual bleeding in terms of efficacy, user satisfaction and quality of life using MMAS score

Background: To compare the efficacy, safety and user satisfaction of levonorgestrel intrauterine system (LNG-IUS) with oral progestogen in medical management of heavy menstrual bleeding (HMB).Methods: This prospective study was conducted on 80 women with HMB in age group of 35-55 years. Patients were divided into two groups of 40 each and followed for six months. In Group I, LNG-IUS was inserted in post menstrual period and in Group II, patients received oral norethisterone 5 mg twice a day during 5th-25th day of cycle for 6 months. Patients were evaluated about amount and duration of blood loss by pictorial blood assessment chart (PBAC) along with haemoglobin estimation on each follow up visit. MMAS (Menorrhagia Multi-Attribute Scale) score comparison between two groups was done to measure the improvement in quality of life. The results were analysed by using Chi-square test and Student t-test.Results: Percentage reduction in PBAC score after six cycles of treatment was 89.3% in LNG IUS group as compared to 68% in norethisterone group. LNG-IUS was found to be more efficient in correcting anemia, lowering duration of bleeding and improving MMAS score as compared to norethisterone.Conclusions: Present study showed that LNG IUS was superior to oral progestogen in decreasing quantity and duration of bleeding and improving overall quality of life over time.

Role Of Ormeloxifene In Management Of Symptomatic Uterine Leiomyoma In Reproductive Age Group

Introduction : Abnormal uterine bleeding due to leiomyoma is commomn problem in the reproductive age group and was found to be third most common cause of hysterectomies in teaching hospital of India1. The search for ideal drug for medical management of fioid is still on so that we can avoid operative interventions in symptomatic women of reproductive age group. Ormeloxifene is Selective Estrogen Receptor Modulator developed at CDRI, Luckhnow. It has proven to be an important drug in treatment of AUB, but its utility in fioid is yet to be defined. Through this study, we have explored its role in AUB due to leiomyoma. Aim and objective: To assess decrease in menstrual blood loss (MBL) by pictorial blood loss assessment chart to assess increase in hemoglobin level, to assess change in endometrial thickness, to assess change in fioid size in patients of AUB with leiomyoma treated with Ormiloxifene. Materials and Methods: Subjects were given tablet ormeloxifene 60 mg biweekly for 3 months, followed by 60mg weekly for next 3 months. Subjects were assessed after 3 months and 6 months for MBL, endometrial thickness, fioid volume and hemoglobin level. Observation: There was statistically significant decrease in MBL, endometrial thickness, (p=0.0334 and p=0.0096) , increase in hemoglobin(p=0.0001) and no change in fioid volume. after 3 months and 6 months respectivelyConclusion: SERM such as ormeloxifene in standard biweekly dosage is effective in providing symptomatic relief in a patient of AUB-L when prescribed for a short period of 6 months

Sporadic lymphangioleiomyomatosis with multiple atypical features: A case report and literature review

Lymphangioleiomyomatosis (LAM) is a rare, genetically determined, progressive interstitial lung disease, which almost exclusively affects women, especially at the childbearing age. The initial symptoms and radiographic changes in a patient with LAM are always associated with the respiratory system. Here, we present a case of mediastinal and abdominal LAM of a 22-year-old male, where LAM cells are negative for human melanoma black-45 ( HMB-45). The report of this uncharacterized LAM case will make a significant contribution to the realization of LAM associated clinical features, diagnostic approaches, and its afterward treatments.

Effect of concurrent training and supplementation with ß-hydroxy- ß-methylbutyirate (hmb) on the prostate: alterations in the androgen receptor and inflammation / Efecto del entrenamiento concomitante y suplementación con ß-hidroxi-ß-metilbutirato (hmb) en la próstata: alteraciones en el receptor de andrógenos y la inflamación

