Effect of individualized physical rehabilitation programs on respiratory function in women with post-mastectomy syndrome

Purpose: The purpose of this study was to determine the effectiveness of an individualized physical rehabilitation programs aimed at improving respiratory function in women with post-mastectomy syndrome. Methods: In a randomized controlled trial 50 women with post-mastectomy syndrome were enrolled in the experimental group (EG, n = 25) or the comparison group (CG, n = 25). The program for the EG included: aqua aerobics (i.e. aqua jogging, aqua building, and aqua stretching); conditional swimming; and recreational aerobics. The program for the CG included: conditional swimming and Pilates exercises. Both intervention groups attended individualized physical rehabilitation programs three times per week for 48 weeks. The primary outcome measure was spirometry of the patients measured before, 6 and 12 months after the intervention. Results: This study demonstrated that most of the respiratory function parameters increased significantly in both groups over the year of exercise training. After the year of training the individualized physical rehabilitation program for the EG was significantly better (p < 0.01) as compared with the CG, except for inspiratory reserve volume and maximal voluntary ventilation, which were not statistically different. Conclusions: The results of the study suggest that individual programs of physical rehabilitation could be considered effective for the improvement of respiratory function of the patients with post-mastectomy syndrome. The results obtained could serve as a basis for more widespread clinical program development.     

Les complications hépatiques de la nutrition parentérale chez l'adulte

Parenteral nutrition-associated liver disease is a frequent and sometimes life-threatening event. The usual presentation consists of chronic cholestasis, which can evolve within months to years to extensive fibrosis and cirrhosis. Histologic lesions are very similar to those observed in cholestatic liver diseases such as primary biliary cirrhosis and sclerosing cholangitis, and can lead to terminal liver failure and portal hypertension. Pathogenic factors involved in these complications are still poorly understood. Patient-dependent factors include very short bowel syndrome and chronic bacterial overgrowth. Nutrition-dependent factors, easy to correct, are hypercaloric parenteral feeding and, especially in Europe, excess fat, the threshold of which is 1 g · kg⁻¹ · d⁻¹ with ω-6 fat emulsions. It is fundamental to decrease the overall frequency of these complications in patients with long-term intestinal failure in order to avoid a combined liver-intestine transplantation. Preventive measures may combine limitation of parenteral fat intake and treatment of putative patient-dependent factors. Ursodeoxycholic acid and taurine-enriched solutions might be promising treatments for such patients.     

Overcoming health inequalities by using the Bug Busting 'whole-school approach' to eradicate head lice

Aims and Objectives. The aim of this paper was to illustrate the socially inclusive nature of the Bug Busting ‘whole‐school approach’ to head louse eradication. Background. In the UK, Belgium and Denmark, persistent head lice in families of all socio‐economic status (SES) is a problem. Since 1995 in the UK and 1998 elsewhere, an educational programme intended to teach families how to detect and treat head lice by using the Bug Busting wet combing method has been organized in some areas. Local schools lead this community strategy for prevention, known as a ‘whole‐school approach’ (UK). Design and methods. We describe five studies applying the Bug Busting approach, four set in districts where some disadvantaged families live (UK and Belgium) and a fifth set in Denmark. Feasibility and consumer satisfaction are examined. One UK study analyses data on area prescribing for head lice and the impact in a deprived locality of raising the profile of Bug Busting. Results. We find parental education in Bug Busting enables families of all SES to participate in a ‘whole‐school approach’ to head lice. Best results are obtained when each family has a Bug Buster Kit. This provides all the combs necessary with full instructions on their use with ordinary shampoo and conditioner to detect lice, eradicate an infestation mechanically, or to check the success of any treatment. In the UK, the promotion of the Bug Busting approach is reducing primary care expenditure on treatment for head lice and professional time spent with worried parents. As a result, healthcare providers can give time to the few families who require one‐to‐one guidance. Relevance to Clinical Practice. Incorporation of the Bug Busting approach to head lice into clinical practice in school communities contributes to sustainable control whilst overcoming health inequalities in participating families.     

