Association between atrial fibrillation reoccurrence and new-onset ischemic stroke among patients with nonvalvular atrial fibrillation / 中华心血管病杂志

Objective: Explore the association between atrial fibrillation (AF) reoccurrence and new-onset ischemic stroke (IS) in patients with nonvalvular AF, and explore whether there is a high-risk period of IS after recurrent episodes of AF. Methods: A nested case-control study design was used. A total of 565 nonvalvular AF patients with new-onset IS after a follow-up of at least 2 years in the China-AF cohort were enrolled as the case group, and 1 693 nonvalvular AF patients without new-onset IS were matched as the control group at a ratio of 1∶3. Frequency and types of recurrent AF in the previous 1 or 2 years were compared between two groups, and the adjusted associations of AF reoccurrence with new onset IS were explored using conditional logistic regression analysis. The proportion of recurrent AF was compared between the case period and control period, and conditional logistic regression analysis was performed to calculate adjusted associations of case-period AF with IS. Results: The nested case-control study design results showed that the proportion of at least one record of recurrent AF in the previous 1 year was higher in the case group than in the control group (72.0% vs. 60.8%, P<0.05), and the recurrent AF was positively correlated with new-onset IS (adjusted OR=1.80, P<0.001). Similar results were also observed in the previous 2 years period. The case-crossover study design analysis showed that among 565 patients with new-onset IS, recurrent AF in the case period was positively correlated with IS (adjusted OR=1.61, P=0.003). Conclusion: Recurrent AF is associated with IS, and there may be a high-risk period of IS after recurrent episodes of AF.

Association between atrial fibrillation reoccurrence and new-onset ischemic stroke among patients with nonvalvular atrial fibrillation / 中华心血管病杂志

Objective: Explore the association between atrial fibrillation (AF) reoccurrence and new-onset ischemic stroke (IS) in patients with nonvalvular AF, and explore whether there is a high-risk period of IS after recurrent episodes of AF. Methods: A nested case-control study design was used. A total of 565 nonvalvular AF patients with new-onset IS after a follow-up of at least 2 years in the China-AF cohort were enrolled as the case group, and 1 693 nonvalvular AF patients without new-onset IS were matched as the control group at a ratio of 1∶3. Frequency and types of recurrent AF in the previous 1 or 2 years were compared between two groups, and the adjusted associations of AF reoccurrence with new onset IS were explored using conditional logistic regression analysis. The proportion of recurrent AF was compared between the case period and control period, and conditional logistic regression analysis was performed to calculate adjusted associations of case-period AF with IS. Results: The nested case-control study design results showed that the proportion of at least one record of recurrent AF in the previous 1 year was higher in the case group than in the control group (72.0% vs. 60.8%, P<0.05), and the recurrent AF was positively correlated with new-onset IS (adjusted OR=1.80, P<0.001). Similar results were also observed in the previous 2 years period. The case-crossover study design analysis showed that among 565 patients with new-onset IS, recurrent AF in the case period was positively correlated with IS (adjusted OR=1.61, P=0.003). Conclusion: Recurrent AF is associated with IS, and there may be a high-risk period of IS after recurrent episodes of AF.

Affective response of postmenopausal women to resistance training on stable and unstable surfaces: a randomized cross-over study / Respostas afetivas de mulheres pós-menopausadas submetidas ao treinamento com pesos em superfície estável e instável: um estudo cross-over randomizado

Objective: To compare the affective response of postmenopausal women who undergo 6 weeks of resistance training on stable and unstable surfaces. Methods: This randomized counterbalanced cross-over study carried included 14 postmenopausal women (55 [SD, 3] years; height 1.55 [SD, 0.03] m; body mass 78.70 [SD, 12.00] kg; and body mass index 32.80 [SD, 4.90] kg/m²), who underwent 6 weeks of resistance training on stable and unstable surfaces. The participants were initially allocated to 1 experimental condition (stable or unstable) in a randomized counterbalanced manner. The intervention consisted of 8 exercises in 3 series of 8-10 repetitions, with intervals of 60-90 seconds, for 3 weeks. After the first 3-week protocol, they were switched to the other experimental condition for another 3 weeks. To evaluate affective response, the Hardy and Rejeski Sensation Scale was applied weekly at the end of each exercise and again at the end of the 6 weeks. Results: Affective response was similar to the general affect observed at the end of the sessions (stable surface: 5.00 [3.00]; unstable surface: 5.00 [1.00]; p = 0.114), except for the bridge exercise (stable surface: 3.00 [2.00]; unstable surface: 4.00 [2.00]; p = 0.048]). Conclusions: The affective response of these women was not affected by training on unstable surfaces, except for the bridge exercise, in which the unstable surface increased affective response

Objetivo: Comparar as respostas afetivas de mulheres pós-menopausadas submetidas a seis semanas de treinamento com pesos realizado em superfície estável e instável. Metodologia: Trata-se de um estudo cross-over, randomizado e contrabalanceado realizado com 14 mulheres pós-menopausadas (55 ± 3 anos; estatura de 1,55 ± 0,03 m; massa corporal 78,70 ± 12,00 kg; e índice de massa corporal de 32,80 ± 4,90 kg/m²) submetidas a seis semanas de treinamento com pesos em superfície estável e instável. As participantes foram alocadas, inicialmente, numa das condições experimentais de forma randomizada e contrabalanceada. A intervenção foi composta por oito exercícios em três séries de oito a dez repetições, com intervalos entre 60 e 90 segundos, durante três semanas. Para avaliação das respostas afetivas, foi aplicada a Escala de Sensação de Hardy e Rejeski ao fim da última série de cada exercício e ao final das sessões, durante as seis semanas. Resultados: As respostas afetivas foram similares para o afeto geral observado ao final das sessões [Superfície estável: 5,00 (3,00); Superfície instável: 5,00 (1,00); p = 0,114], mas não para o exercício de ponte [Superfície estável: 3,00 (2,00); Superfície instável: 4,00 (2,00); p = 0,048)]. Conclusões: Conclui-se que as respostas afetivas de mulheres pós-menopausadas, observadas ao final da sessão, não foram afetas pela instabilidade. Contudo, as sensações de prazer, no exercício de ponte, foram maiores com a inserção da instabilidade

