Quadriceps tendon grafts does not cause patients to have inferior subjective outcome after anterior cruciate ligament (ACL) reconstruction than do hamstring grafts: a 2-year prospective randomised controlled trial.
British journal of sports medicine. 2020;(3):183-187
OBJECTIVE We performed a randomised controlled trial (RCT) in patients undergoing ACL reconstruction (ACLR) using either quadriceps tendon graft (QT) or semitendinosus/gracilis hamstring (STG) graft. We compared subjective outcome (primary outcome) and knee stability, donor site morbidity and function (secondary outcomes). METHODS From 2013 to 2015, we included 99 adults with isolated ACL injuries in the RCT. Fifty patients were randomised to QT grafts and 49 to STG grafts and followed for 2 years. Patient evaluated outcomes were performed by subjective International Knee Documentation Committee, Knee Injury and Osteoarthritis Outcome Score, Kujala and Tegner activity scores. Knee laxity was measured with a KT-1000 arthrometer. Donor site morbidity was evaluated by the 'donor site-related functional problems following ACLR score'. One-leg hop test tested limp strength symmetry. RESULTS At 2-year follow-up, there was no difference between the two graft groups regarding subjective patient outcome, knee stability and reoperations. Also, at 2 years, donor site symptoms were present in 27% of patients in the QT group and 50% of patients in the STG group. The donor site morbidity score was 14 and 22 for the QT and STG, respectively. Hop test demonstrated lower limp symmetry for QT graft than STG graft of 91% and 97% respectively. CONCLUSION QT graft for ACLR did not result in inferior subjective outcome compared with STG graft. However, QT graft was associated with lower donor site morbidity than STG grafts but resulted in more quadriceps muscle strength deficiency than hamstring grafts. Both graft types had similar knee stability outcome. TRIAL REGISTRATION NUMBER NCT02173483.
The efficacy of regular penis-root masturbation, versus Kegel exercise in the treatment of primary premature ejaculation: A quasi-randomised controlled trial.
To explore the efficacy of regular penis-root masturbation (PRM) versus Kegel exercise (KE) in the treatment of primary premature ejaculation (PPE). This study was a prospective quasi-randomised controlled trial. Thirty-seven heterosexual males with PPE were selected according to the time sequence of outpatient consultations and the preliminary results of a pre-experiment and were assigned to an PRM group and a KE group. Differences in intravaginal ejaculatory latency times (IELTs) and premature ejaculation diagnostic tool (PEDT) scores were compared between the two groups. The study was approved by the Ethics Committee of the First Affiliated Hospital of Guangxi Medical University. Among the 37 PPE patients, 18 performed PRM and 19 patients performed KE. The IELTs of patients who performed PRM and KE were significantly prolonged before treatment, and the difference after treatment was statistically significant (p < .05). Compared with the KE group, the IELT prolongation effect in the PRM group was more significant PRM (p < .05). The PEDT scores of patients after performing PRM and KE were significantly lower than those before performing these exercises (p < .05). Compared with the KE group, the PEDT scores of the PRM group exhibited a greater decrease (p < .05). Thus, both PRM and KE have therapeutic effects on PPE. Compared with KE, PRM is more effective in the treatment of PPE.
Role of the carotid chemoreceptors in insulin-mediated sympathoexcitation in humans.
American journal of physiology. Regulatory, integrative and comparative physiology. 2020;(1):R173-R181
We examined the contribution of the carotid chemoreceptors to insulin-mediated increases in muscle sympathetic nerve activity (MSNA) in healthy humans. We hypothesized that reductions in carotid chemoreceptor activity would attenuate the sympathoexcitatory response to hyperinsulinemia. Young, healthy adults (9 male/9 female, 28 ± 1 yr, 24 ± 1 kg/m2) completed a 30-min euglycemic baseline followed by a 90-min hyperinsulinemic (1 mU·kg fat-free mass-1·min-1), euglycemic infusion. MSNA (microneurography of the peroneal nerve) was continuously measured. The role of the carotid chemoreceptors was assessed at baseline and during hyperinsulinemia via 1) acute hyperoxia, 2) low-dose dopamine (1-4 µg·kg-1·min-1), and 3) acute hyperoxia + low-dose dopamine. MSNA burst frequency increased from baseline during hyperinsulinemia (P < 0.01). Acute hyperoxia had no effect on MSNA burst frequency at rest (P = 0.74) or during hyperinsulinemia (P = 0.83). The insulin-mediated increase in MSNA burst frequency (P = 0.02) was unaffected by low-dose dopamine (P = 0.60). When combined with low-dose dopamine, acute hyperoxia had no effect on MSNA burst frequency at rest (P = 0.17) or during hyperinsulinemia (P = 0.85). Carotid chemoreceptor desensitization in young, healthy men and women does not attenuate the sympathoexcitatory response to hyperinsulinemia. Our data suggest that the carotid chemoreceptors do not contribute to acute insulin-mediated increases in MSNA in young, healthy adults.
