Actinomycosis of parotid gland after maxillary molar extraction, case report and review of literature.

Although actinomycosis is frequently seen in the cervicofacial region, it is very rare in the parotid gland. Furthermore, it can be confused with salivary gland malignancies in imaging. The most important underlying causes are cervicofacial trauma, tooth extraction history and poor oral hygiene. A 43-year-old male patient was admitted to otorhinolaryngology department with a complaint of progressive swelling on his cheek. The histopathological examination of fine-needle aspiration (FNA) biopsy showed acute suppurative polymorphous leukocytes and actinomycese hyphae balls within histiocytes. The patient was started on amoxicillin 2 gm per day for two months. With antibiotherapy, the swelling in the patient's parotid gland decreased and completely healed at the end of six months. Primary parotid actinomycosis has been rarely reported in the literature, differential diagnosis is usually problematic as both clinical and radiological findings may mimic parotid tumour; however, it can be useful to apply FNA cytology for a quick diagnosis and treatment.

Postexercise Arterial Compliance and Hemodynamic Responses to Various Durations and Intensities of Aerobic Exercise.

ABSTRACT: Karabulut, M, Bitting, M, and Bejar, J. Postexercise arterial compliance and hemodynamic responses to various durations and intensities of aerobic exercise. J Strength Cond Res 37(3): 589-596, 2023-The purpose of this study was to determine the effects of various aerobic training protocols using different intensities and durations on arterial compliance and hemodynamic responses. Seventeen male subjects (age = 23.1 ± 2.8 years) performed a maximal oxygen consumption (V̇ o2 max) test, followed by 3 randomly assigned exercise test sessions, each on a separate day. At the beginning of each test session, pre-exercise baseline assessments of arterial elasticity, hemodynamic variables, and pulse wave velocity (PWV) were performed after a 10-minute rest. After baseline measurements, participants performed either a bout of aerobic exercise on a treadmill for 60 minutes at 65% of V̇ o2 max (60min); 20 minutes at 40% of V̇ o2 max (20min); or for 20 minutes at 40% of V̇ o2 max with blood flow restriction (BFR; 20min-BFR). All baseline measurements were repeated at the completion of each testing session. Significance for this study was set at p ≤ 0.05. The 60min session resulted in significant increases in small artery elasticity (SAE) compared with the 20min-BFR session ( p < 0.03) and decreases in both systemic vascular resistance (SVR) and total vascular impedance (TVI) compared with both 20min sessions ( p < 0.01). The carotid to radial PWV was significantly lower after both the 60min and the 20min-BFR sessions compared with the 20min session ( p < 0.02). The findings indicate that the duration and the intensity of exercise are important factors for improving SAE, SVR, and TVI. In addition, 20min-BFR at 40% V̇ o2 max may result in site-specific modifications in PWV that is comparable with those seen after 60 minutes of exercise at 65% V̇ o2 max.

Relationship Between Cognitive Performance, Physical Activity, and Socio-Demographic/Individual Characteristics Among Aging Americans.

BACKGROUND: Physical activity (PA) has emerged as a promising approach to delay Alzheimer's disease and related dementias, but the optimal intensity of PA to improve cognitive health remains unknown. OBJECTIVE: To evaluate the association between duration and intensity of PA and cognitive domains (executive function, processing speed, and memory) in aging Americans. METHODS: Linear regressions in hierarchical blocks for variable adjustment and the size of effect (η2) were analyzed by using the data of 2,377 adults (age = 69.3±6.7 years) from the NHANES 2011-2014. RESULTS: Participants with 3-6 h/week of vigorous- and > 1 h/week of moderate-intensity PA scored significantly higher in executive function and processing speed domains of cognition compared to inactive peers (η2 = 0.005 & 0.007 respectively, p < 0.05). After adjustment, the beneficial effects of 1-3 h /week of vigorous-intensity PA became trivial for delayed recall memory domain test scores (ß= 0.33; 95% CI: -0.01,0.67; η2 = 0.002; p = 0.56). There was no linear dose-response relationship between the cognitive test scores and weekly moderate-intensity of PA. Interestingly, higher handgrip strength and higher late-life body mass index were associated with a higher performance across all cognitive domains. CONCLUSION: Our study supports habitual PA with superior cognition health in some but not all domains among older adults. Furthermore, increased muscle strength and higher late-life adiposity may also impact cognition.

