M Keilani

Effect of ischemic preconditioning in skeletal muscle measured by functional magnetic resonance imaging and spectroscopy: a randomized crossover trial

BackgroundNuclear magnetic resonance (NMR) imaging and spectroscopy have been applied to assess skeletal muscle oxidative metabolism. Therefore, in-vivo NMR may enable the characterization of ischemia-reperfusion injury. The goal of this study was to evaluate whether NMR could detect the effects of ischemic preconditioning (IPC) in healthy subjects.MethodsTwenty-three participants were included in two randomized crossover protocols in which the effects of IPC were measured by NMR and muscle force assessments. Leg ischemia was administered for 20 minutes with or without a subsequent impaired reperfusion for 5 minutes (stenosis model). IPC was administered 4 or 48 hours prior to ischemia. Changes in 31phosphate NMR spectroscopy and blood oxygen level-dependent (BOLD) signals were recorded. 3-Tesla NMR data were compared to those obtained for isometric muscular strength.ResultsThe phosphocreatine (PCr) signal decreased robustly during ischemia and recovered rapidly during reperfusion. In contrast to PCr, the recovery of muscular strength was slow. During post-ischemic stenosis, PCr increased only slightly. The BOLD signal intensity decreased during ischemia, ischemic exercise and post-ischemic stenosis but increased during hyperemic reperfusion. IPC 4 hours prior to ischemia significantly increased the maximal PCr reperfusion signal and mitigated the peak BOLD signal during reperfusion.ConclusionsIschemic preconditioning positively influenced muscle metabolism during reperfusion; this resulted in an increase in PCr production and higher oxygen consumption, thereby mitigating the peak BOLD signal. In addition, an impairment of energy replenishment during the low-flow reperfusion was detected in this model. Thus, functional NMR is capable of characterizing changes in reperfusion and in therapeutic interventions in vivo.Trial RegistrationClinicalTrials.gov: NCT00883467

Extracorporeal shockwave treatment is effective in calcific tendonitis of the shoulder. A randomized controlled trial.

SummaryBackgroundCalcific tendonitis of the shoulder is often associated with chronic pain and impairment of function. Extracorporeal Shockwave therapy (ESWT) is considered to be a treatment option. We compared the effects of two different ESWT regimens.Methods43 patients (57 shoulders) with symptomatic calcific tendonitis of the shoulder for more than six months were included in a double-blinded study. Thirty-one shoulders were treated at the area of maximum pain with application of 2×2000 impulses of 0.28mJ/mm2 at an interval of two weeks (treatment group) and 26 shoulders with 2×2000 impulses of <0.07mJ/mm2 at an interval of two weeks (control group), without pretreatment analgesia. Shoulder function (Constant score) and pain (visual analogue scale, VAS) were assessed before treatment and at one week, three months and seven months after treatment. Shoulder X-rays were performed at the 3- and 7-month follow-up visits.ResultsImprovement in Constant score was significantly higher in the treatment group at all follow-up visits (p<0.05). Seven months post-treatment, calcifications dissolved completely in 19% of the treatment group and 8% of the control group, and a >50% reduction was observed in 19% and 8% respectively. With regard to reduction of pain, there was significant improvement in the treatment group compared with the control group at the 1-week follow-up (p<0.05). However, at the 3-month and 7-month visits, no significant between-group difference in pain could be detected.ConclusionAs applied, ESWT with an energy flux density of 0.28mJ/mm2 led to a significantly greater improvement in shoulder function and a slightly higher, nonsignificant, rate of > 50% disintegration of calcific deposits compared with the control group. However, this did not result in reduction of pain.

Aerobic Exercise as Additive Palliative Treatment for a Patient with Advanced Hepatocellular Cancer

