An Investigation Into the Short-Term Effects of Photobiomodulation on the Mechanical Nociceptive Thresholds of M. Longissimus and M. Gluteus Medius, in Relation to Muscle Firing Rate in Horses at Three Different Gaits.

Back pain is a common condition in horses, yet despite this, quantitative assessments of the efficacy of treatment are scarce. Mechanical nociceptive thresholds (MNTs) and acoustic myography (AMG) recordings were obtained, both preinterventionand postintervention, from the left and right epaxial muscles in eight healthy general riding horses (mean age 17 ± 6 yrs). Using an algometer, MNT readings were taken at each of the 6 preselected points along the thoracolumbar M. longissimus and M. gluteus medius region. AMG recordings of the M. longissimus and M. gluteus medius were taken while walking, trotting, and cantering on a left or right hand 20m circle on a longe, on a waxed sand surface in an indoor arena. Horses were then treated using a class 1 laser. Therapy was applied for 1 minute at 1000 Hz to the same preselected points from which MNT measurements had previously been taken. Measurements were subsequently taken 1 hour and 24 hours post-treatment for MNT reading, and only 24 hours after for AMG measurements. No significant effect of treatment was noted for the MNTs. The AMG results were analyzed in terms of their temporal summation (T-score), where statistically significant improvements in the T-scores for M. longissimus and M. gluteus medius were noted for the different gaits. It is concluded that cold laser therapy has a positive effect on horse muscles that reveals a change in their firing frequency that is commensurate with changes seen with analgesia in subjects experiencing pain.

Novel insights into cerebral palsy.

Cerebral palsy (CP) is a neurodevelopmental disorder characterized by abnormalities of muscle tone, movement and motor skills, and is attributed to injury to the developing brain. CP affects about 1 in 500 neonates. CP shows clinical features which evolve with age, and these may over time lead to deterioration of motor function although the lesion to the developing brain is non-progressive. The underlying causes for CP remain unclear. Based on recent research we are able to give a physiological explanation on the appearance and development of the condition. The damage to the central nervous system causes a change in collagen structure, with a higher level of deposition of collagen around the muscles, increasing throughout life. Assuming this premise is correct, the question is, will it by any treatment be possible to delay or prevent this collagen accumulation in the CP muscles, thereby giving CP patients a better prognosis in the future.

Muscle function assessed by the non-invasive method acoustic myography (AMG) in a Danish group of healthy adults.

Acoustic myography (AMG) is a non-invasive method to assess muscle function during daily activities. AMG has great scope for assessment of musculoskeletal problems. The aim of this study was to create an AMG data set for general clinical use and relate these findings to age and gender. 10 healthy subjects (5 men/5 women), in each decade from 20 to 69 years of age (n = 50), were assessed. Their clinical health was tested. AMG measurements were carried out on muscles involved in defined movements of the upper and lower extremities. Muscle performance was measured using efficiency (E-score) and fibre recruitment (temporal (T-score) and spatial (S-score) summation). AMG-measurements showed good reproducibility. In each age group, it was found that for all those daily living skills measured, there was no gender difference. A walking and stair climbing test revealed that both legs are used equally and in a balanced way in healthy subjects. Moreover, there was no change in this function with increasing age up to 69 years. However, a cycling test with loading revealed that in elderly subjects the coordination of muscle use is impaired compared to that of the younger adults. Finally, a flexion test of the arm revealed an age-related decrease in the efficiency/coordination of m.Biceps alone, and a keyboard writing test suggests no effect on m.Trapezius. This reference data set now illustrates the reproducibility and ease of use of acoustic myography in the clinic and provides a means of assessing individuals with musculoskeletal problems.

A comparative multi-site and whole-body assessment of fascia in the horse and dog: a detailed histological investigation.

