Effect of a passive hip exoskeleton on walking distance in neurological patients.

Severe neurodegenerative diseases such as Parkinson's disease or multiple sclerosis and acute events like stroke, spinal cord injuries, or other related pathologies have been shown to negatively impact the central and peripheral nervous systems, thus causing severe impairments to mobility. The development and utilization of exoskeletons as rehabilitation devices have shown good potential for improving patients' gait function. Ten older adults (age: 68.9 ± 9.2 yrs; height: 1.65 ± 0.08 m; mass: 71.6 ± 11.0 kg) affected by neurological diseases impacting their gait function completed a 10-session gait training protocol where they walked for 10 minutes wearing a passive exoskeleton assisting hip flexion, namely, Exoband. Results showed that participants walked a significantly longer distance in the last session of training with respect to the first session (453.1 ± 178.8 m vs 392.4 ± 135.1 m, respectively). This study indicates the potential of Exoband as an effective tool for gait rehabilitation in patients with neurological diseases. Wearable, lightweight, and low-cost devices such as the one involved in this work have the potential to improve walking distance in patients.

Effects of three distinct protocols of fitness training on body composition, strength and blood lactate.

AIM: Circuit training is a very popular methodology in fitness program because it allows to join together cardiovascular and strength training. The purpose of this study was to determine the physiological effects of circuit training performed at different intensities on body composition, strength and blood lactate in middle-aged subjects who had recently undergone only minimum physical training. METHODS: Forty participants (aged 50-65) were assigned to a control group (CG) or to one of the three exercise treatment groups: Endurance Group (EG), Circuit-Low Intensity Group (CLG), Circuit-High Intensity Group (CHG). The three groups exercised three times per week, 50 min per session for 12 wk using EG (N.=10), CLG (N.=10) or CHG (N.=10). Pre- and post-training, participants RESULTS: Among the three groups, CHG showed the greatest reductions in body weight (BW), percentage of fat mass (FM), waistline, blood lactate (produced at 100 Watt during submaximal test) and greater improvement in 6RM in horizontal leg press and underhand cable pulldowns. CONCLUSION: The results obtained favored the conclusion that high-intensity exercise combined with endurance training in the circuit training technique is more effective than endurance training alone or low intensity circuit training in improving body composition, blood lactate, moreover CHG results in significantly greater strength increase compared to traditional circuit training.

The use of a decremental dose regimen in patients treated with a chronic low-dose step-up protocol for WHO Group II anovulation: a prospective randomized multicentre study.

BACKGROUND: In women with chronic anovulation, the choice of the FSH starting dose and the modality of subsequent dose adjustments are critical in controlling the risk of overstimulation. The aim of this prospective randomized study was to assess the efficacy and safety of a decremental FSH dose regimen applied once the leading follicle was 10-13 mm in diameter in women treated for WHO Group II anovulation according to a chronic low-dose (CLD; 75 IU FSH for 14 days with 37.5 IU increment) step-up protocol. METHODS: Two hundred and nine subfertile women were treated with recombinant human FSH (r-hFSH) (Gonal-f) for ovulation induction according to a CLD step-up regimen. When the leading follicle reached a diameter of 10-13 mm, 158 participants were randomized by means of a computer-generated list to receive either the same FSH dose required to achieve the threshold for follicular development (CLD regimen) or half of this FSH dose [sequential (SQ) regimen]. HCG was administered only if not more than three follicles >or=16 mm in diameter were present and/or serum estradiol (E(2)) values were <1200 pg/ml. The primary outcome measure was the number of follicles >or=16 mm in size at the time of hCG administration. RESULTS: Clinical characteristics and ovarian parameters at the time of randomization were similar in the two groups. Both CLD and SQ protocols achieved similar follicular growth as regards the total number of follicles and medium-sized or mature follicles (>/=16 mm: 1.5 +/- 0.9 versus 1.4 +/- 0.7, respectively). Furthermore, serum E(2) levels were equivalent in the two groups at the time of hCG administration (441 +/- 360 versus 425 +/- 480 pg/ml for CLD and SQ protocols, respectively). The rate of mono-follicular development was identical as well as the percentage of patients who ovulated and achieved pregnancy. CONCLUSIONS: The results show that the CLD step-up regimen for FSH administration is efficacious and safe for promoting mono-follicular ovulation in women with WHO Group II anovulation. This study confirms that maintaining the same FSH starting dose for 14 days before increasing the dose in step-up regimen is critical to adequately control the risk of over-response. Strict application of CLD regimen should be recommended in women with WHO Group II anovulation.

