Eficacia y seguridad de la ureteroscopia y la cirugía retrógrada intrarrenal sin fluoroscopia para el tratamiento de la urolitiasis: estudio comparativo / Efficacy and safety of fluoroless ureteroscopy and retrograde intrarenal surgery for the treatment of urolithiasis: A comparative study

Introducción Las técnicas convencionales de ureteroscopia (URS) y cirugía retrógrada intrarrenal (CRIR) requieren el uso de guía fluoroscópica, pero los riesgos derivados de la exposición a radiaciones ionizantes constituyen un motivo de preocupación entre pacientes y urólogos. El objetivo de este estudio fue evaluar la eficacia y la seguridad de la URS y la CRIR sin fluoroscopia y compararlas con los procedimientos convencionales guiados por fluoroscopia para el tratamiento de litiasis ureterales y renales. Material y métodos Los pacientes tratados con URS o CRIR para litiasis urinaria entre agosto de 2018 y diciembre de 2019 fueron evaluados retrospectivamente y agrupados según el uso de o la ausencia de fluoroscopia. Los datos se recopilaron de las historias individuales de los pacientes. Los criterios de valoración principales fueron la tasa libre de cálculos (TLC) y las complicaciones, comparadas entre los grupos con fluoroscopia y sin fluoroscopia. Se realizó un análisis de subgrupos por tipo de procedimiento (URS y CRIR) y un análisis multivariante para identificar los factores predictivos de litiasis residual. Resultados Un total de 231 pacientes cumplieron los criterios de inclusión: 120 (51,9%) en el grupo tratado con fluoroscopia convencional y 111 (48,1%) en el grupo tratado sin fluoroscopia. No se hallaron diferencias significativas entre los grupos en cuanto a la TLC (82,5% vs. 90,1%; p=0,127) o de complicaciones postoperatorias (35,0% vs. 31,5%; p=0,675). No se hallaron diferencias significativas entre estas variables en el análisis de subgrupos, independientemente del procedimiento considerado (AU)

Introduction Ureteroscopy (URS) and retrograde intrarenal surgery (RIRS) are traditionally guided by fluoroscopy, but the risks of exposure to ionizing radiation may present a matter of concern for patients and urologists. The aim of this study was to evaluate the efficacy and safety of fluoroless URS and RIRS compared with conventional fluoroscopy-guided procedures for the treatment of ureteral and renal stones. Material and methods Patients treated with URS or RIRS for urolithiasis between August 2018 and December 2019 were retrospectively evaluated and grouped according to the use of fluoroscopy. Data was collected from individual patient records. The main outcomes were stone-free rate (SFR) and complications, compared between the fluoroscopy and fluoroless groups. A subgroup analysis by type of procedure (URS and RIRS) and a multivariate analysis to identify predictors of residual stones were conducted. Results A total of 231 patients met the inclusion criteria: 120 (51.9%) in the conventional fluoroscopy group and 111 (48.1%) in the fluoroless group. No significant differences were found between groups regarding SFR (82.5% vs 90.1%; P=.127) or postoperative complication rate (35.0% vs 31.5%; P=.675). In the subgroup analysis these variables did not present significant differences, regardless of the procedure considered. In the multivariate analysis the fluoroless technique was not an independent predictor of residual lithiasis (OR: 0.991; 95%IC: 0.407-2.411; P=.983), when adjusted for procedure type, stone size and stone number. Conclusion URS and RIRS can be done without fluoroscopic guidance in selected cases, without affecting the efficacy or safety of the procedure (AU)

Invasive dynamic electrical impedance myography during 100 s of moderate contraction in rats' gastrocnemius muscle.

