Variaciones de la prostatectomía radical para una recuperación de la continencia urinaria precoz: una revisión sistemática / Early continence after radical prostatectomy: A systematic review

Contexto y objetivo: La incontinencia urinaria es el efecto secundario con mayor impacto en la calidad de vida después de la prostatectomía radical. El objetivo de nuestro artículo es revisar la evidencia científica actual sobre las variaciones quirúrgicas descritas para preservar la continencia urinaria después de la prostatectomía radical. Adquisición de la evidencia: Se realizó una revisión sistemática de la literatura en PubMed, Cochrane y ScienceDirect según los criterios PRISMA (Preferred reporting items for systematic reviews and meta-analyses), utilizando los términos: urinary continence, urinary incontinence, urinary leakage, radical prostatectomy, open radical prostatectomy, laparoscopic prostatectomy, robot assisted laparoscopic prostatectomy, robotic prostatectomy y los criterios de selección PICO. Se identificaron 1.603 referencias de las que se seleccionaron 27 publicaciones que cumplieron los criterios de inclusión, 6 fueron ensayos clínicos aleatorizados y 4 metaanálisis. Síntesis de la evidencia: Las técnicas más empleadas para alcanzar una continencia urinaria precoz son la preservación del cuello vesical, de las bandeletas neurovasculares y la reconstrucción del rabdoesfínter, siendo esta la técnica con mayor evidencia, ya que existen 3 ensayos clínicos aleatorizados. Pese que algunas variaciones técnicas han conseguido mejorías en los resultados funcionales, la ausencia de consenso en la definición de incontinencia urinaria y la manera de evaluarla no permiten elaborar recomendaciones técnicas basadas en evidencia científica de calidad. Conclusiones: La reconstrucción del rabdoesfínter es la única técnica que ha demostrado mejoría en la recuperación precoz de la continencia urinaria tras la prostatectomía radical. La evidencia científica actual es heterogénea y limitada, por lo que son necesarios estudios aleatorizados bien diseñados para evaluar las modificaciones técnicas

Background and objective: Urinary incontinence is the adverse effect with more impact on patients’ quality of life after undergoing radical prostatectomy. The objective of this study is to review the present evidence that describes the variations on surgical techniques which aim to preserve urinary continence after radical prostatectomy. Evidence acquisition: We searched the literature on PubMed, Cochrane, and ScienceDirect according to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement, using the PICO review protocol. The search terms were urinary continence, urinary incontinence, urinary leakage, radical prostatectomy, open radical prostatectomy, laparoscopic prostatectomy, robot-assisted laparoscopic prostatectomy, robotic prostatectomy. We identified 1,603 registers, and 27 articles were reviewed for meeting the inclusion criteria. Six of them are randomized clinical trials and 4 of them, meta-analysis. Evidence synthesis: The surgical techniques more frequently used to achieve early urinary continence are bladder neck and neurovascular bundles preservation, as well as the reconstruction of the rhabdosphincter. The latter has been presented in three randomized clinical trials. Even though some approaches have obtained improved functional outcomes, the lack of consensus on the definition of urinary incontinence and its measurement methods have not advocated for the creation of technical recommendations based on scientific evidence. Conclusions: The reconstruction of the rhabdosphincter is the only technique that has shown improved functional results through randomized trials. The current evidence is limited and heterogenous, and more studies with consistent criteria are needed in order to establish a standard surgical technique

Early continence after radical prostatectomy: A systematic review. / Variaciones de la prostatectomía radical para una recuperación de la continencia urinaria precoz: una revisión sistemática.

BACKGROUND AND OBJECTIVE: Urinary incontinence is the adverse effect with more impact on patients' quality of life after undergoing radical prostatectomy. The objective of this study is to review the present evidence that describes the variations on surgical techniques which aim to preserve urinary continence after radical prostatectomy. EVIDENCE ACQUISITION: We searched the literature on PubMed, Cochrane, and ScienceDirect according to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement, using the PICO review protocol. The search terms were urinary continence, urinary incontinence, urinary leakage, radical prostatectomy, open radical prostatectomy, laparoscopic prostatectomy, robot-assisted laparoscopic prostatectomy, robotic prostatectomy. We identified 1,603 registers, and 27 articles were reviewed for meeting the inclusion criteria. Six of them are randomized clinical trials and 4 of them, meta-analysis. EVIDENCE SYNTHESIS: The surgical techniques more frequently used to achieve early urinary continence are bladder neck and neurovascular bundles preservation, as well as the reconstruction of the rhabdosphincter. The latter has been presented in three randomized clinical trials. Even though some approaches have obtained improved functional outcomes, the lack of consensus on the definition of urinary incontinence and its measurement methods have not advocated for the creation of technical recommendations based on scientific evidence. CONCLUSIONS: The reconstruction of the rhabdosphincter is the only technique that has shown improved functional results through randomized trials. The current evidence is limited and heterogenous, and more studies with consistent criteria are needed in order to establish a standard surgical technique.