Fascia in the veterinary sciences is drawing attention, such that physiotherapists and animal practitioners are now applying techniques based on the concept of fascia studies in humans. A comprehensive study of fascia is therefore needed in animals to understand the arrangement of the fascial layers in an unguligrade horse and a digitigrade dog. This study has examined the difference between the horse and the dog fascia at specific regions, in terms of histology, and has compared it with the human model. Histological examinations show that in general the fascia tissue of the horse exhibits a tight and dense composition, while in the dog it is looser and has non-dense structure. Indeed, equine fascia appears to be different from both canine fascia and the human fascia model, whilst canine fascia is very comparable to the human model. Although regional variations were observed, the superficial fascia (fascia superficialis) in the horse was found to be trilaminar in the trunk, yet multilayered in the dog. Moreover, crimping of collagen fibers was more visible in the horse than the dog. Blood vessels and nerves were present in the loose areolar tissue of the superficial and the profound compartment of hypodermis. The deep fascia (fascia profunda) in the horse was thick and tightly attached to the underlying muscle, while in the dog the deep fascia was thin and loosely attached to underlying structures. Superficial and deep fascia fused in the extremities. In conclusion, gross dissection and histology have revealed species variations that are related to the absence or presence of the superficial adipose tissue, the retinacula cutis superficialis, the localization and amount of elastic fibers, as well as the ability to slide and glide between the different layers. Further research is now needed to understand in more detail whether these differences have an influence on the biomechanics, movements and proprioception of these animals.

The relation between maximal voluntary force in m. palmaris longus and the temporal and spatial summation of muscle fiber recruitment in human subjects.

This study aimed at looking at the frequency (T-score) and the amplitude (S-score) of fiber use during contraction of a forearm muscle, m. palmaris longus, as measured by acoustic myography (AMG). An additional aim was to relate the T- and S-scores to the recorded force obtained from a hand dynamometer. The hypothesis being that temporal and spatial summation of muscle fiber contraction in a given muscle during a given movement, can together describe a given obtained force. Force measurements were carried out on 12 healthy human subjects aged 19-68 years (6 men & 6 women), while their m. palmaris longus contractile function was measured using an acoustic myography CURO device. Force production was varied from 90 to 10% of assessed maximal voluntary force (MVF), and also monitored over a 1 min period of 50% MVF. Linear regression analysis was applied to relate force to spatial and temporal summation. Muscle strength was sustained by changing the frequency and/or the number of active fibere at any given point in time. Force production, whilst stronger for men than women, was regulated in a similar fashion for both sexes and was closely correlated with the AMG T- and S-scores. It is concluded that AMG is a noninvasive method which can be readily applied to accurately describe how a subject uses a given muscle during any given movement. These findings have relevance when considering training strategies in subjects with muscle trauma or disease, in the elderly, or for both amateur and top professional athletes.

A more precise, repeatable and diagnostic alternative to surface electromyography - an appraisal of the clinical utility of acoustic myography.

Acoustic myography (AMG) enables a detailed and accurate measurement of those muscles involved in a particular movement and is independent of electrical signals between the nerve and muscle, measuring solely muscle contractions, unlike surface electromyography (sEMG). With modern amplifiers and digital sound recording systems, measurements during physical activity both inside and outside a laboratory setting are now possible and accurate. Muscle sound gives a representation of the work of each muscle group during a complex movement, and under certain forms of movement even reveals both concentric and eccentric activity, something that sEMG is incapable of. Recent findings suggest that AMG has a number of advantages over sEMG, being simple to use, accurate and repeatable as well as being intuitive to interpret. The AMG signal comprises three physiological parameters, namely efficiency/coordination (E-score), spatial summation (S-score) and temporal summation (T-score). It is concluded that modern AMG units have the potential to accurately assess patients with neuromuscular and musculoskeletal complaints in hospital clinics, home monitoring situations as well as sports settings.

The Efficacy of Intermittent Long-term Bell Boot Application for the Correction of Muscle Asymmetry in Equine Subjects.

