The increase in hydric volume is associated to contractile impairment in the calf after the world's most extreme mountain ultra-marathon

BACKGROUND: Studies have recently focused on the effect of running a mountain ultra-marathon (MUM) and their results show muscular inflammation, damage and force loss. However, the link between peripheral oedema and muscle force loss is not really established. We tested the hypothesis that, after a MUM, lower leg muscles' swelling could be associated with muscle force loss. The knee extensor (KE) and the plantar flexor (PF) muscles' contractile function was measured by supramaximal electrical stimulations, potentiated low- and high-frequency doublets (PS10 and PS100) of the KE and the PF were measured by transcutaneous electrical nerve stimulation and bioimpedance was used to assess body composition in the runners (n = 11) before (Pre) and after (Post) the MUM and compared with the controls (n = 8). RESULTS: The maximal voluntary contraction of the KE and the PF significantly decreased by 20 % Post-MUM in the runners. Hydration of the non-fat mass (NF-Hyd) and extracellular water volume (Ve) were increased by 12 % Post-MUM (p < 0.001) in the runners. Calf circumference (+2 %, p < 0.05) was also increased. Significant relationships were found for percentage increases in Ve and NF-Hyd with percentage decrease in PS10 of the PF (r = -0.68 and r = -0.70, p < 0.05) and with percentage increase of calf circumference (r = 0.72 and r = 0.73, p < 0.05) in the runners. CONCLUSIONS: The present study suggests that increases in circumference and in hydric volume are associated to contractile impairment in the calf in ultra-marathon runners.

Spleen Volume Variation in Patients with Locally Advanced Non-Small Cell Lung Cancer Receiving Platinum-Based Chemo-Radiotherapy.

There is renewed interest in the immune regulatory role of the spleen in oncology. To date, very few studies have examined macroscopic variations of splenic volume in the setting of cancer, prior to or during therapy, especially in humans. Changes in splenic volume may be associated with changes in splenic function. The purpose of this study was to investigate variations in spleen volume in NSCLC patients during chemo-radiotherapy. Sixty patients with stage I-IIIB NSCLC underwent radiotherapy (60Gy/30 fractions) for six weeks with concomitant carboplatin/paclitaxel (Ca/P; n = 32) or cisplatin/etoposide (Ci/E; n = 28). A baseline PET/CT scan was performed within 2 weeks prior to treatment and during Weeks 2 and 4 of chemo-radiotherapy. Spleen volume was measured by contouring all CT slices. Significant macroscopic changes in splenic volume occurred early after the commencement of treatment. A significant decrease in spleen volume was observed for 66% of Ca/P and 79% of Ci/E patients between baseline and Week 2. Spleen volume was decreased by 14.2% for Ca/P (p<0.001) and 19.3% for Ci/E (p<0.001) patients. By Week 4, spleen volume was still significantly decreased for Ca/P patients compared to baseline, while for Ci/E patients, spleen volume returned to above baseline levels. This is the first report demonstrating macroscopic changes in the spleen in NSCLC patients undergoing radical chemo-radiotherapy that can be visualized by non-invasive imaging.

Conséquences du stress en période périnatale sur la réponse émotionnelle chez l'enfant prématuré

