Search results for: postoperative exercise

Authors: Nazia Shehzad

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An icebreaker is a facilitation exercise intended to help a group to begin the process of forming themselves into a team. Icebreakers are commonly presented as a game to ‘warm up’ the group by helping the members to get to know each other. They often focus on sharing personal information such as names, hobbies, etc. Challenging icebreakers also have the ability to allow a group to be better prepared to complete its assigned tasks. For example, if the team's objective is to redesign a business process such as Accounts Payable, the icebreaker activity might take the team through a process analysis. The analysis could include the identification of failure points, challenging assumptions, and development of new solutions — all in a simpler and ‘safer’ setting where the team can practice the group dynamics which they will use to solve the assigned problem. Icebreakers help establish a positive environment and provide an opportunity for students to get to know one another and the instructor. Both are critical to the retention and success of students. There are a number of benefits of using ice-breakers activities in the classroom. It reduces both student and instructor anxiety prior to introducing the course, fosters in a powerful way both student-student and faculty-student interactions. It creates an environment where the learner is expected to participate and the instructor is willing to listen, actively engage students from the onset. It conveys the message that the instructor cares about getting to know the students and makes it easier for students to form relationships early in the semester so they can work together both in and out of class.

Keywords: actively engages students, facilitation exercise, faculty- student interactions, group dynamics, warm up

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Authors: Sdiqeh Jalali, M. R. Khazdair

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Liver X receptors (LXR) have an essential role in the regulation of cholesterol metabolism, and their activation increase ABCG5 and ABCG8 genes expression for the improvement of cholesterol excretion from the body during reverse cholesterol transport (RCT). The aim of this study was to investigate the effects of high-intensity interval (HIT) and low intensity continuous (LIT) trainings on gene expression of these substances after a high-fat diet in Wistar rats. Materials and Methods: Fifteen male Wistar rats were divided into 3 groups: control group (n = 5), HIT exercise group (n = 5) and LIT exercise group (n = 5). All groups used a high-fat diet for 13 weeks, and the HIT and LIT groups performed the specific training program. The expression of LXRβ, ABCG5, and ABCG8 genes was measured after the training period. Findings: Data analysis showed significantly higher levels of LXRβ, ABCG5, and ABCG8 gene expression in HIT and LIT groups compared to the control group (P ≤ 0.05). Conclusion: HIT and LIT trainings after a high-fat diet have beneficial effects on RCT that prevent heart attack. Also, HIT training may have a greater effect on cholesterol excretion during the reverse cholesterol transport mechanism than LIT.

Keywords: liver X receptor, atherosclerosis, interval training, endurance training

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Authors: Neeraj Vij, Christian Leber, Kenneth Schmidt

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Introduction: Total knee arthroplasty is a common procedure. It is well known that the biomechanics of the knee do not fully return to their normal state. Motion analysis has been used to study the biomechanics of the knee after total knee arthroplasty. The purpose of this scoping review is to summarize the current use of gait analysis in total knee arthroplasty and to identify the preoperative motion analysis parameters for which a systematic review aimed at determining the reliability and validity may be warranted. Materials and Methods: This IRB-exempt scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist strictly. Five search engines were searched for a total of 279 articles. Articles underwent a title and abstract screening process followed by full-text screening. Included articles were placed in the following sections: the role of gait analysis as a research tool for operative decisions, other research applications for motion analysis in total knee arthroplasty, gait analysis as a tool in predicting radiologic outcomes, gait analysis as a tool in predicting clinical outcomes. Results: Eleven articles studied gait analysis as a research tool in studying operative decisions. Motion analysis is currently used to study surgical approaches, surgical techniques, and implant choice. Five articles studied other research applications for motion analysis in total knee arthroplasty. Other research applications for motion analysis currently include studying the role of the unicompartmental knee arthroplasty and novel physical therapy protocols aimed at optimizing post-operative care. Two articles studied motion analysis as a tool for predicting radiographic outcomes. Preoperative gait analysis has identified parameters than can predict postoperative tibial component migration. 15 articles studied motion analysis in conjunction with clinical scores. Conclusions: There is a broad range of applications within the research domain of total knee arthroplasty. The potential application is likely larger. However, the current literature is limited by vague definitions of ‘gait analysis’ or ‘motion analysis’ and a limited number of articles with preoperative and postoperative functional and clinical measures. Knee adduction moment, knee adduction impulse, total knee range of motion, varus angle, cadence, stride length, and velocity have the potential for integration into composite clinical scores. A systematic review aimed at determining the validity, reliability, sensitivities, and specificities of these variables is warranted.

Keywords: motion analysis, joint replacement, patient-reported outcomes, knee surgery

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Authors: Angela Evans, Gabriel Gijon-Nogueron, Alfonso Martinez-Nova

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Background The health sector, whose mission is protecting health, also contributes to the climate crisis, the greatest health threat of the 21st century. The carbon footprint from healthcare exceeds 5% of emissions globally, surpassing 7% in the USA and Australia. Global recognition has led to the Paris Agreement, the United Nations Sustainable Development Goals, and the World Health Organization's Climate Change Action Plan. It is agreed that the majority of health impacts stem from energy and resource consumption, as well as the production of greenhouse gases in the environment and deforestation. Many professional medical associations and healthcare providers advocate for their members to take the lead in environmental sustainability. Objectives To avail and expand ‘Green Podiatry’ via the three pillars of: Exercise ; Evidence ; Everyday changes; to highlight the benefits of physical activity and exercise for both human health and planet health. Walking and running are beneficial for health, provide low carbon transport, and have evidence-based health benefits. Podiatrists are key healthcare professionals in the physical activity space and can influence and guide their patients to increase physical activity and avert the many non-communicable diseases that are decimating public health, eg diabetes, arthritis, depression, cancer, obesity. Methods Publications, conference presentations, and pilot projects pertinent to ‘Green Podiatry’ have been activated since 2021, and a survey of podiatrist’s knowledge and awareness has been undertaken.The survey assessed attitudes towards environmental sustainability in work environment. The questions addressed commuting habits, hours of physical exercise per week, and attitudes in the clinic, such as prescribing unnecessary treatments or emphasizing sports as primary treatment. Results Teaching and Learning modules have been developed for podiatric medicine students and graduates globally. These will be availed. A pilot foot orthoses recycling project has been undertaken and will be reported, in addition to established footwear recycling. The preliminary survey found almost 90% of respondents had no knowledge of green podiatry or footwear recycling. Only 30% prescribe sports/exercise as the primary treatment for patients, and 45% do not to prescribe unnecessary treatments. Conclusions Podiatrists are in a good position to lead in the crucial area of healthcare and climate change implications. Sufficient education of podiatrists is essential for the profession to beneficially promote health and physical activity, which is beneficial for the health of all peoples and all communities.

