Validity of one-repetition maximum predictive equations in men with spinal cord injury.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: The study aimed (a) to test the cross-validation of current one-repetition maximum (1RM) predictive equations in men with spinal cord injury (SCI); (b) to compare the current 1RM predictive equations to a newly developed equation based on the 4- to 12-repetition maximum test (4-12RM). SETTING: SARAH Rehabilitation Hospital Network, Brasilia, Brazil. METHODS: Forty-five men aged 28.0 years with SCI between C6 and L2 causing complete motor impairment were enrolled in the study. Volunteers were tested, in a random order, in 1RM test or 4-12RM with 2-3 interval days. Multiple regression analysis was used to generate an equation for predicting 1RM. RESULTS: There were no significant differences between 1RM test and the current predictive equations. ICC values were significant and were classified as excellent for all current predictive equations. The predictive equation of Lombardi presented the best Bland-Altman results (0.5 kg and 12.8 kg for mean difference and interval range around the differences, respectively). The two created equation models for 1RM demonstrated the same and a high adjusted R2 (0.971, P<0.01), but different SEE of measured 1RM (2.88 kg or 5.4% and 2.90 kg or 5.5%). CONCLUSION: All 1RM predictive equations are accurate to assess individuals with SCI at the bench press exercise. However, the predictive equation of Lombardi presented the best associated cross-validity results. A specific 1RM prediction equation was also elaborated for individuals with SCI. The created equation should be tested in order to verify whether it presents better accuracy than the current ones.

Reproducibility and responsiveness of heart rate indexes to assess wheeling efficiency in patients with spinal cord injuries.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: To measure the reproducibility and responsiveness of heart rate indexes in measuring energy expenditure during wheelchair locomotion of adults with spinal cord injury (SCI). SETTING: SARAH Rehabilitation Hospital Network-Brasilia, Brazil. METHODS: The study consecutively enrolled 35 individuals with SCI. Volunteers propelled their wheelchairs at a self-selected and comfortable velocity around a circular track. The first assessment day was a responsiveness study, in which three tests were performed, with the wheelchair weight increased randomly during the last two tests. On the second assessment day, the test was conducted without extra weight (that is, baseline conditions) for reproducibility analyses. RESULTS: All indexes demonstrated reproducibility on all statistical analyses. The Propulsion Cardiac Cost Index (PCCI) had a lower variation coefficient than the Physiological Cost Index (PCI; 8.5%, 95% confidence interval (CI) 5.8-11.2 vs 24.2%, 95% CI 16.0-32.4) and lower effect size than the Total Heart Beat Index (THBI; 0.16 vs 0.26). The PCCI also had the best responsiveness results on all statistical tests. The PCCI correlation was the largest (r=0.63, P<0.01, 95% CI 0.43-0.83, followed by PCI (r=0.53, P<0.01, 95% CI 0.34-0.72) and then the THBI (r=0.50, P<0.01, 95% CI 0.29-0.71). CONCLUSIONS: All three indexes were reproducible and responsive. However, the PCCI gave better statistical results. This index may be useful in functional diagnosis and follow-up of rehabilitation.

Validity of heart rate indexes to assess wheeling efficiency in patients with spinal cord injuries.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: To validate heart rate (HR) indexes for the evaluation of energy expenditure during wheelchair propulsion in people with spinal cord injury (SCI). SETTING: SARAH Rehabilitation Hospital Network-Brasilia, Brazil. METHODS: Forty-eight men aged 29.0±7.8 years with a SCI between C6 and L3 causing complete motor impairment were enrolled in the study. The assessment consisted of 5 min of rest while seated in the wheelchair, followed by 5 min of wheelchair propulsion at a self-selected comfortable speed. The main outcomes measured were oxygen consumption, HR, physiological cost index (PCI), total heart beat index (THBI) and propulsion cardiac cost index (PCCI). RESULTS: Using oxygen uptake as gold standard, the highest correlations were found between this and PCCI (r=0.59, P<0.001, 95% confidence interval (CI) 0.36-0.75) and THBI (r=0.58, P<0.001, 95% CI 0.36-74.0), independently of the injury level. The PCI had the lowest correlation coefficient (r=0.38, P<0.01, 95% CI 0.11-0.60). Spearman correlation analysis showed that the indexes mostly associated with lesion level were PCCI (ρ=-0.531; P<0.001; 95% CI -0.708 to -0.291) and THBI (ρ=-0.524; P<0.001; 95% CI -0.704 to -0.282). CONCLUSIONS: Both THBI and PCCI seem to be valid measures for assessing energy expenditure. Both indexes showed a coherent correlation with the spinal injury level.

