Translational and rotational localization errors in cone-beam CT based image-guided lung stereotactic radiotherapy

PurposeAccurate localization is crucial in delivering safe and effective stereotactic body radiation therapy (SBRT). The aim of this study was to analyse the accuracy of image-guidance using the cone-beam computed tomography (CBCT) of the VERO system in 57 patients treated for lung SBRT and to calculate the treatment margins.Materials and methodsThe internal target volume (ITV) was obtained by contouring the tumor on maximum and mean intensity projection CT images reconstructed from a respiration correlated 4D-CT. Translational and rotational tumor localization errors were identified by comparing the manual registration of the ITV to the motion-blurred tumor on the CBCT and they were corrected by means of the robotic couch and the ring rotation. A verification CBCT was acquired after correction in order to evaluate residual errors.ResultsThe mean 3D vector at initial set-up was 6.6 ± 2.3 mm, which was significantly reduced to 1.6 ± 0.8 mm after 6D automatic correction. 94% of the rotational errors were within 3°. The PTV margins used to compensate for residual tumor localization errors were 3.1, 3.5 and 3.3 mm in the LR, SI and AP directions, respectively.ConclusionsOn-line image guidance with the ITV–CBCT matching technique and automatic 6D correction of the VERO system allowed a very accurate tumor localization in lung SBRT.     

Respiratory motion of adrenal gland metastases: Analyses using four-dimensional computed tomography images

PurposeTo evaluate the respiratory motion of adrenal gland metastases in three-dimensional directions using four-dimensional computed tomography (4DCT) images.MethodsFrom January 2013 to May 2016, 12 patients with adrenal gland metastases were included in this study. They all underwent 4DCT scans to assess respiratory motion of adrenal gland metastases in free breathing state. The 4DCT images were sorted into 10 image series according to the respiratory phase from the end inspiration to the end expiration, and then transferred to FocalSim workstation. All gross tumor volumes (GTVs) of adrenal gland metastases were drawn by a single physician and confirmed by a second. Relative coordinates of adrenal gland metastases were automatically generated to calculate adrenal gland metastases motion in different axial directions.ResultsThe average respiratory motion of adrenal gland metastases in left-right (LR), cranial-caudal (CC), anterior-posterior (AP), 3-dimensional (3D) vector directions was 3.4 ± 2.2 mm, 9.5 ± 5.5 mm, 3.8 ± 2.0 mm and 11.3 ± 5.3 mm, respectively. The ratios were 58.6% ± 11.4% and 63.2% ± 12.5% when the volumes of GTV_In0% and GTV _In100% were compared with volume of IGTV_10phase. The volume ratio of IGTV_10phase to GTV_3D was 1.73 ± 0.48.ConclusionsAdrenal gland metastasis is a respiration-induced moving target, and an internal target volume boundary should be provided when designing the treatment plan. The CC motion of adrenal gland metastasis is predominant and >5 mm, thus motion management strategies are recommended for patients undergoing external radiotherapy for adrenal gland metastasis.     

On-site audits to investigate the quality of radiation physics of radiation therapy institutions in the Republic of Korea

PurposeTo investigate and improve the domestic standard of radiation therapy in the Republic of Korea.MethodsOn-site audits were performed for 13 institutions in the Republic of Korea. Six items were investigated by on-site visits of each radiation therapy institution, including collimator, gantry, and couch rotation isocenter check; coincidence between light and radiation fields; photon beam flatness and symmetry; electron beam flatness and symmetry; physical wedge transmission factors; and photon beam and electron beam outputs.ResultsThe average deviations of mechanical collimator, gantry, and couch rotation isocenter were less than 1 mm. Those of radiation isocenter were also less than 1 mm. The average difference between light and radiation fields was 0.9 ± 0.6 mm for the field size of 20 cm × 20 cm. The average values of flatness and symmetry of the photon beams were 2.9% ± 0.6% and 1.1% ± 0.7%, respectively. Those of electron beams were 2.5% ± 0.7% and 0.6% ± 1.0%, respectively. Every institutions showed wedge transmission factor deviations less than 2% except one institution. The output deviations of both photon and electron beams were less than ±3% for every institution.ConclusionsThrough the on-site audit program, we could effectively detect an inappropriately operating linacs and provide some recommendations. The standard of radiation therapy in Korea is expected to improve through such on-site audits.     

