Probiotic supplementation for 24 weeks in patients with non-alcoholic steatohepatitis: the PROBILIVER randomized clinical trial.

Background and aim: Considering the increasing prevalence of non-alcoholic steatohepatitis (NASH) and treatment gaps, this study aimed to evaluate the effect of probiotic supplementation on liver function markers, nutritional status, and clinical parameters. Methods: This double-blind, randomized clinical trial (ClinicalTrials.gov ID: NCT0346782) included adult outpatients with biopsy-proven NASH. The intervention consisted of 24 weeks of supplementation with the probiotic mix Lactobacillus acidophilus (1 × 109 CFU) + Lactobacillus rhamnosus (1 × 109 CFU) + Lactobacillus paracasei (1 × 109 CFU) + Bifidobacterium lactis (1 × 109 CFU), or placebo, twice a day. The following parameters were evaluated: demographic and clinical data, transient elastography (FibroScan), liver enzymes, NAFLD fibrosis score, fatty liver index, laboratory assessment, serum concentration of toll-like receptor-4 (sTLR-4) and cytokeratin 18 (CK-18), anthropometric data, dietary intake, and physical activity. Regarding data analysis, the comparison between the groups was based on the delta of the difference of each variable analyzed (value at the end of treatment minus the baseline value) using the t-test for independent samples or the Mann-Whitney U-test. Results: Forty-four patients with NASH completed the trial (51.4 ± 11.6 years). At baseline, 87% of participants had a mild liver fibrosis degree on biopsy, normal values of liver enzymes, transient elastography values consistent with grade 1 fibrosis in both groups, increased waist circumference (WC), a BMI of 30.97 kg/m2, and 76% presented with metabolic syndrome (MetS). After the intervention, no differences were observed between the probiotic and placebo groups in terms of MetS, WC, BMI scores, or liver enzyme levels (p > 0.05 for all). The elastography values remained consistent with grade 1 fibrosis in both groups. Although CK-18 was reduced in both groups, a larger effect size was noted in the probiotic group (D = 1.336). sTLR-4 was also reduced in both groups, with no difference between groups (p = 0.885). Conclusion: Intervention with probiotics in the early stages of NASH demonstrated no significant change in hepatic and clinical parameters. Clinical trial registration: ClinicalTrials.gov, identifier NCT0346782.

Predictors of genetic diagnosis in individuals with developmental and epileptic encephalopathies.

OBJECTIVE: To evaluate the clinical predictors of positive genetic investigation in developmental and epileptic encephalopathies, beyond the influence of Dravet Syndrome. METHODS: The study included 98 patients diagnosed with developmental and epileptic encephalopathies. The patients underwent Sanger sequencing of SCN1A, Chromosomal Microarray Analysis, and Whole Exome Sequencing. The association of clinical variables with a positive genetic test was investigated using univariate and multivariate analysis. RESULTS: Genetic diagnosis was identified in 47 (48 %) patients with developmental and epileptic encephalopathies. Beyond Dravet Syndrome influence, first seizure in the context of fever (p < 0.01), seizures precipitated by temperature (p = 0.04), cognitive regression (p = 0.04), hypotonia (p < 0.01), and focal seizures (p = 0.03) increased the chances of a positive genetic investigation. In contrast, atonic seizures (p = 0.01) and generalized discharges on electroencephalogram (p = 0.02) decreased the chances. Dravet Syndrome was positively associated with a genetic developmental and epileptic encephalopathies etiology (p < 0.01), whereas epilepsy with myoclonic-atonic seizures (p = 0.01), developmental and epileptic encephalopathies with spike-wave activation in sleep (p = 0.04), and Lennox-Gastaut syndrome (p = 0.03) were negatively associated. In multivariate analysis, the first seizure in the context of fever (p < 0.01) and hypotonia (p = 0.02) were positively, and atonic seizures (p = 0.01) were negatively and independently associated with a genetic etiology. CONCLUSION: The predictive variables of genetic investigation in developmental and epileptic encephalopathies are first seizure in the context of fever and hypotonia, whereas atonic seizures decrease the chances of finding a genetic cause for developmental and epileptic encephalopathies. Regarding epileptic syndromes, Dravet Syndrome is highly associated with a positive genetic test, whereas epilepsy with myoclonic-atonic seizures, developmental and epileptic encephalopathies with spike-wave activation in sleep, and Lennox-Gastaut syndrome are rarely associated with a positive genetic investigation.

Oral 24-week probiotics supplementation did not decrease cardiovascular risk markers in patients with biopsy proven NASH: A double-blind placebo-controlled randomized study.

