Physical activity, sleep pattern and energy expenditure in double-handed offshore sailing.

AIM: The aim of the present study was to quantify total energy expenditure, activity energy expenditure and time spent at three levels of physical activity (low, moderate, high intensity) in four two-person crews during a 500-mile double-handed sailing regatta. METHODS: Physical activity intensity and energy expenditure were assessed during a 500-nautical-mile double-handed offshore competition in eight male sailors (46.3±3.4 years; 180±13 cm; 85.4±12.5 kg). During the whole regatta, they wore an activity monitor that estimated energy expenditure and minutes spent at each level of intensity (sedentary, <1.5 METs; light physical activity, 1.5-2.9 METs; moderate physical activity, 3.0-6.0 METs; vigorous physical activity, >6.0 METs). RESULTS: The sailors spent longer periods (P<0.0001) of time in sedentary (823±193 min/day) and light physical activities (516±177 min/day) than in moderate (95±34 min/day) or vigorous (6±4 min/day) physical activities. They slept 5 times per day (±1.4) for 36 min (±9) in each sleeping period. The total energy expenditure was 14.26±1.89 MJ/day and the activity energy expenditure was 5.06±1.42 MJ/day. Activity energy expenditure was significantly correlated with total sleep time, boat speed, and distance covered each day (P<0.05). CONCLUSION;:The high total energy expenditure was more likely a consequence of the short and rare periods of sleep during the competition rather than of the bouts of moderate and vigorous physical activities.

Water polo throwing velocity and kinematics: differences between competitive levels in male players.

AIM: In water polo, throwing is one of the most important and frequently used technical skills for the player. There is no scientific literature that provides information about differences in throwing between elite and sub-elite water polo players. The aim of our study was to study differences in throwing velocities and kinematic variables in elite and sub-elite level male water polo players. METHODS: We considered the variables under standardized conditions during a typical motion, the five-meter shot (penalty). Thirty-four athletes from the Men's First Division Water Polo Championship and forty-two players participating in the National Fourth Division League, took part in the study. Video analysis measures were taken with high-speed digital cameras and the videos were analyzed offline with Dartfish 5.0 Pro. RESULTS: No correlation was found between body mass, height and throwing velocity. Elite players had higher values ​for ball speed (22.8±2.4 m/s for elite team and 18.4±1.7 m/s for sub-elite team; P=0.002) and greater elbow angle (157.5±10.3 degree for elite team versus 146.7±8.9 degree for sub-elite team; P=0.002). In elite team the throwing time was lower (165.6±22.2 and 188.6±23.9 ms, respectively; P=0.05) and the shoulder angle was smaller (115.1±10.3 and 123.8±12.4 degree, respectively; P=0.03) than in sub-elite team. Head height was significantly greater in elite players (elite players 71.1±8.7 cm, sub-elite players 65.6±6.2 cm; P=0.03). CONCLUSION: Differences in kinematic characteristics between elite and sub-elite players were showed. Differences in elbow and shoulder action must be considered both in training and injury prevention.

Results of open and robot-assisted pancreatectomies with autologous islet transplantations: treating chronic pancreatitis and preventing surgically induced diabetes.

For patients with chronic pancreatitis (CP), standard surgical procedures (eg, partial or total resections, drainage procedures) are inadequate treatment options, because they do not confer pain relief and they leave patients prone to brittle diabetes and hypoglycemia. The combination of total pancreatectomy and islet autotransplantation (TP-IAT), however, can create insulin-independent and pain-free states. At our center, from August 2009 through August 2013, 61 patients with CP underwent either open or robot-assisted TP-IAT. The 30-day mortality rate was 0%. The transplanted islet equivalents per body weight ranged from 10,000 to 17,770. In all, 19% of the patients became insulin independent (after a range of 1-24 months); 27% of patients required <10 units of insulin. Moreover, at 12 months after surgery, 71% of the patients were pain free and no longer required analgesics. Our metabolic outcomes could have been even better if most patients had been referred at an earlier disease stage; instead, ∼80% had already undergone surgical procedures, and 91% had abnormal results on preoperative continuous glucose monitoring tests. Only if patients with CP are referred early for a TP-IAT-rather than being subjected to additional inadequate endoscopic and surgical procedures-can insulin-independent and pain-free states be accomplished in most.

Physical fitness before and after weight restoration in anorexia nervosa.