Desempenho de vacas Girolando mantidas em pastejo de Tifton 85 irrigado ou sequeiro / Performance of crossbred Holstein x Zebu cows rotationally grazing in Tifton 85 pasture irrigated or rainfed

Objetivou-se com este trabalho avaliar a taxa de lotação e a produção de leite de vacas mestiças Holandês x Zebu em pastagens de Tifton 85 irrigadas e em sequeiro, em Uberaba-MG. Os dados foram analisados em um delineamento de blocos inteiramente ao acaso, com três repetições por tratamento, num esquema fatorial 2x10 (dois tratamentos e 10 épocas). Foi utilizado um lote de 11 vacas em lactação por tratamento para avaliação do desempenho animal. As médias foram comparadas por meio do teste de Scott-Knott ao nível de 5% de probabilidade (P<0,05). A pastagem foi manejada em sistema de pastejo rotacionado com três e cinco dias de ocupação e 21 e 35 dias de descanso no período das águas e da seca, respectivamente. A taxa de lotação média do sistema irrigado, no período avaliado, foi de 4,6 UA.ha-1, valor superior (P<0,05) à taxa média de 2,2 UA.ha-1 observada para o sistema de sequeiro. Não houve diferenças nas produções diárias de leite das vacas (P<0,05). A produção de leite média obtida no sistema irrigado foi de 51,7 litros. ha-1.dia-1. A irrigação possibilitou uma considerável intensificação do sistema, na medida em que proporcionou uma taxa de lotação bastante superior ao sistema de sequeiro.

The aim of this study was to determine the stocking rates and milk production of crossbred Holstein x Zebu cows managed under irrigated or rainfed Tifton 85 pastures in Uberaba- MG. The statistical design adopted was completely randomized blocks with three repetitions per treatment, in a 2 x 10 factorial arrangement (2 treatments and 10 seasons). The average was compared using the Scott-Knott test with 5% probability (P<0.05). To evaluate animal performance, 11 lactating cows per treatment were used. The pasture was managed in a rotational grazing system with 21 and 35 days of grazing interval and 3 and 5 days of grazing in each paddock, in the rainy and dry seasons respectively. The stocking rate of the irrigated system was 4.6 UA.ha-1 and was superior (p<0.05) to the stocking rate of the rainfed system that was 2.2 UA.ha-1. There were no differences among the systems (p>0.05) for the average daily milk yield of the cows. In the irrigated system the average milk yield was 51.7 liters.ha-1.dia-1. With irrigation, a considerable intensification of the system was possible because it provided a superior stocking rate capacity compared to the rainfed system.

Determination of normative values for 20 min exercise of wheelchair propulsion by spinal cord injury patients.

STUDY DESIGN: This was a retrospective observational study. OBJECTIVE: The objective was to determine the normative values for 20 min exercise of wheelchair propulsion in spinal cord injury (SCI) subjects. SETTING: Sarah Rehabilitation Hospitals Network, Brazil. METHODS: A total of 413 medical records for SCI patients at different levels and classifications at the Sarah Rehabilitation Hospitals Network, Brazil, who performed 20 min exercise in a rehabilitation programme between the years 2004 and 2009 were consulted. Information regarding patient and performance characteristics was obtained, including distance travelled, mean velocity, rest and exercising heart rate and perceived exertion. The data were analysed by gender and by injury level group: tetraplegia (TT) or paraplegia (PP). RESULTS: The participants' ages ranged from 18 to 64 years, and the median time since injury was 1.2 years. The men and women had different performances regardless of their level of injury. The distance ranged between 495 and 2106 m for men and between 300 and 1901 m for women. The mean velocity of propulsion ranged from 25 to 105 m min(-1) for men and from 15 to 95 m min(-1) for women. CONCLUSIONS: This study provides normative data for the 20 min exercise that could be used to estimate the resistance capacity by manual wheelchair users with SCI and evaluate the effects of training and other therapeutic interventions.