INTRODUCTION AND OBJECTIVES: Cardiovascular disease (CVD) is the major cause of death in non-alcoholic fatty liver disease (NAFLD), a clinical condition without any approved pharmacological therapy. Probiotics are often indicated for the disease, but their results are controversial in part due to the poor quality of studies. Thus, we investigated the impact of 24-week probiotics supplementation on cardiovascular risk (CVR) in biopsy-proven non-alcoholic steatohepatitis (NASH) patients. PATIENTS AND METHODS: Double-blind, placebo-controlled, single-center study (NCT03467282), adult NASH, randomized for 24 weeks daily sachets of probiotic mix (109CFU of Lactobacillus acidophilus, Lactobacillus rhamnosus, Lactobacillus paracasei and Bifidobacterium lactis) or placebo. Clinical scores (atherogenic indexes, atherosclerotic cardiovascular disease-ASCVD and systematic coronary risk evaluation-SCORE), biochemistry, miR-122, miR-33a, plasminogen activator inhibitor-1 (PAI-1), intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), were determined before and after the intervention. RESULTS: Forty-six patients were enrolled (23 received probiotics and 23 placebo), with a mean age of 51.7 years, most of them females and whites. Clinical and demographic features were similar between the groups at the baseline. The Median NAFLD activity score was 4.13 in both groups. Fibrosis was mild in most patients (15.2% and 65.2% F0 and F1, respectively). Treatment did not promote any clinically significant changes in body mass index or laboratory, including lipid and glucose profile. High CVR patients through atherogenic indexes decreased from baseline in both groups, as well as PAI-1 and miR-122 levels, although there was no difference between probiotics and placebo. CONCLUSIONS: A 24-week probiotic mix administration was not superior to placebo in reducing CVR markers in patients with NASH.

Cortisol Reactivity to a physical stressor in Patients with Depression and Alzheimer's disease.

Some prevalent mental disorders in the elderly, such as Alzheimer's disease (AD) and major depression disorder (MDD), are associated with chronic stress and consequently with possible dysregulation of hypothalamic-pituitary-adrenal (HPA) axis and cortisol levels in basal conditions or in the reactivity of an acute stressor. However, evidence of cortisol behavior after a physical stressor in patients with AD and MDD is scarce. Objective: This study aimed to investigate the cortisol reactivity to a single session of physical exercise in patients with MDD and AD and compare it to healthy control (HC) older individuals. Methods: HC individuals (n=10) and elderly with clinical diagnostic of MDD (n=08) and AD (n=13) were submitted to a single bout of aerobic exercise in a treadmill during 30 minutes of moderate intensity. Salivary cortisol was collected before and after acute stressor. A repeated-measure analysis of variance (ANOVA), spearman correlation, and linear regression were performed. Results: The repeated-measure ANOVA revealed no interaction for cortisol on the moment×group [F(2.000, 28.000)=1.285; p=0.293] and no effect for group (F=0.323; p=0.727). However, a significant effect for moment [F(1.000, 28.000)=4.930; p=0.035] was found, with a decreased cortisol levels in postexercise for all groups. The effect size (ES) of cortisol reduction was small for patients with MDD (d=0.402) and trivial for patients with AD (d=0.166) and HC group (d=0.090). Conclusions: All participants show a decreased cortisol reactivity to a physical stressor, which can be associated with an impairment in coping with an acute stressor.

A doença de Alzheimer (DA) e o transtorno depressivo maior (TDM) são transtornos que acometem idosos e estão associadas ao estresse crônico e à desregulação do eixo hipotálamo-hipófise-adrenal (HPA), que repercute em alterações nos níveis de cortisol (basal e reatividade). Objetivo: Investigar a reatividade do cortisol em uma única sessão de exercício físico em pacientes com TDM e com DA e compará-la com a de idosos saudáveis. Métodos: Indivíduos controle saudáveis (n=10) e idosos com diagnóstico clínico de TDM (n=08) e DA (n=13) foram submetidos a uma única sessão de exercício aeróbio em esteira rolante, durante 30 minutos, em intensidade moderada. O cortisol salivar foi coletado antes e depois do estressor agudo. Na estatística, foram realizadas as análises de variância (ANOVA) de medidas repetidas, correlação de spearman e regressão linear. Resultados: Não foi encontrada interação para momento x grupo [F (2.000, 28.000)=1.285; p=0,293] e tampouco efeito para o grupo (F=0,323; p=0,727). Todavia, foi observado efeito significativo para o momento [F(1,000, 28,000)=4,930; p=0,035], mostrando diminuição dos níveis de cortisol no pós-exercício para todos os grupos. O tamanho do efeito (TE) foi considerado pequeno para o grupo TDM (d=0,402) e trivial para o DA (d=0,166) e o saudável (d=0,090). Conclusões: Todos os participantes apresentaram diminuição da reatividade do cortisol a um estressor físico, o que pode estar associado a um comprometimento no enfrentamento de um estressor agudo.

