Altitude-induced effects on neuromuscular, metabolic and perceptual responses before, during and after a high-intensity resistance training session.

PURPOSE: We tested if an acute ascending to 2320 m above sea level (asl) affects corticospinal excitability (CSE) and intracortical inhibition (SICI) measured with transcranial magnetic stimulation (TMS) at rest, before, during and after a traditional hypertrophy-oriented resistance training (RT) session. We also explored whether blood lactate concentration (BLa), ratings of perceived exertion (RPE), perceived muscular pain and total training volume differed when the RT session was performed at hypoxia (H) or normoxia (N). METHODS: Twelve resistance-trained men performed eight sets of 10 repetitions at 70% of one repetition maximum of a bar biceps curl at N (SpO2 = 98.0 ± 0.9%) and H (at 2320 asl, SpO2 = 94.0 ± 1.9%) in random order. Before each session, a subjective well-being questionnaire, the resting motor threshold (rMT) and a single pulse recruitment curve were measured. Before, during and after the RT session, BLa, RPE, muscle pain, CSE and SICI were measured. RESULTS: Before the RT session only the rMT differed between H (- 5.3%) and N (ES = 0.38). RPE, muscle pain and BLa increased through the RT session and were greater at H than N (12%, 54% and 15%, respectively) despite a similar training volume (1618 ± 468 kg vs. 1638 ± 509 kg). CSE was reduced during the RT session (~ 27%) but recovered ten minutes after, regardless of the environmental condition. SICI did not change after any RT session. CONCLUSIONS: The data suggest that acute exposure to moderate hypoxia slightly increased the excitability of the most excitable structures of the corticospinal tract but did not influence intracortical or corticospinal responses to a single RT session.

Postural Stability and Cognitive Performance of Subjects With Parkinson's Disease During a Dual-Task in an Upright Stance.

BACKGROUND: The reviewed studies on center of pressure (COP) displacement in Parkinson's disease (PD) subjects show important methodological differences and contradictory results with regard to healthy subjects. The dual-task paradigm method has been used to examine cognitive prioritization strategies to control concurrent postural and cognitive tasks. The motor requirements, such as pronouncing words, involved in the cognitive tasks used in double-task conditions could be related to the heterogeneity of the results. RESEARCH OBJECTIVE: To compare postural sway and cognitive performance in subjects with PD and controls using a dual-task paradigm with a cognitive task free of motor demands. We tried to examine the prioritization strategy of PD patients regarding healthy adults to control for concurrent postural and cognitive tasks. MATERIALS AND METHODS: 25 subjects with PD and 20 healthy controls carried out a postural task under both single-task and dual-task conditions. The postural task was to stand as still as possible, with eyes first open and then closed. The dual-task condition added a concurrent cognitive task based on phoneme monitoring. COP displacement variables and cognitive performance were compared between the groups and within-subject factors were also examined. RESULTS: PD participants showed higher COP displacement results than the controls. All participants shortened the mean sway radius in dual-task conditions compared with single-task conditions; only healthy subjects presented less transversal COP sway in dual-task conditions than in single-task conditions. The cognitive performance of PD patients on a phoneme monitoring task worsened when they carried it out while maintaining balance in a standing position compared to sitting. The opposite effect occurred in control subjects. CONCLUSION: This study confirms the negative influence of Parkinson's disease on the control of standing stability, increasing the COP sway amplitude. The attentional demands of a postural task, such as standing balance, may be greater in PD patients than in healthy subjects. This would affect the performance of patients during dual-task conditions to be able to control a postural task while performing other cognitive tasks. In these conditions, cognitive performance would be negatively affected. These results suggest that subjects with PD, at least during initial disease stages, prioritize postural control over other concurrent tasks, as is also seen in healthy subjects.

Gait Pattern and Cognitive Performance During Treadmill Walking in Parkinson Disease.