Baru nuts reduce abdominal adiposity in type 2 diabetic adults: a randomized, placebo-controlled, crossover trial / Amêndoa de baru reduz a adiposidade abdominal de adultos com diabetes Mellitus tipo 2: um estudo randomizado, placebo-controlado, crossover

ABSTRACT Objective: This study aimed to evaluate the effect of baru nuts supplementation on body composition and metabolic profile in adults with type 2 diabetes. Methods: This is a randomized, placebo-controlled, crossover trial with 30 adults with type 2 diabetes. The assay had two periods of 12 weeks each, with a washout period of 12 weeks between treatments. The subjects were randomized and received the two treatments in alternate periods: supplementation of 30g baru nuts or placebo. Anthropometry, body composition, blood pressure, blood sampling, food intake, and physical activity data were analyzed. Results: Baru nut intake reduced waist circumference (p=0.032), compared to placebo group. In the intra-group analysis, baru nut intake reduced total cholesterol (p=0.012) and LDL-c (p=0.017). Conclusion: The daily intake of baru nuts improved abdominal adiposity. Therefore, these nuts should be included in the diet to improve the health status of adults with type 2 diabetes.

RESUMO: Objetivo: Avaliar o efeito da suplementação com amêndoa de baru sobre a composição corporal e perfil metabólico de adultos com diabetes Mellitus tipo 2. Métodos: Este é um estudo randomizado, placebo-controlado, crossover com 30 adultos com diabetes Mellitus tipo 2. O ensaio clínico foi dividido em dois períodos de 12 semanas cada, com um washout de 12 semanas entre os tratamentos. Os sujeitos foram randomizados e receberam dois tratamentos em períodos alternativos: suplementação com 30 g de amêndoa de baru ou placebo. Foram coletados dados referentes à antropometria, composição corporal, pressão arterial, amostras de sangue, ingestão de alimentos e práticas de atividade física. Resultados: A ingestão de amêndoa de baru reduziu a circunferência da cintura (p=0,032), em comparação com o grupo placebo. Na análise intragrupo, a ingestão de amêndoa de baru também reduziu o colesterol total (p=0,012) e LDL-c (p=0,017). Conclusão: A ingestão diária de amêndoa de baru melhorou a adiposidade abdominal, portanto, deve ser incluída na dieta para a melhora do estado de saúde de adultos com diabetes Mellitus tipo 2.

Resultados de la ventilación asistida ajustada neuronalmente no invasiva y la presión positiva continua nasal en recién nacidos prematuros: revisión sistemática y metanálisis / Outcomes of noninvasive neurally adjusted ventilatory assist and nasal continuous positive airway pressure in preterm infants: a systematic review and meta-analysis

Introducción: los beneficios de la ventilación asistida ajustada neuronalmente (NAVA) en los recién nacidos prematuros son inciertos. El objetivo de este estudio fue explorar si la NAVA no invasiva (NIV) era más beneficiosa para los recién nacidos prematuros que la presión positiva continua nasal (NCPAP). Diseño del estudio: metanálisis de tres ensayos clínicos: dos ensayos controlados aleatorizados y un estudio de grupos cruzados. Se comparó la NAVA-NIV con la NCPAP y se informó sobre el fracaso del tratamiento, la mortalidad y los eventos adversos como resultados principales. Resultados: tres estudios con 173 pacientes (89 recibieron NAVA-NIV) cumplieron los criterios de inclusión en este metanálisis. No se observaron diferencias en el fracaso del tratamiento entre la NAVA-NIV y la NCPAP (razón de riesgos [RR] = 1,09; intervalo de confianza [IC] del 95 % = 0,65-1,84; diferencia de riesgos = 0,02; IC95% = -0,10-0,14; I2 = 33 %; P = 0,23). De manera similar, no hubo diferencias en la mortalidad (RR = 1,52; IC95% = 0,51-4,52; no aplica heterogeneidad). En comparación con la NCPAP, la NAVA-NIV redujo significativamente el uso de cafeína (RR = 0,85; IC 95% = 0,74-0,98; I2 = 71 %; P = 0,03). Conclusiones: en comparación con la NCPAP, no hay evidencia suficiente para sacar una conclusión sobre los beneficios o daños de la NAVA-NIV en los recién nacidos prematuros. Los hallazgos de esta revisión deben confirmarse en ensayos clínicos con una metodología rigurosa y potencia adecuada

Introduction: The benefits of neurally adjusted ventilatory assist (NAVA) in preterm infants are unclear. This study aimed to explore if noninvasive NAVA is more beneficial for preterm infants than nasal continuous positive airway pressure (NCPAP). Study design: Meta-analysis was performed in three clinical trials comprising two randomized controlled trials and one crossover study. We compared NIV-NAVA and NCPAP and reported treatment failure, mortality, and adverse events as the primary outcomes. Results: Three studies including 173 patients (89 of whom underwent NIV-NAVA) were eligible for this meta-analysis. This review found no difference in treatment failure between NIV-NAVA and NCPAP (RR 1.09, 95% CI 0.65 to 1.84; RD 0.02, 95% CI -0.10-0.14; I2=33%, P=0.23). Similarly, there was no difference in mortality (RR 1.52, 95% CI 0.51-4.52, heterogeneity not applicable). Compared with NCPAP, NIV-NAVA significantly reduced the use of caffeine (RR 0.85, 95% CI 0.74-0.98, I2=71%, P=0.03). Conclusions: Compared with NCPAP, there is insufficient evidence to conclude on the benefits or harm of NIV-NAVA therapy for preterm infants. The findings of this review should be confirmed using methodologically rigorous and adequately powered clinical trials.