New avenues in molecular genetics for the diagnosis and application of therapeutics to the epilepsies.

Genetic epidemiology studies have shown that most epilepsies involve some genetic cause. In addition, twin studies have helped strengthen the hypothesis that in most patients with epilepsy, a complex inheritance is involved. More recently, with the development of high-density single-nucleotide polymorphism (SNP) microarrays and next-generation sequencing (NGS) technologies, the discovery of genes related to the epilepsies has accelerated tremendously. Especially, the use of whole exome sequencing (WES) has had a considerable impact on the identification of rare genetic variants with large effect sizes, including inherited or de novo mutations in severe forms of childhood epilepsies. The identification of pathogenic variants in patients with these childhood epilepsies provides many benefits for patients and families, such as the confirmation of the genetic nature of the diseases. This process will allow for better genetic counseling, more accurate therapy decisions, and a significant positive emotional impact. However, to study the genetic component of the more common forms of epilepsy, the use of high-density SNP arrays in genome-wide association studies (GWAS) seems to be the strategy of choice. As such, researchers can identify loci containing genetic variants associated with the common forms of epilepsy. The knowledge generated over the past two decades about the effects of the mutations that cause the monogenic epilepsy is tremendous; however, the scientific community is just starting to apply this information in order to generate better target treatments.

The impact of post-alignment processing procedures on whole-exome sequencing data.

The use of post-alignment procedures has been suggested to prevent the identification of false-positives in massive DNA sequencing data. Insertions and deletions are most likely to be misinterpreted by variant calling algorithms. Using known genetic variants as references for post-processing pipelines can minimize mismatches. They allow reads to be correctly realigned and recalibrated, resulting in more parsimonious variant calling. In this work, we aim to investigate the impact of using different sets of common variants as references to facilitate variant calling from whole-exome sequencing data. We selected reference variants from common insertions and deletions available within the 1K Genomes project data and from databases from the Latin American Database of Genetic Variation (LatinGen). We used the Genome Analysis Toolkit to perform post-processing procedures like local realignment, quality recalibration procedures, and variant calling in whole exome samples. We identified an increased number of variants from the call set for all groups when no post-processing procedure was performed. We found that there was a higher concordance rate between variants called using 1K Genomes and LatinGen. Therefore, we believe that the increased number of rare variants identified in the analysis without realignment or quality recalibration indicated that they were likely false-positives.

Is Strength Training as Effective as Aerobic Training for Depression in Older Adults? A Randomized Controlled Trial.

BACKGROUND: This study aimed to compare the effects of aerobic training (AT), strength training (ST) and low-intensity exercise in a control group (CG) as adjunct treatments to pharmacotherapy for major depressive disorder (MDD) in older persons. METHODS: Older persons clinically diagnosed with MDD (n = 27) and treated with antidepressants were blindly randomized into three groups: AT, ST and a CG. All patients were evaluated prior to and 12 weeks after the intervention. RESULTS: Compared with the CG, the AT and ST groups showed significant reductions in depressive symptoms (treatment -response = 50% decrease in the pre- to postintervention assessment) through the Hamilton Depression Rating Scale (AT group: χ2, p = 0.044) and Beck Depression Inventory (ST group: χ2, p = 0.044). CONCLUSION: Adding AT or ST with moderate intensity to the usual treatment promoted a greater reduction of MDD symptoms.

Effect of probiotic supplementation in nonalcoholic steatohepatitis patients: PROBILIVER TRIAL protocol.

