Eficacia de la técnica Supramáxima en la corrección de la ptosis palpebral superior moderada y grave / Efficacy of the Supramaximal technique for correction of moderate and severe upper eyelid ptosis

RESUMEN Objetivo: Evaluar la eficacia de la técnica quirúrgica Supramáxima en la corrección de la ptosis palpebral superior moderada y grave. Métodos: Se realizó un ensayo clínico aleatorizado a simple ciega, en 95 pacientes (119 ojos), provenientes de la Consulta de Oftalmología del Hospital Hermanos Ameijeiras, desde febrero del año 2016 a noviembre de 2017, los cuales recibieron tratamiento quirúrgico con la técnica Supramáxima o la técnica Suspensión al frontal. La eficacia del tratamiento se evaluó en cuanto a: caída del párpado, altura del pliegue palpebral, distancia margen reflejo y satisfacción del paciente. Resultados: El promedio de edad fue de 59,35 años, con leve predominio del sexo femenino (56,8 por ciento) y de la ptosis palpebral grave (51,6 por ciento). La diabetes mellitus fue la enfermedad sistémica más frecuente (56,8 por ciento). La eficacia terapéutica de la TSM fue superior (96,7 por ciento) a la TSF (86,2 por ciento). Se constató una mayor satisfacción del paciente con la TSM (97,9 por ciento). Conclusiones: La técnica quirúrgica Supramáxima es más eficaz que la suspensión al frontal en la corrección de la ptosis palpebral superior moderada y grave(AU)

ABSTRACT Objective: Evaluate the efficacy of the Supramaximal surgical technique for correction of moderate and severe upper eyelid ptosis. Methods: A randomized single-blind trial was conducted with 95 patients (119 eyes) from the Ophthalmology Service of Hermanos Ameijeiras Hospital from February 2016 to November 2017. These patients had undergone surgery by either Supramaximal technique or frontal suspension technique. Efficacy of the treatment was evaluated in terms of eyelid ptosis, eyelid crease height, margin-reflex distance and patient satisfaction. Results: Mean age was 59.35 years, with a slight predominance of the female sex (56.8 percent) and of severe eyelid ptosis (51.6 percent). Diabetes mellitus was the most common systemic condition (56.8 percent). The therapeutic efficacy of SMT was higher (96.7 percent) than that of FST (86.2 percent). Patient satisfaction was higher with SMT (97.9 percent). Conclusions: The Supramaximal surgical technique is more effective than frontal suspension for correction of moderate and severe upper eyelid ptosis(AU)

Carbohydrate mouth rinse reduces rating of perceived exertion but does not affect performance and energy systems contribution during a high-intensity exercise

Aim: The study aimed to verify the effect of carbohydrate (CHO) mouth rinse on time to exhaustion, energy systems contribution and rating of perceived exertion (RPE) during a high-intensity exercise. Methods Fourteen men performed an incremental exercise test to determine their maximal oxygen uptake and peak power output (PPO) and two time-to-exhaustion tests at 110% of PPO. Participants rinsed their mouth with 25ml of 6.4% of CHO or placebo (PLA) solution immediately before the time-to-exhaustion test, using a crossover design. The contribution of the energy systems was calculated using the free software GEDAE-LaB®. Results: Time to exhaustion was similar between the conditions (CHO:174.3±42.8s; PLA:166.7±26.3s; p=0.33). In addition, there was no difference between the CHO and PLA condition for aerobic (CHO:135.1±41.2kJ and PLA:129.8±35.3kJ, p=0.34), anaerobic lactic (CHO:57.6±17.1kJ and PLA:53.4±15.1kJ, p=0.10), and anaerobic alactic (CHO:10.4±8.4kJ and PLA:13.2±9.2kJ, p=0.37) contribution. Consequently, total energy expenditure was similar between conditions (CHO:203.2±46.4kJ and PLA:196.5±45.2kJ, p=0.15). However, CHO mouth rinse reduced the RPE at the moment of exhaustion (CHO:18.2±1.0units and PLA:19.1±1.1units; p=0.02). Conclusion: CHO mouth rinse neither increased time to exhaustion nor altered energy systems contribution during a high-intensity exercise, but reduced the perceived effort at the exhaustion.(AU)

