Efectos de un programa de rehabilitación cardíaca fase iii en la capacidad funcional y composición corporal en pacientes con cardiopatía isquémica / Effects of a Phase III cardiac rehabilitation program on functional capacity and body composition for coronary heart disease

Introducción y objetivos: Los programas de rehabilitación cardíaca (PRC) fase III han sido poco investigados tanto por los métodos de entrenamiento como por las modalidades de administración. Estudiamos los efectos en capacidad funcional, composición corporal y adherencia a la actividad física de un PRC interdisciplinar basado en ejercicio terapéutico aeróbico combinado con fuerza muscular tras síndrome coronario agudo. Diseño del estudio: Ensayo clínico aleatorizado. Métodos: Ochenta pacientes con cardiopatía isquémica estable y función sistólica preservada fueron incluidos posteriormente a un PRC fase II. Se distribuyeron en grupo control (GC), con ejercicio autónomo y grupo experimental (GE), con ejercicio aeróbico combinado con fuerza muscular comunitaria, además de estrategia educativa de mensajería telefónica instantánea. Ambos grupos realizaron terapia grupal hospitalaria. Se compararon los resultados de capacidad funcional, composición corporal y nivel de actividad física tras 12 meses. Resultados: La capacidad funcional presentó niveles más altos en el GE en la prueba de marcha de 6min, 26,03m (DE: 27,4; p<0,001), y en la ergometría incremental convencional, 0,6METs (DE: 2,2; p=0,021). El nivel de actividad física domiciliaria medido con el cuestionario IPAQ en el GE incrementó 90,38min/semana (DE: 79,7; (p=0,047), y disminuyó el tiempo sedentario entresemana −50,3min/día (DE: 94,5; p=0,001). Ambos grupos aumentaron el tejido adiposo, sobre todo el GC 1,4% (DE: 3,1; p=0,039). Conclusiones: Los pacientes con síndrome coronario agudo que realizaron un PRC fase III comunitario durante 12 meses, mediante ejercicio terapéutico aeróbico combinado con fuerza muscular y estrategias educativas de mensajería telefónica instantánea, presentaron niveles más altos en capacidad funcional y actividad física reportada.(AU)

Introduction and objectives: The effects of a phase III cardiac rehabilitation program (CRP) have been insufficiently studied in terms of training methods and administration. We studied the impact on functional capacity, body composition and physical activity engagement of interdisciplinary program based on aerobic and community strength therapeutic exercise after an acute coronary syndrome. Trial design: Randomised clinical trial. Methods: Eighty consecutive patients with stable ischemic heart disease and preserved systolic function before phase II CRP were included. They were distributed into a control group (CG), with autonomous exercise, and an experimental group (EG), that follows supervised community program based on aerobic exercise and overload dynamic muscle strength, and an educational strategy through short messaging. Both groups underwent monthly inpatient group therapy. Results were compared after 12 months. Results: Functional capacity presented higher levels in the EG and measured by the 6-min walk test (26.0±27.4m; P<.001), and maximal exercise test (0.6±2.2METs; P=.021). Home physical activity measured in minutes by IPAQ questionnaire increased more in the EG (90±78min/week) (P=.047), and the sitting time during the week decreased (−50.25±94.48min/day) (P=.001). There were no differences in body mass index, although we found a higher percentage of adipose tissue in CG after 12 months (P=.039). Conclusions: A multidisciplinary community phase III CRP based on aerobic and dynamic muscle strength therapeutic exercise combined with a short message service educational strategy was feasible. After 12 months, patients in the EG presented higher levels on functional capacity, reported higher physical activity engagement compared to the CG.(AU)

[Effects of a Phase III cardiac rehabilitation program on functional capacity and body composition for coronary heart disease]. / Efectos de un programa de rehabilitación cardíaca fase iii en la capacidad funcional y composición corporal en pacientes con cardiopatía isquémica.