Biphenotypic sinonasal sarcoma with PAX3/FOXO1 fusion.

Biphenotypic sinonasal sarcoma (BSNS), previously known as low-grade sinonasal sarcoma, is a rare tumour of the sinonasal tract, first described in 2012. It involves both myogenic and neural differentiation and is characterized by PAX3 rearrangement. MAML3 is the most frequent fusion partner of PAX3; however, its partner remains unidentified in a subset of cases. These tumours have significant local recurrence rates but lack metastatic potential. Here, we report a case of BSNS with PAX3/FOXO1 fusion and discuss its clinicopathological features and differential diagnosis.

The Evolution of Blood Flow Restricted Exercise.

The use of blood flow restricted (BFR) exercise has become an accepted alternative approach to improve skeletal muscle mass and function and improve cardiovascular function in individuals that are not able to or do not wish to use traditional exercise protocols that rely on heavy loads and high training volumes. BFR exercise involves the reduction of blood flow to working skeletal muscle by applying a flexible cuff to the most proximal portions of a person's arms or legs that results in decreased arterial flow to the exercising muscle and occluded venous return back to the central circulation. Safety concerns, especially related to the cardiovascular system, have not been consistently reported with a few exceptions; however, most researchers agree that BFR exercise can be a relatively safe technique for most people that are free from serious cardiovascular disease, as well as those with coronary artery disease, and also for people suffering from chronic conditions, such as multiple sclerosis, Parkinson's, and osteoarthritis. Potential mechanisms to explain the benefits of BFR exercise are still mostly speculative and may require more invasive studies or the use of animal models to fully explore mechanisms of adaptation. The setting of absolute resistive pressures has evolved, from being based on an individual's systolic blood pressure to a relative measure that is based on various percentages of the pressures needed to totally occlude blood flow in the exercising limb. However, since several other issues remain unresolved, such as the actual external loads used in combination with BFR, the type of cuff used to induce the blood flow restriction, and whether the restriction is continuous or intermittent, this paper will attempt to address these additional concerns.

The impact of low-intensity blood flow restriction endurance training on aerobic capacity, hemodynamics, and arterial stiffness.

BACKGROUND: The aim of this study was to determine the effects of short-term low-intensity blood flow restriction (BFR) endurance training (ET) programs on measures of aerobic capacity, hemodynamics, and arterial stiffness in healthy young males. METHODS: Thirty-nine healthy young recreationally active males participated in this short-term training study. They were randomly assigned to a high-intensity (HI; N.=11; trained at 60-70% of VO2 reserve [VO2R]), low-intensity (LI; N.=8; trained at 30-40% of VO2R), low-intensity with BFR (LI-BFR; N.=10; trained at 30-40% of VO2R with BFR) or a non-exercising control group (N.=10). The exercising subjects completed a 6-wk training protocol on a treadmill. Assessment of aerobic capacity (VO2max), hemodynamics and arterial stiffness were done before and after training. RESULTS: Statistical analyses revealed a significant condition main effect (P<0.05) for VO2max, indicating significant increase (P<0.05) in VO2max in LI-BFR group compared to control. There were no significant changes for resting heart rate (RHR), systolic blood pressure (SBP), diastolic blood pressure (DBP), carotid-radial pulse wave velocity (PWV), and carotid-femoral PWV (P>0.05). However, femoral-tibial PWV decreased significantly (P<0.05) from baseline to post-training. CONCLUSIONS: The results indicate that the application of BFR during ET may cause faster and/or greater adaptations in one or more physiological systems resulting in improved cardiorespiratory fitness.

Walking Speed Affects Gait Coordination and Variability Among Older Adults With and Without Mobility Limitations.