Análisis del escenario microscópico de una biopsia prostática negativa como predictor del riesgo de cáncer de próstata. Una revisión sistemática / In Search for risk predictors at the microscopic scenario of a negative biopsy. A systematic review

Introducción: Las biopsias prostáticas (BP) de repetición, ante la persistencia de la sospecha de cáncer de próstata (CP), son frecuentes y su rendimiento bajo. En el contexto de una BP negativa existe un escenario microscópico (EM), que definimos como el conjunto de lesiones no neoplásicas identificable. La existencia de algunas de estas lesiones incrementa el riesgo de detección de CP en BP sucesivas, mientras que otras parecen tener un efecto protector. El objetivo de esta revisión sistemática es identificar el conjunto de lesiones que puede formar parte del EM de una BP negativa y analizar la evidencia actual de su asociación con el riesgo de detección de CP en BP sucesivas. Adquisición de la evidencia: Dos revisores independientes realizaron una búsqueda bibliográfica en Medline, Embase y Central Cochrane, con los términos de búsqueda: small acinar proliferation or ASAP or prostatic intraepithelial neoplasia or HGPIN or adjacent small atypical glands or pinatyp or atrophy or proliferative inflammatory atrophy or pia or prostatic inflammation or prostatitis and prostate cancer. Se identificaron 1.015 referencias y siguiendo los principios de la declaración PRISMA y de selección PICO, se identificaron 57 artículos originales válidos para esta revisión. Síntesis de la evidencia: La proliferación acinar atípica de célula pequeña se asocia a una tasa de detección de CP en BP sucesivas que oscila entre el 32 y 48%. La neoplasia intraepitelial prostática de alto grado (HGPIN) se asocia a CP entre el 13 y 42%, siendo su multifocalidad la que define el incremento en el riesgo de detección. La atrofia prostática, la atrofia proliferativa inflamatoria y la infamación prostática parecen tener un efecto protector sobre la detección de CP en BP sucesivas. Por otra parte, el riesgo de detección de CP en varones con HGPIN multifocal se reduce significativamente si coexiste atrofia proliferativa inflamatoria. Conclusiones: El EM de una BP negativa puede estar compuesto por las lesiones de proliferación acinar atípica de célula pequeña, HGPIN, atrofia prostática, atrofia proliferativa inflamatoria e infamación prostática ya que todas parecen estar asociadas al riesgo de detección de CP en BP sucesivas. Esta revisión nos permite generar la hipótesis de que el EM de una BP negativa puede ser de utilidad en la decisión indicar BP de repetición

Introduction: In cases of persistent suspicion of prostate cancer (PC), repeat prostate biopsies (PB) are frequently performed in spite of their low yield. In the context of a negative PB, there is a microscopic scenario (MS), which we define as the group of recognizable non-neoplastic lesions. While some of these lesions seem to have a protective effect, the existence of others increases the risk of PC detection in posterior PB. The objective of this systematic review is to identify the lesions that may belong to the MS of a negative PB and analyse the current evidence of their association with the risk of detecting PC in subsequent PBs. Evidence acquisition: Two independent reviewers conducted a literature search on Medline, Embase and Central Cochrane with the following search terms: small acinar proliferation, ASAP, prostatic intraepithelial neoplasia, HGPIN, adjacent small atypical glands, pinatyp, atrophy, proliferative inflammatory atrophy, pia, prostatic inflammation, prostatitis and prostate cancer. 1,015 references were first identified, and 57 original articles were included in the study, following the PRISMA declaration and the PICO selection principles. Evidence synthesis: Atypical small acinar proliferation is associated with PC detection in repeat PB with rates ranging between 32 and 48%. High-grade prostatic intraepithelial neoplasia (HGPIN) is related to PC in 13 to 42% of cases. Studies show that HGPIN, when multifocal, is a significant independent risk factor for PC. Prostatic atrophy, inflammatory proliferative atrophy and prostatic inflammation seem to act as protective factors on the detection of PC in repeat PB. On the other hand, the risk of PC detection reduces significantly in male patients with multifocal HGPIN and coexistent PIA. Conclusions: The MS of a negative PB may include atypical small acinar proliferation, HGPIN, prostatic atrophy, inflammatory proliferative atrophy and prostatic inflammation lesions, since they all seem to be associated with the risk of PC detection in repeat PB. This review has led us to create the hypothesis that the MS of a negative PB might be a valuable and useful tool when considering repeat PB

