Acute effects of foam rolling on ankle dorsiflexion and squat exercise patterns in extreme conditioning program practitioners: A randomized clinical trial.

BACKGROUND/OBJECTIVES: Joint and muscle overloads commonly occur in extreme conditioning programs (ECP), which require great physical fitness for their practice. For its execution, good functional performance, mobility and adequate movement patterns are required. The fascial system plays a fundamental role in performance in ECP and one of the techniques used to improve joint mobility and movement pattern is the self-myofascial release using a foam roller (FR). Our objective of this study was to evaluate the effect of FR in ankle dorsiflexion (DF) range of motion (ROM), assessed with the Lunge Test, and also in the squat movement pattern, assessed using the Technique smartphone application, in ECP practitioners. METHODS: The study was carried out with 18 ECP practitioners who practiced for over four months and had a mean age of 30.94 years. The participants were randomized and allocated into two groups: control and intervention. The FR was self-applied bilaterally in the sural triceps region for 90 seconds. Tests to assess DF ROM and squat movement pattern were applied before and immediately after using FR (intervention group) or after three-minute rest (control group). RESULTS: The use of the FR promoted an immediate increase in ankle DF ROM during the Lunge Test and during the squat and a decrease in dynamic knee valgus during the squat. CONCLUSION: The FR can be used as a tool for an acute increase in DF ROM and a decrease in dynamic knee valgus, having a positive impact in improving movement patterns.

Low back pain and joint position changes in cyclists: a cross-sectional study / Dolor lumbar y cambios en la posición de las articulaciones en ciclistas: un estudio transversal / Dor lombar e alterações do posicionamento articular em ciclistas: um estudo transversal

ABSTRACT Introduction: Low back pain is one of the most common complaints among cyclists. The disharmony of the cyclist-bike combination may be a predisposing factor. Bike Fit is a technique that aims to adjust the bike to the individual characteristics of the cyclist. Objectives: To investigate the relationship between the cyclist's position on the bicycle and the occurrence of complaints of low back pain. Methods: Data obtained during Bike Fit from 62 amateur cyclists were used in the study. Cyclists were filmed during the act of pedaling on a stationary roller and image analysis was performed using Kinovea® software. Data related to complaints of low back pain and positioning on the bicycle were used in the Chi-Square test and binary logistic regression. Results: The mean age was 38.06 ± 8.82 years, 87.7% of the sample was composed of men and low back pain was found in 40.3% (25/62) of the participants. Univariate analysis showed a positive correlation between low back pain and the following variables: ankle dorsiflexion angle (X2=6.947, p=0.014) and upper limb reach (X2=5.247; p=0.032). Binary logistic regression showed a positive association between reaching with the upper limbs and low back pain (r=2.728; p=0.002) and a negative association between knee advancement and low back pain (r= -2.281; p=0.007). Conclusion: Cyclists with low back pain present changes in their position on the bicycle, which reinforces the importance of evaluating the cyclist/bike combination. However, it is not possible to state whether the positional changes observed in the study sample are causes or consequences of low back pain. Level of evidence: Level III; Cross-sectional observational study.

RESUMEN Introducción: El dolor lumbar es una de las quejas más frecuentes en los practicantes de ciclismo. Puede tener como factor predisponente la falta de armonía del conjunto ciclista-bicicleta. Bike Fit es una técnica que tiene como objetivo ajustar la bicicleta a las características individuales del ciclista. Objetivos: Investigar la relación entre la posición del ciclista en la bicicleta y la aparición de quejas de lumbalgia. Métodos: En el estudio se utilizaron datos obtenidos durante el Bike Fit de 62 ciclistas aficionados. Los ciclistas fueron filmados durante el acto de pedalear sobre un rodillo estacionario y el análisis de las imágenes se realizó utilizando el software Kinovea®. Los datos relacionados con las quejas de dolor lumbar y la posición en la bicicleta se utilizaron en la prueba de Chi-Cuadrado y regresión logística binaria. Resultados: La edad media fue de 38,06 ± 8.82 años, el 87,7% de la muestra estuvo compuesta por hombres y se constató dolor lumbar en el 40,3% (25/62) de los participantes. El análisis univariado mostró una correlación positiva entre el dolor lumbar y las siguientes variables: ángulo de dorsiflexión del tobillo (X2 = 6,947, p = 0,014) y alcance de las extremidades superiores (X2 = 5,247; p = 0,032). La regresión logística binaria mostró una asociación positiva entre el alcance de las extremidades superiores y el dolor lumbar (r = 2,728; p = 0,002) y una asociación negativa para el avance de la rodilla y el dolor lumbar (r = -2,281; p = 0,007). Conclusiones: Los ciclistas con dolor lumbar presentan cambios en su posición sobre la bicicleta, lo que refuerza la importancia de la evaluación del conjunto ciclista-bicicleta. Sin embargo, no es posible afirmar si los cambios posicionales observados en la muestra estudiada son causas o consecuencias del dolor lumbar. Nivel de evidencia: Nivel III; Estudio observacional transversal.

