Effect of walking with blood flow restriction in elderly women with osteoporosis/osteopenia / Efeito da caminhada com restrição do fluxo sanguíneo em idosas com osteoporose/osteopenia

Abstract Introduction The preservation of bone mass in elderly women is associated with better levels of practice of systematic physical exercises. Aerobic training combined with blood flow restriction seems to be a new alternative that determines this process, but knowledge gaps are still observed when referring to exercise associated with blood flow restriction (BFR) and adaptations on bone variables. Objective To analyze the chronic effects of aerobic training with and without BFR on bone mineral density and bone biomarker osteocalcin concentrations in older women. Methods Thirty women were randomized into the following groups: walking on a treadmill at low intensity with BFR; moderate treadmill walking with no BFR; only BFR (no exercise) for 20 minutes, twice a week, for 24 weeks. Bone mineral density was measured before and 24 weeks after intervention. Blood serum osteocalcin concentrations were measured before, 12 and 24 weeks after intervention. Results There were no differences between groups in bone mineral density (femoral neck, p = 0.31; total femur, p = 0.17; lumbar spin, p = 0.06) and osteocalcine (W(2) = 0.27; p = 0.87) ouctomes after 24 weeks of intervention. Conclusion There was no difference between walking training, blood flow restriction only, or walking+blood flow restriction on bone mineral density and osteocalcin concentrations after 24-weeks of intervention in older women with osteopenia/osteoporosis.

Resumo Introdução A preservação da massa óssea em mulheres idosas está associada a melhores níveis de prática de exercícios físicos sistemáticos. O treinamento aeróbico combinado com restrição de fluxo sanguíneo (RFS) parece ser uma nova alternativa que determina esse processo, mas ainda são observadas lacunas de conhecimento quando se refere ao exercício associado à RFS e adaptações nas variáveis ósseas. Objetivo Analisar os efeitos crônicos do treinamento aeróbico com e sem RFS na densidade mineral óssea e nas concentrações do biomarcador ósseo osteocalcina em mulheres idosas. Métodos Trinta mulheres foram randomizadas nos seguintes grupos: caminhada em esteira de baixa intensidade com RFS; caminhada moderada em esteira sem RFS; apenas RFS (sem exercícios) por 20 minutos, duas vezes por semana, durante 24 semanas. A densidade mineral óssea foi medida antes e 24 semanas após a intervenção. As concentrações séricas de osteocalcina no sangue foram medidas antes, 12 e 24 semanas após a intervenção. Resultados Não houve diferenças entre os grupos na densidade mineral óssea (colo do fêmur, p = 0,31; fêmur total, p = 0,17; giro lombar, p = 0,06) e osteocalcina (W(2) = 0,27; p = 0,87) após 24 semanas de intervenção. Conclusão Não houve diferença entre treinamento de caminhada, apenas restrição de fluxo sanguíneo ou caminhada + restrição de fluxo sanguíneo na densidade mineral óssea e nas concentrações de osteocalcina após 24 semanas de intervenção em mulheres idosas com osteopenia/osteoporose.

Oclusão percutânea da comunicação interatrial do tipo seio venoso com stent coberto: a importância dos métodos de imagem para impressão de modelos tridimensionais e a melhor tomada de decisão clínica / Percutaneous occlusion of sinus venosus atrial septal defect using a covered stent: the importance of imaging methods for printing three-dimensional models and better clinical decision-making

