Left ventricular false tendons and electrocardiogram repolarization abnormalities in healthy young subjects

AIM To describe echocardiographically left ventricular false tendon characteristics and the correlation with ventricular repolarization abnormalities in young athletes.METHODS Three hundred and sixteen healthy young athletes from different sport disciplines were evaluated from 2009 to 2011 during routine screening for agonistic sports eligibility. All subjects, as part of standard preparticipation screening medical evaluation, underwent a basal and post step test 12-lead electrocardiogram(ECG). The athletes with abnormal T-wave flattening and/or inversion were considered for an echocardiogram evaluation and an incremental maximal exercise test on a cycle ergometer. Arterial blood pressure and heart rate, during and after exercise, were also measured.RESULTS Twenty-one of the 316 subjects(6.9%) showed false tendons in the left ventricle. The majority of false tendons(52.38%) were localized between the middle segments of the inferior septum and the lateral wall, 19.06% between the distal segments of the septum and the lateral wall, in 5 subjects between the middle segments of the anterior and inferior walls, and in one subject between the middle segments of the anterior septum and the posterior wall. ECG abnormalities, represented by alterations of ventricular repolarization, were found in 11 subjects(52.38%), 90% of these anomalies were T wave abnormalities from V1 to V3. These anomalies disappeared with an increasing heart rate following the three minute step test as well as during the execution of the maximal exercise.CONCLUSION Left ventricular false tendons are frequently localized between the middle segments of the inferior septum and the lateral wall and are statistically associated with ventricular repolarization abnormalities.

Physical exercise intensity prescription to improve health and fitness in overweight and obese subjects: A review of the literature

Obesity is one of the greatest public health challenges of the 21st century. Overweight and obesity drastically increase a person’s risk of developing chronic non-communicable diseases (NCDs), including cardiovascular disease, cancer and diabetes. Furthermore, obesity is already responsible for 2% -8% of health costs and 10% -13% of deaths in several industrialized countries. Lifestyle modifications involving changes in exercise, diet and psychological support are effective in reducing the incidence of overweight. Moreover, positive effects of physical activity (PA) for weight loss and prevention of weight regain are well documented. It was recognized that health benefits regarding both psychological and physiological aspects, such as improving cardiorespiratory and muscular fitness and/or decreasing depression symptoms, can be obtained from numerous activities. Public health institutions (American College of Sports Medicine, World Health Organization) provide recommendations for PA (volume, frequency, intensity and type of exercise) to achieve positive effects, at all ages and for many diseases and disorders situations. Although exercise under guidelines can be safely performed by obese subjects, several questions still need to be fully answered. In facts, the exercise program should be tailored according to an individual’s habitual physical activity, physical function, health status, exercise responses, and stated goals. Thus, this review analyzes the intensity of PA parameters. In the last years, research has been focused on the individualization of the right intensity in which different types of subjects’ condition must undergo to achieve the health goals. Aerobic exercise has been commonly used to reach weight loss goal. Prescription of aerobic exercise in clinical practice is frequently based on the percentage of maximum heart rate (%HRmax), heart rate reserve (%HRreserve), rating of perceived exertion (RPE), maximal oxygen consumption (%VO2max) and for unhealthy subjects, peak oxygen consumption (%VO2peak). It has been shown that unhealthy subjects, such as individuals affected by diabetes, obesity and cardiovascular diseases have a reduced maximal aerobic exercise capacity. For instance, using the formula based on percentage of HRmax or VO2max, it could be prescribed heavy exercises, which would result not appropriated and fully functional for the specific individual goal. To avoid this problem, another approach to individualize aerobic exercise could be to consider the gas exchange parameters such us aerobic gas exchange threshold (AerTGE). AerTGE corresponds to the first increase in blood lactate during incremental exercise. This review offers an overview of the different methods to assess exercise intensity, considering the different subjects health characteristics, in order to choose the right methods to achieve the health goals in obese and overweight subjects.