SummaryAerobic exercise is known to improve biopsychosocial outcomes in cancer patients. Currently, exercise is not regarded as a quality-of-life intervention for patients with advanced cancer. The aim of this case study was to determine the feasibility and effects of an aerobic exercise programme for a patient with advanced hepatocellular cancer.After written informed consent, a 55-year-old male patient with advanced hepatocellular carcinoma participated in an aerobic exercise programme of precise intensity, duration and frequency, consisting of ergometer cycling 2 times a week, carried out for a period of 6 weeks. Exercise testing and a 6-min walk were performed, and the patient’s quality of life was assessed.The feasibility, safety and beneficial effects of the programme were proven for this patient. At the end of the exercise programme, peak work capacity had increased by 20.3%. The patient has experienced an improvement in physical performance, which was underlined by the 6-min walk. Quality of life has been improved (physical functioning, vitality, mental health, role functioning/ emotional, social functioning).Knowledge about the benefits of aerobic exercise for patients suffering from advanced cancer is not yet widespread. Nevertheless, aerobic exercise initiated and executed with appropriate care may serve as a useful additional means of palliative treatment in some patients with advanced cancer.ZusammenfassungAerobes Ausdauertraining hat bekannte positive Effekte auf biopsychosoziale Parameter von Krebspatienten. Derzeit gilt Trainingstherapie nicht als lebensqualitätsverbessernde Maßnahme für Patienten mit fortgeschrittenen Karzinomen. Ziel dieser Fallstudie war es, die Machbarkeit und Effekte eines aeroben Ausdauertrainingsprogramms bei einem Patienten mit fortgeschrittenem hepatozellul7#x00E4;ren Karzinom zu bestimmen. Nach schriftlicher Einwilligung nahm ein 55jähriger männlicher Patient mit fortgeschrittenem hepatozellulärem Karzinom an einem aeroben Ausdauertraining, das nach den Regeln der medizini-schen Trainingslehre durchgeführt wurde, teil. Dabei handelte es sich um ein Fahrradergometertraining, welches zweimal wöchentlich über einen Zeitraum von 6 Wochen durchgeführt wurde. Ergometrien, sechsminütige Gehtests sowie Lebensqualitätsuntersuchungen wurden durchgeführt. Machbarkeit, Sicherheit und positive Effekte des Trainingsprogramms konnten für diesen Patienten bewiesen werden. Nach Beendigung des Trainingsprogramms hatte sich die Leistungsfähigkeit des Patienten um 20,3% verbessert. Der Patient gab eine deutliche Verbesserung seiner körperlichen Leistungsfähigkeit an, was durch das Ergebnis des sechsminütigen Gehtests unterstrichen wurde. Die Lebensqualität verbesserte sich in den Domänen „Körperliche Leistungsfähigkeit“, „Vitalität“, „Mentale Gesundheit“, „Emotionale Rollenfunktion“ und „Soziale Kompetenz“. Das Wissen um positive Effekte aeroben Ausdauertrainings bei Patienten mit fortgeschrittenen Karzinomen und infauster Prognose ist derzeit noch nicht stark verbreitet. Dennoch kann aerobes Ausdauertraining, wenn es entsprechend den Gesetzen der medizinischen Trainingslehre durchgeführt wird, eine sinnvolle Ergänzung in der palliativen Behandlung mancher Patienten mit fortgeschrittener Krebserkrankung darstellen.

Safety of a combined strength and endurance training using neuromuscular electrical stimulation of thighs muscles in patients with heart failure and bipolar sensing cardiac pacemakers