In Search for risk predictors at the microscopic scenario of a negative biopsy. A systematic review. / Análisis del escenario microscópico de una biopsia prostática negativa como predictor del riesgo de cáncer de próstata. Una revisión sistemática.

INTRODUCTION: In cases of persistent suspicion of prostate cancer (PC), repeat prostate biopsies (PB) are frequently performed in spite of their low yield. In the context of a negative PB, there is a microscopic scenario (MS), which we define as the group of recognizable non-neoplastic lesions. While some of these lesions seem to have a protective effect, the existence of others increases the risk of PC detection in posterior PB. The objective of this systematic review is to identify the lesions that may belong to the MS of a negative PB and analyse the current evidence of their association with the risk of detecting PC in subsequent PBs. EVIDENCE ACQUISITION: Two independent reviewers conducted a literature search on Medline, Embase and Central Cochrane with the following search terms: small acinar proliferation, ASAP, prostatic intraepithelial neoplasia, HGPIN, adjacent small atypical glands, pinatyp, atrophy, proliferative inflammatory atrophy, pia, prostatic inflammation, prostatitis and prostate cancer. 1,015 references were first identified, and 57 original articles were included in the study, following the PRISMA declaration and the PICO selection principles. EVIDENCE SYNTHESIS: Atypical small acinar proliferation is associated with PC detection in repeat PB with rates ranging between 32 and 48%. High-grade prostatic intraepithelial neoplasia (HGPIN) is related to PC in 13 to 42% of cases. Studies show that HGPIN, when multifocal, is a significant independent risk factor for PC. Prostatic atrophy, inflammatory proliferative atrophy and prostatic inflammation seem to act as protective factors on the detection of PC in repeat PB. On the other hand, the risk of PC detection reduces significantly in male patients with multifocal HGPIN and coexistent PIA. CONCLUSIONS: The MS of a negative PB may include atypical small acinar proliferation, HGPIN, prostatic atrophy, inflammatory proliferative atrophy and prostatic inflammation lesions, since they all seem to be associated with the risk of PC detection in repeat PB. This review has led us to create the hypothesis that the MS of a negative PB might be a valuable and useful tool when considering repeat PB.

'Exercise to me is a scary word': perceptions of fatigue, sleep dysfunction, and exercise in people with fibromyalgia syndrome-a focus group study.

Fibromyalgia syndrome (FMS) is a common and complex chronic pain condition. Exercise is recommended in the management of the FMS; however, people with FMS often find exercise exacerbates their condition and causes overwhelming fatigue. The objective of this study was to explore the perceptions of fatigue and sleep dysfunction, and exercise in people with FMS. Three, 60-90 min focus groups were conducted with people with FMS (n = 14). Participants were recruited from patient support groups who had experienced therapeutic exercise in the management of their condition. Focus groups were video and audio recorded and transcriptions analysed for thematic content by three independent evaluators. Fatigue, sleep dysfunction, and pain were universally reported by participants. The over-arching theme to emerge was a lack of understanding of the condition by others. A huge sense of loss was a major sub-theme and participants felt that they had fundamentally changed since the onset of FMS. Participants reported that they were unable to carry out their normal activities, including physical activity and exercise. The invisibility of FMS was associated with the lack of understanding by others, the sense of loss, and the impact of FMS. People with FMS perceive that there is a lack of understanding of the condition among health care professionals and the wider society. Those with FMS expressed a profound sense of loss of their former 'self'; part of this loss was the ability to engage in normal physical activity and exercise.

Netrin-1 and multiple sclerosis: a new biomarker for neuroinflammation?

