Acute effects of whole-body vibration on spinal excitability level and ankle plantar flexion spasticity in post-stroke individuals: A randomized controlled trial.

INTRODUCTION: This study aimed to evaluate the acute effects (up to 30 min) of whole-body vibration (WBV) on spinal excitability level and ankle plantar flexion spasticity in chronic stroke subjects. METHODS: Twenty-one subjects (age 30-70 years old) with chronic stroke and ankle plantar flexion spasticity were randomly assigned to the vibration group (VG, n = 11) or the control group (CG, n = 10). Subjects in the VG underwent 10 minutes of WBV with a frequency of 35 Hz and amplitude of 2 mm. Subjects in the CG remained on the platform for 10 min without receiving vibratory stimulus. The spinal excitability level was estimated by the Hmax/Mmax ratio extracted from the H-reflex with simple stimulus examination. The value of the second/first wave ratio (H2/H1 ratio) at the peak of the first facilitation was also considered through the recovery curve with double stimulation. Spasticity was estimated by the Modified Ashworth Scale (MAS) and global perception of change. All outcomes were assessed before and at 10, 20, and 30 min after the WBV, except for MAS, which was evaluated only 10 min after WBV. RESULTS: No between-group differences were found in either the spinal excitability level or plantar flexor spasticity at the three evaluated moments after WBV. CONCLUSION: These results suggest that WBV does not reduce spinal excitability level or spasticity of the plantar flexor muscles in chronic stroke patients in the first 30 min after vibratory stimulus.

Patient-generated subjective global assessment predicts cachexia and death in patients with head, neck and abdominal cancer: A retrospective longitudinal study.

BACKGROUND & AIMS: Cancer is a complex disease, with poor prognosis when associated with malnutrition. This condition can lead to Cancer Cachexia (CC), a syndrome characterized by loss of muscle mass with or without fat loss, often associated with higher risk of death. Although there are recommended screening tools to assess nutritional status in cancer patients, such as Patient-Generated Subjective Global Assessment (PG-SGA), little is known about CC prediction. The aim was to investigate the association between nutritional status of patients with head, neck and abdominal cancer, assessed by PG-SGA at the day of hospitalization, with CC, hospitalization time and death. METHODS: This is a retrospective longitudinal study, where we collected data of 97 patients about PG-SGA nutritional classification, anthropometry, gender, age, cachexia diagnosis and death. RESULTS: PG-SGA classification was strongly associated with all the anthropometric measures (p < 0.0001). According to PG-SGA classification, 30.61% (n = 15) of patients in group A developed pre-cachexia; 38.24% in group B developed CC (n = 13); and 60% (n = 9) in group C developed refractory cachexia (p < 0.0001). Death rate was 24.49% (n = 12), 54.55% (n = 18) and 80% (n = 12) in groups A, B and C, respectively (p < 0.0001). PG-SGA had good sensibility (89.5%) and accuracy (72%) for CC, and also good specificity (75.51%) and accuracy (69%) for death. CONCLUSIONS: PG-SGA demonstrated a significative association with the variables measured and was able to predict CC and death. This, in addition to its simple applicability, suggests that PG-SGA can be a useful tool to screen cancer patients for CC establishment and death risk.

Impact of bilateral nasal polyposis on the interoptic and interzygomatic distance.

PURPOSE: To identify and determine variations on eye distance in patients with bilateral nasal polyposis (BNP) compared to a healthy control group. METHODS: This is a case-control study that included 20 BNP patients and 40 healthy controls. We included all patients with BNP confirmed by pathology and a computed tomography scan. A healthy control group was admitted, filtered by the exclusion criteria of nasal polyposis, craniofacial malformations, and encephalocele. Paranasal sinus CT scans were performed in all participants, and two measures were evaluated, the interoptic (soft tissue) and the interzygomatic (bone structure) distances. RESULTS: A total of 20 BNP subjects, 13 (65%) male and 7 (35%) female, with a mean age of 38.8 years, and 40 healthy controls, 16 (40%) male and 24 (60%) female with a mean age of 43.2 years, were included. The mean interoptic distance was 69.7 mm (71.9 mm men, 66.4 mm women) and interzygomatic distance was 103.1 mm (104.5 mm men, 100.6 mm women). A significant increase of the interoptic (p < 0.001) and interzygomatic (p < 0.002) measurements was found in patients with polyposis compared to the controls. In the receptor operative curve analysis, the interoptic distance had an area under a curve of 96% and the threshold that maximizes the sensitivity and specificity was 59.85 mm (sensitivity 90%, specificity 95%, PPV 90%, NPV 95%). CONCLUSIONS: An increase in ocular and orbital distances was identified in patients with BNP. Polyposis may be identified by measuring eye separation. The established cut point distance identifies patients that may benefit from follow-up. Further research in this study line is suggested.