Efeito agudo da prática esportiva com engajamento cognitivo nas funções executivas em crianças / Acute effect of sports practice with cognitive engagement on children's cognition

O objetivo do presente estudo foi avaliar o efeito agudo da prática de uma sessão de futsal com engajamento cognitivo na memória de trabalho e no controle inibitório de crianças. Trata-se de um estudo controlado e randomizado com abordagem quantitativa do tipo Crossover. Foram recrutadas 33 crianças (com idade entre 8 e 10 anos) de ambos os sexos que foram submetidas a duas sessões experimentais: 1) Sessão jogo com duração de 15 min baseada no futsal com maiores demandas de engajamento cognitivo. 2) Sessão controle que consistiu em 15 min de repouso em uma sala. Foram aplicados imediatamente antes e após as sessões o DigitSpan e o Stroop Test para avaliar a memória de trabalho e o controle inibitório, respectivamente. As equações de estimativas generalizadas foram utilizadas para verificar a interação entre o tempo e as intervenções. Os resultados indicaram interação sessão*tempo significativa para a memória de trabalho, precisamente na ordem direta do DigitSpan, indicando aumento significante de pré para pós-intervenção para a sessão jogo com um tamanho de efeito pequeno (p = 0,012; d = 0,38). Após a sessão jogo, as crianças também apresentaram melhora significativa, com tamanho do efeito médio na acurácia da fase incongruente (p = 0,008; d = 0,63) do Stroop Test e menor tempo para resposta em comparação à sessão controle (p = 0,029). O estudo apontou que a atividade física com engajamento cognitivo teve efeito sobre o controle inibitório de crianças

The aim of the present study was to evaluate the acute effect of practicing a futsal session with cognitive engagement on working memory and inhibitory control in children. This is a controlled and randomized study with a quantitative crossover approach. 33 children (aged between 8 and 10 years) of both sexes were recruited and submitted to two experimental sessions: 1) Game session lasting 15 min based on futsal with greater demands for cognitive engagement. 2) Control session consisting of 15 min of rest in a room. The DigitSpan and Stroop Test were applied immediately before and after the sessions to assess working memory and inhibitory control, respectively. Generalized estimating equations were used to verify the interaction between time and interventions. The results indicated a significant session*time interaction for working memory, precisely in the direct order of DigitSpan, indicating a significant increase from pre to post-in-tervention for the game session with a small effect size (p = 0.012; d = 0.38). After the game session, the children also showed significant improvement, with a mean effect size on the accuracy of the incongruous phase (p = 0.008; d = 0.63) of the Stroop Test and a shorter time to respond compared to the control session (p = 0.029). The study pointed out that physical activity with cognitive engagement had an effect on the inhibitory control of children

Efeitos oxi-hemodinâmicos de diferentes banhos no leito: ensaio clínico randomizado cruzado / Efectos oxihemodinámicos de diferentes baños en cama: ensayo clínico aleatorizado cruzado / Oxy-hemodynamic effects of different bed baths: a randomized crossover clinical trial

Resumo Objetivo Comparar o tempo de execução do banho no leito pelo método tradicional e a seco e seus efeitos sobre as alterações oxi-hemodinâmicas em pacientes críticos. Métodos Ensaio clínico randomizado crossover, aberto, com 50 pacientes submetidos aos dois tipos de banho no leito: tradicional e a seco. Avaliou-se o tempo de execução dos banhos e as variáveis oxi-hemodinâmicas (temperatura timpânica e axilar, saturação de oxigênio arterial, frequência respiratória, frequência cardíaca e pressão arterial média), obtidas no início dos banhos, aos dez minutos, no início e no fim da lateralização dos pacientes, ao final do procedimento e 15 minutos depois. Para análise utilizou-se Teste T de Student pareado e modelo de equações de estimação generalizadas. Resultados O banho no leito a seco foi executado em menor tempo que o tradicional (18,59 versus 26,45 minutos; p<0,001). No banho tradicional, ao longo do tempo, houve redução da temperatura axilar e elevação da frequência respiratória (p<0,001). No banho a seco, apenas a temperatura axilar sofreu alteração, tornando-se menor que o valor inicial (p<0,001). Conclusão O banho a seco foi superior ao tradicional em decorrência do menor tempo de execução e menor instabilidade oxi-hemodinâmica dos pacientes entre os períodos observados. A monitorização dos pacientes é fundamental para identificar tais alterações.

