The latest medical research on General Medicine / Internal Medicine
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Request AccessEffect of 6-week BFRT combined with IASTAM therapy on international standard dancers with chronic ankle instability.
Frontiers in PhysiologyIn sports dance events, athletes often face the risk of ankle injury and instability, which may have a negative impact on their training and athletic performance, and even hinder their rehabilitation process and increase the likelihood of re-injury.
This study aims to observe the effects of exercise intervention (low-load ankle muscle strength training with blood flow restriction training (BFRT) equipment and balance training with blood flow restriction training equipment) combined with instrumentation therapy (Instrument-assisted soft tissue mobilization, IASTM) on ankle function, joint range of motion, and strength in sports dancers with chronic ankle instability (CAI). This study aims to provide an evidence-based approach to rehabilitation for athletes by comparing the effects of combination therapy approaches to traditional ankle strength and stability training.
Forty-two subjects with ankle instability, restriction, or discomfort were selected as observation objects and randomly divided into three groups: the combined group (n = 14, blood flow restriction training combined with IASTM), the simple blood flow restriction training group (n = 15), and the conventional ankle strength and stability training group (n = 13). The intervention lasted for 6 weeks, once a week. The three groups were assessed with the Cumberland ankle instability assessment, Foot and Ankle Ability Measure (FAAM) ankle function assessment score, and ankle range of motion measurement before intervention, after the first intervention, and after 6 weeks of intervention. The ankle strength test was compared and analyzed only before and after intervention.
There was no significant difference in the participant characteristics of the three intervention groups. In terms of Cumberland Ankle Instability Tool (CAIT) scores, within-group comparisons showed that the scores after the first intervention and at the 6-week mark were significantly higher than before the intervention (P < 0.05). Between-group comparisons revealed that the combined intervention group had higher CAIT scores than the other two groups after the 6-week intervention. Regarding the FAAM functional scores, all three interventions significantly improved ankle joint function in patients with chronic ankle instability (P < 0.05), with the BFRT group showing significantly higher FAAM - Activities of Daily Living scale (FAAM-ADL) scores than the control group (P < 0.05). Both the combined and BFRT groups also had significantly higher FAAM-SPORT scores after the first intervention compared to the control (P < 0.05). In terms of ankle range of motion improvement, the combined intervention group showed a significant increase in ankle joint motion after the intervention (P < 0.05), particularly in the improvement of dorsiflexion ability (P < 0.05). As for ankle strength enhancement, all three intervention groups experienced an increase in ankle strength after the intervention (P < 0.05), with the combined intervention group showing a significant improvement in both dorsiflexion and inversion strength compared to the control group (P < 0.05).
BFRT combined with IASTM, isolated BFRT, and conventional ankle strength and stability training significantly improve stability, functionality, and strength in CAI patients. The combined intervention demonstrates superior efficacy in improving ankle range of motion compared to isolated BFRT and conventional approaches.
The oxygen uptake efficiency slope does not accurately predict V ˙ O2peak of children - the Arkansas Active Kids study.
Frontiers in PhysiologyCardiorespiratory fitness (CRF) is a vital indicator of health. However, accurately measuring peak oxygen consumption ( V ˙ O2peak) to determine CRF in children can be challenging. The oxygen uptake efficiency slope (OUES) has been proposed as an alternative metric for predicting V ˙ O2peak in children, but its accuracy and agreement with measured V ˙ O2peak remain unclear.
A post hoc analysis was conducted in 94 children (ages 7-10 years) who completed an incremental cycle ergometer test to measure V ˙ O2peak. Body composition (Dual-energy X-ray absorptiometry) was measured, and fat mass index (FMI, kg/m2) and fat-free mass index (FFMI, kg/m2) were calculated. OUES was determined using all respiratory data (OUES100%) collected during the cycle ergometer test and using data only up to 60% of heart rate reserve (OUES60%HRR). Regression equations to predict V ˙ O2peak (Pred- V ˙ O2peak) were derived from simple and multiple linear regression analysis. Bland-Altman analysis assessed the level of agreement between Pred- V ˙ O2peak and measured V ˙ O2peak.
OUES60%HRR (β = 0.46, p < 0.0001), age (β = 56.0, p = 0.0004), White race (β = 173.3, p < 0.0003), FFMI (β = 0.98.6, p < 0.000), and FMI (β = -0.40.8, p < 0.000) were retained in the final model. The difference between measured V ˙ O2peak and Pred- V ˙ O2peak was not different from zero (p = 0.999). There was a positive association between the difference of measured V ˙ O2peak and Pred- V ˙ O2peak and the average of the two methods (β = 0.79, p = 0.0028).
