Sleep quality and falls in middle-aged and older adults: ELSI-Brazil study.

OBJECTIVE: To verify the association between low self-reported sleep quality (LSQ) and fall in middle-aged and older adults every half-decade of life. METHOD: A cross-sectional study was conducted using data from the first wave (2015-2016) of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), which is nationally representative. The sample consisted of 8,950 participants who were allocated into eight age groups: 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80-84, and ≥ 85 years. The questionnaires used included self-reported sleep quality and the International Physical Activity Questionnaire short version. Fisher's exact test followed by binary logistic regression analysis was performed to identify the odds ratio of sleep quality for fall occurrence, controlled for confounding variables. RESULTS: Individuals aged 50-105 years (63.6 ± 10.2 years), 57.0% females and 43.0% males, participated in this study. Overall, 21.5% of participants experienced at least one fall. The relative frequency of participants classified as having high or LSQ remained constant across each half-decade of life. The LSQ exhibited a statistically significant OR (p < 0.05) for falls across age groups up to 84, even after accounting for confounding variables. CONCLUSION: LSQ is significantly associated with an increased occurrence of fall in adults aged >50 years, but not for ≥ 85 years regardless of sex and physical activity level.

Brain functional training: a perspective article.

Introduction: Physical exercise (PE) positively affects the nervous system, impacting morphology and physiology. It increases brain gray and white matter, improves cerebral blood flow, and stimulates neurogenesis, synaptogenesis, and angiogenesis, promoting brain function. Although exercise already affects cognition, some training modalities place greater demands on the cognitive aspects of physical exercise, such as perceptual-motor and visual-motor training. This type of approach aims to emphasize the cognitive adaptations that occur chronically. Specifically for older people, functional training, a multi-component approach, is a promising exercise modality that stimulates functionality using multi-joint, multi-planar exercises mirroring daily activities. However, applying a greater focus on cognitive adaptations in line with the functional training proposal for maximal benefits remains underexplored. Aim: Thus, this perspective article initially explores different exercise approaches emphasizing cognitive adaptations and proposes Brain Functional Training to improve older adult's functionality. Methods: Furthermore, we explain how brain functional training can be explored to emphasize cognitive aspects based on increasing complexity to stimulate the executive function and its subdomains. Conclusion: This proposal is one alternative to combining motor and cognitive stimuli to promote autonomy and health in older people.

Sarcopenic obesity does not impair lower limb strength and physical performance in sufficiently active older adults: a cross-sectional study.

This study investigated the associations of sarcopenic obesity (SO) with muscle strength and physical performance in sufficiently active older adults. Data from 72 older sarcopenic obese adults classified as sufficiently active were analyzed. Participants were categorized into four groups based on sex and SO status. Muscle strength/physical performance tests were compared using independent sample t-tests. Multiple linear regression and binary logistic regression were performed to examine the associations between SO and muscle strength and physical performance, adjusting for confounding variables. Only handgrip strength showed differences between SO groups, regardless of sex (p < 0.05). SO negatively explained the variability of handgrip strength (p < 0.05). An increase in handgrip strength values was associated with a decrease in the chances of older adults being classified as SO (p < 0.05). The findings suggest that even with SO, sufficiently active older adults did not present a significant reduction in muscle strength in the lower limbs and physical performance.

Sleep quality and falls in middle-aged and older adults: ELSI-Brazil study / Qualidade do sono e quedas em adultos de meia-idade e idosos: Estudo ELSI-Brasil / Calidad del sueño y caídas en adultos de mediana edad y mayores: Estudio ELSI-Brasil

ABSTRACT Objective: To verify the association between low self-reported sleep quality (LSQ) and fall in middle-aged and older adults every half-decade of life. Method: A cross-sectional study was conducted using data from the first wave (2015-2016) of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), which is nationally representative. The sample consisted of 8,950 participants who were allocated into eight age groups: 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80-84, and ≥ 85 years. The questionnaires used included self-reported sleep quality and the International Physical Activity Questionnaire short version. Fisher's exact test followed by binary logistic regression analysis was performed to identify the odds ratio of sleep quality for fall occurrence, controlled for confounding variables. Results: Individuals aged 50-105 years (63.6 ± 10.2 years), 57.0% females and 43.0% males, participated in this study. Overall, 21.5% of participants experienced at least one fall. The relative frequency of participants classified as having high or LSQ remained constant across each half-decade of life. The LSQ exhibited a statistically significant OR (p < 0.05) for falls across age groups up to 84, even after accounting for confounding variables. Conclusion: LSQ is significantly associated with an increased occurrence of fall in adults aged >50 years, but not for ≥ 85 years regardless of sex and physical activity level.