Resumen Objetivo Comparar el tiempo de ejecución del baño en cama mediante el método tradicional y a seco y sus efectos sobre las alteraciones oxihemodinámicas en pacientes críticos. Métodos Ensayo clínico aleatorizado crossover, abierto, con 50 pacientes sometidos a dos tipos de baño en cama: tradicional y a seco. Se evaluó el tiempo de ejecución de los baños y las variables oxihemodinámicas (temperatura timpánica y axilar, saturación del oxígeno arterial, frecuencia respiratoria, frecuencia cardíaca y presión arterial promedio), obtenidas al comienzo de los baños, a los diez minutos, al comienzo y al final de la lateralización de los pacientes, al final del procedimiento y 15 minutos después. Para el análisis se utilizó el Test-T de Student pareado y el modelo de ecuaciones de estimación generalizadas. Resultados El baño en cama a seco fue ejecutado en menor tiempo que el tradicional (18,59 versus 26,45 minutos; p<0,001). En el baño tradicional, a lo largo del tiempo, hubo reducción de la temperatura axilar y elevación de la frecuencia respiratoria (p<0,001). En el baño a seco, solo la temperatura axilar estuvo alterada, fue menor que el valor inicial (p<0,001). Conclusión El baño a seco fue superior al tradicional como consecuencia del menor tiempo de ejecución y menor inestabilidad oxihemodinámica de los pacientes entre los períodos observados. El monitoreo de los pacientes es fundamental para identificar tales alteraciones.

Abstract Objective To compare the bed bath execution time using the traditional and dry method and its effects on the oxy-hemodynamic changes in critically ill patients. Methods This is a crossover, open, randomized clinical trial, with 50 patients submitted to two types of bed bath: traditional and dry. The duration of the baths and the oxy-hemodynamic variables (tympanic and axillary temperature, arterial oxygen saturation, respiratory rate, heart rate and mean arterial pressure), obtained at the beginning of the baths, at ten minutes, at the beginning and at the end of patient lateralization, at the end of the procedure and 15 minutes later. Paired Student's t-test and generalized estimating equations model were used for analysis. Results Dry bed bath was performed in less time than the traditional bath (18.59 versus 26.45 minutes; p<0.001). In traditional bath, over time, there was a reduction in axillary temperature and an increase in respiratory rate (p<0.001). In the dry bath, only the axillary temperature changed, becoming lower than the initial value (p<0.001). Conclusion Dry bath was superior to the traditional one, due to the shorter time of execution and lesser oxy-hemodynamic instability of patients between the periods observed. Monitoring patients is essential to identify such changes.

Acute whole-body electromyostimulation associated with dynamic exercises did not alter cardiac autonomic modulation and oxygen uptake in obese and eutrophic men

Abstract Aim: To contrast the acute effects of whole-body electromyostimulation (WB-EMS) with sham associated with dynamic exercises on cardiovascular, ventilatory, metabolic, and autonomic responses in men with obesity and controls. Methods: A randomized cross-over and double-blind trial with nine eutrophic (23.6 years; 23 ± 1.4 kg/m2) and ten men with obesity (26 ± 4 years; 38 ± 7 kg/m2), who were randomized to receive WB-EMS-Sham or Sham-WB-EMS with 30 min of rest between protocols. WB-EMS protocol (Miha Bodytec®) was applied at the motor level, frequency = 85 Hz, pulse duration = 350 μs, cycle on = 6′; cycle off = 4′. Sham group performed the same exercises with the electric current turned off. Throughout both protocols, subjects executed two dynamic exercises of 5 minutes each (step-up and step down associated with shoulder flexion, and lunge exercise associated with elbow flexion) in the same order. R-R intervals and breath-by-breath respiratory gases analysis were collected during the protocols. Heart rate variability (HRV) indexes were obtained using linear and nonlinear analysis. The level of statistical significance was set at p < 0.05. Results: Regarding both exercises, participants with obesity presented reduced oxygen uptake, higher ventilation, respiratory rate, blood pressure, and Borg scores (p < 0.05) when contrasted with controls, as expected. However, no significant differences were found for HRV indexes between groups (p > 0.05). In addition, WB-EMS did not increase oxygen uptake or altered autonomic modulation when contrasted with sham in both groups (p < 0.05). Conclusion: Obesity has a negative impact on symptoms and functional capacity. However, WB-EMS did not acutely enhance oxygen uptake or HRV during exercise in a population with obesity.

A estratégia LET US Play aumenta a atividade física de crianças nas aulas de educação física escolar / The LET US Play strategy increases children`s physical activity in physical education classes

O estudo objetivou comparar duas estratégias (Tradicional x LET US Play) com o intuito de aumen-tar o número de passos (NP) durante as aulas de educação física escolar de crianças. Trata-se de um ensaio clínico randomizado cruzado (cross over), realizado em uma escola municipal de Cuiabá, Mato Grosso. Foram aplicadas 10 aulas à 25 crianças (11 meninos e 14 meninas) do 4º ano do Ensino Fun-damental. Dividida em dois momentos de 15 minutos (monitorados), com um espaço de 10 minutos entre eles para hidratação (não monitorados), a aula consistia na aplicação das atividades (estafeta, base quatro, futsal, queimada e empresta bandeira) usando a estratégia Tradicional ou LET US Play, de forma alternada e aleatória. Ao final de cada atividade, o NP foi medido por meio da pulseira inteligente Xiaomi Mi band 2. Utilizou ANOVA One Waypara analisar o NP entre as estratégias, estratificada por sexo, com grau de significância de 5%. Observou-se que, o NP dados pelas crianças na intervenção LET US Play foi superior ao Tradicional em todas as atividades (estafeta, base quatro, futsal, queimada, empresta bandeira), tanto em meninos quanto em meninas, independentemente da ordem de aplicação (p < 0,01). Conclui-se que o LET US Play aumentou o NP das crianças durante as aulas de educação física e pode ser uma estratégia interessante para maximizar a atividade física nesse público