OBJECTIVE: The aim of this study was to explore whether attentional demands are involved in gait improvements in Parkinson disease (PD) patients when they walk on a treadmill. DESIGN: Nineteen individuals with idiopathic PD and 19 age-matched healthy controls participated in this study. Participants walked on a treadmill and on overground under single task (walk only) and dual task (walk performing a simultaneous cognitive task) conditions. The dual-task paradigm was used to reveal the attention allocation behavior. Gait pattern and cognitive performance was measured. RESULTS: The PD group showed reduced gait variability when walking on a treadmill in comparison with overground. However, this reduction did not deteriorate during the dual task. Moreover, there were no differences in the cognitive performance between treadmill and overground walking. CONCLUSIONS: This study does not support the proposition attentional resource allocation as a possible mechanism for the treadmill-associated gait improvements observed in PD.

Treadmill training improves overground walking economy in Parkinson's disease: a randomized, controlled pilot study.

Gait disturbances are one of the principal and most incapacitating symptoms of Parkinson's disease (PD). In addition, walking economy is impaired in PD patients and could contribute to excess fatigue in this population. An important number of studies have shown that treadmill training can improve kinematic parameters in PD patients. However, the effects of treadmill and overground walking on the walking economy remain unknown. The goal of this study was to explore the walking economy changes in response to a treadmill and an overground training program, as well as the differences in the walking economy during treadmill and overground walking. Twenty-two mild PD patients were randomly assigned to a treadmill or overground training group. The training program consisted of 5 weeks (3 sessions/week). We evaluated the energy expenditure of overground walking, before and after each of the training programs. The energy expenditure of treadmill walking (before the program) was also evaluated. The treadmill, but not the overground training program, lead to an improvement in the walking economy (the rate of oxygen consumed per distance during overground walking at a preferred speed) in PD patients. In addition, walking on a treadmill required more energy expenditure compared with overground walking at the same speed. This study provides evidence that in mild PD patients, treadmill training is more beneficial compared with that of walking overground, leading to a greater improvement in the walking economy. This finding is of clinical importance for the therapeutic administration of exercise in PD.

The effects of startle and non-startle auditory stimuli on wrist flexion movement in Parkinson's disease.

Startle stimuli lead to shorter reaction times in control subjects and Parkinson's disease (PD) patients. However, non-startle stimuli also enhance movement initiation in PD. We wanted to examine whether a startle-triggered movement would retain similar kinematic and EMG-related characteristics compared to one induced by a non-startle external cue in PD patients. In this study we investigated the electromyography pattern and the reaction time during a wrist flexion movement in response to three different stimuli: a visual imperative stimulus; visual stimulus simultaneous with a non-startle auditory stimulus and with a startle auditory stimulus. Ten PD patients and ten aged matched controls participated in this study. The reaction times were faster for startle and non-startle stimuli in comparison with the visual imperative stimulus, in both patients and control subjects. The startle cue induced a faster reaction than the non-startle cue. The electromyography pattern remained unchanged across the conditions. The results suggest that the startle reaction effect for upper limb movements are unimpaired in PD patients and has different characteristics than the effect of non-startle stimuli.

[The new congenital Spigelian hernia and cryptorchidism syndrome. Analysis of 16 cases]. / El nuevo síndrome de hernia de Spiegel congénita y criptorquidia. Análisis de 16 casos.

INTRODUCTION: Spigelian hernias in childhood are extremely uncommon. The aim of this study was to analyse the pathogenetic factors of paediatric Spigelian hernias. PATIENTS AND METHOD: A retrospective review of worldwide literature for infants who had undergone surgical repair of a Spigelian hernia from 1950 to 2006. Descriptive statistical techniques were applied and percentages and means were calculated. RESULTS: There were 33 patients in whom 40 Spigelian hernias were repaired, 26 males and 7 females, with a sex ratio of 3.7/1. The mean age was 2.7 years. 7 hernias are bilateral. RISK FACTORS: anal stenosis (n = 1). Associated defects: cryptorchidism (n = 22), inguinal hernia (n = 5), umbilical hernia (n = 2). The most common hernia contents are testicle (40%), small intestine ( 27.5%) and omentum (15%). CONCLUSIONS: The mean age of Spigelian hernia in children was 2.7 years, which would suggest a congenital cause. Spigelian hernias in infants are more common in males. There were 21.2% bilateral hernias. No risk factors were detected. Combined hernias accounted for 15.1% of the total. The most frequent hernia content is the testicle (40%). Interestingly, 48.4% of those infants with Spigelian hernias had ipsilateral cryptorchidism, which may suggest a new syndrome.