Pulmonary arterial hypertension: an imaging review comparing MR pulmonary angiography and perfusion with multidetector CT angiography.

Pulmonary hypertension (PH) is a progressive disease that leads to substantial morbidity and eventual death. Pulmonary multidetector CT angiography (MDCTA), pulmonary MR angiography (MRA) and MR-derived pulmonary perfusion (MRPP) imaging are non-invasive imaging techniques for the differential diagnosis of PH. MDCTA is considered the gold standard for the diagnosis of pulmonary embolism, one of the most common causes of PH. MRA and MRPP are promising techniques that do not require the use of ionising radiation or iodinated contrast material, and can be useful for patients for whom such material cannot be used. This review compares the imaging aspects of pulmonary MRA and 64-row MDCTA in patients with chronic thromboembolic or idiopathic PH.

Occupational therapy in spinocerebellar ataxia type 3: an open-label trial

Occupational therapy (OT) is a profession concerned with promoting health and well-being through occupation, by enabling handicapped people to participate in the activities of everyday life. OT is part of the clinical rehabilitation of progressive genetic neurodegenerative diseases such as spinocerebellar ataxias; however, its effects have never been determined in these diseases. Our aim was to investigate the effect of OT on both physical disabilities and depressive symptoms of spinocerebellar ataxia type 3 (SCA3) patients. Genomically diagnosed SCA3 patients older than 18 years were invited to participate in the study. Disability, as evaluated by functional independence measurement and Barthel incapacitation score, Hamilton Rating Scale for Depression, and World Health Organization Quality of Life questionnaire (WHOQOL-BREF), was determined at baseline and after 3 and 6 months of treatment. Twenty-six patients agreed to participate in the study. All were treated because OT prevents blinding of a control group. Fifteen sessions of rehabilitative OT were applied over a period of 6 months. Difficult access to food, clothing, personal hygiene, and leisure were some of the main disabilities focused by these patients. After this treatment, disability scores and quality of life were stable, and the Hamilton scores for depression improved. Since no medication was started up to 6 months before or during OT, this improvement was related to our intervention. No association was found between these endpoints and a CAG tract of the MJD1 gene (CAGn), age, age of onset, or neurological scores at baseline (Spearman test). Although the possibly temporary stabilization of the downhill disabilities as an effect of OT remains to be established, its clear effect on depressive symptoms confirms the recommendation of OT to any patient with SCA3 or spinocerebellar ataxia.

Occupational therapy in spinocerebellar ataxia type 3: an open-label trial.

Occupational therapy (OT) is a profession concerned with promoting health and well-being through occupation, by enabling handicapped people to participate in the activities of everyday life. OT is part of the clinical rehabilitation of progressive genetic neurodegenerative diseases such as spinocerebellar ataxias; however, its effects have never been determined in these diseases. Our aim was to investigate the effect of OT on both physical disabilities and depressive symptoms of spinocerebellar ataxia type 3 (SCA3) patients. Genomically diagnosed SCA3 patients older than 18 years were invited to participate in the study. Disability, as evaluated by functional independence measurement and Barthel incapacitation score, Hamilton Rating Scale for Depression, and World Health Organization Quality of Life questionnaire (WHOQOL-BREF), was determined at baseline and after 3 and 6 months of treatment. Twenty-six patients agreed to participate in the study. All were treated because OT prevents blinding of a control group. Fifteen sessions of rehabilitative OT were applied over a period of 6 months. Difficult access to food, clothing, personal hygiene, and leisure were some of the main disabilities focused by these patients. After this treatment, disability scores and quality of life were stable, and the Hamilton scores for depression improved. Since no medication was started up to 6 months before or during OT, this improvement was related to our intervention. No association was found between these endpoints and a CAG tract of the MJD1 gene (CAGn), age, age of onset, or neurological scores at baseline (Spearman test). Although the possibly temporary stabilization of the downhill disabilities as an effect of OT remains to be established, its clear effect on depressive symptoms confirms the recommendation of OT to any patient with SCA3 or spinocerebellar ataxia.