GOAL: The present study aimed to investigate the behavior of dynamic electrical impedance myography (dEIM) signals during a 100-s period of the dynamic contraction of Wistar rats' gastrocnemius evoked by electrical stimulation and to link the variations in bioimpedance with muscular energy systems. METHODS: Muscle contraction used 30% of the maximum muscular force and persisted for 100 s, along which dynamic bioimpedance signals were acquired. Based on the bioimpedance signals, two parameters, ΔZc and ΔZpc, were calculated to allow the analysis of their changes with the energy systems that supplied adenosine triphosphate (ATP) to the muscle. ΔZc indicated the variation of impedance of a twitch cycle compared to the values observed during the rest period preceding the cycle, and ΔZpc indicated slow bioimpedance variations compared to the values obtained during the rest period. RESULTS: The results indicated that ΔZc followed the force behavior, achieving a change rate of ∼14%. This parameter was associated with instantaneous impedance changes owing to the occurrence of each twitch. CONCLUSION: Although the findings of this study were linked to energy system processes, future studies are required for improving the understanding of the underlying mechanisms involved in dEIM. SIGNIFICANCE: The results contributed to understanding the relation of energy systems that supply ATP to the muscles with dEIM variations that occurred during muscle activity.

Efficacy and safety of fluoroless ureteroscopy and retrograde intrarenal surgery for the treatment of urolithiasis: A comparative study.

INTRODUCTION: Ureteroscopy (URS) and retrograde intrarenal surgery (RIRS) are traditionally guided by fluoroscopy, but the risks of exposure to ionizing radiation may present a matter of concern for patients and urologists. The aim of this study was to evaluate the efficacy and safety of fluoroless URS and RIRS compared with conventional fluoroscopy-guided procedures for the treatment of ureteral and renal stones. MATERIAL AND METHODS: Patients treated with URS or RIRS for urolithiasis between August 2018 and December 2019 were retrospectively evaluated and grouped according to the use of fluoroscopy. Data was collected from individual patient records. The main outcomes were stone-free rate (SFR) and complications, compared between the fluoroscopy and fluoroless groups. A subgroup analysis by type of procedure (URS and RIRS) and a multivariate analysis to identify predictors of residual stones were conducted. RESULTS: A total of 231 patients met the inclusion criteria: 120 (51.9%) in the conventional fluoroscopy group and 111 (48.1%) in the fluoroless group. No significant differences were found between groups regarding SFR (82.5% vs 90.1%, p=.127) or postoperative complication rate (35.0% vs 31.5%, p=.675). In the subgroup analysis these variables did not present significant differences, regardless of the procedure considered. In the multivariate analysis the fluoroless technique was not an independent predictor of residual lithiasis (OR 0.991; 95% IC 0.407-2.411; p=.983), when adjusted for procedure type, stone size and stone number. CONCLUSION: URS and RIRS can be done without fluoroscopic guidance in selected cases, without affecting the efficacy or safety of the procedure.

The Brain Metabolic Signature in Superagers Using In Vivo 1H-MRS: A Pilot Study.

BACKGROUND AND PURPOSE: Youthful memory performance in older adults may reflect an underlying resilience to the conventional pathways of aging. Subjects having this unusual characteristic have been recently termed "superagers." This study aimed to explore the significance of imaging biomarkers acquired by 1H-MRS to characterize superagers and to differentiate them from their normal-aging peers. MATERIALS AND METHODS: Fifty-five patients older than 80 years of age were screened using a detailed neuropsychological protocol, and 25 participants, comprising 12 superagers and 13 age-matched controls, were statistically analyzed. We used state-of-the-art 3T 1H-MR spectroscopy to quantify 18 neurochemicals in the posterior cingulate cortex of our subjects. All 1H-MR spectroscopy data were analyzed using LCModel. Results were further processed using 2 approaches to investigate the technique accuracy: 1) comparison of the average concentration of metabolites estimated with Cramer-Rao lower bounds <20%; and 2) calculation and comparison of the weighted means of metabolites' concentrations. RESULTS: The main finding observed was a higher total N-acetyl aspartate concentration in superagers than in age-matched controls using both approaches (P = .02 and P = .03 for the weighted means), reflecting a positive association of total N-acetyl aspartate with higher cognitive performance. CONCLUSIONS: 1H-MR spectroscopy emerges as a promising technique to unravel neurochemical mechanisms related to cognitive aging in vivo and providing a brain metabolic signature in superagers. This may contribute to monitoring future interventional therapies to avoid or postpone the pathologic processes of aging.