Effect of Net Fiber Reinforcement Surface Treatment on Soft Denture Liner Retention and Longevity

Purpose: To evaluate shear bond strength of Molloplast‐B soft liner attached to different acrylic surfaces (smooth, rough, and Sticktech net fiber‐reinforced interfaces) after 3000 thermal cycles. Materials and Methods: Sixty‐nine specimens were fabricated by attaching Molloplast‐B soft liner to acrylic bases of three interfaces (n= 23); smooth (Group 1, control), rough (Group 2), and Sticktech net fiber‐reinforced interface (Group 3). The specimens underwent 3000 thermocycles (5 and 55°C) before being subject to a shear bond test at 2 mm/min crosshead speed. Debonding sites were investigated using an optical microscope at 40× magnification. Bond failures were categorized as adhesive, cohesive, or mixed. Results: Mean (SD) bond strength values (MPa) were: 0.71 (0.15); 0.63 (0.07); and 0.83 (0.12) for smooth, rough, and fiber‐reinforced acrylic interfaces, respectively. The mean values were analyzed using one‐way ANOVA and Bonferroni post hoc test for pairwise comparisons (p≤ 0.05). The net fiber‐reinforced acrylic interface exhibited a statistically significantly higher bond strength value when compared to smooth and rough acrylic interfaces (P= 0.003 and P= 0.000, respectively). Modes of failure were mainly cohesive (91%), followed by mixed failures (9%). Conclusions: Molloplast‐B exhibited a stronger bond to StickTech Net fiber‐reinforced surfaces when compared to smooth and rough acrylic interfaces after thermocycling. This may enhance prosthesis serviceability during clinical use.     

Muscle hypertrophy in quadriplegics with combined electrical stimulation and body weight support training

We describe the analysis of muscle hypertrophy in complete quadriplegics after 6 months of treadmill gait training with neuromuscular electrical stimulation (NMES). We aim to evaluate the effect of treadmill gait training using NMES, with 30-50% body weight relief, on muscle mass. Fifteen quadriplegics were divided into gait (n=8) and control (n=7) groups. The gait group (GG) performed training, associated to partial body weight support, for 6 months, twice a week, for 20 min. Control group (CG) individuals performed only conventional physiotherapy, but did not perform gait training using NMES. Magnetic resonance imaging (MRI) was performed over quadriceps, at the beginning and after 6 months. The MRI was done to determine the average of cross-sectional area of the quadriceps. Moreover, a gray scale was used to separate the muscle from the conjunctive tissue (when the value is closer to 225, there is a higher amount of muscle tissue). After 6 months there was an increase of cross-sectional area in the gait group (from 49.81+/-9.36 to 57.33+/-10.32 cm2; P=0.01), but not in the control group (from 43.60+/-7.56 to 41.65 +/- 9.44 cm2; P=0.17). The gray scale did not show significant differences after 6 months; however, the mean value of the gray scale inside the quadriceps in the gait group increased by 7.7% and in the control group decreased by 11.4%. Treadmill gait associated with NMES was efficient to promove quadriceps muscle hypertrophy in quadriplegics with chronic lesions even when a partial body weight support was provided.     

Frequent and rapid progression of atrophy and intestinal metaplasia in gastric mucosa of patients with MALT lymphoma

