Sarcopenic obesity: etiology and lifestyle therapy.

OBJECTIVE: Sarcopenic obesity (OS) is a multifactorial condition characterized by the simultaneous presences of sarcopenia and obesity. The prevalence of OS is increasing in adults over 65 years of age; people with OS present greater health risks than people who are only sarcopenic or obese. Therefore, the study of OS and the search for effective treatment are important due to the constant increase of the elderly population. MATERIALS AND METHODS: This review discusses the etiology and evolutionary mechanisms of OS while exploring its molecular, metabolic, oxidative, inflammatory, hormonal, and nutritional stresses. Studies have tried to unravel the causes related to the onset of sarcopenia, which is responsible for the decrease of muscle mass and strength in elderly subjects. The diagnostic criteria and the methods of evaluation of OS are described in these research studies, although there is no univocal definition for these parameters. The most studied treatments in OS are illustrated and highlight how the physical activity performed through both aerobic and resistance exercises, as well as a correct nutritional treatment, prove to be the most effective interventions in the regression of the pathology and in the improvement of physical function. RESULTS: New therapies for OS are hypothesized that will open the way to other possible types of intervention in the future. CONCLUSIONS: The deficiency of muscle mass in obese elderly subjects will be one of the health challenges of the future to reduce the risk of chronic diseases.

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.

The influence of music on exercise in a group of sedentary elderly women: an important tool to help the elderly to stay active.

AIM: The aim of this study was to verify how listening to instrumental asynchronous music, with tempo of 90 bpm, can affect the aerobic physical performance in elderly women engaged in a continuous and constant exercising, predominantly aerobic, consisting of walking routines. METHODS: Twenty women (N.=20, age=75.8±4.2 years) volunteered to the study and underwent a six-week period of physical exercising. All women were previously sedentary, as they had not trained systematically within the last 5 years. The experimental group (Eg=10) performed all the exercise sessions and tests listening to music. The control group (Cg=10) performed the same program without listening to music. Total distances covered, heart rates before and after the tests and the rates of perceived exertion (RPE) were measured. RESULTS: Significant differences between groups (P<0.01) were found in RPE. No statistically significant differences were observed in total distances covered and heart rates, although there was an increase of 9.83% in the total distance covered by the Eg compared to the Cg, in accordance with other previous researches. CONCLUSION: The results are in line with those reported by other authors in different populations and ages, confirming that music may be considered an important tool in supporting elderly people involved in physical exercising.

Detraining in young soccer players.

BACKGROUND: Two types of detraining can be described: short-term detraining with a period of less than 4 weeks, and long-term detraining (period longer than 4 weeks). The purpose of this study is to verify the presence and eventually the magnitude of physiological cardiorespiratory changes in young team sport players after a period of long-term detraining. METHODS: Fourteen young soccer players (15 ± 1 year) were studied with two incremental tests at the end of the regular season and after a six-week total break period from training activities. Physiological variables were evaluated: heart rate (HR), oxygen uptake (VO2), volume of ventilation (VE), aerobic (VA) and anaerobic (Van) running speed at thresholds and maximum effort were recorded. RESULTS: This study shows the magnitude of the physiological changes in young players after a period of long-term detraining. The results showed significant decreases at the end of the detraining period of VO2 at VA of 22.7% (44.54 ± 4.56 vs. 34.41 ± 4.57 mL/kg/min, P<0.05), of 25.8% of VO2 at VAn (54.60 ± 5.81 vs. 40.48 ± 5.07 mL/kg/min, P<0.05) and of 21.2% in VO2 max (62.83 ± 5.77 vs. 49.46 ± 6.51 mL/kg/min, P<0.05). Speed at VA (11.5 ± 0.96 vs. 10.7 ± 0.97 km/h; P<0.05), speed at VAn (15.3 ± 1.05 vs. 14.2 ± 1.48 km/h; P<0.05), peak running speed (18.8 ± 1.20 vs. 17.2 ± 1.1 km/h; P<0.05). CONCLUSION: It is likely that alteration of metabolic parameters may significantly affect the range of physical condition and especially, aerobic-anaerobic resistance and maintenance training would be advisable in young athletes during the transition period. Given the relevance of worsening demonstrated by our data, coaches should avoid very long periods of complete rest (no more than 15 days) at the end of the season.