BACKGROUND: Recently factors in the relationship between gut microbiota, obesity, diabetes and the metabolic syndrome have been suggested in the development and progression of nonalcoholic steatohepatitis (NASH). In this sense, this work aims to evaluate the effects of probiotic supplementation on intestinal microbiota modulation, degree of hepatic steatosis and fibrosis, inflammation, gut permeability, and body composition. METHODS: This double-blind, randomized clinical trial will include adult outpatients with a diagnosis of NASH confirmed by biopsy with or without transient elastography. All patients will undergo a complete anamnesis to investigate their alcohol consumption, previous history, medications, nutritional assessment (dietary intake and body composition), sarcopenia, physical activity level and physical and functional capacity, cardiovascular risk, biochemical parameters for assessment of inflammatory status, lipid profile, hepatic function, gut permeability, and assessment of microbiota. These procedures will be performed at baseline and repeated after 24 weeks (at the end of the study). Through the process of randomization, patients will be allocated to receive treatment A or treatment B. Both patients and researchers involved will be blinded (double-blind study). The intervention consists of treatment with a probiotic mix (Lactobacillus acidophillus + Bifidobacterium lactis + Lactobacillus rhamnosus + Lactobacillus paracasei, 1 x 109 CFU for each) and the placebo which is identical in all its characteristics and packaging. Patients will be instructed to consume two sachets/day during 24 weeks and to report any symptoms or side effects related to the use of the sachets. Adherence control will be carried out through the patient's notes on a form provided, and also by checking the number of sachets used. DISCUSSION: The final results of study will be analyzed and disseminated in 2020. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03467282 . Registered on 15 March 2018.

Hospital-acquired intestinal toxemia botulism in a newly diagnosed adult colon cancer patient.

This manuscript reports a case of intestinal toxemia botulism in an adult with recently diagnosed metastatic colon cancer in whom botulism symptoms began 23 days after hospital admission. Representing the rarest form of botulism presentation in clinical practice, this infectious disease may have developed due to a cluster of predisposing factors that favored Clostridium botulinum colonization and the endogenous production of neurotoxins, among which are previous use of broad-spectrum antibiotics and colon changes related to the development of the neoplasia. This case highlights the importance of considering intestinal toxemia botulism in the differential diagnosis of a patient presenting with symmetrical descending flaccid paralysis, since immediate treatment with botulinum antitoxin may improve clinical outcomes.

Can physical exercise modulate cortisol level in subjects with depression? A systematic review and meta-analysis.

INTRODUCTION: Major depressive disorder (MDD) is a prevalent medical illness that is associated with chronic stress. Patients with MDD can show an imbalance in cortisol levels, which can be restored with the remission of symptoms. Physical exercise training has been used as a tool to promote changes in cortisol levels in healthy individuals. However, it is unknown if exercise can produce the same results in individuals with MDD. OBJECTIVE: To review evidence of cortisol changes after exercise training in individuals with MDD. METHODS: We conducted a search on PubMed, SciELO, LILACS, ISI Web of Knowledge, Scopus, and PsycInfo databases. Random effects meta-analysis was performed and standardized mean difference (SMD) effect size was calculated. Analyses of forest and funnel plots was conducted using Stata v.11.0 software. RESULTS: At first, 463 studies were obtained in the search. After completion of the selection procedure, five articles with seven analyses were included. Type of exercise, frequency of training, cortisol measurement, and type of control group were analyzed. There was a reduction of cortisol levels in the exercise group (SMD = -0.65, 95%CI 1.30-0.01). Moreover, sensitivity analysis and subgroup analyses revealed an effect of type (aerobic exercise) and frequency (five times per week) of exercise on reduction of cortisol levels. However, these results should be interpreted cautiously due to the small number of studies and a substantial heterogeneity among them. CONCLUSION: Physical exercise promotes a reduction in cortisol levels in individuals with MDD. However, this finding can be influenced by type of exercise, weekly frequency, and type of cortisol measurement.

Can physical exercise modulate cortisol level in subjects with depression? A systematic review and meta-analysis / O exercício físico pode modular os níveis de cortisol em indivíduos com depressão? Uma revisão sistemática e metanálise

Abstract Introduction: Major depressive disorder (MDD) is a prevalent medical illness that is associated with chronic stress. Patients with MDD can show an imbalance in cortisol levels, which can be restored with the remission of symptoms. Physical exercise training has been used as a tool to promote changes in cortisol levels in healthy individuals. However, it is unknown if exercise can produce the same results in individuals with MDD. Objective: To review evidence of cortisol changes after exercise training in individuals with MDD. Methods: We conducted a search on PubMed, SciELO, LILACS, ISI Web of Knowledge, Scopus, and PsycInfo databases. Random effects meta-analysis was performed and standardized mean difference (SMD) effect size was calculated. Analyses of forest and funnel plots was conducted using Stata v.11.0 software. Results: At first, 463 studies were obtained in the search. After completion of the selection procedure, five articles with seven analyses were included. Type of exercise, frequency of training, cortisol measurement, and type of control group were analyzed. There was a reduction of cortisol levels in the exercise group (SMD = −0.65, 95%CI 1.30-0.01). Moreover, sensitivity analysis and subgroup analyses revealed an effect of type (aerobic exercise) and frequency (five times per week) of exercise on reduction of cortisol levels. However, these results should be interpreted cautiously due to the small number of studies and a substantial heterogeneity among them. Conclusion: Physical exercise promotes a reduction in cortisol levels in individuals with MDD. However, this finding can be influenced by type of exercise, weekly frequency, and type of cortisol measurement.