Wearable activity trackers and health awareness: Nursing implications

Purpose:Wearable devices are commonly used to measure physical activity.However,it remains unclear the effect of wearing these devices on health awareness.Our aim was to provide evidence related to wearing physical activity trackers and health awareness.Methods:A quantitative comparison study design was used comparing participants who wore physical activity tracking devices(n=108)and those who did not(n=112).A paper-based Physical Health Knowledge survey designed for the purpose of this research was used for data collection in 2018.Results:A difference between participants who wore physical activity tracking devices and those that did not was identified in relation to activity levels and physical health awareness.Wearable devices are suggested as an opportunity for nurses to engage people in physical activity with the potential to improve their health awareness.Conclusions:Nurses are well placed in the healthcare landscape to work with patients who own an activity tracker device concerning increasing activity self-monitoring.This information the patient has from the device can also form the basis of health discussions between nurses and the people in their care.

Common features between neoplastic and preneoplastic lesions of the biliary tract and the pancreas

the bile duct system and pancreas show many similarities due to their anatomical proximity and common embryological origin.Consequently,preneoplastic and neoplastic lesions of the bile duct and pancreas share analogies in terms of molecular,histological and pathophysiological features.Intraepithelial neoplasms are reported in biliary tract,as biliary intraepithelial neoplasm(BilIN),and in pancreas,as pancreatic intraepithelial neoplasm(PanIN).Both can evolve to invasive carcinomas,respectively cholangiocarcinoma(CCA)and pancreatic ductal adenocarcinoma(PDAC).Intraductal papillary neoplasms arise in biliary tract and pancreas.Intraductal papillary neoplasm of the biliary tract(IPNB)share common histologic and phenotypic features such as pancreatobiliary,gastric,intestinal and oncocytic types,and biological behavior with the pancreatic counterpart,the intraductal papillary mucinous neoplasm of the pancreas(IPMN).All these neoplastic lesions exhibit similar immunohistochemical phenotypes,suggesting a common carcinogenic process.Indeed,CCA and PDAC display similar clinic-pathological features as growth pattern,poor response to conventional chemotherapy and radiotherapy and,as a consequence,an unfavorable prognosis.The objective of this review is to discuss similarities and differences between the neoplastic lesions of the pancreas and biliary tract with potential implications on a common origin from similar stem/progenitor cells.

Myocarditis in athlete and myocardial bridge:An innocent bystander?

Myocarditis is a bacterial or viral inflammatory disease,often unnoticed or misdiagnosed.Athletes with myocarditis must stop practicing their activity since International medical Literature described some cases of sudden death.In the present report,we describe a case of an asymptomatic,apparently healthy,competitive athletes,who was diagnosed a myocarditis and as incidental finding a myocardial bridging.We focused the attention on the importance of anamnesis,electrocardiogram and athletes' entourage for the diagnosis of such insidious pathologies and we evaluated the follow up,focusing the attention on electrocardiogram changes as well as on restitution ad integrum and prognosis,especially for the athletes.

Feasibility of breaking up sitting time in mainstream and special schools with a cognitively challenging motor task

