Increased muscle thickness due to eccentric training was related to increased fascicle length and not to pennation angle changes. Although RF and VL have a different fascicular geometry, they had similar morphological adaptations to eccentric training.

This study investigated the chronology of neural and morphological adaptations to knee extensor eccentric training and their contribution to strength gains in isometric, concentric and eccentric muscle actions. 20 male healthy subjects performed a 12-week eccentric training program on an isokinetic dynamometer, and neuromuscular evaluations of knee extensors were performed every 4 weeks. After 12 training weeks, significant increases were observed for: isometric (24%), concentric (15%) and eccentric (29%) torques; isometric (29%) and eccentric (33%) electromyographic activity; muscle thickness (10%) and anatomical cross-sectional area (19%). Eccentric and isometric torques increased progressively until the end of the program. Concentric torque and muscle mass parameters increased until the eighth training week, but did not change from this point to the twelfth training week. Eccentric and isometric activation increased at 4 and 8 training weeks, respectively, while no change was found in concentric activation. These results suggest that: 1) the relative increment in concentric strength was minor and does not relate to neural effects; 2) eccentric and isometric strength gains up to 8 training weeks are explained by the increased neural activation and muscle mass, whereas the increments in the last 4 training weeks seem to be associated with other mechanisms.

Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine.

No abstract

LLLT applied before eccentric training sessions seems to improve the hypertrophic response and muscular strength gain in healthy subjects.

BACKGROUND Clostridium difficile infection (CDI) is the most common healthcare-associated infection and is associated with considerable morbidity. Recurrent CDI is a key contributing factor to this morbidity. Despite an estimated 83,000 recurrences annually in the United States, there are few accurate estimates of costs associated with recurrent CDI. OBJECTIVE We performed this study (1) to identify the health consequences of recurrent CDI including need for repeat hospitalization, intensive care unit (ICU) stay, and surgery; (2) to determine costs associated with recurrent CDI and identify determinants of such costs; and (3) to compare the outcomes and costs of recurrent CDI to those who develop reinfection. METHODS We identified all patients with confirmed recurrent CDI between January to December 2013 at a single referral center. Healthcare burden associated with recurrence including diagnostic testing, pharmacologic treatment, and inpatient and outpatient healthcare visits were identified in the 12 months following the first recurrence. Total healthcare costs were calculated, and the predictors of high healthcare utilization were identified. RESULTS Our study population included 98 patients with recurrent CDI. The median interval between the initial infection and recurrence was 37 days. The mean age of the cohort was 67 years, two-thirds were women (62%), and the mean Charlson index was 8.6. During the year following the first recurrence of CDI, each patient underwent a mean of 4.4 stool C. difficile toxin tests and received a mean of 2.5 prescriptions for oral vancomycin (range, 0-6). Most patients (84%) with recurrence had a CDI-related hospitalization, and 6% underwent colectomy. The mean total CDI-associated cost was $34,104 per patient, with hospitalization costs accounting for 68%, surgery 20%, and drug treatment 8% of this cost, respectively. Extrapolating to the United States overall, we estimate an annual cost of $2.8 billion related to recurrent CDI. CONCLUSION Recurrent CDI is associated with considerable morbidity and cost. Infect Control Hosp Epidemiol 2017;38:196-202.

Background The management of inflammatory bowel diseases (IBD; Crohn’s disease (CD), ulcerative colitis (UC)) is increasingly complex. Specialized care has been associated with improved ambulatory IBD outcomes. Aims To examine if the implementation of specialized inpatient IBD care modified short and long-term clinical outcomes in IBD-related hospitalizations. Methods This retrospective cohort study included IBD patients hospitalized between July 2013 and April 2015 at a single tertiary referral center where a specialized inpatient IBD care model was implemented in July 2014. In-hospital medical and surgical outcomes as well as post-discharge outcomes at 30 and 90 days were analyzed along with measures of quality of in-hospital care. Effect of specialist IBD care was examined on multivariate analysis. Results A total of 408 IBD-related admissions were included. With implementation of specialized IBD inpatient care, we observed increased frequency of use of high-dose biologic therapy for induction (26% vs. 9%, odds ratio (OR) 5.50, 95% CI 1.30 – 23.17) and higher proportion of patients in remission at 90 days after discharge (multivariate OR 1.60, 95% CI 0.99 – 2.69). While there was no difference in surgery by 90 days, among those who underwent surgery, early surgery defined as in-hospital or within 30 days of discharge, was more common in the study period (71%) compared to the control period (46%, multivariate OR 2.73, 95% CI 1.22 – 6.12). There was no difference in length of stay between the two years. Conclusions Implementation of specialized inpatient IBD care beneficially impacted remission and facilitated early surgical treatment.

It is not known if a physically active lifestyle, without systematic training, is sufficient to combat age-related muscle and strength loss. Therefore, the purpose of this study was to evaluate if the maintenance of a physically active lifestyle prevents muscle impairments due to aging. To address this issue, we evaluated 33 healthy men with similar physical activity levels (IPAQ = 2) across a large range of ages. Functional (torque-angle and torque-velocity relations) and morphological (vastus lateralis muscle architecture) properties of the knee extensor muscles were assessed and compared between three age groups: young adults (30 ± 6 y), middle-aged subjects (50 ± 7 y) and elderly subjects (69 ± 5 y). Isometric peak torques were significantly lower (30% to 36%) in elderly group subjects compared with the young adults. Concentric peak torques were significantly lower in the middle aged (18% to 32%) and elderly group (40% to 53%) compared with the young adults. Vastus lateralis thickness and fascicles lengths were significantly smaller in the elderly group subjects (15.8 ± 3.9 mm; 99.1 ± 25.8 mm) compared with the young adults (19.8 ± 3.6 mm; 152.1 ± 42.0 mm). These findings suggest that a physically active lifestyle, without systematic training, is not sufficient to avoid loss of strength and muscle mass with aging.