AIM: The aims of this paper were: 1) to evaluate the feasibility of test for evaluating physical fitness (PF) in patients with anorexia nervosa (AN); 2) to investigate the effects of nutritional rehabilitation in this population of patients; and 3) to compare their level of fitness scores (at baseline and after weight restoration) with an age-matched healthy control group. METHODS: PF was assessed with an adapted version of the Eurofit Physical Fitness Test Battery (EPFTB) administered to 37 consecutive female AN patients, at baseline and after weight restoration, and to 57 healthy age-matched females. RESULTS: The inpatient treatment, based on cognitive behavior therapy, was associated with a significant improvement in BMI (from 14.5±1.5 to 18.8±1.1, P<0.001) and in 5 out of 6 EPFTB tests (P<0.05) in the AN group. However, both in pre and post, AN patients showed significant lower EPFTB than the control group (all P<0.001) with the exception of the Sit-Up score. CONCLUSION: Results indicated that PF is lower in AN patients than in controls both at baseline and after weight restoration. Future studies should evaluate if the inclusion of an individualized health-enhancing physical activity program might improve the restoration of physical fitness.

Anthropometric characteristics of top-class Kenyan marathon runners.

AIM: This study aims to: 1) describe the current anthropometric profiles of Kenyan marathon runners and 2) establish a set of reference values useful for future investigations on athlete selection, talent identification, and training programme development. METHODS: The participants were 14 male top-class Kenyan marathon runners (mean [s] age 27.71 [3.75] yrs, height 171.21 [6.12] cm, body mass 57.71 [4.02] kg, marathon personal best 02h 07min 16s (01min 55s); training volume: 180-220 km·wk-1; high:low intensity training ratio: 1:2). The anthropometric profiles included the measurement of skinfolds, and segment lengths, breadths, and girths. To estimate body density (BD) multiple regression equations were calculated using the sum of 7-skinfolds method and then converted to percentage of body fat (%BF). The somatotype, somatotype dispersion mean (SDM), somatotype attitudinal mean (SAM), and height to weight ratio (HWR) as well as the skinfolds extremity to trunk ratio (E:T) were also calculated. RESULTS: The mean (s) of BD, %BF, SDM, SAM, HWR and E:T were 1.13 (0.02), 8.87 (0.07) %, 4.58 (3.62), 0.51 (0.09), 44.32 (1.06), and 0.36 (0.11), respectively. The mean (s) endomorphy, mesomorphy, and ectomorphy were 1.53 (0.32), 1.61 (1.81), and 3.86 (0.78), respectively. CONCLUSION: Top-class Kenyan marathon runners seem to have ectomorphy as dominant, with endomorphy and mesomorphy more than one-half unit lower. Despite population comparisons would be required to identify any connection between specific anthropometric dimensions, these reference data should be useful to practitioners and researchers, providing useful information for talent identification and development and for the assessment of training progression in marathon.

Different methods for monitoring intensity during water-based aerobic exercises.

The aim of this study was to compare different measurement techniques (indirect calorimetry, IC; heart rate monitoring, HR; an activity monitoring system, AH; rates of perceived exertion, RPE) to estimate physical activity intensity (light, moderate, vigorous) during water-based aerobic exercises (WE). Twelve healthy young women performed five common WE of 10-min duration at three frequencies in an indoor swimming pool. Data recorded from the 5th to 9th minute of exercise were averaged to obtain mean [Formula: see text] (IC), HR and AH values; RPE was recorded at the end of each WE. Oxygen uptake was also estimated from HR data using three different [Formula: see text] versus HR regression equation models. Significant correlations (p < 0.001) were found for the indirect methods that used HR, RPE and AH data regressed as a function of [Formula: see text] (IC); the highest correlations were found between the measured values of [Formula: see text] (IC) and those estimated from the three [Formula: see text] versus HR equations (R > 0.7 in all cases). An ANOVA test showed no significant differences between all predicted and measured [Formula: see text] values; however, when the Bland & Altman analysis was considered, AH data showed the larger explained variances (95% CI) and the larger standard errors. These data indicate that the most accurate way to estimate physical activity intensity during WE is based on HR measurements.

Physiological characteristics of elite sport-dancers.

