Prognostic factors and clinical outcomes after stereotactic radiotherapy for primary lung tumors.

AIM: To characterize the population treated with SBRT for early-stage primary lung tumors in our institution, determine their outcomes, and identify potential prognosis factors. BACKGROUND: Stereotactic radiotherapy (SBRT) is an alternative treatment for inoperable patients with early-stage lung cancer. It confers a local control rate around 90% at 3 years, and 2-3 year overall survival rates of 43-60% in this population. MATERIALS AND METHODS: We retrospectively analyzed all patients treated in our department between 2012 and 2017 and evaluated local progression-free survival (L-PFS), nodal or distant progression-free survival (ND-PFS), global progression-free survival (G-PFS), overall survival (OS), and disease specific survival (DSS). Univariate (UVA) and multivariate (MVA) models were built to assess the influence of each variable. RESULTS: We identified 218 patients with 233 tumors. Most were male (78.9%) with a median age of 73 years. Median follow-up was 22 months. At 18 months, L-PFS was 93.7%, ND-PFS was 82.2%, G-PFS was 76.0%, DSS was 90.5%, and OS was 78.0% in ≤ T2 tumors. On UVA, T2 tumors were associated with lower L-PFS, G-PFS and DSS than T1, with no significant impact on ND-PFS or OS, an effect that persisted on MVA. On UVA, L-PFS and G-PFS were negatively influenced by female gender and a 5-fraction schedule was associated with worse G-PFS, which was not confirmed on MVA. CONCLUSION: Our local and distant control rates and survival were similar to those previously reported. On MVA, T2 tumors displayed lower L-PFS, G-PFS and DSS, with no difference in OS.

Static Stretch Performed After Strength Training Session Induces Hypotensive Response in Trained Men.

Sousa, AC, Gomes, TM, Sousa, MS, Saraiva, AR, Araujo, GS, Figueiredo, T, and Novaes, JS. Static stretch performed after strength training session induces hypotensive response in trained men. J Strength Cond Res 33(11): 2981-2990, 2019-The purpose of this study was to compare the acute effect of 3 different combinations between passive static stretching exercises (SE) with resistance training (RT) on blood pressure (BP) response in normotensive trained men. Twenty-six volunteer subjects (age: 26.1 ± 5.4 years; body mass: 86.5 ± 10.5 kg; height: 1.78 ± 0.6 cm) participated in this study. After assessing 10 repetition maximum loads for the bench press, lat pulldown, shoulder press, leg press, leg extension, and leg curl, the subjects were randomly assigned on 3 experimental conditions: (a) static SE were performed before the RT session (SE + RT); (b) static SE were performed after the RT session (RT + SE); and (c) static SE were performed between the RT session (RTSE). The BP was measured for 60 minutes after the RT session. The 2-way analysis of variance for repeated measures showed no significant difference (p > 0.05) between the experimental conditions. In within comparisons, only the RT + SE experimental condition did not cause significant increases (p = 0.07) on systolic blood pressure (SBP) when compared the baseline and post-test moments (132.2 ± 10.7 vs. 141.3 ± 18.1 mm Hg). In addition, hypotensive effects were found in SBP only in the RT + SE experimental condition when compared SBP baseline (132.2 ± 10.7 mm Hg) vs. SBP30 minutes (121.7 ± 11.8 mm Hg; p = 0.04), SBP45 minutes (120.6 ± 9.8 mm Hg; p = 0.03), and SBP60 minutes (120.0 ± 7.9 mm Hg; p = 0.00). These findings suggest that performing static SE after the RT session provide an ideal combination for a postexercise hypotensive response from 30 minutes after exercise (and this change was enhanced up to 60 minutes). In conclusion, strength and conditioning professionals can prescribe static SE after RT if the goal is to reduce blood pressure after training.

Pituitary Hyperplasia in a Female Patient with a Severe Childhood Abuse History.