There was no mean bias between measured V ˙ O2peak and Pred- V ˙ O2peak. However, magnitude bias was present even after considering other significant predictors of V ˙ O2peak (FMI, FFMI, race, and age) in the regression equation. Caution is advised when using OUES to predict V ˙ O2peak in children.
Effects of lower back foam rolling on the pressure pain threshold and the range of motion of the lumbar spine in healthy individuals.
Frontiers in PhysiologyThe aim of this study was to determine the short- and long-term effects of foam rolling (FR) on the pressure pain threshold and the range of motion of the lumbar spine in healthy subjects.
43 healthy subjects without back problems were randomly assigned to an experimental group (EG) or a control group (CG). The subjects in the EG underwent a 4-week FR program (12 sessions). The subjects in the CG received no intervention. Range of motion was measured using the modified-modified Schober test for flexion and fingertip-to-floor distance for lateral flexion. The pressure pain threshold was measured with a hand-held pressure algometer. The measurements were taken before and after the first FR, after the 4-week program and at the 1-, 3- and 6-month follow-up. The significance level was set at p ≤ 0.05 and the desired power of the test was 92%.
We found an improvement in flexion (p = 0.03) and lateral flexion (p < 0.001) in the EG after the first FR and recorded a significant improvement in all measured variables (flexion, lateral flexion and algometry: p < 0.001) at the end of the entire 4-week program. The effects were noticeable up to 6 months after the end of the program (p ≤ 0.03) and were statistically significantly better than in the CG (p ≤ 0.04). The calculated Cohen's d value was 1.15 for flexion, 1.06 for lateral flexion and 0.98 for algometry, which represents a large effect size.
FR improves the pressure pain threshold and mobility of the lumbar spine in healthy subjects. The effects are noticeable at least 6 months after the end of an FR program.
Collagenase Injection versus Limited Fasciectomy for Dupuytren's Contracture.
N Engl JTreatments for Dupuytren's contracture include limited fasciectomy and collagenase injection. Comparisons of the effectiveness of these treatments have been limited.
We performed an unblinded, multicenter, pragmatic, two-group, randomized, controlled noninferiority trial comparing collagenase injection with limited fasciectomy in persons with moderate Dupuytren's contracture. The primary outcome was the score on the Patient Evaluation Measure-Hand Health Profile (PEM), a questionnaire for assessing hand health as reported by the patient, at 1 year after treatment. Scores on the PEM range from 0 to 100, with higher scores indicating worse outcomes. The prespecified noninferiority margin was 6 points.
A total of 672 persons (336 per group) were assigned to receive collagenase injection or to undergo limited fasciectomy. The primary analysis included 599 persons: 314 in the collagenase group and 285 in the limited-fasciectomy group. The mean score on the PEM at 1 year was 17.8 among the 284 patients with available data in the collagenase group and 11.9 among the 250 patients with available data in the limited-fasciectomy group (estimated difference, 5.9 points; 95% confidence interval [CI], 3.1 to 8.8; one-sided P = 0.49 for noninferiority). Among the patients with available data (229 patients in the collagenase group and 197 patients in the limited-fasciectomy group), the estimated difference in the mean score on the PEM at 2 years was 7.2 points (95% CI, 4.2 to 10.9). Moderate or severe complications of treatment occurred in 1.8% of the patients in the collagenase group and in 5.1% of those in the limited-fasciectomy group; recurrent contracture resulted in reintervention in 14.6% and 3.4%, respectively.
Collagenase injection was not noninferior to limited fasciectomy with respect to the score on the PEM at 1 year after treatment. (Funded by the National Institute for Health and Care Research Health Technology Assessment Programme; DISC ISRCTN Registry number ISRCTN18254597.).
Hematologic Cancer after Gene Therapy for Cerebral Adrenoleukodystrophy.
N Engl JGene therapy with elivaldogene autotemcel (eli-cel) consisting of autologous CD34+ cells transduced with lentiviral vector containing ABCD1 complementary DNA (Lenti-D) has shown efficacy in clinical studies for the treatment of cerebral adrenoleukodystrophy. However, the risk of oncogenesis with eli-cel is unclear.
