Effects of breathing exercises using home-based positive pressure in the expiratory phase in patients with COPD.
Postgraduate medical journal. 2019;(1127):476-481
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) commonly have higher intrinsic positive end-expiratory pressure (PEEPi). A breathing exercise programme strategy employing an appropriate PEEP may improve their pulmonary functional capacity, exercise tolerance and health-related quality of life. Breathing with an expiratory resistive load, which is a method of modulating spontaneous breathing against PEEPi, has not been fully studied in patients with COPD. The objective of this study was to investigate the role of changing spontaneous breathing in home-based conditions and regulating spontaneous breathing with breathing exercises in patients with COPD. METHODS This was a prospective randomised trial including 64 patients with a diagnosis of stage III or IV COPD. Patients were randomised into two groups: standard treatment and standard treatment combined with breathing exercise rehabilitation. The effects of the treatments on the COPD assessment test (CAT) score, 6-minute walk test (6MWT) results and pulmonary function were compared at 0, 6, 12 and 18 months within and between the two groups. RESULTS All outcomes showed no significant differences between the two groups at the beginning of the study, while the 6MWT and CAT scores exhibited clinically and statistically significant improvements (p<0.001) by the end of the study. At month 18, the change in the predicted percentage of forced expiratory volume in 1 s (FEV1%pred) differed between the two groups (p<0.05). In addition, there were statistically significant differences in the 6MWT results, CAT scores and FEV1%pred values between the baseline and month 18 (p<0.0001) in the intervention group. CONCLUSIONS Improvements in 6MWT results, pulmonary function and CAT scores are associated with a successful response to breathing against PEEPi in patients with COPD. TRIAL REGISTRATION This trial was registered at research registry.com (identifier research registry 4816).
Impact of Fecal Microbiota Transplantation on Obesity and Metabolic Syndrome-A Systematic Review.
Plain language summary
Fecal microbiota transplantation (FMT) is a relatively new field of scientific exploration where patients receive faeces from a healthy donor to help repopulate their intestinal tract with healthful bacteria. The gut microbiome is an ecosystem of an estimated 10~100 trillion microorganisms and there is increasing research on the important role these bacteria play in supporting our health and weight. This study reviews all trials involving faecal transports in patients with either clinical obesity or Metabolic syndrome to see if it helped improve weight, bmi or other metabolic parameters. Three studies with 76 male patients were included in this review and the results showed that FMT recipients had improved insulin sensitivity and reduced HbA1c glucose levels after 6 weeks, but these improvements were short-term only. There were no differences in bmi, cholesterol, markers and fasting glucose levels. The conclusion is that whilst FMT may confer benefits there is still much to understand about the fecal microbial preparation, dosing, and method of delivery, as well as the host patient’s response.
undefined: Fecal microbiota transplantation (FMT) is a gut microbial-modulation strategy that has been investigated for the treatment of a variety of human diseases, including obesity-associated metabolic disorders. This study appraises current literature and provides an overview of the effectiveness and limitations of FMT as a potential therapeutic strategy for obesity and metabolic syndrome (MS). Five electronic databases and two gray literature sources were searched up to 10 December 2018. All interventional and observational studies that contained information on the relevant population (adult patients with obesity and MS), intervention (receiving allogeneic FMT) and outcomes (metabolic parameters) were eligible. From 1096 unique citations, three randomized placebo-controlled studies (76 patients with obesity and MS, body mass index = 34.8 ± 4.1 kg/m , fasting plasma glucose = 5.8 ± 0.7 mmol/L) were included for review. Studies reported mixed results with regards to improvement in metabolic parameters. Two studies reported improved peripheral insulin sensitivity (rate of glucose disappearance, RD) at 6 weeks in patients receiving donor FMT versus patients receiving the placebo control. In addition, one study observed lower HbA1c levels in FMT patients at 6 weeks. No differences in fasting plasma glucose, hepatic insulin sensitivity, body mass index (BMI), or cholesterol markers were observed between two groups across all included studies. While promising, the influence of FMT on long-term clinical endpoints needs to be further explored. Future studies are also required to better understand the mechanisms through which changes in gut microbial ecology and engraftment of microbiota affect metabolic outcomes for patients with obesity and MS. In addition, further research is needed to better define the optimal fecal microbial preparation, dosing, and method of delivery.