It has been proposed that manipulating proprioceptive signals of the equine distal limb as part of a rehabilitation process in cases of musculoskeletal pain or neurologic deficits can be used to correct postural control and restore normal motor programs. This trial has examined the effect of treatment with a light-weight and loose-fitting bell boot (82 g) on an imbalance of muscle gluteus superficialis function in horses as measured using acoustic myography (AMG). Eight horses were trained over a 60-minute period every 3 days for 6 weeks, a protocol based on preliminary findings. Acoustic myography measurements, recording the coordination, spatial and temporal summation of muscle contractions, were made at the start (baseline) and at the finish (week 6) after a warmup period and following a set procedure of physical activity. Walking, trotting, and cantering during a left-hand circle at the start of the trial revealed a slight but significant asymmetry between the left and right hind limb muscle, which improved successfully after 6 weeks of proprioception training. Data for the right-hand circle, which revealed no significant asymmetry, during walk, trot, and canter at the start, showed no change after 6 weeks of training at the walk and trot but developed an imbalance during cantering, the result of overcompensation. This study demonstrates that functional musculoskeletal asymmetry measured during periods of activity can not only be accurately detected using AMG but it also reveals an association between the program of proprioceptive training adopted and an improvement in muscular imbalance.

Resistance training and testosterone levels in male patients with chronic kidney disease undergoing dialysis.

BACKGROUND: We investigated serum testosterone and insulin-like growth factor 1 (IGF-1) levels' associations with muscle fibre size and resistance training in male dialysis patients. METHODS: Male patients were included in a 16-week control period followed by 16 weeks of resistance training thrice weekly. Blood samples were obtained to analyse testosterone, luteinizing hormone (LH), IGF-1, and IGF-binding protein 3. Muscle fibres' size was analysed in biopsies from m. vastus lateralis. RESULTS: The patients' testosterone levels were within the normal range at baseline (n = 20) (19.5 (8.2-52.1) nmol/L versus 17.6 (16.1-18.0), resp.) whereas LH levels were higher (13.0 (5.5-82.8) U/L versus 4.3 (3.3-4.6), P < 0.001, resp.). IGF-1 and IGF-binding protein 3 levels were higher in the patients compared with reference values (203 (59-590) ng/mL versus 151 (128-276), P = 0.014, and 5045 (3370-9370) ng/mL versus 3244 (3020-3983), P < 0.001, resp.). All hormone levels and muscle fibre size (n = 12) remained stable throughout the study. Age-adjusted IGF-1 was associated with type 1 and 2 fibre sizes (P < 0.05). CONCLUSION: Patients' total testosterone values were normal due to markedly increased LH values, which suggest a compensated primary insufficiency of the testosterone producing Leydig cell. Even though testosterone values were normal, resistance training was not associated with muscle hypertrophy. This trial is registered with ISRCTN72099857.

Interleukin-6 and vitamin D status during high-intensity resistance training in patients with chronic kidney disease.

Background. The aim of this study was to investigate IL-6 and 25-hydroxyvitamin D (25-OH D) associations with muscle size and muscle function in dialysis patients. Methods. Patients were included in a 16-week control period followed by 16 weeks of high-intensity resistance training thrice weekly. IL-6 and 25-OH D were analysed after an over-night fast. Muscle fibre size was analysed in biopsies from m. vastus lateralis. Muscle power was tested using a Leg Extensor Power Rig. Results. Patients (n = 36) with IL-6 ≥ 6.49 pg/ml (median) were older and had decreased muscle power and a reduced protein intake (P < 0.05) compared with patients with IL-6 < 6.49 pg/ml. IL-6 was not associated with muscle fibre size. Vitamin D deficiency (25-OH D < 50 nmol/l) was present in 51% of the patients and not associated with muscle power. IL-6 remained unchanged during the training period, whilst muscle power increased by 20-23% (P < 0.001). Conclusion. Elevated IL-6 values were associated with decreased muscle power but not with decreased muscle fibre size. Half of the patients were suffering from vitamin D deficiency, which was not associated with muscle power. IL-6 was unchanged by high-intensity resistance training in dialysis patients in this study.

Sexual dysfunction is more than twice as frequent in Danish female predialysis patients compared to age- and gender-matched healthy controls.