AIM: Dancesport is increasing its popularity and it becomes to be considered as a real sport. Few studies are available about the physiological strain of dancesport competitions: moreover, recent changes in the official rules make it mandatory to revise our knowledge about the specific physiologic demands during competition. The aim of our study was to evaluate physiological parameters in top-level dancers. METHODS: Twelve competitive dancesport couples (12 Latin-American and 12 Standard dancers) composed the study population. The first testing session was aimed at determining physical and physiological characteristics of athletes in laboratory; the second, at establishing physiological responses during simulated competition on field, involving the measurement of O(2) uptake (VO(2)), heart rate and blood lactate (BL). RESULTS: Male dancers showed a peak-VO(2) of 60.9±6.0 and 59.2±7.0 mL/kg/min for Standard and Latin-American dancers, respectively. For females, peak-VO(2) was 53.7±5.0 mL/kg/min in Standard and 52.3±5.0 mL/kg/min in Latin-American dancers. During simulated competition, male dancers reached the 75.7±10.6 and 84.2±11.2% of peak-VO(2) (P<0.05) for Standard and Latin-American sequence, respectively. For females, no difference was observed (70.8±13.8% in Latin-American and 72.5±12.8% in Standard). Peak-BL during simulated Standard competition was 6.50±2.1 and 6.91±2.6 mM in males and females, respectively, and, for Latin-American sequence, 7.95±2.1 mM in males and 6.04±2.5 mM in females. CONCLUSION: Dancesport can be defined as a sport discipline with an alternate physical activity with medium lasting and high energy-demanding (both aerobic and anaerobic) consecutive phases, separated by short recovery periods. These data must be kept into account while planning specific training programs in sportdancers.

Outcomes after laparoscopic Nissen fundoplication are not influenced by the pattern of reflux.

The purpose of this study was to compare the outcomes of patients with different types of gastroesophageal reflux disease (upright, supine, or bipositional) after laparoscopic Nissen fundoplication and determine if patients with upright reflux have worse outcomes. Two hundred and twenty-five patients with reflux confirmed by 24-h pH monitoring were divided into three groups based on the type of reflux present. Patients were questioned pre- and post-fundoplication regarding the presence and duration of symptoms (heartburn, regurgitation, dysphagia, cough and chest pain). Symptoms were scored using a 5-point scale, ranging from 0 (no symptom) to 4 (disabling symptom). Esophageal manometry and pH results were also compared. There was no statistically significant difference in lower esophageal sphincter length, pressure or function between the three groups. There was no significant difference in any of the postoperative symptom categories between the three groups. The type of reflux identified preoperatively does not have an adverse effect on postoperative outcomes after Nissen fundoplication and should not discourage physicians from offering antireflux surgery to patients with upright reflux.

Robotically assisted laparoscopic transhiatal esophagectomy.

BACKGROUND: Esophagectomy is a technically demanding operation with high procedure-related morbidity and mortality rates. Minimally invasive techniques were introduced in the late 1980s in an effort to decrease the invasiveness of the procedure. Data concerning the use of robotic systems for esophageal cancer are scarce in the literature. The goal of this report is to describe the authors' early experience using robotically assisted technology to perform transhiatal esophagectomy (RATE). METHODS: Between September 2001 and May 2004, 18 patients underwent RATE at the authors' institution. A retrospective review of prospectively collected data was performed. Gender, age, postoperative diagnosis, operative time, conversion rate, blood loss, hospital stay, length of the follow-up period, and complications were assessed. RESULTS: At the authors' institution, 18 patients underwent RATE, including 16 men (89%), with a mean age of 54 years (range, 41-73 years). The RATE procedure was completed for all 18 patients (100%). The mean operative time was 267 +/- 71 min, and estimated blood loss was 54 ml (range, 10-150 ml). The mean intensive care unit stay was 1.8 days (range, 1-5 days), and the mean hospital stay was 10 days (range, 4-38 days). A total of 12 perioperative complications occurred for 9 patients, including 6 anastomotic leaks, 1 thoracic duct injury, 1 vocal cord paralysis, 1 pleural effusion, and 2 atrial fibrillations. Anastomotic stricture was observed in six patients. There were no perioperative deaths. Pathologic examination of the surgical specimen yielded an average of 14 lymph nodes per patient (range, 7-27). During the mean follow-up period of 22 +/- 8 months, 2 patients died, 2 were lost to follow-up evaluation, 3 had recurrence, and 11 were disease free. CONCLUSION: The current study shows that RATE, with its decreased blood loss, minimal cardiopulmonary complications, and no hospital mortality, represents a safe and effective alternative for the treatment of esophageal adenocarcinoma.

