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Objectives: To examine the effects of aging on the ability of contrast baths to increase the circulation in the skin of the foot compared with immersion in a continuous warm water bath of the same temperature as the warm component of the contrast bath. Methods: A laser Doppler flow meter was used to assess skin blood flow on the dorsal and plantar aspects of the foot during immersion in a warm bath (100 degreesF (37.8 degreesC)) compared with contrast baths with a ratio of 3 minutes of warm (100 degreesF (37.8 degreesC)) and 1 minute of cold (60 degreesF (15.6 degreesC)); the cycle was repeated for 16 minutes. Fourteen participants whose average age was 55.1 +/- 9.1 years were examined and compared with 12 younger participants whose average age was 23.9 +/- 5.8 years. Results: For both groups of participants, the use of alternating hot and cold bath temperatures elicited an increase in skin blood flow above that which was found with warm water immersion alone. The greatest response was in the younger participants. For the older participants, skin blood flow was approximately one-third less than that seen in the younger participants with either continuous warm water immersion or contrast baths. These same results were seen on the dorsal and plantar aspects of the foot, indicating diminished circulation in both areas with aging. Conclusion: We conclude that contrast baths do increase circulation in the skin in the foot of older individuals but the response was less than that of younger people. [ABSTRACT FROM AUTHOR]

For more than 2,000 years, local tissue heating has been used to treat rheumatism, arthritis, muscle strains and sprains, and a variety of other afflictions. Heat can be applied with hot packs, ultrasound, diathermy, microwave, lasers, or a whirlpool bath. The overall effect is the same. Heat is applied to the surface of the skin in an effort to transfer the heat deep into the tissue. However, there is always a possibility of harmful as well as beneficial effects from the heating of the skin. Numerous models have been developed, including the Pennes equation, to understand how blood flow and skin conductivity are related. However, this model does not take into consideration the effect of central sympathetic outflow on skin thermal conductivity. Therefore, the present study examined heat dissipation in the skin on 4 areas on the body in 10 subjects in thermally neutral and warm environments to alter skin sympathetic activity. The results of the experiments showed that if skin thermal conductivity is measured with subjects exposed to a warm environment, heat loss is more pronounced in the skin. Thus in a cold room, hot packs cause a greater change in skin temperature and provide greater stress on the skin. [ABSTRACT FROM AUTHOR]

Fifty subjects diagnosed with type 2 diabetes and 30 subjects with no history of diabetes (controls) were examined to assess their gait characteristics during the initiation of gait, gait in a linear path and during turns. Gait characteristics were measured by pressure sensors in the shoes, accelerometers on the knees and the electromyogram from the medial gastrocnemius and tibialis anterior muscles.Thirty subjects with diabetes (Dl) and 20 control subjects (C) were followed for a period of 1 year to see if gait changed over that period, especially in the diabetic population. Twenty additional subjects with diabetes (D2) were placed on the insulin sensitizer rosiglitazone (RSG) - a drug known to also improve vascular endothelial function - and were also followed for 1 year.The results showed that D1 had more unsteadiness in their gait; they walked more slowly and with more circumduction (lateral movement during the swing phase) than did C D 1 also showed greater muscle use and co-contraction of agonist and antagonist pairs of muscle during gait when compared to controls. While the controls showed no difference in gait over the year, D 1 showed deterioration in gait and D2 showed improved gait over the 1 year. Thus, diabetes seems to continually deteriorate gait unless a drug like RSG is given. When RSG was administered for 1 year, the velocity of gait, circumduction and muscle use was increased to near that of the age-matched controls. [ABSTRACT FROM AUTHOR]

A series of 106 patients with isolated or familial Parkinsonism underwent clinical evaluation and genetic testing for the LRRK2 G2019S mutation which was identified in 34/106 patients (32%). Seventy one of them accepted to be evaluated for neuropsychological and neuropsychiatric studies with the aim to compare mutation carriers with non-carriers. For neuropsychological testing, comparisons between LRRK2 G2019S carriers and non-carriers were made after stratification according to the level of education: median and high school versus low level. Memory was investigated with the five words test, 2 novel tests with verbalized visual material dedicated to illiterate patients, the TNI-93 (nine pictures test), The TMA-93 (associative memory test), and digit spans (forward/backward). Cognitive analyse did not show major differences between the two groups of patients. Nevertheless, behavioral abnormalities, mostly depression and hallucinations, were more frequent in the LRRK2 G2019S carriers, suggesting the presence of a greater involvement of the limbic system in these patients. Sleep disorders which were also more common amongst mutation carriers than non-carriers might be related to depression. [ABSTRACT FROM AUTHOR]