Molecular imaging of a glucagonoma with 18F-FDG PET/CT and 68Ga-DOTATATE PET/CT imaging: A case report and review of the literature.
Radiology case reports. 2020;(1):19-22
A 35-year-old man presented with significant weight loss of 30 kg over the previous 6 months, with newly diagnosed diabetes. Routine laboratory tests were normal, except for markedly elevated blood glucose. Computed tomography (CT) of the abdomen revealed a large severely enhanced mass replacing most of the pancreas and liver metastatic nodules and multiple paraaortic lymph node metastases, 18F-fluorodeoxygluocse positron emission tomography/computed tomography (18F-FDG PET/CT) was performed and revealed mild FDG uptake in the pancreatic mass, as well as mild uptake in the liver and lymph node metastases. A biopsy of the liver metastasis was consistent glucagonoma that was confirmed with markedly elevated serum glucagon level. Subsequently, 68Ga-DOTATATE PET/CT was performed for better tumor characterization and for assessment of the tumors' response to therapy, 68Ga-DOTATATE scan revealed intense uptake in the pancreatic mass, liver metastases, and paraaortic lymph node metastases. The patient responded well to peptide receptor radionuclide therapy. This case highlights the role of both 68Ga-DOTATATE and 18FDG-PET/CT in the diagnosis and management of a glucagonoma. 68Ga-DOTATATE is the tracer of choice for well-differentiated glucagonoma and offers very high diagnostic accuracy as compared with that of cross-sectional and other functional imaging and enables correct patient selection for peptide receptor radionuclide therapy.
Movement patterns of players in the Australian Women's Rugby League team during international competition.
Journal of science and medicine in sport. 2020;(3):315-319
OBJECTIVES To describe the movement patterns of the Australian Women's Rugby League team during international competition. DESIGN Retrospective observational study. METHODS Global Positioning Systems technology recorded the movements of players from the Australian Women's Rugby League team (n=31) during seven international rugby league matches. A subgroup of players (n=18) that played at least 80min in a match were categorized into three positional groups: forwards (n=7), backs (n=7) and halves (n=4), and analysed for external outputs that were classified into multiple speed zones. Mean speed (mmin-1) and mean speed when travelling >12kmh-1 (MS12; mmin-1) were calculated for each 10% interval of playing time of both groups to assess changes in match intensity. RESULTS Total distance travelled was greater in the first half (3332.9m compared to 3249.0m), along with distances travelled at speeds >15kmh-1 (p<0.05), whereas players travelled further at speeds <6kmh-1 in the second half (p=0.005). Backs travelled further at speeds <6kmh-1 (p=0.002) and >15kmh-1 (p=0.007) compared to forwards. Mean speed significantly reduced across the first and second halves (p<0.05), while MS12 reduced by ∼40% in the first half of the match (i.e. first ∼5min compared to the last ∼5min). CONCLUSION These results provide coaches with sport-specific activity profiles of female rugby league players that can be used to individualise training prescription. Given that match-intensity deteriorated across the first and second halves, programs may be targeted at improving endurance and supramaximal exercise tolerance in order for female players to withstand high match-demands of international competition.
Grenada Heart Project-Community Health ActioN to EncouraGe healthy BEhaviors (GHP-CHANGE): A randomized control peer group-based lifestyle intervention.