Effect of robotic assistance on the "learning curve" for laparoscopic hand-assisted donor nephrectomy.

BACKGROUND: The number of living-related donor kidney transplantations have increased since the advent of minimally invasive surgery. Robotic technology has emerged as a promising alternative to laparoscopic techniques. The authors reviewed their institution experience with robotic hand-assisted donor nephrectomies (RHADNs). METHODS: Between August 2000 and April 2006, 273 robotically assisted left donor nephrectomies were performed using a hand-assisted technique. Prospectively collected information for 214 patients regarding complications, hospital stay, blood loss, warm ischemia time, operative time, and outcomes is presented. RESULTS: The cohort of donors included 110 men and 104 women with a mean age of 36 years (range, 18-61 years). These donors included 86 African Americans, 46 Caucasians, 74 Hispanics, and 8 of other races. Left renal artery anomalies were found in 61 patients (29%). Four patients underwent conversion to open surgery. The hospital stay was 2.3 days (range, 1-8 days), the blood loss 82 ml (range, 10-1,500 ml), and the mean warm ischemia time 98 s (range, 50-200 s). The operative time was 201 min (range, 100-320 min) for the first 74 cases, 129 min (range, 65-240 min) for the second 70 cases, and 103 min for the last 70 cases (p < 0.001), for an overall average of 150 min. Complications decreased significantly after the first 74 cases. The 1-year patient survival rate was 100%, and the 1-year graft survival rate was 98%. The average recipient creatinine at 6 months was 1.4 mg/dl. CONCLUSIONS: Specific changes in operative technique over time have improved patient safety and diminished complications with RHADN. Currently, RHADN can be performed expeditiously with a minimal rate of complications and conversion to open procedure by a surgical team with appropriate training and experience.

Laparoscopic adjustable gastric band versus laparoscopic Roux-en-Y gastric bypass: ends justify the means?

BACKGROUND: In the United States, the most frequently performed bariatric procedure is the Roux-en-Y gastric bypass (RYGB). Worldwide, the most common operation performed is the laparoscopic adjustable gastric band (LAGB). The expanding use of LAGB is probably driven by the encouraging data on its safety and effectiveness, in contrast to the disappointing morbidity and mortality rates reported for RYGB. The aim of this study was to evaluate the results of LAGB versus RYGB at a single institution. METHODS: Between November 2000 and July 2004, 590 bariatric procedures were performed. Of these, 120 patients (20%) had laparoscopic RYGB and 470 patients (80%) had LAGB. A retrospective review was performed. RESULTS: In the LAGB group, 376 patients (80%) were female, and the mean age was 41 years (range, 17-65). In the RYGB group, 110 patients (91%) were female, and the mean age was 41 years (range, 20-61). Preoperative body mass index was 47 +/- 8 and 46 +/- 5, respectively (p = not significant). Operative time and hospitalization were significantly shorter in LAGB patients (p < 0.001). Complications and the need for reoperation were comparable in both groups. Weight loss at 12, 18, 24, and 36 months for LAGB and RYGB was 39 +/- 21 versus 65 +/- 13, 39 +/- 20 versus 62 +/- 17, 45 +/- 25 versus 67 +/- 8, and 55 +/- 20 versus 63 +/- 9, respectively. CONCLUSIONS: The current study demonstrates that LAGB is a simpler, less invasive, and safer procedure than RYGB. Although mean percentage excess body weight loss (%EBWL) in RYGB patients increased rapidly during the first postoperative year, it remained nearly unchanged at 3 years. In contrast, in LAGB patients weight loss was slower but steady, achieving satisfactory %EBWL at 3 years. Therefore, we believe that LAGB should be considered the initial approach since it is safer than RYGB and is very effective at achieving weight loss.

Pouch enlargement and band slippage: two different entities.