Keywords: climate change, gait, green, healthcare, sustainability

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Authors: Mohamed M. Ragab, Neveen A. Abdel Raoof, Reham H. Diab

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Background: Delayed onset muscle soreness (DOMS) is the most common symptom when ordinary individuals and athletes are exposed to unaccustomed physical activity, especially eccentric contraction which impairs athletic performance, ordinary people work ability and physical functioning. A multitude of methods have been investigated to reduce DOMS. One of the valuable method to control DOMS is repeated bout effect (RBE) as a prophylactic method. Purpose: To compare the repeated bout effect of submaximal eccentric contraction versus maximal isometric contraction on induced DOMS. Methods: Sixty normal male volunteers were assigned randomly into three groups of equal number: Group (A) “first study group”: 20 subjects received submaximal eccentric contraction on non-dominant elbow flexors as prophylactic exercise. Group (B) “second study group”: 20 subjects received maximal isometric contraction on non-dominant elbow flexors as prophylactic exercise. Group (C) “control group”: 20 subjects did not receive any prophylactic exercise. Maximal isometric contraction peak torque of elbow flexors and patient related elbow evaluation (PREE) scale were measured for each subject 3 times before, immediately after and 48 hours after induction of DOMS. Results: Post-hoc test for maximal isometric peak torque and PREE scale immediately and 48 hours after induction of DOMS revealed that group (A) and group (B) resulted in significant decrease in maximal isometric strength loss and elbow pain and disability rather than control group (C), but submaximal eccentric group (A) was more effective than maximal isometric group (B) as it showed more rapid recovery of functional strength and less degrees of elbow pain and disability. Conclusion: Both submaximal eccentric contraction and maximal isometric contraction were effective in prevention of DOMS but submaximal eccentric contraction had the greatest protective effect.

Keywords: delayed onset muscle soreness, maximal isometric peak torque, patient related elbow evaluation scale, repeated bout effect

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Authors: Shoumodip Roy, Ankit Singhania, M. K. G. Choudhury, Santanu Mallick, M. K. Agarwal, R. V. Ramna, Uttam Singh

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One of the key corporate goals of Tata Steel company is to demonstrate Environment Leadership. Decreasing specific CO₂ emission is one of the key steps to achieve the stated corporate goal. At any Blast Furnace, specific CO₂ emission is directly proportional to fuel intake. To reduce the fuel intake at G Blast Furnace, an initial benchmarking exercise was carried out with international and domestic Blast Furnaces to determine the potential for improvement. The gap identified during the exercise revealed that the benchmark Blast Furnaces operated with superior raw material quality than that in G Blast Furnace. However, since the raw materials to G Blast Furnace are sourced from the captive mines, improvement in the raw material quality was out of scope. Therefore, trials were taken with different operating regimes, to identify the key process parameters, which on optimization could significantly reduce the fuel intake in G Blast Furnace. The key process parameters identified from the trial were the Stoichiometric Oxygen Ratio, Melting Capacity ratio and the burden distribution inside the furnace. These identified process parameters were optimized to bridge the gap in fuel intake at G Blast Furnace, thereby reducing specific CO₂ emission to benchmark levels. This paradigm shift enabled to lower the fuel intake by 70kg per ton of liquid iron produced, thereby reducing the specific CO₂ emission by 15 percent.

Keywords: benchmark, blast furnace, CO₂ emission, fuel rate

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Authors: M. Golzade Gangraj, A. Abdi, N. ganji

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Aim: The aim of this study was to evaluate the Effect of aerobic training with Coriandrum sativum extract on selection of oxidative stress markers in diabetic rats. Methods: The population of male Wistar rats is the Pasteur Institute. Forty rats were randomly selected as subjects. After moving the mouse in vitro and stay for a week in a cage for sustainability, were diabetic. Diabetes induced by injection STZ (55 mg per kg of body weight of mice) was performed. According blood glucose was randomly divided into four experimental groups (control, training, extract and training-extract). Extract group consumed 150 mg per kg of body weight per day coriander juice. Training group performed aerobic training (50-55% VO2max). Result: The results showed that aerobic exercise training and coriander seed extract caused a significant increase in total antioxidant; superoxide dismutase and catalase were significantly decreased malondialdehyde. Conclusion: the research findings can be stated that the exercise with coriander seed extract has the ability to inhibit free radicals and can have beneficial effects on the body's antioxidant defense system and reduce oxidative stress in diabetic rats with STZ. Because it improves the body's antioxidant defense by increasing serum levels of antioxidant enzymes.

Keywords: aerobic training, coriandrum sativum, antioxidant, diabetes

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Authors: Özge Çeliker Tosun, Melda Başer Secer, İsmail Düşmez, Sedat Çapar, İlkay Kozak, Melahat Aktaş, Furkan Can Şimşek, Gökhan Tosun

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Purpose: Portable innovative balance room system with digital game program; It was created to be able to be divided into small areas, such as inside the house, garden, balcony, to enable the person to enter and perform both evaluation and exercise safely, and to ensure that these results can be stored and sent to the therapist live or later when desired. The aim is to compare the effectiveness of the exercise program applied by the elderly within this system and the exercise program implemented under the supervision of a physiotherapist on balance and urinary incontinence symptoms. Materials and Methods: The study was conducted in a randomized controlled manner on 63 people with urinary incontinence (mean age: 75.5 years) at Narlıdere Nursing Home Elderly Care and Rehabilitation Center. Elderly people participating in the study were divided into 3 groups: 1. Group, an exercise program consisting of pelvic floor muscle training and OTOGA exercises, 2. Group, only pelvic floor muscle training, and 3. Group, pelvic floor muscle training and Otoga exercises in the form of a digital game program in a portable balance room system. (self-administered) for 12 weeks. Pelvic floor distress inventory (PTDE-20) and bladder diary were used to evaluate the incontinance symptoms of the cases. Pelvic floor muscle function was evaluated with superficial EMG. Berg, Fall Effectiveness Scale (FES) and Functional Status Evaluations (Chair Stand Test, Eight (8) Food Up and Go Test, Chair Sit and Reach Test, Two Minutes Step Test) were used to evaluate balance. The existence of differences between groups was analyzed using Krusskal Wallis analysis of variance, and the difference between before and after exercise was analyzed with Wilcoxon tests. Results: After treatment, PTDE-20, daily urinary incontinence and toilet visits values decreased significantly in all three groups (p < 0.001). While there was a statistically significant increase in pelvic floor muscle EMG values in the 2nd and third groups after treatment, there was no change in the other group (2nd Group PFM average EMG before-after: 5.5 (4.15-10.95) - 10.95 (8.68-13.68), P=0.05, 3 Group PFM average EMG before-after: 6.5 (4.28-11.55) - 11.75 (8.67-14.26), p=0.04). While BERG score, Chair Stand Test, Eight (8) Food Up and Go Test, and Two Minutes Step Test values increased in all groups (p<0.05), Fall Effectiveness Scale (FES) values did not change after treatment. Conclusion: Although pelvic floor muscle training combined with balance exercises reduces symptoms, it may not lead to a positive improvement in the functions of the pelvic floor muscles. For this reason, recovery lasts for a short time, and then symptoms may reoccur in the future. However, thanks to the new system, when balance exercises are combined with a game program for the pelvic floor muscles, a double effect can be achieved with a single application and both incontinence and balance problems can be treated in a safe environment where the person can do it himself. But more work needs to be done on this subject. However, thanks to the new system, a double effect can be achieved with a single application, and both incontinence and balance problems can be treated in a safe environment where the person can do it himself. But more work needs to be done on new system