Quantification of residual dose estimation error on log file-based patient dose calculation

PurposeThe log file-based patient dose estimation includes a residual dose estimation error caused by leaf miscalibration, which cannot be reflected on the estimated dose. The purpose of this study is to determine this residual dose estimation error.Methods and materialsModified log files for seven head-and-neck and prostate volumetric modulated arc therapy (VMAT) plans simulating leaf miscalibration were generated by shifting both leaf banks (systematic leaf gap errors: ±2.0, ±1.0, and ±0.5 mm in opposite directions and systematic leaf shifts: ±1.0 mm in the same direction) using MATLAB-based (MathWorks, Natick, MA) in-house software. The generated modified and non-modified log files were imported back into the treatment planning system and recalculated. Subsequently, the generalized equivalent uniform dose (gEUD) was quantified for the definition of the planning target volume (PTV) and organs at risks.ResultsFor MLC leaves calibrated within ±0.5 mm, the quantified residual dose estimation errors that obtained from the slope of the linear regression of gEUD changes between non- and modified log file doses per leaf gap are in head-and-neck plans 1.32 ± 0.27% and 0.82 ± 0.17 Gy for PTV and spinal cord, respectively, and in prostate plans 1.22 ± 0.36%, 0.95 ± 0.14 Gy, and 0.45 ± 0.08 Gy for PTV, rectum, and bladder, respectively.ConclusionsIn this work, we determine the residual dose estimation errors for VMAT delivery using the log file-based patient dose calculation according to the MLC calibration accuracy.     

The influence of pre-operative risk on the number of circulating endothelial progenitor cells during cardiopulmonary bypass

Background aimsThe number of circulating endothelial progenitor cells (EPC) depends on cytokine release and is also associated with cardiovascular risk factors. During cardiopulmonary bypass (CPB) the endothelium is the first organ to be affected by mechanical and immunologic stimuli. We hypothesized that the magnitude of EPC mobilization by CPB correlates with the pre-operative cardiovascular morbidity profile.MethodsEPC were quantified in blood samples from 30 patients who underwent cardiac surgery by magnetic bead isolation and fluorescence-activated cell sorting (FACS) analysis, based on concomitant expression of CD34, CD133 and CD309. Patients were divided into two groups based on the European System for Cardiac Operative Risk Evaluation (EuroSCORE): low risk (LR) and high risk (HR). Ten healthy volunteers served as controls. Samples were obtained before the start of CPB and at 1 and 24 h post-operatively. Plasma samples were collected for determination of release levels of cytokines and growth factors.ResultsAll CPB patients showed a significantly reduced basal number of EPC compared with healthy individuals (LR 5.60 ± 0.39/mL, HR 3.89 ± 0.34/ mL, versus control 0.807 ± 0.82/mL, P = 0.012 versus LR, P < 0.001 versus HR). CPB induced EPC release that peaked 1 h after surgery (pre-operative 4.79 ± 0.32/mL, 1 h 57.49 ± 5.31/mL, 24 h 6.67 ± 1.05/mL, P < 0.001 pre-operative versus 1 h, P < 0.001 pre-operative versus 24 h) and was associated with the duration of CPB. However, EPC release was significantly attenuated in HR patients (33.09 ± 3.58/mL versus 81.89 ± 4.36/mL at 1 h after CPB, P < 0.0001) and inversely correlated with the pre-operative EuroSCORE. Serum granulocyte–colony-stimulating factor (G-CSF), stem cell factor (SCF) and vascular endothelial growth factor (VEGF) levels increased throughout the observation period and were also correlated with the EPC count.ConclusionsCardiovascular risk factors influence the mobilization of EPC from the bone marrow after stimulation by CPB. This could be secondary to impaired mobilization or the result of increased EPC turnover, and may have implications for future cell therapy strategies in cardiac surgical patients.     