We performed integration-site analysis, genetic studies, flow cytometry, and morphologic studies in peripheral-blood and bone marrow samples from patients who received eli-cel therapy in two completed phase 2-3 studies (ALD-102 and ALD-104) and an ongoing follow-up study (LTF-304) involving the patients in both ALD-102 and ALD-104.
Hematologic cancer developed in 7 of 67 patients after the receipt of eli-cel (1 of 32 patients in the ALD-102 study and 6 of 35 patients in the ALD-104 study): myelodysplastic syndrome (MDS) with unilineage dysplasia in 2 patients at 14 and 26 months; MDS with excess blasts in 3 patients at 28, 42, and 92 months; MDS in 1 patient at 36 months; and acute myeloid leukemia (AML) in 1 patient at 57 months. In the 6 patients with available data, predominant clones contained lentiviral vector insertions at multiple loci, including at either MECOM-EVI1 (MDS and EVI1 complex protein EVI1 [ecotropic virus integration site 1], in 5 patients) or PRDM16 (positive regulatory domain zinc finger protein 16, in 1 patient). Several patients had cytopenias, and most had vector insertions in multiple genes within the same clone; 6 of the 7 patients also had somatic mutations (KRAS, NRAS, WT1, CDKN2A or CDKN2B, or RUNX1), and 1 of the 7 patients had monosomy 7. Of the 5 patients with MDS with excess blasts or MDS with unilineage dysplasia who underwent allogeneic hematopoietic stem-cell transplantation (HSCT), 4 patients remain free of MDS without recurrence of symptoms of cerebral adrenoleukodystrophy, and 1 patient died from presumed graft-versus-host disease 20 months after HSCT (49 months after receiving eli-cel). The patient with AML is alive and had full donor chimerism after HSCT; the patient with the most recent case of MDS is alive and awaiting HSCT.
Hematologic cancer developed in a subgroup of patients who were treated with eli-cel; the cases are associated with clonal vector insertions within oncogenes and clonal evolution with acquisition of somatic genetic defects. (Funded by Bluebird Bio; ALD-102, ALD-104, and LTF-304 ClinicalTrials.gov numbers, NCT01896102, NCT03852498, and NCT02698579, respectively.).
Lentiviral Gene Therapy for Cerebral Adrenoleukodystrophy.
N Engl JCerebral adrenoleukodystrophy is a severe form of X-linked adrenoleukodystrophy characterized by white-matter disease, loss of neurologic function, and early death. Elivaldogene autotemcel (eli-cel) gene therapy, which consists of autologous CD34+ cells transduced with Lenti-D lentiviral vector containing ABCD1 complementary DNA, is being tested in persons with cerebral adrenoleukodystrophy.
In a phase 2-3 study, we evaluated the efficacy and safety of eli-cel therapy in boys with early-stage cerebral adrenoleukodystrophy and evidence of active inflammation on magnetic resonance imaging (MRI). The primary efficacy end point was survival without any of six major functional disabilities at month 24. The secondary end points included overall survival at month 24 and the change from baseline to month 24 in the total neurologic function score.
A total of 32 patients received eli-cel; 29 patients (91%) completed the 24-month study and are being monitored in the long-term follow-up study. At month 24, none of these 29 patients had major functional disabilities; overall survival was 94%. At the most recent assessment (median follow-up, 6 years), the neurologic function score was stable as compared with the baseline score in 30 of 32 patients (94%); 26 patients (81%) had no major functional disabilities. Four patients had adverse events that were directly related to eli-cel. Myelodysplastic syndrome (MDS) with excess blasts developed in 1 patient at month 92; the patient underwent allogeneic hematopoietic stem-cell transplantation and did not have MDS at the most recent follow-up.
At a median follow-up of 6 years after lentiviral gene therapy, most patients with early cerebral adrenoleukodystrophy and MRI abnormalities had no major functional disabilities. However, insertional oncogenesis is an ongoing risk associated with the integration of viral vectors. (Funded by Bluebird Bio; ALD-102 and LTF-304 ClinicalTrials.gov numbers NCT01896102 and NCT02698579, respectively.).
Taravana syndrome and posterior reversible encephalopathy syndrome: a microbubble hypothesis for neurological accidents in breath-hold divers.
Frontiers in PhysiologyBreath-hold diving is a challenging activity that can lead to serious and dangerous complications, such as the "Taravana" syndrome. This syndrome i...
Protonophore treatment augments energy expenditure in mice housed at thermoneutrality.