RESUMO Objetivo: Verificar a associação entre baixa qualidade do sono autorrelatada (BQS) e quedas em adultos de meia-idade e idosos a cada meia década de vida. Método: Um estudo transversal foi conduzido utilizando dados da primeira onda (2015-2016) do Estudo Longitudinal Brasileiro do Envelhecimento (ELSI-Brasil), que é nacionalmente representativo. A população consistiu em 8.950 participantes que foram alocados em oito grupos etários: 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80-84 e ≥ 85 anos. Os questionários utilizados incluíram qualidade do sono autorrelatada e o Questionário Internacional de Atividade Física versão curta. O teste exato de Fisher seguido pela análise de regressão logística binária foi conduzida para identificar a razão de chances da BQS para ocorrência de queda, controlando por variáveis de confusão. Resultados: Pessoas com idades entre 50 e 105 anos (63,6 ± 10,2 anos), sendo 57,0% do sexo feminino e 43,0% do sexo masculino, participaram deste estudo. No geral, 21,5% dos participantes experimentaram pelo menos uma queda. A frequência relativa de participantes classificados como tendo BQS ou alta permaneceu constante em cada meia década de vida. A BQS exibiu uma OR (p < 0,05) notável para quedas em grupos etários até 84 anos, mesmo após o ajuste para variáveis de confusão. Conclusão: A BQS está significativamente associada a uma maior ocorrência de queda em adultos com mais de 50 anos, mas não para ≥ 85 anos, independentemente do sexo e do nível de atividade física.

RESUMEN Objetivo: Verificar la asociación entre la baja calidad del sueño autorreportada (BCS) y las caídas en adultos de mediana edad y mayores cada media década de vida. Método: Se realizó un estudio transversal utilizando datos de la primera oleada (2015-2016) del Estudio Longitudinal Brasileño sobre el Envejecimiento (ELSI-Brasil), que es representativo a nivel nacional. La muestra consistió en 8,950 participantes que fueron asignados a ocho grupos de edad: 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80-84 y ≥ 85 años. Los cuestionarios utilizados incluyeron calidad del sueño autorreportada y el Cuestionario Internacional de Actividad Física versión corta. Se realizó una prueba exacta de Fisher seguida por un análisis de regresión logística binaria para identificar la razón de probabilidades de la calidad del sueño para la ocurrencia de caídas, controlando las variables de confusión. Resultados: Participaron en este estudio individuos con edades entre 50 y 105 años (63,6 ± 10,2 años), siendo el 57,0% mujeres y el 43,0% hombres. En general, el 21,5% de los participantes experimentaron al menos una caída. La frecuencia relativa de participantes clasificados como con alta calidad de sueño o baja calidad de sueño (BCS) se mantuvo constante a lo largo de cada media década de vida. La BCS mostró un OR (p < 0,05) notable para las caídas en grupos de edad hasta los 84 años, incluso después de ajustar por variables de confusión. Conclusión: La BCS está significativamente asociada con una mayor ocurrencia de caídas en adultos mayores de 50 años, pero no para ≥ 85 años, independientemente del sexo y del nivel de actividad física.

Characteristics of resistance training-based protocols in older adults with sarcopenic obesity: a scoping review of training procedure recommendations.

Background: Sarcopenic obesity (SO) is a clinical and functional disease characterized by the coexistence of obesity and sarcopenia. Resistance training (RT) characteristics for older adults with sarcopenia or obesity are already well established in the scientific literature. Nonetheless, we still do not know how detailed the RT protocols are described for older adults with SO. Therefore, we aimed to analyze the characteristics of RT programs, including each of their variables, recommended for older adults with SO. Methods: This is a scoping review study that was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Scoping Reviews. The search was carried out until November 2022 in PubMed/MEDLINE, EMBASE, Cochrane Library, Web of Science, Scopus, LILACS, Google Scholar, and medRxiv databases. The studies included SO diagnosis and RT as an intervention strategy. The RT variables analyzed were as follows: exercise selection, the volume of sets, the intensity of load, repetition cadence, rest interval between sets, and weekly frequency. Results: A total of 1,693 studies were identified. After applying the exclusion criteria, 15 studies were included in the final analysis. The duration of the RT intervention ranged from 8 to 24 weeks. All studies included full-body routines, with single/multi-joint exercises. Regarding the volume of sets, some studies fixed it in three sets, whereas others varied between one and three sets. The load was reported by repetition range and the weight lifted, elastic-band color/resistance, percentage of one repetition maximum, or perceived exertion scale. Repetition cadence was fixed in some studies, while it was self-selected between concentric and eccentric phases in others. The interval between sets of rest varied from 30 to 180 s. All studies reported progression overload during the interventions. Not all studies reported how the exercise selection, repetition cadence, and rest interval were made. Conclusion: The characteristics of RT protocols and their variables prescribed in the literature for older adults with SO were mapped. The lack of detail on some training variables (i.e., exercise selection, repetition cadence, and rest interval) was identified. RT protocols are heterogeneous and described only partially among studies. The recommendations for RT prescription details in older adults with SO are provided for future studies. Systematic review registration: https://osf.io/wzk3d/.