High-CHO diet increases post-exercise oxygen consumption after a supramaximal exercise bout

We investigated if carbohydrate (CHO) availability could affect the excess post-exercise oxygen consumption (EPOC) after a single supramaximal exercise bout. Five physically active men cycled at 115% of peak oxygen uptake (V̇O2 peak) until exhaustion with low or high pre-exercise CHO availability. The endogenous CHO stores were manipulated by performing a glycogen-depletion exercise protocol 48 h before the trial, followed by 48 h consuming either a low- (10% CHO) or a high-CHO (80% CHO) diet regime. Compared to the low-CHO diet, the high-CHO diet increased time to exhaustion (3.0±0.6 min vs 4.4±0.6, respectively, P=0.01) and the total O2 consumption during the exercise (6.9±0.9 L and 11.3±2.1, respectively, P=0.01). This was accompanied by a higher EPOC magnitude (4.6±1.8 L vs 6.2±2.8, respectively, P=0.03) and a greater total O2 consumption throughout the session (exercise+recovery: 11.5±2.5 L vs 17.5±4.2, respectively, P=0.01). These results suggest that a single bout of supramaximal exercise performed with high CHO availability increases both exercise and post-exercise energy expenditure.

Determinação da concentração alveolar mínima do isofluorano em catetos (Tayassu tajacu) / Isoflurane minimum alveolar concentration in collared peccary (Tayassu tajacu)

A anestesia inalatória vem sendo amplamente difundida na medicina veterinária, no entanto seu uso em animais selvagens ainda é restrito, não sendo observado nenhum estudo referente à sua utilização na espécie Tayassu tajacu. O objetivo da pesquisa foi determinar a concentração alveolar mínima (CAM) do isofluorano em catetos e apresentar os efeitos desta administração sobre as variáveis hemodinâmicas e respiratórias, como também a qualidade da recuperação anestésica. Utilizou-se 10 animais, machos, com idade variando de 1 a 3 anos oriundos do Centro de Multiplicação de Animais Silvestres da Universidade Federal Rural do Semi-Árido, Brasil. Todos os animais tiveram anestesia induzida com 7mg.kg-1 de propofol e posteriormente foram conectados a circuito anestésico com isofluorano e oxigênio 100 por cento. O estímulo noceptivo supramáximo adotado foi pinçamento interdigital, o qual era realizado após 15 minutos de espera para cada concentração de isofluorano fornecida. Ao ser observada resposta negativa frente ao estímulo a concentração era reduzida em 20 por cento, quando verificada resposta positiva o estímulo era cessado, calculando-se a partir daí o valor da CAM. [...] A recuperação anestésica foi tranquila e rápida. Concluiu-se que a CAM do isofluorano para catetos foi maior que a observada em espécies afins. O isofluorano pode ser utilizado nesta espécie, sendo considerado seguro e eficaz. A recuperação dos animais após anestesia com isofluorano foi livre de excitação.

Inhalation anesthesia has been widespread in veterinary medicine. Nevertheless, its use in wild animals is still limited, having no studies on its use been observed in the species. The objective of the research was to determine the isoflurane minimum alveolar concentration (MAC) in peccaries and present the effects of its administration on the hemodynamic and respiratory variables, as well as data concerning the anesthesia recovery. The study used 10 male animals with age ranging from one to three years, from the Centro de Multiplicação de Animais Silvestres of Universidade Federal Rural do Semi-Árido, Brazil. All the animals had anesthesia induced with propofol 7mg.kg-¹, were intubated and connected to the anesthetic circuit with isoflurane and 100 percent oxygen. The supramaximal noxious stimulation used was the interdigital pinch, which was performed after 15 minutes of waiting for each provided isoflurane concentration. When negative response to the stimulus was observed, the concentration was reduced by 20 percent; when positive response was verified, the stimulus was stopped, being the CAM value calculated from that point. [...] Recovery was quiet and smooth. It was concluded that the isoflurane MAC for peccaries was greater than that observed in related species. Isoflurane can be used in this species, being considered safe and effective. The animals' recovery after anesthesia with isoflurane was free from excitement.