Frontiers in PhysiologySub-thermoneutral housing increases facultative thermogenesis in mice, which may mask the pre-clinical efficacy of anti-obesity strategies that target energy expenditure (EE). Here, we quantified the impact of protonophore treatment on whole-body energetics in mice housed at 30°C.
C57BL/6J mice (n = 48, 24M/24F) were housed at 24°C for 2 weeks; 32 (16M/16F) were then transitioned to 30°C for a further 4 weeks. Following 2 weeks acclimation at 30°C, mice (n = 16 per group, 8M/8F) received either normal (0 mg/L; Control) or supplemented (400 mg/L; 2,4-Dinitrophenol [DNP]) drinking water. Mice were singly housed in metabolic cages to determine total EE (TEE) and its components via respiratory gas exchange. Mitochondrial respiratory function of permeabilized liver tissue was determined by high-resolution respirometry.
Transitioning mice from 24°C to 30°C reduced TEE and basal EE (BEE) by 16% and 41%, respectively (both P < 0.001). Compared to 30°C controls, TEE was 2.6 kcal/day greater in DNP-treated mice (95% CI: 1.6-3.6 kcal/day, P < 0.001), which was partly due to a 1.2 kcal/day higher BEE in DNP-treated mice (95% CI: 0.6-1.7 kcal/day, P < 0.001). The absolute TEE of 30°C DNP-treated mice was lower than that of mice housed at 24°C in the absence of DNP (DNP: 9.4 ± 0.7 kcal/day vs. 24°C control: 10.4 ± 1.5 kcal/day). DNP treatment reduced overall body fat of females by 2.9 percentage points versus sex-matched controls (95% CI: 1.3%-4.5%, P < 0.001), which was at least partly due to a reduction in inguinal white fat mass.
Protonophore treatment markedly increases EE in mice housed at 30°C. The magnitude of change in TEE of mice receiving protonophore treatment at 30°C was smaller than that brought about by transitioning mice from 24°C to 30°C, emphasizing that housing temperature must be considered when assessing anti-obesity strategies that target EE in mice.
Terez Shea-Donohue: Optimism helps, and confidence in your work is critical.
J Exp MedTerez Shea-Donohue is the program director of the Division of Digestive Diseases and Nutrition at the National Institute of Diabetes and Digestive ...
Comparison of the effects of cold water immersion and percussive massage on the recovery after exhausting eccentric exercise: A three-armed randomized controlled trial.
Frontiers in PhysiologyAthletic training requires both challenging stimuli for adaptation and sufficient recovery for improved performance. While cold water immersion (CWI) is already a popular recovery method, handheld percussive massage (PM) devices have also gained popularity in recent years. This study aims to assess the effects of CWI and PM on performance recovery after strenuous eccentric exercises compared to a passive rest (PR) control condition.
Thirty-four healthy physically active participants (9 females, 25 males) were randomly divided into three groups: CWI (n = 11), PM (n = 11), and passive rest (PR) (n = 12). They underwent an exhausting eccentric exercise protocol and different measurements at six time points (baseline, POST1, POST2, POST24, POST48, and POST72) over the time course of 72 h. These included subjective assessments of muscle soreness and perceived stiffness as well as measures of skin temperature, leg volume, creatine kinase activity, and three different jump tests. The eccentric exercise protocol consisted of 15 min downhill running (slope: 12%, speed: 10 km/h) and 3 sets of successive depth jumps (dropping height: 0.5 m) until individual exhaustion. After POST1 measurements, participants received 12 min of either CWI (11 ± 0.5°C), PM (40 Hz) or PR (supine posture).
No significant group effects were found for the number of depth jumps performed during the exhaustion protocol. All jump tests displayed a significant group × time interaction effect. Post-hoc analysis indicated significant lower jump heights in ΔPOST2 between CWI and both PM and PR. No other significant group effects were observed at any time point. No significant group × time interaction effects were noted for CK, leg volume, and soreness. The perceived stiffness showed a significant group × time interaction effect. Post-hoc analysis revealed a significant decrease in stiffness for PM compared to PR at ΔPOST2.
Neither CWI nor PM showed any significant improvement in performance recovery over the 72-h period following strenuous eccentric exercise compared to PR. CWI showed an immediate performance decline which may be attributed to a cold-related reduction in motor nerve conduction velocity.
Comparative efficacy of different exercise modalities on metabolic profiles and liver functions in non-alcoholic fatty liver disease: a network meta-analysis.