Olive Oil, Palm Oil, and Hybrid Palm Oil Distinctly Modulate Liver Transcriptome and Induce NAFLD in Mice Fed a High-Fat Diet.

Nonalcoholic fatty liver disease (NAFLD) is highly prevalent worldwide. The most severe form is nonalcoholic steatohepatitis (NASH). Among risk factors for the development of NAFLD is excessive lipid intake. Since palm (P) oil is the most consumed oil in the world, we aimed to investigate the effects of high-fat diets made with P oil, hybrid palm (HP) oil, or olive (O) oil in liver. Twenty-four male mice (C57Bl/6J) were fed a high-fat diet (41% fat) containing P, HP, or O oils for 8 weeks and compared to a control (C) group fed a chow diet. Adiposity was measured with computed tomography. Body, adipose tissue, and liver weights, as well as liver fat (Bligh⁻Dyer), blood lipid profile, glucose, and liver enzymes were measured. Liver histology (hematoxylin⁻eosin) and transcriptome (microarray-based) were performed. ANOVA tests with Newman⁻Keuls were used. Body weight was increased in the P group (p < 0.001) and body fat in the O group (C vs. O p ≤ 0.01, P vs. O p ≤ 0.05, HP vs. O p ≤ 0.05). All high-fat diets disturbed the blood lipid profile and glucose, with marked effects of HP on very low-density lipoprotein cholesterol (VLDL), triglycerides, and alkaline phosphatase (p ≤ 0.001). HP had the highest liver fat (42.76 ± 1.58), followed by P (33.94 ± 1.13). O had a fat amount comparable to C (16.46 ± 0.34, 14.71 ± 0.70, respectively). P and HP oils induced hepatocyte ballooning. Transcriptome alterations of the O group were related to amino acid metabolism and fatty acid (FA) metabolism, the P group to calcium ion homeostasis, and HP oil to protein localization. Both P and HP oils induced NASH in mice via disturbed hepatocyte transcription. This raises concerns about the content of these oils in several industrialized foods.

Sudden sensorineural hearing loss in atypical Cogan's syndrome: A case report.

The Cogan's syndrome (CS) is a very uncommon inflammatory condition that appears in young adults without a gender predisposition. It can be presented as typical, with interstitial non-syphilitic keratitis and Ménière-like audiovestibular manifestations. An atypical form of CS involves uveitis, scleritis, episcleritis, and systemic vascuitis symptoms. This is a case of a 41-year old male who reported eye redness, photophobia, and gait instability. His condition progressed to a sudden sensorineural hearing loss, tinnitus, and constant vertigo accompanied by cephalea. He was evaluated by the Otolaryngology, Ophthalmology, and Neurology departments giving rise to CS, Ménière's syndrome, acoustic neuroma, glaucoma, multiple sclerosis, and meningioma as differential diagnoses. The patient was prescribed with oral and intravenous steroids, ophthalmic antibiotics and steroids, as well as oral omeprazole. The patient was discharged, without his eye manifestations, and for his clinical progress and underwent conventional and speech audiometry, otoacoustic emissions, nystagmography, tympanometry, and auditory steady-state response, that showed a vestibular disfunction and a severe sensorineural hearing loss. His follow-up, six months later resulted with a normal vestibular function and an improvement from severe to mild sensorineural hearing loss. The Cogan's syndrome is a rare condition which can leave the patient with permanent incapacitating secuelae including profound hearing loss. Effective treatment is necessary to avoid complications and improve the patient's condition and life quality.

Dietary supplementation with hybrid palm oil alters liver function in the common Marmoset.

