Purpose: To summarise evidence from observational studies that examined the impact of obesity on Centre of Pressure (CoP) sway during quiet standing in community-dwelling older adults.
Methods: An ...electronic data search (last searched April 2017) was performed on six databases (MEDLine, Web of Science, CINAHL, PsycINFO, Scopus and LILACS). Details of the study design, participants' characteristics, obesity classification criteria, postural control conditions, CoP sway parameters and risk of bias were extracted by two independent reviewers.
Results: Of 265 studies reviewed, four met the inclusion criteria and were appraised. Common to all the included studies was a negative effect of obesity on CoP sway parameters, especially at anteroposterior and mediolateral ranges. Of note, these findings were observed in a wide variety of quiet stance conditions, with significance more evident when vision was restricted. The risk of bias revealed that most studies' samples were not representative of the entire population.
Conclusions: The present systematic review suggests that obesity is associated with reduced static postural control in community-dwelling older adults. However, due to the risk of bias and the large variability of protocols used to measure CoP sway, the evidence remains inconclusive. Future longitudinal studies are needed to confirm the findings.
Cystic fibrosis (CF) is a life-threatening disease affecting about 1:3000 newborns in Caucasian populations. The introduction of newborn screening for cystic fibrosis (CF NBS) has improved the ...clinical outcomes of individuals with CF through early diagnosis and early treatment. NBS strategies have been implemented over time. CF NBS was introduced extensively in 1984 in Tuscany, a region with 3.7 million people, characterized by a high allelic heterogeneity of CFTR gene.
The aim of the study is to present the results from 34 years (1984-2018) of CF NBS, retrospectively evaluating the sensitivity, specificity and predictive values of the tests. In particular, we studied the impact of the introduction of DNA molecular analysis in NBS in a region with high allelic heterogeneity, such as Tuscany.
Over these 34 years, 919,520 neonates were screened, using four different NBS strategies. From 1984 to 1991, CF NBS was performed by the determination of albumin on dried meconium (sensitivity 68.75%; specificity 99.82%). Subsequently, the analysis of immunoreactive trypsinogen on a blood spot was adopted as CF NBS protocol (sensitivity 83.33%; specificity 99.77%). From 1992 to 2010, this strategy was associated with lactase meconium dosage: IRT1/IRT2 + LACT protocol (sensitivity 87.50%; specificity 99.82%). From 2011, when the existing algorithm was integrated by analysis of CF causing variants of the CFTR gene (IRT1/IRT2 + LACT + IRT1/DNA protocol), a substantial improvement in sensitivity was seen (senisitivity 96.15%; specificity 99.75%). Other improved parameters with DNA analysis in the NBS programme, compared with the previous method, were the diagnosis time (52 days vs. 38 days) and the recall rate (0.58 to 0.38%).
The inclusion of DNA analysis in the NBS was a fundamental step in improving sensitivity, even in a region with high allelic variability.
ABSTRACT Previous studies have shown an association between lower limb muscle strength and functional performance, but a dose-response relationship between the strength of each lower limb muscle ...group and performance in daily life activities in older adults has not been well established. Thus, this study aimed to investigate the association between isokinetic muscle strength of all eight major lower limb muscle groups and functional performance in community-dwelling older adults. The muscle strength of the plantar flexors and dorsiflexors of the ankle, flexors and extensors of the knee, and flexors, extensors, adductors, and abductors of the hip were evaluated using a Biodex System 4 Pro® isokinetic dynamometer. Functional performance was evaluated in 109 participants using the five-times sit-to-stand test (STS) and 4-meter usual walking speed (UWS). The multiple linear regression analyses showed that the hip abductors strength predicted 31.3% of the variability for UWS (p=0.011), and the knee extensors strength (p=0.015) predicted 31.6% of the variability for the STS. We conclude that hip abductors and knee extensors could be the key muscle groups involved in sit to stand and walking speed performance in older adults.