OBJECTIVES: Association of gastric mucosa-associated lymphoid tissue (MALT) low-grade lymphoma and adenocarcinoma has repeatedly been reported. The aim of this study was to evaluate the frequency and the spreading of atrophy and intestinal metaplasia in gastric mucosa of patients with gastric MALT lymphoma followed after conservative treatment. METHODS: Forty-five patients (mean age 45 +/- 2.1 yr) with gastric MALT lymphoma, treated by Helicobacter pylori eradication, chemotherapy with per os single alkylating agents, or both treatments have been followed by gastroscopy with biopsies in antrum and corpus at least once a year. Univariate and multivariate analysis evaluated the association between the appearance of atrophy and intestinal metaplasia in antrum or corpus and different factors related to patients, H. pylori status, lymphoma features, and treatment. In addition, histological aspects of gastric biopsies at the diagnosis period and at the end of follow-up were compared with those of two control groups of age-matched patients with H. pylori gastritis. RESULTS: At the diagnosis time, only intestinal metaplasia in corpus was more frequent in patients with gastric MALT lymphoma than in patients with nonulcer dyspepsia. Within median follow-up of 54.4 months (range 9-196), the percentage of patients with gastric atrophy and intestinal metaplasia increased significantly and became significantly higher than in age-matched nonulcer dyspepsia patients. Multivariate analysis showed significant association between corpus intestinal metaplasia and corpus atrophy, intestinal metaplasia in antrum, and duration of the follow-up. CONCLUSIONS: Conservative management of gastric MALT lymphoma including H. pylori eradication is associated with progression of gastric atrophy and intestinal metaplasia with frequent involvement of the corpus which is known to be a precancerous condition. These findings show that long-term endoscopic monitoring should be recommended in such patients.     

Electrical Stimulation During Gait Promotes Increase of Muscle Cross-sectional Area in Quadriplegics: A Preliminary Study

Increases in muscular cross-sectional area (CSA) occur in quadriplegics after training, but the effects of neuromuscular electrical stimulation (NMES) along with training are unknown. Thus, we addressed two questions: (1) Does NMES during treadmill gait training increase the quadriceps CSA in complete quadriplegics?; and (2) Is treadmill gait training alone enough to observe an increase in CSA? Fifteen quadriplegics were divided into gait (n = 8) and control (n = 7) groups. The gait group performed training with NMES for 6 months twice a week for 20 minutes each time. After 6 months of traditional therapy, the control group received the same gait training protocol but without NMES for an additional 6 months. Axial images of the thigh were acquired at the beginning of the study, at 6 months (for both groups), and at 12 months for the control group to determine the average quadriceps CSA. After 6 months, there was an increase of CSA in the gait group (from 49.8 ± 9.4 cm² to 57.3 ± 10.3 cm²), but not in the control group (from 43.6 ± 7.6 cm² to 41.8 ± 8.4 cm²). After another 6 months of gait without NMES in the control group, the CSA did not change (from 41.8 ± 8.4 cm² to 41.7 ± 7.9 cm²). The increase in quadriceps CSA after gait training in patients with chronic complete quadriplegia appears associated with NMES.     

Polymeric Micelles Based on Amphiphilic Scorpion-like Macromolecules: Novel Carriers for Water-Insoluble Drugs

No HeadingPurpose. The objective was to evaluate amphiphilic scorpion-like macromolecules (AScMs) as drug carriers for hydrophobic drugs.Methods. Indomethacin (IMC) was incorporated into two AScM micelles (M₁₂P₅ and M₁₂P₂) by the O/W emulsion technique. The influences of IMC:polymer feed ratio and molecular weight of the hydrophilic block of AScMs on the micelle size, IMC entrapment efficiency and release behavior were investigated. Furthermore, cytotoxicity of the AScMs was evaluated with human umbilical vein endothelial cells (HUVEC).Results. The maximal IMC entrapment efficiency in M₁₂P₅ and M₁₂P₂ micelles (72.3 and 20.2%, respectively) was obtained at ratios of 0.1 to 1 for indomethacin:polymer. The sizes of IMC-loaded M₁₂P₅ and M₁₂P₂ polymeric micelles were <20 nm with a narrow size distribution. In vitro release studies revealed that IMC released from M₁₂P₅ and M₁₂P₂ polymeric micelles showed sustained release behavior during the 24 h of experiment. Additionally, M₁₂P₅ and M₁₂P₂ polymeric micelles did not induce remarkable cytotoxicity against HUVEC cells at concentrations up to 1 and 0.5 mM, respectively.Conclusions. The amphiphilic scorpion-like macromolecules may be useful as novel drug carriers because of their small size, ability to encapsulate hydrophobic drugs and release them in a sustained manner as well as low cytotoxicity.