Pauta óptima de administración de insulina detemir en sujetos diabéticos tipo 1 con mal control metabólico

AimTo compare different administration times of insulin detemir (IDet) in patients with type 1 diabetes and poor metabolic control.Material and MethodsThis 24-week open study included 39 people with type 1 diabetes mellitus (DM) randomized to one injection of IDet before lunch (mean 14.24 ± 00.36 (± SD) h) or at bedtime (23.19 ± 0.42 h). Whenever target glycemia levels were not reached, the regimen was switched to insulin therapy with two injections (IDet-12 h). Insulin aspart was used before main meals.ResultsAt week 24, only 12.2% of patients remained in the IDet bedtime group and 30.3% in the IDet before lunch group. The remaining 57.5% joined the IDet-12 h group. There were no differences between the IDet before lunch and IDet bedtime groups. A subanalysis including the three groups demonstrated better metabolic control in the IDet before lunch group (glycosylated hemoglobin (HbA1c) 7.1 ± 0.2 vs. 7.6 ± 0.4 and 8.1 ± 0.2% in IDet before-lunch, IDet bedtime and IDet-12 h, respectively; p<0.05). An HbA1c value below 7% was achieved in 30.3% of the patients: 15.2% in the IDet before-lunch group, 3.3% in the IDet bedtime group and 12.2% in IDet-12 h group. Quality of life did not differ among treatment groups.ConclusionsOne injection of IDet administered before lunch could improve metabolic control. However, most patients required two injections of IDet.     

Sparing dysphagia/aspiration related structures using novel hybrid volumetric modulated arc therapy

PurposeStudies using split field IMRT to spare dysphagia/aspiration related structures (DARS) have raised concern regarding dose uncertainty at matchline. This study explores the utility of hybrid VMAT in sparing the DARS and assesses matchline dose uncertainty in postoperative oral cavity cancer patients and compares it with VMAT.Methods & materialsTen postoperative oral cavity cancer patients were planned with h-VMAT and VMAT using the same planning CT dataset. PTV and DARS were contoured using standard delineation guidelines. In h-VMAT 80% of the neck dose was planned using AP/PA technique and then VMAT optimization was done for the total PTV by keeping the corresponding AP/PA plan as the base dose. Planning goal for PTV was V_95% ≥ 95% and for DARS, adequate sparing. Plans and dose volume histograms were analyzed using dosimetric indices. Absolute point and portal dose measurements were done for h-VMAT plans to verify dose at the matchline.ResultsCoverage in both the techniques was comparable. Significant differences were observed in mean doses to DARS (Larynx: 24.36 ± 2.51 versus 16.88 ± 2.41 Gy; p < 0.0006, Pharyngeal constrictors: 25.16 ± 2.41 versus 21.2 ± 2.1 Gy; p < 0.005, Esophageal inlet: 18.71 ± 2 versus 12.06 ± 0.79 Gy; p < 0.0002) favoring h-VMAT. Total MU in both the techniques was comparable. Average percentage variations in point dose measurements in h-VMAT done at +3.5 and −3.5 positions were (1.47 ± 1.48 and 2.28 ± 1.35%) respectively. Average gamma agreement for portal dose measured was 97.07%.Conclusionh-VMAT achieves better sparing of DARS with no matchline dose uncertainty. Since these patients have swallowing dysfunction post-operatively, attempts should be made to spare these critical structures as much as possible.     

Comparaison entre OSEM-3D et rétroprojection filtrée pour les images traitées par SISCOM dans l’épilepsie temporale