Determinação do máximo déficit acumulado de oxigênio: efeito da duração dos testes submáximos para predição da demanda de oxigênio / Determination of the maximum accumulated oxygen deficit: effects of the submaximal tests duration for prediction of oxygen demand

O objetivo do presente estudo foi verificar a influência de diferentes tempos de análise dos testes submáximos para determinação do máximo déficit acumulado de oxigênio (MAOD), adotando diferentes janelas de tempo 4-6min, 6-8min e 8-10min. Participaram do estudo 10 ciclistas com idade média de 27,5 ± 4,1 anos, massa corporal 74,4 ± 12,7kg e tempo médio de prática de 9,8 ± 4,7 anos. Os atletas realizaram um teste de esforço progressivo para determinação do consumo de oxigênio de pico (VO2pico) e quatro testes retangulares submáximos (60, 70, 80 e 90 por cento VO2pico) com 10min de duração para estimar os valores da demanda de O2 (DEO2). Os valores médios de VO2 obtidos nas cargas para o tempo 4-6min, 6-8min e 8 a 10min foram aplicados em uma regressão linear entre a intensidade e o consumo de O2 para cada janela de tempo. Os sujeitos realizaram ainda um teste retangular supramáximo (110 por cento VO2pico) para a quantificação do MAOD. Não foi constatada nenhuma diferença significativa no VO2 entre os diferentes períodos de tempo dos testes submáximos (P > 0,05). Da mesma forma, nenhuma diferença significativa foi constatada no DEAO2 e MAOD nos diferentes períodos de análise (P > 0,05). Verificou-se ainda que os valores de MAOD obtidos nos três intervalos de tempo apresentaram boa concordância e forte correlação. Dessa forma, os dados sugerem que os testes submáximos utilizados para gerar os valores do MAOD podem ser reduzidos ao menos nesse tipo de amostra e com a utilização de ciclossimulador.

The aim of this study was to investigate the influence of different assessment time periods of submaximal tests on the determination of the maximal accumulated oxygen deficit (MAOD), through the adoption of different time slots of 4 to 6, 6 to 8 and 8 to 10 min. Ten cyclists with mean age of 27.5 ± 4.1 years, body mass 74.4 ± 12.7 kg and time experience of 9.8 ± 4.7 years participated in this study. The athletes underwent an incremental exercise test to determine the peak oxygen consumption (VO2peak), and four submaximal constant work-load test sessions (60, 70, 80 and 90 percent VO2peak) of 10 min in order to estimate the O2 demand (DEO2). The mean VO2 values obtained on each constant work-load for the 4 to 6, 6 to 8 and 8 to 10 min time-periods intervals were used to perform a linear regression between the intensity and O2 consumption for each time-period. In addition, the subjects performed one supramaximal rectangular test (110 percent VO2peak) for the quantification of MAOD. There was no significant difference in VO2 between the different time-periods for all submaximal tests (P> 0.05). Similarly, no significant difference was found in DEAO2 and MAOD (P> 0.05). Furthermore, the values of MAOD for the three time-periods intervals showed good agreement and strong correlation. Thus, the data suggest that the submaximal tests used to estimate the values of MAOD can be reduced, at least in this type of sample, and with the use of a cycle simulator.

Determinação visual do componente rápido do excesso do consumo de oxigênio após o exercício / Visual determination of the fast component of excessive oxygen uptake after exercise