SUMMARY: Supplementation is a strategy to potentiate physical training through hypertrophy of skeletal muscles, but other tissues such as the prostate may also be affected. Changes in prostate size and function are associated with the behavior of individuals, but evidence for an association with supplementation is scarce. Therefore, the aim of our study was to evaluate the effect of b-hydroxy bmethylbutyrate (HMB) supplementation and concurrent training on the prostate. Wistar rats were divided randomly into four groups with 10 animals each: control group (C), supplemented group (S), training group (T), and supplemented plus training group (TS). The supplemented groups (S and TS) received 76 mg·kg/day of HMB and the concurrent training groups (T and TS) performed exercise three times per week for eight weeks. HMB increased body composition, total weight of the prostate, and altered the histology of prostatic compartments. The lateral prostate of animals in the supplemented group had an increase in mast cells per mm2 (28.0 ± 3.9) compared to the control and exercise group (6.1 ± 3.0; 2.3 ± 0.9) There was also an increase in inflammation in the stroma and lumen of the prostate, and increased expression of androgen receptor (AR) in the supplemented and trained supplemented group (79.8 ± 2.1; 76.8 ± 11.4) in relation to the trained group (61.5 ± 7.0). We concluded that HMB alters hormone receptors that induce morphological changes and inflammation, and animals in the concurrent training group had normal inflammatory and hormonal profiles, and favorable prostatic histology.

RESUMEN: La suplementación con β-hidroxi β-metilbutirato (HMB) es una estrategia para potenciar el entrenamiento físico a través de la hipertrofia de los músculos esqueléticos, pero otros tejidos como la próstata también pueden verse afectados. Los cambios en el tamaño y la función de la próstata están asociados con el comportamiento de las personas, pero la evidencia de una asociación con la suplementación es escasa. Por lo tanto, el objetivo de nuestro estudio fue evaluar el efecto de la suplementación con β-hidroxi βmetilbutirato (HMB) y el entrenamiento concurrente en la próstata. Las ratas Wistar se dividieron aleatoriamente en cuatro grupos con 10 animales cada uno: grupo de control (C), grupo suplementado (S), grupo de entrenamiento (T) y grupo de entrenamiento suplementado (TS). Los grupos suplementados (S y TS) recibieron 76 mg•kg / día de HMB y los grupos de entrenamiento concurrentes (T y TS) realizaron ejercicio tres veces por semana durante ocho semanas. HMB aumentó la composición corporal, el peso total de la próstata y alteró la histología de los compartimentos prostáticos. La próstata lateral de los animales en el grupo suplementado tuvo un aumento en los mastocitos por mm2 (28,0 ± 3,9) en comparación con el grupo de control y ejercicio (6,1 ± 3,0; 2,3 ± 0,9) También hubo un aumento de la inflamación en el estroma y la luz de la próstata, y aumento de la expresión del receptor de andrógenos (AR) en el grupo suplementado y entrenado (79,8 ± 2,1; 76,8 ± 11,4) en relación con el grupo entrenado (61,5 ± 7,0). Concluimos que el HMB altera los receptores de hormonas que inducen cambios morfológicos e inflamación, y los animales en el grupo de entrenamiento concurrente tenían perfiles inflamatorios y hormonales normales y una histología prostática favorable.

Immunohistochemistry: sole tool in diagnosing a rare case of primary vaginal amelanotic melanoma

We report a rare case of vaginal amelanotic melanoma. Malignant melanomas are cutaneous and extracutaneous tumors that arise from embryological remnants of neural crest cells/melanocytes. Amelanotic melanomas at such rare locations can be misdiagnosed both clinically and radiologically. Therefore, histopathological examination and immunohistochemistry are mandatory for the diagnosis of these tumors. We diagnosed this case using histopathology and confirmed the diagnosis based on the presence of immunohistochemical markers human melanoma black 45 (HMB45) and S-100.