This study aimed to compare two strategies (Traditional x LET US Play) focused on increasing the number of steps (NS) during physical education classes for children. This is a randomized crossover clinical trial, carried out in a municipal elementary school from Cuiabá-MT. Ten classes were given to 25 children (11 boys and 14 girls) from the 4th grade. Divided into two moments of 15 minutes each (monitored), with a 10 minutes break between for hydration (not monitored). The class sessions consisted of activities (relay races, base four, futsal, dodgeball and borrow flag) using Traditional or LET US Play strategies, selected randomly and alternately. At the end of each activity the NS was measured through the Xiaomi Mi band 2 smart bracelet. The NP between the strategies and interactions with sex were assessed using one-way analysis of variance (ANOVA) with a statistical significance set at p < 0.05. It was observed that the NS given by the children in the LET US Play intervention was higher than the Traditional in all activities (relay races, kickball, indoor soccer, dodgeball, lend flag) in boys and girls regardless of the delivered order (p < 0,01). It was concluded that LET US Play increased children's NS during physical education classes and can be an interesting strategy to maximize physical activity among this population

Impact of birth season on the years of life lost from respiratory diseases in the elderly related to ambient PM

BACKGROUND@#Ambient fine particle (PM@*METHODS@#A time-stratified case-crossover design was used to analyze YLL from respiratory diseases in the elderly related to ambient PM@*RESULTS@#Each 10 μg/m@*CONCLUSIONS@#Birth season which reflects the early-life PM

Neural control of pressure support ventilation improved patient-ventilator synchrony in patients with different respiratory system mechanical properties: a prospective, crossover trial / 中华医学杂志(英文版)

BACKGROUND@#Conventional pressure support ventilation (PSP) is triggered and cycled off by pneumatic signals such as flow. Patient-ventilator asynchrony is common during pressure support ventilation, thereby contributing to an increased inspiratory effort. Using diaphragm electrical activity, neurally controlled pressure support (PSN) could hypothetically eliminate the asynchrony and reduce inspiratory effort. The purpose of this study was to compare the differences between PSN and PSP in terms of patient-ventilator synchrony, inspiratory effort, and breathing pattern.@*METHODS@#Eight post-operative patients without respiratory system comorbidity, eight patients with acute respiratory distress syndrome (ARDS) and obvious restrictive acute respiratory failure (ARF), and eight patients with chronic obstructive pulmonary disease (COPD) and mixed restrictive and obstructive ARF were enrolled. Patient-ventilator interactions were analyzed with macro asynchronies (ineffective, double, and auto triggering), micro asynchronies (inspiratory trigger delay, premature, and late cycling), and the total asynchrony index (AI). Inspiratory efforts for triggering and total inspiration were analyzed.@*RESULTS@#Total AI of PSN was consistently lower than that of PSP in COPD (3% vs. 93%, P = 0.012 for 100% support level; 8% vs. 104%, P = 0.012 for 150% support level), ARDS (8% vs. 29%, P = 0.012 for 100% support level; 16% vs. 41%, P = 0.017 for 150% support level), and post-operative patients (21% vs. 35%, P = 0.012 for 100% support level; 15% vs. 50%, P = 0.017 for 150% support level). Improved support levels from 100% to 150% statistically increased total AI during PSP but not during PSN in patients with COPD or ARDS. Patients' inspiratory efforts for triggering and total inspiration were significantly lower during PSN than during PSP in patients with COPD or ARDS under both support levels (P < 0.05). There was no difference in breathing patterns between PSN and PSP.@*CONCLUSIONS@#PSN improves patient-ventilator synchrony and generates a respiratory pattern similar to PSP independently of any level of support in patients with different respiratory system mechanical properties. PSN, which reduces the trigger and total patient's inspiratory effort in patients with COPD or ARDS, might be an alternative mode for PSP.@*TRIAL REGISTRATION@#ClinicalTrials.gov, NCT01979627; https://clinicaltrials.gov/ct2/show/record/NCT01979627.

Effect of the Seasonal Adaptability on Carbohydrate-electrolyte Beverage Efforts on Post-exercise Rehydration in Healthy Young Men / 中国医学科学院学报

Objective To compare the effects of carbohydrate-electrolyte beverage on post-exercise rehydration of healthy young men in different seasons,and to explore the influence of seasonal adaptability on fluid and electrolyte balance.Methods Fifteen healthy men,aged(24.4±0.5)years,completed 2 trails in a random crossover design both in summer and winter.During recovery,they consumed a drink volume equivalent to 100% of their sweat loss with plain boiled water(the water group)or carbohydrate-electrolyte beverage(the beverage group).Recovery was monitored for further 180 minutes by the collection of blood and urine samples.Results The dehydration time in summer was significantly shorter by about 20 minutes than that in winter(

Footwear designed to enhance energy return improves running economy compared to a minimalist footwear: does it matter for running performance?

The present study compared the effects of a footwear designed to enhance energy return (thermoplastic polyurethane, TPU) vs minimalist shoes on running economy (RE) and endurance performance. In this counterbalanced and crossover design study, 11 recreational male runners performed two submaximal constant-speed running tests and two 3-km time-trials with the two shoe models. Oxygen uptake was measured during submaximal constant-speed running tests in order to determine the RE at 12 km/h and oxygen cost of running (CTO2) at individual average speed sustained during the 3-km running time-trials wearing either of the two shoes. Our results revealed that RE was improved (2.4%) with TPU shoes compared with minimalist shoes (P=0.01). However, there was no significant difference for CTO2 (P=0.61) and running performance (P=0.52) comparing the TPU (710±60 s) and the minimalist (718±63 s) shoe models. These novel findings demonstrate that shoes with enhanced mechanical energy return (i.e. TPU) produced a lower energy cost of running at low (i.e., 12 km/h) but not at high speeds (i.e., average speed sustained during the 3-km running time-trial, ∼15 km/h), ultimately resulting in similar running performance compared to the minimalist shoe.