BACKGROUND: Pouch enlargement and band slippage are the most common late complications of laparoscopic adjustable gastric banding (LAGB). Often, confusion exists among surgeons regarding the denomination or even the treatment of these two different entities. This study aimed to establish the differences in clinical presentation, radiologic features, and management between pouch enlargement and band slippage. The authors hypothesized that pouch enlargement can be managed nonoperatively (via band deflation), that band slippage is an acute complication requiring surgical treatment, and that tailored adjustment allows earlier diagnosis of pouch enlargement in asymptomatic patients. METHODS: From March 2001 to December 2004, 516 patients underwent LAGB placement. Barium swallow was performed preoperatively, postoperatively, and during band adjustments ("tailored adjustment"). Pouch enlargement was defined as dilation of the pouch, and band slippage was considered when band and stomach were prolapsed. Four radiologic types of pouch enlargement were considered: band 45 degrees, band 45 degrees with covering of the band, band 0 degrees, and band smaller than 0 degrees. RESULTS: A total of 1,600 barium swallows were performed with 516 patients. As a result, pouch enlargement was diagnosed for 61 patients (12%) and band slippage for 12 patients (2%). CONCLUSION: In this study, pouch enlargement was found to be a chronic complication that can be managed conservatively with a 77% success rate. Tailored adjustment allows early diagnosis of pouch enlargement, thus preventing adjustments in patients with undiagnosed pouch enlargement. Surgical treatment should be considered when medical treatment fails. By comparison, band slippage is an acute complication that requires surgical treatment in every case (100%).

Laparoscopic Heller myotomy for achalasia facilitated by robotic assistance.

BACKGROUND: Laparoscopic Heller myotomy is the standard operation for achalasia. The incidence of esophageal perforation is approximately 5% to 10%. Data about the safety and utility of robotically assisted Heller myotomy (RAHM) are scarce. The aim of this study was to assess the efficacy and safety of RAHM for the treatment of esophageal achalasia. METHODS: From a prospectively maintained database, demographic data, symptoms, esophagograms, manometries, and perioperative data from all the RAHMs performed between September 2002 and February 2004 were analyzed. RESULTS: A total of 54 patients underwent RAHM, including 26 men. The mean age of these patients was 43 years (range, 14-75 years). Dysphagia was present in 100% of the patients. Of the 54 patients, 26 (48%) had undergone previous treatment including pneumatic dilation (17 patients), Botox injections (4 patients), or both of these treatments (5 patients). The dissection was performed laparoscopically, and the myotomy was performed with robotic assistance. The operative time, including the robot setup time, averaged 162 min (range, 62-210 min). Blood loss averaged 24 ml. No mucosal perforations were observed. The hospital length of stay was 1.5 days. There were no deaths. At 17 months, 93% of the patients had relief of their dysphagia. CONCLUSIONS: The findings showed RAHM to be safe and effective, with a 0% incidence of perforation and relief of symptoms for 91% of the patients.

Timing of surgical intervention does not influence return of esophageal peristalsis or outcome for patients with achalasia.

BACKGROUND: It has been suggested that abnormal function of the lower esophageal sphincter is the primary abnormality in esophageal achalasia, and that the absence of esophageal peristalsis is secondary to the outflow obstruction caused by the lower esophageal sphincter. Furthermore, it has been proposed that early elimination of the resistance at the level of the gastroesophageal junction by surgical intervention could result in return of esophageal peristalsis. This study aimed to assess whether the timing of surgical intervention affects the return of esophageal peristalsis and the clinical outcome for patients with achalasia. METHODS: Between January 1991 and May 2003, 173 patients underwent a Heller myotomy by minimally invasive surgery for treatment of esophageal achalasia. Of these patients, 41 (24%) had pre- and postoperative esophageal manometry. These patients were divided into three groups based on the duration of symptoms: group A (10 patients; duration of symptoms 12 months group B (19 patients, duration of symptoms 12 to 60 months), and group C (12 patients; duration of symptoms longer than 60 months). RESULTS: The average duration of symptoms (dysphagia was present in all patients) was as follows: group A (8 +/- 4 months), group B, (35 +/- 16 months), and group C, (157 +/- 94 months). Vigorous achalasia was present in 40%, 21%, and 17% of the groups respectively. The differences between the groups were not significant. Postoperatively, improvement in esophageal motility was seen in no patient in group A, 1 patient (5%) in group B, and 1 patient (8%) in group C. Excellent or good results were obtained for 90% of the group A patients, 95% of group B patients, and 92% of the group C patients. Again, the differences were not significant. CONCLUSIONS: The results show that: a) the presence of vigorous achalasia is independent of symptoms duration; b) the timing of surgical intervention does not influence the return of peristalsis; and c) the results of a Heller myotomy are independent of symptoms duration.