Keywords: fall, urinary incontinance, balance, elderly

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Authors: Samar Mousa, Ryan Kerstein, Mohanad Adam

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Regional anaesthesia has been associated with favourable outcomes in patients undergoing a wide range of surgeries. Beneficial effects have been demonstrated in terms of postoperative respiratory and cardiovascular endpoints, 7-day survival, time to ambulation and hospital discharge, and postoperative analgesia. Our project aimed at assessing the regional anaesthesia practice in the plastic surgery department of Buckinghamshire trust and finding out ways to improve the service in collaboration with the anaesthesia team. It is a retrospective study associated with a questionnaire filled out by plastic surgeons and anaesthetists to get the full picture behind the numbers. The study period was between 1/3/2022 and 23/5/2022 (12 weeks). The operative notes of all patients who had an operation under plastic surgery, whether emergency or elective, were reviewed. The criteria of suitable candidates for the regional block were put by the consultant anaesthetists as follows: age above 16, single surgical site (arm, forearm, leg, foot), no drug allergy, no pre-existing neuropathy, no bleeding disorders, not on ant-coagulation, no infection to the site of the block. For 12 weeks, 1061 operations were performed by plastic surgeons. Local cases were excluded leaving 319 cases. Of the 319, 102 patients were suitable candidates for regional block after applying the previously mentioned criteria. However, only seven patients had their operations under the regional block, and the rest had general anaesthesia that could have been easily avoided. An online questionnaire was filled out by both plastic surgeons and anaesthetists of different training levels to find out the reasons behind the obvious preference for general over regional anaesthesia, even if this was against the patients’ interest. The questionnaire included the following points: training level, time taken to give GA or RA, factors that influence the decision, percentage of RA candidates that had GA, reasons behind this percentage, recommendations. Forty-four clinicians filled out the questionnaire, among which were 23 plastic surgeons and 21 anaesthetists. As regards the training level, there were 21 consultants, 4 associate specialists, 9 registrars, and 10 senior house officers. The actual percentage of patients who were good candidates for RA but had GA instead is 93%. The replies estimated this percentage as between 10-30%. 29% of the respondents thought that this percentage is because of surgeons’ preference to have GA rather than RA for their operations without medical support for the decision. 37% of the replies thought that anaesthetists prefer giving GA even if the patient is a suitable candidate for RA. 22.6% of the replies thought that patients refused to have RA, and 11.3% had other causes. The recommendations were in 5 main accesses, which are protocols and pathways for regional blocks, more training opportunities for anaesthetists on regional blocks, providing a separate block room in the hospital, better communication between surgeons and anaesthetists, patient education about the benefits of regional blocks.

Keywords: regional anaesthesia, regional block, plastic surgery, general anaesthesia

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Authors: Amany Mohamed, Alaa Balbaa, Magdoline Mishel

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Background: Pain in the neck or scapular region is one of the most frequent symptoms in cervical radiculopathy, which is commonly caused by degenerative process in the spine. Purpose: To determine the effect of scapular stabilization exercises in the treatment of chronic neck pain regarding pain and disability and limitation in the range of motion. Patients and Methods: Thirty male and female patients with chronic neck pain were involved. Aged between 30-50 years old. They were randomly assigned into two groups. In group (A), patients received physical therapy program in the form of infrared, transcutaneous electrical nerve stimulation (TENS), Stretching and cervical stabilization exercises. In group (B), patients received scapular stabilization exercises in addition to the same physical therapy program. Treatment was given 3 times a week for 4 weeks. Range of motion of the cervical spine, range of motion of the scapula, neck pain and disability were assessed before and after treatment. Results: There was significant improvement in both groups (A and B) in cervical range of motion, pain and disability. Group (B) showed more significant improvement than group (A) in cervical range of motion and pain and disability. There was no significant improvement in both groups in scapular range of motion. Conclusion: Scapular stabilization exercises should be used as an integral part in the rehabilitation program

Keywords: Neck pain, neck stabilization exercise, scapular stabilization exercise, chronic neck pain

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Authors: Renee Moten

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Introduction: Knee pain becomes chronic because the therapy used focuses only on the symptoms of knee pain and not the causes of knee pain. Preventing knee injuries is not in the toolbox of the traditional practitioner. This research was done to show that we must reduce the inflammation (holistically), reduce the swelling and regain flexibility before considering any type of exercise. This method of performing the correct exercise stops the bowing of the knee, corrects the walking gait, and starts to relieve knee, hip, back, and shoulder pain. Method: The holistic method that is used to heal knees is called the Knee Pain Recipe. It’s a six step system that only uses alternative medicine methods to reduce, relieve and restore knee joint mobility. The system is low cost, with no hospital bills, no physical therapy, and no painkillers that can cause damage to the kidneys and liver. This method has been tested on 200 women with knee, back, hip, and shoulder pain. Results: All 200 women reduce their knee pain by 50%, some by as much as 90%. Learning about ankle and foot flexibility, along with understanding the kinetic chain, helps improve the walking gait, which takes the pressure off the knee, hip and back. The knee pain recipe also has helped to reduce the need for a cortisone injection, stem cell procedures, to take painkillers, and surgeries. What has also been noted in the research was that if the women's knees were too far gone, the Knee Pain Recipe helped prepare the women for knee replacement surgery. Conclusion: It is believed that the Knee Pain Recipe, when performed by men and women from around the world, will give them a holistic alternative to drugs, injections, and surgeries.

Keywords: knee, surgery, healing, holistic

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Authors: Majid Moshirfar, Kyle Margulies, Yasmyne C. Ronquillo, Phillip Hoopes

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A total of 66 articles were reviewed to compare glaucoma and its associated surgeries' effect on central corneal endothelium cell density (CECD). The paper reports the average reported central CECD loss at 3-, 6-, 12-, 24-, 36-, 48-, and 60-month post-operation for each glaucoma surgery. ALT, MLT, SLT, CS AGV, VC BGI, Hydrus + phaco, XEN gel + phaco, PRESERFLO, Dual iStent, or Trabectome had no significant impact on postoperative CECD compared to either preoperative CECD or control group CECD. The highest CECD loss was found to be EXPRESS-phaco, AC AGV, CS BGI, CS BGI, AC BGI, and AC BGI at the 3-, 6-, 12-, 24-, 36-, 48-, and 60-month follow-ups, respectively. AC AGV, Trab + MMC, Trab, AC BGI, Trab + MMC, Cypass, and Cypass showed the smallest reduction of CECD at the 3-, 6-, 12-, 24-, 36-, 48-, and 60-month follow-ups.