IntroductionWhen ictal and interictal brain SPECT are reconstructed with filtered backprojection (FBP), the noise level of subtraction images is frequently high and requires the use of thresholding methods. The aim of this study was to compare the subtraction images for cerebral SPECT reconstructed either with FBP or with a 3D iterative reconstruction method (OSEM-3D).Material and methodsAfter optimisation of the reconstruction parameters on phantom, the subtraction SPECT images, which were obtained with FBP or with OSEM-3D and coregistered with MRI images, were analyzed in 15 patients with refractory temporal epilepsy.ResultsOn phantom and with the constrain of high enough spatial resolution (full width at half of maximum for a punctual source less than or equal to 11 mm) were reached using: (i) a Butterworth filter with a cut-off frequency of 0.4 Nyquist at order 6 for FBP and (ii) five iterations, 16 subsets and a 9 mm gaussian filter for OSEM-3D. On the subtraction images, which were obtained with these optimal parameters, the temporal foci from patients were smaller with OSEM-3D than with FBP (11 ± 6 cm³ versus 17 ± 10 cm³, P = 0.02), mean voxel activities were equivalent between the two methods within temporal foci (6.30 ± 3.13 counts versus 6.34 ± 4.93 counts) but these activities were dramatically reduced by OSEM-3D within background regions (0.02 ± 0.02 counts versus 0.19 ± 0.12 counts, P < 0.001).ConclusionFor the ictal–interictal subtraction SPECT images, which are obtained in patients with refractory temporal epilepsy, the use of an optimized OSEM-3D method leads to dramatically reduce the volume of temporal foci, as well as the background noise level, two properties that are likely to facilitate the detection and localisation of epilepsy foci.     

Biomechanical failure properties and microstructural content of ruptured and unruptured abdominal aortic aneurysms

PurposeTo test the hypothesis that ruptured abdominal aortic aneurysms (AAA) are globally weaker than unruptured ones.MethodsFour ruptured and seven unruptured AAA specimens were harvested whole from fresh cadavers during autopsies performed over an 18-month period. Multiple regionally distributed longitudinally oriented rectangular strips were cut from each AAA specimen for a total of 77 specimen strips. Strips were subjected to uniaxial extension until failure. Sections from approximately the strongest and weakest specimen strips were studied histologically and histochemically. From the load-extension data, failure tension, failure stress and failure strain were calculated. Rupture site characteristics such as location, arc length of rupture and orientation of rupture were also documented.ResultsThe failure tension, a measure of the tissue mechanical caliber was remarkably similar between ruptured and unruptured AAA (group mean±standard deviation of within-subject means: 11.2±2.3 versus 11.6±3.6 N/cm; p=0.866 by mixed model ANOVA). In post-hoc analysis, there was little difference between the groups in other measures of tissue mechanical caliber as well such as failure stress (95±28 versus 98±23 N/cm²; p=0.870), failure strain (0.39±0.09 versus 0.36±0.09; p=0.705), wall thickness (1.7±0.4 versus 1.5±0.4 mm; p=0.470) , and % coverage of collagen within tissue cross section (49.6±12.9% versus 60.8±9.6%; p=0.133). In the four ruptured AAA, primary rupture sites were on the lateral quadrants (two on left; one on left-posterior; one on right). Remarkably, all rupture lines had a longitudinal orientation and ranged from 1 to 6 cm in length.ConclusionThe findings are not consistent with the hypothesis that ruptured aortic aneurysms are globally weaker than unruptured ones.     

Multi-institutional comparison of simulated treatment delivery errors in ssIMRT,manually planned VMAT and autoplan-VMAT plans for nasopharyngeal radiotherapy

PurposeTo quantify the impact of simulated errors for nasopharynx radiotherapy across multiple institutions and planning techniques (auto-plan generated Volumetric Modulated Arc Therapy (ap-VMAT), manually planned VMAT (mp-VMAT) and manually planned step and shoot Intensity Modulated Radiation Therapy (mp-ssIMRT)).MethodsTen patients were retrospectively planned with VMAT according to three institution’s protocols. Within one institution two further treatment plans were generated using differing treatment planning techniques. This resulted in mp-ssIMRT, mp-VMAT, and ap-VMAT plans. Introduced treatment errors included Multi Leaf Collimator (MLC) shifts, MLC field size (MLCfs), gantry and collimator errors. A change of more than 5% in most selected dose metrics was considered to have potential clinical impact. The original patient plan total Monitor Units (MUs) were correlated to the total number of dose metrics exceeded.ResultsThe impact of different errors was consistent, with ap-VMAT plans (two institutions) showing larger dose deviations than mp-VMAT created plans (one institution). Across all institutions’ VMAT plans the significant errors included; ±5° for the collimator angle, ±5 mm for the MLC shift and +1, ±2 and ±5 mm for the MLC field size. The total number of dose metrics exceeding tolerance was positively correlated to the VMAT total plan MUs (r = 0.51, p < 0.001), across all institutions and techniques.ConclusionsDifferences in VMAT robustness to simulated errors across institutions occurred due to planning method differences. Whilst ap-VMAT was most sensitive to MLC errors, it also produced the best quality treatment plans. Mp-ssIMRT was most robust to errors. Higher VMAT treatment plan complexity led to less robust plans.     