Throwing velocity and kinematics in elite male water polo players.

AIM: Fifty-three members of the Italian Men Water Polo Team were filmed using two synchronized cameras, while they were shooting a goal. Considering the differences in body mass, height, training strategies and the technical-tactical features of the players, the aims of this study were to employ video-analysis techniques in order to investigate selected kinematic parameters in water polo throwing, and to provide comprehensive quantitative information on the throwing movement in relation to the different team player positions. METHODS: Video analysis was used to estimate the elbow angle at release, the shoulder angle at follow through, the back and head height at ball release, trunk rotation angle and ball velocity at release. RESULTS: Ball release velocities ranged from 21.0 to 29.8 m/s (average value 25.3±1.4 m/s), for field players. Goal keepers show the lowest team values (average 21.7±0.3 m/s). Similar to previous study results, ball release was typically reached just prior to the elbow approaching full extension (151.6±3.6°), and the follow through shoulder angle was 143±5.9°. CONCLUSION: No significant statistical difference was recorded between injured and non-injured athletes. No positive association was demonstrated between physical characteristics (body mass and height) and ball velocity.

Physiological profile of water polo players in different competitive levels.

AIM: The purpose of this study was to determine if there are different physiological characteristics in water polo players of three different competitive levels (national team, NT, junior national team, NJ, and amateur club, AC). METHODS: To better define the training levels of water polo players competing at different levels, we administered a shuttle swim test (SST, a specific test used by Italian coaches) and a classic speed-lactate test. The shuttle swim test is based on actions at maximum intensity followed by incomplete recoveries. To compare the athletes, we used their morphological characteristics, the speed during an incremental test associated with fixed blood lactate concentrations of 2 mmol*1-1 (Aerobic Threshold, AT) and 4 mmol*1-1 (Anaerobic Threshold, AnT), and the SST data (speed, heart rate and lactate concentration). RESULTS: The heart rate at the end of the SST was 164+/-12 beats*min-1 for NT, 166+/-10 beats*min-1 for NJ (no significant difference, P>0.05) and 179+/-9 beats*min-1 for AC (significantly different from NT and NJ, P<0.05). The AT and AnT speeds were significantly higher in NT than in AC and NJ (P<0.05). No significant differences were found in AT and AnT speeds between AC and NJ (P>0.05). The mean speed during the shuttle swim test was significantly higher in NT and NJ than in AC (P<0.05). Lactate values were similar in the NT, AC and NJ groups (P>0.05). The SST mean speed was significantly correlated with the AT (P<0.01) and AnT speeds (P<0.05) in three groups . In all groups no significant correlation was found between SST blood lactate and AT or AnT speeds (P>0.05). CONCLUSION: Some differences were found among the senior and junior professional and amateur water polo players in both SST performance and Aerobic and Anaerobic Thre-shold speeds. The shuttle swim test for water polo provides conditioning coaches and sport scientists with data on the sport-specific movement speed and the competition-specific fatigue resistance in each athlete.

Shuttle swim test for water polo players: validity and reliability.

AIM: The purpose of this study, carried out on elite water polo players, was to examine: 1) the relationship between the shuttle swim test (SST) and the performance during official water polo games, and 2) the SST reliability. METHODS: Sixteen male players of the Italian National Water Polo Team (age: 27.9 + or - 2.1 years, body mass: 88.5 + or - 10.3 kg, height: 186.6 + or - 6.9 cm) performed the SST, consisting of two sets of seven repetitions from 40 to 10 m (total of 120 m for each set) at a maximal intensity with 90 s of rest between sets. During the SST, average swimming speed, blood lactate concentration and heart rate were recorded. Direct validity of the SST was evaluated by comparing the average swimming speed with the total distance covered (TD) and the distance covered at high intensity swimming (above 1.8 m x s(-1), HIS) during three official water polo games. SST reliability was assessed by testing the same athletes one week apart. RESULTS: Average swimming speed during the SST was significantly correlated with TD (r=0.67, P<0.01) and HIS (r=0.74, P<0.004). The mean average speed during SST showed high reliability (TE=0.4%; CI 95%: 0.2% to 1.0% ). The T1 vs. T2 difference in mean average speed was not significant. CONCLUSIONS: Present findings demonstrate the validity and reliability of the SST for evaluation of the swimming fitness of water polo players.