Resumo Introdução: A depressão maior (DM) é uma doença associada ao estresse crônico que pode apresentar um desequilíbrio nos níveis de cortisol, podendo ser recuperado com a remissão dos sintomas. O exercício tem sido utilizado como uma ferramenta para promover mudanças nos níveis de cortisol em indivíduos saudáveis. No entanto, não se sabe se o exercício produz os mesmos resultados em indivíduos com DM. Objetivo: Revisar evidências de alterações dos níveis de cortisol após o exercício em indivíduos com DM. Métodos: Foi realizada busca nas bases de dados PubMed, SciELO, LILACS, ISI Web of Knowledge, Scopus e PsycInfo. Procedeu-se a metanálise com o cálculo do tamanho do efeito da diferença de média padronizada. Foi utilizado o software Stata v.11.0. Resultados: Foram obtidos na busca 463 estudos. Após o procedimento de seleção, cinco artigos com sete análises foram incluídos. O tipo de exercício, frequência de treinamento, tipo de medida do cortisol e tipo de grupo controle foram analisados como subgrupos. Houve uma redução dos níveis de cortisol no grupo de exercício. Além disso, a análise de sensibilidade e análises de subgrupos revelaram um efeito do tipo (exercício aeróbico) e da frequência (cinco vezes por semana) de exercício na redução dos níveis de cortisol. No entanto, esses resultados devem ser interpretados com cautela, devido ao pequeno número de estudos e uma heterogeneidade substancial entre eles. Conclusão: O exercício promove redução dos níveis de cortisol em indivíduos com DM. No entanto, esse achado pode ser influenciado pelo tipo de exercício, medida do cortisol e frequência semanal.

Heart Rate Variability Indexes in Dementia: A Systematic Review with a Quantitative Analysis.

BACKGROUND: Decreased heart rate variability (HRV) indexes indicate low vagal activity and may be associated with development of dementia. The neurodegenerative process is associated with the cardiovascular autonomic control. OBJECTIVE: The aim of this systematic review was to investigate the effect size (ES) magnitude of the HRV indexes in the evaluation of autonomic dysfunction in older persons with dementia. METHODS: PubMed (Medline), Web of Science, Scopus, Scielo, Lilacs, and APA Psycnet were consulted. Complete original articles published in English or Portuguese, investigating the association between autonomic dysfunction and dementia, using the HRV indexes were included. RESULTS: The search identified 97 potentially relevant articles. After screening the full text, eight articles were included in the qualitative analysis and six were included in the quantitative analysis. Almost all indexes showed a negative ES for all types of dementia and mild cognitive impairment. The most common frequency band of the power spectrum density function was the high frequency, which was reported by six studies. The meta-analysis of high frequency power in Alzheimer's disease group showed high heterogeneity and inconsistent results. CONCLUSION: The negative effect size suggests an autonomic dysfunction in all types of dementia as well as mild cognitive impairment. However, further analysis is necessary to support these results.

Cortisol, DHEA, and depression in the elderly: the influence of physical capacity.

OBJECTIVE: Major depression have been associated with cortisol and dehydroepiandrosterone (DHEA) changes in old depressed patients. We examined the association between depression, cortisol, and DHEA, correcting for confounding variables, including physical capacity. In addition, the association between hormone levels and physical capacity in these two experimental groups was also analyzed. METHOD: Depressed patients (n = 32) and healthy control (n = 31) old adults, both matched for age, were analyzed. Subjects were submitted to a physical capacity evaluation, including physical activity levels, functional fitness test, and balance scale. RESULTS: Depressed patients showed significant lower levels of cortisol than controls, which became non-significant after controlling for physical capacity. A positive correlation was observed between cortisol levels and physical capacity. CONCLUSIONS: The data suggest that physical capacity modulates the relationship between depression and cortisol levels and needs to be taken into consideration in the future investigations.