RESUMO Introdução: A dor lombar é uma das queixas mais comuns nos praticantes de ciclismo. Pode ter como fator predisponente a desarmonia do conjunto ciclista-bicicleta. O Bike Fit é uma técnica que visa ajustar a bicicleta às características individuais do ciclista. Objetivos: Investigar a relação entre o posicionamento do ciclista na bicicleta e a ocorrência de queixas de dor lombar. Métodos: Os dados obtidos durante o Bike Fit de 62 ciclistas amadores foram utilizados no estudo. Os ciclistas foram filmados durante a pedalada em um rolo estacionário e a análise das imagens foi realizada pelo software Kinovea®. Os dados relacionados com a queixa de dor lombar e ao posicionamento na bicicleta foram utilizados no teste do Qui-quadrado e de regressão logística binária. Resultados: A média de idade foi de 38,06 ± 8,82 anos, 87,7% da amostra foi composta por homens e a dor lombar foi constatada em 40,3% (25/62) dos participantes. A análise univariada mostrou correlação positiva entre a dor lombar e as seguintes variáveis: ângulo de dorsiflexão do tornozelo (X2 = 6,947, p = 0,014) e alcance dos membros superiores (X2 = 5,247; p = 0,032). A regressão logística binária mostrou uma associação positiva entre alcance dos membros superiores e dor lombar (r = 2,728; p = 0,002) e associação negativa para avanço dos joelhos e dor lombar (r = -2,281; p = 0,007). Conclusão: Os ciclistas com dor lombar apresentam alterações de posicionamento na bicicleta, o que reforça a importância da avaliação do conjunto ciclista-bicicleta. Entretanto, não é possível afirmar se as alterações de posicionamento observadas na amostra estudada são causas ou consequências da dor lombar. Nível de evidência: Nível III; Estudo observacional transversal.

Contribution of the practice of resistance exercises and the type of delivery to the diastasis of the rectus abdominis muscles in primiparous women / Contribución de la práctica de ejercicios de resistencia y el tipo de parto a la diástasis de los músculos rectos abdominales en mujeres primíparas / Contribuição da prática de exercício resistido e do tipo de parto para a diástase dos músculos retos do abdome em primíparas

ABSTRACT Maternal organism suffers physiological and biomechanical changes during pregnancy, including the separation of rectus abdominis muscles (RAM). This cross-sectional study aimed to compare the distance between the RAM among sedentary and active primiparous women who had vaginal childbirth and cesarean section, to correlate RAM separation with maternal and child variables and to compare these variables between primiparous women with and without RAM diastasis. In total, 56 women were evaluated in their ninth postpartum week, divided into four groups according to the mode of delivery and the practice of resistance exercises. RAM distance was calipered in the supraumbilical, umbilical, and infraumbilical regions. The values obtained were verified via analysis of variance (ANOVA), Pearson's correlation, and independent t-test. We found no main effect between mode of delivery and practice of resistance exercises or interaction between mode of delivery and practice of resistance exercises (p≥0.118) for RAM distance. We found significant correlation between body weight before pregnancy and RAM distance (p<0.001). There was no association between body weight gain during pregnancy and the newborn's weight with RAM distance (p≥0.132). We observed significant difference in body weight before pregnancy between primiparous women with and without RAM diastasis (p<0.005). We found no differences between groups regarding body weight gain during pregnancy and the newborn's weight (p≥0.122). It was concluded that the practice of resistance exercises and the mode of delivery have no impact on the separation of supraumbilical, umbilical, and infraumbilical regions of RAM in primiparous women.

RESUMEN El cuerpo materno sufre cambios fisiológicos y biomecánicos durante el embarazo, entre los cuales se destaca el alejamiento de los músculos rectos abdominales (MRA). Los objetivos de este estudio transversal fueron: comparar la distancia entre los MRA entre mujeres primíparas que realizaban entrenamiento y las sedentarias que se sometieron a parto vaginal y cesárea; correlacionar el alejamiento de los MRA con las variables materno-infantiles; y comparar estas variables entre mujeres primíparas con y sin diástasis de los MRA. Se evaluaron a 56 mujeres en la novena semana posparto, quienes fueron divididas en cuatro grupos según el tipo de parto y la práctica de ejercicios de resistencia. La distancia entre los MRA se midió con un calibre en las regiones supraumbilical, umbilical e infraumbilical. En los datos se aplicaron el análisis de varianza (Anova), la correlación de Pearson y la prueba t independiente. No hubo efecto del tipo de parto, la práctica de ejercicios de resistencia o la interacción del tipo de parto y la práctica de ejercicios de resistencia (p≥0,118) en la distancia entre los MRA. Hubo una correlación significativa entre el peso antes del embarazo y la distancia entre los MRA (p<0,001). No hubo asociación entre el aumento de peso durante el embarazo y el peso del bebé con la distancia entre los MRA (p≥0,132). Hubo una diferencia significativa en el peso antes del embarazo entre mujeres primíparas con y sin diástasis de los MRA (p<0,005). No hubo diferencia entre los grupos en el aumento de peso durante el embarazo y el peso del bebé (p≥0,122). Se concluye que la práctica de ejercicios de resistencia y el tipo de parto no tienen impacto en el alejamiento de los MRA en las regiones supraumbilical, umbilical e infraumbilical en mujeres primíparas.