Two new fluorescent dyes applicable for visualization of fungal cell walls.

Two fluorophores, Solophenyl Flavine 7GFE 500 and Pontamine Fast Scarlet 4B, not heretofore reported upon are described as useful dyes of fungal cell walls, septa and bud scars examined microscopically. The dyes, depending on the filter sets used, yield fluorescently stained material generally in the blue to green and yellow to red wavelengths for Solophenyl Flavine 7GFE 500 and Pontamine Fast Scarlet 4B, respectively. They provide an excellent alternative to the more commonly used fluorophore, Calcofluor White M2R. The two fluorophores, in addition to being used at various spectral wavelengths from mercury arc sources, can be used with laser sources providing 488 nm and 543 nm line wavelengths, common to most scanning confocal microscopes. Unlike Calcofluor, Solophenyl Flavine 7GFE 500 and Pontamine Fast Scarlet 4B do not fade quickly when exposed to selected light wavelengths; however, like Calcofluors they are compatible with living fungal cells.

Preoperative lower esophageal sphincter pressure has little influence on the outcome of laparoscopic Heller myotomy for achalasia.

BACKGROUND: It is believed that in untreated patients with achalasia, the lower esophageal sphincter (LES) is almost always hypertensive and a Heller myotomy resolves symptoms by decreasing the LES pressure. The incidence of a normal or hypotensive LES in untreated achalasia patients is unknown. The goals of this study were to determine the incidence of a normal or hypotensive LES in untreated achalasia patients and the outcome of laparoscopic Heller myotomy in achalasia patients with either normal or low LES pressure. METHODS: Between January 1990 and May 2002, a diagnosis of achalasia was made in 239 patients. Among 109 patients (46%) who had not previously received any form of treatment, 53 patients underwent laparoscopic Heller myotomy and Dor fundoplication. Based on the preoperative LES pressure (normal, 14-24 mmHg) they were divided into three groups: group A--four patients (7.5%), LES pressure <14 mmHg; group B--18 patients (34%), LES pressure 14-24 mmHg; and group C-31 patients (58.5%), LES pressure >24 mmHg. RESULTS: Among the 109 untreated patients, the LES was hypertensive in 49 patients (45%), normal in 29 patients (27%), and hypotensive in 31 patients (28%). The clinical outcome was good among the three groups of patients who underwent laparoscopic Heller myotomy, with poor outcome in only approximately 10% in each group. CONCLUSIONS: These data show that in 55% of untreated. achalasia patients the LES pressure is either normal or low, and that laparoscopic Heller myotomy usually relieves symptoms regardless of preoperative LES pressure.

Effects of non-specific vs individualized exercise training protocols on aerobic, anaerobic and strength performance in severely obese subjects during a short-term body mass reduction program.

The purpose of the present study was to compare aerobic, anaerobic and strength performance changes induced by two short-term (3-week) body mass reduction programs based on the same low-calory diet (1200-1500 kcal/day), nutritional education and psychological counseling, but entailing different exercise training protocols. An individualized, low-volume and moderate-intensity exercise training (IET) was contrasted with a non-specific, high-volume, low-intensity exercise training (NET). Thirty obese in-patients (12 males, 18 females; mean age +/- SD: 33.9 +/- 9.4 yr, range: 19-51yr; mean BMI: 40.5 +/- 3.8 kg/m2, range: 35.3-51.4 kg/m2) were randomly divided in two gender-matched groups of 15 subjects each undergoing a different exercise training protocol. Maximum oxygen uptake (VO2max) determined with a submaximal indirect test on a bicycle ergometer, lower limb maximum power output (W(max)) determined with the jumping method, global motor capabilities determined by analysis of locomotor pattern during a short (8 m) running, maximum strength (1-RM) of upper and lower limb muscle groups determined with isotonic machines were tested before and after the program. Adherence to an individual exercise activity and maintenance of body weight (bw) loss were evaluated with a telephonic interview 6 months after the completion of the program. In both groups a significant (p < 0.001) and comparable weight loss was observed (IET: -4.27%; NET: -4.17%). In both groups VO2max and W(max) increased significantly (p < 0.05-0.001) when expressed relatively to body mass, while in absolute terms they were significantly (p < 0.001) improved only in IET group. 1-RM in all tested muscle groups was significantly increased in both IET and NET subjects (p < 0.001-0.01), but improvements were significantly greater in IET as compared with NET (p < 0.05-0.001). The analysis of locomotor pattern during the short running indicated that IET subjects significantly improved their global motor capabilities (p < 0.05-0.001), while no change was observed in NET group. After 6 months, IET subjects reported a level of spontaneously chosen physical activity significantly higher (p < 0.05) than NET subjects, displaying a trend of further decrease in bw. It was concluded that, although no difference in bw loss was appreciated between the two studied groups and significant improvements were found also in subjects performing NET protocol, the IET protocol offers better overall results in terms of muscle performance and physical fitness, with a possibly stronger motivation to subsequent exercise activity.