Bodyweight and Combined Training Reduce Chronic Low-Grade Inflammation and Improve Functional Fitness of Postmenopausal Women.

Exercise is an important tool against the deleterious effects of aging. Among the possibilities of exercise, bodyweight training (BWT) has been highlighted in the last years as a safe option to improve the health of older people. We compared the effects of 24 weeks of BWT and combined training (CT) on low-grade systematic inflammation and functional fitness in postmenopausal women. For this, 40 women were allocated and submitted to CT (n = 20, 64.43 ± 3.13 years, 29.56 ± 4.80 kg/m²) and BWT (n = 20, 65.10 ± 4.86 years, 28.76 ± 4.26 kg/m²). We measured inflammation by the interleukin-6 (IL-6), interleukin-10 (IL-10), and tumor necrosis factor-α (TNF-α) assessments. For functional fitness, we used tests similar to activities of daily living. At the end of the 16 weeks, data from 24 women were analyzed, CT (n = 14) and BT (n = 10). Both groups reduced TNF-α and IL-6 levels, without differences in IL-10. Regarding functional fitness, both groups demonstrated improvements in all tests after 24 weeks, except for rise from prone position and the 400-meter walk test for CT. In summary, CT and BWT are effective in reducing the plasma concentration of pro-inflammatory cytokines and improving functional fitness in postmenopausal women.

Resistance Circuit Training or Walking Training: Which Program Improves Muscle Strength and Functional Autonomy More in Older Women?

To evaluate the effects of two programs (resistance and walking training) on the functional autonomy and muscle strength (isometric and dynamic) of older women, 67 subjects were divided randomly into three groups: resistance training (RTG; Mean = 64.70 ± 6.74 years), walking (WG, Mean = 65.56 ± 7.82 years), and control (CG; Mean = 64.81 ± 4.34). The experimental groups underwent a 16-week intervention. Muscle strength (isometric and dynamic) and functional autonomy were assessed. The subjects participating in the RTG showed improvements in the comparison pre to post-test in the maximal forces of upper limb (MULS) (Δ% = 49.48%; p = 0.001) and lower limb (MLLS) (Δ% = 56.70%; p = 0.001), isometric biceps forces (BIS) (Δ% = 30.13%; p = 0.001) and quadriceps forces (QIS) (Δ% = 65.92%; p = 0.001), and in the general index (GI) of functional autonomy (Δ% = −18.32%; p = 0.002). The WG improved in all functional autonomy tests, except for the standing up from prone position test (SVDP). In strength tests, the WG obtained improvements only in the QIS (Δ% = 41.80%; p = 0.001) and MLLS (Δ% = 49.13%; p = 0.001) tests. The RTG obtained better results (p < 0.05) when compared to the WG and CG. The results allow us to infer that resistance exercise programs are more effective in increasing strength and functional autonomy, a fact that may mitigate the deleterious effects on health of aging.

Rhabdomyolysis Episode in an Individual with McArdle's Disease after Low Aerobic Exercise.

McArdle's disease, known as blockage of muscle glycogen metabolism, is characterized by glycogen accumulation of chains in skeletal striated muscles. One of the typical symptoms of the disease is the feeling of intolerance to exercise. Severe muscle cram and contracture, which often cause stiffness, occur due to a lack of muscle energy substrate during the exercise. These factors can lead to muscle damage, myoglobinuria, and, in severe cases, renal failure and rhabdomyolysis. Rhabdomyolysis is a syndrome that presents injury and necrosis of muscle cells leading to the release of intracellular material to the circulatory system. The present study aimed to report rhabdomyolysis in an individual with McArdle's disease after exercise of walking with low intensity. Patient, aged 33 years, was treated in the emergency room of a hospital located in the State of Rio de Janeiro, Brazil. After performing a full lap on the block of home (~500 m in ~4 min 37 s), walking at a moderate speed (~6.5 km/h), the individual felt sick and was rescued, later being hospitalized. The examinations collected presented hematocrit (HCT) compatible with chronic disease anemia and myoglobinuria. The patient was discharged from the intensive care center on the 3rd day, after a 45% drop in creatine kinase. The patient described in the present study achieved full recovery. Attention to symptoms, early diagnosis, and immediate treatment made it possible to interrupt the development of complications caused by rhabdomyolysis, not allowing progression to acute renal failure.