Keywords: glaucoma, corneal endothelium, cell density, surgery outcome

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Authors: Babarina Maria, Andropova Margarita

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Introduction: Hypoparathyroidism (HypoPT) is a rare endocrine disorder with an estimated prevalence of 0.25 per 1000 individuals. The most common cause of HypoPT is the loss of active parathyroid tissue following thyroid or parathyroid surgery. Sometimes permanent postoperative HypoPT occures, manifested by hypocalcemia in combination with low levels of PTH during 6 months or more after surgery. Cognitive impairments in patients with hypocalcemia due to chronic HypoPT are observed, and this can lead to problems and challenges in everyday living: memory loss and impaired concentration, that may be the cause of poor compliance. Clinical case: Patient K., 66 years old, underwent thyroidectomy in 2013 (at the age of 55) because of papillary thyroid cancer T1NxMx, histopathology findings confirmed the diagnosis. 5 years after the surgery, she was followed up on an outpatient basis, TSH levelsonly were monitored, and the dose of levothyroxine was adjusted. In 2018 due to, increasing complaints include tingling and cramps in the arms and legs, memory loss, sleep disorder, fatigue, anxiety, hair loss, muscle pain, tachycardia, positive Chvostek, and Trousseau signs were diagnosed during examination, also in blood analyses: total Ca 1.86 mmol/l (2.15-2.55), Ca++ 0.96 mmol/l (1.12-1.3), P 1.55 mmol/l (0.74-1.52), Mg 0.79 mmol/l (0.66-1.07) - chronic postoperative HypoPT was diagnosed. Therapy was initiated: alfacalcidol 0.5 mcg per day, calcium carbonate 2000 mg per day, cholecalciferol 1000 IU per day, magnesium orotate 3000 mg per day. During the case follow-up, hypocalcemia, hyperphosphatemia persisted, hypercalciuria15.7 mmol/day (2.5-6.5) was diagnosed. Dietary recommendations were given because of the high content of phosphorus rich foods, and therapy was adjusted: the dose of alfacalcidol was increased to 2.5 mcg per day, and the dose of calcium carbonate was reduced to 1500 mg per day. As part of the screening for complications of hypoPT, data for cataracts, Fahr syndrome, nephrocalcinosis, and kidney stone disease were not obtained. However, HypoPT compensation was not achieved, and therefore hydrochlorothiazide 25 mg was initiated, the dose of alfacalcidol was increased to 3 mcg per day, calcium carbonate to 3000 mg per day, magnesium orotate and cholecalciferol were continued at the same doses. Therapeutic goals were achieved: calcium phosphate product <4.4 mmol2/l2, there were no episodes of hypercalcemia, twenty-four-hour urinary calcium excretion was significantly reduced. Conclusion: Timely prescription, careful explanation of drugs usage rules, and monitoring and maintaining blood and urine parameters within the target contribute to the prevention of HypoPT complications development and life-threatening events.

Keywords: hypoparathyroidism, hypocalcemia, hyperphosphatemia, hypercalciuria

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Authors: Lakmali Anthony, Madeline Gillies

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Background: Colorectal cancer (CRC) is usually managed with surgical resection. Many of the outcomes traditionally used to define successful operative management, such as resection margin, do not adequately reflect patients’ experience. Patient-reported outcomes (PRO), such as Health-Related Quality of life (HRQoL), provide a means by which the impact of surgery for cancer can be reported in a patient-centered way. HRQoL has previously been shown to be impacted by psychosocial, behavioral and disease-specific characteristics. This exploratory cross-sectional study aims to; (1) describe postoperative HRQoL in patients who underwent primary resection in a regional Australian hospital; (2) describe the prevalence of anxiety, depression and clinically significant fear of cancer recurrence (FCR) in this population; and (3) identify demographic, psychosocial, disease and treatment factors associated with poorer self-reported HRQoL. Methods: Consecutive patients who had resection of colorectal cancer in a single regional Australian hospital between 2015 and 2022 were eligible. Participants were asked to complete a survey instrument designed to assess HRQoL, as well as validated instruments that assess several other psychosocial PROs hypothesized to be associated with HRQoL; emotional distress, fear of cancer recurrence, social support, dispositional optimism, body image and spirituality. Demographic and disease-specific data were also collected via medical record review. Results: Forty-six patients completed the survey. Clinically significant levels of fear of recurrence as well as emotional distress, were present in this group. Many domains of HRQoL were significantly worse than an Australian reference population for CRC. Demographic and disease factors associated with poor HRQoL included smoking and ongoing adjuvant systemic therapy. The primary operation was not associated with HRQoL; however, the operative approach (laparoscopic vs. open) was associated with HRQoL for these patients. All psychosocial factors measured were associated with HRQoL, including cancer worry, emotional distress, body image and dispositional optimism. Conclusion: HRQoL is an important outcome in surgery for both research and clinical practice. This study provides an overview of the quality of life in a regional Australian population of postoperative colorectal cancer patients and the factors that affect it. Understanding HRQoL and awareness of patients particularly vulnerable to poor outcomes should be used to aid the informed consent and shared decision-making process between surgeon and patient.

Keywords: surgery, colorectal, cancer, PRO, HRQoL

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Authors: Emily Moore, Dora Amos, Tracy Ellimah, Natasha Parrott

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Postoperative haematoma is a well-recognised complication of thyroid surgery with an incidence of 1-5%. Haematoma formation causes progressive airway obstruction, necessitating emergency bedside haematoma evacuation in up to ¼ of patients. ENT UK, BAETS and DAS have developed consensus guidelines to improve perioperative care, recommending that all healthcare staff interacting with patients undergoing thyroid surgery should be trained in managing post-thyroidectomy haematoma. The aim was to assess the effectiveness of a hybrid simulation model in improving clinician’s confidence in dealing with this surgical emergency. A hybrid simulation was designed, consisting of a standardised patient wearing a part-task trainer to mimic a post-thyroidectomy haematoma in a real patient. The part-task trainer was an adapted C-spine collar with layers of silicone representing the skin and strap muscles and thickened jelly representing the haematoma. Both the skin and strap muscle layers had to be opened in order to evacuate the haematoma. Boxes have been implemented into the appropriate post operative areas (recovery and surgical wards), which contain a printed algorithm designed to assist in remembering a sequence of steps for haematoma evacuation using the ‘SCOOP’ method (skin exposure, cut sutures, open skin, open muscles, pack wound) along with all the necessary equipment to open the front of the neck. Small-group teaching sessions were delivered by ENT and anaesthetic trainees to members of the multidisciplinary team normally involved in perioperative patient care, which included ENT surgeons, anaesthetists, recovery nurses, HCAs and ODPs. The DESATS acronym of signs and symptoms to recognise (difficulty swallowing, EWS score, swelling, anxiety, tachycardia, stridor) was highlighted. Then participants took part in the hybrid simulation in order to practice this ‘SCOOP’ method of haematoma evacuation. Participants were surveyed using a Likert scale to assess their level of confidence pre- and post teaching session. 30 clinicians took part. Confidence (agreed/strongly agreed) in recognition of post thyroidectomy haematoma improved from 58.6% to 96.5%. Confidence in management improved from 27.5% to 89.7%. All participants successfully decompressed the haematoma. All participants agreed/strongly agreed, that the sessions were useful for their learning. Multidisciplinary team simulation teaching is effective at significantly improving confidence in both the recognition and management of postoperative haematoma. Hybrid simulation sessions are useful and should be incorporated into training for clinicians.