PURPOSE: This study aimed to compare sexual dysfunction in Danish female predialysis patients with chronic kidney disease (CKD) stage 4-5 with age-matched healthy women in Denmark. METHODS: Twenty-seven adult female predialysis patients (CKD stage 4-5 ~ creatinine clearance ≤ 30 ml/min) without diagnosed depression and 54 randomly assigned healthy female controls completed the questionnaires Female Sexual Function Index, Female Sexual Distress Scale, and the Major Depression Inventory. RESULTS: Predialysis patients reported lower Female Sexual Function Index scores compared to the controls (14.2 ± 2.1 vs. 20.1 ± 1.7, respectively, p = 0.048), more frequent sexual distress (44 vs. 22 %, respectively, p = 0.044), and more frequent sexual dysfunction (41 vs. 17 %, respectively, p = 0.041). There was no difference between the patients' and the controls' depression scores (12.2 ± 2.2 vs. 8.6 ± 1.1, respectively, p = 0.180). CONCLUSION: Sexual dysfunction was found to be more than two times as frequent in Danish female predialysis patients with CKD stage 4-5 compared to age- and gender-matched healthy controls, and this result emphasizes the need for attention towards sexual function in the treatment for CKD.

Portable acoustic myography - a realistic noninvasive method for assessment of muscle activity and coordination in human subjects in most home and sports settings.

Muscle sound gives a local picture of muscles involved in a particular movement and is independent of electrical signals between nerve and muscle. Sound recording (acoustic myography) is a well-known noninvasive technique that has suffered from not being easily applicable, as well as not being able to register at sufficient sampling speed. With modern amplifiers and digital sound recording this has changed, and such assessment during movement outside a laboratory setting may be possible. Our aim was to develop a setup for muscle-sound assessment, which could be reliably applied in any local setting. A group of healthy subjects were assessed during standing, stair climbing, walking, and running. Piezoelectric microphones were applied to the skin using contact gel. A digital sound recorder enabled sampling speeds of around 96,000 Hz. Surface electromyography was measured in parallel as a comparison. The recorded signals were assessed and described in terms of signal frequency (Hz) and peak-to-peak amplitude (mV) using Chart software. Bioimpedance of the involved muscles was measured. Sound recording was shown to be an easy noninvasive method for assessment of muscle function during movement with the possibility of being applied in most clinical, sports, and home settings. Muscle sound gives a representation of the work of each muscle group during a complex movement, illustrated here by a step test, which revealed both concentric and eccentric activity. The method in the presented new setup has great potential for assessment of function in patients with musculoskeletal complaints in out-of-clinic settings, as well as in sports.

Increased rate of force development and neuromuscular activity after high-load resistance training in patients undergoing dialysis.

AIM: The aim of this study was to investigate the effects of high-load resistance training on the rate of force development and neuromuscular function in patients undergoing dialysis. METHODS: Twenty-nine patients were tested before and after 16 weeks of resistance training. The rate of force development was tested using the Good Strength dynamometer chair. Muscle strength and neuromuscular function in the m. Vastus lateralis was estimated using electromyography in a one repetition maximum test during dynamic knee extension and during a 20 s isometric knee extension with 50% of the one repetition maximum load. Muscle biopsies from the m. Vastus lateralis were analysed for morphologic characteristics. RESULTS: One repetition maximum in knee extension increased by 46% (P<0.001) after the training programme. Rate of force development increased by 21-38% (P<0.05). The electromyography amplitude increased during 200-300 msec from 183 ± 36 µV to 315 ± 66 µV, (P<0.05), whilst electromyography frequency remained unchanged. The electromyography signals, during isometric contractions, remained unchanged. A higher rate of force development was found to be significantly associated with larger type 2 muscle fibres (r=0.647). CONCLUSION: Muscle strength in patients undergoing dialysis was increased after 16 weeks of resistance training in parallel with changed neuromuscular function and greater rate of force development, both of which have important clinical implications in terms of improved physical performance.

Improved glucose tolerance after high-load strength training in patients undergoing dialysis.