Analytical and clinical evaluation of the Immulite estradiol assay in serum from patients undergoing in vitro fertilization: estradiol increase in mature follicles.

We examined an immunoassay for estradiol (E2) on the Immulite-an automated, random access chemiluminescent immunoassay system-to determine its accuracy and precision required for in vitro fertilization (IVF) studies. The assay, which has a reportable range from 73 to 7300 pmol/L, demonstrated good linearity under dilution, a detection limit of 44 pmol/L, and interassay CVs of 12.6% and 7.6% at 466 and 6164 pmol/L, respectively. In a retrospective analysis of 545 serum samples, the assay showed adequate agreement with an antibody-coated-tube RIA. The two E2 assays showed good agreement, even on samples from patients receiving a variety of different estrogen replacement therapies. Longitudinal studies of individual IVF cycles showed good parallelism between the automated system and the RIA, and results by the automated assay correlated well with the total number of follicles.

[Treatment of impotence with intracavernous auto-injections: moxisylyte diminishes the risks compared to papaverine]. / Traitement de l'impuissance par auto-injections intracaverneuses: le moxisylyte diminue les risques par comparaison avec la papavérine.

The alpha-blocking agent Moxisylyte was tested in auto-intracavernous injections (auto-ICI) in 72 impotent patients. The side-effects were compared to those observed in a group of 34 impotent patients treated with auto-ICI of Papaverine during the same period of time. The Moxisylyte auto-ICI improved 83% of the patients including 68% reporting a complete and durable success. Moxisylyte proved to be safer due to a reduced rate of prolonged erections (1.3% of the patients versus 8.8% with Papaverine) and corporeal fibrosis (1.3% versus 32% with Papaverine). Though less potent than Papaverine, and often seeming insufficient when tested in the office, this type of alpha-blocking agent could be tried in a first time in most candidates to auto-ICI before resorting to Papaverine or Prostaglandin E1 if it fails.

[Contribution of pure FSH in ovulation induction excluding fertilization in vitro]. / Apport de la FSH pure dans l'induction de l'ovulation hors fécondation in vitro.

The use of pure FSH reduces the likelihood of multifollicular development and increases the safety of ovulation induction without affecting the overall pregnancy rate. The authors propose a "slow" protocol, which is said to provide the same level of safety, but also to increase the number of pregnancies.

Luteal support after luteinizing hormone-releasing hormone agonist for in vitro fertilization: superiority of human chorionic gonadotropin over oral progesterone.

It has been reported that the pregnancy rate after in vitro fertilization (IVF) after pituitary desensitization with luteinizing hormone-releasing hormone agonist (LH-RH-a) is twice as low if the luteal phase is not supported. We therefore tested the respective advantages of luteal support using human chorionic gonadotropin (hCG, 1,500 IU three times) and progesterone (P, micronized, oral administration, 400 mg/d) after 171 embryo transfers (ET) in which the cycle was stimulated with the LH-RH-a triptoreline. The type of luteal phase support was randomly selected except when the estradiol level exceeded 2,700 pg/mL. The clinical pregnancy rate and the ongoing pregnancy rate were significantly higher using hCG (after the transfer of 3 embryos, 45% and 43% with hCG versus 23% and 17% with P). The same results were noted for the embryo implantation rate per ET (19% of embryos are viable after 6 months of pregnancy after hCG versus 7.5% after P). Adequate luteal support, therefore, significantly improves the results of IVF when LH-RH-a are used. The poor results obtained with P in this study might be related to its poor bioavailability after oral administration.

Purified follicle-stimulating hormone in polycystic ovary syndrome: slow administration is safer and more effective.

Twenty-seven infertile patients presenting with clomiphene citrate- (CC) resistant polycystic ovary syndrome (PCOS) were treated with purified urinary follicle-stimulating hormone (pFSH). We compared the conventional stepwise protocol with a slow protocol starting with 75 IU/d, not increased until 14 days, supplemented by human chorionic gonadotropins (hCG). The slow protocol was characterized by a slightly longer duration of stimulation but a more physiological ovarian response (mono- or biovulatory cycles in 70% versus 19% with the conventional protocol, less follicles, and a lower plasma estradiol [E2] resulting in significantly less discontinuation of treatment for risk of hyperstimulation or multiple birth). The pregnancy rate per cycle was higher with the slow protocol (23% versus 15%). The slow protocol could thus be the treatment of choice for CC-resistant PCOS, as it appeared safer and more effective.