Keywords: thyroid surgery, haematoma, teaching, hybrid simulation

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Authors: Amós García Montaño

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In a democracy, a public policy must be developed within the regulatory framework and considering citizen participation in its planning, design, execution, and evaluation stages, necessary factors to have both legal support and sufficient legitimacy for its operation. However, the complexity and magnitude of certain public problems results in difficulties for the generation of consensus among society members, leading to unstable and unsuccessful scenarios for the exercise of the right to citizen participation and the generation of effective and efficient public policies. This is the case of public policies against corruption, an issue that in Mexico is difficult to define and generates conflicting opinions. To provide a possible solution to this delicate reality, this paper analyzes the principle of reasonableness as a tool for identifying the basic elements that guarantee a fundamental level of the exercise of the right to citizen participation in the fight against corruption, adopting elements of human rights indicator methodologies. In this sense, the relevance of having a legal framework that establishes obligations to incorporate proactive and transversal citizen participation in the matter is observed. It is also noted the need to monitor the operation of various citizen participation mechanisms in the decision-making processes of the institutions involved in the fight and prevention of corruption, which lead to an increase in the improvement of the perception of the citizen role as a relevant actor in this field. It is concluded that the principle of reasonableness is presented as a very useful tool for the identification of basic elements that facilitate the fulfillment of human rights commitments in the field of public policies.

Keywords: anticorruption, public participation, public policies, reasonableness

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Authors: Itee Chowdhury, Shikha Modi

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Introduction: Cancer is beginning to outpace cardiovascular disease as a cause of death affecting every major organ system with profound implications for perioperative management. Breast cancer is the most common cancer in women in India, accounting for 27% of all cancers. The small changes in analgesic management of cancer patients can greatly improve prognosis and reduce the risk of postsurgical cancer recurrence as opioid-based analgesia has a deleterious effect on cancer outcomes. Shortened postsurgical recovery time facilitates earlier return to intended oncological therapy maximising the chance of successful treatment. Literature reveals that the role of BIS since FDA approval has been assessed in various types of surgeries, but clinical data on its use in oncosurgical patients are scanty. Our study focuses on the role of BIS-guided anaesthesia for breast cancer surgery patients. Methods: A prospective randomized controlled study in patients aged 36-55years scheduled for modified radical mastectomy was conducted in 51 patients in each group who met the inclusion and exclusion criteria, and randomization was done by sealed envelope technique. In BIS guided anaesthesia group (B), sevoflurane was titrated to keep the BIS value 45-60, and thereafter if the patient showed hypertension/tachycardia, an opioid was given. In standard anaesthesia care (group C), sevoflurane was titrated to keep MAC in the range of 0.8-1, and fentanyl was given if the patient showed hypertension/tachycardia. Intraoperative opioid consumption was calculated. Postsurgery recovery characteristics, including Aldrete score, were assessed. Patients were questioned for pain, PONV, and recall of the intraoperative event. A comparison of age, BMI, ASA, recovery characteristics, opioid, and VAS score was made using the non-parametric Mann-Whitney U test. Categorical data like intraoperative awareness of surgery and PONV was studied using the Chi-square test. A comparison of heart rate and MAP was made by an independent sample t-test. #ggplot2 package was used to show the trend of the BIS index for all intraoperative time points for each patient. For a statistical test of significance, the cut-off p-value was set as <0.05. Conclusions: BIS monitoring led to reduced opioid consumption and early recovery from anaesthesia in breast cancer patients undergoing MRM resulting in less postoperative nausea and vomiting and less pain intensity in the immediate postoperative period without any recall of the intraoperative event. Thus, the use of a Bispectral index monitor allows for tailoring of anaesthesia administration with a good outcome.

Keywords: bispectral index, depth of anaesthesia, recovery, opioid consumption

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Authors: Seyyed Javad Ziaolhagh

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Background: The purpose of present study was to investigate, the effects of anabolic steroid Boldenone (BOL) with eight weeks of resistance training on structural changes in rat liver. Method: 21 Male adult Wistar rats, 12 weeks old and 228/53±7/94 g initial body weight were randomly assigned to three groups: group1: Control+ Placebo (C), group2: training+ Placebo (T), group3: Boldenone intramuscular injections 5mg/kg (B). The endurance training protocol consisted three exercise sessions weekly started by a 30-minute run with the speed of 12 m/min and lasted by 60min run with the speed of 30 m/min in 8 weeks. At the end of the experiment, for light microscopic study Slides were prepared. Results: Sections stained of rat's livers showed no any cell degeneration and cytoplasmic lipid vacuoles in all groups, but few samples were seen. Indeed, congested blood sinusoids, cell infiltration and degeneration were seen in the Boldenone-treated group. Hepatotoxic effects were severe in group treatment received 5 mg/kg and directly depended on the doses. Indeed, training group was no any hepatocyte degeneration, inflammation and congestion. Conclusion: The present results showed that BOL has a marked adverse effect on the liver tissue, even with low– dose and endurance training. As a result, athletes should aware of Boldenone dosage consumption.

Keywords: anabolic androgenic steroids, Boldenone, blood congestion, cellular inflammation, cellular degeneration, lipid vocuolations, endurance training

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Authors: Kei Okubo, Yosuke Kurihara, Takashi Kaburagi, Kajiro Watanabe

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Many of the ever-growing elderly population require exercise, such as running, for health management. One important element of a runner’s training is the choice of shoes for exercise; shoes are important because they provide the interface between the feet and road. When we purchase shoes, we may instinctively choose a pair after trying on many different pairs of shoes. Selecting the shoes instinctively may work, but it does not guarantee a suitable fit for running activities. Therefore, if we could select suitable shoes for each runner from the viewpoint of brain activities, it would be helpful for validating shoe selection. In this paper, we describe how brain activities show different characteristics during particular task, corresponding to different properties of shoes. Using five subjects, we performed a verification experiment, applying weight, softness, and flexibility as shoe properties. In order to affect the shoe property’s differences to the brain, subjects run for ten min. Before and after running, subjects conducted a paced auditory serial addition task (PASAT) as the particular task; and the subjects’ brain activities during the PASAT are evaluated based on oxyhemoglobin and deoxyhemoglobin relative concentration changes, measured by near-infrared spectroscopy (NIRS). When the brain works actively, oxihemoglobin and deoxyhemoglobin concentration drastically changes; therefore, we calculate the maximum values of concentration changes. In order to normalize relative concentration changes after running, the maximum value are divided by before running maximum value as evaluation parameters. The classification of the groups of shoes is expressed on a self-organizing map (SOM). As a result, deoxyhemoglobin can make clusters for two of the three types of shoes.