OBJECTIVE: To determine if poorer gait variability and gait coordination among mobility-limited older adults is related to their slower walking speed. DESIGN: Cross-sectional analysis. SETTING: University research laboratory. PARTICIPANTS: Community-dwelling adults (N=69) 68 years or older with (Short Physical Performance Battery score ≤9; n=37) and without (n=32) mobility limitations. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The variability of step length, swing time percent, and step width. Gait coordination was assessed along with the Phase Coordination Index. RESULTS: The usual pace gait speed of those without mobility limitations was faster (1.22±0.14m/s vs 0.71±0.14m/s; P<.001) and less variable in all gait characteristics (all P<.001), with the exception of step width (P=.185), than those with limitations. When those without limitations slowed their walking pace (0.71m/s±0.14), their gait coordination became poorer (P<.001), and the variability of all gait characteristics increased (all P<.001) except for step width, which decreased (P=.002). When those without mobility limitations walked at a slow pace, they had better gait coordination (P=.008) and less variable step length (P=.014) and swing time percent (P=.036). The variability of stride time (P=.260) and step width (P=.385) were not significantly different than that of their peers with limitations. CONCLUSIONS: Increased variability in some gait characteristics of mobility-limited older adults appears to be related to their slower walking speed. Gait coordination and the variability of step length and swing time percent may reflect intrinsic differences in mobility-limited older adults that are independent of walking speed.

Epithelial-myoepithelial carcinoma on lower lip and microinvasive verrucous carcinoma in vocal cord: Case report.

Epithelial-myoepithelial carcinoma is a biphasic low-grade malignant tumor, which represents approximately 1% of all salivary gland tumors. This tumor occurs mostly in the parotid gland, followed by submandibular gland and minor salivary glands. Women, mostly fifth to the eighth decade of life, are commonly affected. Histopathologically, epithelial-myoepithelial carcinoma is composed of an inner single layer of eosinophilic cuboidal ductal cells and outer single or multiple layers of clear myoepithelial cells. We present a case of a 69 years old man who had a scar on lower the lip for 10 years and voice annoyance for three months. The biopsy for lower lip was reported "infiltrative clear cell epithelioid neoplasm" and vocal cord biopsy result was "verrucous carcinoma". After cordectomy and wedge resection of the lower lip, histopathology revealed Epithelial-Myoepithelial Carcinoma for the lower lip and microinvasive verrucous carcinoma for the left vocal cord. Our case has a very uncommon location and presentation for EMC. The tumor location was minor salivary glands of the lower lip and the clinical presentation was quite different. Coexistence with microinvasive verrucous carcinoma of the vocal cord is the other unique part of our case.

Aerobic training session length affects arterial elasticity.

PURPOSE: The purpose of this study was to examine haemodynamic and arterial elasticity responses to aerobic exercise of varying durations. METHODS: Eighteen male subjects (age = 23·4 ± 2·0) performed a maximal aerobic fitness (VO2max ) test. Participants met in the laboratory following an overnight fast for three randomly assigned sessions. Assessments for large and small arterial elasticity (SAE), systemic vascular resistance (SVR), total vascular impedance (TVI), systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), stroke volume (SV), cardiac output (CO), pulse pressure (PP) and cardiac ejection time (CET) were performed using applanation tonometry at the radial artery. Following baseline measurements, participants executed aerobic exercise on a treadmill at 65% of their respective VO2max for 30, 45 or 60 min on three different occasions. Postexercise measurements were performed immediately, 10, 20 and 40 min postexercise cessation. RESULTS: The 60-min exercise bout resulted in significantly increased SAE values (P < 0·04) and decreased SVR values (P < 0·02) when compared with the 30-min exercise bout. The 60-min session also caused significantly higher HR values and significantly lower values for SV and DBP values following exercise (P < 0·04). CONCLUSIONS: The results of this study emphasize that varying the length of moderate-intensity aerobic exercise bouts affects arterial elasticity response and total vascular resistance.

An incidental giant preperitoneal fibrolipoma diagnosed during laparoscopic cholecystectomy.

Preperitoneal lipomas are rare in clinical practice. Here we report an unexpected diagnosis of a giant preperitoneal fibrolipoma detected intraoperatively during laparoscopic cholecystectomy in a 56-year-old woman. The mass was excised and a histopathological examination confirmed fibrolipoma. No recurrence was found on follow-up. In the literature, there have been many cases with unexpected diagnoses during laparoscopy. Here, we present an incidental giant preperitoneal fibrolipoma, which was overlooked by ultrasound and physical examination, but was detected during laparoscopic cholecystectomy.

Small arteries stay stiff for a longer period following vibration exercises in combination with blood flow restriction.