BACKGROUND AND PURPOSE: Netrin-1, an axon guidance protein, reduces serum levels of pro-inflammatory mediators and stabilizes the blood-brain barrier limiting the entrance of immune cells into the central nervous system. The aim was to investigate its presence in the experimental autoimmune encephalomyelitis (EAE) model and in multiple sclerosis (MS) patients with and without clinical activity. METHODS: Netrin-1 levels were evaluated in EAE mouse tissues. Afterwards, serum netrin-1 was cross-sectionally quantified in 90 patients with different MS phenotypes and 30 control subjects. An additional group of 10 relapsing-remitting MS (RRMS) patients was longitudinally evaluated throughout a relapse (RRMSr) with an interval of 60 days. Tumour necrosis factor α (TNFα), a reference inflammatory cytokine, and netrin-1 were quantified by enzyme-linked immunosorbent assay. RESULTS: Experimental autoimmune encephalomyelitis mice showed significantly lower netrin-1 levels and higher TNFα amounts in sera, spinal cord and cerebella than healthy control mice. MS patients showed significantly lower serum netrin-1 levels than controls (511.62 ± 209.30 and 748.32 ± 103.24 pg/ml, respectively; P ≤ 0.005). The lowest protein levels were found in RRMSr, remaining significantly lower throughout the relapse. TNFα serum concentrations were higher in MS patients compared to controls, and negatively correlated with netrin-1 levels (r = -0.3734, P ≤ 0.0001). CONCLUSIONS: Netrin-1 decreased in EAE and in MS patients, mainly during relapse, suggesting an anti-inflammatory role of netrin-1. Further research should be performed in a larger cohort of patients to validate netrin-1 as a biomarker of MS inflammatory activity.

Educación Deportiva versus Enseñanza Tradicional: influencia sobre la regulación motivacional en alumnado de Bachillerato / Educação Desportiva versus Ensino Tradicional: influência sobre a regulação motivacional de alunos do Ensino Médio / Sport Education versus Traditional Teaching: influence on motivational regulation in High School students

El objetivo de esta investigación fue analizar el impacto de una intervención basada en el Modelo de Educación Deportiva (MED), en comparación con el Modelo de Enseñanza Tradicional (MET), sobre la regulación motivacional en alumnado de bachillerato en clase de Educación Física. Participó un total de 44 estudiantes (22 hombres y 22 mujeres, Medad = 16.32, DT = 0.57) de bachillerato. El diseño fue un estudio cuasi-experimental con medidas pre- y post-test y comparaciones intra- e inter-grupo. El programa de intervención consistió en 12 sesiones para la enseñanza del baloncesto, siguiéndose las directrices recomendadas por la literatura tanto para el grupo MED como para el grupo MET. Los resultados han indicado que el MED, respecto al MET, mejoró significativamente el nivel de motivación intrínseca y de regulación identificada. Los hallazgos también han mostrado como el MED redujo significativamente el nivel de regulación externa y desmotivación comparado con el MET. Como conclusión, el MED es un modelo de enseñanza deportiva que favorece el desarrollo de las regulaciones de motivación más autodeterminadas (motivación intrínseca y regulación identificada) en el proceso de enseñanza-aprendizaje en el contexto escolar, lo que podría suscitar el interés en el alumnado por la práctica deportiva de modo regular en el tiempo libre (AU)

O objetivo dessa investigação foi analisar o impacto de uma intervenção baseada no Modelo de Educação Desportiva (MED), em comparação com o Modelo de Ensino Tradicional (MET), sobre a regulação motivacional de alunos do Ensino Médio em aulas de Educação Física. O total de participantes foi de 44 estudantes (22 homens e 22 mulheres, Midade = 16.32, DT = .57). O desenho do estudo se configurou como quase-experimental com medidas pré - e pós-teste e comparações intra- e inter- grupo. O programa de intervenção consistiu em 12 sessões para o ensino do basquetebol, seguindo as diretrizes recomendadas pela literatura para o grupo MED e para o grupo MET. Os resultados indicaram que o MED, com relação ao MET, melhorou significativamente o nível de motivação intrínseca e de regulação identificada. As descobertas também mostraram que o MED reduziu significativamente o nível de regulação externa e desmotivação comparado com o MET. Como conclusão, o Modelo de Educação Desportiva é um modelo de ensino desportivo que favorece o desenvolvimento das regulações de motivação mais autodeterminadas (motivação intrínseca e regulação identificada) no processo de ensino-aprendizagem no contexto escolar, o que poderia suscitar o interesse dos alunos pela prática desportiva de modo regular em seu tempo livre (AU)