Cross-validation of 20 anthropometric prediction equations for appendicular muscle mass in older Brazilian women: a cross-sectional study / Validação cruzada de 20 equações antropométricas de massa muscular apendicular para idosas brasileiras: um estudo transversal

Objective: To test the cross-validation of anthropometric prediction equations for appendicular muscle mass (AMM) in older Brazilian women. Methods: Sixty-seven older women (69.84 ± 5.95 years old) underwent anthropometric measurements. AMM (kg) reference values obtained by dual-energy X-ray absorptiometry (AMMDXA) were compared to 20 anthropometric equations for estimating AMM in older adults. A paired t-test (p > 0.05), standard error of estimate (SEE < 3.50 kg), and r2 > 0.70 confirmed the validity of the equations. The agreement between predictions and the reference was also verified (Bland-Altman analysis of agreement between methods). Results: Four American equations and one Mexican equation were not statistically different from AMMDXA (p > 0.05) but did not present suitable r2 values for validation. The American equation from the National Health and Nutrition Examination Survey (NHANES), AMM (kg) = (-0.04 × age [years]) + (0.46 × calf circumference [cm]) + (0.32 × arm circumference [cm]) + (0.11 × thigh circumference [cm]) ­ (0.27 × body mass index [BMI, kg/m2 ]) + (0.07 × waist circumference [cm]) ­ 13 119 showed the best performance (r2 = 0.64; SEE = 3.24 kg), with minimal mean difference (0.26 kg), no heteroscedasticity for extreme values, and with high agreement with the Brazilian sample (-3.90 to 3.40 kg). Conclusion: When specific equations for a given population are not available, the use of generic equations of greater sample representativeness with scientifically and reliably analyzed data is allowed.

Objetivo: Testar a validação cruzada das equações antropométricas preditivas da massa muscular apendicular (MMA) em idosas brasileiras. Metodologia: Sessenta e sete idosas (69,84 ± 5,95 anos) foram submetidas a medidas antropométricas. Os valores de referência da MMA (kg) fornecida pela absorciometria de raios X de dupla energia (MMADXA) foi comparada com 20 equações antropométricas preditivas para estimar a MMA para idosos. Teste t pareado (p > 0,05), erro padrão de estimativa (EPE) < 3,50 kg e r2 > 0,70 confirmaram a validade das equações. A concordância entre as previsões e a referência também foi verificada (análise de concordância entre métodos de Bland-Altman). Resultados: Quatro equações americanas e uma equação mexicana não foram estatisticamente diferentes da MMADXA (p > 0,05), mas nenhuma delas apresentou r2 adequado para validação. A equação americana dos dados do National Health and Nutrition Examination Survey (NHANES), MMA (kg) = (-0,04 × idade [anos]) + (0,46 × circunferência da panturrilha [cm]) + (0,32 × circunferência do braço [cm]) + (0,11 × circunferência da coxa [cm]) ­ (0,27 × índice de massa corporal-IMC [kg/m2 ]) + (0,07 × circunferência da cintura [cm]) ­ 13,12 apresentou o melhor desempenho (r2 = 0,64; EPE = 3,24 kg): com diferença média mínima (0,26 kg), sem heterocedasticidade para valores extremos e alta concordância com a amostra brasileira (-3,90 a 3,40 kg). Conclusão: Quando não existem equações específicas para uma determinada população, é permitida a utilização de equações genéricas de maior representatividade amostral, cujos dados tenham sido analisados de forma científica e confiável

Surgery of the adrenal metastases.

BACKGROUND: Adrenal metastases are the most common malignant lesions of the adrenal glands and the second most common tumor after adenomas. The location of the primary tumor is described: lung (39%), breast (35%), gastrointestinal tract, among other. Several studies show that surgery improves survival in selected cases. METHOD: Retrospective and single-center observational study of patients operated for adrenal metastasis over a period of 11 years. The characteristics of the disease and surgical results were described. RESULTS: 14 suprarenalectomies were performed. The average age was 65.85 years. The primary tumors described: non-small cell lung carcinoma (42.8%) and clear cell renal carcinoma (14.20%). In 92.8% the injury was unilateral. In 64.2% it was metachronous. An initial laparoscopic approach was performed in 85.71%. The morbidity of our series was 14.28%. The median overall survival was 30 months. Survival was 75% per year, 55.5% at 3 years and 40% at 5 years. CONCLUSIONS: Age, primary location, degree of differentiation, histological type, size greater, laterality, disease-free interval, chemotherapy and surgical technique are not associated with changes in survival. In the presence of a single adrenal mass, surgical evaluation is mandatory and surgery could play a role in patients with metastases in other locations with control of the primary disease.