A comunicação interatrial do tipo seio venoso superior geralmente acompanha-se de uma conexão venosa anômala de veia ou veias pulmonares superiores ou médias direitas, que drenam diretamente na veia cava superior ou, ainda, na junção cavoatrial. Relatamos o caso de uma paciente do sexo feminino, de 62 anos, com diagnóstico de comunicação interatrial do tipo seio venoso, com sobrecarga das câmaras direitas, para quem foi planejado o procedimento de oclusão percutânea do defeito por meio da realização prévia de tomografia cardiovascular e, sequencialmente, estudo anatômico tridimensional, com o software de acesso público 3D Slicer. Além disso, foi realizada a impressão do modelo em resina para inspeção e simulação de implante de um stent. A paciente foi tratada de maneira percutânea com um stent Chetham-Platinum coberto de 60mm de extensão, com oclusão total do defeito, ausência de shunts residuais e direcionamento do fluxo da veia pulmonar superior direita para o átrio esquerdo por comunicação posterior entre os átrios, condição essencial para a realização desse tipo de procedimento. O planejamento do procedimento de oclusão percutânea da comunicação interatrial do tipo seio venoso passa por avaliação criteriosa dos exames de imagem. A impressão de modelos virtuais ou físicos, derivados da angiotomografia cardíaca, é fundamental para estudo detalhado do defeito e das estruturas anatômicas associadas, minimizando a ocorrência de complicações.

A superior sinus venosus atrial septal defect is usually accompanied by an anomalous venous connection to a right superior or middle pulmonary vein or veins, draining directly into the superior vena cava or even into the cavoatrial junction. This is a case report of a 62-year-old female patient, diagnosed with a sinus venosus atrial septal defect, with overload of the right chambers, for whom a percutaneous occlusion procedure was planned, using a previous cardiovascular tomography and, sequentially, a three-dimensional anatomical study, with the publicly available software 3D Slicer. In addition, a resin model was printed for inspection and simulation of a stent implantation. The patient was treated percutaneously with a 60-mm covered Chetham-Platinum stent, with total occlusion of the defect, absence of residual shunts, and draining flow from the right superior pulmonary vein to the left atrium, through a posterior communication between the atria, a sine qua non prerequisite to perform this type of procedure. Planning of the percutaneous occlusion procedure of the sinus venosus atrial septal defect involves careful evaluation of imaging tests. The printing of virtual or physical models, derived from computed tomography angiography of the heart, is essential for a detailed study of the defect and associated anatomical structures, minimizing the occurrence of complications.

Vascular Occlusion of the Quadriceps Muscle in Postural Control of Women with Patellofemoral Dysfunction / Oclusão Vascular do Músculo Quadríceps no Controle Postural de Mulheres com Disfunção Patelofemoral

Abstract The partial vascular occlusion (PVO) associated with exercises, proposed by the KAATSU Training method, has the objective of strengthening and muscle hypertrophy with low joint overload. Currently, PVO has been associated with exercises to strengthen then quadriceps, however it is not known about its influence on postural control or the possibility of imbalances during the performance of exercises. Objectives: To evaluate the effect of quadriceps vascular occlusion on postural control in women with patellofemoral pain syndrome (PFPS). Methods: The sample in this study was composed of four sedentary women, aged between 18 and 40 years, with a clinical diagnosis of patellofemoral dysfunction. Participants responded to the Visual Analog Pain Scale (VAS) and the Anterior Knee Pain Scale (AKPS). They were submitted to an evaluation of postural control over the force platform, by means of dynamic one-legged squat activity, with and without PVO. The variables of postural control analyzed were Area of pressure center (A-COP), Anteroposterior (AP) and medium-lateral (ML), Velocity AP and ML. Results: No significant differences were found for the variables of postural control analyzed when comparing the moments with and without peripheral vascular occlusion during single-legged squat activities. Conclusion: The single leg squat with vascular occlusion does not change the postural control of patients with PFPS with and without PVO, and that the method can be used for training these patients, without impairments related to postural control. (AU)