Invasive electrical impedance myography at different levels of contraction of gastrocnemius muscle of rat.

Electrical impedance myography (EIM) is as an experimental technique that associates muscle impedance with muscular activity. Changes in muscle impedance during contraction occur mainly due to changes in the morphological and physiological characteristics of muscles that lead to different impeditivities in comparison with the resting condition. There is no consensus on the details of muscular impedance during muscle activity. EIM measurements on humans are also influenced by factors such as the electrode-skin interface, layers of skin and fat, and the connective tissue that can generate undesirable effects in the impedance signal. These effects can be avoided if EIM measurements are carried out directly on the muscle by using the models of animals. This study investigates changes in the EIM signal in the gastrocnemius muscles of Wistar rats during different levels of muscular contraction. In vivo experiments were conducted on 19 male rats. The muscle was exposed, fixed on a load cell, and electrically stimulated to evoke different levels of muscle contraction. Signals of the components of impedance were analyzed against the muscular force signal. The results show moderate correlations (p < 0.05) among the impedance-related parameters of resistance (r = -0.76), reactance (r = 0.57), and phase (r = 0.53). In addition to providing an experimental protocol for the invasive collection of data on electrical impedance to minimize problems associated with surface electrodes, this study shows that of the components of impedance, resistance is most affected by the intensity of muscular contractions and that morphological changes influence impedance mainly at low intensities.

The calcium sensing receptor modulates H+-ATPase activity in intercalated cells.

Previous studies found that calcium sensing receptor (CaSR) it's expressed in intercalated cells of the collecting duct and that its activation by calcium in the luminal membrane promotes acidification of urine. Therefore, the aim of the study was to analyze the effects of CaSR stimulus on the biochemical activity of the vacuolar H+-ATPase in a cellular model of intercalated cells, MDCK-C11 cells. Biochemical activity of H+-ATPase was performed using cell homogenates and the inorganic phosphate released was determined by a colorimetric method. Changes in cytosolic ionized calcium ([Ca2+]i) were also determined using Fluo-4. A significant increase of vacuolar H+-ATPase activity was observed when the CaSR was stimulated with agonists such as Gd3+ (300 µM), neomycin (200 µM) and by the calcimimetic R-568 (1 µM). This activity was also stimulated in a dose-dependent fashion by changes in extracellular Ca2+ concentration ([Ca2+]o) between 10-2 and 2 mM. The calciolytic NPS 2143 (150 nM) significantly reduced the vacuolar H+-ATPase activity observed with 2 mM [Ca2+]o. Inhibition of phospholipase C (PLC) activity with U73122 (5 x 10-7 M) reversed the increase in pump activity observed in the presence of Gd3+. Activation of CaSR by the specific CaSR agonist R-568 produced a sustained rise of [Ca2+]i, an effect that disappears when extracellular calcium was removed in the presence of thapsigargin. In summary, CaSR stimulation induces an increase in the vacuolar H+-ATPase activity of MDCK-C11 cells, an effect that involves an increase in [Ca2+]i and require PLC activity. The consequent decrease in intratubular pH could lead to increase ionization of luminal calcium, potentially reducing the formation of calcium phosphate stones.

Prevalence of Endoparasites in Urban Stray Dogs from Brazil Diagnosed with Leishmania, with Potential for Human Zoonoses.