A 24-year-old Caucasian female patient was referred to our endocrinology service to investigate a structural magnetic resonance imaging (sMRI) finding of "pituitary mass". The first two sMRI were identified as pituitary adenoma but the following two examinations suggested the possibility of pituitary hyperplasia (PH). The patient was referred to our service for diagnostic clarification and therapy due to the divergence in sMRI reports and the surgical procedure indicated by the neurosurgical team of the other institution. The patient had no complaints, laboratory tests were all normal, and the sMRI clearly showed a PH. However, what caught our attention was her behavior. During the interview she was intermittently talking and acting like a child even though her age was 24. She reported being a foster child and was severely mistreated during childhood. Parallel psychiatric evaluation was requested and an association between the PH and the childhood abuse was identified. Early life stress may be associated with accelerated pituitary gland volume development, but there is still a paucity of data in literature about this issue. We should be aware of other cases like this one, and a correct differential diagnosis may contribute to contraindicate transsphenoidal surgery. When a childhood abuse history is present, we recommend admission to a psychiatric facility for adequate treatment.

Influence of Rest Interval Length Between Sets on Blood Pressure and Heart Rate Variability After a Strength Training Session Performed By Prehypertensive Men.

Figueiredo, T, Willardson, JM, Miranda, H, Bentes, CM, Machado Reis, V, Freitas de Salles, B, and Simão, R. Influence of rest interval length between sets on blood pressure and heart rate variability after a strength training session performed by prehypertensive men. J Strength Cond Res 30(7): 1813-1824, 2016-The purposes of this study were to compare the effects of 2 different rest interval lengths between sets and exercises during strength training (ST) on blood pressure (BP) and heart rate variability (HRV) in prehypertensive trained men, and to verify how HRV influences BP. Eleven volunteer subjects (age: 26.1 ± 3.6 years; body mass: 74.1 ± 7.9 kg; height: 172.1 ± 4.1 cm; % body fat: 18.3 ± 6.3; ST experience: 1.7 ± 0.8 years) participated in this study. After assessing one repetition maximum (1RM) loads for the free weight bench press, lat pull-down, shoulder press, biceps curl, triceps extension, leg press, leg extension, and leg curl exercises; subjects performed 2 sessions with different rest intervals between sets and exercises in random order and 72 hours apart. Each ST session consisted of performing 3 sets of eight to 10 repetitions at 70% of a 1RM for each exercise, with either 1-minute (sequence 1 [SEQ1]) or 2-minute (sequence 2 [SEQ2]) rest intervals between sets and exercises, respectively. Before and after each session, BP and HRV (low frequency band, high frequency [HF] band, and square root of the mean squared difference of successive RR-interval index) were tracked for 60 minutes. The results demonstrated a postexercise hypotensive response (PEH) after both rest interval conditions (p ≤ 0.05). Additionally, increases in cardiac stress were noted after SEQ1, with a greater withdrawal in parasympathetic activity vs. baseline as noted in the HF band at 1-, 10-, and 20-minute postexercise (p ≤ 0.05). These results indicate that both sequences provided an effective stimulus for a PEH. Therefore, strength and conditioning professionals may prescribe 1- or 2-minute rest between sets and exercises when the goal is to reduce BP after training sessions. However, resting 1 minute between sets and exercises was associated with greater cardiac stress, and so this may necessitate prescription of longer rest intervals between sets and exercises when working with individuals who have been diagnosed with cardiovascular dysfunction.

Influence of Load Intensity on Postexercise Hypotension and Heart Rate Variability after a Strength Training Session.

The purpose of this study was to compare blood pressure and heart rate variability (HRV) responses in trained men after strength training (ST) sessions with loads of 60, 70, and 80% of a 1 repetition maximum (1RM). Eleven men (age: 26.1 ± 3.6 years; body mass: 74.1 ± 8.1 kg; height: 172.0 ± 4.0 cm; body mass index: 25.0 ± 1.96 kg·m(-2); %G: 18.3 ± 6.4) with at least 6-month ST experience participated in this study. After assessment of 1RM loads for the bench press (BP), lat pull-down (LPD), shoulder press (SP), biceps curl (BC), triceps extension (TE), leg press (LP), leg extension (LE), and leg curl (LC), subjects performed 3 experimental sessions in random order. During each experimental session, subjects performed 3 sets of 8-10 repetitions at 60, 70, or 80% of 1RM loads, with 2-minute rest intervals between sets and exercises. All experimental sessions were performed in the following exercise order: BP, LPD, SP, BC, TE, LP, LE, and LC. Before and for 1 hour after each experimental session, blood pressure and HRV were tracked. The results demonstrated a greater duration of postexercise hypotension (PEH) after the 70% of 1RM session vs. the 60 or 80% of 1RM session. These results indicate that the load/volume associated with completion of 8-10 repetitions at 70% of 1RM load may provide the best stimulus for the PEH response when compared with training with a 60 or 80% of 1RM loads. In conclusion, strength and conditioning professionals may prescribe exercises with 60, 70, and 80% of 1RM loads if the intent is to elicit an acute decrease in blood pressure after an ST session; however, 70% of 1RM provides a longer PEH.

