ABSTRACT
Myoelectric activity and range of motion during ULNT1 were recorded in 62 breast cancer (BC) survivors who had axillary lymph node dissection (nâ¯=â¯30) or sentinel lymph node biopsy (nâ¯=â¯32) within the previous 18 months, and 63 age-matched healthy women. BC survivors' symptoms were reproduced by ULNT1 and exhibited greater myoelectric activity in the biceps brachii than healthy women (MD (95% CI): 21,26 (10,83-31,70)). No differences between the axillary lymph node dissection and sentinel lymph node biopsy groups (MD (95% CI): 8,47 (-7,84-24,79)) were found. Myoelectric activity in the triceps brachii was greater in the sentinel lymph node biopsy group (MD (95% CI): 2,70 (-2,06-7,60)). BC survivors exhibited less shoulder and elbow range of motion during ULNT1 than healthy women. Increased upper limb nerve mechanosensitivity in BC survivors was associated with a greater protective muscle response during ULNT1.
Subject(s)
Breast Neoplasms/rehabilitation , Cancer Survivors , Lymph Node Excision/rehabilitation , Muscle Contraction/physiology , Muscle, Skeletal/physiology , Range of Motion, Articular/physiology , Shoulder Joint/physiology , Adult , Aged , Cross-Sectional Studies , Female , Humans , Middle AgedABSTRACT
OBJECTIVE: The condition of critically ill patients in the emergency department (ED) varies from moment to moment. The aims of this study are to quantify sequential organ failure assessment (SOFA) and changes in SOFA scores over time and determine its prognostic impact. PATIENTS AND METHODS: This is a prospective observational cohort study. We included 269 patients consecutively admitted to the ICU from the ED over 18 months. The SOFA scores at ED admission (ED-SOFA) and ICU admission (ICU-SOFA) were obtained. Relative changes in SOFA scores were calculated as follows: Δ-SOFA=ICU-SOFA-ED-SOFA. Patients were divided into two groups depending on the Δ-SOFA score: (a) Δ-SOFA=0-1; and (b) Δ-SOFA more than or equal to 2. RESULTS: The median ED-SOFA score was two points (interquartile range: 1-4.5) and the Δ-SOFA score was 2 points (interquartile range: 0-3). The Δ-SOFA score was more powerful (area under the curve: 0.81) than the ED-SOFA score (area under the curve: 0.75) in predicting hospital mortality. Sixteen (6%) patients had a Δ-SOFA score less than 0, 116 (43%) patients had a Δ-SOFA=0-1, and 137 (51%) patients had a Δ-SOFA of at least 2 points. The probability of being alive at hospital discharge was 51 and 86.5% in Δ-SOFA of at least 2 and Δ-SOFA=0-1 groups, respectively (P<0.001). Risk factors for an increase of two or more SOFA points were age, cirrhosis, a diagnosis of sepsis, and a prolonged ED stay. CONCLUSION: SOFA and changes in the SOFA score over time are potentially useful tools for risk stratification when applied to critically ill patients admitted to ICUs from the ED.
Subject(s)
APACHE , Critical Care/methods , Critical Illness/classification , Hospital Mortality , Multiple Organ Failure/diagnosis , Multiple Organ Failure/mortality , Adult , Cohort Studies , Combined Modality Therapy , Critical Illness/mortality , Critical Illness/therapy , Emergency Service, Hospital , Female , Humans , Kaplan-Meier Estimate , Length of Stay , Male , Middle Aged , Multiple Organ Failure/therapy , Organ Dysfunction Scores , Predictive Value of Tests , Prognosis , Prospective Studies , ROC Curve , Risk Assessment , Treatment OutcomeABSTRACT
INTRODUCTION AND OBJECTIVES: To analyze the association between sitting time and biomarkers of insulin resistance and inflammation in a sample of healthy male workers. METHODS: Cross-sectional study carried out in a sample of 929 volunteers belonging to the Aragon Workers' Health Study cohort. Sociodemographic, anthropometric, pharmacological and laboratory data were collected: lipids-total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, apolipoproteins A-1 and B-100, lipoprotein (a)-, insulin resistance-glucose, glycated hemoglobin, homeostasis model assessment of insulin resistance, insulin, and triglyceride/high-density lipoprotein cholesterol ratio-, and inflammatory profile-C-reactive protein and leukocytes. Information on sitting time and physical activity was assessed using a questionnaire. Sedentary behavior was analyzed in terms of prevalences and medians, according to tertiles, using a multivariate model (crude and adjusted linear regression) with biomarkers of inflammation and insulin resistance. RESULTS: The most sedentary individuals had higher body mass index, greater waist circumference, and higher systolic blood pressure, with a significant upward trend in each tertile. Likewise, they had a worse lipid profile with a higher C-reactive protein level, homeostasis model assessment of insulin resistance index, triglyceride/high-density lipoprotein cholesterol ratio, and insulin concentration. In the multivariate analysis, we observed a significant association between the latter parameters and sitting time in hours (log C-reactive protein [ß = 0.07], log homeostasis model assessment of insulin resistance index [ß = 0.05], triglyceride/high-density lipoprotein cholesterol ratio [ß = 0.23], and insulin [ß = 0.44]), which remained after adjustment for metabolic equivalents-h/week. CONCLUSIONS: Workers who spend more time sitting show a worse inflammatory and insulin resistance profile independently of the physical activity performed.