BACKGROUND: In tropical environments, abandoned animals can be an important source for human zoonotic infections, such as human visceral leishmaniasis and other vector-borne diseases. Here, we report the frequency of protozoan and helminth intestinal parasites in stray dogs, which might have an implication for human health in urban Brazilian settings. MATERIAL AND METHODS: We performed necropsies on 93 animals, euthanized due to canine visceral leishmaniasis control program, and examined their intestines looking for the presence of helminths; we determined the parasite load, and the elimination of eggs and cysts of protozoan parasites in fecal samples. Further, we performed serology tests for the detection of specific antibodies against Toxoplasma gondii. RESULTS: Overall, a high prevalence of intestinal parasites with potential for human zoonoses resulted and only 8.6% of examined intestines remained negative. The most prevalent helminths were Ancylostoma caninum and Dipylidium caninum. For nematodes, high worm burdens were detected for A. caninum and Trichuris vulpis. Additionally, we analyzed worm burdens and quantitative stool examinations, but found no significant association between positive serology for Leishmania infection and intestinal parasite burden. Interestingly, serology for T. gondii infection revealed a prevalence of 33.3% and a positive result was significantly associated with a higher A. caninum adult worm recovery (p = 0.0087). CONCLUSION: Our results showed stray dogs living in urban areas are heavily parasitized, which presents a potential risk for humans. Beyond the control of canine visceral leishmaniasis, we propose an improvement of the control program to reduce the risk for other parasitic diseases in dogs and humans.

The aminoglycoside antibiotic gentamicin is able to alter metabolic activity and morphology of MDCK-C11 cells: a cell model of intercalated cells.

It is well known that the aminoglycoside antibiotic gentamicin is capable of causing damage to kidney cells. Given the known involvement of Ca2+ in the nephrotoxic action of gentamicin, the purpose of this study was to establish a relationship between the concentration of intracellular Ca2+ ([Ca2+]i) and cellular cytotoxicity using MDCK-C11 cells, a clone that has several properties that resemble those of intercalated cells of the distal nephron. Changes in [Ca2+]i was determined using fluorescence microscopy. Cell viability was evaluated by the neutral red method, and cell cytotoxicity by the MTT method. The [Ca2+]i gradually increased when cells were exposed to 0.1 mM gentamicin for 10, 20, and 30 min. The presence of extracellular Ca2+ was found to be necessary to stimulate the increase in [Ca2+]i induced by gentamicin, since this stimulus disappeared by using 1.8 mM EGTA (a Ca2+ chelator). Morphological changes were observed with scanning electron microscopy in epithelial cells exposed to the antibiotic. Furthermore, with the MTT method, a decrease in metabolic activity induced by gentamicin was observed, which indicates a cytotoxic effect. In conclusion, gentamicin was able to alter [Ca2+]i, change the morphology of MDCK-C11 cells, and promote cytotoxicity.

Assessing resistance of sugarcane varieties to sugarcane borer Diatraea saccharalis Fab. (Lepidoptera: Crambidae).

In this study, we investigated resistance traits to the sugarcane borer Diatraea saccharalis Fab. (Lepidoptera: Crambidae) in the leaves and stalks of six sugarcane cultivars in a series of greenhouse and laboratory assays. Investigation of plant factors and infestation rates to better discriminate stalk damage by the sugarcane borer indicated that infestation of 7-month-old, single plants with 20 larvae at the third or fourth instar per plant was suitable to assess tunneling length. Three cultivars (i.e. SP803280, RB928064, and RB835486) had lower stalk damage (i.e. tunnel length) than cultivar SP891115, which exhibited relatively greater susceptibility to tunneling by the borer. The time required for the larvae to enter the sugarcane stalk was longer for cultivar SP803280, indicating resistance traits on the stalk surface, which correlated with lower stalk damage. Larvae feeding on SP813250 stalks had the lowest weight gain, indicating that this cultivar has resistance traits to larval development within its stalks. Cultivars RB867515 and SP891115 resulted in the highest mortality of early-stage larvae feeding on leaves, indicating the presence of resistance factors in their leaves. Multi-trait cluster and principal component analyses placed the cultivars into three and four clusters, respectively. The cultivars placed in different groups that exhibited resistance to leaf feeding, stalk entrance, and tunneling by the sugarcane borer could be used for crossings in sugarcane breeding programs with the goal of obtaining higher levels of resistance to D. saccharalis.