Cortisol, DHEA, and depression in the elderly: the influence of physical capacity / Cortisol, DHEA e a depressão no idoso: a influência da capacidade física

ABSTRACT Objective Major depression have been associated with cortisol and dehydroepiandrosterone (DHEA) changes in old depressed patients. We examined the association between depression, cortisol, and DHEA, correcting for confounding variables, including physical capacity. In addition, the association between hormone levels and physical capacity in these two experimental groups was also analyzed. Method Depressed patients (n = 32) and healthy control (n = 31) old adults, both matched for age, were analyzed. Subjects were submitted to a physical capacity evaluation, including physical activity levels, functional fitness test, and balance scale. Results Depressed patients showed significant lower levels of cortisol than controls, which became non-significant after controlling for physical capacity. A positive correlation was observed between cortisol levels and physical capacity. Conclusions The data suggest that physical capacity modulates the relationship between depression and cortisol levels and needs to be taken into consideration in the future investigations.

RESUMO Objetivo A depressão maior tem sido associada a alterações nos níveis de cortisol e dehidroepiandrosterona (DHEA) em pacientes idosos depressivos. O presente estudo objetivou investigar a associação entre depressão, cortisol e DHEA, corrigindo por variáveis intervenientes, incluindo a capacidade física. Além disso, a associação entre os níveis hormonais e a capacidade física nos dois grupos experimentais também foi analisada. Método Pacientes idosos depressivos (n = 32) e idosos controles saudáveis (n = 31), pareados pela idade foram analisados. Os sujeitos foram submetidos a uma avaliação da capacidade física, incluindo níveis de atividade física, testes de capacidade funcional e escalas de equilíbrio. Resultados Os pacientes depressivos mostraram níveis significativamente menores de cortisol, os quais tornaram-se não significantes após controlados pela capacidade física. Uma correlação positiva foi observada entre os níveis de cortisol e a capacidade física. Resultados não significativos foram observados para DHEA, possivelmente devido a inclusão de pacientes depressivos e uma única coleta de amostra. Conclusão Os dados sugerem que a capacidade física modula a relação entre depressão e os níveis de cortisol e deve ser considerada em futuras investigações.

Assessing cardiorespiratory capacity in older adults with major depression and Alzheimer disease / Avaliação da capacidade cardiorrespiratória em idosos com depressão maior e doença de Alzheimer

ABSTRACT Objective To assess cardiorespiratory capacity through subjective and objective tests in older adults diagnosed with major depression (MDD), Alzheimer disease (AD) and healthy older adults. Methods Fifty seven subjects (72 ± 7.9 years) were divided into three groups: MDD (n = 20), AD (n = 17) and Healthy (n = 20). The subjects answered Hamilton Scale (HAM-D), Mini-Mental State Examination (MMSE), Veterans Specific Activity Questionnaire (VSAQ) and 2-minute Step test. Results MDD and AD showed lower scores than healthy group for Nomogram VSAQ (p < 0.001) and 2-minute Step (p = 0.009; p = 0.008, respectively). Adjusted for age and educational level, no differences among groups were observed for Step (MDD, p = 0.097; AD, p = 0.102). AD group did not present differences to healthy group for Step, when adjusting for MMSE (p = 0.261). Conclusions Despite the lower cardiorespiratory fitness of elderly patients with DM and DA have been found in both evaluations, the results should be viewed with caution, since the tests showed low correlation and different risk classifications of functional loss. In addition, age, level educational and cognitive performance are variables that can influence the performance objective evaluation.

RESUMO Objetivo Avaliar a capacidade cardiorrespiratória em idosos com depressão maior (DM), doença de Alzheimer (DA) e saudáveis, subjetiva (nomograma VSAQ) e objetivamente (2-minute STEP). Métodos Cinquenta e sete idosos (72 ± 7,9 anos) foram divididos em três grupos: DM (n = 20), DA (n = 17) e saudáveis (n = 20). Os sujeitos responderam a escala de Hamilton (HAM-D), Miniexame do Estado Mental (MEEM), VSAQ (Veterans Specific Activity Questionnaire) e o teste 2-minute Step. Resultados DM e DA apresentaram menores escores comparados aos saudáveis no nomograma VSAQ (p < 0,001) e no teste Step (p = 0,009 e p = 0,008). Controlado por idade e escolaridade, não houve diferenças entre os grupos no Step (DM, p = 0,097; DA, p = 0,102). DA também não mostrou diferenças no STEP em comparação aos saudáveis, quando controlado pelo MEEM (p = 0,261). Conclusões Apesar de a menor aptidão cardiorrespiratória de idosos com DM e DA ter sido encontrada nas duas avaliações, os resultados devem ser observados com cautela, uma vez que os testes apresentaram baixa correlação e classificações de risco de perda funcional divergentes. Além disso, a idade, o nível educacional e a capacidade cognitiva são variáveis que podem influenciar o desempenho na avaliação objetiva.