BACKGROUND/AIMS: The aim of this controlled study was to investigate the effect of high-load strength training on glucose tolerance in patients undergoing dialysis. METHODS: 23 patients treated by dialysis underwent a 16-week control period followed by 16 weeks of strength training three times a week. Muscle fiber size, composition and capillary density were analyzed in biopsies obtained in the vastus lateralis muscle. Glucose tolerance and the insulin response were measured by a 2-hour oral glucose tolerance test. RESULTS: All outcome measures remained unchanged during the control period. After strength training the relative area of type 2X fibers was decreased. Muscle fiber size and capillary density remained unchanged. After the strength training, insulin concentrations were significantly lower in patients with impaired glucose tolerance or type 2 diabetes (n = 14) (fasting insulin from 68 ± 12 (46-96) to 54 ± 10 (37-77) pmol/l, p < 0.05, 2-hour insulin from 533 ± 104 (356-776) to 344 ± 68 (226-510) pmol/l, p < 0.05, total insulin area under the curve from 1,868 ± 334 (1,268-2,536) to 1,465 ± 222 (1,094-1,913), p < 0.05). Insulin concentrations were unchanged in patients with normal glucose tolerance (n = 9). CONCLUSION: The conducted strength training was associated with a significant improvement in glucose tolerance in patients with impaired glucose tolerance or type 2 diabetes undergoing dialysis. The effect was apparently not associated with muscle hypertrophy, whereas the muscle fiber type composition was changed.

The effects of high-load strength training with protein- or nonprotein-containing nutritional supplementation in patients undergoing dialysis.

OBJECTIVE: The aim of this study was to investigate the effects of high-load strength training and protein intake in patients undergoing dialysis with a focus on muscle strength, physical performance, and muscle morphology. DESIGN: This was a randomized controlled study conducted in three dialysis centers. SUBJECTS: Subjects for the study included 29 patients undergoing dialysis. INTERVENTION: The participants went through a control period of 16 weeks before completing 16 weeks of strength training. Before the training period, the participants were randomly assigned to receive a protein or a nonprotein drink after every training session. MAIN OUTCOME MEASURE: Muscle strength and power were tested using the good strength equipment and the leg extensor power rig. Physical performance and function were assessed using a chair stand test and the Short Form 36 questionnaire. Muscle fiber type size and composition were analyzed in biopsies obtained from the m. vastus lateralis. RESULTS: All variables remained unchanged during the control period. After training, muscle strength and power, physical performance, and physical function increased significantly. Muscle fiber composition was changed by a relative decrease in type 2x muscle fiber number whereas muscle size at the fiber level was unchanged. There were no effects of combining the training with protein intake. CONCLUSIONS: High-load strength training is associated with improvements in muscle strength and power, physical performance, and quality of life. The effects were surprisingly not associated with muscle hypertrophy, and the results did not reveal any additional benefit of combining the training with protein intake. The positive results in muscle strength and physical performance have clinically relevant implications in the treatment of patients undergoing dialysis.

Transdermal opioid patches for pain treatment in ancient Greece.

Pain treatment in ancient Greece, and through the middle ages in Europe, was to a great extent based on the expertise of the Greek physician Galen (c. 129-200 A.D.). Galen makes particular reference to "Olympic Victor's Dark Ointment" (OVDO), which is listed with a number of collyria. Galen states that OVDO can be useful for treating extreme pain and swellings, forming one of the best eye salves. Olympic Victor's Dark Ointment, an opium-based treatment, forms a "patch" when applied externally as an ointment, because it quickly dries to cover a localized region but still retains its elastic properties. This study has recreated OVDO and applied the ointment to abdominal mouse skin, in vitro. To assess the efficacy of OVDO, the transdermal transfer of morphine was measured when given as OVDO and compared to morphine administered in the form of a solution of Opium + PBS (ringer). Olympic Victor's Dark Ointment showed a transdermal transfer of morphine over time comparable to 25% of the most efficient modern transdermal opioid patches, while hardly any morphine was able to penetrate the skin when applied mixed in PBS. We conclude that OVDO is very efficient in its composition and may carry some forgotten abilities in terms of drug delivery, which could be transferred to modern medicine. Indeed, this may lead to a better choice of morphine use and controlled management in individual patient cases, taking both pain relief and anti-inflammatory aspects into account.

Validity and reliability of short form-12 questionnaire in Iranian hemodialysis patients.