RESUMO O organismo materno sofre alterações fisiológicas e biomecânicas durante a gestação, dentre elas o afastamento dos músculos retos do abdome (MRAs). Os objetivos deste estudo transversal foram: comparar a distância entre os MRAs entre primíparas treinadas e sedentárias que realizaram parto vaginal e cesárea; correlacionar o afastamento dos MRAs com variáveis materno-infantis; e comparar essas variáveis entre primíparas com e sem diástase dos MRAs. Foram avaliadas 56 mulheres na nona semana pós-parto, divididas em quatro grupos de acordo com o tipo de parto e a prática de exercício resistido. A distância entre os MRAs foi mensurada com paquímetro nas regiões supraumbilical, umbilical e infraumbilical. Os dados foram submetidos à análise de variância (Anova), correlação de Pearson e teste t independente. Não houve efeito do tipo de parto, da prática de exercício resistido ou da interação tipo de parto e prática de exercício resistido (p≥0,118) para a distância entre os MRAs. Houve correlação significativa entre peso antes da gestação e distância entre os MRAs (p<0,001). Não houve associação entre ganho de peso na gestação e peso do bebê com a distância entre os MRAs (p≥0,132). Houve diferença significativa no peso antes da gestação entre primíparas com e sem diástase dos MRAs (p<0,005). Não houve diferença entre grupos no ganho de peso na gestação e no peso do bebê (p≥0,122). Conclui-se que a prática de exercício resistido e o tipo de parto não têm impacto no afastamento entre os MRAs nas regiões supraumbilical, umbilical e infraumbilical em primíparas.

Return to sport after anterior cruciate ligament reconstruction: a qualitative analysis / Retorno ao esporte após reconstrução do ligamento cruzado anterior: uma análise qualitativa

Abstract Introduction Return to sport is a desired outcome in individuals submitted to anterior cruciate ligament reconstruction (ACLR). Objective Understand the factors that affect return to pre-injury level sport after ACLR from the patient's perspective. Methods The sample consisted of 29 individuals submitted to ACLR who participated in sport before the ligament injury. This is a narrative analysis with a qualitative approach, using a semi-structured interview as a methodological resource. Standardized instruments were also applied to evaluate psychological readiness to return to sport, via the Anterior Cruciate Ligament - Return to Sport after Injury Scale (ACL-RSI); self-perceived knee function using the International Knee Documentation Committee (IKDC) subjective questionnaire; and the frequency of participation in sports with the Marx scale. Results Analysis of the interviews produced three main themes related to post-ACLR return to sport: self-discipline, fear of reinjury and social support. In qualitative analysis, the average scores obtained were 59.17 (± 23.22) on the ACL-RSI scale, 78.16 (± 19.03) for the IKDC questionnaire and 9.62 (± 4.73) and 7.86 (± 5.44) for the Marx scale before and after surgery, respectively. Conclusion: Psychological factors influence the decision to return to sport post-ACLR. Physiotherapists should therefore be aware of the psychological aspects and expectations of patients, and that other health professionals may be needed to help prepare these individuals to return to their preinjury sports level and achieve more satisfactory outcomes after ACLR.

Resumo Introdução O retorno ao esporte é um desfecho alme-jado pelos indivíduos que se submetem à reconstrução do ligamento cruzado anterior (RLCA). Objetivo Com-preender os fatores que interferem no retorno ao esporte no nível anterior à lesão ligamentar em indivíduos submetidos à RLCA sob o ponto de vista do paciente. Métodos A amostra foi composta por 29 indivíduos que se submeteram à RLCA e praticavam esporte antes da lesão ligamentar. O estudo é caracterizado como uma pesquisa narrativa de abordagem qualitativa, utilizando como recurso metodológico a entrevista semiestrutu-rada. Com o uso de instrumentos padronizados, avaliou-se também a prontidão psicológica para retornar ao esporte, utilizando a escala ACL-RSI; a autopercepção da função do joelho, utilizando o questionário subjetivo do IKDC; e a frequência de participação esportiva antes da lesão e após a cirurgia, utilizando a Escala de Marx. Resultados A análise das entrevistas gerou três unidades temáticas principais relacionadas com o retorno ao esporte pós-RLCA: autodisciplina, medo de uma nova lesão e suporte social. Na análise quantitativa, obteve-se média de 59,17 pontos (± 23,22) na escala ACL-RSI, 78,16 pontos (± 19,03) no IKDC, e 9,62 (± 4,73) e 7,86 pontos (± 5,44) na escala de Marx, antes da lesão e após a cirurgia, respectivamente. Conclusão Fatores psicológicos influenciam a decisão de retorno ao esporte pós-RLCA. Os fisioterapeutas, portanto, devem estar atentos aos aspectos psicológicos e expectativas dos pacientes, considerando a necessidade de outros profissionais da saúde auxiliarem na preparação do indivíduo para retornar ao nível esportivo pré-lesão e alcançar resultados mais satisfatórios pós-RLCA.

Foot pronation affects pelvic motion during the loading response phase of gait.

BACKGROUND: Increased foot pronation during walking has been associated with low back pain. This association may be due to the impact of increased pronation on pelvic motion. OBJECTIVE: To investigate the effects of increased bilateral foot pronation on pelvic kinematic in frontal and transverse planes during the loading response phase of gait. METHODS: Pelvic, hip, and foot angular positions of 20 participants were collected while they walked at fast speed wearing flat and medially inclined insoles inserted in the shoes. Pelvic motion in frontal and transverse planes was analyzed during the loading response phase. Foot eversion-inversion was analyzed during the complete stance phase to verify the insoles effectiveness in inducing increased pronation and to exclude excessive pronators. RESULTS: Inclined insoles were effective in inducing increased foot pronation. Pelvic and hip motion were altered in the increased pronation condition compared to the control condition. In the frontal plane, mean pelvic position was more inclined to the contralateral side (mean difference [MD]: 0.54°; 95%CI: 0.23, 0.86) and its range of motion (ROM) was reduced (MD: 0.50°; 95%CI: 0.20, 0.79). In the transverse plane, mean pelvic position was less rotated toward the contralateral leg (MD: 1.03°; 95%CI: 0.65, 1.60) without changes in ROM (MD: 0.04°; 95%CI: -0.17, 0.25). The hip was more internally rotated (MD: 1.37°; 95%CI: 0.76, 1.98) without changes in ROM (MD: 0.10°; 95%CI: -1.02, 1.23). CONCLUSION: Increased bilateral foot pronation changes pelvic motion during walking and should be assessed, as a contributing factor to possible pelvic and lower back disorders.