Background: Children spend 70% of the school day sitting in class. Classroom-based active breaks can benefit children's physical health, but if the breaks are cognitively demanding(i.e., combine physical exertion and mental engagement), they may also improve focus and cognitive functions. Teachers and students play a crucial role in the successful implementation of active breaks, and their perspectives are critical to the feasibility of these strategies. The aim of this study was to assess the feasibility of implementing a cognitively challenging motor task as an active break in mainstream and special primary schools.Methods: A total of 5 teachers in 2 mainstream schools and 7 teachers in 1 special school(attended by children with neurodevelopmental disorders) attended a 20-min training on how to implement a 4-min cognitively challenging active break, before conducting a feasibility trial(twice a day for 1 week). To understand individual perceptions, one-on-one semistructured interviews were conducted before and after the trial with teachers, and focus group interviews were conducted with typically developing children after the trial. Questions were based on a predefined framework for feasibility studies. All interviews were audio recorded, transcribed and analyzed in NVivo 11 using a framework approach. A total of 12 teachers(11 females; 7 between 20 and 34 years old) and 34 children(16 girls; 9.3 § 1.7 years, mean § SD) participated in the interviews.Results: In mainstream schools, teachers viewed the cognitively challenging motor task as appropriate and potentially beneficial for children's health and focus. Children reported enjoying the active breaks. Teachers in special schools viewed the task as complex and potentially frustrating for children. In both school types, children's disruptive behavior and lack of time were seen as the main potential barriers to implementation. The use of music, videos, visual cards, and support staff were noted as potential facilitators.Conclusion: The cognitively challenging motor task was a feasible way to interrupt children's sitting time and promote physical activity in mainstream schools, but required changes in special schools. Further research could investigate the effectiveness of these types of task interruptions on children's physical and cognitive health.

The demands of the extra-time period of soccer:A systematic review

Background:Soccer match-play is typically contested over 90 min;however,in some cup and tournament scenarios,when matches are tied,they proceed to an additional 30 min,which is termed "extra-time^(ET).This systematic review sought to appraise the literature available on 120-min of soccer-specific exercise,with a view to identifying practical recommendations and future research opportunities.Methods:The review was conducted according to the PRISMA guidelines.Independent researchers performed a systematic search of PubMed,CINAHL,and PsycINFO in May 2019,with the following keywords entered in various combinations:"soccer","football","extra-time","extra time","extratime","120 minutes","120 min","additional 30 minutes",and "additional 30 min".Results:The search yielded an initial 73 articles.Following the screening process,11 articles were accepted for analyses.Articles were subsequently organized into the following 5 categories:movement demands of ET,performance responses to ET,physiological and neuromuscular response during ET,nutritional interventions,and recovery and ET.The results highlighted that during competitive match-play,players cover5%-12% less distance relative to match duration(i.e.,meters per minute) during ET compared to the preceding 90 min.Reductions in technical performance(i.e.,shot speed,number of passes and dribbles) were also observed during ET.Additionally,carbohydrate provision may attenuate and improve dribbling performance during ET.Moreover,objective and subjective measures of recovery may be further compromised following ET when compared to 90 min.Conclusion:Additional investigations are warranted to further substantiate these findings and identify interventions to improve performance during ET.

Maturity-associated considerations for training load,injury risk,and physical performance in youth soccer:One size does not fit all

Biological maturation can be defined as the timing and tempo of progress to achieving a mature state.The estimation of age of peak height velocity(PHV)or percentage of final estimated adult stature attainment(%EASA)is typically used to inform the training process in young athletes.In youth soccer,maturity-related changes in anthropometric and physical fitness characteristics are diverse among individuals,particularly around PHV.During this time,players are also at an increased risk of sustaining an overuse or growth-related injury.As a result,the implementation of training interventions can be challenging.The purpose of this review was to(1)highlight and discuss many of the methods that can be used to estimate maturation in the applied setting and(2)discuss the implications of manipulating training load around PHV on physical development and injury risk.We have provided key stakeholders with a practical online tool for estimating player maturation status(Supplementary Maturity Estimation Tools).Whilst estimating maturity using predictive equations is useful in guiding the training process,practitioners should be aware of its limitations.To increase the accuracy and usefulness of data,it is also vital that sports scientists implement reliable testing protocols at predetermined time-points.

