Physical fitness profile of military lifeguards.

Introduction: Throughout a lifeguard's career, regardless of age, the physical demands of performing a water rescue are likely to remain constant. Objectives: To establish a physical fitness profile by age group of a sample composed of professional beach lifeguards who regularly engage in physical activity. Methods: One hundred and seventy-two lifeguards were initially recruited for this study. Data from 99 male lifeguards were provided for analysis. Anthropometric measurements, lower limb strength, and handgrip measurements were taken at the initial visit. During a second visit, running tests were performed on sand. All testing procedures followed the same predefined sequence for all individuals. Results: One-way analysis of variance with post hoc Bonferroni or Kruskal-Wallis adjusted analysis was performed to assess differences between age groups depending on the exact variable. The significance level was set at p ≤ 0.05. There were statistically significant differences in all power and velocity performance parameters as well as body fat percentage with better results found in the younger age groups (20-29;30-39) compared to an older age group (40-49). However, there were no statistically significant differences between the groups for handgrip strength. Conclusions: The results of the present study indicate significant differences in physical fitness between different age groups. The authors suggest that the squat jump, countermovement jump, 20-meter linear sprint test, zigzag change-of-direction test, and running anaerobic sprint test assessment should be used as screening tools for fitness.

Introdução: Ao longo da vida profissional de um guarda-vidas, independentemente da idade, as exigências físicas impostas durante um salvamento provavelmente se manterão constantes. Objetivos: Estabelecer um perfil de aptidão física de uma amostra composta por guarda-vidas profissionais praticantes de atividade física regular. Métodos: Cento e setenta e dois salva-vidas foram inicialmente recrutados para este estudo. Dados de 99 indivíduos foram utilizados para análise. Medidas antropométricas foram obtidas durante a primeira visita, assim como a análise da potência de membros inferiores e da força de preensão manual. Testes de velocidade e mudança de direção foram realizados em uma segunda visita. A testagem seguiu a mesma ordem predefinida para todos os indivíduos. Resultados: Uma análise de variância com post-hoc de Bonferroni ou o teste de Kruskal-Wallis com comparações por pares ajustada foi utilizado para comparação entre grupos, a depender da variável. O nível de significância adotado foi de ≤ 0,05. Foram observadas diferenças estatisticamente significativas entre as faixas etárias para todos os testes de potência e velocidade, bem como no percentual de gordura corporal, com melhores resultados encontrados nas faixas etárias mais jovens (20-29 e 30-39 anos quando comparados ao grupo 40-49). No entanto, não houve diferença estatisticamente significativa entre os grupos em relação à força de preensão manual. Conclusões: Os resultados indicam diferenças estatisticamente significativas na aptidão física de guarda-vidas entre as diferentes faixas etárias. É sugerido que o salto vertical, sem e com contramovimento, o teste de 20 metros, o teste de corrida anaeróbica e o teste em zigue-zague sejam implementados como ferramenta para triagem da aptidão física.

Acute brachial plexopathy secondary to surgical management of an atrophic nonunion of a clavicle fracture.

We report the case of a 28-year-old patient who developed acute transient brachial plexopathy secondary to surgical management of an atrophic clavicle nonunion. The treatment was conservative, with symptom resolution at 4 months after surgery. This is the first reported case with electromyographic and neuroconduction follow-up, demonstrating complete and spontaneous resolution of axonal damage. The limited number of cases reported in the scientific literature allows for exploring some underlying causes of the acute plexopathy depending on the nature of the non-union (hypertrophic or atrophic).

Infratentorial Cerebral Cavernous Malformation May be a Risk Factor for Symptomatic Bleeding and Precocity of Symptoms: A Multicenter, Propensity Score Matched, Case-Control Study.

BACKGROUND: Cerebral Cavernous Malformation (CCM) is one of the most common types of vascular malformation of the central nervous system. Intracerebral hemorrhage, seizures, and lesional growth are the main clinical manifestations. Natural history studies have tried to identify many risk factors; however, the clinical course remains highly unpredictable. OBJECTIVE: Here, we have analyzed a multicenter CCM cohort looking for the differential clinical data regarding the patients harboring supra and/or infratentorial cavernous malformations in order to better understand risk factors involved in the anatomical location of the unique neurosurgical disease. METHODS: We have presented a multicenter, Propensity Score Matched (PSM), case-control study including 149 consecutive CCM cases clinically evaluated from May 2017 to December 2022 from three different neurosurgical centers. Epidemiological data were defined at each clinical assessment. Logistic regression was used to identify the independent contribution of each possible risk factor to the bleeding risk. To balance baseline covariates between patients with and without symptoms, and specifically between those with and without symptomatic bleeding, we used a PSM strategy. The Kaplan-Meier curve was drawn to evaluate if patients with infratentorial lesions had a greater chance of bleeding earlier in their life. RESULTS: The presence of infratentorial lesions was a risk factor in the multivariate analysis comparing the bleeding risk with pure asymptomatic individuals (OR: 3.23, 95% CI 1.43 - 7.26, P = 0.005). Also, having an infratentorial CCM was a risk factor after PSM (OR: 4.56, 95% CI 1.47 - 14.10, P = 0.008). The presence of an infratentorial lesion was related to precocity of symptoms when the time to first bleed was compared to all other clinical presentations in the overall cohort (P = 0.0328) and in the PSM group (P = 0.03). CONCLUSION: Here, we have provided some evidence that infratentorial cerebral cavernous malformation may have a more aggressive clinical course, being a risk factor for symptomatic haemorrhage and precocity of bleeding.

