Quality and reporting of guidelines on the diagnosis and management of dystonia.

BACKGROUND AND PURPOSE: The quality of clinical practice guidelines on dystonia has not yet been assessed. Our aim was to appraise the methodological quality of guidelines worldwide and to analyze the consistency of their recommendations. METHODS: We searched for clinical practice guidelines on dystonia diagnosis/treatment in the National Guideline Clearinghouse, PubMed, National Institute for Health and Care Excellence, Guidelines International Network and Web of Science databases. We also searched for guidelines on homepages of international neurological societies. We asked for guidelines from every Management Committee member of the BM1101 Action of the Cooperation between Science and Technology European framework and every member of the International Parkinson and Movement Disorders Society with special interest in dystonia. RESULTS: Fifteen guidelines were evaluated. Among guidelines on treatment, only one from the American Academy of Neurology could be considered as high quality. Among guidelines on diagnosis and therapy, the guideline from the European Federation of Neurological Societies was recommended by the appraisers. Clinical applicability and reports of editorial independence were the greatest shortcomings. The rigor of development was poor and stakeholder involvement was also incomplete in most guidelines. Discrepancies among recommendations may result from the weight given to consensus statements and expert opinions due to the lack of evidence, as well as inaccuracy of disease classification. CONCLUSIONS: The quality of appraised guidelines was low. It is necessary to improve the quality of guidelines on dystonia, and the applied terminology of dystonia also needs to be standardized.

Should menopausal characteristics be considered during cardiorespiratory exercise prescription in postmenopausal women?

OBJECTIVE: Menopausal characteristics (i.e. the nature of menopause, hormone therapy, and time elapsed since menopause) are known to affect women's health-related quality of life. The purpose of this study was to determine whether menopausal characteristics affect the cardiorespiratory exercise response and which characteristics should be considered for exercise prescription. METHODS: Fifty-eight postmenopausal women (60.21 ± 4.49 years of age; 66.26 ± 8.99 kg body weight; 157.09 ± 4.92 cm in height; 29.70 ± 4.79 ml·kg(-1)·min(-1) maximal oxygen uptake) participated in this study. A graded 25-W/min(2) cycle ergometer exercise protocol was applied to assess aerobic power and ventilatory thresholds. Participants' heart rates and gas-exchange variables were measured continuously using a COSMED K4b(2) portable gas analyzer system. The first and the second ventilatory thresholds were determined by the time-course curves of ventilation and oxygen and carbon dioxide ventilatory equivalents. Using age as a covariate, an analysis of covariance was performed to assess the effect of menopause characteristics upon the data. RESULTS: Regardless of the nature of menopause, use of hormone therapy, time elapsed since menopause, and the interaction between these characteristics, the participants presented no differences in maximal oxygen uptake values, neither on submaximal variables often used in evaluations of exercise prescription, such as percent of maximal oxygen uptake, maximal heart rate, and heart rate reserve, nor in respiratory exchange ratio and gas exchange energy expenditure at aerobic and anaerobic ventilatory thresholds. CONCLUSIONS: These data suggest that a personalized cardiorespiratory target zone for this population should be set according to the published literature, and that consideration of the individual menopausal characteristics seems to be unnecessary.

A randomized study on lipids response to different exercise programs in overweight older men.

UNLABELLED: This study compared the effects of 2 long-term training programs on blood lipid profiles in overweight older adults. 59 older men with BMI≥25 and <35 kg/m(2) ages 65-75 years were randomly assigned to an aerobic training group (ATG, n=19), a mixed aerobic and resistance training group (MTG, n=20), or a control group (n=20). Both programs were moderate-to-vigorous intensity, involving 60-min training sessions 3 days/week for 32 weeks. Blood lipids were measured on 5 different occasions. Repeated measure ANCOVA was used for primary data analysis, and the independence between blood lipids variables and group factor was tested. Pre-to-post mean values of triglycerides, total cholesterol and low-density lipoprotein decreased in both ATG and MTG (-10.1 and -25.8, -1.0 and -17.6, -8.9 and -17.2 mg/dl, respectively), but not significantly. There was a significant association for triglycerides (P=0.025) and total cholesterol (P=0.025) in the MTG (baseline vs. post-test), with significant individual lipid profile modifications. The number of individuals with clinically high triglycerides and total cholesterol significantly decreased after the mixed training program. Combined aerobic and resistance training was more effective in the chronic modification of lipid profile. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01874132.

Effects of a 12-month multi-component exercise program on the body composition of postmenopausal women.