PURPOSE: The aim of this study was to assess the effect of isometric exercises performed during whole-body vibration (WBV) with and without blood flow restriction (BFR) on arterial elasticity and hemodynamic variables. METHODS: Eight male subjects performed static upper body (UB) and lower body (LB) exercises on a vibration platform with and without BFR. During BFR sessions, BFR cuffs were placed on the arms or legs and inflated to a target pressure. Exercises consisted of eight 45-s sets for UB, and ten 1-min sets for LB. Arterial elasticity and hemodynamic variables were assessed before, at 10 min and 40 min postexercise. Repeated measures ANOVA was used to test the mean differences in related variables. RESULTS: A significant condition (BFR versus no-BFR) main effect was detected for small arterial elasticity (P<0·05). For heart rate (HR), there were significant time (P<0·01), condition (P = 0·02) and body (P = 0·04) main effects during exercise and condition (P<0·04) and time (P<0·01) main effects following exercise. Significantly lower values in systemic vascular resistance were detected at 10 min post compared to 40 min post (P<0·02) and UB compared to LB (P = 0·02). CONCLUSIONS: Results showed that small arteries stayed stiffer for a longer period of time after vibration exercises with BFR and BFR placed a greater demand on cardiovascular system. Findings also indicated that the type of exercises performed and/or the measurement location are very important and should be taken into account when examining arterial response.

Acute resistance exercise with blood flow restriction in elderly hypertensive women: haemodynamic, rating of perceived exertion and blood lactate.

PURPOSE: This study aimed to compare haemodynamic, rating of perceived exertion and blood lactate responses during resistance exercise with blood flow restriction (BFR) compared with traditional high-intensity resistance exercise in hypertensive older women. METHODS: Eighteen hypertensive women (age = 67·0 ± 1·7 years.) undertook three random sessions: (i) three sets; 10 repetitions; 20% of one repetition maximum (1RM) with BFR; (ii) three sets; 10 repetitions; 65% of 1RM; without BFR; and (iii) no-exercise with BFR. The exercise sessions were performed on knee extension equipment. RESULTS: Systolic (SBP) and diastolic blood pressure (DBP), heart rate (HR), stroke volume (SV) and cardiac output (CO) were significantly higher (P<0·05) in all sets of exercise sessions than the control. No statistically significant differences were detected between exercise sessions. However, SBP, DBP and systemic vascular resistance were higher (P<0·05) and SV and CO were lower (P<0·05) during the rest intervals in the session with BFR. The perceived exertion was significantly higher (P<0·01) in the 1st (4·8 ± 0·4 versus 3·1 ± 0·3), 2nd (7·3 ± 0·4 versus 5·7 ± 0·4) and 3rd sets (8·6 ± 0·5 versus 7·5 ± 0·4) of the traditional high-intensity resistance exercise compared with the exercise with BFR. Blood lactate was higher (P<0·05) in the traditional high-intensity resistance exercise (6·2 ± 0·7 mmol) than in the exercise with BFR (4·5 ± 0·4 mmol). CONCLUSION: In comparison with high-intensity resistance exercise, low-intensity resistance exercise with BFR can elicit: (i) same haemodynamic values during exercise; (ii) lower rating of perceived exertion; (iii) lower blood lactate; (iv) higher haemodynamic demand during the rest intervals.

Coordination Impairments Are Associated With Falling Among Older Adults.

Background/Study Context: Approximately one third of older adults over the age of 65, and over 40% of those over 80 years, fall each year, leading to fractures, morbidity, and mortality. Annual direct medical costs due to falls in the United States are approximately $19.2 billion. The identification of new treatable risk factors for falls has the potential to advance their prevention and rehabilitation. METHODS: A cross-sectional study of 127 community-dwelling adults aged 67-99 years was conducted. An electronic gait walkway was used to assess gait coordination, measured as the Phase Coordination Index during normal speed walking. A motion capture system was used to assess rhythmic interlimb antiphase ankle coordination, measured as the standard deviation of ankle relative phase. Having fallen in the previous year was self-reported retrospectively. Odds ratios for falling as a function of coordination quartiles were determined using multivariable logistic regression. RESULTS: Adjusting for age, sex, body mass index, number of chronic conditions, Mini-Mental State Examination score, gait speed, and the variability of step length, time, and width, the odds ratios for falling based upon being in the 4th (the poorest) quartiles of gait or ankle coordination were 5.5 (95% confidence interval [CI]: 1.2-24.7) and 8.2 (95% CI: 2.2-31.3), respectively, and 3.7 (95% CI: 1.0-13.8) for the 3rd quartile of gait coordination, compared with the best (the 1st) coordination quartiles. Similar results were found in regression without adjustment for gait characteristics. CONCLUSION: The results support the hypothesis that impaired gait and rhythmic interlimb ankle coordination are associated with a history of falls in the past year. Prospective longitudinal research is needed to determine the possible direction of causality between falls and impaired coordination.

