Search Results (289)

Chronic Obstructive Pulmonary Disease (COPD) is a multifactorial condition associated with significant systemic complications such as cardiovascular disease (CVD), metabolic disorders, muscle wasting, and sarcopenia. While Body Mass Index (BMI) is a well-established indicator of obesity and has prognostic value in COPD, its role in predicting disease outcomes is complex. Muscle wasting is prevalent in COPD patients and exacerbates disease severity, contributing to poor physical performance, reduced quality of life, and increased mortality. Additionally, COPD is linked to metabolic disorders, such as dyslipidemia and diabetes, which contribute to systemic inflammation and worse prognosis and, therefore, should be treated. The systemic inflammatory response plays a central role in the development of sarcopenia. In this review, we highlight the mixed efficacy of statins in managing dyslipidemia in COPD, considering side effects, including muscle toxicity in such a frail population. Alternative lipid-lowering therapies and nutraceuticals, in addition to standard treatment, have the potential to target hypercholesterolemia, which is a coexisting condition present in more than 50% of all COPD patients, without worsening muscle wasting. The interference between adipose tissue and lung, and particularly the potential protective role of adiponectin, an adipocytokine with anti-inflammatory properties, is also reviewed. Respiratory, metabolic and muscular health in COPD is comprehensively assessed. Identifying and managing dyslipidemia and paying attention to other relevant COPD comorbidities, such as sarcopenia and muscle wasting, is important to improve the quality of life and to reduce the clinical burden of COPD patients. Future research should focus on understanding the relationships between these intimate mechanisms to facilitate specific treatment for systemic involvement of COPD. Full article

Background/Objectives: Myasthenia Gravis (MG) and myasthenic syndrome (MSyn) are neurological disorders induced by different types of autoantibodies, characterized by generalized muscle weakness, sometimes involving the respiratory muscles and necessitating ventilatory support. One therapeutic option for severe Myasthenia Gravis (MG) is total plasma exchange (TPE). This procedure reduces the concentration of autoantibodies by extracting the patient’s plasma and replacing it with donor plasma. The TPE efficacy varies among different types of MG, and patient response to TPE is evaluated solely through clinical markers, such as muscle strength. So far, no laboratory method is available for monitoring TPE treatment progress. Objective: In this study, we aimed to determine whether differential scanning calorimetry (DSC) of blood plasma from myasthenic patients is an appropriate tool to monitor and evaluate their condition and the TPE effect. Methods: We performed DSC prior to and after TPE course on blood plasma from three patients with different types of MG: Case 1. Patient with Acetylcholine Receptor Myasthenia Gravis (AChR MG); Case 2. Patient with Muscle-specific tyrosine kinase Myasthenia Gravis (MuSK MG); Case 3. Patient with Myasthenic syndrome (MSyn). Results: DSC thermogram examination revealed increased plasma protein fractions, primarily immunoglobulins (IG), as well as to some extent fibrinogen, relative to a suppressed serum albumin fraction. Successive TPE procedures resulted in IG fraction decline in AChR MG (Case 1) and MSyn (Case 3), and upsurge of the IG fraction in MuSK MG (Case 2). These findings aligned with the clinical presentation of all three cases. Conclusions: DSC revealed distinct, very significant differences in the heat capacity profiles of blood plasma from MG patients relative to healthy controls, as well as strong TPE influence on the plasma thermal behavior. DSC showed promise as a reliable and informative technique for the monitoring of myasthenia and TPE effects across diverse myasthenic patient populations. Further research is needed to confirm and expand on these findings. Full article

