Microcirculation of skeletal muscle adapts differently to a resistive exercise intervention with and without superimposed whole‐body vibrations

Whole‐body vibration (WBV) training is commonly practiced and may enhance peripheral blood flow. Here, we investigated muscle morphology and acute microcirculatory responses before and after a 6‐week resistive exercise training intervention without (RE) or with (RVE) simultaneous whole‐body vibrations (20 Hz, 6 mm peak‐to‐peak amplitude) in 26 healthy men in a randomized, controlled parallel‐design study. Total haemoglobin (tHb) and tissue oxygenation index (TOI) were measured in gastrocnemius muscle (GM) with near‐infrared spectroscopy (NIRS). Whole‐body oxygen consumption (VO₂) was measured via spirometry, and skeletal muscle morphology was determined in soleus (SOL) muscle biopsies. Our data reveal that exercise‐induced muscle deoxygenation both before and after 6 weeks training was similar in RE and RVE (P = 0·76), although VO₂ was 20% higher in the RVE group (P<0·001). The RVE group showed a 14%‐point increase in reactive hyperaemia (P = 0·007) and a 27% increase in blood volume (P<0·01) in GM after 6 weeks of training. The number of capillaries around fibres was increased by 15% after 6 weeks training in both groups (P<0·001) with no specific effect of superimposed WBV (P = 0·61). Neither of the training regimens induced fibre hypertrophy in SOL. The present findings suggest an increased blood volume and vasodilator response in GM as an adaptation to long‐term RVE, which was not observed after RE alone. We conclude that RVE training enhances vasodilation of small arterioles and possibly capillaries. This effect might be advantageous for muscle thermoregulation and the delivery of oxygen and nutrients to exercising muscle and removal of carbon dioxide and metabolites.     

High-dose fast infusion of parenteral iron isomaltoside is efficacious in inflammatory bowel disease patients with iron-deficiency anaemia without profound changes in phosphate or fibroblast growth factor 23

Objective: Iron isomaltoside (Monofer^®) is a high-dose intravenous iron preparation with good tolerability and efficacy in inflammatory bowel disease (IBD) patients with iron deficiency anaemia (IDA). This trial evaluates the safety and efficacy, including effect on intact fibroblast growth factor 23 (iFGF23) of a high single dose and cumulative doses of iron isomaltoside in IBD patients with IDA.

Materials and methods: The trial was a prospective, open-label, multi-centre trial conducted in IBD patients with IDA. Based upon haemoglobin (Hb) levels at baseline and weight, the patients received 1500, 2000, 2500 or 3000?mg of iron isomaltoside infused in single doses up to 2000?mg. The outcome measurements included adverse drug reactions (ADRs) and changes in haematology and biochemistry parameters.

Results: Twenty-one IBD patients with IDA were enrolled, receiving 1500 (seven patients), 2000 (eight patients), 2500?mg (four patients) or 3000 (two patients) mg of iron. No serious ADRs were observed. Four patients experienced nine mild to moderate ADRs (hypersensitivity, pyrexia, vomiting, constipation, abdominal pain, dyspepsia (two events) and eye allergy (two events)). In total, 15 (75%) patients had an increase in Hb of ≥2.0?g/dL during the trial, with normalisation of ferritin. No changes in iFGF23 or clinically significant hypophosphataemia were found.

Conclusion: Rapid infusions of high-dose iron isomaltoside, administered as single doses up to 2000?mg and cumulative doses up to 3000?mg, were without safety concerns and were efficacious in increasing Hb levels in IBD patients. Iron isomaltoside did not induce profound phosphate wasting via increased iFGF23 levels.     