Rhythmic Interlimb Coordination Impairments Are Associated With Mobility Limitations Among Older Adults.

Background/Study Context: Mobility limitations affect more than 25% of adults aged 70 years or older. This study tested the hypothesis that impairments in ankle and shoulder coordination are associated with mobility limitations among older adults. METHODS: his study consisted of conducted a cross-sectional analysis from a sample of community-dwelling older adults (N = 130) aged ≥67 years. Motion capture equipment was used to collect kinematic data during rhythmic antiphase coordination of the right and left: (a) ankles moving in dorsi-plantarflexion; and (b) glenohumeral ("shoulder") moving in flexion-extension while paced by an auditory metronome. Coordination variability was measured as the standard deviation of the relative phase between right and left body segments. Mobility limitations were defined as a score of ≤9 on the Short Physical Performance Battery (SPPB). Odds ratios for mobility limitations as a function of coordination variability quartiles were determined using multivariable logistic regression. RESULTS: Adjusting for age, gender, body mass index, number of chronic conditions and Mini-Mental State Examination score, the odds ratios for mobility limitation (SPPB score ≤9) were 7.38 (95% confidence interval [CI]: 2.20-24.78) and 15.40 (95% CI: 4.31-55.07) for the 3rd and 4th (the poorest) ankle coordination quartiles, respectively, and 6.73 (95% CI: 2.11-21.51) for the 4th shoulder coordination quartile, compared with the best (the 1st) coordination quartiles. CONCLUSION: The results supported the hypothesis that impaired interlimb ankle and shoulder coordination are associated with the manifestation of mobility limitations. These findings indicate the need for further study of the role of coordination impairments as potential contributors to poor mobility among older adults.

Hemodynamic responses and energy expenditure during blood flow restriction exercise in obese population.

PURPOSE: The study investigated the acute effects of different initial restrictive pressures (IRP; tightness of cuffs before inflation with air) on heart rate (HR), systolic (SBP) and diastolic blood pressure (DBP), rating of perceived exertion (RPE), respiratory exchange ratio (RER) and energy expenditure (EE) during constant-load upright cycling. METHODS: In a within subject study design, 34 obese men (age = 24·3, n = 18) and women (age = 23·1, n = 16) completed three cycling sessions (two blood flow restriction and one control sessions). The cycling exercise was performed with an external load of 1kp at 50 rpm for 20 min with 1-min rest after the 10th-min. The blood flow restriction (BFR) cuffs were placed on the thigh of both legs during BFR sessions and IRP and IRP of ~40 or ~60 mmHg were applied in random order. RESULTS: There were significant condition × time interactions for HR, SBP, RPE and RER and time × gender interactions for HR and SBP. There were also significant condition and time main effects for HR, SBP, RPE and RER (P<0·01) and a significant condition effect for EE (P<0·05). CONCLUSION: The intensity of exercise with BFR was higher and affected by IRP, but the subjects perceived the effort as 'light'. Low-intensity cycling with BFR shows potential to reduce the time requirement per session to elicit greater EE while placing greater demands on the circulatory system.

Mobility limitations and fear of falling in non-English speaking older Mexican-Americans.