Immunohistochemistry of Janus Kinase 1 (JAK1) Expression in Vitiligo

BACKGROUND: Vitiligo is a chronic autoimmune disease in which the destruction of melanocytes causes white spots on the affected skin. Janus kinase (JAK) is a family of intracellular, non-receptor tyrosine kinases that transduce cytokine-mediated signals via the JAK–signal transducer and activator of transcription pathway. The aim of the present study is to explore the possible role of JAK1 in the pathogenesis of vitiligo using immunohistochemical methods. METHODS: The current study was conducted in a sample of 39 patients who presented with vitiligo and 22 healthy individuals who were age and sex matched as a control group. We used immunohistochemistry to evaluate JAK1 status (intensity and distribution) and assess the percentage of residual melanocytes using human melanoma black 45 (HMB45). RESULTS: Intense and diffuse JAK1 expression was significantly more likely to indicate vitiliginous skin compared to normal skin (p < .001). Strong and diffuse JAK1 expression was associated with short disease duration, female sex, and lower percentage of melanocytes (detected by HMB45) (p < .05). CONCLUSIONS: JAK1 may be involved in the pathogenesis of vitiligo, as indicated by intense and diffuse expression compared to control and association with lower percentage of melanocytes detected by HMB45 immunostaining.

A Misdiagnosed Case of Anal Canal Malignant Melanoma: A Case Report.

Anal canal malignant melanoma is an uncommon malignancy. It is a highly aggressive tumor that tends to spread early in the course and present with distant metastasis. Due to the rarity of the condition, treatment is yet to be standardized. We report a case of a 47-y ear-old male patient who presented with the history of mass coming out of anus for 6 months, which was misdiagnosed as a case of hemorrhoids. Abdominoperineal resection was done based on tissue biopsy which suggested it to be a primary anal canal malignant melanoma. The diagnosis was later confirmed by histopathological and immunohistochemistry studies, which was strongly positive for HMB 45 AND Melan-A.

Hepatic perivascular epithelioid cell tumor (PEComa): a case report with a review of literatures

Hepatic perivascular epithelioid cell tumors (PEComas) are very rare. We report a primary hepatic PEComa with a review of the literature. A 56-year-old women presented with a nodular mass detected during the management of chronic renal failure and chronic hepatitis C. Diagnostic imaging studies suggested a nodular hepatocellular carcinoma in segment 5 of the liver. The patient underwent partial hepatectomy. A brown-colored expansile mass measuring 3.2×3.0 cm was relatively demarcated from the surrounding liver parenchyma. The tumor was mainly composed of epithelioid cells that were arranged in a trabecular growth pattern. Adipose tissue and thick-walled blood vessels were minimally identified. A small amount of extramedullary hematopoiesis was observed in the sinusoidal spaces between tumor cells. Tumor cells were diffusely immunoreactive for human melanoma black 45 (HMB45) and Melan A, focally immunoreactive for smooth muscle actin, but not for hepatocyte specific antigen (HSA).

Perivascular Epithelioid Cell Tumor in the Stomach

Perivascular epithelioid cell tumors or PEComas can arise in any location in the body. However, a limited number of cases of gastric PEComa have been reported. We present two cases of gastric PEComas. The first case involved a 62-year-old woman who presented with a 4.2 cm gastric subepithelial mass in the prepyloric antrum, and the second case involved a 67-year-old man with a 5.0 cm mass slightly below the gastroesophageal junction. Microscopic examination revealed that both tumors were composed of perivascular epithelioid cells that were immunoreactive for melanocytic and smooth muscle markers. Prior to surgery, the clinical impression of both tumors was gastrointestinal stromal tumor (GIST), and the second case was erroneously diagnosed as GIST even after microscopic examination. Although gastric PEComa is a very rare neoplasm, it should be considered in the differential diagnosis of gastric submucosal lesions.

The effect of ß-hydroxy-ß-methylbutyrate (HMB) on the morphology of skeletal muscle after concurrent training

The aim of the present study was to investigate the effects of β-hydroxy-β-methylbutyrate (HMB) supplementation in association with concurrent training on morphological soleus muscle of rats. Wistar male rats were divided randomly into four groups: Control (C), Supplemented (S), Training (T) and Training + Supplemented (TS). Groups S and TS received 76mg/kg/day of HMB and the training groups (T and TS) were inserted into concurrent training program 3 times/week for 8 weeks. HMB had positive effects either on body composition of the animals or in type II muscle fibers. The concurrent exercise training was able in reducing the total fat mass as well as in increasing the diameter of muscle fibers. Our findings shows that HMB had an anti-catabolic effect with reference to the parameters of volume, weight and morphology of the soleus muscle, and there was a positive interaction between HMB supplementation and concurrent exercise training