First Report of Concomitant Pathogenic Mutations Within MGC4607/CCM2 and KRIT1/CCM1 in a Familial Cerebral Cavernous Malformation Patient.

BACKGROUND: Familial cerebral cavernous malformations (CCM) are among the most common vascular malformations of the central nervous system (CNS) and are linked to mutations on the specific genes CCM1/KRIT1, CCM2/MGC4607, and CCM3/PDCD10. We present the first report in the literature of a pharmaco-resistant epileptic patient harboring co-occurring pathogenic mutations within CCM2/MGC4607 and CCM1/KRIT1. CASE DESCRIPTION: A 51-year-old patient first presented at age of 33 years with episodes of seizures. Magnetic resonance imaging including a susceptibility-weighted imaging sequence had shown multiple cerebral cavernous malformation lesions. She had partial response of symptoms and remained in routine follow-up needing progressive pharmacological improvement. Direct sequencing allowed the detection of 1 nonsense pathogenic mutation in CCM2/MGC4607 (c.118C>T; p.Arg40Ter) and 1 unclassified frameshift insertion variant in CCM1/KRIT1 (c.1687_1688insT; p.Tyr563LeufsTer5). CONCLUSIONS: Although the CCM2/MGC460 variant seems to be the major contributor for the patient's CCM phenotype, the mutated CCM1/KRIT1 seems to act as a booster to CCM overall pathogenicity.

Redescription of Naineris aurantiaca (Müller, 1858) and designation of a neotype from the Brazilian coast (Annelida: Orbiniidae).

The genus Naineris differs from other genera of the Orbiniidae in that all its species possess a rounded prostomium and one or two achaetous rings. Currently, 21 species of this genus have been described worldwide, five of which are recorded from Brazil. Naineris aurantiaca is the only species originally described from the Brazilian coast and the original description is the only record of this species. The description is short and vague, making identification difficult. From recent samples obtained in the type locality of Florianópolis, Brazil, we were able to study specimens of Naineris aurantiaca and redescribe the species. Diagnostic characters for this species are the presence of pre- and post-branchial papillae, anterior branchiae in thoracic segments considerably smaller than those of the rest of the body, distinct dorsal sensory organ from chaetiger 12 onwards, the chaetal arrangement of the thoracic neuropodia (crenulated capillaries in a lower oblique row, uncini in an upper oblique row, subuluncini in two anterior transverse rows, and acicular spines in a posterior row), interramal papillae only present on abdominal parapodia, and the presence of furcate chaetae in the abdominal notopodia. Here, we designate a neotype for the species and discuss the morphological variations we observed among specimens.

Functional capacity, renal function and vitamin D in community-dwelling oldest old.

PURPOSE: The aim of this study was to evaluate the association between the decline in estimated glomerular filtration rate (eGFR) and serum 25(OH)D with the physical and mental functional capacity of elderly individuals aged 80 years or older. METHODS: We evaluated the functional capacity in its multidomain aspects: Geriatric Depression Scale (GDS), Instrumental Activities of Daily Living (IADL), Mental State Mini-Exam (MMSE), Verbal Fluency Test (VF), handgrip strength and time to sit and rise from a chair five times, combined creatinine and cystatin C-based eGFR and 25(OH)D levels in 205 independent asymptomatic and community-dwelling elderly subjects in a cross-sectional study. RESULTS: Every 1 year of life, there was reduction of about 10% chance of adequate performance in functional capacity. Each 1 ml/min/m2 in eGFR was associated with 2% better chance of adequate performance in the IADL. We found no association between eGFR and cognition. Serum 25(OH)D between 15.00 and 22.29 ng/ml increased the chance of better performance in VF, IADL, handgrip strength and sit and rise from the chair compared to the lower level of serum vitamin D. CONCLUSIONS: Decreased renal function associated with age compromises the ability to perform activities for independent life in the community, but we did not observe influence in specific domains of cognition and physical performance. Low serum level of 25(OH)D appears to be a marker of greater risk of functional decline than eGFR measurement in independent oldest old dwelling in the community.