Assessment of mother-to-child HIV-1 and HIV-2 transmission: an AIDS reference laboratory collaborative study.

OBJECTIVE: A prospective study was carried out to assess HIV-1 and HIV-2 mother-to-child transmission (MTCT) rates in Portugal between 1999 and 2005 by analysing the proportion of diagnosed infected children born to HIV-positive mothers. MATERIALS AND METHODS: Serial blood samples were collected from 1315 children at risk of HIV-1 infection, 131 children at risk of HIV-2 infection and six children at risk of both HIV-1 and HIV-2 infections attending 25 Health Institutions. HIV proviral DNA was detected by nested polymerase chain reaction (PCR) and statistical analysis was performed using spss. RESULTS: DNA PCR using HIV-1 and HIV-2 long terminal repeat (LTR) primers amplified 92.5% and 75% of maternal HIV infections, respectively. Overall, MTCT occurred in 3.4% [95% confidence interval (CI) 2.5-4.6%] of HIV-1 and 1.5% (95% CI 0.2-5.4%) of HIV-2 mother-child pairs. A significant decrease in HIV-1 MTCT was observed with time, from 7.0% (95% CI 2.6-14.6%) in 1999 to 0.5% (95% CI 0.0-2.5%) in 2005. HIV MTCT was associated with an absence of antiretroviral therapy in infected pregnant women (P<0.0001). Of the 48 infected children (46 with HIV-1 and two with HIV-2), the schedule of blood sample collection was followed for only 26 children. In 14 (53.8%) of those 26 children the infections were diagnosed in the first sample collected before they were 48 h old, suggesting in utero transmission. Despite the national recommendations for antenatal HIV testing, a high overall proportion (22.2% for HIV-1 and 44.3% for HIV-2) of mothers did not access any MTCT prevention measures, mostly because of late diagnosis in pregnancy. A small but significant proportion of HIV-2 infection was found in mothers with no identifiable link with West Africa. CONCLUSION: HIV-2 transmission rates are low (1.5% in this study), and this may have led to a lower uptake of interventions, but in the absence of interventions transmission does occur. HIV-1 transmission was also associated with a lack of intervention, mostly as a result of late presentation. Use of primers restricted to a single sequence led to false-negative maternal results in a significant proportion of cases. In part this may have been attributable to very low HIV DNA loads as well as primer template mismatches. HIV infection was not documented in children born to mothers with negative HIV DNA PCR results.

Activity-based costing via an information system: an application created for a breast imaging center.

Activity-based costing (ABC) is a process that enables the estimation of the cost of producing a product or service. More accurate than traditional charge-based approaches, it emphasizes analysis of processes, and more specific identification of both direct and indirect costs. This accuracy is essential in today's healthcare environment, in which managed care organizations necessitate responsible and accountable costing. However, to be successfully utilized, it requires time, effort, expertise, and support. Data collection can be tedious and expensive. By integrating ABC with information management (IM) and systems (IS), organizations can take advantage of the process orientation of both, extend and improve ABC, and decrease resource utilization for ABC projects. In our case study, we have examined the process of a multidisciplinary breast center. We have mapped the constituent activities and established cost drivers. This information has been structured and included in our information system database for subsequent analysis.

Choledocholithiasis in a premature neonate.

Choledocholithiasis in neonates and infants has been reported only rarely. Infants with complications of prematurity are more predisposed to development of biliary calculi. With the current widespread use of diagnostic ultrasonography, more neonates may be found to have gallstones and common bile duct stones. We describe a case of choledocholithiasis and cholelithiasis in a premature neonate successfully treated by surgical placement of a cholecystotomy tube and irrigation of the biliary system.