Resumo A oclusão vascular parcial (OVP) associada a exercícios, proposta pelo método KAATSU Training, tem como objetivo o fortalecimento e hipertrofia muscular com baixa sobrecarga articular. Atualmente, a OVP tem sido associada a exercícios de fortalecimento do quadríceps, porém não se sabe sobre sua influência no controle postural ou na possibilidade de desequilíbrios durante a execução dos exercícios. Objetivos: Avaliar o efeito da oclusão vascular do quadríceps no controle postural de mulheres com síndrome da dor patelofemoral (SDFP). Métodos: A amostra deste estudo foi composta por quatro mulheres sedentárias, com idade entre 18 e 40 anos, com diagnóstico clínico de disfunção femoropatelar. Os participantes responderam à Escala Visual Analógica de Dor (VAS) e à Escala de Dor Anterior no Joelho (AKPS). Elas foram submetidas à avaliação do controle postural sobre a plataforma de força, por meio da atividade de agachamento unipodal dinâmico, com e sem OVP. As variáveis de controle postural analisadas foram área do centro de pressão (A-COP), ântero-posterior (AP) e médio-lateral (ML), velocidade AP e ML. Resultados: Não foram encontradas diferenças significativas para as variáveis de controle postural analisadas na comparação dos momentos com e sem OVP durante o agachamento unipodal. Conclusão: O agachamento unipodal com OVP não alterou o controle postural de mulheres com SDFP, e o método pode ser utilizado para treinar esses pacientes, sem prejuízos relacionados ao controle postural. (AU)

Effect of hemihepatic vascular exclusion versus total hepatic vascular exclusion in hepatectomy for primary liver cancer: A Meta-analysis / 临床肝胆病杂志

ObjectiveTo systematically evaluate the effect of Pringle’s measure (PM) versus hemihepatic vascular occlusion (HVO) in hepatectomy for primary liver cancer. MethodsRelated Chinese and English databases were searched for control studies on HVI versus PM in the treatment of primary liver cancer published up to June 2020. After quality evaluation and data extraction of the included studies, RevMan5.3 software was used for the meta-analysis. ResultsA total of 10 studies were included in the Meta-analysis, with 1272 patients in total. On days 1 and 3 after surgery, the HVO group had a significantly lower level of alanine aminotransferase than the PM group (day 1: mean difference ［MD］=-172.71, 95% confidence interval ［CI］: -289.26 to -56.16, P=0.004; day 3: MD=-130.35, 95%CI: -221.25 to -39.45, P=0.005). On day 3 after surgery, the HVO group had a significantly lower level of aspartate aminotransferase than the PM group (MD=-84.56, 95%CI: -166.47 to -2.65, P=0.04), and on days 1 and 3 after surgery, the HVO group had a significantly higher level of albumin than the PM group (day 1: MD=1.31, 95%CI: 0.06-2.56, P=0.04; day 3: MD=1.81, 95%CI: 027-335, P=0.02). The HVO group had a significantly longer time of operation than the PM group (MD=8.95, 95%CI: 4.30-13.60, P＜0.01). ConclusionHVO is a safe and effective method for vascular occlusion, and compared with PM, it can effectively alleviate liver injury. However, surgeons should select a suitable method for occlusion based on their own personal experience, patients’ conditions, and specific situation during surgery.

Are there differences in the activation of the agonist and antagonist muscles during resistance training sessions with continuous or intermittent blood flow restriction? / Existem diferenças na ativação dos músculos agonista e antagonista durante sessões de treinamento de força com restrição de fluxo sanguíneo contínua ou intermitente?

Resistance training (RT) with blood flow restriction (BFR) has been used to increase muscle strength and hypertrophy, however, the best strategy to perform BFR (continuous or intermittent) has not yet been established. The aim of this study was to analyze the chronic effect of RT with continuous or intermittent blood flow restriction (CBFR or IBFR) on muscle activation. A total of 24 men with RT experience were randomly divided into three experimental groups: low-load exercises at 20% of one repetition maximum (1RM) combined with CBFR (LL + CBFR), low-load exercises at 20% of 1RM combined with IBFR (LL + IBFR), or low-load exercises at 20% of 1RM without BFR (LL). Twelve RT sessions were performed for 6 weeks, twice a week. A comparative analysis of the activation of the biceps and triceps brachial muscles after the bench press, triceps pulley, and biceps pulley exercises did not reveal group × evaluations × sets, group × evaluations, group × sets, or evaluations × sets interactions with regard to group, evaluation, or sets (p > 0.05). However, the evaluations showed a significant increase in the LI+IBFR group after the 1st, 2nd, and 4th sets (p < 0.05) only with regard to biceps muscle activation. It was concluded that the muscle activations of the biceps and triceps are similar with regard to the bench press, triceps pulley, and biceps pulley exercises when CBFR is compared with IBFR; however, IBFR improved the muscle activation of the biceps brachial only with regard to the front pull down exercise.se....(AU)