OBJECTIVE: To determine whether older Mexican-Americans who cannot speak and/or understand spoken English have higher rates of mobility limitations or fear of falling than their English-speaking counterparts. DESIGN: We conducted a cross-sectional analysis of 1169 community-dwelling Mexican-Americans aged 72-96 years from the 2000-2001 wave of the Hispanic Established Population for the Epidemiological Study of the Elderly. Mobility limitations were defined as having a Short Physical Performance Battery score ≤9, and fear of falling by participant report of being somewhat, fairly, or very afraid of falling. We determined the rates and odds ratios, for having mobility limitations and fear of falling as a function of English ability in those who were 72-96, <80, and ≥80 years of age. RESULTS: Among participants who were unable to speak and/or understand spoken English 85.7% had mobility limitations and 61.6% were afraid of falling, compared to 77.6% and 57.5%, respectively, of English speakers. Before adjusting for covariates, participants who did not speak and/or understand spoken English were more likely to have mobility limitations (odds ratio: 1.7; 95% CI: 1.3-2.4) but not fear of falling, compared to English speakers. Among those aged ≥80 years, but not those <80 years, who did not speak or understand English were more likely to have mobility limitations (odds ratio: 4.8; 95% CI:2.0-11.5) and fear of falling (odds ratio: 2.0; 95% CI:1.3-3.1). CONCLUSION: Older Mexican-Americans who do not speak or understand spoken English have a higher rate of mobility limitations and fear of falling than their English-speaking counterparts.

Pleomorphic adenoma of the larynx.

Pleomorphic adenoma (PA) is the most common benign neoplasm of the salivary glands. It usually occurs in major salivary glands, such as the parotid and submandibular glands. Occasionally, however, it occurs in the larynx. These lesions generally present as a slow-growing, painless mass. Malignant transformation is very rare, but it increases with time. The present report is the case of a 59-year-old male who presented with a complaint of hoarseness. Right vertical partial hemilaryngectomy revealed an intact, mucosa-covered, fleshy 2×1.5×1 cm mass in the supraglottic area of the larynx. Lesion had histological characteristics of a PA, and this was confirmed by immunohistochemical expression of cytokeratin, S100 protein, Glial fibrillary acidic protein (GFAP) and vimentin. Their histopathological identification is, however, not always straightforward; immunohistochemistry can contribute significantly to formulation of a definitive diagnosis and to the realization of appropriate follow-up.

A Rare Cause of Prepubertal Gynecomastia: Sertoli Cell Tumor.

Prepubertal gynecomastia due to testis tumors is a very rare condition. Nearly 5% of the patients with testicular mass present with gynecomastia. Sertoli cell tumors are sporadic in 60% of the reported cases, while the remaining is a component of multiple neoplasia syndromes such as Peutz-Jeghers syndrome and Carney complex. We present a 4-year-old boy with gynecomastia due to Sertoli cell tumor with no evidence of Peutz-Jeghers syndrome or Carney complex.

Classic Mediterranean type of epiglottic Kaposi sarcoma.

Kaposi sarcoma is a malignant, multifocal, vascular, and low-grade tumor that mostly occurs in mucocutaneous sites. Kaposi sarcoma is usually associated with acquired immunodeficiency syndrome and involves lymphatic nodes and visceral organs. In this report, an 81-year-old man with epiglottic Kaposi sarcoma who screened negative for human immunodeficiency virus is presented.

Tissue oxygenation, strength and lactate response to different blood flow restrictive pressures.

This study aimed to determine whether changes in initial restrictive pressures (IRP, tightness of the cuff before inflation with air) affect tissue oxygenation, lactate production and leg strength before, during and after knee extension exercises. The cuff was positioned on the right thigh, and the IRP of either 40-45 or 60-65 mmHg were applied randomly prior to inflating the cuff to the final restrictive pressure (the pressure reached after inflating the cuff with air). Subjects performed four sets (30, 15, 15 and 15 reps) of isotonic knee extensions with 1-min rest between sets. Tissue oxygenation and blood lactate levels were assessed prior to, during and after exercise, and leg strength was assessed pre- and postexercise. There were significant condition by time interactions (P<0·01) and main effects for both condition (P<0·01) and time (P<0·01) for tissue oxygenation, deoxyhaemoglobin, total haemoglobin. Significant main effects were detected for both condition (P<0·01) and time (P<0·01) for leg strength values. There was only a significant time main effect for lactate concentrations. This study is the first to show that a higher IRP had a significant impact on percent tissue oxygenation, leg strength and deoxygenated haemoglobin accumulation during exercise.