CARGA INTERNA DE TREINAMENTO E RESPOSTAS COMPORTAMENTAIS EM JOVENS GINASTAS / INTERNAL TRAINING LOAD AND BEHAVIORAL RESPONSES IN YOUNG GYMNASTS

Objetivo deste estudo foi investigar a dinâmica da CIT (via método da PSE da sessão), da tolerância ao estresse (TE para fontes e sintomas; questionário DALDA) e dos sintomas de infecção do trato respiratório superior (ITRS; questionário WURSS-21) em 28 jovens ginastas (10,7 ± 1,3 anos), durante 8 semanas. Observou-se maior CIT (p< 0,001), menor TE (fontes, p=0,032) para o período com competição comparado ao período de treinamento sem competição; foram observadas correlações significantes (0,41-0,58) entre a CIT, TE e ITRS. Em conclusão, o aumento da CIT foi acompanhado pela redução da TE no período com competição, sugerindo maiores cargas de treinamento com a aproximação e realização de competições, comprometendo a TE. Esses resultados sugerem a importância de um monitoramento apropriado da CIT e TE e da correta manipulação das cargas de treinamento na ginástica, para minimizar os efeitos e respostas adaptativas negativas do treinamento, particularmente durante períodos com competição.

The aim of this study was to investigate the dynamics of ITL (by session-RPE method), stress tolerance (ST for sources and symptoms; DALDA questionnaire) and symptoms of upper respiratory tract infection (URTI; WURSS-21 questionnaire) in 28 young gymnasts (10.7 ± 1.3 years) for 8 weeks. A higher ITL (p < 0.001), lower ST (sources, p = 0.032) were observed for the competition period in comparison with training period without competition; significant correlations (p <0.05; 0.41 to 0.58) between the ITL, ST and URTI were observed . In conclusion, the increase in ITL was accompanied by a reduction in ST for the competition period, suggesting that a higher training load when approaching to competitions would compromise the ST. These results suggest the importance of an appropriate ITL and ST monitoring in order to minimize the chances of undesirable negative adaptive responses, particularly during periods of competition.

Doença de Alzheimer: novas diretrizes para o diagnóstico / Alzheimer?s disease: new guidelines for diagnosis

Durante 27 anos, o diagnóstico clínico da doença de Alzheimer foi baseado nos critérios feitos, em 1984, pela National Institute of Neurological and Communicative Disorders and Strokes (NINCDS) e pelo Alzheimer?s Disease and Related Disorders Association (ADRDA). Contudo, com o passar dos anos, os avanços científicos permitiram melhor compreensão da sua fisiopatologia, bem como melhor entendimento sobre as outras formas de demência - que culminaram na necessidade de revisão dos antigos critérios. Por isso, em 2011 foram publicados quatro artigos com novas recomendações da NINCDS-ADRDA. As principais mudanças nas novas diretrizes envolvem a identificaçãode estágios não demenciais para doença e a incorporação dos biomarcadores.

For 27 years, the clinical diagnosis of Alzheimer?s disease was based on the criteria established in 1984 by the National Institute of Neurological and Communicative Disorders and Strokes (NINCDS) and the Alzheimer?s Disease and Related Disorders Association (ADRDA). However, over the years, scientific advances allowed a better understanding of its pathophysiology as well as about other forms of dementia - culminating in the need for a revision of the old criteria. Thus, in 2011, four articles with new recommendations from the NINCDS-ADRDA were published. The main changes in the new guidelines involve the identification of non-dementia stages for disease and incorporation of biomarkers.

Does Testosterone Modulate Mood States and Physical Performance in Young Basketball Players?