Do exercise-based prevention programmes reduce non-contact musculoskeletal injuries in football (soccer)? A systematic review and meta-analysis with 13 355 athletes and more than 1 million exposure hours.

OBJECTIVE: The aim of this systematic review was to investigate the effect of exercise-based programmes in the prevention of non-contact musculoskeletal injuries among football players in comparison to a control group. DESIGN: Systematic review and meta-analysis of randomised controlled trials. DATA SOURCES: MEDLINE, EMBASE, CENTRAL, CINAHL, PEDro and SPORTDiscus databases were searched from the earliest record to January 2021. ELIGIBILITY CRITERIA: Studies were eligible if they (1) included football players aged 13 years or older, (2) used exercise-based programmes as intervention, (3) presented the number of non-contact musculoskeletal injuries (ie, defined as any acute sudden onset musculoskeletal injury that occurred without physical contact) and exposure hours for each group, and (4) had a control group (eg, usual training, minimal intervention, education). All types of exercise-based prevention programmes were eligible for inclusion. Risk of bias for each included study and overall quality of evidence for the meta-analysis were assessed. RESULTS: Ten original randomised controlled trials with 13 355 football players and 1 062 711 hours of exposure were selected. Pooled injury risk ratio showed very low-quality evidence that exercise-based prevention programmes reduced the risk of non-contact musculoskeletal injuries by 23% (0.77 (95% CI 0.61 to 0.97)) compared with a control group. CONCLUSION: Exercise-based prevention programmes may reduce the risk of non-contact musculoskeletal injuries by 23% among football players. Future high-quality trials are still needed to clarify the role of exercise-based programmes in preventing non-contact musculoskeletal injuries among football players. PROSPERO REGISTRATION NUMBER: CRD42020173017.

Efficacy and Safety of Repeated Micropulse Transscleral Diode Cyclophotocoagulation in Advanced Glaucoma.

PRECIS: Repeat micropulse transscleral cyclophotocoagulation (MPTCP) has some benefit in lowering intraocular pressure (IOP). There was a small risk of loss of vision, prolonged hypotony, and phthisis bulbi. AIM: This study aimed to determine the efficacy and safety of repeated MPTCP for an Asian population with refractory glaucoma. METHODS: This is a retrospective case series of 43 eyes (43 patients) with severe glaucoma which underwent repeated MPTCP. Baseline parameters were taken from the visit just before the second MPTCP session. Success was defined as IOP of 6 to 21 mm Hg or ≥20% reduction in IOP without an increase in glaucoma medication from baseline, without further glaucoma reoperation, and ≤3 total MPTCP episodes. The IOP, number of IOP-lowering medications, and best-corrected visual acuity were documented preoperatively and postoperatively. Postoperative complications were also analyzed. RESULTS: The mean age±SD was 57.4±18.2 years with a mean follow-up duration of 28.9±27.5 months. Neovascular glaucoma was the most common type of glaucoma [18 eyes (41.9%)]. The success rates at postoperative years 1, 2, and 3, and the latest follow-up were 36.4%, 42.9%, 32.0%, and 39.5%, respectively. The median survival time of repeat MPTCP was 4.6 months. Compared with the preoperative mean IOP (35.2±11.0 mm Hg), the mean IOP at postoperative years 1, 2, and 3, and latest follow-up, was 27.8±13.7 mm Hg (P=0.004), 27.4±12.4 (P=0.003), 31.8±13.2 (P=0.35), and 27.1±13.8 mm Hg (P=0.002), respectively. The mean number of IOP-lowering medications was reduced from 3.3±0.9 preoperatively to 2.8±1.3 at the final follow-up (P=0.007). Postoperative complications included prolonged hypotony [3 eyes (7.0%)] and phthisis bulbi [2 eyes (4.7%)]. CONCLUSION: Repeated MPTCP is at best moderately effective in lowering IOP for eyes with advanced glaucoma.

A novel single-leg squat test with speed and accuracy requirements: Reliability and validity in anterior cruciate ligament reconstructed individuals.

BACKGROUND: Some traditional single-leg squat tests focused on number of repetitions may not demand precise control of lower limb dynamic alignment, especially in the frontal and transverse planes. The primary objective of this study was to evaluate test-retest reliability and construct validity of a novel single-leg squat test - the 'precision-squat test' (PST) - designed to assess performance under varying task demands that can impact the execution of lower limb movements. A secondary objective was to investigate whether musculoskeletal factors predict performance in the PST in healthy individuals. METHODS: Thirty healthy participants were assessed to verify test-retest reliability. To verify the test's construct validity, we compared the performance of 21 anterior cruciate ligament reconstructed (ACLR) individuals and 21 matched controls. Finally, 36 healthy individuals were assessed to verify the musculoskeletal factors related to PST performance. All participants performed the PST: they executed single-leg squats while moving a laser pointer (attached to the thigh) between two targets. We varied target size and distance between targets to manipulate the task difficulty. RESULTS: Reliability of the PST was excellent at all demand levels (intraclass correlation coefficient (ICC)(3,2) > 0.93). Squat time increased under test conditions involving higher task difficulty (P < 0.001) and in ACLR individuals compared with age-matched controls (P < 0.05). Regression analyses revealed that reduced knee extensors and hip external rotators torques are related to increased squat time (P < 0.05). CONCLUSIONS: PST is a valid and reliable tool to assess performance of healthy and ACLR individuals. In addition, hip and knee strength are associated with performance during the test.