Página web DiabeTIC: estudio piloto de la satisfacción e impacto sobre el control metabólico

ObjectivesTo evaluate satisfaction and short-term impact on metabolic control of diabetes monitoring through the DiabeTIC website.Patients and methodsA prospective, uncontrolled intervention study was conducted in 32 patients aged 29.7 ± 9.7 years (65% female) incorporated to the telemedicine platform DiabeTIC between March and September 2012. All patients completed a satisfaction questionnaire in the first month, and impact on metabolic control was evaluated at three and six months.ResultsIn the satisfaction survey conducted in the first month of follow-up, the following mean scores (0-10) were obtained: overall impression with the platform: 8.6 ± 1.8; ease of use: 8.1 ± 1.5; intuitive navigation: 6.7 ± 3.0; value of measurements: 9.1 ± 1.1; importance of the platform in diabetes management: 9.5 ± 0.9; sense of security: 9.5 ± 0.8; value of the library: 9.4 ± 1.1; value of messages: 9.1 ± 1.4, and recommendation to use the platform: 9.4 ± 0.9. Glycosilated hemoglobin concentrations significantly improved at six months as compared to study start (7.0 ± 0.8 versus 8.1 ± 1.9; p = 0.007). Nine patients were discharged from DiabeTIC before completing six months of follow-up.ConclusionsPatients with diabetes monitored through the DiabeTIC website report a high degree of satisfaction, showing improved metabolic control at short-term follow-up.     

High resolution ion chamber array delivery quality assurance for robotic radiosurgery: Commissioning and validation

PurposeHigh precision radiosurgery demands comprehensive delivery-quality-assurance techniques. The use of a liquid-filled ion-chamber-array for robotic-radiosurgery delivery-quality-assurance was investigated and validated using several test scenarios and routine patient plans.Methods and materialPreliminary evaluation consisted of beam profile validation and analysis of source–detector-distance and beam-incidence-angle response dependence. The delivery-quality-assurance analysis is performed in four steps: (1) Array-to-plan registration, (2) Evaluation with standard Gamma-Index criteria (local-dose-difference ⩽ 2%, distance-to-agreement ⩽ 2 mm, pass-rate ⩾ 90%), (3) Dose profile alignment and dose distribution shift until maximum pass-rate is found, and (4) Final evaluation with 1 mm distance-to-agreement criterion. Test scenarios consisted of intended phantom misalignments, dose miscalibrations, and undelivered Monitor Units. Preliminary method validation was performed on 55 clinical plans in five institutions.ResultsThe 1000SRS profile measurements showed sufficient agreement compared with a microDiamond detector for all collimator sizes. The relative response changes can be up to 2.2% per 10 cm source–detector-distance change, but remains within 1% for the clinically relevant source–detector-distance range. Planned and measured dose under different beam-incidence-angles showed deviations below 1% for angles between 0° and 80°. Small-intended errors were detected by 1 mm distance-to-agreement criterion while 2 mm criteria failed to reveal some of these deviations. All analyzed delivery-quality-assurance clinical patient plans were within our tight tolerance criteria.ConclusionWe demonstrated that a high-resolution liquid-filled ion-chamber-array can be suitable for robotic radiosurgery delivery-quality-assurance and that small errors can be detected with tight distance-to-agreement criterion. Further improvement may come from beam specific correction for incidence angle and source–detector-distance response.     