ANTECEDENTES: Las metástasis suprarrenales son las lesiones malignas más frecuentes de las glándulas suprarrenales. Como localización del tumor primario se encuentran el pulmón (39%), la mama (35%), el riñón y el tracto gastrointestinal, entre otros. La cirugía mejora la supervivencia en casos seleccionados. MÉTODO: Estudio observacional, retrospectivo y unicéntrico de pacientes intervenidos de suprarrenalectomía por metástasis suprarrenal en un periodo de 11 años. Se describen las características de la enfermedad y los resultados quirúrgicos. RESULTADOS: Se realizaron 14 suprarrenalectomías. La media de edad de los pacientes fue de 65.85 años. Los tumores primarios fueron carcinoma no microcítico pulmonar (42.8%) y carcinoma renal de células claras (14.20%). En el 92.8% de los casos fue unilateral y en el 64.2% metacrónica. Se realizó laparoscopia inicial en el 85.71%. La morbilidad fue del 14.28%. La mediana de supervivencia global fue de 30 meses. La supervivencia fue del 75% al año, el 55.5% a los 3 años y el 40% a los 5 años. CONCLUSIONES: La edad, la localización primaria, el grado de diferenciación, el tipo histológico, el tamaño, la lateralidad, el intervalo libre de enfermedad, la quimioterapia y la técnica quirúrgica no se asocian a cambios en la supervivencia. Ante una masa suprarrenal única, la valoración quirúrgica es mandatoria y la cirugía podría ocupar un papel en pacientes con metástasis en otras localizaciones con control de la enfermedad primaria.

La Resolución 1325: Mujeres, Paz y Seguridad en las Operaciones de Mantenimiento de la Paz / The Resolution 1325: Women, Peace, and Security in the Peacekeeping Operations / Resolução 1325: mulheres, paz e segurança nas Operações de Manutenção da Paz

Resumen Este artículo analiza la incorporación de la Resolución 1325 del Consejo de Seguridad de Naciones Unidas y sus Resoluciones Complementarias -las que conforman la Agenda Mujeres, Paz y Seguridad- en las Resoluciones que crearon las Operaciones de Mantenimiento de la Paz desde el año 2000 en adelante, que justamente son creadas por el mismo Organismo. Teóricamente, se proponen tres estadios de análisis: la mujer como sujeto de protección, la mujer como sujeto de pacificación y la promoción de la perspectiva de género, basándose en el contenido de la Agenda Mujeres, Paz y Seguridad. Tales estadios se aplican en las Resoluciones seleccionadas por medio de un análisis de texto. Las conclusiones evidencian falencias en la incorporación de la Resolución 1325 y sus Resoluciones Complementarias, instrumentos promovidos desde el propio Consejo de Seguridad de Naciones Unidas, junto con mostrar la existencia de una variabilidad en la forma como se incorporaron estos estadios de análisis en la selección de casos.

Abstract This article analyzes the incorporation of Resolution 1325 of the United Nations Security Council and it's Complementary Resolutions -that compose the Women, Peace, and Security Agenda- in the Resolutions that have created the Peacekeeping Operations from the year 2000 onwards, which are just created by the same Organization. Theoretically three concepts of analysis are proposed: the woman as subject of protection, the woman as subject of pacification, and the promotion of the gender perspective, based on the content of the Women, Peace, and Security Agenda. Such concepts are applied in the Resolutions selected by means of a text analysis. The conclusions show weaknesses in the incorporation of Resolution 1325 and it's Complementary Resolutions, instruments promoted by the United Nations Security Council itself, together with the existence of variability in the way in which these stages of analysis were incorporated into the selection of cases.

Resumo Este artigo analisa a incorporação da Resolução 1325 do Conselho de Segurança das Nações Unidas e suas Resoluções Complementares - as que compõem a Agenda de Mulheres, Paz e Segurança- nas Resoluções que criaram as Operações da Manutenção da Paz a partir do ano 2000, que são criados apenas pela mesma agência. Teoricamente, três etapas de análise são propostas: a mulher como sujeito de proteção, a mulher como sujeito de pacificação e a promoção da perspectiva de gênero, com base no conteúdo da Agenda da Mulher de Paz e Segurança. Tais estágios são aplicados nas Resoluções selecionadas por meio de uma análise de texto. As conclusões mostram fragilidade na incorporação da Resolução 1325 e suas Resoluções Complementares, nos instrumentos promovidos pelo próprio Conselho de Segurança das Nações Unidas, além de mostrar a existência de uma variabilidade na forma como essas etapas de analise foram Incorporadas Na Seleção De Casos.