Current clinical practice and return-to-sport criteria after anterior cruciate ligament reconstruction: a survey of Brazilian physical therapists.

BACKGROUND: Adherence to the use of recommended measures/criteria for return to sport clearance after anterior cruciate ligament reconstruction is crucial for successful rehabilitation. OBJECTIVES: The purpose of this study was to describe the current clinical practice of Brazilian physical therapists that treat patients after anterior cruciate ligament reconstruction, including the measures/criteria used to support the decision-making process regarding return to sport. The secondary aim was to investigate factors associated with the use of the most recommended measures/criteria for return to sport. METHODS: An electronic survey questionnaire was sent to Brazilian physical therapists. The survey consisted of questions about demographics and professional and clinical practice data related to anterior cruciate ligament reconstruction postoperative rehabilitation and return to sport criteria. Descriptive statistics and chi-square tests were used for analyses. RESULTS: A sample of 439 professionals participated in the survey. Only 6.4% of the physical therapists use the most recommended measures/criteria for return to sport after anterior cruciate ligament reconstruction. Professional certification in Sports Physical Therapy was the only factor associated with the use of these recommended measures/criteria (p=0.02). The measures most used for return to sport clearance were related to physical factors (65.3% to 75.1%), such as range of motion and muscle strength. A small number of professionals use questionnaires to assess functional (16.6%) and psychological (19.1%) aspects of their patients to support the decision-making process. CONCLUSION: In their clinical practice, most Brazilian physical therapists do not use the recommended measures/criteria for return to sport after anterior cruciate ligament reconstruction.

Fibrillarin Ribonuclease Activity is Dependent on the GAR Domain and Modulated by Phospholipids.

Fibrillarin is a highly conserved nucleolar methyltransferase responsible for ribosomal RNA methylation across evolution from Archaea to humans. It has been reported that fibrillarin is involved in the methylation of histone H2A in nucleoli and other processes, including viral progression, cellular stress, nuclear shape, and cell cycle progression. We show that fibrillarin has an additional activity as a ribonuclease. The activity is affected by phosphoinositides and phosphatidic acid and insensitive to ribonuclease inhibitors. Furthermore, the presence of phosphatidic acid releases the fibrillarin-U3 snoRNA complex. We show that the ribonuclease activity localizes to the GAR (glycine/arginine-rich) domain conserved in a small group of RNA interacting proteins. The introduction of the GAR domain occurred in evolution in the transition from archaea to eukaryotic cells. The interaction of this domain with phospholipids may allow a phase separation of this protein in nucleoli.

MP3 Plus: A Modified Micropulse Transscleral Cyclophototherapy Technique for the Treatment of Refractory Glaucoma.

PRéCIS:: In advanced refractory glaucoma which has failed prior MP3 laser, MP3 Plus is effective in reducing intraocular pressure (IOP) without significant complications. It is also useful as a temporizing procedure before incisional surgery. PURPOSE: To evaluate the efficacy and safety of MP3 Plus, a novel technique using modified micropulse transscleral cyclophototherapy (MPTCP) in eyes with refractory glaucoma or failed MPTCP treatment. METHODS: This is a retrospective interventional case series. In total, 32 consecutive eyes from 29 patients with uncontrolled IOPs who had previous MPTCP or refractory glaucoma underwent MP3 Plus, a modified MPTCP where additional discrete pulses are applied. The main outcome measurement was IOP at 1, 3, 6, and 12 months postprocedure, with success defined as a 20% reduction in baseline IOP, an IOP of 25 mmHg or less, and no need for further reoperation. We collected and analyzed visual acuity, number of glaucoma medications, and complications. RESULTS: The patients had an average of 1.4±0.9 glaucoma procedures before treatment, where 87.5% underwent one or more previous MPTCP with suboptimal response. Of the eyes presenting for follow-up, 51.6% (n=31), 37.0% (n=27), 35.7% (n=28), and 25.9% (n=27) achieved the primary outcome at 1, 3, 6, and 12 months, respectively. Baseline IOP was 33.7±11.6 mmHg (n=32 eyes) and posttreatment IOP at 1, 3, 6, and 12 months were 21.0±9.0 mmHg (n=31; P<0.0001), 26.2±10.8 mmHg (n=25; P<0.0001), 23.2±9.4 mmHg (n=20; P<0.05), and 24.6±9.8 mmHg (n=16; P<0.001), respectively. There was a reduction in glaucoma medications from 3.4±0.8 preoperatively to 2.8±1.2 (n=16; P<0.05) at 12 months. There were no cases of prolonged inflammation or hypotony. CONCLUSIONS: MP3 Plus is effective and safe in lowering IOP in eyes with refractory glaucoma after previous failed MPTCP.

Clinical Measures Related to Forward Shoulder Posture: A Reliability and Correlational Study.