Attitudes, Knowledge, and Perceptions of Patients Regarding Type-2 Diabetes in Jordan

Introduction: Poorly controlled Type 2 diabetes is considered a major public health problem and associated with adverse outcomes in Jordan. Good diabetes knowledge may facilitate adaptation of healthy behaviors and improve patients’ adherence to their diabetes management plans. Purpose: To gain an in-depth understanding of attitudes, perceptions and knowledge of patients which underpin their behaviors in Jordan. Methods: 8 focus groups with 38 patients with poorly controlled Type 2 diabetes were conducted. The focus group sessions were audio recorded and transcribed. Thematic analysis was employed to analyze the qualitative data. All transcripts were uploaded into the qualitative data analysis software pack NVivo. Results: Patients reported the different ways in which they were diagnosed with Type 2 diabetes. Most of the patients visited the health facility after experiencing signs and symptoms of diabetes, often for some time before seeking medical help. Stress and family history were perceived as causes of developing diabetes and reasons for poorly controlled diabetes. Fatalistic beliefs were shared when the patients were talking about the causes of diabetes, the reasons for developing diabetes and their inability to control their blood glucose levels. Patients also associated fatalistic attitudes with religious beliefs and the power of God as illness being in God’s hands. Patients’ responses also showed a poor understanding of the basic knowledge of diabetes. Conclusions: Effective health education programs need to be tailored to meet the individual needs of patients. Patients need to be provided with accurate information about medications, side effects and therapeutic effects. An educational program may rectify misconceptions among

Acceptance and Commitment Therapy for Adults with ADHD during COVID-19: An Open Trial

This exploratory study reports the outcomes of a remotely delivered manualised form of Acceptance and Commitment Therapy (ACT) to adults with Attention Deficit Hyperactivity Disorder (ADHD) during the COVID-19 imposed “lockdown”. Adults completing this intervention (N = 12) reported statistically and clinically significant improvements on outcomes relating to self-reported mood F(1.356, 14.917) = 21.64, p < 0.001, η2 = 0.66), anxiety F(2, 22) = 22.93, p < 0.001, η2 = 0.68), psychosocial adjustment (χ2(4) = 26.51, p < 0.001) and treatment acceptability was good. Preliminary findings suggest this cost effective and remotely delivered psychotherapeutic approach might be one appropriate method for supporting the well-being and adjustment of adults with ADHD during future COVID-19 or other pandemic related lockdowns. Further research is urgently required to establish efficacy using larger sample sizes and the implementation of wait list and treatment comparison groups. Future research might also explore the use of this manualised approach in other clinical subgroups and the general population.

Sarcopenic Obesity: Correlation with Clinical, Functional, and Psychological Status in a Rehabilitation Setting

Obesity and sarcopenia combination, appropriately defined as sarcopenic obesity (SO), due to disproportionally reduced/low lean body mass compared to excess fat mass, may lead to disability. Aims: The aim of our study was to investigate the relationship among sarcopenic obesity, physical performance, disability, and quality of life in a rehabilitation setting. Methods: Participants were recruited among obese patients (BMI > 30 kg/m2) admitted to the rehabilitation facility at the Department of Experimental Medicine, Medical Physiopatology, Food Science and Endocrinology Section during a 1-year period. A multidimensional evaluation was performed through bioelectrical impedance analysis and anthropometry, handgrip strength test, Short Physical Performance Battery (SPPB), 6-minute walk test (6MWT) and blood chemistry parameters. Psychological status (SCL-90 questionnaire), quality of life, and comorbidity (Charlson comorbidity index score) were also evaluated. Obesity was diagnosed as increased fat mass by 35% in women and by 25% in men. Sarcopenia was defined if lean body mass (LBM) was <90% of the subject’s ideal LBM. Results: 79 patients (48 women and 31 men;mean age: 60.1 ± 11.5 years, and 58.6 ± 10.8 years, respectively) were enrolled. Results showed a high prevalence of SO (54.4%) in our samples of obese subjects. Sarcopenia was present not only among older obese adults but also among younger obese subjects, and was related to reduced functional performance, to inflammatory status and to worse psychological status and quality of life.