Problématique: Les naissances prématurées sont des situations cliniques à risque pour l'enfant. Celui-ci arrive au monde avec une capacité amoindrie à être autonome, que ce soit, par exemple, au niveau respiratoire ou de la régulation thermique. Lors de leur séjour aux soins intensifs, les enfants prématurés subissent des interventions qui peuvent être douloureuses, ils sont souvent manipulés et exposés à des bruits et des lumières intenses; ceci peut induire un stress important pour l'enfant qui est déjà vulnérable du fait de sa prématurité. Lorsque confronté à une situation stressante, l'organisme humain réagit par l'activation de l'axe hypothalamo-hypophysio-surrénalien (HHS). Une des hormones principales sécrétées par l'axe HHS est le cortisol. Plusieurs études suggèrent que le cortisol, lorsque sécrété en quantités importantes, risque d'altérer la matière grise, en induisant une diminution de volume, notamment celui de l'hippocampe (Plotsky & Meaney, 1993; Sapolsky, 2000; McEwen, 1994; 2000; Sandman et al., 1994; Meaney et al., 1991;1996). Ces altérations auraient comme effet un dérèglement de l'axe HHS (Heim & Nemeroff, 1999) avec comme conséquence une variation de la réponse au stress mais aussi de la mémoire et de la régulation émotionnelle (Stam et al., 2000 et Siegel, 1998). Objectifs: Nous allons nous intéresser aux grands prématurés nés à moins de 32 semaines de gestations selon leur exposition à des interventions stressantes et douloureuses ou des complications postnatales. Nous allons étudier l'impact qu'un stress modéré ou sévère sur un prématuré a sur la réponse de l'axe HHS et sur sa régulation émotionnelle lorsque celui-ci est confronté à des situations de stress modéré ultérieurement, plus précisément à six mois d'age corrigé. Méthodologie: Dans le cadre de l'étude «Stress néonatal et réactivité au stress ultérieur: effets préventifs d'une intervention précoce» (SNF 3200 BO-104230) menée au SUPEA en collaboration avec le service de néonatologie du DMCP, le Lab-TAB (Laboratory Temperament Assessment Battery, prelocomotor version 3.1, Goldsmith & Rothbart, 1999) a été utilisé comme outil pour analyser le tempérament d'un enfant par l'analyse de ses réactions émotionnelles à certaines situations. L'enfant, qui était filmé, a été confronté à des mises en scène conçues pour susciter diverses émotions comme la peur, la colère, la frustration, la curiosité ou le plaisir. Un système de codage dérivé de celui du Lab-TAB sera utilisé par deux codeurs différents pour analyser les réactions émotionnelles des enfants. Les taux de cortisol sécrétés ont été mesurés dans la salive de l'enfant. La mesure du cortisol libre dans la salive montre une bonne corrélation avec le cortisol plasmatique ; plusieurs prélèvements de salive ont été faits avant, pendant et après la situation de stress. Les situations filmées n'ont pas encore été codés, ni les taux analysés par l'équipe de la SUPEA. Nous allons observer 40 vidéos, 20 d'enfants nés prématurément et 20 d'enfants nés à terme comme groupe contrôle, et examiner la réponse endocrinienne au stress ainsi que leur régulation émotionnelle au niveau de leur comportement comme l'excitation, les pleurs, l'évitement... Hypothèse : L'intensité de l'exposition au stress postnatal chez l'enfant prématuré induirait des variations de la réponse de l'axe HHS mais aussi de la régulation émotionnelle. Il n'est pas clair selon la littérature actuelle si les variations des réponses de l'axe HHS dues à l'exposition à un stress précoce vont dans les sens de l'hypo- ou l'hyperréactivité, et si cette réponse corrèle avec la régulation émotionnelle au niveau des comportements. C'est ce que l'analyse des données nous permettra de déterminer.

To return or to discard? Randomised trial on gastric residual volume management

Background: The control of gastric residual volume (GRV) is a common nursing intervention in intensive care; however the literature shows a wide variation in clinical practice regarding the management of GRV, potentially affecting patients" clinical outcomes. The aim of this study is to determine the effect of returning or discarding GRV, on gastric emptying delays and feeding, electrolyte and comfort outcomes in critically ill patients. Method: A randomised, prospective, clinical trial design was used to study 125 critically ill patients, assigned to the return or the discard group. Main outcome measure was delayed gastric emptying. Feeding outcomes were determined measuring intolerance indicators, feeding delays and feeding potential complications. Fluid and electrolyte measures included serum potassium, glycaemia control and fluid balance. Discomfort was identified by significant changes in vital signs. Results: Patients in both groups presented similar mean GRV with no significant differences found (p=0.111), but participants in the intervention arm showed a lower incidence and severity of delayed gastric emptying episodes (p=0.001). No significant differences were found for the rest of outcome measurements, except for hyperglycaemia. Conclusions: The results of this study support the recommendation to reintroduce gastric content aspirated to improve GRV management without increasing the risk for potential complications.

Late Major Hemoptysis After Lung Volume Reduction With Coils Induced by Dual Antiaggregation Therapy.

Lung-volume reduction using coils is an effective and safe treatment for selected patients presenting severe emphysema and hyperinflation. Most complications occur during the first 30 days after the procedure. Although frequent, hemoptysis is usually transient and minor. Antiaggregation therapy is common in patients with emphysema who, very often, have additional tobacco-associated comorbidities. Aspirin is considered safe for most major interventions; however, clopidogrel is mainly contraindicated and considered an exclusion criterion. We present a case of life-threatening hemoptysis caused by dual antiaggregation therapy "accidentally" introduced 3 months after the procedure. So far no recommendations exist on the optimal therapeutic strategy after lung-volume reduction with coils.

Thoracic fat volume is independently associated with coronary vasomotion.