Altered scapular kinematics is associated with shoulder pain. Resistance exercise is a common treatment; however, the effects of lifting an external load on scapular kinematics is limited. Understanding whether an external handheld load affects scapular kinematics in a healthy population can provide normal values utilized for comparison to individuals with shoulder pain. Currently, no studies have examined the effect of incrementally increased handheld loads. We defined the effects of varying external handheld loads on scapular kinematics during a shoulder elevation task. Healthy participants ( n  = 50) elevated their shoulder in the scapular plane over 4 trials. One trial of no loading (control) and 3 trials with incrementally increased external handheld loads. Scapular kinematic rotations and translations were measured during ascent and descent phases using 3D motion capture. Compared to no load, the highest external load during ascent increased scapular elevation [mean difference = 3.2 degrees (95%CI: 0.9, 5.4), p  = 0.006], and during descent increased scapular elevation [mean difference = 3.9 degrees (95%CI: 2.8, 5.1), p  < 0.001] and increased scapular upward rotation [mean difference = 4.5 degrees (95%CI: 2.4, 6.6), p  < 0.001]. External handheld loads result in small increases in scapular elevation and scapular upward rotation . These results should be utilized as normal values to compare to individuals with shoulder pain.

Objectives: The main purpose of this research study was to compare mean modified straight-leg raise test (mSLR) and hamstring muscle length (HL) between chronic non-specific low back pain (LBP) and healthy subjects to understand the possibility of neuropathic causes in LBP population as it may impact the diagnosis and treatment of LBP. Another purpose was to compare mean mSLR between those with lumbar nerve root impingement and those without as determine by magnetic resonance imaging (MRI)., Methods: The design of the study is cross sectional and included 32 subjects with ages ranging from 18-50 years old. Clinical exam objective measures were collected such as patient questionnaires, somatosensory tests, HL range of motion, and a mSLR test, and were compared to the findings from a structural lumbar spine MRI., Results: There were no significant differences in mean HL angulation and mSLR angulation between LBP and healthy subjects (p>0.05). There was no significant difference in mean HL by impingement by versus no impingement (38.3±15.6 versus 44.8±9.4, p = 0.08, Cohen's d = 0.50). On the other hand, there was a significant difference in mean mSLR angulation by impingement (57.6.3±8.7 versus 63.8±11.6, p = 0.05, Cohen's d = 0.60)., Conclusions: The mSLR test was found to be associated with lumbar nerve root compression, regardless of the existence of radiating leg symptoms, and showed no association solely with the report of LBP. The findings highlight the diagnostic dilemma facing clinicians in patients with chronic nonspecific LBP with uncorrelated neuroanatomical image findings. Clinically, it may be necessary to reevaluate the common practice of exclusively using the mSLR test for patients with leg symptoms. This study may impact the way chronic LBP and neuropathic symptoms are diagnosed, potentially improving treatment methods, reducing persistent symptoms, and ultimately improving disabling effects., Competing Interests: The authors have declared no competing interests exist., (Copyright: © 2024 Hermosura et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Pelvic organ prolapse (POP) is a significant health concern for young Nepali women, with potential risk factors including pelvic floor trauma from vaginal delivery and heavy lifting. The prevalence of symptomatic POP (SPOP) among nulliparous women in Nepal is 6%, while the general population of Nepali women aged 15-49 years reports a prevalence of 7%. Surprisingly, the average age of SPOP onset in Nepal is 27 years, challenging the assumption that postmenopausal age and vaginal delivery are the sole risk factors. This study aims to investigate the influence of increased intra-abdominal pressure (IAP) during lifting tasks on pelvic organ descent in Nepali women across different menstrual cycle stages., Methods: The study included 22 asymptomatic Nepali women aged 18-30 years who regularly engage in heavy lifting. Intra-abdominal pressure was measured intra-vaginally during typical and simulated lifting tasks, which encompassed various scenarios such as ballistic lifting, ramped lifting, and pre-contraction of pelvic floor muscles, as well as coughing, Valsalva maneuver, and pelvic floor contractions. Pelvic floor displacement was recorded using transperineal ultrasound during menstruation, ovulation, and the mid-luteal phase., Results: Results indicated that pelvic floor displacement was greater during menstruation than ovulation when performing a simulated ballistic lifting task (6.0 ± 1.6 mm vs. 5.1 ± 1.5 mm, p  = 0.03, d  = 0.6). However, there was no significant difference in pelvic floor displacement during lifting when the pelvic muscles were pre-contracted., Conclusion: These findings suggest that lifting heavy loads during menstruation may increase the risk of stretching and injuring pelvic floor supportive tissues, potentially contributing to SPOP in young Nepali women. Pre-contracting pelvic floor muscles during lifting tasks may offer a protective effect. Understanding these factors could aid in developing targeted preventive measures and raising awareness about the impact of heavy lifting on pelvic floor health among Nepali women., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Biswokarma, Brandon, Lohman, Stafford, Daher, Petrofsky, Thapa, Berk, Hitchcock and Hodges.)