Effects of physical activity in Parkinson's disease: A new tool for rehabilitation

Parkinson's disease(PD) is a common neurodegenerative disease characterized by bradykinesia, tremor, rigidity, and postural instability. Motor disorders are composite and combined, adversely affecting the patient's health. Tremor and rigidity are correlated with worsening manual dexterity as well as postural changes such as akinesia and camptocormia. Moreover, gait alteration as well as postural instability, with consequent impairment in balance, increase the risk of falls. It is well known that these symptoms respond poorly to pharmacologic therapy in PD patients. Physical therapy is the most effective non-pharmacological aid to PD patients. Available data in the literature indicate that any rehabilitation protocol has to focus on: cognitive movement strategies, cueing strategies, and improved physical capacity and balance. Different training programs for PD patients have been designed and evaluated but only specific training strategies, tailored and individualized for each patient, may produce improvements in gait speed and stride length, decrease motor and balance symptoms and improve quality of life. Furthermore, aerobic training may improve muscle trophism, strength and mobility. It seems reasonable to state that tailoredphysical activity is a valid tool to be included in the therapeutic program of PD patients, considering that this approach may ameliorate the symptoms as well as the overall physical incapacity, reduce the risk of falls and injuries, and ultimately improve quality of life.

Pre-participation screening for the prevention of sudden cardiac death in athletes

Pre-partecipation screening is the systematic practice of medically evaluating large populations of athletes before participation in sport activities for the purpose of identifying abnormalities that could cause disease progression or sudden death.In order to prevent sudden cardiac death(SCD),cardiovascular screening should include a strategy for excluding high-risk subjects from athletic and vigorous exercise.There are two major screening programmes in the world.In the United States competitive athletes are screened by means of family and personal history and physical examination.In Italy there is a mandatory screening for competitive athletes,which includes a resting electrocardiogram(ECG)for the detection of cardiac abnormalities.The most important issue to be addressed is whether a screened subject is really guaranteed that she/he is not suffering from any cardiac disease or at risk for SCD.Conceivably,the introduction of echocardiogram during the pre-participation screening,could be reasonable,despite the discrete sensitivity of ECG,in raising clinical suspicions of severe cardiac alterations predisposing to SCD.It is clear that the costbenefit ratio per saved lives of the ECG screening is abenchmark of the Public Health policy.On the contrary,the additional introduction of echocardiography in a large population screening programme seems to be too much expansive for the Public Health and for this reason not easily practicable,even if useful and not invasive.Even if we strongly believe that a saved life is more important than any cost-efficacy evaluation,the issue of the economical impact of this approach should be further assessed.

用威斯康星卡片分类测验不能确定急性运动对执行功能的影响（英文）

目的:已有研究将急性运动与执行功能改善相关联,但关于用威斯康星卡片分类测验(Wisconsin Card Sorting Test,WCST)评估的执行功能还很少被了解。本研究包括两项实验,目的是确定急性有氧运动是否会影响连续的WCST表现。方法:在实验1中,27名青年被随机分到锻炼组或读书对照组,受试前后分别接受一次WCST。锻炼组受试者完成一轮20 min中等强度固定自行车有氧运动。实验2重复相似方案,为探求受年龄差异并控制青年年龄上限效应,受试者为24名中年人。结果:尽管在青年中观察到有显著的时间影响,这两项研究都表明对任何WCST指标,实验内容及其与时间的相互作用均无重大影响。结论:WCST评估显示,急性有氧运动无法影响执行功能,表明这项传统的关于执行功能的神经心理学测验对急性运动不敏感。本研究结果显示,急性运动不会广泛影响整体的执行功能,或如同Etnier和Chang在2009年提出的,它对执行功能的某个具体方面的影响可能取决于任务本身。

The Management Problem of Miliary Tuberculosis in the Service of Pneumo-Phtisiology at the National References University Teaching Hospital of N’Djamena (Chad): About 103 Cases