PURPOSE: Thoracic fat has been associated with an increased risk of coronary artery disease (CAD). As endothelium-dependent vasoreactivity is a surrogate of cardiovascular events and is impaired early in atherosclerosis, we aimed at assessing the possible relationship between thoracic fat volume (TFV) and endothelium-dependent coronary vasomotion. METHODS: Fifty healthy volunteers without known CAD or major cardiovascular risk factors (CRFs) prospectively underwent a (82)Rb cardiac PET/CT to quantify myocardial blood flow (MBF) at rest, and MBF response to cold pressor testing (CPT-MBF) and adenosine (i.e., stress-MBF). TFV was measured by a 2D volumetric CT method and common laboratory blood tests (glucose and insulin levels, HOMA-IR, cholesterol, triglyceride, hsCRP) were performed. Relationships between CPT-MBF, TFV and other CRFs were assessed using non-parametric Spearman rank correlation testing and multivariate linear regression analysis. RESULTS: All of the 50 participants (58 ± 10y) had normal stress-MBF (2.7 ± 0.6 mL/min/g; 95 % CI: 2.6-2.9) and myocardial flow reserve (2.8 ± 0.8; 95 % CI: 2.6-3.0) excluding underlying CAD. Univariate analysis revealed a significant inverse relation between absolute CPT-MBF and sex (ρ = -0.47, p = 0.0006), triglyceride (ρ = -0.32, p = 0.024) and insulin levels (ρ = -0.43, p = 0.0024), HOMA-IR (ρ = -0.39, p = 0.007), BMI (ρ = -0.51, p = 0.0002) and TFV (ρ = -0.52, p = 0.0001). MBF response to adenosine was also correlated with TFV (ρ = -0.32, p = 0.026). On multivariate analysis, TFV emerged as the only significant predictor of MBF response to CPT (p = 0.014). CONCLUSIONS: TFV is significantly correlated with endothelium-dependent and -independent coronary vasomotion. High TF burden might negatively influence MBF response to CPT and to adenosine stress, even in persons without CAD, suggesting a link between thoracic fat and future cardiovascular events.

Independent and combined associations of risky single-occasion drinking and drinking volume with alcohol use disorder: Evidence from a sample of young Swiss men.

BACKGROUND: Risky single-occasion drinking (RSOD) is a prevalent and potentially harmful alcohol use pattern associated with increased alcohol use disorder (AUD). However, RSOD is commonly associated with a higher level of alcohol intake, and most studies have not controlled for drinking volume (DV). Thus, it is unclear whether the findings provide information about RSOD or DV. This study sought to investigate the independent and combined effects of RSOD and DV on AUD. METHODS: Data were collected in the longitudinal Cohort Study on Substance Use Risk Factors (C-SURF) among 5598 young Swiss male alcohol users in their early twenties. Assessment included DV, RSOD, and AUD at two time points. Generalized linear models for binomial distributions provided evidence regarding associations of DV, RSOD, and their interaction. RESULTS: DV, RSOD, and their interaction were significantly related to the number of AUD criteria. The slope of the interaction was steeper for non/rare RSOD than for frequent RSOD. CONCLUSIONS: RSOD appears to be a harmful pattern of drinking, associated with increased AUD and it moderated the relationship between DV and AUD. This study highlighted the importance of taking drinking patterns into account, for both research and public health planning, since RSO drinkers constitute a vulnerable subgroup for AUD.

Role of Doppler ultrasonography evaluation of superior mesenteric artery flow volume in the assessment of Crohn's disease activity

Objective To investigate superior mesenteric artery flow measurement by Doppler ultrasonography as a means of characterizing inflammatory activity in Crohn's disease. Materials and Methods Forty patients were examined and divided into two groups – disease activity and remission – according to their Crohn's disease activity index score. Mean superior mesenteric artery flow volume was calculated for each group and correlated with Crohn's disease activity index score. Results The mean superior mesenteric artery flow volume was significantly greater in the patients with active disease (626 ml/min ± 236 × 376 ml/min ± 190; p = 0.001). As a cut off corresponding to 500 ml/min was utilized, the superior mesenteric artery flow volume demonstrated sensitivity of 83% and specificity of 82% for the diagnosis of Crohn's disease activity. Conclusion The present results suggest that patients with active Crohn's disease have increased superior mesenteric artery flow volume as compared with patients in remission. Superior mesenteric artery flow measurement had a good performance in the assessment of disease activity in this study sample.

Multidetector-row computed tomography in the preoperative diagnosis of intestinal complications caused by clinically unsuspected ingested dietary foreign bodies: a case series emphasizing the use of volume rendering techniques

Objective The present study was aimed at describing a case series where a preoperative diagnosis of intestinal complications secondary to accidentally ingested dietary foreign bodies was made by multidetector-row computed tomography (MDCT), with emphasis on complementary findings yielded by volume rendering techniques (VRT) and curved multiplanar reconstructions (MPR). Materials and Methods The authors retrospectively assessed five patients with surgically confirmed intestinal complications (perforation and /or obstruction) secondary to unsuspected ingested dietary foreign bodies, consecutively assisted in their institution between 2010 and 2012. Demographic, clinical, laboratory and radiological data were analyzed. VRT and curved MPR were subsequently performed. Results Preoperative diagnosis of intestinal complications was originally performed in all cases. In one case the presence of a foreign body was not initially identified as the causal factor, and the use of complementary techniques facilitated its retrospective identification. In all cases these tools allowed a better depiction of the entire foreign bodies on a single image section, contributing to the assessment of their morphology. Conclusion Although the use of complementary techniques has not had a direct impact on diagnostic performance in most cases of this series, they may provide a better depiction of foreign bodies' morphology on a single image section.