INTRODUCTION AND OBJECTIVES: The effects of a phase III cardiac rehabilitation program (CRP) have been insufficiently studied in terms of training methods and administration. We studied the impact on functional capacity, body composition and physical activity engagement of interdisciplinary program based on aerobic and community strength therapeutic exercise after an acute coronary syndrome. TRIAL DESIGN: Randomised clinical trial. METHODS: Eighty consecutive patients with stable ischemic heart disease and preserved systolic function before phase II CRP were included. They were distributed into a control group (CG), with autonomous exercise, and an experimental group (EG), that follows supervised community program based on aerobic exercise and overload dynamic muscle strength, and an educational strategy through short messaging. Both groups underwent monthly inpatient group therapy. Results were compared after 12 months. RESULTS: Functional capacity presented higher levels in the EG and measured by the 6-min walk test (26.0±27.4m; P<.001), and maximal exercise test (0.6±2.2METs; P=.021). Home physical activity measured in minutes by IPAQ questionnaire increased more in the EG (90±78min/week) (P=.047), and the sitting time during the week decreased (-50.25±94.48min/day) (P=.001). There were no differences in body mass index, although we found a higher percentage of adipose tissue in CG after 12 months (P=.039). CONCLUSIONS: A multidisciplinary community phase III CRP based on aerobic and dynamic muscle strength therapeutic exercise combined with a short message service educational strategy was feasible. After 12 months, patients in the EG presented higher levels on functional capacity, reported higher physical activity engagement compared to the CG.

Efectos de un programa interdisciplinar combinado con entrenamiento aeróbico continuo variable y fuerza dinámica en el síndrome coronario agudo / Effects of an interdisciplinary program combining aerobic interval training and dynamic strength in acute coronary syndrome

Antecedentes y objetivo: La rehabilitación cardíaca tiene el máximo nivel de evidencia en las guías médicas de referencia, sin embargo, existen todavía modalidades de entrenamiento poco exploradas. Estudiamos los efectos de un programa interdisciplinar tras síndrome coronario agudo (SCA) en prevención secundaria fase II. Métodos: Entre enero 2008 y diciembre 2018 se incluyeron 439 pacientes con cardiopatía isquémica estable y función sistólica preservada, máximo dos meses después del SCA. Se aplicó un entrenamiento combinado de resistencia aeróbica en método continuo variable de alta intensidad y de tonificación muscular dinámica con sobrecarga y/o lastre, además de asesoramiento nutricional y terapia psicológica-educativa durante 12 semanas. Resultados: Finalizaron 378 pacientes. La capacidad funcional aumentó en la prueba de esfuerzo incremental (1,76 METS; IC 95% 1,59 a 1,96 p < 0,001) y en la prueba de marcha de seis minutos (32,58 m; IC 95% 29,24 a 35,92 p < 0,001). Aumentó la actividad física de ocio en el IPAQ (763,27 min/semana; IC 95% 583,31 a 943,16 p < 0,001) y disminuyó el tiempo sentado entre semana (-28,85 min/día; IC 95% -43,94 a -13,77 p < 0,001). Además, mejoraron los hábitos alimentarios en el PREDIMED (2,58 unidades; IC 95% 1,43 a 3,73 p < 0,001), disminuyó el peso corporal (-0,88 kg; IC 95% -1,26 a -0,49 p < 0,001), el perímetro abdominal (1,57 cm; IC 95% 2,23 a 0,90 p < 0,001) y el tejido adiposo (-0,80%; IC 95% -1,10 a -0,51 p < 0,001). Conclusiones: Un programa interdisciplinar con entrenamiento continuo variable de alta intensidad combinado con tonificación muscular dinámica produce mejorías en la capacidad funcional, en el nivel de actividad física, en la composición corporal y en los hábitos alimentarios en pacientes con SCA.(AU)

Introduction and objectives: Cardiac rehabilitation has the highest level of recognition in medical guideline references, however there are still little-explored training modalities. We study the effects of an interdisciplinary program after acute coronary syndrome (ACS) in phase II secondary prevention. Methods: Between January 2008 and December 2018, 439 patients with stable ischemic heart disease and preserved systolic function were included, as maximum 2 month after the ACS. A combined aerobic resistance training program in a variable continuous method and muscle toning with overload and/or ballast was applied, in addition to nutritional counseling and psychological-educational therapy for 12 weeks. Results: 378 patients finished. The functional capacity increases in the incremental stress test (1.76 METS; CI 95%: 1.59–1.96, p < 0.001) and in the six minutes walking test (32.58 m; CI 95%: 29.24–35.92, p < 0.001). Leisure physical activity in IPAQ increased (763.27 min/week; CI 95%: 583.31–943.16, p < 0.001) and the time sitting during the week decreased (−28.85 min/day; CI 95%: −43.94 to −13.77, p < 0.001). Also, eating habits improved in PREDIMED (2.58 units; CI 95%: 1.43–3.73, p < 0.001), decreased body weight (−0.88 kg; CI 95%: −1.26 to −0.49, p < 0.001), the abdominal perimeter (1.57 cm; CI 95%: 2.23–0.90, p < 0.001) and adipose tissue (−0.80%; CI 95%: −1.10 to −0.51, p < 0.001). Conclusions: An interdisciplinary program with high intensity variable continuous training combined with dynamic muscle toning increases functional capacity, the level of physical activity, improves body composition and eating habits in ACS patients.(AU)