OBJECTIVES: The purpose of this study was to examine the reliability of clinical measures related to forward shoulder posture (pectoralis minor index [PMI], scapular index [SI], abduction index [AI], acromion to the wall index [AWI] acromion to the treatment table index [ATI], and thoracic curvature [TC]), and to investigate the association (redundancy) among these measures. METHODS: Twenty-one asymptomatic participants participated in this study. Two physiotherapists were trained to perform the clinical measurements. Intraclass correlation coefficients (ICC2,k) were calculated to assess intra- and interrater reliabilities. Pearson product moment correlation was used to investigate the existence of possible redundancy between the measures that showed high intra- and interrater reliabilities. RESULTS: The measures showed ICCs between 0.30 and 0.97. Five measures, PMI, SI, AWI, ATI, and TC, showed appropriate values for intrarater reliability (ICCs 0.77-0.94), and 3 measures, AWI, ATI, and TC, for interrater reliability (ICCs 0.82-0.85). Among measures that showed acceptable intra- and interrater reliability values, 2 measures were redundant, showing high association (AWI vs ATI) (r = 0.80, P < .001). CONCLUSION: For PMI, SI, AWI, ATI, and TC measures, adequate values of intrarater reliability were observed. For AWI, ATI, and TC, adequate values of interrater reliability were found. Two pairs of measures were highly associated (PMI with SI; AWI with ATI), which indicates redundancy among them. Our results suggest that, when the same examiner performs the assessment, the combined use of the PMI, AWI, and TC measures allows a quick but comprehensive evaluation of the presence of forward shoulder posture.

Most common histopathological patterns of the Minas Gerais Association of the Centers of Nephrology.

INTRODUCTION: We analyzed the distribution and frequency of glomerular diseases in patients biopsied between 1992 and 2016 in centers that make up the AMICEN (Minas Gerais Association of Nephrology Centers). METHODS: We analyzed the biopsy reports of patients from 9 AMICEN nephrology centers. We took note of their age, gender, ultrasound use, post-biopsy resting time, whether the kidney was native or a graft, number of glomeruli and indication for the biopsy. The kidney biopsy findings were broken down into four categories: glomerular and non-glomerular diseases, normal kidneys and insufficient material for analysis. Those patients diagnosed with glomerular diseases were further divided into having primary or secondary glomerular diseases. RESULTS: We obtained 582 biopsy reports. The median age was 38 years (1 to 85). The number of glomeruli varied between 0 and 70 (median = 13.0). In total, 97.8% of the biopsies were ultrasound guided. The main indication was nephrotic syndrome (36.9%), followed by hematuria-proteinuria association (16.2%). Primary glomerular diseases proved to be the most frequent (75.3%), followed by secondary diseases (24.7%). Among the primary glomerular diseases, FSGS was found at a higher frequency (28.8%), while among the secondary diseases, SLE was the most prevalent (42.4%). Regarding prevalence findings, those for both primary and secondary diseases were similar to those found in the large Brazilian registries published thus far. CONCLUSION: Glomerular disease registries are an important tool to identify the prevalence of such disease in regions of interest and can serve as an instrument to guide public policy decisions concerning the prevention of terminal kidney diseases.

Most common histopathological patterns of the Minas Gerais Association of the Centers of Nephrology

SUMMARY INTRODUCTION: We analyzed the distribution and frequency of glomerular diseases in patients biopsied between 1992 and 2016 in centers that make up the AMICEN (Minas Gerais Association of Nephrology Centers). METHODS: We analyzed the biopsy reports of patients from 9 AMICEN nephrology centers. We took note of their age, gender, ultrasound use, post-biopsy resting time, whether the kidney was native or a graft, number of glomeruli and indication for the biopsy. The kidney biopsy findings were broken down into four categories: glomerular and non-glomerular diseases, normal kidneys and insufficient material for analysis. Those patients diagnosed with glomerular diseases were further divided into having primary or secondary glomerular diseases. RESULTS: We obtained 582 biopsy reports. The median age was 38 years (1 to 85). The number of glomeruli varied between 0 and 70 (median = 13.0). In total, 97.8% of the biopsies were ultrasound guided. The main indication was nephrotic syndrome (36.9%), followed by hematuria-proteinuria association (16.2%). Primary glomerular diseases proved to be the most frequent (75.3%), followed by secondary diseases (24.7%). Among the primary glomerular diseases, FSGS was found at a higher frequency (28.8%), while among the secondary diseases, SLE was the most prevalent (42.4%). Regarding prevalence findings, those for both primary and secondary diseases were similar to those found in the large Brazilian registries published thus far. CONCLUSION: Glomerular disease registries are an important tool to identify the prevalence of such disease in regions of interest and can serve as an instrument to guide public policy decisions concerning the prevention of terminal kidney diseases.