American heart journal. 2020;:20-28
BACKGROUND The incidence of cardiovascular (CV) risk factors is increasing globally, with a disproportionate burden in the low and low-middle income countries (L/LMICs). Peer support, as a low-cost lifestyle intervention, has succeeded in managing chronic illness. For global CV risk reduction, limited data exists in LMICs. AIM: The GHP-CHANGE was designed as a community-based randomized trial to test the effectiveness of peer support strategy for CV risk reduction in the island of Grenada, a LMIC. METHODS We recruited 402 adults from the Grenada Heart Project (GHP) Cohort Study of 2827 subjects with at least two CV risk factors. Subjects were randomized in a 1:1 fashion to a peer-group based intervention group (n = 206) or a self-management control group (n = 196) for 12 months. The primary outcome was the change from baseline in a composite score related to Blood pressure, Exercise, Weight, Alimentation and Tobacco (FBS, Fuster-BEWAT Score), ranging from 0 to 15 (ideal health = 15). Linear mixed-effects models were used to test for intervention effects. RESULTS Participants mean age was 51.4 years (SD 14.5) years, two-thirds were female, and baseline mean FBS was 8.9 (SD 2.6) and 8.5 (SD 2.6) in the intervention and control group, respectively (P = .152). At post intervention, the mean FBS was higher in the intervention group compared to the control group [9.1 (SD 2.7) vs 8.5 (SD 2.6), P = .028]. When balancing baseline health profile, the between-group difference (intervention vs. control) in the change of FBS was 0.31 points (95% CI: -0.12 to 0.75; P = .154). CONCLUSIONS The GHP-CHANGE trial showed that a peer-support lifestyle intervention program was feasible; however, it did not demonstrate a significant improvement in the FBS as compared to the control group. Further studies should assess the effects of low-cost lifestyle interventions in LMICs.
Neurodevelopmental outcome in 7-year-old children is not affected by exercise during pregnancy: follow up of a multicentre randomised controlled trial.
BJOG : an international journal of obstetrics and gynaecology. 2020;(4):508-517
OBJECTIVE To investigate whether regular moderate intensity exercise during pregnancy had adverse effect on neurodevelopment of offspring at 7 years of age. DESIGN Follow up of a multicentre randomised controlled trial. SETTING St Olavs Hospital, Trondheim University Hospital and Stavanger University Hospital, Norway (2007-09). POPULATION Women randomised to follow a 12-week structured exercise protocol or standard antenatal care during pregnancy. METHODS At 7 years of age, neurodevelopmental outcome was assessed by the parent questionnaire Five-To-Fifteen (FTF), including motor skills, executive functions, perception, memory, language, social skills and possible emotional/behavioural problems. MAIN OUTCOME MEASURE Continuous and dichotomised (cut-off 90th centile) FTF scores. RESULTS A total of 855 women were randomised to exercise (n = 429) or standard antenatal care (n = 426) during pregnancy. At follow up, 164 (38.2%) children born to mothers in the intervention group and 115 (27.0%) children born to mothers in the control group participated. We found no group differences in FTF scores or in the proportion of children with scores ≥90th centile. Stratified analyses by sex, subgroup analyses of women who adhered to the exercise protocol or sensitivity analyses excluding preterm children and/or children who had been admitted to the neonatal intensive care unit did not change the results. CONCLUSIONS In the present randomised controlled trial follow-up study, regular moderate intensity exercise during pregnancy did not have adverse effect on neurodevelopment of offspring at 7 years of age. TWEETABLE ABSTRACT Moderate intensity exercise during pregnancy had no adverse effect on neurodevelopment of offspring at 7 years of age.
Short halt in vaping modifies cardiorespiratory parameters and urine metabolome: a randomized trial.