Efectos del entrenamiento de fuerza domiciliario durante el confinamiento por COVID-19 en el síndrome coronario agudo / Effects of home-based strength training during COVID-19 lockdown in acute coronary syndrome

Introducción y objetivo: La rehabilitación cardíaca tiene el máximo nivel de evidencia en las guías médicas de referencia. Estudiamos los efectos de un programa interdisciplinar dirigido mediante telemedicina tras síndrome coronario agudo en prevención secundaria fase ii en periodo de confinamiento por COVID-19. Métodos: Entre el 2 y 11 de marzo de 2020 se incluyeron 37 pacientes predominantemente con cardiopatía isquémica estable (76,4%) y función sistólica preservada sometidos a tratamiento 12 semanas. Se aplicó un programa de entrenamiento de tonificación muscular dinámico con sobrecarga domiciliario, además de asesoramiento nutricional y terapia psicológica y educativa mediante telemedicina. Resultados: De la cohorte inicial, finalizaron 30 pacientes. La capacidad funcional aumentó en la prueba de marcha de seis minutos (47,13m; IC95% 32,82 a 61,45; p<0,001), donde se produjo también un descenso de la sensación subjetiva de disnea inicial (−0,5unidades; IC95% −0,76 a −0,24; p=0,001) en la escala de Borg modificada y de la tensión arterial sistólica inicial (−6,67mmHg; IC95% −10,98 a −2,35; p=0,004) y final (−7mmHg; IC95% −12,86 a −1,14; p=0,021). Se observó un aumento del nivel de actividad física en el tiempo de ocio en el IPAQ (1162,93min/semana; IC95% 237,36 a 2088,5; p=0,016) y mejoraron los hábitos alimentarios mediterráneos en el test PREDIMED (2,1unidades; IC95% 1,32 a 2,28; p<0,001). Conclusiones: Los pacientes que realizaron 3 meses de rehabilitación cardíaca domiciliaria aumentaron la capacidad funcional y mejoraron los hábitos higiénico-alimentarios, además disminuyeron su sensación de disnea inicial. La rehabilitación cardíaca domiciliaria mediante telemedicina produce una mejoría del paciente tras sufrir síndrome coronario agudo.(AU)

Introduction and objective: Cardiac rehabilitation has the highest level of recognition in medical guideline references. The rise of COVID-19 pandemic, particularly during the first months of strict containment, cause to temporally stop most of the ongoing programs. We studied the effects of an interdisciplinary phase II secondary prevention in patients diagnosed with a recent acute coronary syndrome with the use of new technologies, home-exercise and telemedicine. Methods: Between the 2nd and 11th of March 2020, we included 37 patients with recent acute coronary syndrome (76.4%), low-risk and preserved systolic function and underwent a 12-week treatment. A dynamic muscle toning with overload domiciliary training program was applied, in addition to nutritional counselling, as well as psychological and educational therapy. Results: Of the initial cohort, 30 patients finished. At the end of the program, we observed and increased functional capacity over the 6-min walking test (+47.13m; 95% CI: 32.82-61.45, P<.001), and improvement to the subjective feeling of dyspnoea on the modified Borg scale (−0.5 units; 95% CI: −0.76 to −0.24, P=.001), and an improvement over both initial and final training systolic blood pressure (−6.67mmHg; 95% CI: −10.98 to −2.35, P=.004) (−7mmHg; 95% CI: −12.86 to −1.14, P=.021). We also observed an increase in the level of physical activity during leisure time in the IPAQ questionnaire (+1162.93min/week; 95% CI: 237.36–2088.5, P=.016), and in the Mediterranean eating habits on the PREDIMED test (+2.1units; 95% CI: 1.32–2.28, P<.001). Conclusions: After three months of a domiciliary cardiac rehabilitation program, patients increased their functional capacity, feeling of dyspnoea, blood pressure and eating habits. Domiciliary telemedicine cardiac rehabilitation program produces an improvement in the patient after acute coronary syndrome.(AU)

[Effects of home-based strength training during COVID-19 lockdown in acute coronary syndrome]. / Efectos del entrenamiento de fuerza domiciliario durante el confinamiento por COVID-19 en el síndrome coronario agudo.