INTRODUCTION: The aim of the study was to assess the validity and reliability of the SF-12 questionnaire in a sample of Iranian patients undergoing hemodialysis. MATERIALS AND METHODS: One hundred and forty-four hemodialysis patients were included from dialysis centers in Zanjan, Iran, and were asked to complete the SF-12 and SF-36 questionnaires. An initial test-retest reliability evaluation was performed on a sample of 70 patients from the total group, with a retest interval of 14 days. Reliability was estimated by internal consistency and validity was assessed using known-group comparisons and construct validity on the patient group as a whole. A linear regression analysis was used to assess any variation in the physical component summary and mental component summary scores of the SF-36 with the respective component summary scores of the SF-12. In addition, the factor structure of the questionnaire was extracted by performing a confirmatory factor analysis. RESULTS: Cronbach alpha for physical and mental component summaries were 0.89 and 0.90, respectively. The SF-12 showed a good discriminatory ability between subgroups of patients based on demographic and clinical variables. The confirmatory factor analysis for the original two-factor structure showed a good fit index (chi2 = 23.30, degrees of freedom = 13), goodness-of-fit index = 0.96, and root mean squared error of approximation = 0.079). CONCLUSIONS: In general, the SF-12 has good psychometric properties and can be used as a shorter version of the SF-36 questionnaire in future studies involving Iranian patients undergoing hemodialysis.

Translation, cultural adaptation assessment, and both validity and reliability testing of the Kidney Disease Quality of Life--Short Form version 1.3 for use with Iranian patients.

AIM: The aims of the study were to translate the Kidney Disease Quality of Life--Short Form version 1.3 (KDQOL-SF ver. 1.3) questionnaire into Iranian (Farsi), and to then assess it in terms of validity and reliability on Iranian patients. METHODS: The questionnaire was first translated into Farsi by two independent translators, and then subsequently translated back into English. After translation disparities had been reconciled, the final Iranian questionnaire was tested. An initial test-retest reliability evaluation was performed over a 10 day period on a sample of 20 patients recruited from a larger group (212 patients with end-stage renal disease on haemodialysis). Afterwards, reliability was estimated by internal consistency, and validity was assessed using known group comparisons and constructs for the patient group as a whole. Finally, the factor structure of the questionnaire was extracted by performing exploratory factor analysis. RESULTS: All of the scales in the questionnaire showed good test-retest reliability (i.e. intraclass correlations between test and retest scores were >0.7). All of the scales met the minimal criteria (0.7) for internal consistency and Cronbach's-α ranged 0.71-0.93. Furthermore, results from a discriminate validity evaluation showed that the questionnaire could be used to discriminate between subgroups of the patients. Finally, a principal component analysis of the disease-specific scales indicated that this part of the questionnaire could be summarized into an 11 factor structure that jointly accounted for 79.81% of the variance. CONCLUSION: The Iranian version of the KDQOL-SF questionnaire is both highly reliable and valid for use with Iranian patients on haemodialysis.

Dietary keto-acid feed-back on pituitary activity in gilthead sea bream: effects of oral doses of AKG. A proteomic approach.

The influence of a daily oral dose of alpha-ketoglutarate (AKG, 0.1 g/kg body weight), an intermediate metabolite in the Krebs cycle and a dietary additive, on the pituitary proteome of gilthead sea bream was determined by two-dimensional electrophoresis (2-DE). A high-resolution map of the sea bream pituitary proteome was generated. Proteins with a modified expression between Controls and AKG treated fish were further analysed by MALDI-TOF/TOF-MS and liquid chromatography combined with a nanoelectrospray (LC-MS/MS). The main changes in the proteome induced by AKG treatment were grouped. Metabolic proteins up-regulated with AKG supplementation included fructose-bis-phosphate aldolase, glyceraldehyde-phosphate dehydrogenase and malate dehydrogenase, all related to glucose metabolism (p<0.000). Protein folding related up-regulation with AKG supplementation included two isoforms of heat shock proteins as well as cyclophylin and chaperonin (p<0.000). An unexpected form of apolipoprotein-A-1 with lower molecular weight (15-16 kDa) was evidenced as being highly abundant in the pituitary proteome of Controls, yet it was down-regulated by AKG treatment. Finally, proteins found to be associated with regeneration of neural function namely cofilin and Vat-protein were up-regulated after AKG supplementation. The only hormone to be modified by AKG treatment was somatolactin, which was significantly down-regulated cf. Controls. In summary, these results provide evidence of a potential endocrine/metabolic regulatory loop activated by AKG supplementation.