Six Cases of Amelanotic Melanoma: Focused on the Difficulty of Early Differential Diagnosis / 대한피부과학회지

Amelanotic melanoma comprises only 1.8~8.1% of malignant melanomas, and is difficult to diagnose clinically due to the lack of the diagnostic evidence of clinical pigmentation. To our knowledge, it is rarely reported, and only 10 cases have been reported in the Korean dermatological literature. It presents rather conflicting features such as a pink or red macule, papule, plaque, or nodule mimicking various benign and malignant conditions; therefore, it is difficult to diagnose. We performed a review of six patients with amelanotic melanoma focusing on differential diagnosis, particularly at the time of the initial visit. Clinical impressions included pyogenic granuloma, dermatofibrosarcoma protuberans, eccrine poroma, epidermal cyst, keloid, pilomatricoma, and squamous cell carcinoma in addition to malignant melanoma. The biopsy specimens were consistent with malignant melanoma with little or no melanin pigment on hematoxylin and eosin and Fontana-Masson stains. Four of the six patients were positive for S-100 and HMB-45, but two patients were positive for S-100 only. We report these cases to remind clinicians of the necessity of including malignant melanoma in the differential diagnosis process when patients show poor and unpredictable responses to treatment after a clinical diagnosis of other benign and malignant conditions.

Resistance training & beta-hydroxy-beta-methylbutyrate supplementation on hormones / Treinamento de resistência e suplementação de beta-hidroxi-beta-metilbutirato em hormônios / Entrenamiento de resistencia y suplementación de beta-hidroxi-beta-metilbutirato en hormonas

RESUMOIntroduction:In recent years, there was an increased interest on the effects of beta-hydroxy-beta-methylbutyrate (HMB) supplementation on skeletal muscle due to its anti-catabolic effects.Objectives:To investigate the effect of HMB supplementation on body composition, muscular strength and anabolic-catabolic hormones after resistance training.Methods:Twenty amateur male athletes were randomly assigned to supplement and control groups in a double-blind crossover design and participated in four weeks resistance training. Before and after the test period fasting blood samples were obtained to determine anabolic (the growth hormone and testosterone) and catabolic (cortisol) hormones, and fat mass, lean body mass (LBM) and muscular strength were measured. Dependent and independent t-tests were used to analyze data.Results:After the training period, there were no significant differen-ces between the groups with respect to fat mass, LBM and anabolic-catabolic hormones. HMB supplementation resulted in a significantly greater strength gain (p≤0.05).Conclusion:Greater increase in strength for HMB group was not accompanied by body composition and basal circulating anabolic-catabolic hormonal changes. It seems that HMB supplementation may have beneficial effects on neurological adaptations of strength gain.

ABSTRACTIntrodução:Nos últimos anos, houve um aumento no interesse sobre os efeitos da suplementação de beta-hidroxi--beta-metilbutirato (HMB) no musculoesquelético devido aos seus efeitos anticatabólicos.Objetivos:Investigar o efeito da suplementação de HMB na composição corporal, força muscular e hormônios anabólicos-catabólicos após treinamento de resistência.Métodos:Vinte atletas amadores do sexo masculino foram aleatoriamente designados a grupos de su-plemento e de controle em design cruzado duplo-cego, tendo participado de treinamento de resistência durante quatro semanas. Antes e depois do período de teste, foram obtidas amostras de sangue em jejum para determinar os hormônios anabólicos (o hormônio do crescimento e a testosterona) e catabólico (cortisol), tendo a massa adiposa, massa corporal magra (LBM) e força muscular sido mensuradas. Testes t dependentes e independentes foram usados para analisar os dados.Resultados:Após o período de treinamento, não houve nenhuma diferença significativa entre os grupos no que diz respeito à massa adiposa, LBM e hormônios anabólicos-catabólicos. A suplementação de HMB resultou em um ganho de força significativamente maior (p<0,05).Conclusão:O maior aumento na força no grupo HMB não foi acompanhado por alterações na composição corporal e alterações hormonais anabólicas-catabólicas basais na circulação. Parece que a suplementação de HMB pode ter efeitos benéficos sobre as adaptações neurológicas do ganho de força.

