PPARα Gene Is Involved in Body Composition Variation in Response to an Aerobic Training Program in Overweight/Obese.

The objective of this study was to investigate the relationship of the polymorphism in Intron 7 G/C (rs 4253778) of the peroxisome proliferator-activated receptor alpha (PPARα) gene with the magnitude of changes in the body composition of an overweight and obese population that underwent an aerobic training program. Fifty-eight previously inactive men and women, body mass index (BMI) 31.5 ± 2.8 kg/m2, 46.5% (n = 27) genotyped as CC genotype and 53.5% (n = 31) as CA+AA, underwent a 12-week aerobic training (walking/running). Aerobic capacity (ergospirometry), body composition (DXA), and nutritional assessment were made before and 48 h after the experimental protocol. Two-way ANOVA, chi-square test, and logistic regression were used (p < 0.05). Twenty-seven volunteers (46.5%) were identified as CC genotype and 31 (53.5%) as CA+AA genotype. Time-group interaction showed that there was no difference in these between two allele groups. However, differences in distribution of respondents or nonresponders according to allele A were identified for fat mass (p ≤ 0.003), percentage fat mass (p ≤ 0.002), the waist (p ≤ 0.009), abdomen (p ≤ 0.000), and hip (p ≤ 0.001), this difference being independent for the fat mass. Meanwhile, sex, age, and nutritional management have also been found to be influential factors. It is concluded that the PPARα gene is involved in varying body composition in response to an aerobic training program.

Oxidative stress does not influence weight loss induced by aerobic training in adults: randomized clinical trials.

BACKGROUND: High levels of oxidative stress promote degradation of the cell membrane impairing cellular function in fat oxidation. However, the influence of oxidative stress on exercise-induced weight-loss has not yet been investigated. Therefore, the aim of this study was to verify the influence of a lipidic peroxidation marker (malondialdehyde, MDA) and antioxidant status (total antioxidant capacity marker, TAC) on the magnitude of weight-loss by aerobic-induced exercise in previously sedentary overweight or obese individuals. METHODS: Seventy-five physically inactive adults were randomized into experimental (N.=58) and control (N.=17) groups, who engaged in a 12-week program of aerobic training walking and/or running (3 to 5 days/week) or stretching (1 day/week), respectively. Body composition (DXA), aerobic capacity (ergospirometric) and blood collections for oxidative stress analysis (MDA and TAC) were determined before and after the experimental protocol. Two-way ANOVA for repeated measures or Friedman's test were used to evaluate differences in time/group interaction. Pearson correlation was used to verify the relationship between the variables of oxidative stress and of body composition. RESULTS: Significant reduction was found in fat body mass of experimental when compared to control group (-1.3±1.9 kg versus -0.3±1.3, P=0.04). Experimental group also altered significantly the total body mass (-1.2±4.7 kg; effect size 0.44), body mass index - BMI (-0.3±1.1 effect size 0.37), fat percentage (1.3±1.6%; effect size 0.50) and lean body mass (0.6±1.5 kg; effect size 0.32).There was increase in MDA of 2.3 µmol/L to 2.7 µmol/L (P=0.00), without changes to TAC (25.6±13.9% to 28.0±10.4%). No correlation was found between these variations in body composition with either the initial values of MDA and TAC or delta variation of these indicators of oxidative stress in response to the training program. CONCLUSIONS: Indicators of oxidative stress (MDA and TAC) does not influence the magnitude of weight-loss induced by aerobic training.

Validity of the Brazilian version of the Geriatric Depression Scale (GDS) among primary care patients.

BACKGROUND: The aim of the present study was to determine the validity of the Brazilian version of the Geriatric Depression Scale (GDS) with 30 (GDS-30), 15 (GDS-15), 10 (GDS-10), 4 (GDS-4) and 1 (GDS-1) items and to calculate the optimum cutoff points for identifying depression among elderly primary care subjects. METHODS: A cross-sectional study was carried out involving 220 elderly patients recruited from four primary care clinics in northeastern Brazil. The following measurements were obtained: sociodemographic variables, Katz scale of independence in activities of daily living, and the GDS with 30, 15, 10, 4 and 1 item(s). A psychiatrist blinded to the results of the GDS applied the mood module of the Structured Clinical Interview for the DSM-IV for the diagnosis of major depressive episodes as the "gold standard." RESULTS: The use of the cut-off point of 10/11 for the GDS-30 produced sensitivity and specificity rates of 92.0% (95% CI: 70-98) and 79% (95% CI: 73-85), respectively. The positive predictive value (PPV) and the negative predictive value (NPV) were 49% and 98%, respectively. The optimum cut-off point for the GDS-15 was 4/5, at which sensitivity was 87% (95% CI: 71-95) and specificity was 82% (95% CI: 76-91), PPV was 51% and NPV was 97%. At the cut-off point of 3/4 the sensitivity, specificity, PPV and NPV for the GDS-10 were 76% (95% CI: 60-89), 81% (95% CI: 75-87), 46% (95% CI: 33-59%), and 94% (95% CI 89-97%), respectively. The optimum cut-off point for the GDS-4 was 0/1, at which sensitivity was 84% (95% CI: 68-93%); specificity was 75% (95% CI; 68-91%); PPV was 41% and NPV was 96%. For the GDS-1, sensitivity was 47%, specificity was 96%; PPV was 69% and NPV was 90%. CONCLUSIONS: The GDS-30, GDS-15, GDS-10 and GDS-4 proved to be good screening instruments for depression in primary care clinics in Brazil, whereas the GDS-1 failed to perform adequately.