RESUMO INTRODUÇÃO: Analisamos a distribuição e frequência de doenças glomerulares de pacientes biopsiados entre 1992 e 2016 em centros que compõem a Amicen (Associação de Minas Gerais de Nefrologia). MÉTODOS: Analisamos os relatórios de biópsia de pacientes de nove centros de nefrologia da Amicen. Observamos idade, gênero, uso de ultrassom, tempo de descanso pós-biópsia, se o rim era nativo ou um enxerto, número de glomérulos e indicação para a biópsia. Os achados da biópsia do rim foram divididos em quatro categorias: doenças glomerulares e não glomerulares, rins normais e material insuficiente para análise. Os pacientes diagnosticados com doenças glomerulares foram ainda divididos em doenças glomerulares primárias ou secundárias. RESULTADOS: Obtivemos 582 relatórios de biópsia. A idade mediana foi de 38 anos (1 a 85). O número de glomérulos variou entre zero e 70 (mediana = 13,0). No total, 97,8% das biópsias foram guiadas por ultrassom. A principal indicação foi síndrome nefrótica (36,9%), seguida de associação hematúria-proteinúria (16,2%). As doenças glomerulares primárias revelaram-se as mais frequentes (75,3%), seguidas de doenças secundárias (24,7%). Entre as doenças glomerulares primárias, o FSGS foi encontrado em maior frequência (28,8%), enquanto nas doenças secundárias, o lúpus eritematoso sistêmico foi o mais prevalente (42,4%). Quanto aos achados de prevalência, aqueles para doenças primárias e secundárias foram semelhantes aos encontrados nos grandes registros brasileiros publicados até o momento. CONCLUSÃO: Os registros de doenças glomerulares são uma ferramenta importante para identificar a prevalência dessas doenças em regiões de interesse e pode servir como um instrumento para orientar decisões de políticas públicas relativas à prevenção de doenças renais terminais.

Outcomes and Complications of Ahmed Tube Implantation in Asian Eyes.

PURPOSE: There is a lack of long-term Asian studies on the efficacy and safety of Ahmed glaucoma valve (AGV) implantation. This study seeks to determine the outcomes and complications of AGV implantation in Asians. METHODS: A retrospective review of AGV surgeries performed at a single center in Singapore was conducted. A total of 76 patients with primary and secondary glaucoma who underwent their first AGV surgery from January 1, 2010 to December 31, 2012 were considered for our study. Primary outcomes evaluated were as follows: failure, intraocular pressure, best-corrected visual acuity, number of intraocular pressure (IOP)-lowering medications, and complications. Failure was defined by the following: IOP >21 mm Hg on 2 consecutive visits after 3 months, IOP≤5 mm Hg on 2 consecutive visits after 3 months, reoperation for glaucoma, removal of implant, or loss of light perception vision. RESULTS: Mean follow-up duration was 33.2±6.9 months. There was significant reduction in IOP (mean reduction, 25.9%; P<0.001) and number of IOP-lowering medications (mean reduction, 77.8%; P<0.001) at 3 years. Absolute failure rate was 23.9% at 3 years with no difference between eyes with or without previous trabeculectomy and between eyes with primary or secondary glaucoma. Occurrence of postoperative hyphema was a significant risk factor for failure. The commonest postoperative complications were hyphema and tube exposure. CONCLUSIONS: At 3 years after AGV surgery in Asian eyes, less than one-quarter of the eyes fulfilled the criteria for surgical failure.

Success rates of 2-site phacoemulsification combined with fornix-based trabeculectomy using mitomycin C for primary angle-closure glaucoma and primary open-angle glaucoma in an Asian population.

PURPOSE: To determine the long-term outcomes of 2-site phacoemulsification combined with fornix-based trabeculectomy using mitomycin C (MMC) for primary angle-closure glaucoma (PACG) and primary open-angle glaucoma (POAG) in an Asian population. METHODS: We reviewed the records of all patients with POAG or PACG who underwent phacoemulsification with trabeculectomy using MMC from January 2008 through December 2010 in a tertiary ophthalmology unit in Singapore. The primary outcome measure was cumulative success rates defined as complete [intraocular pressure (IOP) <21, 18, 15 mmHg without medication] and qualified (IOP <21, 18, 15 mmHg with at least 1 medication) success. RESULTS: In total, 168 eyes (110 POAG and 58 PACG) were included (43.5% female; mean age ± SD, 68.3 ± 8.2 years). The respective 3-year qualified success rates were 88.4, 79.3, and 52.5% for IOP <21, 18, and 15 mmHg. The corresponding complete success rates were 79.0, 70.9, and 51.1%. The mean 3-year postoperative IOP was 14.5 ± 4.4 mmHg, and the IOP reduction was significantly greater for PACG than for POAG eyes (P = 0.006). After surgery, the mean number of medications was significantly reduced and visual acuity, significantly improved (both P < 0.001). Occurrence of postoperative complications, higher number of topical medications, younger age, and presence of diabetes mellitus were significant risk factors for surgical failure. CONCLUSION: Two-site phacoemulsification combined with fornix-based trabeculectomy using MMC is a good surgical approach for Asian eyes with concomitant mild-to-moderate primary glaucoma and cataracts.

[Health promotion in the basic units: analysis of the users' social representations about the role of the physical therapy]. / Promoção de saúde em unidades básicas: análise das representações sociais dos usuários sobre a atuação da fisioterapia.

The aim of this article is to identify the social representations of the users of operative groups about health and the physical therapy role in the health/disease process, as well as to verify how the representations of the users are related to the purposes of these groups. The present study was developed under a qualitative approach using the semi-structured interview. Users of the "Quality of Life" project from four basic health units of the city of Divinópolis, Minas Gerais State, were interviewed. The interviews were recorded and transcribed in order to preserve the totality of the statements. The analysis of the data was performed based on the thematic units. The main themes that emerged were: health as absence of disease, dependency of the group, physical therapy linked to physical rehabilitation and to health promotion, physical therapy linked to the psychological improvement and humanization of the physical therapy assistance. The knowledge of the social representations of the users from the "Quality of Life" project reinforces the need of the participation of the population in the development, accomplishment and evaluation of the health programs in order to reach coherence between the user expectations and the purposes of the program.