Frontiers in PhysiologyResearch evidence suggests that exercise is a potent therapeutic strategy for non-alcoholic fatty liver disease (NAFLD). Many investigations have delved into the curative potential of diverse exercise regimens on NAFLD. This investigation synthesizes findings from randomized controlled trials via a network meta-analysis to evaluate the efficacy of exercise-based interventions on NAFLD.
We conducted a search across five electronic databases (Web of Science, EMBASE, PubMed, SCOPUS, and CNKI)to identify randomized controlled trials (RCTs) comparing the effects of different exercise modalities on metabolic profiles and liver functions in patients with NAFLD. The literature search was comprehensive up to 15, December 2023. The selected studies were subjected to a rigorous quality appraisal and risk of bias analysis in accordance with the Cochrane Handbook's guidelines, version 5.1.0. We employed Stata/MP 17 for the network meta-analysis, presenting effect sizes as standardized mean differences (SMD).
This study aggregated results from 28 studies, involving a total of 1,606 participants. The network meta-analysis revealed that aerobic exercise was the most effective intervention for improving BMI in patients with NAFLD, demonstrating a significant decrease in BMI (-0.72, 95%CI: -0.98 to -0.46; p < 0.05; Surface Under the Cumulative Ranking (SUCRA) = 79.8%). HIIT was the top intervention for enhancing HDL-C (0.12, 95% CI: 0.04 to 0.20; p < 0.05; SUCRA = 76.1%). Resistance exercise was the most effective for reducing LDL-C (-0.20, 95% CI: -0.33 to -0.06; p < 0.05; SUCRA = 69.7%). Mind-body exercise showed superior effectiveness in improving TC (-0.67, 95% CI: -1.10 to -0.24; p < 0.05; SUCRA = 89.7%), TG = -0.67, 95% CI: -1.10 to -0.24; p < 0.05; SUCRA = 99.6%), AST (-8.07, 95% CI: -12.88 to -3.25; p < 0.05; SUCRA = 76.1%), ALT (-12.56, 95% CI: -17.54 to -7.58; p < 0.05; SUCRA = 99.5%), and GGT (-13.77, 95% CI: -22.00 to -5.54; p < 0.05; SUCRA = 81.8%).
This network meta-analysis demonstrates that exercise interventions positively affect various metabolic profiles and liver functions in NAFLD patients. Mind-body exercises are particularly effective, surpassing other exercise forms in improving metabolic profiles and liver functions.
https://www.crd.york.ac.uk/PROSPERO/, identifier registration number CRD42024526332.
Meta-analysis of the effect of plyometric training on the athletic performance of youth basketball players.
Frontiers in PhysiologyTo investigate the effects of Plyometric Training (PT) on the athletic performance of youth basketball players (age 5-17.99) and to provide a theoretical basis for applying PT in basketball training practice.
PubMed, Web of Science, Cochrane Library, EBSCO and other data platforms were searched, and Meta-analysis was performed using STATA 16.0 software.
A total of 24 studies were included, with a sample size of 738 participants. The results showed that PT improved jumping, linear sprinting, change of direction (COD) speed, and balance in youth basketball players (p < 0.05) but did not significantly improve lower limb strength (p > 0.05). The results of subgroup analyses showed that:1) Regarding the effect of PT on different aspects of athletic performance, enhancements were found for vertical jump, 5-10 m, 20-30 m sprinting ability, velocity-oriented and force-oriented COD speed, and dynamic balance ability of youth basketball players. 2) When analyzing different participant subgroups, basketball players aged 5 to 10.99 and 11-14.99 years appeared to improve their jump, sprinting ability, and COD speed through PT training, whereas no improvements in sprinting ability and COD speed were found for players aged 15 to 17.99. Male and female youth basketball players could improve their jumping through PT, in contrast, straight-line sprinting ability and COD speed were significantly improved only by male youth basketball players, and balance ability was significantly improved only by female youth basketball players. 3) Regarding different training protocols, high-frequency PT (>2 times/week) with a low-volume (jumping ≤150 times/week) and Single-type PT (one specific movement) improved only jumping ability. In contrast, low-frequency PT (1-2 times/week) with a high-volume (jumping >150 times/week) and mixed-type PT (varied jumping drills) protocols significantly improved jumping, linear sprinting, COD speed, and balancing abilities.
PT can enhance the jumping, linear sprinting, COD speed, and balance of youth basketball players, but it does not affect lower limb strength. It is recommended that coaches make full use of the training-sensitive periods of young athletes by incorporating low-frequency, high-volume, and mixed-type PT into their regular training routines over the long term.