O treinamento de força (TF) com restrição de fluxo sanguíneo (RFS) tem sido utilizado para o aumento da força e hipertrofia muscular, entretanto, ainda não foi estabelecido a melhor estratégia para realizar a RFS (contínua ou intermitente). O objetivo do estudo foi analisar o efeito crônico do TF com a RFS, contínua ou intermitente, sobre ativação muscular. Participaram do estudo 24 homens com experiência em TF que foram divididos aleatoriamente em três grupos experimentais: a) exercícios de baixa carga a 20% de 1RM combinado com a RFS contínua (BC + RFSC), b) exercícios de baixa carga a 20% de 1RM combinado com a RFS intermitente (BC + RFSI), c) exercícios de baixa carga a 20% de 1RM sem a RFS (BC). Foram realizadas 12 sessões de TF (duração de seis semanas, sendo duas vezes por semana). Na primeira e na última sessão foi avaliada a ativação muscular do bíceps e tríceps nos quatro exercícios (supino reto, puxada frontal, rosca tríceps e rosca bíceps, respectivamente). Na análise comparativa da ativação muscular do bíceps e do tríceps braquial nos exercícios: supino reto, rosca tríceps e rosca bíceps, observou-se que não existiram interações entre grupo × avaliações × séries, grupo × avaliações, grupo × séries, avaliações × séries, no grupo, nas avaliações e nas séries (p > 0,05); entretanto, nas avaliações houve aumento significativo no grupo BC+RFSI, na 1ª, 2ª e 4ª séries (p < 0,05) apenas na ativação muscular do bíceps. Conclui-se que a ativação muscular do bíceps e tríceps parecem ser semelhantes nos exercícios supino reto, rosca tríceps e rosca bíceps quando comparada a RFS contínua vs. intermitente, porém, a RFS intermitente parece melhorar a ativação muscular do bíceps braquial apenas no exercício puxada frontal....(AU)

Are there differences in auscultatory pulse in total blood flow restriction between positions, limbs and body segments? / Existem diferenças no pulso auscultatório da restrição total de fluxo sanguíneo entre as posições, membros e segmentos corporais?

Verification of the auscultatory pulse in total blood flow restriction (BFR) has been a limiting factor in studies due to the way in which it is evaluated and prescribed, as hemodynamic measurements can be directly affected by gravity. The aim of the present study was to compare the auscultatory pulse in BFR between positions, genders, limbs and body segments in healthy young individuals. A total of 156 subjects participated in the study, 76 of whom were male and 80 of whom were female (23.9±3.7 years, 66.5±11.5 kg, 1.67±0.07 m). After filling in registration data, anthropometry was evaluated, and BFR pressure was determined. BFR was evaluated in a randomized manner in both limbs (upper and lower) and in both segments (right and left) in the following positions: a) lying in the supine position; B) sitting with knees and trunk at 90°; and c) standing in the anatomical position. Significant differences were observed between the lying, sitting and standing positions (p<0.05), between genders (p<0.05), between limbs (p<0.05) and between the right and left segments in the lower limb in both genders [males (p=0.014) and females (p=0.009)] in the lying position. However, no significant differences were observed between the right and left segments in the upper limbs (p>0.05). The BFR point appears to differ between positions, genders, lower limbs and segments. Therefore, it is recommended that health professionals should check the BFR point in the position relating to the exercise that will be performed, taking into account gender, lower limbs and body segments.