INTRODUCTION AND OBJECTIVE: Cardiac rehabilitation has the highest level of recognition in medical guideline references. The rise of COVID-19 pandemic, particularly during the first months of strict containment, cause to temporally stop most of the ongoing programs. We studied the effects of an interdisciplinary phase II secondary prevention in patients diagnosed with a recent acute coronary syndrome with the use of new technologies, home-exercise and telemedicine. METHODS: Between the 2nd and 11th of March 2020, we included 37 patients with recent acute coronary syndrome (76.4%), low-risk and preserved systolic function and underwent a 12-week treatment. A dynamic muscle toning with overload domiciliary training program was applied, in addition to nutritional counselling, as well as psychological and educational therapy. RESULTS: Of the initial cohort, 30 patients finished. At the end of the program, we observed and increased functional capacity over the 6-min walking test (+47.13m; 95% CI: 32.82-61.45, P<.001), and improvement to the subjective feeling of dyspnoea on the modified Borg scale (-0.5 units; 95% CI: -0.76 to -0.24, P=.001), and an improvement over both initial and final training systolic blood pressure (-6.67mmHg; 95% CI: -10.98 to -2.35, P=.004) (-7mmHg; 95% CI: -12.86 to -1.14, P=.021). We also observed an increase in the level of physical activity during leisure time in the IPAQ questionnaire (+1162.93min/week; 95% CI: 237.36-2088.5, P=.016), and in the Mediterranean eating habits on the PREDIMED test (+2.1units; 95% CI: 1.32-2.28, P<.001). CONCLUSIONS: After three months of a domiciliary cardiac rehabilitation program, patients increased their functional capacity, feeling of dyspnoea, blood pressure and eating habits. Domiciliary telemedicine cardiac rehabilitation program produces an improvement in the patient after acute coronary syndrome.

[Effects of an interdisciplinary program combining aerobic interval training and dynamic strength in acute coronary syndrome]. / Efectos de un programa interdisciplinar combinado con entrenamiento aeróbico continuo variable y fuerza dinámica en el síndrome coronario agudo.

INTRODUCTION AND OBJECTIVES: Cardiac rehabilitation has the highest level of recognition in medical guideline references, however there are still little-explored training modalities. We study the effects of an interdisciplinary program after acute coronary syndrome (ACS) in phase II secondary prevention. METHODS: Between January 2008 and December 2018, 439 patients with stable ischemic heart disease and preserved systolic function were included, as maximum 2 month after the ACS. A combined aerobic resistance training program in a variable continuous method and muscle toning with overload and/or ballast was applied, in addition to nutritional counseling and psychological-educational therapy for 12 weeks. RESULTS: 378 patients finished. The functional capacity increases in the incremental stress test (1.76 METS; CI 95%: 1.59-1.96, p < 0.001) and in the six minutes walking test (32.58 m; CI 95%: 29.24-35.92, p < 0.001). Leisure physical activity in IPAQ increased (763.27 min/week; CI 95%: 583.31-943.16, p < 0.001) and the time sitting during the week decreased (-28.85 min/day; CI 95%: -43.94 to -13.77, p < 0.001). Also, eating habits improved in PREDIMED (2.58 units; CI 95%: 1.43-3.73, p < 0.001), decreased body weight (-0.88 kg; CI 95%: -1.26 to -0.49, p < 0.001), the abdominal perimeter (1.57 cm; CI 95%: 2.23-0.90, p < 0.001) and adipose tissue (-0.80%; CI 95%: -1.10 to -0.51, p < 0.001). CONCLUSIONS: An interdisciplinary program with high intensity variable continuous training combined with dynamic muscle toning increases functional capacity, the level of physical activity, improves body composition and eating habits in ACS patients.