Hybrid palm oil, which contains higher levels of oleic acid and lower saturated fatty acids in comparison with African palm oil, has been proposed to be somehow equivalent to extra virgin olive oil. However, the biological effects of its consumption are poorly described. Here we have explored the effects of its overconsumption on lipid metabolism in a non-human primate model, the common marmoset. Dietary supplementation of marmoset with hyperlipidic diet containing hybrid palm oil for 3 months did not modify plasma lipids levels, but increased glucose levels as compared to the supplementation with African palm oil. Liver volume was unexpectedly found to be more increased in marmosets consuming hybrid palm oil than in those consuming African palm oil. Hepatic total lipid content and circulating transaminases were dramatically increased in animals consuming hybrid palm oil, as well as an increased degree of fibrosis. Analysis of liver miRNAs showed a selective modulation of certain miRNAs by hybrid palm oil, some of which were predicted to target genes involved in cell adhesion molecules and peroxisomal pathways. Our data suggest that consumption of hybrid palm oil should be monitored carefully, as its overconsumption compared to that of African palm oil could involve important alterations to hepatic metabolism.

High-velocity low-amplitude manipulation (thrust) and athletic performance: a systematic review / Manipulação em alta velocidade/baixa amplitude e desempenho atlético: uma revisão sistemática

Abstract Introduction: The high demand level in sports has encouraged the search for strategies to increase the yield. In this context, manual therapy through high-velocity low-amplitude (thrust) has been employed in many sports. Despite the adhesion of manual therapists in clinical practice, there were no systematic reviews on this topic. Objective: To evaluate the effects of thrust on the performance of athletes in relation to the outcomes hand-grip strength, jump height and running speed. Methods: The databases used in the search were MEDLINE / PUBMED, LILACS, CINAHL, PEDro, WEB OF SCIENCE, CENTRAL and SCOPUS, and Randomized controlled trials were included, whose participants were professionals or recreational athletes and had thrust as intervention. The methodological quality of the studies was assessed using the PEDro scale of 10 points. Intervention effects were determined by the mean difference and confidence interval. The data analysis was done in the descriptive form due to the heterogeneity found among studies. Results: Five trials were included with a total of 95 individuals. The methodological quality of studies was low, with an average value of 5.6 on the PEDro scale. It was found two articles for each outcome, but in none of them was presented differences between the experimental and control groups considering the confidence interval. Conclusion: The current evidence is insufficient to determine the use or nonuse the MAVBA in sports in order to improve performance.

Resumo Introdução: O elevado nível de exigência no meio esportivo tem incentivado a busca por estratégias para aumentar o rendimento. Nesse contexto, a terapia manual através da Manipulação em Alta e Velocidade e Baixa Amplitude (MAVBA) tem sido empregada em vários esportes. Apesar da adesão dos terapeutas manuais na prática clínica, não foram encontradas revisões sistemáticas acerca do tema. Objetivo: Avaliar os efeitos da manipulação de alta velocidade e baixa amplitude sobre o desempenho de atletas. Métodos: As bases de dados utilizadas na busca foram MEDLINE/PUBMED, LILACS, CINAHL, PEDro, WEB OF SCIENCE, CENTRAL e SCOPUS. Foram incluídos Ensaios Randomizados e Controlados, cujos participantes eram atletas profissionais ou recreacionais, que aplicaram a MAVBA como intervenção. A qualidade metodológica dos estudos foi avaliada por meio da Escala PEDro. Os efeitos da intervenção foram determinados através da diferença de média e do respectivo intervalo de confiança (IC). A análise dos dados foi realizada de maneira descritiva, em virtude da heterogeneidade encontrada entre os estudos. Resultados: Cinco ensaios foram incluídos com um total de 95 indivíduos. A qualidade metodológica dos estudos foi baixa, com uma média de 5.6 na Escala de PEDro. Foram encontrados dois artigos para cada desfecho, e em nenhum deles foi detectada diferença entre o grupo experimental e controle quando levado em consideração o IC. Conclusão: A evidência atual é insuficiente para determinar o uso ou o não uso da MAVBA em com objetivo de melhorar o desempenho esportivo.