A verificação do pulso auscultatório da restrição de fluxo sanguíneo (RFS) total tem sido fator limitante dos estudos devido à forma de avaliação e prescrição, já que as medidas hemodinâmicas podem sofrer influência direta da gravidade. O objetivo do presente estudo foi comparar o pulso auscultatório da RFS entre as posições, sexo, membros e segmentos corporais em jovens saudáveis. Participaram do estudo 156 sujeitos, sendo 76 homens e 80 mulheres (23,9±3,7 anos, 66,5±11,5 kg, 1,67±0,07 m). Após o preenchimento da ficha cadastral, foram avaliadas a antropometria e em seguida houve a determinação da pressão de RFS. A RFS foi avaliada de forma randomizada em ambos os membros (superiores e inferiores) e ambos os segmentos (direito e esquerdo) nas posições: a) deitada em decúbito dorsal; b) sentada com joelhos e tronco em 90°; e c) em pé na posição anatômica. Observaram-se diferenças significativas entre as posições deitado, sentado e em pé (p<0,05), entre os sexos (p<0,05), entre os membros (p<0,05) e entre os segmentos direito vs. esquerdo no membro inferior em ambos os sexos [homem (p=0,014) e mulher (p=0,009)] na posição deitada. Entretanto, observou-se não existir diferenças significativas entre os segmentos direito vs. esquerdo no membro superior (p>0,05). O ponto da RFS parece diferir entre as posições, sexo, membros inferiores e segmentos. Portanto, recomenda-se que os profissionais da área da saúde devam verificar o ponto da RFS na posição referente ao exercício que será realizado, levando em consideração o sexo, membros inferiores e segmentos corporais.

Laparoscopic uterine artery occlusion before cervical curettage in cervical ectopic pregnancy: Safe and effective for preventing massive bleeding

Cervical ectopic pregnancy is associated with high risk for massive bleeding conditions. Cervical ectopic pregnancy can usually be treated by methotrexate injection or surgery. We present 4 cases of cervical ectopic pregnancy that were treated successfully with different uterine-conserving methods. By comparing our experience of 4 cases managed in different ways, we found that laparoscopic uterine artery occlusion before cervical curettage is more effective method for preventing massive bleeding.

Postoperative Ureteral Leak Treated Using a Silicone-Covered Nitinol Stent / 대한배뇨장애요실금학회지

Ureteral fistula is a serious complication of abdomino-pelvic surgeries, often resulting in poor outcomes owing to lack of proper treatment. We report the case of a 49-year-old woman who underwent placement of a silicone-covered ureteral occlusion stent in her right ureter for the management of ureteral leakage after pelvic surgery. A ureterogram obtained 18 months following the stent placement confirmed that there was no stent migration or additional urine leakage. We propose that the silicone-covered ureteral occlusion stent is practical, fast, and safe for the management of ureteral leakage.

Evaluation of histological changes after tracheal occlusion at different gestational ages in a fetal rat model

OBJECTIVES: To evaluate the histological changes of tracheal cartilage and epithelium caused by tracheal occlusion at different gestational ages in a fetal rat model. METHODS: Rat fetuses were divided into two groups: a) External control, composed of non-operated rats, and b) Interventional group, composed of rats operated upon on gestational day 18.5 (term = 22 days), divided into triads: 1) Tracheal occlusion, 2) Internal control and 3) Sham (manipulated but not operated). Morphological data for body weight, total lung weight and total lung weight/body weight ratio were collected and measured on gestational days 19.5, 20.5 and 21.5. Tracheal samples were histologically processed, and epithelial, chondral and total tracheal thicknesses were measured on each gestational day. RESULTS: The tracheal occlusion group exhibited an increase in total lung weight/body weight ratio (p<0.001). Histologically, this group had a thicker epithelial thickness (p<0.05) and thinner chondral (p<0.05) and total tracheal thicknesses (p<0.001). These differences were more prominent on gestational days 20.5 and 21.5. CONCLUSION: Tracheal occlusion changed tracheal morphology, increased epithelial thickness and considerably decreased total tracheal thickness. These changes in the tracheal wall could explain the development of tracheomegaly, recently reported in some human fetuses subjected to tracheal occlusion.