OBJECTIVE: The aims of this study were to identify the effects of a 12-month exercise program on the body composition of postmenopausal women and to examine the interaction of menopause characteristics (nature and time since menopause, hormone therapy) with exercise. METHODS: A total of 158 postmenopausal Caucasian women were analyzed in this study (70 in the control and 88 in the exercise group). This subset is part of the 'Shape up during menopause' which is a program that aims to develop exercise and health promotion in postmenopausal women. Exercise and control groups were tested before and at the end of the program. Data related to menopause were obtained through medical history. Measurements of fat mass, visceral fat area, skeletal muscle mass, fat-free mass, soft lean mass, and basal metabolic rate were assessed by octopolar bioimpedance. RESULTS: Alongside basal metabolic rate, all the anthropometric and body composition variables were influenced by the exercise program. The major differences between groups were found in skeletal muscle mass, total soft lean mass, fat-free mass, and skeletal muscle mass index (effect sizes ranged from 0.89 to 6.64). There were no interactive effects found between exercise and menopause characteristics. CONCLUSIONS: There were positive changes in all measured variables and no significant interactive effects with menopause characteristics; therefore, our data suggest that exercise alone promoted improvements in the body composition of postmenopausal women.

Physiological responses to treadmill and cycle exercise.

This study aimed to identify differences in the acute cardio-respiratory, metabolic and perceptual responses between exercise performed on the treadmill and on the cycle ergometer at several intensities. The sample comprised of 20 voluntary male participants (age=22.5 ± 1.8 years; height=177.7 ± 7.0 cm; body mass=72.6 ± 7.9 kg; fat mass=7.87 ± 1.3%) that performed 5 submaximal 8 min exercise bouts, interspersed with a 10 min period of passive recovery. Exercise intensity used on the treadmill was 10, 12, 14, 15 and 16 km/h (0% gradient), and 80, 120, 160, 180 and 200 W on the cycle ergometer (65-70 rpm). There was a significant mode effect and also mode×intensity interaction in oxygen uptake and heart rate with higher values in the treadmill protocol (F=32.0 p=0.000, η2=0.65 and F=132.0 p=0.000, η2=0.88, respectively). The respiratory exchange ratio and blood lactate concentrations were not different across modes (F1, 18=1.9 p=0.183 and F1, 17=0.1 p=0.964, respectively) and rate of perceived exertion values were higher in the cycle ergometer (F1, 12=1.2 p=0.288). Generally, results showed a larger exercise mode effect on the cardio-respiratory variables with higher response patterns on the treadmill, differing according to exercise intensity.

Oxygen uptake, heart rate and energy expenditure during slideboard routines at different cadence.

AIM: Little is known about the physiological response during slideboard exercise (SE). The aim of the present study was to analyse the oxygen uptake (V.O2), the heart rate (HR) and the energy expenditure (EE) during a typical slideboard exercise session and investigate differences on these variables when performing the same choreography at two different cadences (130 e 145 beats per minute - bpm). METHODS: The sample comprised 13 female university students (21,77+/-0,97 years), apparently healthy and physically active, with past training in SE and mastering the technical levels 1 and 2. The subjects performed randomly exercise sessions at 130 bpm and 145 bpm. The ventilatory response was measured by an open air circuit system (COSMED K4b2, Rome, Italy) and HR was measured by a portable monitor (Polar Wireless Double Electrode, Kempele, Finland). HR and V.O2, during SE at 130 bpm, were 179.88+/-834 bpm and 37.95+/-3.71 mL/kg/min respectively. At 145 bpm SE mean values were 182.08+/-9.58 bpm and 39.67+/-3.82 mL/kg/min respectively. EE during 130 bpm exercise was 10.60+/-1.69 kcal/min and at 145 bpm was 10.90+/-1.36 kcal/min. No differences were found between 130 and 145 bpm in none of the variables. We conclude that slideboard exercise cardio respiratory response does not seem affected by the rhythm of execution. Moreover the EE associated with this type of exercise is above the literature reports for other types of group aerobic exercises.

Liver morphology with enphasis on bile ducts changes and survival analysis in mice submitted to multiple Schistosoma mansoni infections and chemotherapy

Numa tentativa de estar o mais próximo possível a pacientes infectados e tratados nas áreas endêmicas de esquistosomose (S. mansoni) e também para obter um período mais longo de seguimento, camundongos foram repetidamente infectado com um número baixo de cercarias. Dados de sobrevivência e variáveis histológicas tais como granuloma esquistosomótico, alteraçöes portais, necrose hepatocelular, regeneraçäo hepática, pigmento esquistosomótico, fibrose periductal e principalmente, alteraçöes dos ductos biliares foram analisados nos animais infectados tratados e näo tratados. Aa terapêutica por oxamniquina ns animais repetidamente infectados prolonga a sobrevivência de maneira singificante (Chi-quadrado 9,24, p = 0,0024), portanto confirmando resultados anteriores com um modelo semelhante mas com um período mais curto de seguimento. Ainda, a mortalidadade decresce rapidamente depois do tratamento, sugerindo uma abrupta reduçäo na gravidade das lesöes hepáticas. O fígado foi anida estudados sob o ponto de vista morfológico imunohistoquímico. Fibrose portal, com um quadro que lembra a fibrose humana do tipo Symmers está presente na fase tardia da infecçäo. As alteraçöes de ductos biliares säo muito próximas daquelas descritas na esquistosomose manônica humana. Antígeno esquistomótico foi observado e, uma célula isolada do revestimento alterado de ductos biliares. A patogênese das alteraçöes ductais e sua possível relaçäo com a infecçäo parasitária e/ou seus antígenos foi discutida