Comparison of CT artifacts and image recognition of various fiducial markers including two types of thinner fiducial markers for CyberKnife treatment

AimThe aim of the study was to evaluate computed tomography (CT) artifacts and image recognition of the CyberKnife system. Regarding fiducial markers, VISICOIL of 0.5 mm × 5.0 mm and 0.75 mm × 5.0 mm, ball-shaped Gold Anchor (GA) of 0.28 mm × 10 mm and 0.28 mm × 20 mm, were compared with the standard cylinder marker of 0.9 mm × 3.0 mm (ACCULOC).BackgroundRecently, various kinds of commercial fiducial markers have been available in CyberKnife treatment.Materials and methodsThe CT images of a water equivalent gel with each fiducial marker were acquired for the evaluation of CT artifacts. The evaluation was performed using the standard deviation of Hounsfield Unit (HU) value for a rectangle region near the fiducial marker. Then, to evaluate the image recognition, each fiducial marker was located to overlap in the target locating system (TLS) for the two sites; the vertebral bone and the pubic bone.ResultsFor CT artifacts, the standard deviations of the VISICOIL of 0.5 mm × 5.0 mm was the smallest. The image recognition of four fiducial markers had a value close to the standard cylinder marker and was feasible for common use, but was slightly poorer when using GA of 0.28 mm × 10 mm in the dynamic conditions.ConclusionOur results indicated that VISICOIL 0.5 × 5.0 mm and the GAs can be used nearly always for CyberKnife treatment in spite of their much thinner needles than those of cylinder types.     

Evaluation of the target dose coverage of stereotactic body radiotherapy for lung cancer using helical tomotherapy: A dynamic phantom study

AimTo evaluate the target dose coverage for lung stereotactic body radiotherapy (SBRT) using helical tomotherapy (HT) with the internal tumor volume (ITV) margin settings adjusted according to the degree of tumor motion.BackgroundLung SBRT with HT may cause a dosimetric error when the target motion is large.Materials and methodsTwo lung SBRT plans were created using a tomotherapy planning station. Using these original plans, five plans with different ITV margins (4.0–20.0 mm for superior-inferior [SI] dimension) were generated. To evaluate the effects of respiratory motion on HT, an original dynamic motion phantom was developed. The respiratory wave of a healthy volunteer was used for dynamic motion as the typical tumor respiratory motion. Five patterns of motion amplitude that corresponded to five ITV margin sizes and three breathing cycles of 7, 14, and 28 breaths per minute were used. We evaluated the target dose change between a static delivery and a dynamic delivery with each motion pattern.ResultsThe target dose difference increased as the tumor size decreased and as the tumor motion increased. Although a target dose difference of <5 % was observed at ≤10 mm of tumor motion for each condition, a maximum difference of -9.94 % ± 7.10 % was observed in cases of small tumors with 20 mm of tumor motion under slow respiration.ConclusionsMinimizing respiratory movement is recommended as much as possible for lung SBRT with HT, especially for cases involving small tumors.     

Changes in force and tendinous tissue elongation during the early phase of tetanic summation in in vivo human tibialis anterior muscle

The purpose of this study was to determine the changes that occur in tendinous tissue properties during the early phase of tetanic summation in the in vivo human tibialis anterior muscle (TA). The torque response and tendinous tissue elongation following single stimuli, two-pulse trains, and three-pulse trains were recorded in the TA during isometric contractions. The elongation, compliance, and lengthening velocity of tendinous tissue were determined by real-time ultrasonography. The contribution of the response to the second stimulation (C2) was obtained by subtracting the response to the single stimulation (C1) from the response of doublet. The third contribution (C3) was obtained by subtracting the response to the doublet from that of the triplet. C2 (7.8±0.5 Nm) and C3 (7.3±0.6 Nm) had torque responses significantly higher than C1 (3.6±0.7 Nm). In contrast, the elongations of tendinous tissue for C2 (2.8±0.4 mm) and C3 (1.7±0.2 mm) were significantly lower than for C1 (4.9±0.3 mm), indicating that the summation pattern of tendinous tissue elongation is different from the summation pattern of torque response. In addition, this showed considerable difference both between C1 (0.12±0.01 mm/N; 83±4.6 mm/s) and C2 (0.03±0.005 mm/N; 50±6.3 mm/s) and between C1 and C3 (0.02±0.002 mm/N; 39±6.4 mm/s) in the compliance and lengthening velocity of tendinous tissue. These results suggest that changes in tendinous tissue properties between first and second contraction are related to different summation patterns of force and tendinous tissue elongation during early phase of tetanic summation.     