Keywords: brain activities, NIRS, PASAT, running shoes

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Authors: Elnaz Sabzehparvar, Pouya Rabiei, Houman Rezaei

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Few studies have been conducted about the effects of compound exercises emphasizing local stability and global stabilization subsystems on the performance of athletes. The present research aimed to study the effect of 6 weeks of compound exercises emphasizing local and global stability on the dynamic balance of elite male Taekwondo athletes. Twenty-seven elite male Taekwondo athletes (with a mean age, mass, and height of 24.4 ± 4.9 years, 75.7 ± 15.1kg, and 181.4 ± 7.8 cm, respectively) were assigned to two groups of control (n=12) and exercise (n=15). 6 weeks of compound exercises in 2 local and global phases. The first phase included activation exercises which were done separately and locally for 3 weeks. Then, integrative exercises specific to the global stabilization subsystems (longitudinal-depth, posterior oblique and anterior, and lateral) was carried out for next 3 weeks. The dynamic balance of subjects was measured in the pre-test and post-test using the Y Balance Test (YBT). After 6 weeks of compound exercises, scores of the YBT in the exercise group showed a significant improvement in all three anterior (p=0.035), posterolateral (p=0.017) and medial (p=0.001) directions in the post-test compared to the control group (p ≤ 0.05 for all comparisons). The findings of the present study suggested that compound exercises focusing on muscle as separate units and then as interdependent chains (muscular subsystems) can significantly increase YBT on elite male Taekwondo athletes in all three directions.

Keywords: Taekwondo, compound exercises, local and global stability, muscular subsystems

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Authors: Hanan H. ALQahtani, Karen Jones

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Catching a ball during sitting is a functional exercise commonly used in rehabilitation to enhance trunk muscle activity. To progress this exercise, physiotherapists incorporate a Swiss ball or change seat height. However, no study has assessed the effect of different seating surfaces on trunk muscle activity while catching a ball. Objective: To investigate the effect of catching a ball during sitting on a Swiss ball, a low seat and a high seat on trunk muscle activity. Method: A repeated-measures, counterbalanced design was used. A total of 26 healthy participants (15 female and 11 male) performed three repetitions of catching a ball on each seating surface. Using surface electromyography (sEMG), the activity of the bilateral transversus abdominis/internal oblique (TrA/IO), rectus abdominis (RA), erector spinae (ES) and lumbar multifidus (MF) was recorded. Trunk muscle activity was normalized using maximum voluntary isometric contraction and analyzed. Statistical significance was set at p ≤ .05. Results: No significant differences were observed in the activity of RA, TrA/IO, ES or MF between a low seat and a Swiss ball. However, the activity of the right and left ES on a low seat was significantly greater than on a high seat (p = .017 and p = .017, respectively). Conversely, the activity of the right and left RA on a high seat was significantly greater than on a low seat (p = .007 and p = .004, respectively). Conclusion: This study suggests that replacing a low seat with a Swiss ball while catching a ball is insufficient to increase trunk muscle activity, whereas changing the seat height could induce different trunk muscle activities. However, research conducted on patients is needed before translating these results into clinical settings.

Keywords: catching, electromyography, seating, trunk

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Authors: Chiung-Hua Chan, Fang-Yuan Chang, Li-Chi Huang

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Stroke patients received regular rehabilitation therapy have measurable advancement in muscle strength, balance, control upper and lower physical activity, walking speed and endurance. This study aimed to investigate the relationship between increases in bedside rehabilitation time and the function of activities and daily living (ADL) in stroke patients. The study was quasi-experimental research design and randomized sampling. The researcher collected 12 stroke patients of stroke patients transferred to rehabilitation ward unit of a medical center during 1 January to 31 March 2017. All participants then were assigned to case group and control group. Data collection was through direct observation of assessment ADL of stroke patients by researchers on Day 1. Case group received regular rehabilitation, exercises in increase of bedside rehabilitation schedules exercise programs by ward nurses. Bedside rehabilitation exercise content with physical, functional and linguistic frequency and time, Control group only give routine rehabilitation schedule care. This was a randomized study performed in 12 patients who were stroke patients and transferred to rehabilitation ward unit of a medical center during 1 January to 31 March 2017. First, the researcher explained the purpose and method of the study to the patients or the family members. All participants completed a consent informed before participation. Patients were randomly assigned to a ‘bedside rehabilitation program’ (BRP) group and a control (C) group. The BRP group received bedside rehabilitation schedules exercise programs by ward nurses. while the C group did not. Both groups received routine rehabilitation schedule. The Functional Independence Measure was used to measure outcome at the first, 14th and the 28th day of rehabilitation ward admitted. Data were analyzed using SPSS 22.0. After implementation of standardized ‘‘bedside rehabilitation program’, the results were: (1) the increasing of bedside rehabilitation had significant difference (p<.05) in promotion ADL function of stroke patients (2) the extend time of the bedside rehabilitation has significant difference (p<.05) in promotion ADL function of stroke patients compared with the control group. This study demonstrated that the ‘bedside rehabilitation program’ enhanced the ADL function in stroke patients. The nurses and rehabilitation ward managers need to understand that the extend time and frequency of rehabilitation provide a chance to enhanced the ADL function of stroke patients.

Keywords: stroke, bedside rehabilitation, functional activity, ADL

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Authors: Reham H. Diab, Amira A. A. Abdallah, Eman A. Embaby

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Background: The effectiveness of bracing on preventing spino-pelvic alignment deterioration in idiopathic scoliosis has been extensively studied especially in the frontal plane. Yet, there is lack of knowledge regarding the effect of soft braces on spino-pelvic alignment in the sagittal plane. Achieving harmonious sagittal plane spino-pelvic balance is critical for the preservation of physiologic posture and spinal health. Purpose: This study examined the kyphotic angle, lordotic angle and pelvic inclination in the sagittal plane and trunk imbalance in the frontal plane before and after a six-month rehabilitation period. Methods: Nineteen patients with idiopathic scoliosis participated in the study. They were divided into two groups; experimental and control. The experimental group (group I) used the SpineCor brace in addition to a rehabilitation exercise program while the control group (group II) had the exercise program only. The mean ±SD age, weight and height were 16.89±2.15 vs. 15.3±2.5 years; 59.78±6.85 vs. 62.5±8.33 Kg and 162.78±5.76 vs. 159±5.72 cm for group I vs. group II. Data were collected using for metric Π system. Results: Mixed design MANOVA showed that there were significant (p < 0.05) decreases in all the tested variables after the six-month period compared with “before” in both groups. Moreover, there was a significant decrease in the kyphotic angle in group I compared with group II after the six-month period. Interpretation and conclusion: SpineCor brace is beneficial in reducing spino-pelvic alignment deterioration in both sagittal and frontal planes.

Keywords: adolescent idiopathic scoliosis, SpineCor, spino-pelvic alignment, biomechanics

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Authors: Kasbparast Mehdi, Hassani Zainab

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Aim: The purpose of this research was to investigate the effectiveness of therapeutical sensorimotor exercise. The statistical population of women who were diagnosed with patellofemoral pain syndrome by a doctor and were between the ages of 35 and 45 and registered for the first time in a sports club in the 4th district of Tehran, 30 people by random sampling and according to The include and exclude criteria were selected and divided into 2 equal control and experimental and homogeneous groups (in terms of height, weight and BMI).In both control and experimental groups, the pain was measured using a Visual Analog Scale(VAS) functionality was measured using the step-down test and quality of life was measured using a World Health Organization Quality of Life Scale (WHOQOL-BREF) (pre-test). Then, only the experimental group performed sensorimotor exercises for 12 weeks and 3 sessions each week, a total of 24 sessions and each session for 1 hour, and during this period, the control group only continued their daily activities. After the end of the training period, the desired factors were evaluated again (post-test) in the same way as the pre-test was done for them (experimental group and control group), with the same quality. Findings: The statistical results showed that in the experimental group, the amount of pain, function and quality of life had a statistical improvement (P≤0.05). Conclusion: In general conclusion, it can be stated that using sensorimotor exercises not only improved functionality and quality of life but also reduced the amount of pain in people with patellofemoral pain syndrome.