Safety of intracavernous injections using an alpha-blocking agent.

We tested the possibility of using intracavernous injections of the alpha-blocking agent moxisylyte (6-acetoxy-thymoxy-ethyl-dimethylamine) as treatment of erectile impotence. Laboratory studies proved moxisylyte to be more active than saline (double-blind with crossover) but less active than papaverine (crossover), since it induced prolonged erection in most patients but rigid erection in only a few. However, penile vibration proved to enhance the moxisylyte effects, the combination resulting in rigid erection in 5 of 8 patients tested. Repeated office injections of moxisylyte in 70 patients resulted in clear improvement of impotence during the subsequent weeks in 50 per cent of the psychogenic, and 18 per cent of the organic and mixed impotent patients. Of 91 impotent patients 42 achieved satisfactory intercourse within 2 hours after an office injection, although previously the same dose induced a rigid erection in the office in only 24. Of 37 patients instructed in moxisylyte self-injections 92 per cent achieved successful results without any significant side effect. The main advantage of moxisylyte proved to be its safety, allowing for less compelling precautions than with papaverine: only 2 of the 170 patients injected with moxisylyte at our clinic had prolonged erections, that is 1.1 per cent compared to 14 per cent in a personal series who received papaverine. In regard to the therapeutic applications of intracavernous injection facilitating drugs, such as moxisylyte, should be tried first, with use of the more potent but also more dangerous drugs, such as papaverine, only when impotence fails to improve.

[Impotence due to venous incompetence. Research on reliable diagnostic criteria]. / Impuissance par fuite veineuse. A la recherche de critères diagnostiques fiables.

"Venous incompetence" is thought to be an organic cause of impotence. Its diagnosis is usually based upon Artificial Erection Test (AET); now, the reliability of this procedure is contested. We tested it in 9 controls, 13 psychogenic impotent patients and 65 impotent patients presenting "venous incompetence" according AET (maintenance flow rate needed for erection--MFR greater than 75 ml/min). Organicity of impotence was evaluated by Nocturnal Penile Tumescence monitoring and by the results of a sex-therapy. AET reproducibility was tested in 24 cases. The interest to perform an intracavernous injection of 80 mg papaverine before AET was tested in 18 impotent patients. Our results confirm that MFR is the most reliable criterion for interpreting AET. But 15% of the impotent patients with a MFR greater than 120 ml/min, 32% of those with a MFR greater than or equal to 80 ml/min and 66% of those with a MFR between 80 and 120 ml/min were in fact psychogenic patients. Moreover, we found "excessive" MFR in 3 of the 13 psychogenic patients and one of the normal controls (160 ml/min). In 50% of our patients, AET results were not reproducible. Injecting papaverine before AET significantly reduces MFR, but false positive results do still exist. Some recent physiopathologic data suggest that AET performed after papaverine injection might logically be disturbed by stress. These data should incite to be cautious when interpreting AET results, and results of "venous incompetence" surgery.

[Diagnostic and therapeutic applications of intracavernous injection of vasoactive drugs in impotence. Defense for the use of facilitating drugs. Part I--Pharmacology, classification and complications of active drugs]. / Applications diagnostiques et thérapeutiques des injections intracaverneuses (IC) de drogues vasoactives dans l'impuissance. Plaidoyer pour l'utilisation des drogues facilitatrices. Partie I--Pharmacologie, classification et complications des drogues actives.

The article discusses drugs which promote erection when injected via the intracavernous (IC) route during consultation. The diagnostic and therapeutic applications in the treatment of impotence are discussed also. 25% of impotent patients noted an improvement after this treatment while 50% of patients suffering from impotence of psychological origin noted an improvement. Auto-injection is also discussed. IC treatment now seems justified in most cases which have not responded to traditional therapeutic approaches and this includes cases of psychological origin. Vasoactive drugs can be described as being inducers (use of these drugs induces a rigid erection, even in the presence of the doctor), facilitating drugs (which produce a rigid erection only if sexual stimulation is present also) and inhibitors (which stop the erection). The former group (which has papaverine as leader) produces a significant number of side effects, not least of these being priapism; there is a risk of lasting iatrogenic impotence which is not negligible. These risks are reduced considerably when one uses facilitating drugs which, although less powerful, suffice in treating a large proportion of cases of impotence. Papaverine can not be replaced as a diagnostic drug but facilitating drugs should be used first in therapy and inducers should be used only if these facilitating drugs have failed.