RESUMENIntroducción:En los últimos años hubo un aumento en el interés sobre los efectos de la suplementación de beta-hidroxi-beta-metilbutirato (HMB) en el músculo esquelético debido a sus efectos anticatabólicos.Objetivos:Investigar el efecto de la suplementación de HMB en la composición corporal, fuerza muscular y hormonas ana-bólicas-catabólicas después de entrenamiento de resistencia.Métodos:Veinte atletas amateurs del sexo masculino fueron aleatoriamente designados a grupos de suplemento y de control en un diseño cruzado doble ciego, habiendo participado en entrenamiento de resistencia durante cuatro semanas. Antes y después del período de test, fueron obtenidas muestras de sangre en ayunas para determinar las hormonas anabólicas (la hormona del crecimiento y la testosterona) y catabólica (cortisol), habiendo sido medidas la masa adiposa, masa corporal magra (LBM) y fuerza muscular. Los Tests-t dependientes e independientes fueron usados para analizar los datos.Resultados:Des-pués del período de entrenamiento, no hubo ninguna diferencia significativa entre los grupos en lo que se refiere a la masa adiposa, LBM y hormonas anabólicas-catabólicas. La suplementación de HMB resultó en un aumento de fuerza significativamente mayor (p<0,05).Conclusión:El mayor aumento en la fuerza en el grupo HMB no fue acompañado por alteraciones en la composición corporal y alteraciones hormonales anabólicas-catabólicas ba-sales en la circulación. Parece que la suplementación de HMB puede tener efectos benéficos sobre las adaptaciones neurológicas del aumento de fuerza.

A Rare Case of Extracardiac Growing Angiomyolipoma Originating from the Interatrial Septum / 日本心臓血管外科学会雑誌

A 58-year-old man was admitted with a complaint of exertional chest discomfort. A mass, 53×55×66 mm in size, was detected in the transverse sinus of the pericardium, just cranial to the inter-atrial septum with enhanced chest CT. We performed resection of the tumor under cardiopulmonary bypass. Histopathological findings showed that the tumor was angiomyolipoma originated from the heart. Angiomyolipoma is a benign tumor, most frequently found in the kidney or liver and usually associated with tuberous sclerosis. Extra-cardiac growth of the cardiac angiomyolipoma is extremely rare, and only few have been reported previously.

Malignant Perivascular Epithelioid Cell Tumor (PEComa) Arising in the Omentum with Metastatic Peritoneal Seeding: A Case Report / 대한내과학회지

The World Health Organization (WHO) defines a perivascular epithelioid cell tumor (PEComa) as a mesenchymal neoplasia composed of perivascular epithelioid cells with characteristic morphological and immunohistochemical features. They are rarely malignant. Indeed, only a few cases have been reported in the English literature, and this is the first case of PEComa reported in Korea. A 64-year-old man presented with an abdominal mass and peritoneal seeding. The patient underwent mass excision with descending colon resection and anastomosis. The primary mass and peritoneal seeding was diagnosed as a PEComa histopathologically. Seven months later, he developed liver metastasis and aggravated peritoneal seeding. Here, we report a case of malignant PEComa of the omentum.

Unilateral Pigmented Extramammary Paget's Disease of the Axilla Associated with a Benign Mole: A Case Study and a Review of Literature

Pigmented extramammary Paget's disease (PEMPD) is an uncommon intraepithelial adenocarcinoma and a rare variant of Paget's disease affecting skin that is rich in apocrine sweat glands such as the axilla, perianal region and vulva. It most commonly occurs in postmenopausal women and presents as a superficial pigmented scaly macule, mimicking a melanocytic lesion. The histological presentation is adenocarcinoma in situ with an increased number of melanocytes scattered between the Paget's cells. Therefore, PEMPD may be misdiagnosed as a melanocytic tumour both clinically and histologically. The tumour cells are usually positive for cytokeratin 7, epithelial membrane antigen, Cam 5.2, HER2, and mucicarmine stain while S100 and human melanoma black-45 highlight the processes of reactive dendritic cells. The association between Paget's cells and intratumoural reactive melanocytes is still unclear. We report our first case of PEMPD associated with an intradermal naevus involving the axilla in a 63-year-old woman.