Liver morphology with emphasis on bile ducts changes and survival analysis in mice submitted to multiple Schistosoma mansoni infections and chemotherapy.

In an attempt to be as close as possible to the infected and treated patients of the endemic areas of schistosomiasis (S. mansoni) and in order to achieve a long period of follow-up, mice were repeatedly infected with a low number of cercariae. Survival data and histological variables such as schistosomal granuloma, portal changes, hepatocellular necrosis, hepatocellular regeneration, schistosomotic pigment, periductal fibrosis and chiefly bile ducts changes were analysed in the infected treated and non treated mice. Oxamniquine chemotherapy in repeatedly infected mice prolonged survival significantly when compared to non-treated animals (chi-square 9.24, p = 0.0024), thus confirming previous results with a similar experimental model but with a shorter term follow-up. Furthermore, mortality decreased rapidly after treatment suggesting an abrupt reduction in the severity of hepatic lesions. A morphological and immunohistochemical study of the liver was carried out. Portal fibrosis, with a pattern resembling human Symmers fibrosis was present at a late phase in the infected animals. Bile duct lesions were quite close to those described in human Mansonian schistosomiasis. Schistosomal antigen was observed in one isolated altered bile duct cell. The pathogenesis of the bile duct changes and its relation to the parasite infection and/or their antigens are discussed.

[Treatment of anemia in patients with chronic kidney insufficiency in hemodialysis with erythropoietin]. / Tratamento da anemia dos doentes insuficientes renais crónicos em hemidiálise com eritropoietina.

A group of 50 patients (26 men and 24 women, mean age 50 +/- 19 years and range 21 to 67) on chronic hemodialysis (HD) and with basal levels of hemoglobin (Hb) less than or equal to 8 g/dl was treated with recombinant human erythropoietin (r-HuEpo) during 3 months. r-HuEpo was started at 50 U/kg I.V. 3 times a week, immediately after each session of HD, for 4 weeks, and this dose was increased in steps of 25 U/kg until a Hb level of 12 g/dl or a maximum dose of 100 U/kg were reached. Complete blood counts and biochemical profile were performed before the first dose of r-HuEpo and once weekly and monthly respectively during the period of treatment. In 8 patients the red-cell life span was studied with cromium 51 labelled erythrocytes just before and after treatment. One patient had a grand mal seizure and the r-HuEpo was discontinued. In 44 patients the mean hematocrit increased from 21.8% to 32.1% and in the other 5 there were no response because of iron deficiency. There were no changes in leucocytes and platelets counts and consistent decreases in iron and ferritin serum concentrations were observed despite oral supplementation of iron. In the 8 patients studied the shortened erythrocyte survival did not suffer any significant variation with r-HuEpo. Predialysis creatinine, urea and phosphorus blood levels increased significantly at 3th month of treatment but there was no increase in potassium. In 32.6% of previously normotensive and hypertensive patients an increase in blood pressure was founded. Thrombosis of arteriovenous fistulas and other severe clinical side effects were not observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Schistosomiasis mansoni: immunodiagnosis aspects and search for an immunological marker related to therapeutic efficacy.

The recent findings on immunodiagnosis of schistosomiasis mansoni have shown that purified Schistosoma mansoni antigens do not provide maximum positivity. Therefore, the authors suggest the use of semi-purified antigens for diagnostic purposes. So far, no serological marker for cured patients as shown by negative stool examination was found. However, a tendency of IgG antibody titre decrease was observed, when egg antigen was used.

Effects of chemotherapy on mice submitted to multiple Schistosoma mansoni infections. A controlled randomized prospective study.

In an attempt to reproduce experimentally as close a possible the conditions found in endemic areas of mansonian schistosomiasis, a controlled trial in mice submitted to weakly infections with cercariae of S. mansoni was performed. One group (I) was not treated, the other (II) was treated with a single oral doses (100 mg/kg) of oxamniquine at the 13th week. After treatment infections were maintained bi-weekly. Mortality was significantly higher in group I (p less than 0.0001). A comparative morphological and immunoenzymatic study of the liver in the two groups was also carried out, showing a tendency to smaller granulomas and to more efficient antigen restriction in the treated group.