RESUMO Estudos anteriores já demonstraram a associação entre força muscular de membros inferiores e desempenho funcional, mas a contribuição dos principais músculos dos membros inferiores para o desempenho de pessoas idosas nas atividades cotidianas não foi bem estabelecida. O objetivo deste estudo foi investigar a associação entre a força muscular isocinética dos oito principais grupos musculares dos membros inferiores e o desempenho funcional em pessoas idosas da comunidade. A força muscular dos plantiflexores e dorsiflexores do tornozelo, flexores e extensores do joelho e flexores, extensores, adutores e abdutores do quadril foi avaliada utilizando um dinamômetro isocinético Biodex System 4 Pro®. O desempenho funcional de 109 participantes foi avaliado usando o teste de sentar e levantar cinco vezes (TSL) e de velocidade de marcha habitual de 4 metros (VMH). As análises de regressão linear múltipla mostraram que a força dos abdutores do quadril previu 31,3% da variabilidade para a VMH (p=0,011), e a força dos extensores do joelho (p=0,015) 31,6% da variabilidade para o TSL. Concluímos que os abdutores do quadril e os extensores do joelho podem ser os principais grupos musculares envolvidos no desempenho de pessoas idosas para sentar-levantar e caminhar.
RESUMEN Estudios previos ya demostraron la asociación entre la fuerza muscular de los miembros inferiores y el rendimiento funcional, sin embargo, no está bien establecida la contribución de los principales músculos de los miembros inferiores sobre el rendimiento de las personas mayores en las actividades diarias. El objetivo de este estudio fue evaluar la asociación entre la fuerza muscular isocinética de los ocho principales grupos musculares de los miembros inferiores y el rendimiento funcional en personas mayores que viven en la comunidad. La fuerza muscular de los plantiflexores y dorsiflexores del tobillo, los flexores y extensores de la rodilla y los flexores, extensores, aductores y abductores de la cadera se evaluaron por medio del dinamómetro isocinético Biodex System 4 Pro®. El rendimiento funcional de 109 participantes se evaluó mediante el test de sentarse y pararse cinco veces (STS) y la velocidad de marcha habitual de 4 metros. Los análisis de regresión lineal múltiple mostraron que la fuerza de los abductores de la cadera predijo el 31,3% de la variabilidad para la velocidad de marcha habitual (p=0,011); y la fuerza de los extensores de la rodilla (p=0,015), el 31,6% de variabilidad para STS. Se concluyó que los abductores de la cadera y los extensores de la rodilla pueden ser los principales grupos musculares involucrados en el rendimiento de los adultos mayores para sentarse, pararse y caminar.
Abstract This is the third article related to a review of the literature based on data from national cystic fibrosis (CF) patient registries up to June 2008 and covering a total of 115 published ...studies. It focuses on several topics: CF incidence, genotype/phenotype correlation, microbiology, pregnancy/paternity, clinical complications, lung transplantation, and others. Seventy seven papers meeting the inclusion criteria were found to be related to the topics listed above. Another seven studies, already evaluated in previous papers of this series, were recalled for specific topics. Incidence is described by several studies, results being quite different from one country to another and quite inhomogeneous among regions within the same country. Studies on genetics address the genotype/phenotype correlation and look for a predictive value of CFTR mutations in terms of clinical outcome, with controversial results. Papers on microbiology describe the clinical relevance of different pathogens and their role in the progress of CF lung disease. A few articles give information on the features of CF women undergoing a pregnancy and try to identify the ones associated with a better outcome. Studies on clinical complications discuss prevalence and the role of haemoptysis, pneumothorax, CF related diabetes, ABPA and cancer. Papers on lung transplantation focus on models able to improve the selection criteria for transplantation candidates and the factors linked to post transplantation survival. Finally, several studies deal with a number of interesting topics related to CF epidemiology: clinical trial methodology, quality of care comparison among countries and centers, relationship between diagnosis and age/gender, and evaluation of pharmacological therapy. On the whole, CF Registries have already contributed to important advances in the knowledge of the natural history of CF, establishing the foundations for future improvement in CF research and care.
Abstract
BACKGROUND AND AIMS
Sarcopenia is a risk factor for adverse outcomes in older adults,1, but this has yet to be confirmed in chronic kidney disease (CKD).2 We conducted a systematic review to ...investigate the association between sarcopenia and its traits with mortality, hospitalization and end-stage kidney disease (ESKD) progression in CKD patients.
METHOD
Five electronic databases were searched, including MEDLINE and Embase. Observational cohort studies with CKD patients were included. The sarcopenia traits assessed were low muscle strength, low muscle mass and low physical performance, as well as confirmed sarcopenia (combined low muscle mass and low strength/performance).3 Hazard ratios (HR), risk ratios (RR), odds ratios (OR) and 95% confidence intervals (CI) were pooled using random-effect meta-analyses.