Influence of number of sets on blood pressure and heart rate variability after a strength training session.

The purpose of this study was to compare the acute effects of 1, 3, and 5 sets of strength training (ST), on heart rate variability (HRV) and blood pressure. Eleven male volunteers (age: 26.1 ± 3.6 years; body mass: 74.1 ± 8.1 kg; height: 172 ± 4 cm) with at least 6 months previous experience in ST participated in the study. After determining the 1 repetition maximum (1RM) load for the bench press (BP), lat pull down (LPD), shoulder press (SP), biceps curl (BC), triceps extension (TE), leg press (LP), leg extension (LE), and leg curl (LC), the participants performed 3 different exercise sequences in a random order and 72 hours apart. During the first sequence, subjects performed a single set of 8-10 repetitions, at 70% 1RM, and with 2-minute rest interval between exercises. Exercises were performed in the following order: BP, LPD, SP, BC, TE, LP, LE, and LC. During the second sequence, subjects performed the same exercise sequence, with the same intensity, 2-minute rest interval between sets and exercises, but with 3 consecutive sets of each exercise. During the third sequence, the same protocol was followed but with 5 sets of each exercise. Before and after the training sessions, blood pressure and HRV were measured. The statistical analysis demonstrated a greater duration of postexercise hypotension after the 5-set program vs. the 1 set or 3 sets (p ≤ 0.05). However, the 5-set program promoted a substantial cardiac stress, as demonstrated by HRV (p ≤ 0.05). These results indicate that 5 sets of 8-10 repetitions at 70% 1RM load may provide the ideal stimulus for a postexercise hypotensive response. Therefore, ST composed of upper- and lower-body exercises and performed with high volumes are capable of producing significant and extended postexercise hypotensive response. In conclusion, strength and conditioning professionals can prescribe 5 sets per exercises if the goal is to reduce blood pressure after training. In addition, these findings may have importance, specifically in the early phase of high blood pressure development, but more research is needed in hypertensive populations to validate this hypothesis.

Influence of exercise order on repetition performance among all possible combinations on resistance training.

The purposes of this study were to compare the repetition performance and rating of perceived exertion (RPE) in different exercises order of three resistance training (RT) exercises: bench press (BP), shoulder press (SP), and triceps extension (TE). Twelve trained men participated in this study (26.75 ± 2.49 years; 177 ± 4.66 cm; 77.7 ± 6.20 kg; 12.61 ± 2.01% body fat; RT experience 3.58 ± 1.24 years). Data were collected in two phases: (1) 10 RM test for BP, SP, and TE and (2) performance of six RT sequences. The sequences were: SEQA (BP, SP, TE), SEQB (BP, TE, SP), SEQC (SP, BP, TE), SEQD (SP, TE, BP), SEQE (TE, BP, SP), and SEQF (TE, SP, BP). The repetition performance on SEQD was significantly smaller than SEQE and SEQF. No significant differences were found for repetition performance and RPE among other sequences. These data indicate that priority might be given to exercises performed in the beginning of the RT session.

Influence of exercise order on repetition performance during low-intensity resistance exercise.

The purpose of this study was to compare repetition maximum performance and ratings of perceived exertion during resistance exercise sessions conducted at a low intensity (i.e., 20 RM) and in different exercise orders. Twenty-one recreationally trained men performed two total body resistance exercise sessions in opposite orders; each exercise was performed for three sets with 2 minutes passive rest between sets and exercises. The results indicated significantly greater total repetitions for each exercise when performed near the beginning of a sequence and for the first set of each exercise, irrespective of the sequence. The ratings of perceived exertion, however, were not significantly different between sequences. In conclusion, repetition maximum performance for resistance exercise sessions conducted at a low intensity is significantly different based on exercise order. Therefore, when performing high repetitions with relatively low intensity loads, exercises should be prioritized based on individual needs and sports-specific movement patterns for greater volume and potential for the desired neuromuscular adaptations.