Autonomic function may not modulate irisin release in healthy adults: findings from a randomized cross-over study

ABSTRACT Objective Autonomic nervous system, especially the sympathetic nervous system, may stimulate the expression of peroxisome proliferator-activated receptor γ coactivator-1α, which regulates irisin. This study aimed to explore whether there was any association between autonomic function as assessed by heart rate related indices and irisin release following acute exercise. Subjects and methods Seventeen healthy adults were asked to perform an incremental exhaustive cycling as well as an incremental exhaustive running separately on different days. Heart rate was monitored, and blood samples were collected before, immediately, 10-, and 60-minutes post-exercise. Serum irisin was measured using ELISA kit. Results Markers for autonomic function, such as heart rate at rest, peak, or recovery, heart rate reserve, heart rate recovery, and chronotropic index, were comparable between cycling and running (all P > 0.10). Irisin was increased immediately following both exercise. No significant association was observed between heart rate at rest, peak, or recovery and irisin level at the corresponding time-point, as well as between heart rate reserve, heart rate recovery, or chronotropic index and exercise induced irisin release, with or without controlling for age, body mass index, and glucose (all P > 0.10). Conclusions Autonomic function might not be associated with irisin release in healthy adults. Arch Endocrinol Metab. 2020;64(3):201-4

Intensivists' Direct Management without Residents May Improve the Survival Rate Compared to High-Intensity Intensivist Staffing in Academic Intensive Care Units: Retrospective and Crossover Study Design

Randomized trial of physiotherapy and hypertonic saline techniques for sputum induction in asthmatic children and adolescents

OBJECTIVES: This study aimed to analyze the efficiency of physiotherapy techniques in sputum induction and in the evaluation of pulmonary inflammation in asthmatic children and adolescents. Although hypertonic saline (HS) is widely used for sputum induction (SI), specific techniques and maneuvers of physiotherapy (P) may facilitate the collection of mucus in some asthmatic children and adolescents. METHODS: A randomized crossover study was performed in patients with well-controlled asthma, and 90 sputum samples were collected. Children and adolescents were assessed using spirometry and randomized at entry into one of three sputum induction techniques: (i) 3% hypertonic saline - HS technique; (ii) physiotherapy (oscillatory positive expiratory pressure, forced expiration, and acceleration of expiratory flow) - P technique; and (iii) hypertonic saline + physiotherapy - HSP technique. ClinicalTrials.gov: NCT03136042. RESULTS: The total cells (mL) and the percentage (%) of differential inflammatory cells were similar in all techniques. The sputum weight (g) in the HSP technique was significantly higher than that in the HS technique. In all techniques, the percentage of viable cells was >50%, and there was no difference between the HS and P techniques. Moreover, sputum induction did not cause any alterations in the pulmonary function of patients. CONCLUSION: The physiotherapy sputum collection technique was effective in obtaining viable cells from mucus samples and yielded the same amount of sputum as the gold standard technique (hypertonic saline). In addition, the physiotherapy maneuvers were both safe and useful for sputum induction in asthmatic children and adolescents with well-controlled asthma.

Comparison of the effects of voluntary and involuntary breath stacking techniques on respiratory mechanics and lung function patterns in tracheostomized patients: a randomized crossover clinical trial / Comparação dos efeitos das técnicas breath stacking e air stacking sobre a mecânica respiratória e o padrão ventilatório em pacientes traqueostomizados: ensaio clínico cruzado randomizado

ABSTRACT Objective: To compare the effects of voluntary breath stacking (VBS) and involuntary breath stacking (IBS) techniques on respiratory mechanics, lung function patterns, and inspiratory capacity in tracheostomized patients. Methods: This was a randomized crossover clinical trial involving 20 tracheostomized patients admitted to the ICU and submitted to the VBS and IBS techniques, in random order, with an interval of 5 h between each. Ten cycles of each technique were performed with an interval of 30 s between each cycle. In VBS, patients performed successive inspirations for up to 30 s through a one-way valve, whereas in IBS, successive slow insufflations were performed with a resuscitator bag until the pressure reached 40 cmH2O. Respiratory mechanics, inspiratory capacity, and the lung function pattern were evaluated before and after the interventions. Results: After IBS, there was an increase in static compliance (p = 0.007), which was also higher after IBS than after VBS (p = 0.03). There was no significant difference between the pre-VBS and post-VBS evaluations in terms of static compliance (p = 0.42). Inspiratory capacity was also greater after IBS than after VBS (2,420.7 ± 480.9 mL vs. 1,211.3 ± 562.8 mL; p < 0.001), as was airway pressure (38.3 ± 2.6 cmH2O vs. 25.8 ± 5.5 cmH2O; p < 0.001). There were no changes in resistance or lung function pattern after the application of either technique. Conclusions: In comparison with VBS, IBS promoted greater inspiratory capacity and higher airway pressure, resulting in an increase in static compliance.