Análisis comparativo de los valores de las presiones respiratorias máximas con los valores de referencia en una población adulta sana / Comparative analysis of maximal respiratory pressures with the reference values of a healthy adult population

Antecedentes y objetivo: La determinación de las presiones respiratorias máximas es un procedimiento no invasivo de gran utilidad clínica para la evaluación de la fuerza de los músculos respiratorios. El objetivo es analizar en qué medida las ecuaciones predictivas existentes para población española, se ajustan a los valores observados de presión inspiratoria y espiratoria máximas (PEM y PIM) en una muestra de sujetos adultos sanos. Material y métodos: Estudio descriptivo observacional de corte transversal en el que se reclutaron 63 sujetos sanos mediante muestreo probabilístico aleatorizado simple entre la comunidad universitaria de la Universidade da Coruña. Las presiones respiratorias máximas se efectuaron con un transductor de presiones conectado a una boquilla de submarinista, siguiendo las recomendaciones de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR). Se compararon los resultados con las ecuaciones de Morales de 1997. Resultados: Se presentan los datos de 24 mujeres y 39 hombres (45,94 ± 16,71 años). Existe una diferencia estadísticamente significativa en las mujeres de -19,08 ± 23,57 cmH2O y de -28,13 ± 29,93 cmH2O para la PIM y la PEM, respectivamente, entre el valor observado y el valor predicho. Asimismo, en el caso de los hombres se observó una diferencia estadísticamente significativa de -25,18 ± 24,31 cmH2O para la PIM y de -39,53 ± 44,38 cm H2O para la PEM. Conclusiones: Las ecuaciones predictivas disponibles para las presiones respiratorias máximas sobreestiman considerablemente los valores alcanzados de la PIM y la PEM. Los resultados del presente estudio ponen de manifiesto la necesidad de realizar nuevas ecuaciones de referencia a través de un estudio multicéntrico representativo de toda la población española

Background and aim: The determination of maximal respiratory pressures is a non-invasive process of high clinical value for assessing respiratory muscle strength. The aim is to analyse to what extent the existing predictive equations for the Spanish population are adjusted to the maximal inspiratory and expiratory pressures (MIP and MEP) values observed in a sample of healthy adult subjects. Material and methods: A cross-sectional study was conducted on a sample of 63 healthy subjects recruited from the A Coruña University community using a simple random probabilistic method. Maximal respiratory pressures were performed using a pressure transducer connected to a scuba mouthpiece according to the standards of Spanish Society of Pulmonology and Thoracic Surgery (SEPAR). The results were compared with predictive equations proposed by Morales in 1997. Results: The study included the results from 24 females and 39 males (45.94 ± 16.71 years). Females showed a statically significant difference between the observed and predictive values, with -19.08 ± 23.57 cm H2O and -28.13 ± 29.93 cm H2O for MIP and MEP. A statistically significant difference was also observed for males with -25.18 ± 24.31 cm H2O for MIP and -39.53 ± 44.38 cm H2O for MEP. Conclusions: Predictive equations to calculate the theoretical values of maximal respiratory pressures in a healthy Spanish adult population overestimate considerably the real values of MIP and MEP. The results of this study highlight the need to create new reference equations by conducting a multicentre study representative of the entire Spanish population

30-Day unplanned surgery in cervical spondylotic myelopathy surgically treated: a single-center experience.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: Analyze the rate and risk factors associated with Unplanned Surgeries (US) during the first 30 days in patients treated for cervical spondylotic myelopathy. BACKGROUND: US are often regarded as a potentially useful quality of care indicator. METHODS: We defined US as any, non-planned, surgical procedure as a complication after "index" surgery. Demographic data, comorbidities, ASA, smoking status, surgical details and postoperative complications were collected. We conducted a subjective outcome test using the Global Outcome Score (GOS). To assess risk factors, a bivariate analysis was performed using T Student or Chi-square. Risk is shown as odds ratio (OR) with 95% confidence interval (CI). Multivariable logistic regression models with bootstrap resampling procedure were performed. RESULTS: The study included 303 patients (200 men) with mean age of 57.7 years (27-86) and mean follow-up of 75.35 months (16-126 m). 63.3% patients were ASA 1 or 2 and 41.9% were smokers. 77.9% of patients had some comorbidity. Anterior approach surgeries were 65.7%. Perioperative complications: 29% medical, 8.9% intraoperative and 3% implant related. US rate was 2.6%. Causes for revision were postoperative infection or deep hematomas. After bivariate analysis, the risk factors associated were diabetes mellitus (OR 2.6; 95% CI 1-5.5) and intraoperative complications (OR 6.5, 95% CI 1-40). The presence of US does not have influence in satisfaction using GOS score. CONCLUSIONS: Our US rate was 2.6%, similar to the literature. Diabetics and patients suffering an intraoperative complication are more likely to need an early reinterventions (OR 2.2 and 6.5, respectively). US did not alter the patient's outcomes. These slides can be retrieved under Electronic Supplementary Material.