Disentangling the Phenomenology of Mind-Wandering.

OBJECTIVE: In the last decade, the research about mind-wandering (MW) significantly improved and allowed us to depth the phenomenology of thoughts. Prototypically, excessive MW was linked with ADHD symptoms. However, many studies have demonstrated the need to relate the type of mind-wandering with specific phenomenological presentations. METHOD: Participants (N = 53; 54.7% male; age range 18-36 years) selfreported the Mind Excessively Wandering Scale (MEWS), and they were investigated for ADHD, impulsivity levels, and anxiety/depressive symptoms. RESULTS: The exploratory analysis indicated a meaningful correlation between MEWS and anxiety traits and depressive symptoms. There was no significant relationship with ADHD symptoms. CONCLUSION: These findings based our discussion about MW's phenomenology considering the novel classification model based on the consideration of clinical markers such as thoughts' content.

Interpersonal negotiation skills in ADHD.

Social interaction difficulties are amongst the most prevalent and pervasive adverse outcomes for children and adolescents with ADHD. Problem-solving strategies are impaired in affected individuals, according to the literature. This study aimed to investigate the social problem-solving skills of children and adolescents with and without ADHD, using objective quantitative measures provided by the Interpersonal Negotiation Strategies Interview (INSI). Since verbal communication skills and working memory may be impaired in ADHD, we investigated their contribution to the performance. Forty-three children and adolescents with ADHD and 27 clinical controls with clinical diagnoses other than ADHD completed the INSI along with measures of verbal communication skills (Verbal Comprehension Index [VCI]): Similarities, Vocabulary and Comprehension subtests from the Wechsler Battery, visual (Corsi Blocks) and verbal (Digit Span) working memory tasks. Groups performed similarly on measures of intellectual functioning, working memory, and verbal communication. For the entire sample, VCI scores were positively correlated with INSI performance scores. The ADHD group performed worse on the INSI than the clinical control group. Linear regression analysis showed that inattention and hyperactivity/impulsivity levels and Similarities predicted INSI's performance. Our findings indicate that interpersonal negotiation difficulties in ADHD are related to DSM-5 defining symptoms of the disorder.

Effects of aerobic, strength, and combined training during pregnancy in the blood pressure: A systematic review and meta-analysis.

Gestational hypertension can lead to fetal complications, and, if untreated, high blood pressure during pregnancy may cause eclampsia and even death in the mother and fetus. Exercise is a strategy for preventing blood pressure disorders. There is little knowledge about the physiological impacts of different physical types of training on blood pressure during pregnancy. For that, this meta-analysis aimed to compare the effects of different physical exercise modalities (i.e., aerobic training-AT, strength training-ST, and combined training-AT + ST) on systolic blood pressure (SBP) and diastolic blood pressure (DBP) of pregnant women. A search was performed on PUBMED, LILACS, CINAHL, Sport discus, EMBASE, SCOPUS, and Cochrane Central Register of Controlled Trials to identify researchers. From 3,450 studies, 20 and 19 were included in the qualitative and quantitative analyses. AT studies presented a medium effect size (ES) on SBP [-0.29 (-2.95 to 2.36) p = 0.83], with substantial heterogeneity (I2 = 64%), and had a large impact on DBP [-1.34 (-2.98 to 0.30) p = 0.11], with moderate heterogeneity (I2 = 30%). ST researchers showed a large ES on SBP [-1.09 (-3.66 to 1.49) p = 0.41], with a reduced heterogeneity (I2 = 0%), and a medium ES on DBP [-0.26 (-2.77 to 2.19) p = 0.83] with moderate heterogeneity (I2 = 38%). AT + ST studies had a large ES on SBP [-1.69 (-3.88 to 0.49) p = 0.13] and DBP [-01.29 (-2.26 to 0.31) p = 0.01] with considerable (I2 = 83%) and moderate heterogeneity (I2 = 47%), respectively. These findings are essential for developing new research protocols to avoid gestational hypertension and preeclampsia. AT + ST had a large impact on the SBP and DBP reduction; however, there is a need for more similar procedures to reduce heterogeneity between studies, promoting consensual results. Systematic Review Registration: [PROSPERO], identifier [CRD42021256509].

