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Objective: To define the role of the flexion-relaxation phenomenon (FRP), assessed through ratios (FRR), as a diagnostic test to define impairment in patients with chronic low back pain (CLBP)., Material and Method: The study sample consisted of 180 participants (16 healthy volunteers and 164 patients on work disability due to CLBP), who were consecutively referred for evaluation at the Biomechanics Laboratory of a workplace accident insurance company from January 2012 to December 2017. The evaluations consisted of an isometric dynamometry test, a kinematic test and assessment of the FRP phenomenon. Minimum criteria were established in the performance of the tests for their acceptance as valid for the study. Lumbar impairment or clinical recovery was defined on the basis of the results of the dynamometry and kinematic tests. The FRP response was assessed with FRRs. A total of 4 different ratios were taken for analysis with ROC curves., Results: A total of 86 valid tests were obtained (16 classified as lumbar impairment and 71 as recovered cases). The best ratio obtained an area under the ROC curve of 0.87, with a sensitivity of 0.84, a specificity of 0.87, and a positive predictive value of 97%., Conclusions: The FRP test, along with dynamometry and kinematic evaluations, is effective in identifying lumbar impairment and is the easiest test for patients with CLBP to perform., (Copyright © 2020 Sociedad Española de Rehabilitación y Medicina Física. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To describe variability of lower esophageal sphincter (LES) pressure in patients with diagnosis of achalasia based in esophageal manometry., Methods: We included 29 patients with diagnosis of achalasia confirmed by water perfusion manometry performed between July 2000 and June 2002 at the Digestive and Liver Disease Center in Guadalajara, Jalisco. Three were excluded due to impossibility of evaluating LES., Results: Esophageal aperistalsis was found in all patients. LES pressure was normal in 73%, low (hypotension) in 8%, and high (hypertension) in only 19% of patients. Relaxation of LES showed different responses ranging from absence to complete relaxation after degluttion. There was absence of relaxation after degluttion in all patients with LES hypertension and hypotension., Conclusion: Hypertension of LES in our cohort of patients with achalasia was seen only in 19%. Knowledgement of manometric variability is fundamental to avoid errors in achalasia diagnosis and further patient treatment.

In this article the macroscopic structure of the ventricular myocardium is described, which is configurated as a band along which four segments can be distinguished. Such band traces a helicoids with two spiral turns in the space, in its trajectory from the pulmonary artery root to the aortic root, delimits both ventricular cavities. Our interest in achieving the knowledge of the coherent relationship between that anatomical fact and cardiac mechanics, which necessarily exist between the form and the function of any organ, has led us to perform some experimental approaches which show that the volume decrease of the ventricular cavities takes place, simultaneously with the descent of the base, thanks to the agonist contraction of the descending segment of the band, previously stretched out in a rectilinear way. Meanwhile, the volume increase takes place, simultaneously with the ascent of the base, as a consequence of the antagonist contraction of the ascendent segment of the band, previously extended in a curvilinear way.

Endothelium controls vascular smooth muscle tone by secreting relaxing and contracting factors. There is a constant release of endothelium derived relaxing factors, mainly nitric oxide, a potent vasodilator, inhibitor of platelet aggregation, monocyte adhesion and smooth muscle proliferation. In addition, the endothelium may increase the release of NO in response to humoral stimulation by vasoactive substances such as acetylcholine, bradykinin or substance P. Although the endothelium releases a number of products, no single blood test has yet proved useful to determine normal endothelial function or as early abnormalities. The most useful test of endothelial function relies on the measurement of endothelium-dependent dilatation in response to pharmacological or physiologic stimuli. The alteration of this response is known as endothelial dysfunction and has been observed in a variety of circumstances related to cardiovascular risk. This review summarizes the evidence that sustains this association and emphasizes the clinical utility of assessing endothelial function presenting two clinical cases of hypercholesterolemia in which a high-resolution vascular ultrasound in the brachial artery was used.

To evaluate the changes of blood flow velocities of the uterine and external iliac arteries, we studied a total of 15 normal full term pregnant, which were in the active phase of labor. The mean maternal age was 21.6 +/- 5.2 years (X +/- SD), the mean parity was 0.6 +/- 0.5, and the mean gestational age was 39.2 +/- 1.1 weeks. All patients had normal deliveries, the newborn weight was 3440 +/- 621 g, and the apgar score was 8.6 +/- 1.6 and 9.0 +/- 0.7 at 1 and 5 min, respectively. In the uterine artery, the systolic/diastolic ratio and the resistance index increased significantly from 1.83 +/- 0.25 to 4.24 +/- 1.55 (p < 0.05) and from 0.46 +/- 0.05 to 0.74 +/- 0.08 (p < 0.01), respectively from the relaxation phase to the contraction phase. In all 15 patients the external iliac artery showed a reverse diastolic flow during uterine relaxation, whereas only 2 of the 14 patients showed this reverse flow during uterine contraction (p < 0.01). Furthermore, the flow velocity was modified with maternal hyperventilation. Finally, we conclude that uterine contraction induced profound changes in the blood flow velocities in the uterine and external iliac arteries. We proposed that these changes could be explained by uterine muscular contractions causing the blood flow to be shunted to areas of less resistance.