Prognostic value of baseline total metabolic tumor volume (TMTV0) measured on FDG-PET/CT in patients with peripheral T-cell lymphoma (PTCL).

BACKGROUND: Most peripheral T-cell lymphoma (PTCL) patients have a poor outcome and the identification of prognostic factors at diagnosis is needed. PATIENTS AND METHODS: The prognostic impact of total metabolic tumor volume (TMTV0), measured on baseline [(18)F]2-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography, was evaluated in a retrospective study including 108 PTCL patients (27 PTCL not otherwise specified, 43 angioimmunoblastic T-cell lymphomas and 38 anaplastic large-cell lymphomas). All received anthracycline-based chemotherapy. TMTV0 was computed with the 41% maximum standardized uptake value threshold method and an optimal cut-off point for binary outcomes was determined and compared with others prognostic factors. RESULTS: With a median follow-up of 23 months, 2-year progression-free survival (PFS) was 49% and 2-year overall survival (OS) was 67%. High TMTV0 was significantly associated with a worse prognosis. At 2 years, PFS was 26% in patients with a high TMTV0 (>230 cm(3), n = 53) versus 71% for those with a low TMTV0, [P < 0.0001, hazard ratio (HR) = 4], whereas OS was 50% versus 80%, respectively, (P = 0.0005, HR = 3.1). In multivariate analysis, TMTV0 was the only significant independent parameter for both PFS and OS. TMTV0, combined with PIT, discriminated even better than TMTV0 alone, patients with an adverse outcome (TMTV0 >230 cm(3) and PIT >1, n = 33,) from those with good prognosis (TMTV0 ≤230 cm(3) and PIT ≤1, n = 40): 19% versus 73% 2-year PFS (P < 0.0001) and 43% versus 81% 2-year OS, respectively (P = 0.0002). Thirty-one patients (other TMTV0-PIT combinations) had an intermediate outcome, 50% 2-year PFS and 68% 2-year OS. CONCLUSION: TMTV0 appears as an independent predictor of PTCL outcome. Combined with PIT, it could identify different risk categories at diagnosis and warrants further validation as a prognostic marker.

Strategies to evaluate the impact of rectal volume on prostate motion during three-dimensional conformal radiotherapy for prostate cancer

Abstract Objective: To evaluate the rectal volume influence on prostate motion during three-dimensional conformal radiotherapy (3D-CRT) for prostate cancer. Materials and Methods: Fifty-one patients with prostate cancer underwent a series of three computed tomography scans including an initial planning scan and two subsequent scans during 3D-CRT. The organs of interest were outlined. The prostate contour was compared with the initial CT images considering the anterior, posterior, superior, inferior and lateral edges of the organ. Variations in the anterior limits and volume of the rectum were assessed and correlated with prostate motion in the anteroposterior direction. Results: The maximum range of prostate motion was observed in the superoinferior direction, followed by the anteroposterior direction. A significant correlation was observed between prostate motion and rectal volume variation ( p = 0.037). A baseline rectal volume superior to 70 cm3 had a significant influence on the prostate motion in the anteroposterior direction ( p = 0.045). Conclusion: The present study showed a significant interfraction motion of the prostate during 3D-CRT with greatest variations in the superoinferior and anteroposterior directions, and that a large rectal volume influences the prostate motion with a cutoff value of 70 cm3. Therefore, the treatment of patients with a rectal volume > 70 cm3 should be re-planned with appropriate rectal preparation.

Guillem Masó, mercader de Sant Joan de les Abadesses: bestiar, draps i crèdit en una vila monàstica al darrer quart del segle XIV

El present treball es fonamenta amb el contingut del llibre particular o extraordinari del mercader Guillem Masó, de Sant Joan de les Abadesses, actiu durant la segona meitat del segle XIV. La majoria d’assentaments que conté el volum fan referència a tractes de bestiar, amb la inclusió de diverses tipologies o variants en els contractes, des de la simple compravenda fins a comandes-parceria. L’activitat del mercader Masó, tanmateix, no se centra exclusivament en aquests negocis. S’intueix una diversificació de les seves activitats que es vinculen, fonamentalment, amb la producció i comercialització de draps de llana i de lli. El context social i econòmic de la vila de Sant Joan durant aquest període afavoreix la presència d’aquests empresaris tèxtils que, per a aconseguir els seus objectius, s’introdueixen en els ressorts del poder civil de la vila i en els dels gremis i confraries que regulen i controlen els processos de fabricació dels productes