Mantenimiento de los efectos tras la rehabilitación pulmonar en pacientes con enfermedad pulmonar obstructiva crónica / Maintenance of effects after pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

Antecedentes/objetivo: La duración de los efectos de la rehabilitación pulmonar (RP) en pacientes con enfermedad pulmonar obstructiva crónica (EPOC) es limitada. El objetivo del estudio fue describir los efectos a corto y largo plazo de varias modalidades de programas clínicos de RP en pacientes con EPOC e identificar los posibles factores influyentes. Pacientes/métodos: Estudio observacional longitudinal retrospectivo. Sujetos con EPOC (n=35) que recibieron uno de los siguientes programas clínicos de RP (8 semanas): PRP1 (entrenamiento aeróbico), PRP2 (entrenamiento aeróbico-fuerza) y PRP3 (entrenamiento aeróbico-fuerza-músculos respiratorios). Variables: capacidad de ejercicio (distancia en la Prueba de Marcha de Seis Minutos, 6MWD), disnea (escala modificada del Medical Research Council, mMRC) y presiones respiratorias (solo PRP3), evaluadas pretratamiento, postratamiento y tras 12 meses. Resultados: Postratamiento mejoró la 6MWD (59,1±27,3 m; p <0,01) y se redujo la escala mMRC (−0,7±0,4; p <0,01). Tras 12 meses desde el postratamiento, se produjo un declive en la 6MWD (−49,8±23 m; p <0,01) y un incremento en la escala mMRC (0,7±0,4; p <0,01). Estos resultados fueron ligeramente superiores en los grupos PRP2 y PRP3, pero sin diferencias significativas (p> 0,05). Un comportamiento similar se observó en las presiones respiratorias. Se analizaron los posibles factores influyentes en el declive en la 6MWD durante el seguimiento. Solo se encontró una correlación significativa e inversa entre el incremento en la 6MWD postratamiento y su declive postseguimiento (r=−0,52; p <0,01). Conclusión: Los programas convencionales de RP en EPOC mejoran la capacidad de ejercicio y la disnea, pero estos beneficios se pierden tras 12 meses sin mantenimiento. El incremento en la 6MWD tras la RP puede ser un factor pronóstico del declive en la tolerancia al ejercicio

Background/objective: The duration of the effects of pulmonary rehabilitation (PR) in patients with chronic obstructive pulmonary disease (COPD) is limited. The aim of the study was to describe the short- and long-term effects of various modalities of clinical PR programs in COPD patients and to identify possible influencing factors. Patients/methods: Retrospective longitudinal observational study was conducted on 35 COPD subjects who received one of the following PR clinical programs (8 weeks): PRP1 (endurance training), PRP2 (endurance-strength training), and PRP3 (endurance-strength-respiratory muscle training). Variables: exercise capacity (distance in the Six-Minute Walk Test, 6MWD), dyspnoea (modified Medical Research Council Scale, mMRC), and respiratory pressures (only PRP3), evaluated pre-treatment, post-treatment and post-12 months. Results: The 6MWD improved post-treatment (59.1±27.3 m, P <.01) and the mMRC Scale was reduced (−0.7±0.4, P <0.01). Post−12 months after treatment there was a decline in 6MWD (−49.8±23 m, P <0.01) and an increase in mMRC Scale (0.7±0.4, P <0.01). These results were slightly higher in the PRP2 and PRP3 groups, but without significant differences (P> 0.05). A similar behaviour was observed in the respiratory pressures. An analysis was made of the possible influencing factors in the decline in 6MWD during follow−up. Only a significant and inverse correlation was found between the increase in post−treatment 6MWD and its post−12 months decline (r=−0.52, P <0.01). Conclusion: Conventional PR programs in COPD improve exercise capacity and dyspnoea, but these benefits are lost after 12 months without maintenance. The increase in 6MWD after PR may be a prognostic factor of decline in exercise tolerance

TRPM8, ASIC1, and ASIC3 localization and expression in the human oropharynx.