Background/Objectives: Sarcopenia is an age-related muscle disease that reduces strength and function in older adults. Exercise is a key intervention, but existing protocols vary widely and often lack adaptation to sarcopenia severity. The present study aims to review the effectiveness of exercise protocols developed after the EWGSOP2 consensus and evaluate their adaptation to sarcopenia severity stages. Methods: This systematic review followed PRISMA guidelines. PubMed and Scopus were searched for studies published after the EWGSOP2 consensus involving participants of 65 years and over with primary sarcopenia and managed through exercise-only interventions. Risk of bias was assessed with the Cochrane Risk of Bias tool, and quality and transparency of exercise intervention were assessed with the Consensus on Exercise Reporting Template. Results: Ten studies met the inclusion criteria, with a total of 558 participants. Most interventions included resistance training, often within multicomponent programs. Statistically significant improvements were reported in muscle strength, mass, and physical performance. Additional benefits included enhancements in sleep quality, respiratory function, and specific biomarkers. However, only two studies classified sarcopenia severity, and reporting quality varied considerably. Conclusions: Exercise interventions, especially multicomponent and individualized protocols, are effective at improving outcomes related to sarcopenia in older adults. However, better alignment with diagnostic classifications and standardized reporting are needed to improve clinical translation and program replication. Full article

Background/Objectives: The vestibulo-respiratory reflex regulates the tension of the respiratory muscles, which prevents apneas and awakenings during sleep. This study aimed to determine whether functional deficits in the inner ear disturb sleep quality. Methods: We compared sleep parameters in patients with their first episode of acute inner ear deficit (Group A: sudden idiopathic vertigo attack, sudden sensorineural hearing loss), chronic functional inner ear impairment (Group B: chronic peripheral vertigo, permanent hearing loss), and in healthy individuals (Group C). Polygraphy recordings were performed twice, in Group A at the onset of acute otoneurological symptoms and the second time after their withdrawal with an interval of 1 to 13 days, in Group B after 1 to 6 days, and in Group C after 1 to 8 days. Results: In Group A during the symptomatic night, overall and central apnea-hypopnea indices were significantly higher and snoring time was longer. Group A also had higher central apnea-hypopnea index on the first night compared to healthy individuals. In chronic disorders, sleep recordings showed lower autonomic arousal index than in controls or symptomatic nights in Group A. Conclusions: These findings highlight the severity of sleep apnea indicators in Group A. Our results suggest that acute dysfunction of the inner ear substantially impacts central neuronal signaling responsible for regulating normal sleep-related breathing and leads to a deterioration in sleep quality in contrast to individuals with chronic inner ear impairments. It can also be assumed that people with chronic vertigo or hearing loss experience less interrupted sleep than healthy individuals. Full article

Background: Sarcopenia is characterized by low muscle mass and strength, as well as impaired physical performance. Older adults with sarcopenia experience decreased cardiorespiratory fitness. Physical exercise is recommended for the prevention and treatment of sarcopenia. Virtual reality (VR) exercise was introduced to improve physical activity. However, the effect of VR on cardiorespiratory function in older adults with sarcopenia has not been fully explored. This study aimed to explore the effects of home-based VR aerobic exercise combined with resistive exercise on cardiorespiratory performance in community-dwelling older adults with sarcopenia. Subjects and Methods: In a randomized controlled trial, 53 older adults with sarcopenia were divided into a home-based VR (n = 26) and a control group (CG; n = 27). The VR program combined aerobic and resistance exercises, performed three times per week for 12 weeks, while the CG received knowledge regarding the benefit of exercise and continued with their regular daily activities. All participants were required to undergo respiratory muscle strength and functional capacity tests before and after the 12-week intervention. Two-way mixed repeated ANOVA was conducted to compare within and between groups in cardiorespiratory performance. Results: The home-based VR exercise group showed significant improvement in pre-post (i.e., maximal inspiratory pressure (12.96 ± 1.49 cmH₂O), maximal expiratory pressure (13.73 ± 1.72 cmH₂O), functional capacity (28.32 ± 3.48 m), and between-group (maximal expiratory pressure (F (1,51) = 10.446, p = 0.002, np² = 0.170). In contrast, the CG displayed a reduction in maximal expiratory pressure (−3.93 ± 1.69 cmH₂O, p = 0.024) and functional capacity (−10.39 ± 3.42 m, p = 0.004) after the 12-week program. Conclusions: The home-based VR program provides older adults with sarcopenia an alternative exercise modality that can improve their cardiovascular performance. Full article