Effects of different training protocols on exercise performance during a short-term body weight reduction programme in severely obese patients.

The effects on aerobic, anaerobic and strength performance of aerobic (A) or A and strength (AS) training, integrated with a 3-week body weight reduction programme involving an energy-restricted diet, nutritional education and psychological counselling, were evaluated in 52 grade II or III obese individuals (A: n = 26; AS: n = 26). After 3 weeks, both training programmes led to a similar and significant reduction (p < 0.001) in body mass (A: 4.8%; AS: 4.4%) and an increase (p < 0.05 - p < 0.01) in maximal oxygen consumption (A: 16.8%; AS: 10.9%). A significant (p < 0.05 - p < 0.001) increase was found in absolute lower limb anaerobic power output evaluated by means of a jumping test (A: 13.7%; AS: 18.1%) and stair climbing test (A: 9.7%; AS: 4.3%), without any significant difference between A and AS. A comparable and significant (p < 0.01) increase was also found in average horizontal velocity during a short sprint running test (A: 8.1%; AS: 7.1%), with a shorter time of foot-ground contact (A: 4.9%; AS: 6.6.%) and a higher step frequency (A: 4.0%; AS: 10.4%). The maximum strength increase after the body weight reduction programme determined by one maximal repetition test of lower and upper limb muscle groups was significantly greater (p < 0.05 - p < 0.001) in the AS group, ranging from 11.4% to 25.4% (A) and from 26.7% to 41.8% (AS). These results indicate that integrating a body weight reduction programme involving diet nutritional education and psychological counselling with A or AS exercise has similar positive effects in lowering body mass and improving A and anaerobic performance. However, the addition of strength training to A conditioning increases maximum strength.

Laparoscopic antireflux surgery: preoperative lower esophageal sphincter pressure does not affect outcome.

BACKGROUND: Concern has been raised about operating on patients with gastroesophageal reflux disease (GERD) and normal lower esophageal sphincter (LES) pressure for the fear that a fundoplication may fail to control reflux and result in a high rate of postoperative dysphagia. We hypothesized that fundoplication is effective in patients with GERD irrespective of the preoperative LES pressure, and that in patients with normal LES pressure, a total fundoplication does not result in a high incidence of dysphagia. METHODS: We studied 280 unselected patients with GERD who underwent laparoscopic fundoplication. They were divided in three groups based on the preoperative LES pressure (normal, 14-24 mmHg): group A (LES pressure, 0-6 mmHg; 61 patients; 22%); group B (LES pressure, 7-13 mmHg; 178 patients; 64%); group C (LES pressure, >or=14 mmHg; 41 patients; 14%). De novo dysphagia was defined as new onset of postoperative dysphagia lasting more than 10 weeks. The average follow-up period was 17 +/- 22 months. RESULTS: There was no difference in resolution of symptoms among the three groups. Heartburn and regurgitation resolved or improved respectively in 96% of group A, 90% of group B, and 91% of group C patients. In addition, there was no difference in the incidence of de novo dysphagia, which occurred in 8% of group A, 7% of group B, and 2% of group C. CONCLUSIONS: We conclude that fundoplication controlled GERD irrespective of preoperative LES pressure, and that a normal LES pressure before surgery was not associated with a higher rate of postoperative dysphagia.

Purification of the RelB and RelE proteins of Escherichia coli: RelE binds to RelB and to ribosomes.

The direct interaction of the Escherichia coli cytotoxin RelE with its specific antidote, RelB, was demonstrated in two ways: (i) copurification of the two proteins and (ii) a positive yeast two-hybrid assay involving the relB and relE genes. In addition, the purified RelE protein exhibited ribosome-binding activity in an in vitro assay, supporting previous observations suggesting that it is an inhibitor of translation.