Pilates training induces changes in the trunk musculature of adolescents / Treinamento com pilates induz alterações na musculatura do tronco de adolescentes / Entrenamiento de pilates induce cambios en la musculatura del tronco de adolescentes

ABSTRACT Introduction The Pilates Method may be an appropriate form of exercise for improving trunk muscle strength, which can be a predictor of pain and musculoskeletal problems. Objective The objective of this study was to assess the effects of the Pilates Method on muscle strength and endurance of the extensor and flexor muscles of the trunk in a group of adolescents. Methods The sample consisted of 101 high-school students divided into two groups: an experimental group (EG=81) and a control group (CG=20). The intervention was carried out twice a week for six weeks. Each session lasted 55 minutes, and was divided into three parts: warm-up, main part, and cool down. Muscle strength was assessed by the Sörensen Test and the Bench Trunk-curl Test. The paired sample T-test, the T- test for independent samples, and Pearson's correlation coefficient were applied. The size of the effect (d) was determined. Results The EG showed significant improvements in both tests (+34.77 points; +18.55 points, respectively). No changes were observed in the CG. The effect size was high (d>1.15) for both tests, which means that the results were improved in a large proportion of the participants. The control group showed a decline in strength of the trunk musculature. In the experimental group, both boys and girls showed significant improvements in both tests. This strength increase was enhanced for a large proportion of boys and girls (d>1.15). The effect size was high (d>1.15) for both tests and for both sexes. Conclusion Six-weeks after implementing the Pilates Method in Physical Education lessons, the muscle strength of the flexor and extensor muscles of the trunk in adolescents was improved. Level of Evidence II; Therapeutic studies-Investigation of treatment results.

RESUMO Introdução O método Pilates pode ser uma forma adequada de exercício para melhorar a força dos músculos do tronco, que podem ser um preditor de dor e problemas musculoesqueléticos. Objetivo O objetivo deste estudo foi avaliar os efeitos do método Pilates sobre a força muscular e resistência dos músculos extensores e flexores do tronco em um grupo de adolescentes. Métodos A amostra foi composta de 101 estudantes do ensino médio divididos em dois grupos: um grupo experimental (GE = 81) e um grupo controle (GC = 20). A intervenção foi realizada duas vezes por semana durante seis semanas. Cada sessão durou 55 minutos e foi dividida em três partes: aquecimento, parte principal e relaxamento. A força muscular foi avaliada com o teste de Sörensen e o teste de flexão abdominal com apoio de pernas. Para a análise de dados, foram empregados o teste t de amostras pareadas, o teste t para amostras independentes e o coeficiente de correlação de Pearson. O tamanho do efeito (d) foi determinado. Resultados O GE apresentou melhoras significativas em ambos os testes (+34,77 pontos; +18,55 pontos, respectivamente). Não foram observadas alterações no GC. O tamanho do efeito foi alto (d > 1,15) para ambos os testes, o que significa que os resultados foram melhores em uma grande proporção de participantes. O grupo controle apresentou declínio da força muscular do tronco. No grupo experimental, meninos e meninas apresentaram melhoras significativas em ambos os testes. Esse aumento de força foi atingido por uma alta proporção de meninos e meninas (d > 1,15). O tamanho do efeito foi alto (d > 1,15) nos dois testes e sexos. Conclusão Seis semanas depois da implantação do método Pilates nas aulas de educação física, a força muscular dos flexores e extensores do tronco aumentou nos adolescentes. Nível de Evidência II; Estudos Terapêuticos - Investigação dos resultados do tratamento.

RESUMEN Introducción El método Pilates puede ser una forma apropiada de ejercicio para la mejora de la fuerza de la musculatura del tronco, la cual puede ser un predictor de dolor y problemas musculoesquéticos. Objetivo El objetivo de este estudio fue evaluar los efectos del método Pilates sobre la fuerza muscular y la resistencia de los músculos extensores y flexores del tronco en un grupo de adolescentes. Métodos La muestra consistió en 101 estudiantes de secundaria divididos en dos grupos: un grupo experimental (GE = 81) y un grupo control (GC = 20). La intervención se realizó dos veces a la semana durante seis semanas. Cada sesión duró 55 minutos y se dividió en tres partes: calentamiento, parte principal y relajación. La fuerza muscular se evaluó mediante la prueba de Sörensen y la prueba de flexión abdominal con apoyo de piernas. Se aplicaron pruebas t de muestras pareadas t de muestras independientes y el coeficiente de correlación de Pearson. Se determinó el tamaño del efecto (d). Resultados El GE mostró mejoras significativas en ambas pruebas (+34,77 puntos; +18,55 puntos, respectivamente). No se observaron cambios en el GC. El tamaño del efecto fue alto (d > 1,15) para ambas pruebas, lo que significa que los resultados mejoraron en una gran proporción de participantes. El grupo control mostró una disminución en la fuerza de la musculatura del tronco. En el grupo experimental, tanto los niños como las niñas mostraron mejoras significativas en ambas pruebas. Este aumento de la fuerza fue mayor para una alta proporción de niños y niñas (d > 1,15). El tamaño del efecto fue alto (d > 1,15) para ambas pruebas y para ambos sexos. Conclusión Después de seis semanas de implementar el método Pilates en las clases de educación física, se mejoró la fuerza muscular de los flexores y extensores del tronco en adolescentes. Nivel de evidencia II; Tipo de estudio: Estudios terapéuticos - Investigación de resultados de tratamiento.