Thylakoids suppress appetite by increasing cholecystokinin resulting in lower food intake and body weight in high‐fat fed mice

Thylakoids are membranes isolated from plant chloroplasts which have previously been shown to inhibit pancreatic lipase/colipase catalysed hydrolysis of fat in vitro and induce short‐term satiety in vivo. The purpose of the present study was to examine if dietary supplementation of thylakoids could affect food intake and body weight during long‐term feeding in mice. Female apolipoprotein E‐deficient mice were fed a high‐fat diet containing 41% of fat by energy with and without thylakoids for 100 days. Mice fed the thylakoid‐enriched diet had suppressed food intake, body weight gain and body fat compared with the high‐fat fed control mice. Reduced serum glucose, serum triglyceride and serum free fatty acid levels were found in the thylakoid‐treated animals. The satiety hormone cholecystokinin was elevated, suggesting this hormone mediates satiety. Leptin levels were reduced, reflecting a decreased fat mass. There was no sign of desensitization in the animals treated with thylakoids. The results suggest that thylakoids are useful to suppress appetite and body weight gain when supplemented to a high‐fat food during long‐term feeding. Copyright © 2009 John Wiley & Sons, Ltd.     

Behavioral goal assessment in patients with persistent musculoskeletal pain

Identification and achievement of behavioral goals is an important issue in pain rehabilitation. For this dual purpose, we developed a patient-specific clinical tool—the Patient Goal Priority Questionnaire (PGPQ). Using the PGPQ, this study identifies patients' behavioral goals for physical therapy (PT) in a primary health care sample of patients with persistent musculoskeletal pain. In addition, this study examines the concurrent validity of the PGPQ in relation to a generic measure of disability, the Pain Disability Index (PDI). In all, 197 subjects participated in the study. The behavioral goals differed among the patients, comprehending several everyday activities and behaviors, and thus an individualized and behavioral focus was relevant for these patients. The PGPQ was negatively and moderately correlated with the PDI, indicating patient-specific properties of the new instrument. An elaborated version of the PGPQ can serve (a) as a clinical tool for identification of the patient's priorities of behavioral goals for PT, (b) as a clinical tool for collaborative formative evaluation during treatment, and (c) as a complementary measure in research for assessment of clinically significant changes related to behavioral performance.     

Long‐term follow‐up of tailored behavioural treatment and exercise based physical therapy in persistent musculoskeletal pain: A randomized controlled trial in primary care

This study examined long‐term effects of a tailored behavioural treatment protocol (TBT), as compared with an exercise based physical therapy protocol (EBT). One‐hundred and twenty‐two patients who, due to persistent musculoskeletal pain, consulted physical therapists in primary care were originally randomized to either of the two conditions. Follow‐up assessments two‐year post‐treatment were completed by 65 participants. According to per‐protocol analyses, short‐term effects were maintained in both groups for the primary outcome, pain‐related disability. The TT‐group reported lower disability levels compared with the EBT‐group. Intention‐to‐treat analyses (ITT) conveyed similar results. Secondary outcomes of pain intensity, pain control, and functional self‐efficacy were maintained over the 2‐year post‐treatment, but previous group differences were levelled out according to the most conservative method of ITT. Fear of movement/(re)injury increased in the EBT‐group, and EBT participants reported higher fear of movement/(re)injury two years post‐treatment compared to TT. The study supports tailoring of treatments in concordance with patients’ needs and preferences of activity goals and functional behavioural analyses including predictors of pain‐related disability, for successful immediate outcomes and their maintenance in the long run. Exercise‐based treatments resulted in somewhat smaller immediate treatment effects but had similar maintenance of effects over the 2‐year follow‐up period.     

Diagnostic considerations of tongue-base malignancies

Summary Forty-two patients with malignancies localized to the base of the tongue were treated at Sahlgrenska Hospital between 1971 and 1980. These patients were re-analyzed with respect to symptomatology and clinical outcome. Pain in the mouth, throat, and ears as well as swallowing difficulties were the most frequent overt symptoms of disease. In general, patients experienced symptoms for at least 3 months before a positive tumor diagnosis was made. In all, 75% of the patients were found to have large tumors which extended beyond the base of the tongue. Most of the patients were treated with irradiation. The overall 3-year survival rate was 28%, while individual patient survival was related to the size of the primary tumor and to the occurrence of lymph node metastases. Careful attention to symptomatology may reduce delays in establishing an accurate diagnosis and consequently improve the prognosis for patients with these cancers.