Use of the Brazilian version of the Interpersonal Negotiation Strategies Interview (INSI) in a child and adolescent sample: a pilot study.

INTRODUCTION: Interpersonal negotiation skills (INS) comprise actions used to solve social situations between interacting individuals involving different needs or desires. These abilities are part of one's social competence and may be impaired in some psychiatric conditions. There are few validated psychometric tools for measuring INS in the literature. This pilot study aimed to investigate some basic psychometric properties of the Brazilian version of the Interpersonal Negotiation Strategies Interview (INSI) in children and adolescents. METHODS: We developed a new version of the INSI adapted to the Brazilian culture using eight different dilemmas in dyadic situations (with peers and adults), presented visually as drawings on cards. A group of psychologists and psychiatrists chose and adapted the dilemmas formerly proposed by the original version. The same scoring criteria as for the original instrument were used. A total of 20 children and adolescents were included in this pilot study. We investigated test reliability using measures of interrater reliability, test-retest, and internal consistency. The content validity of the INSI was also evaluated by comparison with scores from the Child Behavior Checklist-Revised (CBCL). RESULTS: Internal consistency and test-retest evaluations were acceptable (rater 1: α = 0.77; rater 2: α = 0.72); the reliability of the instrument was excellent (K = 0.078; intraclass correlation coefficient = 0.98; 95% confidence interval 0.97-0.99); and content validity was strongly significant (p < 0.001). CONCLUSIONS: Preliminary results suggest that this version of the INSI has good interrater reliability and internal consistency and constitutes a promising tool to assess social competence.

Can Post-Exercise Hemodynamic Response Be Influenced by Different Recovery Methods in Paraplegic Sportsmen?

Post-exercise hypotension is of great clinical relevance and also in sports training settings, as recovery speed is important. The aim of this study was to compare the influence of different recovery methods on post-exercise hemodynamic response. Twelve male paraplegic sportsmen (25.40 ± 3.30 years) performed a strength training (ST) session using the bench press exercise. After the ST, three recovery methods were randomly performed over a 15-min period: passive recovery (PR), cold-water (CW) and dry needle (DN). Blood pressure (BP), heart rate (HR) and myocardial oxygen were measured before and post ST, as well as post the recovery method. Results: Dry needling induced lower systolic blood pressure (SBP) immediately after the treatment when compared with the other recovery methods, but the contrary was observed at 50 and 60-min post recovery, where records with DN exhibit higher mean values (η2p = 0.330). There were no differences in post-exercise diastolic BP and mean BP between recovery methods. There was a significantly higher HR after the PR method, when compared with CW and with DN (η2p = 0.426). The same was observed for double product and for myocardial oxygen, though with a larger effect size (η2p = 0.446). We conclude that dry needling seems to induce a faster SBP lowering immediately after the procedure but at 50-min post procedure the cold-water method showed better result. As for HR, both procedures (DN and CW) showed a better recovery when compared with passive recovery, along the several moments of measurement.

The Recurrence of Motor Tics Mediated by Oral Prednisolone Use in Autistic Children: A Case Report.

OBJECTIVES: This study aimed to report motor tics worsening by prednisolone acute treatment, despite the use of aripiprazole and clonidine. It was also aimed to discuss the mechanisms involved in neuropsychiatric adverse effects with the use of corticosteroids. METHODS: It was reported a 7-year-old boy patient with a history of autism spectrum disorder and motor tics. He has remitted motor tics with an association between aripiprazole and clonidine. However, was registered motor tics' recurrence with acute use of prednisolone. CONCLUSIONS: The neuropsychiatric adverse effects mediated by corticosteroid use are low explored, mainly in pediatric clinical practice. The prednisolone prescription is widespread in childhood and, considering some vulnerable conditions to this type of adverse effects, is imperative.

Impulsivity as an Endophenotype in ADHD: Negative Findings.