Background: Oesophageal perforation (OP) is a life-threatening condition requiring prompt diagnosis and treatment. Mortality is influenced by several factors, such as aetiology, defect location, comorbidities, age, and delays in treatment. This study reviews patients with OP undergoing surgery, analysing mortality risks and the impact of timing on surgical outcomes. Methods: Medical records of 45 patients surgically treated for OP across three tertiary centers were analysed. Results: Of the 45 patients, 31 were male (68.88%) and 14 were female (31.11%), with a mean age of 66.00 ± 17.75 years. Pre-operative CT was performed in all patients, and 18 (40%) underwent oesophagogastroduodenoscopy. As many as 25 patients (55.55%) presented within 24 h, 10 (22.22%) within 24–72 h, and 10 (22.22%) after 72 h. Symptoms included pain, vomiting, fever, dysphagia, and subcutaneous emphysema. Foreign body ingestion and Boerhaave’s syndrome were the leading causes (33.33% each), followed by caustic ingestion (17.77%) and iatrogenic and traumatic cases. Treatments included primary repair, debridement, oesophagectomy, and oesophagogastrectomy. Primary repair was performed in 22 cases (48.88%), and muscle flaps reinforced 11 of these. Direct repair showed the highest success rate when performed within 24 h. Thirty patients (66.66%) experienced complications, including respiratory failure, oesophagopleural fistula, and sub-stenosis. The hospital stay average was 36.34 ± 35.03 days. Nine patients underwent same-session/two-stage gastroplasty or retrosternal coloplasty for reconstruction, with complications including stenosis and leaks. Six patients (13.33%) died within the first 24 h after surgery, primarily due to severe comorbidities (three (50%) were octogenarians). Conclusions: OP is a life-threatening condition with high mortality. Primary repair is the preferred treatment. Oesophagectomy and gastrectomy are reserved for extensive lesions. Muscle flaps can reinforce sutures in cervical and thoracic perforations. Mortality is mainly influenced by the severity of the patient’s clinical picture and comorbidities, rather than by time and type of treatment. Full article

The endocannabinoid system (ECS) is known to regulate crucial bodily functions, including healthy muscle activity. However, its precise roles in normal skeletal muscle function and the development of muscle disorders remain unclear. Previously, we developed a tamoxifen-inducible, skeletal muscle-specific CB₁ receptor knockdown (skmCB1-KD) mouse model using the Cre/LoxP system. In this study, we aimed to clarify the mechanisms behind the observed reduction in muscle force generation in these mice. To investigate this, we analyzed calcium dynamics following electrical stimulation-induced muscle fatigue, assessed store-operated calcium entry (SOCE), and performed functional analysis of mitochondrial respiration. Our findings suggest that the reduced muscle performance observed in vivo likely arises from interconnected alterations in ATP production by mitochondria. Moreover, in skmCB1-KD mice, we detected a significant decrease in a component of the respiratory chain (complex IV) and a slowed dissipation of mitochondrial membrane potential upon the addition of an un-coupler (FCCP). Full article