Keywords: pain, PFPS, sensori motor training, functionality

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Authors: Trevor R. Higgins

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The aim of this study was to compare muscle activation of the latissimus dorsi between pin-loaded machine (Lat Pull Down), resistance band (Lat Pull Down) and body-weight (Chin Up) exercises. A convenient sample of male college students with >2 years resistance training experience volunteered for the study. A paired t-test with repeated measures designs was carried out on results from EMG analysis. EMG analysis was conducted with Trigno wireless sensors (Delsys) placed laterally on the latissimus dorsi (left and right) of each participant. By conventional criteria the two-tailed P value suggested that differences between pin-loaded and body-weight was not significantly different (p = 0.93) and differences between pin-loaded and resistance band was not significantly different (p = 0.17) in muscle activity. In relation to conventional criteria the two-tailed P value suggested differences between body-weight and resistance band was not quite significantly different (p = 0.06) in muscle activity. However, effect size trends indicated that both body-weight and pin-loaded exercises where more effective in stimulating muscle electrical activity than a resistance band with male college athletes with >2 years resistance training experience. Although, resistance bands have increased in popularity in health and fitness centres, that for well-trained participants, they may not be effective in stimulating muscles of the latissimus dorsi. Therefore, when considering equipment and exercise selection for experienced resistance training participants pin-loaded machines and body-weight should be prescribed.

Keywords: pin-loaded, resistance bands, body weight, EMG analysis

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Authors: Y. H. Chen, P. Y. Chiang, T. Sugiarto, I. Karsuna, Y. J. Lin, C. C. Chang, W. C. Hsu

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Task-specific training with intense practice of functional tasks has been emphasized for the approaches in motor rehabilitation in patients with hemiplegic strokes. Although reciprocal actions which may increase demands on motor control during seated stepping exercise, motor control is not explicitly trained with emphasis and instruction focused on traditional strengthening. Apart from cycling and treadmill, various forms of seated exerciser are becoming available for the lower extremity exercise. The benefit of seated exerciser has been focused on the effect on the cardiopulmonary system. Thus, the aim of current study is to investigate the effect of seated distance on muscle activation during seated strengthening in patients with stroke with extensor synergy pattern in the lower extremities. Electrodes were placed on the surface of lower limbs muscles, including rectus femoris (RF), vastus lateralis (VL), biceps femoris (BF) and gastrocnemius (GT) of both sides. Maximal voluntary contraction (MVC) of the muscles were obtained to normalize the EMG amplitude obtained during dynamic trials with analog raw data digitized with a sampling frequency of 2000 Hz, fully rectified and the linear enveloped. Movement cycle was separated into two phases by pushing (PP) and Return (RP). Integral EMG (iEMG) is then used to quantify level of activation during each of the phases. Subjects performed strengthening with moderate resistance with speed of 60 rpm in two different distances (D1, short) and (D2, long). The results showed greater iEMG in RF and smaller iEMG in VL and BF with obvious increase range of motion of hip flexion in D1 condition. On the contrary, no significant involvement of RF while greater level of muscular activation in VL and BF during RP was found during PP in D2 condition. In addition, greater hip internal rotation was observed in D2 condition. In patients with stroke with abnormal tone revealed by extensor synergy in the lower extremities, shorter seated distance is suggested to facilitate hip flexor muscle activation while avoid inducing hyper extensor tone which may prevent a smooth repetitive motion. Repetitive muscular contraction exercise of hip flexor may be helpful for further gait training as it may assist hip flexion during swing phase of the walking.

Keywords: seated strengthening, patients with stroke, electromyography, synergy pattern

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Authors: Sadia Suri Kashif, Raheeda Fatima, Maqsood Ahmed Khan

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Purpose of the study: The objective of this research was to determine the perception of Pakistani physicians (whether primary care, specialists or residents) in Karachi, being one of the largest and highly populated cities of Pakistan, regarding clinical approaches towards diet, exercise, and therapy in obese patients. This research determines their understanding of obesity and employability of obesity management in their daily practices. Research methodology: This is a questionnaire-based survey. A minimum of 300 questionnaires (N=300) were distributed and filled by practicing physicians in a random selection of medical setups in Karachi. Randomly 246 physicians responded to the survey. The survey tested their views regarding weight management, importance of general awareness and their strategies to control weight. Results: In the first part of survey the physicians responded to almost 66% regarding the seriousness of obesity management with advising diet modification, physical exercise and decreasing calorie intake; 57% failed to employ Body Mass Index and Waist Hip Ratio as weight measurement tools in their daily practice; 50% disagreed on using pharmacotherapy as an option; 67% were not sure about the proper dosage and indication of anti-obesity medication while almost same disagreed on using surgical options for management of obesity; 83.3% physicians agreed on the increased obesity pandemic in Pakistan. Conclusion: The findings indicate that there is a gap between awareness and knowledge among Pakistani practicing physicians regarding pharmacotherapy for obesity. There is a need to frequently update latest guidelines to help manage this condition, which is becoming more prevalent in our country day by day. Physicians should be obligated to use updated knowledge for managing obesity.

Keywords: obesity, physicians, BMI, weight management, obesity awareness

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Authors: Daniel Thompson, Muhammad Peerbux, Sophie Cerutti, Hansraj Bookun