Upper limbs total occlusion pressure assessment: Doppler ultrasound reproducibility and determination of predictive variables.

Total occlusion pressure (TOP) is an important variable to ischaemic exercise training because the optimal pressure of flow restriction (OPR), applied during this exercise modality, is derived from it. Despite the common use of Doppler ultrasound (DU) to determine the TOP, the reproducibility of this assessment was not evaluated yet. Given this, the objective was to evaluate the reproducibility of DU for the measurement of TOP in upper limbs and determine the predictive variables. Thirteen male volunteers attended three times to the laboratory. On the 1st day, we assessed arm circumference (AC), systolic blood pressure (SBP) and diastolic (DBP), and brachial artery TOP. On 2nd and 3rd days, only TOP was assessed. We found a coefficient of variation of 5·6% and an intraclass correlation coefficient of 0·795 for the DU. In the analysis of TOP predictive variables, the Spearman coefficients (R) were 0·813 (SBP), 0·786 (DBP) and 0·388 (AC). Therefore, these results support that DU has good reproducibility for the TOP and that SBP and DBP should be considered to the determination of TOP in upper limbs.

Coativação e pico de torque dos músculos extensores e flexores do joelho em indivíduos hemiparéticos crônicos nas posições sentada e supina / Coactivación y pico de torque de los músculos extensores y flexores de rodilla en sujetos hemiparéticos crónicos en las posiciones sentada y supina / Coactivation and peak torque of extensors and flexors knee muscle in chronic hemiparetics in sitting and supine positions

RESUMO Distúrbios na coativação e diminuição de força muscular são frequentemente descritos em indivíduos hemiparéticos. Alterações do comprimento muscular decorrentes da mudança postural podem resultar em diferentes respostas de coativação e força desses indivíduos. O objetivo deste estudo foi avaliar a influência das posições sentada e supina no Índice de Coativação (ICa) e no pico de torque (PT) de indivíduos hemiparéticos crônicos pós-AVE. Participaram do estudo vinte indivíduos com média de 54±12,14 anos; Índice de Massa Corpórea médio de 26,93±3,34 kg/m²; tempo médio de AVE 55,85±49,4 meses; escore do miniexame do estado mental entre 27-30 e Fugl-Meyer do membro inferior entre 15-30. O registro eletromiográfico foi obtido enquanto os voluntários executavam cinco contrações isocinéticas (60º/s) de extensão e flexão do joelho, nas posições sentada e supina. O músculo semitendíneo do membro parético exibiu ICa menor na posição supina em comparação à sentada: 0,36±0,33; 0,44±0,33 (p=0,048). Não houve diferença no ICa do reto femoral entre as posições sentada (0,28±0,25) e supina (0,23±0,21). O PT dos músculos extensores e flexores do membro parético não variou entre as posições (PT extensor: sentado = 56,48±37,62Nm, supino = 52,29±32,37 Nm; PT flexor: sentado = 12±11,1Nm; supino = 10,95±6,4Nm). A posição supina mostrou menor ICa no músculo semitendíneo do membro parético. A mudança de posição não influenciou o ICa do músculo reto femoral nem o PT de ambos os grupos musculares do membro parético. Assim, a posição supina parece ser indicada durante mobilizações e treinamento de força desses músculos em pacientes hemiparéticos crônicos pós-AVE.