ZusammenfassungFür Patienten mit schwerer chronischer Herzinsuffizienz ist Ausdauer- und Krafttraining durch neuromuskuläre Elektrostimulation (NMES) eine effektive und nicht belastende Alternative zum aktiven Training. Wegen möglicher elektromagnetischer Interferenz werden Herzschrittmacherpatienten häufig von einer NMES-Behandlung ausgeschlossen. Ziel dieser Pilotstudie war die Untersuchung der Sicherheit eines kombinierten NMES-Ausdauer- und Krafttrainingsprotokolles für Patienten mit Herzschrittmachern.In die Studie wurden sieben Patienten mit schwerer chronischer Herzinsuffizienz und implantierten Herzschrittmachern mit bipolar wahrnehmenden Elektroden eingeschlossen und ein ärztlich supervidiertes kombiniertes Ausdauer- und Krafttraining mittels NMES unter Pulsmonitoring durchgeführt. Das NMES-Protokoll bestand aus biphasischen, symmetrischen Rechteckimpulsen mit unterschiedlichen Frequenzen von 8 Hz bis 50 Hz, Impulsdauern bis 60 s (8 Hz), 4s (15 Hz), 4 s (30 Hz) und 6 s (50 Hz), sowie Amplituden bis ±100 mA (alle Frequenzen). Die Stromapplikation erfolgte über Oberflächenelektroden (8×13 cm) im Bereich der Streck- und Beugemuskulatur beider Oberschenkel.Eine akute elektromagnetische Interferenz trat im Verlauf eines Sicherheitschecks (Telemetriemonitoring) vor Beginn der NMES-Therapie bei keinem der Patienten auf. Den 7 Patienten wurden während jeweils 20 NMES-Therapie-Einheiten komplikationslos bei insgesamt 23.380 Einschaltphasen 2.194,08×103 Stimuli appliziert. Es wurden keine Änderungen der simultan registrierten Herzfrequenz detektiert und keine Fehlfunktion des Schrittmachers festgestellt.Die Durchführung eines kombinierten NMES-Ausdauer-und Krafttrainingsprogrammes der Oberschenkelmuskulatur erscheint bei Patienten mit Herzinsuffizienz und implantierten bipolaren Herzschrittmachern unter Berücksichtigung der beschriebenen Elektrodenlagen und Parametergrenzen sicher.SummaryNeuromuscular electrical stimulation (NMES) is an effective and non-strenuous therapy to enhance the strength and endurance capacity of the skeletal muscles in patients with severe chronic heart failure. NMES in patients with pacemakers is controversial because potential electromagnetic interference may result in pacemaker malfunction. Therefore, such patients are in general excluded from NMES. The aim of this pilot study was to evaluate the safety of a combined NMES protocol to increase strength and endurance capacity of the skeletal muscles in patients with heart failure and implanted pacemakers.Seven patients with chronic heart failure and implanted cardiac pacemakers with bipolar sensing leads received NMES treatment of thigh muscles, using a combined protocol comprising biphasic, symmetric, rectangular constant current impulses at different frequencies (8–50 Hz), pulse width up to 60 s (8 Hz), 4 s (15 Hz), 4 s (30 Hz), and 5 s (50 Hz), and amplitudes up to ±100 mA (all frequencies) applied to both knee extensor and flexor muscles via surface electrodes (8×13 cm each).Acute electromagnetic interference during a safety procedure (telemetric monitoring) before therapeutic NMES application was not observed in any of the patients. The 7 patients received during 20 therapeutic NMES sessions a total of 23,380 on-phases, comprising 2194.08×103 biphasic electrical pulses, without adverse events. Heart rate monitoring during stimulation and pacemaker interrogation revealed no abnormalities.NMES treatment of thigh muscles using a combined NMES protocol to enhance strength and endurance capacity appears to be safe in patients with heart failure and implanted pacemakers with bipolar sensing, as far as the described electrode configuration and parameter range is applied.

Resistance exercise and secondary lymphedema in breast cancer survivors-a systematic review.

PurposeThe aim of the present review was to determine effects of strength exercise on secondary lymphedema in breast cancer patients.MethodsResearch was conducted by using the databases PubMed/Medline and Embase. Randomized controlled trials published from January 1966 to May 2015 investigating the effects of resistance exercise on breast cancer patients with or at risk of secondary lymphedema in accordance with the American College of Sports Medicine exercise guidelines for cancer survivors were included in the present study.ResultsNine original articles with a total of 957 patients met the inclusion criteria. None of the included articles showed adverse effects of a resistance exercise intervention on lymphedema status. In all included studies, resistance exercise intensity was described as moderate to high.ConclusionsStrength exercise seems not to have negative effects on lymphedema status or might not increase risk of development of lymphedema in breast cancer patients. Further research is needed in order to investigate the effects of resistance exercise for patients suffering from lymphedema.

Strength of skeletal muscle and quality of life in patients suffering from “typical male” carcinomas

AimThis pilot study aimed to compare muscle strength and quality of life (QOL) in cancer patients suffering from two different “typical male” cancer entities (prostate cancer and head and neck cancer).MethodsThe Biodex System 3 device was used for isokinetic strength testing of thigh muscles in both groups. QOL was evaluated by using the SF-36 Health Survey.Results and discussionSurprisingly, prostate cancer patients showed significantly higher values for muscular strength of thigh muscles than significant younger patients with head and neck cancer. Furthermore, prostate cancer patients revealed significantly better values in QOL subscales “bodily pain” and “physical functioning”.