RESUMO Objetivo: Comparar os efeitos das técnicas breath stacking (BS) e air stacking (AS) sobre a mecânica respiratória, o padrão ventilatório e a capacidade inspiratória em pacientes traqueostomizados. Métodos: Ensaio clínico cruzado randomizado envolvendo 20 pacientes traqueostomizados internados em UTI e submetidos a ambas as técnicas, com intervalo de 5 h entre si, de acordo com a randomização. Foram realizados dez ciclos de cada técnica com intervalos de 30 segundos entre si. No BS, os pacientes realizaram inspirações sucessivas por até 30 s por meio de uma válvula unidirecional, enquanto no AS foram realizadas insuflações lentas sucessivas através de um ressuscitador manual até que a pressão atingisse 40 cmH2O. Os pacientes foram avaliados quanto a mecânica respiratória, capacidade inspiratória e padrão ventilatório antes e depois da realização das intervenções. Resultados: Com relação à mecânica respiratória no AS, houve aumento da complacência estática na comparação pré- e pós-intervenção (p = 0,007), assim como entre os momentos pós-AS e pós-BS (p = 0,03). Não houve diferença significativa da complacência estática na realização do BS (p = 0,42). A capacidade inspiratória foi maior após o AS que após o BS (2.420,7 ± 480,9 mL vs. 1.211,3 ± 562,8 mL; p < 0,001), bem como em relação à pressão nas vias aéreas (38,3 ± 2,6 cmH2O vs. 25,8 ± 5,5 cmH2O; p < 0,001). Não foram observadas alterações na resistência ou no padrão ventilatório em ambas as técnicas. Conclusões: Na presente amostra, o AS promoveu maior capacidade inspiratória e maior pressão nas vias aéreas que as observadas após o BS, com consequente aumento da complacência estática.

Evaluation of the bioequivalence of two formulations containing the combination of 400 mg of acetaminophen (paracetamol), 4 mg of phenylephrine and 4 mg of chlorpheniramine in capsules: open-label, three-way crossover study, partially replicated in healthy volunteers of both sexes

This study was carried out in order to compare the relative bioavailability of two different formulations containing 400 mg of acetaminophen + 4 mg of phenylephrine hydrochloride + 4 mg of chlorpheniramine maleate, Test formulation (Cimegripe®) and Reference formulation (Resfenol®) in 84 healthy volunteers of both sexes under fasting conditions. The study was conducted in a single dose, randomized, open-label, crossover 3-way and partially replicated. The tolerability was evaluated by the monitoring of adverse events and vital signs, results of clinical and laboratory tests. Plasma concentrations were quantified by validated bioanalytical methods using the ultra-performance liquid chromatography coupled to tandem mass spectrometry. The Cmax, Tmax, AUC0-t, AUC0-inf, T1/2 and Kel pharmacokinetic parameters were calculated from these obtained concentrations. The 90% confidence intervals were constructed for the ratio reference/test from the geometric average of the Cmax and AUC parameters which were comprised between 80% and 125%. Only the Cmax parameter of the phenylephrine was applied the scaled average bioequivalence due to the intraindividual coefficient of variation > 30% obtained, thus extending the acceptance limits of the interval. It can be concluded that the two formulations were bioequivalent in terms of rate and absorption extent and thus interchangeable

Electric toothbrush for biofilm control in individuals with Down syndrome: a crossover randomized clinical trial

Abstract Poor oral hygiene seems to be the norm in children and teenagers with Down Syndrome (DS). Advances in design and types of toothbrushes may improve biofilm control. This randomized, single-blind, crossover clinical trial evaluated the effectiveness of electric toothbrushes regarding mechanical control of biofilm in children and teenagers with DS and their cooperation. Twenty-nine participants with DS, aged 6 to 14 years, used both types of toothbrushes: electric (ET) and manual (MT). The order of use of the different types of toothbrushes was randomly defined, including a 7-day period with each type with 7-day washout period in between. The Turesky-Quigley-Hein biofilm index was used before and after brushing to assess the effectiveness of the technique. Frankl's behavioral scale was used during toothbrushing to assess the participants' cooperation. Paired T-test, Mann Whitney, Chi-square, and Fisher's Exact tests were applied, with a significance level of 5%. The quantity of dental biofilm was significantly reduced after both brushing techniques (p < 0.001). However, no significant difference was found in total biofilm (ET: 0.73 ± 0.36; MT: 0.73 ± 0.34; p = 0.985) or % biofilm reduction (ET: 72.22%; MT: 70.96%; p = 0.762) after brushing between techniques or in % biofilm reduction between toothbrushes of age groups (6 -9 years, p = 0.919; 10-14 years, p = 0.671). Participants showed similar cooperation level with the two types of toothbrush (p = 1.000). The use of electric or manual toothbrush had no effect on the quantity of dental biofilm removed in children and teenagers with DS, nor did it influence their cooperation during the procedure.

Efeitos do banho no leito a seco e tradicional sobre as alterações oxi-hemodinâmicas: ensaio clínico randomizado cruzado / Effects of dry and traditional bed bathing on oxyhemodynamic changes: randomized crossover clinical trial