RESUMEN Los trastornos en la coactivación y disminución de la fuerza muscular están frecuentemente descriptos en sujetos hemiparéticos. Las alteraciones del tamaño muscular debido al cambio postural a los sujetos les pueden resultar diferentes respuestas de coactivación y de fuerza. En este estudio se pretende evaluar la influencia de las posiciones sentada y supina en el Índice de Coactivación (ICa) y en el pico de torque (PT) de sujetos hemiparéticos crónicos pos-ACV. Veinte personas han participado del estudio con promedio de 54±12,14 años; Índice de Masa Corporal promedio de 26,93±3,34kg/m²; promedio de tiempo del ACV de 55,85±49,4 meses; puntuación del Mini-Examen Cognoscitivo entre 27-30 y Fugl-Meyer del miembro inferior entre 15-30. Se obtuvo el registro electomiográfico mientras los participantes ejercían cinco contracciones isocinéticas (60º/s) de extensión y de flexión de la rodilla, en las posiciones sentada y supina. El músculo semitendinoso del miembro parético presentó ICa menor en la posición supina que en la sentada: 0,36±0,33; 0,44±0,33 (p=0,048). No hubo diferencias en el ICa del recto femoral entre las posiciones sentada (0,28±0,25) y supina (0,23±0,21). El PT de los músculos extensores y flexores del miembro parético no presentó variación entre las posiciones (PT extensor: sentada = 56,48±37,62Nm, supina = 52,29±32,37Nm; PT flexor: sentada = 12±11,1Nm; supina = 10,95±6,4Nm). La posición supina mostró menor ICa en el músculo semitendinoso del miembro parético. El cambio de posición no influyó el ICa del músculo recto femoral tampoco el PT de ambos grupos musculares del miembro parético. De esta manera, la posición supina parece ser la indicada durante movilizaciones y entrenamientos de fuerza de dichos músculos de sujetos hemiparéticos crónicos pos-ACV.

ABSTRACT Disorders in co-activation and decreased muscle strength are often described in hemiparetic subjects. Changes in muscle length resulting from postural change may result in different responses of co-activation and strength of these individuals. The objective of this study was to evaluate the influence of sitting and supine positions in Co-activation Index (CI) and peak torque (PT) of chronic hemiparetic subjects after stroke. The participants were twenty individuals with mean age of 54±12.14 years; mean body mass index of 26.93±3.34 kg/m²; average stroke time of 55.85±49.4 months; Mini-Mental State Examination score between 27-30; and Fugl-Meyer of lower limb between 15-30. The electromyographic record was obtained while the volunteers performed five isokinetic contractions (60º/s) of knee extension and flexion in the sitting and supine positions. The semitendinosus muscle of paretic limb exhibited lower CI in the supine position compared to sitting: 0.36±0.33; 0.44±0.33 (p=0.048). There was no difference in CI of the rectus femoris between positions: 0.28±0.25 sitting and 0.23±0.21 supine. The PT of extensor and flexor muscles of the paretic limb did not vary between positions (PT extensor: sitting = 56.48±37.62 Nm, supine = 52.29±32.37 Nm; PT flexor: sitting = 12±11.1 Nm, supine = 10.95±6.4 Nm). The supine position showed lower CI in the semitendinosus muscle of paretic limb. The change of position did not influence the CI of rectus femoris muscle neither the PT of both muscle groups of the paretic limb. Thus, the supine position appears to be indicated during movement and strength training of these muscles in chronic hemiparetic patients after stroke.

Use of natural pH variation to increase the flocculation of the marine microalgae Nannochloropsis oculata.

Microalgae is largely used in aquaculture as feed. More recently, these microorganisms have been considered as an important feedstock for biodiesel production. However, the concentration of produced biomass represents a large parcel of production costs. In this study, we have evaluated the influence of natural pH variation of culture medium, caused by photosynthetic activity, on the flocculation of the marine microalgae Nannochloropsis oculata. Experiments were conducted with the same culture with different pH values (8.5 and 9.6), obtained after exposing the cells to different light conditions. For each pH value, different treatments were composed by adding 0, 5, 10, and 30 mM of NaOH and the flocculant Flopam® (FO4800 SH) at concentrations of 0, 0.5, 1, and 5 ppm. Higher flocculation efficiencies were obtained for the culture with pH 9.6 in comparison to 8.5 for the same NaOH and Flopam concentrations. Lower concentrations of base and flocculant were needed for flocculating the culture in higher pH, representing an economy of 20 % in the costs of crop harvesting.

Emphysematous gastritis and severe aplastic anemia.

Emphysematous gastritis is a life-threatening disease. It is characterized by the presence of gas within the wall of the stomach. The etiology includes firstly infections with gas-forming organisms; other predisposing causes are the ingestion of corrosive substances and alcohol abuse. Diagnosis is based on radiological techniques, mainly computed tomographic scan (CT). The election treatment is antibiotics and surgery. The evolution is generally fatal. We present the first known case reported, which is associated with aplastic anemia with immunosuppressive therapy, its evolution with medical treatment and a literature review.