Effects of a pilates school program on hamstrings flexibility of adolescents / Efeitos de um programa escolar de pilates sobre a flexibilidade dos isquiotibiais de adolescentes / Efectos de un programa escolar de pilates sobre la flexibilidad de los isquiosurales de adolescentes

INTRODUCTION: Low levels of hamstring flexibility may trigger certain acute and chronic pathologies and injuries. Poor flexibility is observed among teenagers and several authors have recommended the use of specific programs in this population to improve flexibility levels. The Pilates Method (PM) may be an appropriate intervention to achieve this purpose and has rarely been used with this population. Objective: Study was to assess changes in the flexibility of hamstrings after running a didactic PM unit for high-school students.METHODS: This research was developed through a quasi-experimental design. The sample consisted of 66 high-school students divided into experimental group (EG=39) and control group (CG=27). The intervention was carried out 2 times a week for six weeks. Each session lasted 55 minutes divided into three parts: warm-up, main part and cool down. Hamstring flexibility was assessed using the toe-touch test. Paired Student t-test and t-test for independent samples were applied. The size of the effect (d) was determined.RESULTS: The EG showed significant provident in hamstring flexibility (+3.54±3.9cm). The effect size was low (d>d>0,2<0,53), which means that a small proportion of participants improved their results. The control group did not have significant changes after the intervention. In the experimental group, both boys (+3.38± 3.7cm) and girls (+3.85 ± 4.2cm) showed significant improvements. The effect size was low for boys (d>d>0.2<0.53), which means that a small proportion of participants improved their results, and high for girls (d>1.15) which means that a large proportion of participants improved their results.CONCLUSION: This study showed that six-weeks of Pilates training in Physical Education classes has significantly improved the hamstrings flexibility among adolescents.

INTRODUÇÃO: Baixos níveis de flexibilidade dos músculos isquiotibiais podem desencadear patologias e lesões agudas e crônicas. Esses níveis baixos são observados entre adolescentes, e diversos autores têm recomendado o uso de programas específicos nesta população para melhorar a flexibilidade. O método Pilates (MP) pode ser uma intervenção adequada para alcançar essa finalidade, mas raramente tem sido utilizado nessa população. Objetivo: Avaliar as alterações nos níveis de flexibilidade dos isquiotibiais após a aplicação de uma unidade didática do MP nas aulas de Educação Física para adolescentes.MÉTODOS: Esta pesquisa foi desenvolvida por meio de um desenho quase-experimental. A amostra foi composta de 66 alunos do ensino médio, divididos em um grupo experimental (GE = 39) e um grupo controle (GC = 27). A intervenção foi realizada com frequência de duas vezes por semana durante seis semanas. Cada sessão durou 55 minutos e foi dividida em três partes: aquecimento, parte principal e relaxamento. Os níveis de flexibilidade dos isquiotibiais foram avaliados através do teste de toque nos dedos dos pés. Foram empregados testes t de Student pareado e, para amostras independentes o teste t. O tamanho do efeito (d) foi calculado.RESULTADOS: O GE apresentou aumento significativo dos níveis de flexibilidade dos isquiotibiais (+3,54 ± 3,9 cm). O tamanho do efeito foi baixo (d>d>0,2<0,53), o que significa que uma pequena parte dos participantes melhorou seu resultado. O GC não apresentou alterações significativas após o período de treinamento. No GE, os grupos masculino (+3,38 ± 3,7 cm) e feminino (+3,85 ± 4,2 cm) apresentaram melhoras significativas. O tamanho do efeito foi baixo para o grupo masculino (d>d>0,2<0,53), o que significa que uma pequena parte dos participantes melhorou seu resultado, e foi alto para o grupo feminino (d >1,15), mostrando que grande parte dos adolescentes melhorou seu resultado.CONCLUSÃO: Este estudo mostrou que seis semanas de aplicação do método de Pilates nas aulas de Educação Física proporcionaram melhoras significativas nos níveis de flexibilidade dos isquiotibiais entre os adolescentes.