Background/Objectives: The aim of this review was to evaluate the effectiveness of respiratory muscle strength training in patients with Parkinson’s disease (PD). Methods: A systematic review and meta-analysis of randomised controlled trials (RCTs) was performed on PubMed, Web of Science, and Scopus databases. We included RCTs that evaluated the effectiveness of respiratory muscle training in patients with PD versus no intervention, sham treatment, or a different type of intervention. Quality assessment and risk of bias were assessed using the Downs and Black scale and the ROB2 tool. Results: Finally, 10 studies were included. The methodological quality of the studies was “good” in most of the studies, with results ranging from 21 to 25. In terms of risk of bias, six of them indicated low risk and four of them showed unclear risk of bias. Data were pooled and a meta-analysis of maximum expiratory pressure (MEP), maximum inspiratory pressure (MIP), and voluntary peak expiratory flow rate (PEFR) was performed. Meta-analysis indicated a significant overall effect of respiratory muscle strength training on MEP (MD = 17.08; 95% CI = 2.32, 31.84; p = 0.02) and on voluntary PEFR (MD = 1.50; 95% CI = 0.51, 2.48; p = 0.003). However, results in the meta-analysis showed a non-significant overall effect of respiratory muscle strength training on MIP (MD = 1.69; 95% CI = −11.91, 16.29; p = 0.82). Conclusions: The synthesis of evidence presented in this systematic review and meta-analysis underscores the potential of respiratory muscle strength training as an effective means of increasing MEP and PEFR in patients with PD. Full article

Background and Objectives: This study aimed to evaluate the predictive value of ultrasonographic abdominal muscle thickness and thickening ratios for expiratory muscle strength in SCI patients. Materials and Methods: A case-controlled, cross-sectional study was conducted with 36 SCI patients and 30 age- and sex-matched healthy controls. Ultrasonographic measurements of the rectus abdominis (RA), external oblique (EO), internal oblique (IO), and transversus abdominis (TrA) were performed at rest and during forced expiration. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured to assess respiratory muscle strength. Correlation and regression analyses were performed to determine the relationship between ultrasonography (USG) parameters and expiratory muscle function. Results: SCI patients exhibited significantly lower MIP (76.27 ± 29 cmH₂O vs. 91.63 ± 17.3 cmH₂O, p = 0.007) and MEP (64.52 ± 21.55 cmH₂O vs. 119.1 ± 26.48 cmH₂O, p < 0.001) compared to healthy individuals. Ultrasonographic measurements revealed a significant reduction in forced thickness and thickening ratios of EO, IO, and TrA muscles in SCI patients (p < 0.001). MEP was positively correlated with EO forced thickness (r = 0.333, p = 0.047), IO forced thickness (r = 0.501, p = 0.002), and TrA forced thickness (r = 0.530, p = 0.001). Multiple linear regression analysis identified TrA forced thickness as the strongest predictor of MEP (β = 0.49, p = 0.001). Conclusions: Ultrasonographic measurements of abdominal muscle thickness and thickening ratios provide valuable insights into expiratory muscle dysfunction in SCI patients. TrA forced thickness demonstrated the strongest association with MEP, suggesting its potential as a novel, non-invasive biomarker for expiratory muscle weakness. These results support the use of USG as a practical clinical tool for guiding respiratory assessment and rehabilitation strategies in patients with spinal cord injury. Full article

Vitamin D and magnesium are essential nutrients that play key roles in an athlete’s performance, recovery, and overall health. Vitamin D is crucial for bone health (aiding calcium absorption and preventing stress fractures), muscle function (preventing weakness and injury), and reducing respiratory infections. Magnesium is fundamental in muscle function, adenosine triphosphate production for muscle contraction, electrolyte balance, bone strength, and cardiovascular health. The magnesium requirement of healthy adults is estimated at 300–400 mg/day, but there is evidence that athletes may have higher magnesium needs compared to sedentary persons. Magnesium and vitamin D are closely linked—vitamin D aids magnesium absorption, while magnesium is vital for vitamin D synthesis, transport, and activation. Given their importance in athletes, this article explores their functions, interactions, and the effects of deficiencies and supplementation in athletic populations. Full article