The objective of this research was to examine the influence of an intervention based on Sport Education Model (SEM), in comparison with Traditional Teaching Model (TTM), on motivational regulation in high school students in Physical Education class. A total of 44 high school students (22 men and 22 women, Mage = 16.32, SD = .57) participated. The design was a quasi-experimental study with pre- and post-test measures and intra- and inter-group analysis. The intervention consisted of 12 sessions for teaching of basketball, following the guidelines recommended by literature both for the SEM group and for the TTM group. The results have indicated that SEM significantly improved the level of intrinsic motivation and of identified regulation in relation to TTM. The findings have also showed that SE has significantly reduced the level of external regulation and of amotivation in the students regarding TTM. In conclusion, SEM is a teaching model of sport which encourage the development of the most selfdetermined regulations of motivation (intrinsic motivation and identified regulation) in teaching-learning process in school setting, which could arouse the interest of students for regular practice of sport in free time (AU)

Association of Dietary Habits with Psychosocial Outcomes in Women with Fibromyalgia: The al-Ándalus Project.

BACKGROUND: Fibromyalgia (FM) is a complex multidimensional disorder with pain as its main symptom. Fibromyalgia imposes a psychosocial burden on individuals that negatively impacts quality of life. The relationship of dietary habits with these psychosocial aspects is still unclear. OBJECTIVE: The purpose of this cross-sectional study was to assess dietary habits in a representative sample of women with FM and to explore their association with mental health, depression, and optimism in this population. DESIGN: A cross-sectional study was conducted between November 2011 and January 2013. PARTICIPANTS: The study sample comprised 486 women (ages 35 to 65 years) with FM from Andalucía (southern Spain). MAIN OUTCOME MEASURES: Mental health, depression, and optimism were evaluated by means of the mental component scale of the 36-item Short-Form Health Survey, the Beck Depression Inventory (BDI-II), and the Life Orientation Test Revised, respectively. A short form of a validated food frequency questionnaire was used to assess dietary habits. STATISTICAL ANALYSES PERFORMED: Analysis of covariance was used to assess associations between dietary habits and mental health, depression, and optimism. The presence of severe depression (BDI-II ≥29) as a function of dietary habits was examined with logistic regression. RESULTS: A daily or almost-daily consumption of fruit and vegetables and a moderate consumption of fish (2 to 5 servings per week) were associated with higher scores in mental health (P<0.001, P<0.05, and P<0.001, respectively) and lower levels of depression (P<0.001, P<0.01, and P<0.01, respectively). A daily or almost-daily consumption of vegetables and a moderate consumption of dairy products and fish were associated with higher levels of optimism (P<0.05, P<0.05, and P<0.001, respectively). A daily or almost-daily consumption of cured meats and sweetened beverages were associated with higher levels of depression and lower levels of optimism, respectively (both P<0.05). CONCLUSION: The results this study suggest that a daily or almost-daily intake of fruit and vegetables and a moderate intake of fish may be associated with more favorable psychosocial outcomes in women with FM. Conversely, excessive intake of cured meats and sweetened beverages was related to worse scores in optimism and depression outcomes. Future research analyzing dietary patterns as well as intervention studies evaluating the effects of healthy dietary patterns on psychosocial and physical outcomes in individuals with FM are warranted.

Physical fitness reference standards in fibromyalgia: The al-Ándalus project.

We aimed (1) to report age-specific physical fitness levels in people with fibromyalgia of a representative sample from Andalusia; and (2) to compare the fitness levels of people with fibromyalgia with non-fibromyalgia controls. This cross-sectional study included 468 (21 men) patients with fibromyalgia and 360 (55 men) controls. The fibromyalgia sample was geographically representative from southern Spain. Physical fitness was assessed with the Senior Fitness Test battery plus the handgrip test. We applied the Generalized Additive Model for Location, Scale and Shape to calculate percentile curves for women and fitted mean curves using a linear regression for men. Our results show that people with fibromyalgia reached worse performance in all fitness tests than controls (P < 0.001) in all age ranges (P < 0.001). This study provides a comprehensive description of age-specific physical fitness levels among patients with fibromyalgia and controls in a large sample of patients with fibromyalgia from southern of Spain. Physical fitness levels of people with fibromyalgia from Andalusia are very low in comparison with age-matched healthy controls. This information could be useful to correctly interpret physical fitness assessments and helping health care providers to identify individuals at risk for losing physical independence.

Association of sedentary time and physical activity with pain, fatigue, and impact of fibromyalgia: the al-Ándalus study.