The aminoglycoside antibiotic gentamicin is able to alter metabolic activity and morphology of MDCK-C11 cells: a cell model of intercalated cells

It is well known that the aminoglycoside antibiotic gentamicin is capable of causing damage to kidney cells. Given the known involvement of Ca2+ in the nephrotoxic action of gentamicin, the purpose of this study was to establish a relationship between the concentration of intracellular Ca2+ ([Ca2+]i) and cellular cytotoxicity using MDCK-C11 cells, a clone that has several properties that resemble those of intercalated cells of the distal nephron. Changes in [Ca2+]i was determined using fluorescence microscopy. Cell viability was evaluated by the neutral red method, and cell cytotoxicity by the MTT method. The [Ca2+]i gradually increased when cells were exposed to 0.1 mM gentamicin for 10, 20, and 30 min. The presence of extracellular Ca2+ was found to be necessary to stimulate the increase in [Ca2+]i induced by gentamicin, since this stimulus disappeared by using 1.8 mM EGTA (a Ca2+ chelator). Morphological changes were observed with scanning electron microscopy in epithelial cells exposed to the antibiotic. Furthermore, with the MTT method, a decrease in metabolic activity induced by gentamicin was observed, which indicates a cytotoxic effect. In conclusion, gentamicin was able to alter [Ca2+]i, change the morphology of MDCK-C11 cells, and promote cytotoxicity.

Long term post PrePex male circumcision outcomes in an urban population in Uganda: a cohort study.

OBJECTIVE: The objective of this study was to determine the long term adverse events profile at least a year after safe male circumcision. RESULTS: A cohort study, investigating patients who had undergone a non surgical circumcision procedure called Prepex. The study variables included scar appearance and sexual experiences. Clients were contacted for a phone interview and data were collected using a questionnaire, for some, a physical examination was done. We obtained ethical committee approval. Data from 304 out of a possible 625 men were analyzed, the rest was lost to follow up. The follow up period was 12-24 months. The mean age was 28 years. Up to 97% were satisfied with the penile scar appearance and the absence of pain. There was no keloids formation, though one developed a hypertrophic scar. Participants reported improved sexual intercourse enjoyment (post circumcision). Up to 17% resumed sexual intercourse before the 6-week long mandatory abstinence period. The average self-reported healing time was 4.7 weeks. There was a high level of scar appearance satisfaction, there was no keloids formation. There was a perceived improvement of sexual enjoyment after circumcision. Trial registration ClinicalTrials. Gov Identifier: NCT02245126 (Date of registration: September 19, 2014).

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

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

Lactate threshold by muscle electrical impedance in professional rowers.

Lactate threshold (LT) is one of the physiological parameters usually used in rowing sport training prescription because it indicates the transitions from aerobic to anaerobic metabolism. Assessment of LT is classically based on a series of values of blood lactate concentrations obtained during progressive exercise tests and thus has an invasive aspect. The feasibility of noninvasive LT estimative through bioelectrical impedance spectroscopy (BIS) data collected in thigh muscles during rowing ergometer exercise tests was investigated. Nineteen professional rowers, age 19 (mean) ± 4.8 (standard deviation) yr, height 187.3 ± 6.6 cm, body mass 83 ± 7.7 kg, and training experience of 7 ± 4 yr, were evaluated in a rowing ergometer progressive test with paired measures of blood lactate concentration and BIS in thigh muscles. Bioelectrical impedance data were obtained by using a bipolar method of spectroscopy based on the current response to a voltage step. An electrical model was used to interpret BIS data and to derive parameters that were investigated to estimate LT noninvasively. From the serial blood lactate measurements, LT was also determined through Dmax method (LTDmax). The zero crossing of the second derivative of kinetic of the capacitance electrode (Ce), one of the BIS parameters, was used to estimate LT. The agreement between the LT estimates through BIS (LTBIS) and through Dmax method (LTDmax) was evaluated using Bland-Altman plots, leading to a mean difference between the estimates of just 0.07 W and a Pearson correlation coefficient r = 0.85. This result supports the utilization of the proposed method based on BIS parameters for estimating noninvasively the lactate threshold in rowing.

Correlation of causal factors that influence construction safety performance: A model.