Background/Objectives: Upper airway patency is a key pathophysiological factor in obstructive sleep apnea (OSA). Research has primarily focused on the role of the genioglossus muscle in maintaining airway patency in OSA. However, hypoglossal nerve stimulation (HNS) therapy, which activates the genioglossus muscle, has been associated with poor outcomes in patients with lateral oropharyngeal collapse. The stylopharyngeus muscle is an upper airway dilator muscle that supports the lateral pharyngeal wall. Its role in maintaining upper airway patency and its effect on normal respiratory airflow is unclear. We hypothesize that bilateral transection of the stylopharyngeus muscles disrupts normal breathing. Currently, no animal model depicting lateral pharyngeal collapse has been reported. This study aims to introduce a novel rodent model with bilateral transection of the stylopharyngeus muscles to examine its effect on respiratory airflow and tracing. Methods: Adult male Sprague Dawley rats were divided into two groups: (1) bilateral stylopharyngeus muscle transection (n = 4) and (2) sham surgery (n = 2). Under anesthesia, the stylopharyngeus muscle was transected bilaterally in the transection group, while only exposure of the muscle was performed in the sham group. Respiratory airflow was measured using whole-body plethysmography before and after surgery, and airflow tracings were analyzed. Results: Significant alterations in respiratory airflow and tracings, particularly a flattening in inspiratory flow and sharp expiratory peaks, were observed on the first post-operative day in the transection group. The flattening of the inspiratory flow persisted over 3 days. No significant changes were noted in the sham group. Conclusions: Bilateral stylopharyngeus muscle transection alters normal airflow in a conscious rodent model, supporting the hypothesis that stylopharyngeus muscle plays a vital role in shaping respiratory airflow. The flattening of the inspiratory airflow is an indication of flow limitations through the upper airway patency due to the loss of stylopharyngeus function. Full article

Objective: The use of transcatheter aortic valve implantation (TAVI) has expanded in patients with severe aortic stenosis who are deemed inoperable. However, sarcopenia may be a determining factor in their survival. The aim of our study is to assess the impact of sarcopenia, evaluated by computed tomography (CT), on mortality in this patient population. Methods: Patients with severe aortic stenosis undergoing follow-up after TAVI at Hospital Universitario de la Princesa were recruited. Body composition was analyzed using routine CT scans and open-source software. Survival analysis was performed, and correlations between body composition parameters at the T12 and L3 vertebral levels were assessed. Results: Our sample comprised 97 subjects. Time to mortality was associated with diabetes mellitus (p = 0.050), atrial fibrillation (p = 0.02), and respiratory disease (p = 0.03). Interestingly, sarcopenia (p = 0.039) and normal-density muscle area (p = 0.025) were also associated with time to mortality, with the association between sarcopenia and time to mortality becoming stronger after adjusting for covariates (p < 0.001). The correlation between different body composition parameters at the T12 and L3 vertebral levels was substantial and statistically significant. Conclusions: The use of CT to assess sarcopenia in patients with severe aortic stenosis undergoing TAVI is highly valuable and can predict time to mortality. Sarcopenia should be considered as a relevant parameter in the comprehensive evaluation of these patients. Full article

Objectives: The aim of this study was to evaluate the effectiveness of respiratory muscle training in runners in relation to gender and trainers (PowerBreathe and Threshold). Methods: This study comprised 32 athletes training in middle-distance running at a high sports level. The subjects were divided into groups depending on the applied breathing training (IMT): group IMT on the PowerBreath, group IMT on the Threshold, and the control group labeled sham-IMT. The following tests were performed on each athlete: spirometry, maximal inspiratory pressure, expiratory pressure, and physical performance. Results: A significant increase in the levels of the parameters VO₂/kg, PEF, PI_max, and PE_max, as well as a decrease in lactic acid levels and an increase in lactate threshold in both sexes, were observed as a result of the training on the PowerBreathe device. There were no significant differences in the levels of the parameters VO₂/kg, PEF, PI_max, lactic acid, and lactate threshold in either sex after Threshold training. A significant increase in PE_max was found in the Threshold device training group. Conclusions: Most of the assessed parameters of physical fitness and lung ventilation function, along with the respiratory muscle strength of women and men running middle distances, increased significantly after the use of IMT on PowerBreathe, and these results were maintained in the third stud, in contrast to the use of IMT on Threshold, with which there was no significant improvement. Full article