Promoção de saúde em unidades básicas: análise das representações sociais dos usuários sobre a atuação da fisioterapia / Health promotion in the basic units: analysis of the users' social representations about the role of the physical therapy

O objetivo deste estudo foi identificar as representações sociais dos usuários de grupos operativos sobre saúde e a atuação da fisioterapia no processo saúde/doença, além de verificar como as representações dos usuários relacionam-se com os propósitos destes grupos. O presente estudo foi desenvolvido numa abordagem qualitativa, utilizando-se a entrevista semi-estruturada. Foram entrevistados os usuários que participam de grupos operativos coordenados por fisioterapeutas em quatro Unidades Básicas de Saúde do município de Divinópolis (MG). As entrevistas foram gravadas e transcritas de forma a recuperar a integralidade dos depoimentos. A análise dos dados foi feita com base em unidades temáticas. Os principais temas que surgiram foram saúde como ausência de doença, dependência do grupo, fisioterapia ligada à reabilitação física e à promoção da saúde, fisioterapia ligada à melhora psicológica e humanização da assistência fisioterapêutica. O conhecimento das representações sociais dos usuários de grupos operativos reforça a necessidade de participação da população no desenvolvimento, realização e avaliação dos programas de saúde, de forma a alcançar uma coerência entre as expectativas do usuário e os propósitos do programa.

The aim of this article is to identify the social representations of the users of operative groups about health and the physical therapy role in the health/disease process, as well as to verify how the representations of the users are related to the purposes of these groups. The present study was developed under a qualitative approach using the semi-structured interview. Users of the "Quality of Life" project from four basic health units of the city of Divinópolis, Minas Gerais State, were interviewed. The interviews were recorded and transcribed in order to preserve the totality of the statements. The analysis of the data was performed based on the thematic units. The main themes that emerged were: health as absence of disease, dependency of the group, physical therapy linked to physical rehabilitation and to health promotion, physical therapy linked to the psychological improvement and humanization of the physical therapy assistance. The knowledge of the social representations of the users from the "Quality of Life" project reinforces the need of the participation of the population in the development, accomplishment and evaluation of the health programs in order to reach coherence between the user expectations and the purposes of the program.

Análise da relação entre dor lombar e desequilíbrio de força muscular em bailarinas / Analysis of the relationship between low back pain and muscle strength imbalance in ballet dancers

Objetivo: Investigar a relação entre dor lombar e desequilíbrio de força muscular na região lombopélvica em bailarinas clássicas. Métodos: O estudo foi do tipo exploratório transversal e desenvolvidonas academias de dança das cidades de Divinópolis e Oliveira, MG. Foram selecionadas 42 bailarinas,divididas em dois grupos (Grupos Dor e Sem Dor) de acordo com a presença ou não de queixas de dor na região lombar. Inicialmente, as bailarinas foram submetidas, por um único examinador, a quatro de força muscular na região lombopélvica: músculos glúteo máximo × isquiossurais e glúteo máximo × paravertebrais no movimento de extensão de quadril; glúteos máximo e médio × tensor da fáscia lata no movimento de abdução de quadril; abdominais e flexores de quadril no movimento de flexão de quadril. Em seguida, um segundo examinador aplicou os testes de força muscular para os músculos abdominais e paravertebrais. Para verificar a associação entre a queixa de dor lombar e a presença de desequilíbrios musculares foi utilizado o teste qui-quadrado. O nível de significância estabelecido foi de α = 0,05. Resultados: A maioria das bailarinas, independente do grupo do qual participavam, apresentou desequilíbrios de força muscular na região lombopélvica,porém apenas o desequilíbrio entre abdominais × flexores de quadril teve associação significativa coma dor lombar (p = 0,043). Conclusão: Desequilíbrios musculares lombopélvicos são frequentes em bailarinas clássicas. Entretanto, não é possível afirmar se tais desequilíbrios são adaptações específicas do balé clássico ou disfunções associadas a quadros álgicos resultantes de falhas no treinamento.

Objective: To investigate the relationship between low back pain and muscle strength imbalance in the lumbopelvic region of classical ballet dancers. Methods: This cross-sectional exploratory study was developed in the ballet academies of Divinópolis and Oliveira, Minas Gerais State. Forty-two ballet dancers were selected and then divided into two groups (Pain and Painless Groups), according to the presence or absence of pain complaints in the low back. Firstly, the ballet dancers were submitted, by one examiner, to four tests of muscle strength imbalance in the lumbopelvic region: gluteus maximus × hamstrings muscles and gluteus maximus × paraspinal muscles in the hip extension movement; gluteus maximus and medius × tensor fascia latae muscles in the hip abduction movement; abdominal × hip flexors in the hip flexion movement. After that, a second examiner applied the muscular strength tests for the abdominal and paraspinal muscles. Chi-square tests were used to verify the association between low back pain and muscle imbalances. The level of significance was set at α = 0.05. Results: Most of the ballet dancers, independently of the group, showed muscle strength imbalances in the lumbopelvic region. The abdominal × hip flexors test demonstrated a significant association with low back pain (p = 0.043). Conclusion: Muscle imbalances in the lumbopelvic region are common in classical ballet dancers. However, it is not possible to assure that these muscle imbalances are specific adaptations to the classical ballet or dysfunctions associated to algic symptoms resulted from training faults.