Introduction: Miliary tuberculosis (MT) is a rare form of tuberculosis (TB) and it is a major public health problem in our countries with limited resources. Materials and Methods: It is a retrospective and descriptive study that started from 1st January 2018 to 31 December 2020 at the pneumo-phtisiology service of the CHU-RN of N’Djamena., All records of patients aged at least 15 years treated for miliary tuberculosis confirmed by X-ray chest were included in our study. Results: The prevalence of TD was 1.5% (n = 103) of all TB diagnosed in the service. The sex ratio was 1.34. The average age was 37.7 years with extremes ranging from 19 to 80 years. A low social economic level was found in 75.7%. The principal comorbidity found in this study was HIV with the prevalence of (22.3%). The general signs were dominated by deterioration of general condition (96.1%) and fever (91.3%). The main symptoms were cough (85.4%) and dyspnea (52.4%). The radiology of chest found a homogeneous dissemination and symmetrical in both lung fields in 100% of cases. Our study reported that 14 (13.6%) of death cases were found among patients. Conclusion: TM is a severe form of TB;it affects a young population in our context. Mortality remains high with prevalence of 13.6% of cases. Early management would improve the prognosis.

Statistical Medical Pattern Recognition for Body Composition Data Using Bioelectrical Impedance Analyzer

Identifying patterns,recognition systems,prediction methods,and detection methods is a major challenge in solving different medical issues.Few categories of devices for personal and professional assessment of body composition are available.Bioelectrical impedance analyzer is a simple,safe,affordable,mobile,non-invasive,and less expensive alternative device for body composition assessment.Identifying the body composition pattern of different groups with varying age and gender is a major challenge in defining an optimal level because of the body shape,body mass,energy requirements,physical fitness,health status,and metabolic profile.Thus,this research aims to identify the statistical medical pattern recognition of body composition data by using a bioelectrical impedance analyzer.In previous studies,a pattern was identified for four indicators that concern body composition(e.g.,body mass index(BMI),body fat,muscle mass,and total body water).The novelty of our study is the fact that we identified a recognition pattern by using medical statistical methods for a body composition that contains seven indicators(e.g.,body fat,visceral fat,BMI,muscle mass,skeletal muscle mass,sarcopenic index,and total body water).The youth that exhibited the body composition pattern identified in our study could be considered healthy.Every deviation of one or more parameters outside the margins of the pattern for body composition could be associated with health issues,and more medical investigations would be needed for a diagnosis.BIA is considered a valid and reliable device to assess body composition along with medical statistical methods to identify a pattern for body composition according to the age,gender,and other relevant parameters.

Intrahepatic cholangiocarcinoma: review and update

Cholangiocarcinoma (CCA) is a heterogeneous group of malignancies that could develop at any level from the biliary tree. CCA is currently classified into intrahepatic (iCCA), perihilar and distal on the basis of its anatomical location. Of note, these three CCA subtypes have common features but also important inter-tumor and intra-tumor differences that can affect the pathogenesis and outcome. A unique feature of iCCA is that it recognizes as origin tissues, the hepatic parenchyma or large intrahepatic and extrahepatic bile ducts, which are furnished by two distinct stem cell niches, the canals of Hering and the peribiliary glands, respectively. The complexity of iCCA pathogenesis highlights the need of a multidisciplinary, translational and systemic approach to this malignancy. This review will focus on the advances of iCCA epidemiology, histo-morphology, risk factors, molecular pathogenesis, revealing the existence of multiple subsets of iCCA.

诊断 粪便免疫化学检测有望正确排除有症状患者的结直肠癌诊断

背景 致力于改善结直肠癌(CRC)症状知晓度和减少急诊发现CRC病例的努力,可能导致诊断胜结肠镜检查的需求急剧增长,超过了现有内镜检查的接待容量。本篇系统性综述旨在分析定量粪便免疫化学检测(FIT)在有下腹症状的患者中的诊断能力。