We examined the association of objectively measured sedentary time (ST) and physical activity (PA) levels with pain, fatigue, and the impact of the disease in women with fibromyalgia. Four hundred and nineteen (mean age ± SD = 51.7 ± 7.6 years old) women with fibromyalgia participated. ST and PA levels (light, moderate, and moderate-to-vigorous [MVPA]) were measured with triaxial accelerometry. We assessed experimental pain with algometry and clinical pain, fatigue, and impact of fibromyalgia with a number of questionnaires. The association of ST and light PA with most of the pain- and fatigue-related outcomes and impact of fibromyalgia (all, P ≤ 0.019) was independent of moderate and vigorous PA. Furthermore, the association of vigorous PA with general and physical fatigue was independent of ST and light and moderate PA (all, P < 0.001). In conclusion, lower levels of ST or higher levels of light PA are associated with lower pain, fatigue, and the overall impact of the disease independent of moderate and vigorous PA in women with fibromyalgia. Interestingly, higher vigorous PA is independently associated with lower general and physical fatigue. These results are significant for future ST and PA intervention studies in this population.

Percentage of hypochromic erythrocytes and reticulocyte hemoglobin equivalent predictors of response to intravenous iron in hemodialysis patients.

INTRODUCTION: Reticulocyte hemoglobin content and percentage of hypochromic red cells are incorporated into the European best practice guidelines on anemia management in chronic kidney disease. Sysmex XN analyzer (Sysmex Corporation, Kobe, Japan) reports reticulocyte hemoglobin equivalent (Ret-He) and the hypochromic fraction of erythrocytes (%Hypo-He). Our aim was to assess the value of these parameters, in terms of the sensitivity and specificity for detecting functional iron deficiency, in hemodialysis (HD) patients. METHODS: Forty HD patients in the maintenance phase of erythropoietin therapy were included. Intravenous iron supplementation was interrupted at least 3 weeks before recruitment. Two samples were analyzed for each patient: the baseline after the iron-free period and the second sample after 4 weeks of IV iron administration. Hemogram and biochemical parameters of the iron status were measured. Patients were classified as responders or nonresponders to an iron load; responders had an increase in Hb of at least 10 g/L after iron administration, compared to the baseline. To identify the efficiency of the test for predicting the response to iron administration, receiver operating characteristic analysis (ROC) was performed. RESULTS: According to the established criteria, 21 patients were responders and 19 nonresponders. ROC analysis results: Ret-He area under curve (AUC) was 0.84 (95% CI 0.64-0.93), at cutoff 30.8 pg, sensitivity 78.7%, and specificity 87.2%. % Hypo-He AUC was 0.78 (95% CI 0.64-0.91), at cutoff 2.4%, sensitivity 72.2%, and specificity 88.1%. CONCLUSIONS: % Hypo-He and Ret-He are reliable parameters for the study of erythropoiesis status in HD patients.

The association of total and central body fat with pain, fatigue and the impact of fibromyalgia in women; role of physical fitness.

BACKGROUND: The relationship between estimates of total and central body fat with fibromyalgia pain, fatigue and overall impact has not been fully described. We aimed to assess the individual and combined association of body fat (total and central) with pain, fatigue and the overall impact in fibromyalgia women; and to study the possible mediation role of physical fitness in these associations. METHODS: A total of 486 fibromyalgia women with a mean (standard deviation) age of 52.2 (8.0) years participated. Pain was measured with self-reported measures and algometry, whereas fatigue with the Multidimensional Fatigue Inventory. The impact of fibromyalgia was measured with the Revised Fibromyalgia Impact Questionnaire (FIQR) total score. Total and central body fat were assessed by means of bioelectrical impedance and waist circumference, respectively. The Functional Senior Fitness Test battery and the handgrip strength test were used to assess physical fitness. RESULTS: Total and central body fat were positively associated with pain- and fatigue-related measures and the FIQR total score (ß from 0.10 to 0.25; all, p < 0.05). A combined effect of total and central body fat was observed on pain (FIQR and 36-item Short-Form Health Survey), general and physical-related fatigue and FIQR total score (all, overall p < 0.05), so that the group with no total and central obesity had more favourable results than those with total and central obesity. Cardiorespiratory fitness partially mediated (between 22-40% of the total effect) the associations between total and central body fat with pain, general fatigue, physical fatigue and reduced activity, and largely mediated (80%) the association of central body fat with the FIQR total score. CONCLUSIONS: Physical fitness might potentially explain the association between obesity and fibromyalgia symptoms.

Physical fitness is associated with anxiety levels in women with fibromyalgia: the al-Ándalus project.