O objetivo do presente estudo foi analisar a validade, a reprodutibilidade e a objetividade do método de inspeção visual durante a identificação da fase rápida do excesso do consumo de oxigênio após o exercício (EPOC RÁPIDO). Dez homens fisicamente ativos (idade de 23,0 ± 4,0 anos, estatura de 176,4 ± 6,8cm, massa corporal de 72,4 ± 8,2kg, VòO2max 3,0 ± 0,5L ? min-1) realizaram um teste incremental máximo e um teste de carga constante até a exaustão a 110 por cento da carga máxima obtida no teste incremental. O consumo de oxigênio foi mensurado respiração a respiração durante dez minutos de recuperação passiva após o teste de carga constante. O EPOC RÁPIDO foi determinado matematicamente e visualmente por três avaliadores. O método visual foi aplicado duas vezes nos três avaliadores para verificar a sua reprodutibilidade. Não foram detectadas diferenças significativas entre os valores do EPOC RÁPIDO estabelecidos pelo método matemático (0,98 ± 0,45L) e pelo método visual identificado pelos três avaliadores (1,04 ± 0,45L, 1,02 ± 0,45L e1,02 ± 0,45L). Nenhuma diferença foi encontrada entre a primeira e a segunda identificação feita pelos avaliadores (avaliador 1: 1,04 ± 0,45L vs 1,04 ± 0,49L; avaliador 2: 1,02 ± 0,45L vs 1,01 ± 0,44L e avaliador 3: 1,02 ± 0,45L vs1,03 ± 0,47L). Além disso, o coeficiente de correlação intraclasse entre as duas identificações foi alto para todos os avaliadores (ICC entre 0,97 e0,99). Esses resultados sugerem que a inspeção visual é um método válido, objetivo e reprodutivo para a estimativa do EPOC RÁPIDO.

The objective of this study was to analyze the validity, reproducibility and objectivity of the visual inspection method during the identification of the fast component of excess post-exercise oxygen consumption (EPOC FAST). Ten healthy physically active men (age = 23.0 + 4.0 years; height = 176.4 + 6.8 cm; body mass = 72.4 + 8.2 kg; VO2MAX = 3.0 + 0.5 L.min-1) performed a maximal incremental exercise and a constant workload test until exhaustion corresponding to 110 percent of maximal workload reached during the maximal incremental exercise. Oxygen consumption was measured breath-by-breath for 10 minutes during the passive recovery after the constant workload test. EPOC FAST was mathematically and visually determined by three evaluators. Double visual determination of EPOC FAST was carried out by each evaluator for reproducibility determination. There were no significant differences between EPOCFAST values obtained by mathematical (0.98 ± 0.45 L) or visual method (1.04 ± 0.45 L; 1.02 ± 0.45 L and 1.02 ± 0.45 L). None significant difference was found between the first and second visual assessment carried out by the evaluators (evaluator 1: 1.04 ± 0.45 L vs 1.04 ± 0.49 L; evaluator 2: 1.02 ± 0.45 L vs 1.01 ± 0.44 L and evaluator 3: 1.02 ± 0.45 L vs 1.03 ± 0.47 L). Finally, coefficient of intra-class correlation between determinations was high for all evaluators (ICC from 0.97 to 0.99). These results suggest that the visual method is valid, objective and reproducible for determination of the EPOC FAST.

Periosteal Fixation in Bilateral Total Third Nerve Palsy

PURPOSE: We present a new technique of anchoring the eyeball to the nasal periosteum with supramaximal recession of the lateral rectus muscle in one eye for exotropia management in bilateral total third nerve palsy combined with trochlear nerve palsy. CASE SUMMARY: A 38-year-old man presented with drooping of both upper lids and exodeviation of the left eye with a history of intraventricular hemorrhage 9 months previously. We noted bilateral ptosis, dilated pupils, right fixing eye, left face turn, and left exotropia over 100 prism diopters (PD) in the primary position with an inability to move both eyes together except abduction. He was diagnosed with bilateral total third nerve palsy and trochlear nerve palsy. We fixated the left globe (sclera anterior to the insertion of the medial rectus muscle) to the nasal periosteum including the medial palpebral ligament using a nonabsorbable suture. A large recession of the left lateral rectus muscle (14 mm) was also performed. Ocular alignment in the primary position was exotropia of 25PD and cosmetically satisfactory after 6 months of follow-up. CONCLUSION: Supramaximal recession of the lateral rectus muscle and periosteal fixation using nonabsorbable suture is an effective technique for the management of exotropia secondary to total third nerve palsy.

