The use of a task through virtual reality in cerebral palsy using two different interaction devices (concrete and abstract) - a cross-sectional randomized study.

BACKGROUND: Cerebral Palsy (CP) is characterised by variable difficulties in muscular action, resulting in inability of the individual to perform functional movement. An option to provide functionality to the individual with CP is the use of computer innovation. The aim of this paper was to verify if there was any performance improvement in a task performed in a virtual environment and if there was transfer to the task performed in the real environment and vice versa in this population. METHODS: A computer program was developed comprising a motor task, but with two possibilities of user interaction: a) concrete interface (with physical contact): in which the individual touches the computer screen to finish the task and b) abstract interface (no physical contact): in which the individual performs a hand movement in front of the Kinect device. Participants were split into two groups. The experimental group consisted of 28 individuals with CP within the ages of 6 and 15 years old. The control group included 28 typically developing individuals mirroring the age and sex of the experimental group. RESULTS: Individuals from both groups were able to improve task performance and retain acquired information. The CP group presented worse performance than the control group in all phases of the study. Further findings showed that the CP group presented better performance in the abstract interface than in the concrete interface, whereas, in the control group, the opposite occurred: their best performance was in the concrete. CONCLUSIONS: Motor tasks performed by individuals with CP through an interface with a more virtual environment feature (abstract interface: Kinect) provided better performance when compared to an interface with a more real characteristic (concrete interface: Touchscreen). TRIAL REGISTRATION: ClinicalTrials.gov Identifier - NCT03352440; Date of registration - November 17, 2017.

The effects of different doses of oral creatine supplementation on tibial muscle resistence and fatigue in wistar rats / Efeito de diferentes doses de suplementação de creatina na resistência muscular e fadiga em ratos wistar

The aim of the present study was to investigate the effects of different doses of oral creatine supplementation on tibial muscle resistance and fatigue in Wistar rats. The treatment protocols included swimming exercises, supplementation alone (different doses), and supplementation (different doses) + swimming exercises. Analysis of the effect of creatine supplementation on skeletal muscle fatigue was performed using the intensity of muscle contraction to electrical stimulation to evaluate the intensity of muscle contraction, decay time of muscle tetanic contraction to 50% of maximum tension (fatigue), and the area under the curve for the intensity x time ratio, besides AST, LDH, and urea plasmatic analysis. Our results suggest that creatine supplementation seems to be able to produce ergogenic effects on contractile metabolism in the group treated with the dose of 280 mg/kg + swim exercise. This creatine dose presented a statistically significant increase in decay time of muscle tetanic contraction (C280+swim (119±13.1), C500+swim (110±23.6) and C1000+swim (87±15.1)), area under the curve between tetanic contractions, and plasma LDH decrease, when compared to the other doses. These data clearly demonstrate that high doses do not lead to any additional ergogenic effects. We conclude that the dose of 280 mg/kg+swim exercise obtained the best ergogenic effects on tibial muscle resistance and fatigue in Wistar rats.

O objetivo do presente estudo foi investigar os efeitos de diferentes doses de suplementação oral de creatina sobre a resistência e fadiga do músculo tibial em ratos wistar. Os protocolos de tratamento incluíram exercícios de natação, suplementação isolada (doses diferentes) e suplementação (doses diferentes) + exercícios de natação. A análise do efeito da suplementação de creatina na fadiga do músculo esquelético foi realizada utilizando-se a intensidade da contração muscular à uma estimulação elétrica, aferindo a intensidade da contração muscular, tempo de decaimento da contração tetânica do músculo a 50% da tensão máxima (fadiga) e a área sob a curva para a razão de intensidade x tempo, além de análises plasmática de AST, LDH e ureia. Nossos resultados sugerem que a suplementação de creatina parece ser capaz de produzir efeitos ergogênicos no metabolismo contrátil no grupo tratado, com a dose de 280 mg/kg+natação. Esta dose de creatina teve um aumento estatisticamente significativo no tempo de decaimento da contracção tetânica muscular (C280+natação (119±13.1), C500+natação (110±23.6) e C1000+natação (87±15.1)), área sob a curva entre as contrações tetânicas e também diminuição da LDH plasmática quando comparada com as outras doses. Estes dados demonstraram claramente que doses elevadas não conduzem a qualquer aumento adicional de efeitos ergogênicos. Concluimos que a dose de 280 mg / kg + exercício de natação obteve os melhores efeitos ergogênicos sobre a resistência e fadiga do músculo tibial em ratos wistar.

Achilles Tendon Penetration for Continuous 810 nm and Superpulsed 904 nm Lasers Before and After Ice Application: An In Situ Study on Healthy Young Adults.