Background: Post-COVID-19 syndrome (PCS) is defined as the persistence of symptoms 3 months after acute SARS-CoV-2 infection. The long-term prevalence and clinical progression of PCS has not been established. Our aim was to investigate the symptoms in PCS patients, explore the degree of physical activity, according to the fatigue severity score, and analyze its association with basic cardio-pulmonary exercise testing (CPET) parameters. Methods: A total of 192 subjects with history of SARSCoV-2 infection were included. They filled in the Chronic Fatigue Syndrome Questionnaire (CFSQ) and were divided into symptomatic and asymptomatic groups. Forty-seven had persistent post-COVID complaints—reduced physical capacity, fatigue, dyspnea, sleep disturbances, muscle pain. CPET was performed and the pathophysiological parameters in the different fatigue severity groups were compared. Results: Subjects with persistent long-term PCS were divided into two groups—mild (20) and moderate–severe (27), depending on the CFSQ score; forty-eight PCS subjects without complaints served as a control group. The average period between the acute illness and the study was 1028 ± 214 days. Subjects with moderate–severe PCS had more symptoms during CPET (73.6% vs. 24.8% vs. 17.4%), as compared to mild/asymptomatic. The rate of perceived effort was subjective and did not correspond to the workload, heart, or breathing rate in the symptomatic group. These subjects were unable to reach the anaerobic threshold, compared to mild/asymptomatic subjects (51.8% vs. 25%, vs. 12.5%). Patients with moderate–severe PCS showed lower peak VO₂ (24.13 ± 6.1 mL/min/kg vs. 26.73 ± 5.9 mL/min/kg, vs. 27.01 ± 6.3 mL/min/kg), as compared to mild/asymptomatic subjects. Conclusions: Long-term PCS is still present in up to 24% of the general population, more than thirty months after the acute episode. It is characterized by increased perception of symptom burden and diminished aerobic metabolism. A third of the long-term PCS exhibit lower cardio-respiratory fitness, independently from the severity of the symptoms. Full article

Background/Objectives: Athletic performance matters for athletes and fitness enthusiasts. Scientific dietary intervention may boost athletic performance alongside training. Intermittent fasting, like time-restricted fasting (TF), may enhance metabolic health. NAD⁺ supplement nicotinamide mononucleotide (NMN) improves mitochondrial activity. Both potentially boost athletic performance. However, whether TF combined with NMN treatment can further enhance athletic ability is unclear. Methods: Healthy Kunming mice were utilized to test the effects of NMN and TF on the athletic performance of mice. To simulate the in vivo state and further verify the role of TF and NMN, low glucose combined with NMN was used to intervene in C2C12 cells. The exercise capacity of mice was evaluated through motor behavior experiments. At the same time, blood gas analysis and kit tests were used to assess oxygen uptake capacity and post-exercise oxidative stress levels. Muscle development and mitochondrial function were examined through gene expression, protein analysis, and enzyme activity tests, and the distribution of intestinal microbiota and short-chain fatty acid content were also analyzed. Results: The results show that TF combined with NMN improved mitochondrial dynamics and biosynthesis, mitochondrial respiratory function, and oxidative metabolism. Then, the intervention enhanced mice’s endurance, limb strength, motor coordination, and balance and reduced oxidative damage after exercise. Moreover, TF combined with NMN significantly increased the gut microbiota diversity and upregulated Ruminococcus, Roseburia, and Akkermansia in intestinal bacteria and short-chain fatty acids, which are associated with athletic performance. Conclusion: TF combined with NMN enhanced mitochondrial function, improved energy metabolism, modulated the gut microbiota and short-chain fatty acids, and affected muscle fiber transformation, ultimately leading to an overall improvement in exercise performance. These findings provide a theoretical framework for expanding the application of NMN and TF in kinesiology. Full article