American journal of physiology. Lung cellular and molecular physiology. 2020;(2):L331-L344
Propylene glycol and glycerol are e-cigarette constituents that facilitate liquid vaporization and nicotine transport. As these small hydrophilic molecules quickly cross the lung epithelium, we hypothesized that short-term cessation of vaping in regular users would completely clear aerosol deposit from the lungs and reverse vaping-induced cardiorespiratory toxicity. We aimed to assess the acute effects of vaping and their reversibility on biological/clinical cardiorespiratory parameters [serum/urine pneumoproteins, hemodynamic parameters, lung-function test and diffusing capacities, transcutaneous gas tensions (primary outcome), and skin microcirculatory blood flow]. Regular e-cigarette users were enrolled in this randomized, investigator-blinded, three-period crossover study. The periods consisted of nicotine-vaping (nicotine-session), nicotine-free vaping (nicotine-free-session), and complete cessation of vaping (stop-session), all maintained for 5 days before the session began. Multiparametric metabolomic analyses were used to verify subjects' protocol compliance. Biological/clinical cardiorespiratory parameters were assessed at the beginning of each session (baseline) and after acute vaping exposure. Compared with the nicotine- and nicotine-free-sessions, a specific metabolomic signature characterized the stop-session. Baseline serum club cell protein-16 was higher during the stop-session than the other sessions (P < 0.01), and heart rate was higher in the nicotine-session (P < 0.001). Compared with acute sham-vaping in the stop-session, acute nicotine-vaping (nicotine-session) and acute nicotine-free vaping (nicotine-free-session) slightly decreased skin oxygen tension (P < 0.05). In regular e-cigarette-users, short-term vaping cessation seemed to shift baseline urine metabolome and increased serum club cell protein-16 concentration, suggesting a decrease in lung inflammation. Additionally, acute vaping with and without nicotine decreased slightly transcutaneous oxygen tension, likely as a result of lung gas exchanges disturbances.
Intact and hydrolyzed casein lead to similar ileal endogenous protein and amino acid flows in adult humans.
The American journal of clinical nutrition. 2020;(1):90-97
BACKGROUND Endogenous amino acids (AAs) contribute to terminal ileal digesta and must be corrected for in determining coefficients of true ileal digestibility. Such estimates are also needed for the factorial calculation of AA requirements. OBJECTIVE The effect of the form of delivery of dietary AAs on endogenous nitrogen and AA flows at the end of the ileum was studied. METHODS Isotopically labeled 15N-casein (33-34 g), in either a hydrolyzed (HC) or intact (C) form, was included as the sole source of nitrogen in a mixed meal (320 mmol N) consumed by healthy adult humans equipped with a triple-lumen sampling tube in the small intestine. Ileal endogenous AA flows were determined by isotope dilution. An additional meal (A) containing a free AA mixture (306 mmol N) simulating the AA composition of casein was included. Serine was omitted from the AA mixture to allow direct determination of its ileal endogenous flow. RESULTS Endogenous N and AA flows did not differ (P > 0.05) for diets C and HC, with mean respective N flows of 728 and 617 mg/8 h (± pooled SD: 144 mg/8 h). Endogenous serine flow was similar (P > 0.05) for diets C, HC, and A [181, 169, and 191 mg/8 h (± 56 mg/8 h)]. Recycling of the 15N marker was determined to be ∼11%, suggesting that the 15N endogenous loss values could underestimate endogenous protein and AA losses by ∼6% (the proportion of recycled 15N divided by the sum of endogenous N and recycled 15N). CONCLUSIONS The 3 different forms of dietary AA delivery (free AAs, HC, or C) elicited similar ileal endogenous AA flows in the adult human.This study was registered at clinicaltrials.gov as NCT00873951.
Predictive risk factors for autoimmune thyroid diseases in patients with pernicious anemia.
Medicina clinica. 2020;(9):344-347
BACKGROUND Patients with pernicious anemia (PA) have a higher prevalence of other autoimmune diseases. We assessed the correlation between PA and autoimmune thyroid diseases (AITD), and evaluated the risk factors for this association. METHODS A longitudinal study was conducted involving patients with PA between 2010 and 2017. RESULTS A total of 86 patients with PA were evaluated, 74 (86%) female, with a median age of 51.5 years. Thyroid abnormalities were detected in 45 (52.3%) patients, including 28 (32.3%) hypothyroidism, 3 (3.5%) hyperthyroidism and 20 (23.3%) thyroperoxidase antibody positivity. Logistic regression analysis identified risk factors for having AITD in PA patients: weight loss (OR 12.03; 95% CI 1.06-137.02, P=0.045), diabetes mellitus (OR 4.68, 95% CI 1.15-26.58, P=0.047) and gastric antibodies positivity (OR 5.05, 95% CI 1.45-18.24, P=0.013). CONCLUSION PA and AITD are frequently associated, suggesting all patients with PA should be investigated for occult thyroid disease, especially those with weight loss, diabetes mellitus and gastric autoantibodies.