Impulsivity has a strong genetic component and is considered an endophenotype in many psychiatric disorders. Impulsivity in adult ADHD has become a focus of interest more recently because of its suggested prominence in this age. Objective: This study aimed to access self-reported impulsivity levels in biological parents of ADHD offspring, according to their status: non-ADHD (controls), remitted, nonremitted. Method: Impulsivity levels of 155 parents of ADHD children were compared according to their status using the Barratt Impulsiveness Scale (BIS-11). Results: The ADHD group presented the highest levels of impulsivity compared with all other groups. The remitted ADHD and control groups showed no significant differences in impulsivity levels. Conclusion: Impulsivity tended to remit alongside ADHD symptoms in remitters and to persist in those presenting with the residual form of adult ADHD suggesting it should not be considered as an endophenotype. Only the attentional dimension was impaired, cautioning against Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) impulsivity proposed criteria.

Disregarding Impairment in ADHD Diagnosis Inflates Its Prevalence.

Diagnostic and Statistical Manual of Mental Disorders-fifth edition (DSM-V) diagnostic criteria for attention-deficit hyperactivity disorder (ADHD) has reemphasized impairment although many studies have demonstrated that such approach may inflate prevalence rates. However, there is no consensus on how impairment should be measured and a myriad of approaches in different studies make comparisons difficult. Objective: To investigate whether impairment measured using a previous validate quantitative measure modifies prevalence rates in a sample of Brazilian children and adolescents. Method: Of 109 children (72 males, 37 females), mean age of 12.4 years, 68 were with ADHD (according to DSM criteria, except for impairment) and 41 were typically developing children. All were evaluated with semi-structured interviews and completed the Functional Impairment Scale (FIS). Results: Thirty-five percent of ADHD cases had impairment in one single domain or no impairment at all (among school performance, social life, family life, and self-perception) in the FIS. Conclusion: Disregarding impairment clearly inflates ADHD diagnosis.

Mind-wandering, depression, anxiety and ADHD: Disentangling the relationship.

BACKGROUND: Mind Wandering (MW) has been associated with ADHD in a very small number of studies with adults and children. However, anxiety and depression have also been associated with MW and both are often comorbid with ADHD. The aim of this study was to investigate the role of anxiety and depression in MW in patients with ADHD. METHODS: The Mind Excessively Wandering Scale (MEWS) compared the levels of MW controlling for the presence of anxiety and depression symptoms in 78 adolescents (53 males and 25 females) comprising ADHD, clinical controls and typically developing individuals. Correlational analysis between MEWS score, demographic variables, ADHD, anxiety and depressive symptoms was performed using simple and multiple linear regression analysis demonstrating that only anxiety predicted MW scores. On a second analysis, we compared Anxiety and Non-Anxiety as well as ADHD and non-ADHD groups. RESULTS: Levels of MW were significantly correlated with anxiety symptoms, but not with depression. In addition, there were no differences in ADHD and non-ADHD groups regarding MW levels. CONCLUSIONS: Our results suggest MW is associated with anxiety levels, independently of an ADHD diagnosis.

Comparison between traditional strength training and complex contrast training on soccer players.

BACKGROUND: The purpose of this study was to compare traditional strength training (TST) versus complex and contrast training (CCT) on sprint, change of direction speed (COD) and squat jump (SJ) in young male soccer players. METHODS: Twenty-two soccer players (age: 18.4±0.4 years, body mass: 70.2±9.1 kg, height: 179.9±7.5 cm), were randomly assigned to one of two groups: TST (N.=12) and CCT (N.=10). The study was conducted using a randomized experimental design over an eight-week period. The participants assigned to the CCT group performed high-power exercises paired with high-velocity exercises. The participants assigned to the TST group performed resistance exercises in a straight-set forma. During the study period, sprint tests for 5, 10, 20 and 30 m split times, COD and SJ were applied. A two-way ANOVA was applied, and the alpha level was P<0.05. RESULTS: The results demonstrated that the CCT regimen elicited significant within-group differences in 5 m sprint time (1.032 s to 0.997 s, pre- and postintervention, respectively, effect size (ES) = -0.5, medium; P=0.04), COD (5.963 s to 5.639 s, pre- and postintervention, respectively, ES -2.7, large; P<0.001) and SJ (30.9 cm to 34.4 cm, pre- and postintervention, respectively, ES =0.8, large; P<0.001). Conversely, the TST did not elicit significant within-group differences for any of the dependent variables. No differences were found between groups at the post-test time point. CONCLUSIONS: In conclusion, the CCT protocol could be used to improve sprint, COD and SJ in male soccer players.