Myocardial delayed enhancement in patients with pulmonary hypertension and right ventricular failure: evaluation by cardiac MRI.

In this study, we evaluated patients with pulmonary arterial hypertension (PAH) and impaired right ventricular function. We used cardiac MRI for the detection of myocardial delayed enhancement (MDE) and its possible association with other clinical variables. 20 patients (6 males and 14 females, aged 44.5+/-11 years; 15 New York Heart Association class III, 5 class IV) with known PAH (13 idiopathic, 7 resulting from chronic pulmonary embolism) were evaluated for the detection of MDE. Short-axis cine images of the heart were made for ventricular function assessment using a steady-state free precession sequence. For MDE evaluation, a short-axis phase-sensitive inversion recovery sequence was performed 10 min after intravenous administration of 0.2 mmol kg(-1) gadodiamide. Right ventricle (RV) systolic dysfunction, RV enlargement and RV hypertrophy were present in 20 patients (RV ejection fraction, 21.5+/-7.2%; RV diastolic diameter, 5.97+/-0.79 cm; RV wall thickness, 0.73+/-0.10 cm). 13 of the 20 patients (65%) were positive for MDE (10 anterior, 12 inferior). All 13 positive patients with MDE demonstrated small hyperintense areas at the insertion points of the RV free wall in the interventricular septum. We found no significant correlation between MDE and ejection fraction or other haemodynamic variables. In this study, MDE correlated positively only with the duration of disease. We found that septal MDE can be present in patients with PAH and impaired ventricular function. However, further studies are necessary to investigate this possible association and its prognostic implication.

Case report. Isolated left ventricular myocardium non-compaction: MR imaging findings from three cases.

The purpose of this study is to report three cases of left ventricular myocardium non-compaction (LVNC), with emphasis on the MRI findings. From May 2006 to February 2007, three patients -- 2 females (6 years and 42 years of age) and 1 male (18 years of age) -- presented to our radiology department, two of them with fatigue, shortness of breath and episodes of syncope and arrhythmia, for further investigation by cardiac MRI because an apparent asymmetrical pattern of hypertrophy of the left ventricular myocardium was suspected by transthoracic echocardiography. The 18-year-old patient was only experiencing arrhythmia, and arrhythmogenic right ventricular dysplasia was suspected. The images (produced by a 1.5T MRI system) were interpreted by two experienced radiologists and post-processed with Argus software (Siemens, Germany) for ejection fraction calculation. In all three patients, MRI aided in the correct identification of prominent ventricular myocardial trabeculations and deep intertrabecular recesses communicating with the ventricular cavity, as well as areas of hypokinesia with depressed systolic function, and showed the absence of myocardial delayed enhancement and other structural heart defects. In conclusion, cardiac MRI was useful for correctly identifying this rare congenital heart disorder and appears to increase diagnostic accuracy. Although considered a rare anomaly, radiologists should be capable of recognizing LVNC, as current non-invasive imaging methods have increased the frequency of this diagnosis and timely detection is vital in considering early-stage transplantation.

Infra-renal abdominal aorta agenesis: a case report with emphasis on MR angiography findings.

The purpose of this study is to report a case of infra-renal aorta agenesis with emphasis on the MR angiography (MRA) findings. A 66-year-old woman presented with urinary complaints. Pelvic and abdominal ultrasound showed hydronephrosis secondary to ureteral lithiasis; the distal portion of the abdominal aorta was not identified. Abdominal CT showed that the infra-renal portion of the abdominal aorta was apparently absent. MRI and MRA demonstrated that, after the origin of the renal arteries, the abdominal aorta spontaneously terminated in two lumbar hypertrophic arteries. In addition, MRA showed a dilated superior mesenteric artery that formed a vascular loop, which continued posterior and inferiorly towards the posterior pelvic region. In this region, it bifurcated and formed internal iliac branches, which were responsible for the arterial supply of the pelvis. In conclusion, MRA allows for precise evaluation of patients with infra-renal abdominal aorta agenesis. Although it is a rare entity, radiologists should be able to recognize it in ultrasound, CT and MRI studies.