Health-related quality of life in a sample of Iranian patients on hemodialysis.

INTRODUCTION: This study evaluated the health-related quality of life (HRQOL) in a sample of Iranian patients undergoing maintenance hemodialysis. The data were compared with the HRQOL for the Iranian general population. MATERIALS AND METHODS: Two-hundred and fifty patients undergoing hemodialysis were included using a convenience sampling approach in a cross-sectional study. Data collection was performed using a Persian translation of the Short Form-36 questionnaire in combination with demographic and clinically related questions. The collected data were analyzed using a logistic regression model with physical and mental summary scales as dependent variables. RESULTS: The patients' mean Short Form-36 scores were significantly lower than those obtained for the general population for all scales. Patients with longer duration of being on hemodialysis, poor adherence to treatment, higher body mass index, and comorbidity diseases suffered from a poorer physical health. Poor mental health was associated with a lower level of education, longer duration of hemodialysis, lower economic status, a lower degree of knowledge on disease, and comorbidity diseases. CONCLUSIONS: This study affirms the fact that patients undergoing hemodialysis suffer from poor HRQOL. In comparison with data from other studies from Asian and European countries, this sample of Iranian patients on hemodialysis had a lower HRQOL, a discrepancy that might be due to differences in life style, socioeconomic status, the general level of education of the patients, as well as physician-patient communication.

Metallurgy, environmental pollution and the decline of Etruscan civilisation.

BACKGROUND, AIM AND SCOPE: The Etruscans were justifiably famous in antiquity for their advanced metallurgy and for the rich mineral resources of their region (including La Tolfa, the Colline Metallifere, Mont'Amiata and Elba). We offer a new perspective on certain Iron Age and Archaic (ca. 1,000-480 BC: ) Etruscan industrial and habitation sites, and on the problem of heavy metal poisoning, still being investigated today, coincidentally in some of the same areas that originally saw Etruscan mines and workshops. MATERIALS AND METHODS: This study investigates ancient sources, including literature and excavation reports, in the light of modern studies of heavy metal poisoning on human beings, plant and animal life. Furthermore, it is the first to use non-invasive Niton X-ray fluorescence analysis of samples of Etruscan (strictly ethnically Faliscan) hair (c. 350 BCE: ). RESULTS: The findings show the strong likelihood of heavy metal poisoning in areas of Etruscan metallurgical activity with the effects of this being responsible for or contributing to the abandonment of a number of these sites around the 6th century BC: . No thoroughly satisfactory explanation of this phenomenon has previously been offered. However, findings suggest that Faliscan women, represented by sample CG 2004-6-2, were not exposed to high levels of arsenic in life, which is not perhaps surprising for an urban aristocratic woman of the mid-4th century BC: . DISCUSSION: The reasons for the abandonment of several flourishing settlements are without doubt complex, and include political and social change. We suggest heavy metal contamination as an additional stimulus to the noted phenomenon of the peaceful abandonment, at the beginning, and at the end of the 6th century BC: , of sites in southern and northern Etruria such as Marsiliana d'Albegna (late 7th c.), Lago dell'Accesa, Acquarossa and Poggio Civitate-Murlo (late 6th c.). CONCLUSIONS: While the historical truth of the demise of Etruscan civilisation is much more complex, an interim set of related events, the desertion of several important settlements during and at the end of the Archaic period, might actually have been stimulated by the consequences of industrial pollution and arsenic poisoning. RECOMMENDATIONS AND PERSPECTIVES: We call for archaeologists and curators to test any available human and animal remains in their museums and collections for evidence of heavy metal poisoning, taking due caution and consideration of course to the relevance of the aristocracy, and urge the application of analytical techniques developed in response to this serious modern problem, to provide additional insights into the ancient situation.