INTRODUCCIÓN: Bajos niveles de flexibilidad de la musculatura isquiosural pueden desencadenar ciertas patologías y lesiones agudas y crónicas. Se observa una pobre flexibilidad entre los adolescentes y varios autores han recomendado el uso de programas específicos en esta población para mejorar los niveles de flexibilidad. El Método Pilates (MP) puede ser una intervención adecuada para lograr este propósito, y rara vez se ha utilizado con esta población. Objetivo: Evaluar los cambios en la flexibilidad de los isquiosurales después de enseñar una unidad didáctica con el MP en jóvenes adolescentes.MÉTODOS: Esta investigación se desarrolla a través de un diseño cuasi-experimental. La muestra estuvo formada por 66 estudiantes de secundaria divididos en grupo experimental (GE = 39) y grupo control (GC = 27). La intervención se llevó a cabo 2 veces a la semana durante seis semanas. Cada sesión duró 55 minutos divididos en tres partes: calentamiento, parte principal y relajación. La flexibilidad de los isquiosurales se evaluó mediante la prueba toe-touch. Se aplicaron pruebas pareadas t de Student y pruebas t para muestras independientes. Se determinó el tamaño del efecto (d).RESULTADOS: El GE mostró significativamente una mejora en la flexibilidad isquiosural (+ 3,54 ± 3,9cm). El tamaño del efecto fue bajo (d> d> 0,2 <0,53), lo que significa que una pequeña proporción de los participantes mejoraron sus resultados. El GC no tuvo cambios significativos después de la intervención. En el GE, tanto los niños (+ 3,38 ± 3,7 cm) como las niñas (3,85 ± 4,2 cm) mostraron mejoras significativas. El tamaño del efecto fue bajo para los varones (d> d> 0,2 <0,53), lo que significa que una pequeña proporción de los participantes mejoraron sus resultados, y alto para las niñas (d > 1,15) lo que significa que una gran proporción de los participantes mejoraron sus resultados.CONCLUSIÓN: Este estudio mostró que seis semanas de instrucción de Pilates en las clases de Educación Física mejoran de manera significativa la flexibilidad de los isquiosurales entre los adolescentes.

Impact of the incorporation of tyrosine kinase inhibitor agents on the treatment of patients with a diagnosis of advanced renal cell carcinoma: study based on experience at the Hospital Universitario Central de Asturias.

INTRODUCTION: For nearly the past two decades, cytokines (CKs) have been the only systemic treatment option available for advanced renal cell carcinoma (RCC). In recent years, tyrosine kinase inhibitors (TKIs) have demonstrated clinical activity on this tumour. Our purpose is to describe one centre's experience with the use of CKs and TKIs in the treatment of patients with advanced RCC. MATERIALS AND METHODS: This study was designed as a retrospective chart review of RCC patients who were treated with CKs and/or TKIs in our department between July 1996 and June 2008. Efficacy and toxicity were assessed using World Health Organization (WHO) criteria. The Kaplan-Meier method was used to estimate progression-free (PFS) and overall (OS) survival. RESULTS: Ninety-four patients were classified into three groups depending on the modality of treatment administered: 46 were treated with CKs alone and/or chemotherapy (27 with immunotherapy, one with chemotherapy and 18 with both), 28 with TKIs alone (25 with sunitinib and 13 with sorafenib) and 20 with TKIs in second-line treatment following failure with CKs (17 with sunitinib, eight with sorafenib, four with bevacizumab and one with lapatinib). The median age was 60 years in the CK group and 65 and 62, respectively, in TKI in first and second-line treatment groups. Eighty-five percent of patients treated with CKs and 75% in the TKI group in first-line treatment and 80% in second-line treatment were men. Overall, 89% of patients had favourable risk, and 11% had intermediate risk. All patients were considered evaluable for toxicity. The main grade 3-4 (%) toxicity was asthenia for both groups, (ten in TKIs and 15 in CKs). Other grade 1-2 toxicities were mucositis (39), bleeding (8), hypertension (19), skin toxicity (33) and hypothyroidism (12.5) associated with TKIs; and anaemia (33), cough (29), asthenia (39) and emesis (14) associated with CKs. The objective response rate among 80 patients evaluable for activity was 10.6% with CKs and 46.5% and 35%, respectively, with TKIs in first- and second-line treatments. Disease stabilisation with CKs was recorded at 59% of patients and with TKIs 25% and 50% in first- and second-line treatment groups, respectively. The median progression-free survival (PFS) with CKs was 122 days [95% confidence interval (CI) 82-162] and with TKIs 201 days (65-337) in the first and 346 days (256-436) in second-line treatment groups. The median overall survival (OS) was 229 days (142-316) and 2,074 days (1,152-2,996) for patients treated with CKs and TKIs. CONCLUSIONS: Our results are in line with the activity and survival rates previously reported in the literature regarding the use of TKIs for patients with advanced RCC in first- and second-line treatment, which has demonstrated an acceptable toxicity level.

Amenaza bioterrorista en Argentina / Bioterrorist threatening in Argentina

This report describes present concepts related to biological terrorism with special reference to he factibility of bioterrorist attack in Argenina(AU)

Amenaza bioterrorista en Argentina / Bioterrorist threatening in Argentina

This report describes present concepts related to biological terrorism with special reference to he factibility of bioterrorist' attack in Argenina

Local thrombus as an isolated sign of traumatic aortic injury.

We report an unusual case of blunt traumatic aortic injury in which a mobile thrombus located at the isthmus was the only abnormality detected by transesophageal echocardiography. The case illustrates the high sensitivity of this diagnostic tool in aortic trauma and underscores the possibility of finding infrequent evidence of injury in subtle aortic lesions.