Muscular Dysfunction in COPD: Systemic Effect or Deconditioning?

BACKGROUND: Muscular dysfunction has been described as one of the systemic manifestations of chronic obstructive pulmonary disease (COPD). OBJECTIVE: The aim of this study was to evaluate muscular strength of the different anatomical compartments in patients with severe COPD compared with healthy controls. METHOD: We performed a cross-sectional study in patients with severe COPD. We evaluated the muscular strength of the respiratory muscles, flexors and extensors of the cervical spine and knee, as well as handgrip force. The 6-min walking test (6MWT) and serum inflammatory markers were also analysed. RESULTS: Twenty-eight male patients with COPD (mean age 67.8 years, mean FEV1 (%) 39 %) and 24 male healthy controls (mean age 70.2 years) were studied. The strength of the flexors and extensors of the knee was significantly reduced in patients with COPD (p < 0.001 and p = 0.003). No differences were observed in the flexors and extensors of the cervical spine and handgrip force between groups. No correlation was observed between the muscular strength in the different anatomic compartments and the concentrations of blood inflammatory biomarkers or the metres walked in the 6MWT in COPD patients. However, a significant negative linear correlation was observed between the 6MWT and IL-6 and IL-8 levels (rho = -0.67, p = 0.001; rho = -0.57, p = 0.008). In addition, we found a negative correlation between the 6MWT and inspiratory capacity (rho = -0.755, p = 0.031). CONCLUSIONS: Our results suggest that muscular dysfunction in patients with COPD differs in different muscular compartments. The main factor for a reduced exercise capacity was a reduction in inspiratory capacity.

Improving physical activity in patients with COPD with urban walking circuits.

BACKGROUND: Even after a rehabilitation program, levels of physical activity in COPD progressively decrease unless strategies to encourage activity are implemented. We analyzed the effects of the implementation of urban walking circuits on levels of physical activity and exercise capacity of patients with severe and very severe COPD after a rehabilitation program. METHOD: A total of 83 patients were randomized to either urban circuits group (UCG) or usual care in the non-circuit group (NCG), after completing a 2-week rehabilitation program. Results were evaluated 9 months after completion of the rehabilitation program and were compared with a control group of 54 patients not enrolled in the rehabilitation program. RESULTS: At the end of follow-up, UCG patients increased their physical activity by a mean of 32.4 (SE = 5.9) min per day and 1.09 (SE = 0.22) days walked per week; 33.9 (SE = 5.6) min per day and 1.12 (SE = 0.24) days per week more compared to the NCG (p < 0.001). There was a significant positive correlation between the results of the 6-min walking test and minutes walked per day in the UCG (r(2) = 0.52, p < 0.05) but not in the NCG (r(2) = 0.094, p > 0.05). Controls showed a significant decrease in exercise capacity and physical activity over the follow-up. CONCLUSIONS: Urban circuits are an easy, inexpensive strategy, which demonstrated to be useful to stimulate physical activity in our population of severe and very severe COPD patients and resulted in increased exercise capacity even 9 months after completion of a rehabilitation program.

Effectiveness of using blended learning strategies for teaching and learning human anatomy.

OBJECTIVES: This study aimed to implement innovative teaching methods--blended learning strategies--that include the use of new information technologies in the teaching of human anatomy and to analyse both the impact of these strategies on academic performance, and the degree of user satisfaction. METHODS: The study was carried out among students in Year 1 of the biology degree curriculum (human biology profile) at Pompeu Fabra University, Barcelona. Two groups of students were tested on knowledge of the anatomy of the locomotor system and results compared between groups. Blended learning strategies were employed in 1 group (BL group, n = 69); the other (TT group; n = 65) received traditional teaching aided by complementary material that could be accessed on the Internet. Both groups were evaluated using the same types of examination. RESULTS: The average marks presented statistically significant differences (BL 6.3 versus TT 5.0; P < 0.0001). The percentage pass rate for the subject in the first call was higher in the BL group (87.9% versus 71.4%; P = 0.02), reflecting a lower incidence of students who failed to sit the examination (BL 4.3% versus TT 13.8%; P = 0.05). There were no differences regarding overall satisfaction with the teaching received. CONCLUSIONS: Blended learning was more effective than traditional teaching for teaching human anatomy.

A simple method for safe identification of the facial nerve using palpable landmarks.

HYPOTHESIS: External palpable landmarks can be used to identify the facial nerve trunk quickly and safely. DESIGN: Prospective anatomical dissection study. SETTING: University department of human anatomy and university hospital. METHODS: A total of 40 human cadaver heads (79 facial nerves) were dissected by 2 prosectors, a surgeon with experience in the anatomy of the parotid region (J.A.P.; n = 39) and a medical student with experience in anatomical dissection and basic knowledge of the facial nerve disposition (A.M.; n = 40). A 3-cm skin incision was made in the center of the triangle formed by the temporomandibular joint, the mastoid process, and the angle of the mandible, and dissection was continued deep until the main facial nerve trunk was identified. MAIN OUTCOME MEASURES: The time taken from the skin incision to the identification of the nerve was monitored with a chronometer by an independent observer. The distance between the predicted and actual position of the facial nerve was measured. RESULTS: In all cases, the facial nerve was identified and there were no significant differences in the dissection time between the 2 prosectors (144 vs 148 seconds). The mean distance between the predicted and the actual position of the nerve was 1.42 mm. CONCLUSION: The proposed localization landmarks allowed a fast and safe identification of the facial nerve and may be of significant help during surgery around the parotid region.