Em virtude dos riscos gerados para os pacientes pelo tradicional banho no leito, métodos alternativos como o banho a seco, vem sendo incorporados à prática clínica. No entanto, há carência de estudos que comparem os efeitos oxi-hemodinâmicos desses dois banhos. Assim, realizou-se esta pesquisa com o objetivo de avaliar os efeitos do banho no leito a seco em relação ao banho no leito tradicional sobre as alterações oxi-hemodinâmicas (temperatura corporal, frequência respiratória, frequência cardíaca, saturação transcutânea de oxigênio arterial e pressão arterial) em pacientes críticos. Trata-se de um Ensaio Clínico Randomizado, crossover, aberto, realizado com 50 pacientes críticos, entre os meses de setembro de 2018 e fevereiro de 2019. Cada paciente foi o seu próprio controle e recebeu, de forma aleatória, o banho no leito a seco e o tradicional, com um intervalo de 24 horas entre eles. As variáveis oxi-hemodinâmicas foram mensuradas em seis momentos: no início dos banhos, aos 10 minutos, no início e no fim da lateralização dos pacientes, ao final do procedimento e 15 minutos após o seu encerramento. Avaliou-se também o tempo de execução dos banhos e de lateralização dos pacientes. Realizou-se análise descritiva e inferencial, utilizando-se o modelo de Equações de Estimações Generalizadas. O tamanho do efeito foi verificado pela análise do d de Cohen e delta de Cliff. O estudo foi aprovado pelo Comitê de Ética em Pesquisas (parecer 2.550.114). Não houve diferença estatisticamente significativa das variáveis oxi-hemodinâmicas entre os diferentes banhos, mas ao longo do tempo, observou-se redução da temperatura axilar dos pacientes nos dois procedimentos (p<0,05). No banho tradicional, os pacientes também apresentaram, ao final da sua lateralização, elevação da frequência respiratória (24,58 incursões por minuto) (p=0,029). Em relação à significância clínica, o efeito gerado pelo banho a seco sobre as variáveis oxi-hemodinâmicas foi considerado desprezível. O tradicional banho no leito gerou um efeito de pequena magnitude sobre a redução da temperatura axilar e elevação da frequência respiratória. O banho no leito a seco foi considerado mais rápido (18,59 minutos) que o tradicional (26,45 minutos) (p <0,001). Nesse tipo de banho, os pacientes permaneceram lateralizados por um tempo inferior (6,59 minutos) ao do banho tradicional (7,59 minutos) (p<0,001). Concluiu-se que ao serem submetidos ao banho no leito a seco, os pacientes apresentaram, ao longo das mensurações, redução da temperatura axilar. Durante o banho tradicional, além da redução da temperatura axilar, houve elevação da frequência respiratória. Clinicamente, os efeitos gerados pelo banho a seco sobre as variáveis oxi-hemodinâmicas foram considerados desprezíveis, assim como a maioria dos efeitos do banho tradicional. No entanto, o tradicional banho no leito apresentou efeitos negativos sobre a temperatura axilar e frequência respiratória, que apesar de serem de pequena magnitude não devem ser negligenciados. O banho a seco foi superior ao tradicional pelo menor tempo de execução e lateralização dos pacientes. Os aspectos positivos desse método de banho poderão encorajar a sua incorporação nos serviços de saúde. Ademais, independentemente do tipo de banho realizado, espera-se que sejam mantidos o rigor metodológico e a monitorização oxi-hemodinâmica dos pacientes.

Em virtude dos riscos gerados para os pacientes pelo tradicional banho no leito, métodos alternativos como o banho a seco, vem sendo incorporados à prática clínica. No entanto, há carência de estudos que comparem os efeitos oxi-hemodinâmicos desses dois banhos. Assim, realizou-se esta pesquisa com o objetivo de avaliar os efeitos do banho no leito a seco em relação ao banho no leito tradicional sobre as alterações oxi-hemodinâmicas (temperatura corporal, frequência respiratória, frequência cardíaca, saturação transcutânea de oxigênio arterial e pressão arterial) em pacientes críticos. Trata-se de um Ensaio Clínico Randomizado, crossover, aberto, realizado com 50 pacientes críticos, entre os meses de setembro de 2018 e fevereiro de 2019. Cada paciente foi o seu próprio controle e recebeu, de forma aleatória, o banho no leito a seco e o tradicional, com um intervalo de 24 horas entre eles. As variáveis oxi-hemodinâmicas foram mensuradas em seis momentos: no início dos banhos, aos 10 minutos, no início e no fim da lateralização dos pacientes, ao final do procedimento e 15 minutos após o seu encerramento. Avaliou-se também o tempo de execução dos banhos e de lateralização dos pacientes. Realizou-se análise descritiva e inferencial, utilizando-se o modelo de Equações de Estimações Generalizadas. O tamanho do efeito foi verificado pela análise do d de Cohen e delta de Cliff. O estudo foi aprovado pelo Comitê de Ética em Pesquisas (parecer 2.550.114). Não houve diferença estatisticamente significativa das variáveis oxi-hemodinâmicas entre os diferentes banhos, mas ao longo do tempo, observou-se redução da temperatura axilar dos pacientes nos dois procedimentos (p<0,05). No banho tradicional, os pacientes também apresentaram, ao final da sua lateralização, elevação da frequência respiratória (24,58 incursões por minuto) (p=0,029). Em relação à significância clínica, o efeito gerado pelo banho a seco sobre as variáveis oxi-hemodinâmicas foi considerado desprezível. O tradicional banho no leito gerou um efeito de pequena magnitude sobre a redução da temperatura axilar e elevação da frequência respiratória. O banho no leito a seco foi considerado mais rápido (18,59 minutos) que o tradicional (26,45 minutos) (p <0,001). Nesse tipo de banho, os pacientes permaneceram lateralizados por um tempo inferior (6,59 minutos) ao do banho tradicional (7,59 minutos) (p<0,001). Concluiu-se que ao serem submetidos ao banho no leito a seco, os pacientes apresentaram, ao longo das mensurações, redução da temperatura axilar. Durante o banho tradicional, além da redução da temperatura axilar, houve elevação da frequência respiratória. Clinicamente, os efeitos gerados pelo banho a seco sobre as variáveis oxi-hemodinâmicas foram considerados desprezíveis, assim como a maioria dos efeitos do banho tradicional. No entanto, o tradicional banho no leito apresentou efeitos negativos sobre a temperatura axilar e frequência respiratória, que apesar de serem de pequena magnitude não devem ser negligenciados. O banho a seco foi superior ao tradicional pelo menor tempo de execução e lateralização dos pacientes. Os aspectos positivos desse método de banho poderão encorajar a sua incorporação nos serviços de saúde. Ademais, independentemente do tipo de banho realizado, espera-se que sejam mantidos o rigor metodológico e a monitorização oxi-hemodinâmica dos pacientes.