Inflammatory myofibroblastic tumors in the kidney and abdominal wall mimicking malignancy: A case report.
RATIONALE Inflammatory myofibroblastic tumor (IMT) is uncommon, coexistence of IMTs in the kidney and abdominal wall are more uncommon. PATIENT CONCERNS AND DIAGNOSIS We report a 74-year-old female who presented with 6 months history of left flank pain and approximately 5 kg weight loss that were diagnosed as renal cell carcinoma and locally metastatic abdominal wall tumor. INTERVENTIONS AND OUTCOMES A left radical nephrectomy and excision of the abdominal wall tumor were done. The pathologic result was IMTs. After follow-up for 66 months, the patient showed no signs of tumor recurrence. LESSONS Coexistence of IMTs in the kidney and abdominal wall is extremely rare and is often diagnosed as malignancy. Therefore, IMTs should be considered in the diagnosis of the patient with both kidney and abdominal wall tumors.
Effect of Post-Exercise Massage on Passive Muscle Stiffness Measured Using Myotonometry - A Double-Blind Study.
Journal of sports science & medicine. 2018;(4):599-606
It is commonly believed that massage can reduce muscle stiffness and is desirable for recovery from exercise. However, the effect massage on muscle stiffness following eccentric exercises is currently unknown. This study aimed to examine the effect of post-exercise massage on passive muscle stiffness over a five-day period. A randomised cross-over study design was adopted. After 40 minutes of downhill running, 18 male recreational runners had one leg received a 16-minute massage and the contralateral leg received a 16-minute sham ultrasound treatment. Passive stiffness for four leg muscles (rectus femoris, biceps femoris, tibialis anterior, and gastrocnemius) was assessed using myotonometry at baseline, immediately post-run, post-treatment, 24, 48, 72, and 96 hours post-run. A 2 (treatment) × 7 (time) mixed ANOVA was conducted with a robust procedure on the myotonometry data of each leg muscle to examine the effect of treatment on stiffness. Passive stiffness for all muscles changed over time but no treatment effect was found. Stiffness increased at 24 hours post-run and remained elevated from baseline levels for up to 96 hours across all four muscles. Significant treatment × time interaction was only found in the tibialis anterior but no post-hoc differences were identified. Passive stiffness of major leg muscles increased after a bout of unaccustomed eccentric exercise and remained elevated for up to four days post-exercise. Compared with the placebo treatment, post-exercise massage had no beneficial effect in alleviating altered muscle stiffness in major leg muscles.
Comparison of Lower Limb and Back Exercises for Runners with Chronic Low Back Pain.
Medicine and science in sports and exercise. 2017;(12):2374-2384
INTRODUCTION This single-blind randomized trial was conducted to compare the treatment effect of lower limb (LL) exercises versus conventional lumbar extensor (LE) and lumbar stabilization (LS) exercises in recreational runners with chronic low back pain (cLBP), because there is currently no specific protocol for managing runners with cLBP. METHODS Eighty-four recreational runners with cLBP were allocated to three exercise groups (LL, LE, LS) for an 8-wk intervention. Outcome measures included self-rated pain and running capability, LL strength, back muscle function, and running gait. Participants were assessed at preintervention, mid-intervention, and end-intervention; selected outcomes also followed up at 3 and 6 months. Generalized estimating equation was adopted to examine group-time interaction. RESULTS The LL group improved 0.949 points per time point in Patient-Specific Functional Scale (P < 0.001), which was higher than the LE (B = -0.198, P = 0.001) and LS groups (B = -0.263, P < 0.001). All three groups improved on average 0.746 points per time point in Numeric Pain Rating Scale for running-induced pain (P < 0.001). Knee extension strength increased 0.260 N·m·kg per time point (P < 0.001) in the LL group, which was higher than the LE (B = -0.220, P < 0.001) and LS groups (B = -0.206, P < 0.001). The LL group also showed a greater increase in running step length (2.464 cm per time point, P = 0.001) compared with LS group (B = -2.213, P = 0.013). All three groups improved similarly in back muscle function. CONCLUSION LL exercise therapy could be a new option for cLPB management given its superior effects in improving running capability, knee extension strength, and running gait.