BACKGROUND: Oropharyngeal dysphagia (OD) is a prevalent disease with poor prognosis among older people and has no pharmacological treatment. Polymodal sensory receptors like the TRP or ASIC family receptors are potential targets to treat OD. TRPM8 agonists and acidic solutions can improve the swallow response in patients with OD, but little is known about the expression of TRPM8, ASIC1, and ASIC3 in the human oropharynx. The aim of this study was to assess the expression and localization of TRPM8, ASIC1, and ASIC3 in human samples of the oropharynx to lay the basis for new pharmacological treatments for OD. METHODS: Pathology-free samples from oropharyngeal regions innervated by cranial nerves V, IX, and X were obtained during major ENT surgery and processed to obtain mRNA (20 patients) or to be used in immunohistochemical assays (12 patients). TRPM8, ASIC1, and ASIC3 expression and localization were studied with RT-qPCR and fluorescent immunohistochemistry. KEY RESULTS: ASIC3 was expressed in the 3 regions studied with similar levels and was localized on sensory fibers innervating the mucosa below the basal lamina of all studied regions. TRPM8 was also co-localized on the sensory fibers innervating the mucosa below the basal lamina of all studied regions. In contrast, ASIC1 was only found in the nerves innervating the tongue muscular fibers. CONCLUSIONS & INFERENCES: TRPM8 and ASIC3 are found on submucosal sensory nerves in the human oropharynx. Our study lays the basis to use oropharyngeal TRPM8 and ASIC3 receptors as therapeutic targets to develop new active pharmacological treatments for OD patients.

Pericytes, integral components of adult hematopoietic stem cell niches.

The interest in perivascular cells as a niche for adult hematopoietic stem cells (HSCs) is significantly growing. In the adult bone marrow (BM), perivascular cells and HSCs cohabit. Among perivascular cells, pericytes are precursors of mesenchymal stem/stromal cells (MSCs) that are capable of differentiating into osteoblasts, adipocytes and chondrocytes. In situ, pericytes are recognised by their localisation to the abluminal side of the blood vessel wall and closely associated with endothelial cells, in combination with the expression of markers such as CD146, neural glial 2 (NG2), platelet derived growth factor receptor ß (PDGFRß), α-smooth muscle actin (α-SMA), nestin (Nes) and/or leptin receptor (LepR). However, not all pericytes share a common phenotype: different immunophenotypes can be associated with distinct mesenchymal features, including hematopoietic support. In adult BM, arteriolar and sinusoidal pericytes control HSC behaviour, maintenance, quiescence and trafficking through paracrine effects. Different groups identified and characterized hematopoietic supportive pericyte subpopulations using various markers and mouse models. In this review, we summarize recent work performed by others to understand the role of the perivascular niche in the biology of HSCs in adults, as well as their importance in the development of therapies.

Oropharyngeal and laryngeal sensory innervation in the pathophysiology of swallowing disorders and sensory stimulation treatments.

Oropharyngeal dysphagia (OD) affects older and neurological patients, causing malnutrition and dehydration and increasing the risk for aspiration pneumonia. There is evidence that sensory deficits in those populations are closely related to swallowing disorders, and several research groups are developing new therapies based on sensory stimulation of this area. More information on the sensory innervation participating in the swallow response is needed to better understand the pathophysiology of OD and to develop new treatments. This review focuses on the sensory innervation of the human oropharynx and larynx in healthy people compared with patients with swallowing disorders in order to unravel the abnormalities that may lead to the loss of sensitivity in patients with OD. We also hypothesize the pathway through which active sensory-enhancement treatments may elicit their therapeutic effect on patients with swallowing dysfunctions. As far as we know, this is the first time a review covers the anatomy, histology, ultrastructure, and molecular biology of the sensory innervation of the swallowing function.

Localization and expression of TRPV1 and TRPA1 in the human oropharynx and larynx.

BACKGROUND: Previous studies have found that TRPV1 and TRPA1 receptor agonists improve swallow response in patients with oropharyngeal dysphagia (OD), but little is known about the expression of these receptors in the human oropharynx. The aim of this study was to assess the expression and localization of TRPV1 and TRPA1 in human samples from the oropharynx of healthy patients, to provide the basis for new pharmacological treatments for OD. METHODS: Samples from oropharyngeal regions innervated by cranial nerves V, IX, and X (tongue, pharynx, and epiglottis) were obtained during ENT surgery and processed either for mRNA (21 patients) or for immunohistochemical assays (seven patients). The expression analysis was performed with RT-qPCR using ACTBh as reference gene. Hemotoxylin and eosin staining was used to study the histology; the immunohistochemical assay used (i) neuron-specific enolase to detect nerve fibers or (ii) fluorescent probes to locate TRPV1 and TRPA1. RESULTS: TRPV1 was expressed in the three studied regions, with higher levels in CN V region (tongue) than in CN X region (epiglottis; p < 0.05), and was localized at epithelial cells and nociceptive fibers in all studied regions. TRPA1 was also expressed in all studied regions, but was always localized below the basal lamina. No immunoreactivity for TRPA1 was found on epithelial cells. CONCLUSIONS & INFERENCES: TRPV1 and TRPA1 are widely expressed in the human oropharynx with two distinct patterns. Our study further confirms that TRPV1/A1 receptors are promising therapeutic targets to develop active treatments for OD patients.