PURPOSE: To assess the independent associations of individual physical fitness components with anxiety in women with fibromyalgia and to test which physical fitness component shows the greatest association. METHODS: This population-based cross-sectional study included 439 women with fibromyalgia (age 52.2 ± 8.0 years). Anxiety symptoms were measured with the State Trait Anxiety Inventory (STAI) and the anxiety item of the Revised Fibromyalgia Impact Questionnaire (FIQR). Physical fitness was assessed through the Senior Fitness Test battery and handgrip strength test. RESULTS: Overall, lower physical fitness was associated with higher anxiety levels (all, p < 0.05). The coefficients of the optimal regression model (stepwise selection method) between anxiety symptoms and physical fitness components adjusted for age, body fat percentage and anxiolytics intake showed that the back scratch test (b = -0.18), the chair sit-and-reach test (b = -0.12; p = 0.027) and the 6-min walk test (b = -0.02; p = 0.024) were independently and inversely associated with STAI. The back scratch test and the arm- curl test were associated with FIQR-anxiety (b = -0.05; p < 0.001 and b = -0.07; p = 0.021, respectively). CONCLUSION: Physical fitness was inversely and consistently associated with anxiety in women with fibromyalgia, regardless of the fitness component evaluated. In particular, upper-body flexibility was an independent indicator of anxiety levels, followed by cardiorespiratory fitness and muscular strength.

Impacto de un entrenamiento robótico de la marcha en pacientes con mielomeningocele / Robotic gait training impact in patients with myelomeningocele

Introducción: Los defectos del tubo neural, en especial el mielomeningocele (MMC), son causa de discapacidad para la marcha con un grado variable de severidad, según el nivel de lesión. Dentro de las intervenciones terapéuticas, se propone utilizar el entrenamiento robótico de la marcha (ERM). Objetivo: Evaluar los efectos del ERM en pacientes con MMC del Centro de Rehabilitación Infantil Teletón (CRIT) Guerrero. Material y métodos: Estudio casi experimental, prospectivo y longitudinal, realizado en 5 pacientes con MMC de grado L3 o más bajo, según la clasificación de Sharrard, en los que se aplicó la escala American Spinal Cord Association (ASIA), la prueba de la caminata de 6 minutos, los cuestionarios Functional Independence Measure (FIM) y Spinal Cord Independence Measure (SCIM III), y los parámetros de Lokomat (distancia recorrida, velocidad, descarga y fuerza guiada), antes y después del tratamiento. En total se proporcionaron 10 sesiones de 30 minutos, 2 veces por semana. Se llevó a cabo la recopilación de los datos mediante el programa Excel versión 2010, y el análisis estadístico con la prueba de la t de Student (p <0,05) para establecer la significación estadística. Resultados: Se encontró significación estadística en las variables de la escala ASIA motor total (p= 0,05) y la funcionalidad, determinada por las escalas SCIM III (p= 0,005) y FIM (p= 0,0005), así como la distancia recorrida en la prueba de la caminata de 6 minutos (p= 0,03) y los parámetros de Lokomat® Pro: fuerza guiada (p= 0,002), velocidad de la marcha (p= 0,03) y descarga de peso (p= 0,0008). Las variables sin cambios fueron la sensibilidad (ASIA) y la distancia recorrida. Conclusiones: El ERM representa una herramienta más en la mejora de la función para la marcha en pacientes con MMC, ya que es posible controlar las variables de entrenamiento de forma constante, ofreciendo la posibilidad de mejorar la fuerza en miotomos preservados y la funcionalidad (AU)

Introduction: Neural tube defects, especially myelomeningocele (MMC), are cause of disability for walking with varying degrees of severity, depending on the level of injury. Within therapeutic interventions intends to use the robotic training run (ERM). Objective: To evaluate the effects of MRA in patients with MMC CRIT Guerrero. Material and methods: Quasi-experimental, prospective and longitudinal study in 5 patients with MMC Sharrard L3 or lower, evaluating the ASIA, walk test six minutes, FIM, SCIM III and Lokomat parameters (distance, speed, download and Guided) strength, before and after treatment. In total 10 sessions of 30 minutes were provided, 2 times a week. Collecting data using Excel version 2010 and statistical analysis with Student t test (p <0.05) to establish statistical significance. Results: Statistical significance was found between the variables of the total score ASIA motor (p= 0.05); functionality: SCIM III (p= 0.005), FIM (p= 0.0005), distance in 6-minute walk (p= 0.03). Lokomat® Pro parameters: guided force (p= 0.002), walking speed (p= 0.03) and discharge weight (p= 0.0008). The variables were unchanged sensitivity (ASIA), and distance. Conclusions: The ERM is a tool to improve gait function in patients with MMC, since it is possible to control training variables constantly, offering the possibility of improving strength in myotomes preserved and functionality (AU)

Reliability and feasibility of physical fitness tests in female fibromyalgia patients.