Breaking down automaticity: case ambiguity and the shift to reflective approaches in clinical reasoning.

CONTEXT: Two modes of case processing have been shown to underlie diagnostic judgements: analytical and non-analytical reasoning. An optimal form of clinical reasoning is suggested to combine both modes. Conditions leading doctors to shift from the usual mode of non-analytical reasoning to reflective reasoning have not been identified. This paper reports a study aimed at exploring these conditions by investigating the effects of ambiguity of clinical cases on clinical reasoning. METHODS: Participants were 16 internal medicine residents in the Brazilian state of Ceará. They were asked to diagnose 20 clinical cases and recall case information. The independent variable was the degree of ambiguity of clinical cases, with 2 levels: straightforward (i.e. non-ambiguous) and ambiguous. Dependent variables were processing time, diagnostic accuracy and proposition per category recalled. Data were analysed using a repeated measures design. RESULTS: Participants processed straightforward cases faster and more accurately than ambiguous ones. The proportion of text propositions recalled was significantly lower (t[15] = 2.29, P = 0.037) in ambiguous cases, and an interaction effect between case version and proposition category was also found (F[5, 75] = 4.52, P = 0.001, d = 0.232, observed power = 0.962). Furthermore, participants recalled significantly more literal propositions from the ambiguous cases than from the straightforward cases (t[15] = 2.28, P = 0.037). CONCLUSIONS: Ambiguity of clinical cases was shown to lead residents to switch from automatic to reflective reasoning, as indicated by longer processing time, and more literal propositions recalled in ambiguous cases.

Anastomose mamária interna-artéria pulmonar para o tratamento paliativo das cardiopatias congênitas cianóticas / Internal mammary-pulmonary anastomosis for the palliative treatment of cyanotic congenital cardiopathies

As anastomoses sistêmico-pulmonares continuam sendo um importante procedimento no tratamento e na preparaçao dos cardiopatas cianóticos, com hipoplasia das artérias pulmonares, para a correçao total. Todas têm vantagens e desvantagens e os resultados dependerao de idade e peso dos pacientes e da complexidade da cardiopatia. O presente estudo relata a experiência com sete casos de anastomoses mamária-artéria pulmonar, realizadas através de toracotomia direita (5) e esquerda (2), em pacientes portadores de tetralogia de Fallot (quatro femininos e três masculinos). A idade variou de dois a 63 meses (m = 18,4), com peso médio de 7,9 kg. Seis apresentavam graus variados de hipoplasia pulmonar. Houve dois óbitos pós-operatórios (l( e 2( dias), devidos a trombose da artéria mamária, no local de seu clampleamento. Dois pacientes foram submetidos a correçao total (um mês e três anos após): no 1( (menina de 24 meses, 10 kg de peso), a anastomose foi feita pelas más condiçoes gerais, apesar do bom tamanho das pulmonares. No 2( (menino de 15 meses, 8,1 kg, no qual uma operaçao de Blalock-Taussig clássica foi feita e trombosou no 3( mês de vida), foi possível observar o progressivo desenvolvimento das artérias pulmonares, por estudo hemodinâmico. Em ambos, o funcionamento da anastomose era perfeito e a correçao foi bem sucedida. Três outros pacientes aguardam o momento oportuno para a correçao final. Apesar do reduzido número e do curto tempo de observaçao, acredita-se que a anastomose mamária-pulmonar possa ser outra opçao paliativa para os portadores de cardiopatias congênitas cianogênicas, com hipoplasia das artérias pulmonares e que os melhores resultados devam ser obtidos nos pacientes maiores, fora de situaçoes de emergência e com pequenas artérias pulmonares.