Aerobes Ausdauertraining für Krebspatienten

ZusammenfassungMit zunehmender Zahl an mittelbis langfristig überlebenden Krebspatienten steigt der Bedarf an Mitteln zur Behandlung der physischen und psychischen Begleiterscheinungen und Nebenwirkungen der Krebserkrankung und ihrer onkologischen Therapie. Verminderte körperliche Leistungsfähigkeit, Erschöpfung/Fatigue, Übelkeit, Gewichtsverlust, psychologischer Distreß, Körperschemastörungen, Abhängigkeit und verminderte Lebensqualität sind Kurz- und Langzeitfolgen bei Krebserkrankungen.Wir beschreiben die wissenschaftliche Datenlage erstens über Effekte des aeroben Ausdauertrainings bei Krebspatienten, und über die Machbarkeit des aeroben Ausdauertrainings, zweitens unter onkologischer Therapie und drittens bei Patienten mit fortgeschrittener Krebserkrankung.Die Daten aus der Literatur belegen, daß aerobes Ausdauertraining als additive Therapiemaßnahme hilft, die Dekonditionierung und körperlichen Einschränkungen zu überwinden und somit zur Rehabilitation und zur Besserung der Lebensqualität von Krebspatienten beitragen kann. Die Machbarkeit des aeroben Ausdauertrainings konnte auch für Patienten, die an fortgeschrittener Krebserkrankung leiden, demonstriert werden. Aerobes Ausdauertraining hat sich als positiv für Krebspatienten erwiesen, da es die Rekonditionierung ermöglicht, wodurch den Patienten die Rückkehr zu einem aktiven Lebensstil ermöglicht wird. Aerobes Ausdauertraining scheint eine effektive Möglichkeit zu sein, die Folgen einer Krebserkrankung zu vermindern und damit zur Steigerung der Lebensqualität beizutragen.SummaryWith the increase in the number of patients who survive cancer, there is a growing need to attend to the physical and emotional effects of cancer and oncological treatment. Reduced physical performance, fatigue, nausea, weight gain, psychological distress, changes in body image, dependency, and reduced quality of life are some of the short- and long-term sequelae of cancer.We describe data from the literature about firstly the effects of aerobic exercise as an additive treatment for cancer patients, and about the feasibility of aerobic exercise secondly during oncological treatment, and thirdly in patients suffering from terminal cancer.The data from the literature support that exercise as an additive treatment may help to attenuate the physical limitations caused by cancer and oncological treatment and there by contribute to rehabilitation and quality of life of cancer patients. Feasibility of aerobic exercise has been demonstrated also for patients suffering from advanced cancer. Aerobic exercise has been shown to provide benefits to cancer patients. It enables these patients to recover their physical function and to return to an active lifestyle. Aerobic exercise seems to be an effective possibility to reduce sequelea of cancer and to increase quality of life.

Skateboarding Injuries in Vienna: Location, Frequency, and Severity

To describe injury patterns of skateboard‐associated injuries (SAIs) and to assess the frequency and severity of SAIs depending on an athletes skateboarding experience.

Serum levels of tumour necrosis factor-α and interleukin-6 and their correlation with body mass index, weight loss, appetite and survival rate – preliminary data of Viennese outpatients with metastatic cancer during palliative chemotherapy

The serum cytokine levels (in particular interleukine-6 (IL-6) and tumour necrosis factor-alpha (TNF-alpha)) of 61 advanced stage cancer patients receiving palliative chemotherapy as outpatients were determined with quantikine immunoassays. The values were correlated with body mass index (BMI), weight loss and appetite. Furthermore cytokine levels of patients who have died within one year were compared with those of patients who have survived more than a year. Serum levels of IL-6 (median: 1.93 pg/ml, range: 0.32-42.87) and of TNF-alpha (median: 2.55 pg/ml, range: 1.03-34.06) did not correlate with BMI, weight loss and appetite. Serum IL-6 levels of patients with survival time less than one year were significantly higher than the levels of patients who survived more than one year, no significant differences in TNF-alpha serum levels were evident. The data of this observation are consistent with current literature. Due to changes in serum levels of proinflammatory cytokines in response to chemotherapy and additional therapy, it is unlikely that IL-6 and TNF-alpha can be used as independent indicators for weight loss and appetite. Nevertheless, high serum levels of IL-6 correlate with short-time mortality.

Effects of neuromuscular electrical stimulation of the knee extensor muscles on muscle soreness and different serum parameters in young male athletes: preliminary data

Aim: To evaluate the effects of neuromuscular electrical stimulation (NMES) on muscle soreness and on a variety of serum parameters during and after NMES of knee extensor muscles of young, well trained subjects over a study period of 96 h. Methods: Five male cyclists were included in this clinical observation. NMES (biphasic, asymmetric impulses) was applied through surface electrodes to both knee extensor muscles of each subject for 30 min. To determine changes in serum concentration of muscle proteins, blood samples were drawn at defined measure points before and after NMES. Muscle soreness was evaluated using a visual analogue scale at all measure points. Results: There was a maximum (p<0.05) for “muscle pain” during stimulation but no significant changes could be detected after the stimulation period. Serum creatine kinase showed a peak with a significant increase (p<0.05) 24 h after NMES. Serum lactate levels only increased slightly (p = 0.08) during NMES. Conclusions: Although the changes of blood parameters measured in the present work correspond to those reported in the literature on eccentric strength training, no delayed onset muscle pain could be detected. Further studies should be carried out, also investigating different stimulation protocols in non-trained healthy subjects and in patients with less muscle mass.