The aim of the present study was to determine the reliability and feasibility of physical fitness tests in female fibromyalgia patients. 100 female fibromyalgia patients (aged 50.6±8.6 years) performed the following tests twice (7 days interval test-retest): chair sit and reach, back scratch, handgrip strength, arm curl, chair stand, 8 feet up and go, and 6-min walk. Significant differences between test and retest were found in the arm curl (mean difference: 1.25±2.16 repetitions, Cohen d=0.251), chair stand (0.99±1.7 repetitions, Cohen d=0.254) and 8 feet up and go (-0.38±1.09 s, Cohen d=0.111) tests. Intraclass correlation coefficients (ICC) range from 0.92 in the arm curl test to 0.96 in the back scratch test. The feasibility of the tests (patients able to complete the test) ranged from 89% in the arm curl test to 100% in the handgrip strength test. Therefore, the reliability and feasibility of the physical fitness tests examined is acceptable for female fibromyalgia patients.

Are there differences in quality of life, symptomatology and functional capacity among different obesity classes in women with fibromyalgia? The al-Ándalus project.

Obesity may influence fibromyalgia severity. The present study aimed to examine fibromyalgia (FM) symptomatology, quality of life (QoL), and functional capacity across obesity class categories. A total sample of 208 obese FM patients and 108 obese control women were included in the study. The sample was further categorized following the international criteria for obesity classes: obesity I (BMI 30.0-34.99 kg/m(2)), obesity II (BMI 35.0-39.99 kg/m(2)), and obesity III (BMI ≥40.0 kg/m(2)). QoL was assessed by means of the Short-Form-36 Health Survey (SF-36) and FM symptomatology with the Fibromyalgia Impact Questionnaire (FIQ). Standardized field-based fitness tests were used to assess cardiorespiratory fitness, muscular strength, flexibility, agility, and balance. All the dimensions of QoL, as measured by SF-36, were worse in obese FM patients compared to the obese control group (all p < 0.001). Obese FM patients also scored worse in the entire functional capacity tests studied (all p < 0.001). Except for the higher FIQ-depression across obesity status categories (p < 0.05), no differences between obesity status groups were found in QoL and FM impact. However, upper-body muscular strength and cardiorespiratory fitness were worse across obesity class categories and pairwise comparisons showed differences mainly between obesity I and II (p < 0.05, and p < 0.01, respectively). The absence of clear differences in QoL and FM symptomatology among obesity classes suggests that just avoiding any obese status may be a useful advice for a better management of the disease. Nevertheless, upper-body muscular strength and cardiorespiratory fitness, which are important health indicators highly related to the mortality risk, were worse across obesity categories.

Dermatosis neutrofílica sobre área de linfedema posmastectomía / Neutrophilic Dermatosis on Postmastectomy Lymphedema

No disponible

Nifedipine and cyclosporin affect fibroblast calcium and gingiva.

It has been stated that cyclosporin and nifedipine produce gingival overgrowth. However, the specific pathogenic mechanism remains uncertain. We used an experimental rat model to test the hypothesis that changes in collagen metabolism and numbers of gingival blood vessels are not mediated by intracellular calcium concentration (ratiometric Fura-2 AM measurement) in gingival fibroblasts. In the cyclosporin group, both width (364.2 +/- 67.5 mum) and microvessel density (number of vessels/mm(2), stained with anti-CD34 antibody) (41.6 +/- 5.1) of gingiva were statistically different when compared with those in the control group (width = 184.3 +/- 35.2 mum, microvessel density = 19.6 +/- 2.4). The nifedipine group showed the highest content of collagen (proportion of total stroma occupied by collagen, stained with Picro-Mallory) (nifedipine group = 66.3 +/- 9.4, cyclosporin group = 55.2 +/- 7.9, control group = 30.1 +/- 10.2). Freshly cultured fibroblasts from the cyclosporin group exhibited higher ratiometric values of fluorescence than did both the control and nifedipine groups (p = 0.03). Our results support the hypothesis that changes in gingival collagen metabolism are not mediated by calcium intracellular oscillations.