[Retarded ejaculation and anejaculation without orgasm. Apropos of the results of studies and of treatment in 60 cases]. / Ejaculation retardée et anéjaculation sans orgasme. A propos des résultats des explorations et du traitement dans 60 cas.

The physiological mechanism of ejaculation is recalled. The different kinds of abnormalities of ejaculation and their etiologies (drugs, post-surgery, neurological, endocrinological, psychological) are specified. The diagnosis and the therapeutical management of the different varieties are discussed and the results of a personal experience of 60 cases are reported.

A randomized trial of human chorionic gonadotropin support following in vitro fertilization and embryo transfer.

This article reports on the effects of human chorionic gonadotropin (hCG) on progesterone (P) and estradiol (E2), luteal phase length, and conception in 116 cycles treated by in vitro fertilization and embryo transfer (IVF-ET). In 60 cycles, the luteal phase was supported by hCG, 1500 IU three times at 2-day intervals from the day of ET. The remaining 56 cycles served as controls. hCG significantly increased the P level (93 +/- 53 versus 62 +/- 46 ng/ml), the P/E2 ratio, and the luteal phase length (17.4 +/- 1.3 versus 12.2 +/- 1.7 days). However, the total pregnancy rate did not significantly differ between the two groups, though the pregnancy rate after transfer of two or three embryos was slightly higher in the hCG group (26.9 versus 22% in the control group), as was the rate of implanted embryo per transferred embryo after transfer of two or three embryos (25 versus 15.3%). It was concluded that, while hCG increased the magnitude and duration of the luteal P secretion, it did not clearly improve the pregnancy rate.

["Hidden" organic causes of impotence. Diagnostic methods and critical evaluation of their responsibility]. / Les causes organiques "cachées" de l'impuissance. Méthodes diagnostiques et évaluation critique de leur responsabilité.

In five per cent of impotent, sexual dysfunction obviously results from an organic factor which can be today qualified as "classical". "Hidden" organic factors have also been implicated in a variable ratio of the other cases. This paper constitutes a critical review of the role they play in impotence, and of the methods allowing their detection. On one hand, methods allowing evaluation of the respective responsibilities of organic and psychogenic factors (the most important of which remain nocturnal penile tumescence monitoring); on the other hand, specific investigations of each factor. It is no longer possible to deny the existence of "hidden" organic factors in impotence. These factors intervene to varying degrees in one third of cases. Among them erectile failure only by themselves. Hyperprolactinaemia, moderate hypogonadism, infraclinical neuropathies, arterial stenoses and moderate venous leakages seem to play a partial role of organic starter or cofactor, the sexual consequences of which are amplified by psychological factors, partly secondary to the initial sexual failures. Nevertheless, the conjunction of several "hidden" organic factors may probably be sufficient to induce an impotence without involvement of psychological factors.

[Mechanisms of diabetic impotence. 25 cases]. / Les mécanismes de l'impuissance diabétique. Vingt-cinq cas.

Twenty-five impotent diatetics were investigated by means of nocturnal penile tumescence monitoring, hormone determinations, penile blood pressure measurement, artificial erection test and dynamic cavernosography, bulbocavernous reflex latency time measurement and cortical evoked responses from pudendal nerves. Sexological treatment was then attempted for a better evaluation of the psychogenic element. Penile blood pressure was also measured in 15 non-impotent diabetics and was found to be abnormal as often as in impotent diabetics. The results as a whole demonstrated that impotence was predominantly psychogenic in 9 cases, predominantly organic in 12 cases and mixed psychogenic and organic in 4 cases. Diabetic impotence is often due to several causative factors, as was the case in 12 of our patients. The factors most frequently responsible were psychological (present in 13 cases), neurological (present in 12 cases) and vascular factors (arterial abnormalities in 7 cases, "venous leakage" in 4 cases). Endocrine abnormalities were observed in only 2 cases.