THE RELATIVE CONTRIBUTION OF ANAEROBIC AND AEROBIC ENERGY SYSTEMS DURING FLAT-WATER KAYAK PADDLING / 体力科学

The purposes of this study were to investigate the characteristics of physiological responses during flat-water kayaking events, and to quantify the contribution of aerobic and anaerobic energy systems. Eight male kayak paddlers participated in the study. The subjects performed an incremental test and five all-out tests (20, 40, 120, 240 and 600 sec) on a kayak ergometer. Peak oxygen uptake (VO₂peak ; 3790 ml · min^-1) in the incremental test was significantly lower than maximal oxygen uptake (VO₂max ; 3944 ml · min^-1) in the all-out test. In contrast, power at VO₂peak (154.0 W) was significantly higher than power at VO₂max (144.1 W). The contributions of energy systems were calculated by measurements of the accumulated oxygen uptake and accumulated oxygen deficit. The relative anaerobic energy system contributions for 200 m(40 sec), 500 m (120 sec), and1000 m (240 sec) averaged 71%, 43%, and 26%, respectively. These higher relative anaerobic energy system contributions, due to higher anaerobic capacity in kayak athletes, and the smaller muscle mass involved in kayak paddling limit oxygen uptake when exercise intensity is high. Furthermore, slower exercise cadence in kayak paddling leads to higher muscular tension, and thus may enhance the limiting of oxygen uptake.

RELATIONSHIP BETWEEN FLAT-WATER KAYAK PERFORMANCE AND ENERGY SUPPLY CAPACITY / 体力科学

The purpose of this study was to investigate the relationship between 2-min kayak ergometer performance (KEP) and energy supply capacity. Seventeen (male : 9, female : 8) kayak paddlers completed a maximal incremental test to determine aerobic capacity{maximal oxygen uptake (VO_2max) and lactate threshold (LT)}, and a 2-min all-out test to measure performance and anaerobic capacity{maximal accumulated oxygen deficit (MAOD)}. In addition, total energy supply capacity was estimated by these variables [{(T-score of VO_2max+T-score of LT)/2+T-score of MAOD}/2]. Oxygen uptake and blood lactate concentrations were continuously measured during the incremental test and at the completion of both tests. These tests were conducted on an air-braked kayak ergometer. Unlike the previous research, no significant relationships were found between KEP and VO_2max and LT in either male or female. MAOD correlated with KEP in female (r=0.75, p<0.05), but not in male. On the other hand, there was a significant correlation between KEP and total energy supply capacity (r=0.89, p<0.05, both male and female). In conclusion, total energy supply capacity accounted for a large part of KEP. These results indicate that flat-water kayak paddlers need to develop both aerobic and anaerobic capacities.

The relationship between high power output during intermittent exercise and three energy delivery systems / 体力科学

This study investigated the relationship of high-power work capacity with physiological variables during supramaximal intermittent exercise and individually measured alactic (ATP-CP), lactic (LA), and oxygen (O<SUB>2</SUB>) energy delivery systems. Nineteen university handball players (experiment 1) and 23 university basketball players (experiment 2) performed an intermittent exercise routine consisting of a combination of high-power and low-power exercise. The exercise protocols were a laboratory test consisting of pedaling on a bicycle ergometer (experiment 1) and a field test consisting of a running protocol incorporating changes in direction (experiment 2) . The main results were as follows :<BR>(1) The ATP-CP system was significantly related to power output during the early stage of intermittent exercise and the O<SUB>2</SUB> system was significantly related to power output in the middle and late stages of intermittent exercise. As an indicator of the O2 system, blood lactate concentration during submaximal exercise correlated more closely with power output during intermittent exercise compared with VO<SUB>2</SUB>max/BW. The LA system was not significantly related to power output during intermittent exercise.<BR>(2) Subjects were divided into 2 groups according to energy delivery ability and then power output ability during intermittent exercise was compared. The high ATP-CP system group had a significantly higher power output during the early stage of intermittent exercise compared with the low ATP-CP system group. The high O<SUB>2</SUB> system group had a significantly higher power output in the middle and late stages of intermittent exercise compared with the low O<SUB>2</SUB> system group. Compared to the low O<SUB>2</SUB> system group, the high O<SUB>2</SUB> system group had a higher absolute VO<SUB>2</SUB> during the low intensity active recovery periods of intermittent exercise, as well as a tendency to have lower blood lactate levels. The high LA system group showed lower power output over the course of intermittent exercise compared with the low LA system group.<BR>These results indicate that the O<SUB>2</SUB> system is important for exerting higher power output during supramaximal intermittent exercise.