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Introduction: Dialysis access is a key component of the care of patients with end stage renal failure. In our institution, a combined service of vascular surgeons and nephrologists are responsible for the creation and maintenance of arteriovenous fisultas (AVF), tenckhoff cathethers and Hickman/permcath lines. This poster investigates the last 10 years of dialysis access surgery conducted at St. Vincent’s Hospital Melbourne. Method: A cross-sectional retrospective analysis was conducted of patients of St. Vincent’s Hospital Melbourne (Victoria, Australia) utilising data collection from the Australasian Vascular Audit (Australian and New Zealand Society for Vascular Surgery). Descriptive demographic analysis was carried out as well as operation type, length of hospital stays, postoperative deaths and need for reoperation. Results: 2085 patients with renal failure were operated on between the years of 2011 and 2020. 1315 were male (63.1%) and 770 were female (36.9%). The mean age was 58 (SD 13.8). 92% of patients scored three or greater on the American Society of Anesthiologiests classification system. Almost half had a history of ischaemic heart disease (48.4%), more than half had a history of diabetes (64%), and a majority had hypertension (88.4%). 1784 patients had a creatinine over 150mmol/L (85.6%), the rest were on dialysis (14.4%). The most common access procedure was AVF creation, with 474 autologous AVFs and 64 prosthetic AVFs. There were 263 Tenckhoff insertions. We performed 160 cadeveric renal transplants. The most common location for AVF formation was brachiocephalic (43.88%) followed by radiocephalic (36.7%) and brachiobasilic (16.67%). Fistulas that required re-intervention were most commonly angioplastied (n=163), followed by thrombectomy (n=136). There were 107 local fistula repairs. Average length of stay was 7.6 days, (SD 12). There were 106 unplanned returns to theatre, most commonly for fistula creation, insertion of tenckhoff or permacath removal (71.7%). There were 8 deaths in the immediately postoperative period. Discussion: Access to dialysis is vital for patients with end stage kidney disease, and requires a multidisciplinary approach from both nephrologists, vascular surgeons, and allied health practitioners. Our service provides a variety of dialysis access methods, predominately fistula creation and tenckhoff insertion. Patients with renal failure are heavily comorbid, and prolonged hospital admission following surgery is a source of significant healthcare expenditure. AVFs require careful monitoring and maintenance for ongoing utility, and our data reflects a multitude of operations required to maintain usable access. The requirement for dialysis is growing worldwide and our data demonstrates a local experience in access, with preferred methods, common complications and the associated surgical interventions.

Keywords: dialysis, fistula, nephrology, vascular surgery

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Authors: P. J. Sweeney, T. Ahtoniemi, J. Puoliväli, T. Laitinen, K.Lehtimäki, A. Nurmi, D. Wells

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Duchenne muscular dystrophy (DMD) is an X-linked, lethal muscle wasting disease for which there are currently no treatment that effectively prevents the muscle necrosis and progressive muscle loss. DMD is among the most common of inherited diseases affecting around 1/3500 live male births. MDX (X-linked muscular dystrophy) mice only partially encapsulate the disease in humans and display weakness in muscles, muscle damage and edema during a period deemed the “critical period” when these mice go through cycles of muscular degeneration and regeneration. Although the MDX mutant mouse model has been extensively studied as a model for DMD, to-date an extensive temporal, non-invasive imaging profile that utilizes magnetic resonance imaging (MRI) and 1H-magnetic resonance spectroscopy (1H-MRS) has not been performed.. In addition, longitudinal imaging characterization has not coincided with attempts to exacerbate the progressive muscle damage by exercise. In this study we employed an 11.7 T small animal MRI in order to characterize the MRI and MRS profile of MDX mice longitudinally during a 12 month period during which MDX mice were subjected to exercise. Male mutant MDX mice (n=15) and male wild-type mice (n=15) were subjected to a chronic exercise regime of treadmill walking (30 min/ session) bi-weekly over the whole 12 month follow-up period. Mouse gastrocnemius and tibialis anterior muscles were profiled with baseline T2-MRI and 1H-MRS at 6 weeks of age. Imaging and spectroscopy was repeated again at 3 months, 6 months, 9 months and 12 months of age. Plasma creatine kinase (CK) level measurements were coincided with time-points for T2-MRI and 1H-MRS, but also after the “critical period” at 10 weeks of age. The results obtained from this study indicate that chronic exercise extends dystrophic phenotype of MDX mice as evidenced by T2-MRI and1H-MRS. T2-MRI revealed extent and location of the muscle damage in gastrocnemius and tibialis anterior muscles as hyperintensities (lesions and edema) in exercised MDX mice over follow-up period.. The magnitude of the muscle damage remained stable over time in exercised mice. No evident fat infiltration or cumulation to the muscle tissues was seen at any time-point in exercised MDX mice. Creatine, choline and taurine levels evaluated by 1H-MRS from the same muscles were found significantly decreased in each time-point, Extramyocellular (EMCL) and intramyocellular lipids (IMCL) did not change in exercised mice supporting the findings from anatomical T2-MRI scans for fat content. Creatine kinase levels were found to be significantly higher in exercised MDX mice during the follow-up period and importantly CK levels remained stable over the whole follow-up period. Taken together, we have described here longitudinal prophile for muscle damage and muscle metabolic changes in MDX mice subjected to chronic exercised. The extent of the muscle damage by T2-MRI was found to be stable through the follow-up period in muscles examined. In addition, metabolic profile, especially creatine, choline and taurine levels in muscles, was found to be sustained between time-points. The anatomical muscle damage evaluated by T2-MRI was supported by plasma CK levels which remained stable over the follow-up period. These findings show that non-invasive imaging and spectroscopy can be used effectively to evaluate chronic muscle pathology. These techniques can be also used to evaluate the effect of various manipulations, like here exercise, on the phenotype of the mice. Many of the findings we present here are translatable to clinical disease, such as decreased creatine, choline and taurine levels in muscles. Imaging by T2-MRI and 1H-MRS also revealed that fat content or extramyocellar and intramyocellular lipids, respectively, are not changed in MDX mice, which is in contrast to clinical manifestation of the Duchenne’s muscle dystrophy. Findings show that non-invasive imaging can be used to characterize the phenotype of a MDX model and its translatability to clinical disease, and to study events that have traditionally been not examined, like here rigorous exercise related sustained muscle damage after the “critical period”. The ability for this model to display sustained damage beyond the spontaneous “critical period“ and in turn to study drug effects on this extended phenotype will increase the value of the MDX mouse model as a tool to study therapies and treatments aimed at DMD and associated diseases.

Keywords: 1H-MRS, MRI, muscular dystrophy, mouse model

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Authors: M. J. Pourvaghar, M. E. Bahram, M. Sayyah, Sh. Khoshemehry

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Adiponectin is a cytokine secreted by the adipose tissue that functions as an anti-inflammatory, antiathrogenic and anti-diabetic substance. Its density is inversely correlated with body mass index. The purpose of this research was to examine the effect of 12 weeks of high intensity interval training (HIIT) with the level of serum adiponectin and some selected adiposity markers in overweight and fat college students. This was a clinical research in which 24 students with BMI between 25 kg/m² to 30 kg/m². The sample was purposefully selected and then randomly assigned into two groups of experimental (age =22.7±1.5 yr.; weight = 85.8±3.18 kg and height =178.7±3.29 cm) and control (age =23.1±1.1 yr.; weight = 79.1±2.4 kg and height =181.3±4.6 cm), respectively. The experimental group participated in an aerobic exercise program for 12 weeks, three sessions per weeks at a high intensity between 85% to 95% of maximum heart rate (considering the over load principle). Prior and after the termination of exercise protocol, the level of serum adiponectin, BMI, waist to hip ratio, and body fat percentages were calculated. The data were analyzed by using SPSS: PC 16.0 and statistical procedure such as ANCOVA, was used. The results indicated that 12 weeks of intensive interval training led to the increase of serum adiponectin level and decrease of body weight, body fat percent, body mass index and waist to hip ratio (P < 0.05). Based on the results of this research, it may be concluded that participation in intensive interval training for 12 weeks is a non-invasive treatment to increase the adiponectin level while decreasing some of the anthropometric indices associated with obesity or being overweight.

Keywords: adiponectin, cardiovascular, interval, overweight, training

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