Atlanto axial instability due to neurofibromatosis: case report.

Neurofibromatosis is an autosomal dominant genetic disease, characterized by café au lait spots, neurofibromas and several bony anomalies. Deformities of the spine are the most frequent alterations. Involvement of the cervical spine has been studied less frequently. The case of a 16-year-old male patient affected by neurofibromatosis, with cervical pain without neurological symptoms is presented. X-rays, CT-scan and MRI demonstrated the presence of cervical kyphosis, occipitoaxial instability and atlantoaxial instability with subluxation. Posterior occipito-C2 fusion was performed with prior placement of a halo-vest. The outcome at four years was good with solid occipito axial fusion, moderate loss of cervical spine flexion and moderate-to-severe limitation of cervical spine rotation. The incidence and variety of alterations of the cervical spine in patients affected with neurofibromatosis is discussed, as well as the results obtained by the treatment.

Vertebral artery occlusion after acute cervical spine trauma.

STUDY DESIGN: A retrospective study of vertebral artery injury diagnosed during the last 6 years in our institution. OBJECTIVES: To determine the clinical and radiologic features of vertebral artery injury. SUMMARY OF BACKGROUND DATA: Extracranial occlusion of the vertebral artery associated with cervical spine fracture is uncommon and can cause serious and even fatal neurologic deficit due to back lifting and cerebellar infarction. Magnetic resonance imaging and magnetic resonance angiography are extremely helpful in the examination of acute injuries of the cervical spine. METHODS: Magnetic resonance imaging and magnetic resonance angiography were performed at the time of injury. RESULTS: The authors reviewed six patients with cervical spine fractures who were diagnosed with a unilateral occlusion of the vertebral artery by means of magnetic resonance imaging/magnetic resonance angiography. One patient had signs of vertebrobasilar insufficiency and another with complete cord lesion had cerebellar and back lifting infarctions. Surgical anterior spinal fusion was performed in five patients, and one was treated by traction and orthosis. At the time of discharge, five patients had no vertebrobasilar symptoms, and the patient who experienced vertebrobasilar territory infarctions showed no progression of the neurologic damage. CONCLUSIONS: Vertebral artery injury should be suspected in cervical trauma patients with facet joint dislocation or transverse foramen fracture. Magnetic resonance imaging/magnetic resonance angiography is a helpful test to rule out vascular injury. Vertebral artery injury affects the extracranial segment at the same level as the cervical fracture. This is a retrospective review that did not permit drawing conclusions about the effects of early surgical stabilization in the treatment of cervical spine injuries with associated vertebral artery injury; however, surgical stabilization may avoid propagation and embolization of the clot located at the site of the lesion.

[Efficacy and safety of dotarizine vs. cinnarizine in the symptomatic treatment of acute balance disorders (common vertigo)]. / Eficacia y seguridad de dotarizina frente a cinarizina en el tratamiento sintomático de los trastornos agudos del equilibrio (vértigo común).

One hundred and ten adult patients suffering from peripheral vertigo were treated in a multifactorial double-blind randomized clinical trial with dotarizine (50 mg b.i.d.) or cinnarizine (75 mg b.i.d.). There was a 60 days clinical follow-up. Results showed that dotarizine was significantly active against the vertigo attacks and its associated symptoms (mainly neurovegetative). The global superiority of dotarizine was confirmed by statistically significant differences between treatments in the improvement of the severity of vertigo, hearing loss in audiometries, global relief of symptoms, disability produced by crises and global assessment by the investigators themselves. No clinically significant unwanted effects were seen in either group on blood pressure, heart rate or analytical parameters. No serious adverse effects to dotarizine were reported. This study confirms the value of dotarizine in the treatment of peripheral vertigo.