BACKGROUND: The construction sector has presented positive development regarding the decrease in occupational accident rates in recent years. Regardless, the construction sector stands out systematically from other industries due to its high number of fatalities. OBJECTIVE: The aim of this paper is to deeply understand the causality of construction accidents from the early design phase through a model. METHODS: This study reviewed several research papers presenting various analytical models that correlate the contributing factors to occupational accidents in this sector. This study also analysed different construction projects and conducted a survey of design and site supervision teams. RESULTS: This paper proposes a model developed from the analysis of existing ones, which correlates the causal factors through all the construction phases. CONCLUSIONS: It was concluded that effective risk prevention can only be achieved by a global correlation of causal factors including not only production ones but also client requirements, financial climate, design team competence, project and risk management, financial capacity, health and safety policy and early planning. Accordingly, a model is proposed.

Colostrum composition of Santa Inês sheep and passive transfer of immunity to lambs.

This study aimed to analyze the chemical composition and the IgG concentration of the colostrum, transitional milk, and mature milk of Santa Inês ewes as well as the transfer of passive immunity to lambs. Thirty-two pregnant ewes and 38 lambs were used. Ewes were milked immediately after lambing and at 12, 24, 36 h and 10 d postpartum. Colostrum was provided to the lambs at 40±15 min (mean±SE) after birth and then at 30-min intervals for obtaining the intake closest to 10% of body weight, and transitional milk was provided ad libitum. Blood from the lambs was collected 36 h after birth for measuring the serum concentrations of IgG, total protein, albumin, and gamma-globulin. The production was lower in primiparous than in multiparous ewes with body condition score (BCS)<2.75, but did not differ between primiparous and multiparous with BCS≥2.75 (interaction parity and BCS). The IgG concentration and fat, protein, lactose, and defatted dry extract percentages were not affected by the BCS of the ewe at lambing or by the parity. The total solids percentage in the colostrum was higher in ewes with BCS<2.75 (interaction BCS and time). The production and the protein, total solid, and defatted dry extract percentages showed quadratic behavior, the fat percentage decreased linearly, and the lactose percentage increased linearly with time postpartum. The IgG concentration in the colostrum was not correlated with the ewe's weight or BCS at the time of lambing. Moreover, the parity, the BCS, the ewe's type of gestation, and the lamb's sex did not influence the serum concentrations of IgG, total protein, albumin, and gamma-globulin in lambs. Adequate passive immune transfer (PIT) was observed in lambs for which the IgG intake was higher than 30 g. Failure in PIT was observed in 39.5% of lambs when considering a serum IgG concentration lower than 15 mg/mL and in 21% when considering a serum total protein concentration lower than 45 mg/mL. The mean apparent efficiency of absorption was 38.10%, with values between 0.02% and 98.80%. The serum IgG concentration was correlated with the total protein concentration (according to the enzymatic colorimetric method), the gamma-globulin concentration, and the absorption efficiency. The extreme variation on apparent efficiency of absorption may have an effect on the success of PIT. Lambs should consume at least 30 g of IgG in the first 24 h of life to ensure adequate PIT.

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

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

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

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

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

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

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

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

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

Cross-cultural adaptation and validation of the Portuguese version of the Living with Asthma Questionnaire.

OBJECTIVE: To translate and culturally adapt the Living with Asthma Questionnaire (LWAQ) to the Portuguese language and to test its reliability and validity. METHODS: The Portuguese version of this disease-specific health-related quality of life measure was obtained with forward/backward translations, consensus panels and a pre-test. The Portuguese LWAQ and Medical Outcomes Study - 36 item Short Form (SF-36) questionnaires, and a form for the characteristics of the patients were administered to 61 subjects with asthma. RESULTS: Reliability of LWAQ scores was good with Cronbach's alpha coefficients ranging from 0.70 to 0.97 [with the exception of "preoccupation" (0.62) construct, and "sleep" (0.67) and "effects on others" (0.47) domains] and intraclass correlation coefficients between 0.86 and 0.99. Construct validity was supported by the confirmation of predefined hypotheses involving expected significant correlations between LWAQ total, constructs and domains, and SF-36 dimensions with similar content. CONCLUSION: The Portuguese LWAQ exhibited suitable psychometric properties, in terms of internal consistency, reproducibility and construct validity.