Maintaining long-term central venous access by repetitive hepatic vein cannulation.

Long-term central venous access has become a critical issue in the treatment of pediatric patients. Exhaustion of access sites can lead to superior and inferior vena cava thrombosis, limiting the choices for central line placement. Under such circumstances, hepatic vein cannulation is a viable option. We present the cases of two patients who, combined, have undergone five hepatic vein catheterizations. One patient has received four consecutive central lines via a hepatic vein. This experience suggests that the hepatic vein is a reusable site of cannulation in patients with no other alternative for venous access.

Normal thymus simulating pericardial disease: diagnostic value of magnetic resonance imaging.

Normal enlargement of the thymus in infancy can often lead to erroneous clinical suspicion of cardiomegaly. Roentgenographic differentiation is not always definitive but echocardiography is generally effective in differentiating cardiac pathology from an enlarged thymus. In this patient, magnetic resonance imaging was necessary to differentiate benign thymic hyperplasia from pericardial or mediastinal pathology. Thymic involution with a severe neonatal illness, followed by thymic rebound, which later subsided, added to the interest and initial confusion in this patient.

The question of parallax-effect on radiographic assessment of short trachea in infants and children.

Disproportionately short trachea, can be recognized in AP chest radiographs of infants and older children taken during quiet respiration and showing an evaluable air tracheobronchogram, by the thoracic vertebral level of the carina (normally at T4 in neonates and infants, and at T5 in children two years of age or older). To establish the extent to which a parallax-effect of differing angles of X-ray beam relative to the patient can influence the radiologic assessment of carinal level, we measured the tracheal-vertebral distance at the carina in 29 lateral radiographs of neonates, infants and children, prepared diagrams of the loci of carinal beam intercept of the vertebral column for different angles of beam to body, from tracings of lateral radiographs of two 2-week-old infants, one with trachea of normal length and one with short trachea; of a nine-year-old child with short trachea, and of a ten-year-old with normal trachea, and made radiographs of a postmortem tracheobronchogram of a two-day-old infant at different beam angles. We conclude that tube-body angles of the order of 10-15 degrees from vertical at 27 inches (68.6 cm) or at 40 inches (101.6 cm) FFD do not significantly affect the apparent thoracic vertebral level of the carina in AP chest radiographs, and that a beam angle of 20 degrees or more from vertical is necessary to change the apparent level of tracheal bifurcation by one vertebral body, depending on the patient's age and on whether the patient's position relative to the X-ray beam is lordotic or anti-lordotic.(ABSTRACT TRUNCATED AT 250 WORDS)

Serial section-reconstruction of anomalous tracheobronchial branching patterns from CT scan images: bridging bronchus associated with sling left pulmonary artery.

The use of the technique of wax-plate serial section-reconstruction, based on contiguous axial plane CT images of the upper thorax, to prepare a replica of the central air-way (trachea and major bronchi) of an infant with sling left pulmonary artery type 2B, with bridging bronchus, abortive right main bronchus, and tracheal stenosis due to absence of the tracheal pars membranacea with "ring" tracheal cartilages is described. The technique is applicable to demonstration of the anatomic features of other abnormalities of branching pattern or caliber of the trachea and major bronchi.

Mediastinal masses: a system for diagnosis based on computed tomography.

A revised system for mediastinal mass differentiation has been developed and used at the Veterans Administration Medical Center, San Diego, and University Hospital of the University of California, San Diego. Contrast medium infusion or bolus computed tomography of the entire mediastinum is obtained, except when the mass is probably a thyroid mass (123I scan then obtained first) or an esophageal mass (barium swallow evaluation then obtained first). Next computed tomography density is determined, and only subsequently are masses of similar density subdivided by location. Further differentiation is based on computed tomography imaging parameters. A new algorithm for evaluation of mediastinal masses has resulted from use of this system. The system has been shown to increase specificity of differential diagnosis and to result in increased efficiency of evaluation of patients with mediastinal masses.