This study aimed to examine and compare mood states profile and physical performance during different training phases between 2 groups of adolescent basketball players that were differentiated according to baseline testosterone concentration (T). The basketball players were submitted to an intensified training period (OVL) followed by a tapering period (TP). Twenty-three young male basketball players initiated the study. Experimental criteria data were used to stratify 16 players into high-testosterone (HTC) or low-testosterone (LTC) concentration groups. All the 16 athletes undertook 5 weeks of OVL followed by a 3-week TP. Saliva sampling, Yo-Yo intermittent recovery level 1 (Yo-Yo IRL1) test and the T-test were conducted at the beginning (T1), after OVL (T2), and after TP (T3). A similar increase in internal training load was observed during OVL when compared with TP in both groups (p < 0.05). No difference in mood states was observed between groups (p > 0.05); however, LTC displayed a higher score for fatigue (p < 0.05) and a lower score for energy index (p < 0.05) in OVL, compared with TP. A significant improvement in the Yo-Yo IRL1 test and the T-test was observed (T1 to T3) (p < 0.05), with no difference between groups (p > 0.05). In conclusion, these results suggest that LTC athletes may be more susceptible to changes in mood states during intensified training periods. In addition, data indicate that a periodized training program successfully improved the physical performance (endurance and agility) of young basketball players; however, this improvement was not affected by testosterone level.

Impaired cognition in depression and Alzheimer (AD): a gradient from depression to depression in AD.

OBJECTIVE: To assess cognition in major depressed (MD), Alzheimer's disease (AD), and depression in AD elderly. METHOD: Subjects were evaluated by Mini Mental, Rey Auditory Verbal Learning Test, Rey Complex Figure, Digit Span, Similarities, Trail Making A/B, Verbal Fluency and Stroop. One-way ANOVA and multivariate models were used to compare the performance of each group on neuropsychological tests. RESULTS: We evaluated 212 subjects. Compared to MD, attention, working memory, processing speed and recall showed significantly better in controls. Controls showed significantly higher performance in all cognitive measures, except in attention compared to AD. Verbal fluency, memory, processing speed and abstract reasoning in MD was significantly higher compared to AD. AD was significantly better in general cognitive state than depression in AD. All other cognitive domains were similar. CONCLUSION: A decreasing gradient in cognition appeared from the control to depression in AD, with MD and AD in an intermediate position.

Impact of physical exercise on quality of life of older adults with depression or Alzheimer's disease: a systematic review / O impacto do exercício físico na qualidade de vida de idosos com depressão ou com doença de Alzheimer: uma revisão sistemática

INTRODUCTION: Physical exercise has been associated with improvement of quality of live (QoL), but its effect among the elderly with depression and Alzheimer's disease (AD) is still unclear. This systematic review evaluated randomized and controlled studies about the effect of physical exercise on QoL of older individuals with a clinical diagnosis of depression and AD. METHODS: We searched PubMed, ISI, SciELO and Scopus from December 2011 to June 2013 using the following keywords: physical exercise, quality of life, elderly, depression, Alzheimer's disease. Only six studies met inclusion criteria: two examined patients with AD and four, patients with depression. RESULTS: The studies used different methods to prescribe exercise and evaluate QoL, but all had high quality methods. Findings of most studies with individuals with depression suggested that exercise training improved QoL, but studies with patients with AD had divergent results. CONCLUSIONS: Although different methods were used, results suggested that physical exercise is an effective non-pharmacological intervention to improve the QoL of elderly individuals with depression and AD. Future studies should investigate the effect of other factors, such as the use of specific scales for the elderly, controlled exercise prescriptions and type of control groups (AU)

INTRODUÇÃO: O exercício físico parece estar relacionado à melhora na qualidade de vida (QdV), mas seus efeitos em populações de indivíduos idosos com depressão ou Doença de Alzheimer (DA) ainda não foram estabelecidos. Esta revisão sistemática avaliou estudos controlados randomizados sobre os efeitos do exercício físico sobre a QdV em idosos com diagnóstico clínico de depressão e DA. MÉTODOS: Foi feita uma busca nas bases de dados PubMed, ISI, SciELO e Scopus de dezembro de 2011 a junho de 2013 usando os seguintes descritores: exercício físico, qualidade de vida, idosos, depressão, doença de Alzheimer. Apenas seis estudos satisfizeram os critérios de inclusão: Dois com pacientes com DA e quatro com pacientes com depressão. RESULTADOS: Os estudos adotaram metodologias diferentes de prescrição de exercícios e avaliação de QdV, mas todos preencheram os requisitos de alta qualidade metodológica. Os resultados da maioria dos estudos com idosos com depressão sugerem que a QdV melhora com o treinamento físico, mas os estudos com pacientes com DA tiveram resultados divergentes. CONCLUSÕES: Apesar de os estudos usarem metodologias diferentes, seus resultados sugerem que os exercícios físicos são uma intervenção não-farmacológica efetiva para melhorar a QdV entre idosos com depressão e DA. Estudos futuros devem investigar os efeitos de outros fatores, tais como o uso de questionários específicos para idosos, a prescrição controlada de exercícios, e o tipo de grupo controle (AU)