While the relationship between exercise and life span is well-documented, little is known about the effects of specific exercise protocols on modern measures of biological age. Transcriptomic age (TA) predictors provide an opportunity to test the effects of high-intensity interval training (HIIT) on biological age utilizing whole-genome expression data. A single-site, single-blinded, randomized controlled clinical trial design was utilized. Thirty sedentary participants (aged 40-65) were assigned to either a HIIT group or a no-exercise control group. After collecting baseline measures, HIIT participants performed three 10 × 1 HIIT sessions per week for 4 weeks. Each session lasted 23 min, and total exercise duration was 276 min over the course of the 1-month exercise protocol. TA, PSS-10 score, PSQI score, PHQ-9 score, and various measures of body composition were all measured at baseline and again following the conclusion of exercise/control protocols. Transcriptomic age reduction of 3.59 years was observed in the exercise group while a 3.29-years increase was observed in the control group. Also, PHQ-9, PSQI, BMI, body fat mass, and visceral fat measures were all improved in the exercise group. A hypothesis-generation gene expression analysis suggested exercise may modify autophagy, mTOR, AMPK, PI3K, neurotrophin signaling, insulin signaling, and other age-related pathways. A low dose of HIIT can reduce an mRNA-based measure of biological age in sedentary adults between the ages of 40 and 65 years old. Other changes in gene expression were relatively modest, which may indicate a focal effect of exercise on age-related biological processes., (© 2023 The Authors. Aging Cell published by Anatomical Society and John Wiley & Sons Ltd.)

Introduction: The optimal treatment for unresected nonmetastatic biliary tract cancer (uBTC) is not well-established. The objective of this study was to analyze the treatment patterns and compare the differences in overall survival (OS) between different treatment strategies amongst older adults with uBTC., Materials and Methods: We identified patients aged ≥65 years with uBTC using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database (2004-2015). Treatments were classified into chemotherapy, chemoradiotherapy, and radiotherapy. The primary outcome was OS. The differences in OS were analyzed using Kaplan-Meier curves and multivariable Cox proportional hazard regression., Results: A total of 4352 patients with uBTC were included. The median age was 80 years and median OS was 4.1 months. Most patients (67.3%, n = 2931) received no treatment, 19.1% chemotherapy (n = 833), 8.1% chemoradiotherapy (n = 354), and 5.4% radiotherapy alone (n = 234). Patients receiving no treatment were older and had more comorbidities. Chemotherapy was associated with significantly longer OS than no treatment in uBTC (hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.79-0.95), but no difference was found in the subgroups of intrahepatic cholangiocarcinoma (iCCA; HR 0.87, 95% CI 0.75-1.00) and gallbladder carcinoma (GBC; HR 1.09, 95% CI 0.86-1.39). In the sensitivity analyses, capecitabine-based chemoradiotherapy showed significantly longer OS in uBTC compared to chemotherapy (adjusted HR 0.71, 95% CI 0.53-0.95)., Discussion: A minority of older patients with uBTC receive systemic treatments. Chemotherapy was associated with longer OS compared to no treatment in uBTC, but not in the subgroups of iCCA and GBC. The efficacy of chemoradiotherapy, especially in perihilar cholangiocarcinoma using capecitabine-based chemoradiotherapy, may be further evaluated in prospective clinical trials., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: In patients with resected gallbladder cancer (GBC), the role of adjuvant chemotherapy (aCT) remains ill-defined, especially in elderly patients. This study evaluates the value of aCT in elderly patients with GBC and assesses response according to tumor stage., Methods: Patients of ≥65 years of age with resected GBC diagnosed from 2004-2015 were identified using a Surveillance, Epidemiology and End Results (SEER)/Medicare linked database. After propensity score matching, survival of patients treated with aCT was compared to survival of patients who did not receive aCT using Kaplan-Meier and Cox proportional hazards analysis., Results: Of 2,179 patients with resected GBC, 876 (25%) received aCT. In the full cohort of 810 propensity-score matched patients, survival did not differ between patients treated with aCT (17.6 months ) and without aCT (19.5 months, P=0.7720). Subgroup analysis showed that survival was significantly better after aCT in T3/T4 disease (12.3 vs. 7.2 months, P=0.013). Interaction analysis showed that benefit of aCT was primarily seen in combined T3/T4, node-positive disease (HR 0.612 , P=0.006)., Conclusions: In this large cohort of elderly patients with resected GBC, aCT was not associated with increased survival. However, aCT may provide a survival benefit in T3/4, node-positive disease., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (Available at https://jgo.amegroups.com/article/view/10.21037/jgo-22-348/coif). The authors have no conflicts of interest to declare., (2022 Journal of Gastrointestinal Oncology. All rights reserved.)