El nuevo síndrome de hernia de Spiegel congénita y criptorquidia. Análisis de 16 casos / The new congenital spigelian hernia and cryptorchidism syndrome. Analysis of 16 cases

Introducción. La hernia de Spiegel es muy poco frecuente en la infancia. El objetivo de este trabajo es analizar los aspectos etiopatogénicos de estas hernias. Material y método. Analizamos retrospectivamente a los pacientes pediátricos con reparación quirúrgica recogidos en la literatura entre 1950 y 2006. Se aplicó estadística descriptiva con cálculo de porcentajes y medias. Resultados. Se analiza a 33 pacientes menores de16 años tratados quirúrgicamente de 40 hernias de Spiegel. La media de edad fue 2,7 años. Había 26 varones y 7 mujeres, en proporción de 3,71:1. Había 15hernias derechas, 11 izquierdas y 7 bilaterales. Factores predisponentes: estenosis de ano (n = 1). Anomalías asociadas: criptorquidia (n = 22) (10 ipsolateralesy 6 bilaterales), hernia inguinal (n = 5), hernia umbilical(n = 2). El contenido del saco más frecuente fue el testículo (el 40% de todas las hernias), seguido de intestino delgado (27,5%) y epiplón (15%).Conclusiones. La media de edad de los pacientes pediátricos con hernias de Spiegel es de 2,7 años, lo que indica una causa congénita. Las hernias de Spiegel pediátricas son más frecuentes en varones. Estas hernias son bilaterales en el 21,2% de los pacientes. Hay pocos factores predisponentes. Aparecen hernias asociadas en el 15,1%. El contenido del saco más frecuente es el testículo (40%). La asociación entre hernia de Spiegel y criptorquidia ipsolateral ocurre en el 48,4% de los pacientes, lo que puede significar un nuevo síndrome (AU)

Introduction. Spigelian hernias in childhood are extremely uncommon. The aim of this study was to analyse the pathogenetic factors of paediatric Spigelianhernias. Patients and method. A retrospective review of worldwide literature for infants who had undergone surgical repair of a Spigelian hernia from 1950 to2006. Descriptive statistical techniques were applied and percentages and means were calculated. Results. There were 33 patients in whom 40 Spigelian hernias were repaired, 26 males and 7 females, with a sex ratio of 3.7/1. The mean age was 2.7 years.7 hernias are bilateral. Risk factors: anal stenosis (n =1). Associated defects: cryptorchidism (n = 22), inguinal hernia (n = 5), umbilical hernia (n = 2). The most common hernia contents are testicle (40%), small intestine( 27.5%) and omentum (15%).Conclusions. The mean age of Spigelian hernia in children was 2.7 years, which would suggest a congenital cause. Spigelian hernias in infants are more common in males. There were 21.2% bilateral hernias. No risk factors were detected. Combined hernias accounted for 15.1% of the total. The most frequent hernia content is the testicle (40%). Interestingly, 48.4%of those infants with Spigelian hernias had ipsilateral cryptorchidism, which may suggest a new syndrome (AU)

Hernia lumbar / Lumbar hernia

La hernia lumbar es un defecto poco frecuente. Presentamos dos casos de hernia lumbar operados en nuestro Servicio. El primer caso era una mujer de 83 años con hernia espontánea del triángulo lumbar superior. El segundo caso era una paciente de 49 años y hernia incisional en el triángulo lumbar inferior. El diagnóstico se confirmó mediante estudio ecográfico en las dos ocasiones, demostrando la solución de continuidad fascial y el contenido herniario móvil. Se revisa la anatomía y el tratamiento quirúrgico de estas hernias. Nuestro primer caso se reparó con malla de Prolene y el segundo con cierre simple. Es necesario utilizar material protésico cuando el tamaño del defecto es grande. No hemos observado recurrencia en nuestros pacientes (AU)