BACKGROUND AND OBJECTIVE: There is a lack of knowledge about the influence tissue temperature may have on laser light penetration and tendon structure. The purpose of this study was to investigate whether penetration of laser energy in human Achilles tendons differed before and after ice pack application. MATERIALS AND METHODS: The Achilles tendons (n = 54) from 27 healthy young adults were irradiated with two class 3B lasers (810 nm 200 mW continuous mode laser and a 904 nm 60 mW superpulsed mode laser). The optical energy penetrating the Achilles area was measured before and after 20 min of ice application. Measurements were obtained after 30, 60, and 120 sec irradiation with the 904 nm laser and after 30 and 60 sec irradiation with the 810 nm laser. Achilles tendon thickness was measured with ultrasonography. RESULTS: Optical energy penetration increased significantly (p < 0.01) after ice application for both lasers and at all time points from 0.34% to 0.39% of energy before ice application to 0.43-0.52% of energy after ice application for the 904 nm laser and from 0.24% to 0.25% of energy before ice application to 0.30-0.31% of energy after ice application for the 810 nm laser. The energy loss per centimeter of irradiated tissue was significantly higher (p < 0.05) at all time points after ice application. Ultrasonography imaging of skin-to-skin and transversal tendon thickness was significantly reduced after ice application at p = 0.05 and p = 0.03, respectively. Achilles tendon thickness in the longitudinal plane remained unchanged (p = 0.49). CONCLUSIONS: The penetration of laser light increased significantly through healthy Achilles tendons subjected to 20 min of cooling. These findings occurred in the presence of a significant reduction in skin temperature and Achilles tendon thickness.

A novel method for predicting the risk of thrombosis and thromboembolism

INTRODUCTION: Thrombosis is a complex disease that is often silent and is characterized by thrombus formation within the blood vessel. It can lead to a venous obstruction in the body, severe sequelae and even death. Thrombus formation occurs when there is reduced blood flow and/or the release of procoagulant substances caused by external factors. In Brazil, the data on this pathology are still underestimated, and its incidence is approximately 0.8 cases/1000 inhabitants per year according to the literature. The aim of this study was to develop and validate a predictive method for the risk of thrombosis or thromboembolism according to various risk factors. METHODS: This is an observational and retrospective study based on a convenience sample of records. It was approved by the Institutional Review Board (IRB) of the University Mogi das Cruzes and the Heart Hospital of the São Paulo. The sample was classified according to the risk, and the assessment of concordance was performed by determining the Kappa coefficient and accuracy. RESULTS: Of the observed patients, 23 (46%) were women, and 86% were over 45 years old. The mean age of the patients was 60.8 years. Forty-eight percent of the patients underwent surgery for more than 30 minutes. In this study, the method categorized 29 (58%) patients as moderate risk, 10 as low risk and 11 as high risk. Two cases of thrombotic disease were sufficient for validation. CONCLUSION: The use of this software as a predictive method was feasible, providing fast filling, immediate scoring, flexibility and an upgrade over previous systems. The software will not substitute for diagnosis, which is a medical competence, but it may help as a warning of risk.

Impact of coronary artery bypass grafting in elderly patients.

OBJECTIVE: To analyze the results of isolated on-pump coronary artery bypass graft surgery (CABG) in patients > 65 years-old. METHODS: Patients undergoing isolated on-pump CABG from December 1st 2010 to July 31th 2012 were divided in two groups: GE (elderly > 65 years-old, n=103) and GA (adults < 65 years-old, n=150). Preoperative data, intraoperative (as cardiopulmonar bypass time, aortic clamping time, time length of stay in mechanical ventilation--MV--and number of grafts), and postoperative variable (as morbidity, mortality and time length of stay in hospital) were analyzed during hospitalization. RESULTS: In GE, the morbidity rate was greater than in GA (30% vs. 14%, P=0.004), but there was no difference in the mortality rate (5.8% vs. 2.0%, P=0.165). In GA, there was higher prevalence DM (39.6% vs. 27%, P=0.043) and smoking (32.2% versus 19.8%, P=0.042); and in GE, higher prevalence of stroke (17% vs. 6.7%, P=0.013). There was no difference between the groups regarding intraoperative variables. After multivariate analysis, age > 65-year-old was associated with greater morbidity, but it was not independent predictive factor for in-hospital mortality. Considering in-hospital mortality, stay in ward time length (P=0.006), cardiac (P=0.011) and respiratory complications (P=0.026) were independent predictive factors. CONCLUSION: This study suggests that patients > 65-year old were at increased risk of postoperative complications when submitted to isolated on-pump CABG in comparison to patients < 65-year-old, but not under increased risk of death.