RESULTS
From a total of 4922 screened studies, 50 (72 347 patients) were included in the review and 38 (59 070 patients) in the meta-analyses. Most of the included studies were in dialysis patients (n = 29, 58%). Table 1 shows that low muscle strength (15 studies; HR: 1.99; 95% CI: 1.65–2.41; I²:45%), low muscle mass (20 studies; HR: 1.51; 95% CI: 1.36–1.68; I²: 26%), low physical performance (five studies; HR: 2.09; 95% CI: 1.68–2.59; I²: 0%) and confirmed sarcopenia (eight studies in dialysis patients; HR: 1.87; 95% CI: 1.35–2.59; I²: 40%) were associated with an increased mortality risk. On the other hand, for dialysis patients it was uncertain whether low muscle mass was associated with hospitalization (two studies; RR: 1.81; 95% CI: 0.78–4.22; I²: 59%). Further, limited ESKD progression measures prevented meta-analysis for this outcome.
CONCLUSION
Low muscle strength, low muscle mass and low physical performance are associated with higher mortality in CKD patients. In dialysis patients, confirmed sarcopenia also represented higher mortality risk. Evidence to conclude associations with hospitalization and ESKD progression are currently lacking.
CI, confidence interval
Novel concepts in red blood cell clearance Neri, Silvia; Swinkels, Dorine W; Matlung, Hanke L ...
Current opinion in hematology,
11/2021, Letnik:
28, Številka:
6
Journal Article
Red blood cell (RBC) clearance has been studied for decades in many different pathologies, which has revealed different routes of RBC degradation, depending on the situation. This review summarizes ...the latest mechanistic insights on RBC clearance in different contexts; during homeostatic removal, immune-mediated destruction, and systemic inflammation.
Besides the recognition of a variety of potential 'eat me' signals on RBCs, recent evidence suggests that normal RBC degradation is driven by the increase of the adhesive properties of RBCs, mediating the retention in the spleen and leading to RBC hemolysis. Furthermore, immune-mediated degradation of RBCs seems to be fine-tuned by the balance between the density of the antigens expressed on RBCs and the presence of 'don't eat me' signals. Moreover, besides RBC clearance by macrophages, neutrophils seem to play a much more prominent role in immune-mediated RBC removal than anticipated. Lastly, RBC clearance during systemic inflammation appears to be driven by a combination of extreme macrophage activity in response to proinflammatory cytokines as well as direct damage of RBC by the inflammation or inflammatory agent.
Recent studies on RBC clearance have expanded our knowledge on their destruction in different contexts.
The main purpose of this study was to analyze patient-related factors that may influence the risk of hernia recurrence following laparoscopic incisional hernia repair (LIHR), including the potential ...role of chosen materials.
A multicenter, retrospective cohort study was conducted on all patients who were aged >18 years and who underwent elective laparoscopic incisional hernia mesh repair at the Departments of Surgery of the S. Anna University Hospital in Ferrara and Sassuolo Hospital in Modena, Italy. Exclusion criteria were as follows: patients undergoing an open or emergency incisional hernia repair or with primary ventral hernia. All hernia and operative variables that may favor hernia recurrence were collected and analyzed. Follow-up was conducted through a standardized telephone interview, followed by an outpatient visit and diagnostic imaging if needed.
From September 2002 to September 2017, 312 consecutive patients underwent elective laparoscopic incisional hernia mesh repair. At a mean 22-month follow-up, 273 patients presented no recurrence of incisional hernia and 39 had relapsed. Intra- and postoperative complications were similar between groups. Unadjusted Cox regression analysis showed a statistically significant association between both the partially absorbable mesh (
< .0001) and absorbable tacks (
= .001) and recurrence, while after adjusting for potential confounders, only the partially absorbable mesh was significantly associated with recurrence (
= .007).
The laparoscopic approach may be considered safe for incisional hernia mesh repair. In this multicenter, retrospective cohort study, the use of a partially absorbable mesh in LIHR was the only predictor of hernia recurrence. The partially absorbable mesh that was investigated, however, has been withdrawn from the market.
En 2017 la Fondation François Pinault à Venise présente l’exposition inédite de l’artiste Damien Hirst, intitulée Treasures from the Wreck of the Unbelievable. L’étude qui suit présente l’analyse du ...faux comme création artistique contemporaine orientée vers la construction d’une réalité basée sur la fiction et la légende. La question de départ en est l’exposition et l’autorité qu’elle représente : une fake exhibition au sein d’une institution européenne prestigieuse représente-t-elle le renversement des paramètres éthiques de l’art, du musée et du marché de l’art ?
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