Valoración de la musculatura isquiosural en personas mayores

Objectiveto evaluate hamstring flexibility in older adults.Materials and methodsa total of 177 subjects (13 men and 164 women) aged between 43 and 80 years old (mean age = 63.4 ± 6.7 years) who attended fitness classes were evaluated. The mean height was 161 ± 10 cm and the mean weight was 74 ± 5.6 kg. Hamstring flexibility was evaluated using the straight leg raise test.Resultsthe mean flexion in the right hip was 72° ± 13.2° and the mean flexion of the left hip was 72.4° ± 13.8°. No significant differences were found in the values obtained from the straight leg raise test in the left and right legs. For the right leg, 48.02% of the subjects’ values were within the normal range, while 28.81% showed grade I shortness, and 23.61% showed grade II shortness. For the left leg, 49.94% showed normal values, 29.94% showed grade I shortness, and 22.03% showed grade II shortness.Conclusionshalf of the adults and elderly individuals that took part in the present study had hamstring shortness, which increased in frequency with age.     

Effects of cilnidipine on sympathetic outflow and sympathetic arterial pressure and heart rate regulations in rats

AimsCilnidipine is a unique Ca^2 + channel blocker that inhibits both L-type and N-type Ca^2 + channels. The present study aimed to assess the effects of intravenous cilnidipine on sympathetic outflow and sympathetic arterial pressure (AP) and heart rate (HR) regulations.Main methodsCarotid sinus baroreceptor regions were isolated from the systemic circulation in anesthetized and vagotomized Wistar Kyoto rats. Changes in efferent sympathetic nerve activity (SNA), AP and HR in response to a stepwise input of carotid sinus pressure were examined before and during intravenous cilnidipine administration (30 μg/kg bolus + 100 μg kg^? 1 h^? 1 infusion, n = 6).Key findingsCilnidipine significantly reduced the AP response range (from 68.0 ± 10.2 to 34.6 ± 4.1 mmHg, P = 0.007) but did not affect the SNA response range (from 90.4 ± 10.3 to 84.7 ± 9.5%, P = 0.297) or the HR response range (from 50.4 ± 10.1 to 48.1 ± 6.2 beats/min, P = 0.719).SignificanceCilnidipine, at a depressor dose used in the present study, does not acutely suppress sympathetic outflow from the central nervous system. Also, it spared the sympathetic HR response, suggesting that N-type Ca^2 + channel blocking action at the cardiac sympathetic nerve endings may be a modest one.     

Changes in muscle activation patterns and subjective low back pain ratings during prolonged standing in response to an exercise intervention

BackgroundLow back pain (LBP) development has been associated with occupational standing. Increased hip and trunk muscle co-activation is considered to be predisposing for LBP development during standing in previously asymptomatic individuals. The purpose of this work was to investigate muscle activation and LBP responses to a prescribed exercise program. Pain-developing (PD) individuals were expected to have decreased LBP and muscle co-activation following exercise intervention.MethodsElectromyography (EMG) data were recorded from trunk and hip muscle groups during 2-h of standing. An increase of >10 mm on visual analog scale (VAS) during standing was threshold for PD categorization. Participants were assigned to progressive exercise program with weekly supervision or control (usual activity) for 4 weeks then re-tested.ResultsForty percent were categorized as PD on day 1, VAS = 24.2 (±4.0) mm. PD exercisers (PDEX) had lower VAS scores (8.93 ± 3.66 mm) than PD control (PDCON) (16.5 ± 6.3 mm) on day 2 (p = 0.007). Male PDEX had decreased gluteus medius co-activation levels (p < 0.05) on day 2.DiscussionThe exercise program proved beneficial in reducing LBP during standing. There were changes in muscle activation patterns previously associated with LBP. Predisposing factors for LBP during standing were shown to change positively with appropriate exercise intervention.