Impact of coronary artery bypass grafting in elderly patients / Impacto da cirurgia de revascularização do miocárdio em pacientes idosos

OBJECTIVE: To analyze the results of isolated on-pump coronary artery bypass graft surgery (CABG) in patients > 65 years-old. METHODS: Patients undergoing isolated on-pump CABG from December 1st 2010 to July 31th 2012 were divided in two groups: GE (elderly > 65 years-old, n=103) and GA (adults < 65 years-old, n=150). Preoperative data, intraoperative (as cardiopulmonar bypass time, aortic clamping time, time length of stay in mechanical ventilation - MV - and number of grafts), and postoperative variable (as morbidity, mortality and time length of stay in hospital) were analyzed during hospitalization. RESULTS: In GE, the morbidity rate was greater than in GA (30% vs. 14%, P=0.004), but there was no difference in the mortality rate (5.8% vs. 2.0%, P=0.165). In GA, there was higher prevalence DM (39.6% vs. 27%, P=0.043) and smoking (32.2% versus 19.8%, P=0.042); and in GE, higher prevalence of stroke (17% vs. 6.7%, P=0.013). There was no difference between the groups regarding intraoperative variables. After multivariate analysis, age > 65-year-old was associated with greater morbidity, but it was not independent predictive factor for in-hospital mortality. Considering in-hospital mortality, stay in ward time length (P=0.006), cardiac (P=0.011) and respiratory complications (P=0.026) were independent predictive factors. CONCLUSION: This study suggests that patients > 65-year old were at increased risk of postoperative complications when submitted to isolated on-pump CABG in comparison to patients < 65-year-old, but not under increased risk of death.

OBJETIVO: Analisar os desfechos da cirurgia de revascularização do miocárdio (CRM) isolada com circulação extracorpórea em pacientes com idade > 65 anos em comparação àqueles com < 65 anos. MÉTODOS: foram analisados 253 pacientes submetidos consecutivamente à CRM isolada entre 1º de dezembro de 2010 a 31 de julho de 2012. Os pacientes foram separados em dois grupos: GI (idosos > 65 anos) e GA (adultos < 65 anos). Foram analisadas variáveis pré-operatórias, intraoperatórias (tempo de CEC, tempo de pinçamento aórtico, tempo de submissão à VM e número de enxertos) e pós-operatórias (morbidade, mortalidade e tempo de internação). RESULTADOS: Dos 253 pacientes, 103 pertenciam ao GI (40,7%) e 150 ao GA (59,3%). A taxa de morbidade foi significativamente maior no GI quando comparada ao GA (30% vs. 14%, P=0,004), porém não houve diferença na taxa de mortalidade (5,8% vs. 2,0%, P=0,165). No GA havia maior prevalência DM (39,6% vs. 27%, P=0,043) e tabagismo (32,2% vs. 19,8%, P=0,042); e no GI, maior prevalência de acidente vascular encefálico prévio (17% vs. 6,7%, P=0,013). Não houve diferença entre os grupos quanto às variáveis intraoperatórias. Na análise multivariada: tempo de internação na enfermaria (P=0,006), complicações cardíacas (P=0,011) e complicações respiratórias (P=0,026) foram variáveis preditoras de risco para maior mortalidade intra-hospitalar. No entanto, a idade > 65 anos não foi um fator preditor de risco associada a variável óbito. CONCLUSÃO: Este estudo sugere que pacientes com idade igual ou superior a 65 anos possuem um maior risco de complicações intra-hospitalares no pós-operatório de CRM isolada com CEC em comparação com pacientes mais jovens.

Inducible nitric oxide synthase inhibition attenuates physical stress-induced lung hyper-responsiveness and oxidative stress in animals with lung inflammation.

Mechanisms involved in stress-induced asthmatic alterations have been poorly characterised. We assessed whether inducible nitric oxide synthase (iNOS) inhibition modulates the stress-amplified lung parenchyma responsiveness, oxidative stress and extracellular matrix remodelling that was previously increased by chronic lung inflammation. Guinea pigs were subjected to 7 exposures to ovalbumin (1-5 mg/ml) or saline (OVA and SAL groups) over 4 weeks. To induce behavioural stress, animals were subjected to a forced swimming protocol (5 times/week, over 2 weeks; SAL-Stress and OVA-Stress groups) 24 h after the 4th inhalation. 1400W (iNOS-specific inhibitor) was administered intraperitoneally in the last 4 days of the protocol (SAL-1400W, OVA-1400W, SAL-Stress+1400W and OVA-Stress+1400W groups). Seventy-two hours after the last inhalation, animals were anaesthetised and exsanguinated, and adrenal glands were removed. Lung tissue resistance and elastance were evaluated by oscillatory mechanics and submitted for histopathological evaluation. Stressed animals had higher adrenal weights compared to non-stressed groups, which were reduced by 1400W treatment. Behavioural stress in sensitised animals amplified the resistance and elastance responses after antigen challenge, numbers of eosinophils and iNOS+ cells, actin content and 8-iso-PGF2α density in the distal lung compared to the OVA group. 1400W treatment in ovalbumin-exposed and stressed animals reduced lung mechanics, iNOS+ cell numbers and 8-iso-PGF2α density compared to sensitised and stressed animals that received vehicle treatment. We concluded that stress amplifies the distal lung constriction, eosinophilic inflammation, iNOS expression, actin content and oxidative stress previously induced by chronic lung inflammation. iNOS-derived NO contributes to stress-augmented lung tissue functional alterations in this animal model and is at least partially due to activation of the oxidative stress pathway.