Prevalence of chronic kidney disease and comorbidities in isolated African descent communities (PREVRENAL): methodological design of a cohort study.

BACKGROUND: Chronic kidney disease (CKD) is considered a serious public health problem, both in Brazil and worldwide, with an increasing number of cases observed inrecent years. Especially, CKD has been reported to be highly prevalent in those of African descent. However, Brazil lacks data from early-stage CKD population studies, and the prevalence of CKD is unknown for both the overall and African descent populations. Hence, the present study aimsto estimate the prevalence of early-stage CKD and its associated risk factors in African-Brazilians from isolated African-descent communities. Herein, the detailed methodology design of the study is described. METHODS: This population-based, prospective, longitudinal, cohort study (PREVRENAL) is performed in three stages: first, clinical, nutritional, and anthropometric evaluations; measurements of serum and urinary markers; and examinations of comorbiditieswere performed. Second, repeated examinations of individuals with CKD, systemic arterial hypertension, and/or diabetes mellitus; image screening; and cardiac risk assessment were performed. Third, long-term monitoring of all selected individuals will be conducted (ongoing). Using probability sampling, 1539 individuals from 32 communities were selected. CKD was defined asaglomerular filtration rate (GFR) ≤60 mL/min/1.73m2 and albuminuria > 30 mg/day. DISCUSSION: This study proposes to identify and monitor individuals with and without reduced GFR and high albuminuria in isolated populations of African descendants in Brazil. As there are currently no specific recommendations for detecting CKD in African descendants, four equations for estimating the GFR based on serum creatinine and cystatin C were used and will be retrospectively compared. The present report describes the characteristics of the target population, selection of individuals, and detection of a population at risk, along with the imaging, clinical, and laboratory methodologies used. The first and second stages have been concluded and the results will be published in the near future. The subsequent (third) stage is the long-term, continuous monitoring of individuals diagnosed with renal abnormalities or with CKD risk factors. The entire study population will be re-evaluated five years after the study initiation. The expectation is to obtain information about CKD evolution among this population, including the progression rate, complication development, and cardiovascular events.

Doença de Creutzfeldt-Jakob: forma esporádica: relato de caso em paciente de 81 anos / Creutzfeldt-Jacob disease-sporadic form: case report of 81-year-old patient

As doenças priônicas são neurodegenerativas e possuem longo período de incubação, progredindo inexoravelmente, assim que os sintomas clínicos aparecem. A doença de Creutzfeldt-Jakob é a mais frequente das doenças priônicas, embora ainda seja rara. O quadro clínico dela é caracterizado por uma demência rapidamente progressiva, sintomas cerebelares e extrapiramidais, e a ressonância magnética, o eletroencefalograma e a análise do líquido cefalorraquidiano possuem achados típicos. Relatamos o caso de um paciente de 81 anos que se apresentou com declínio cognitivo rapidamente progressivo seguido, posteriormente, de mutismo acinético. Proteína 14-3-3 foi detectada no líquido cefalorraquidiano. A ressonância magnética revelou hipersinal do núcleo caudado e putâmen em imagem em difusão, T2 e FLAIR.(AU)

Prion diseases are neurodegenerative, and have long incubation periods, progressing inexorably once clinical symptoms appear. Creutzfeldt-Jakob disease (CJD) is the most frequent of the human prion diseases, although being still rare. The clinical picture of this disease is characterized by a rapidly progressing dementia, cerebellar and extrapyramidal symptoms, and rather specific magnetic resonance (MR), electroencephalography and cerebrospinal fluid (CSF) findings. We report the case of an 81-year-old patient who presented with rapidly progressive cognitive decline followed by akinetic mutism. Protein 14-3-3 in cerebrospinal fluid was detected. Magnetic resonance imaging findings revealed hyperintensity of the caudate and putamen in diffusion-weighted imaging, T2 Weighted sequences and FLAIR images. Patients who have progressive dementia should be evaluated by means of magnetic resonance imaging and cerebrospinal fluid analysis for Creutzfeldt-Jakob.(AU)

Papel da titina na modulação da função cardíaca e suas implicações fisiopatológicas / The role of titin in the modulation of cardiac function and its pathophysiological implications / Papel de la Titina en la Modulación de la Función Cardíaca y sus Implicaciones Fisiopatológicas

A titina é uma proteína sarcomérica gigante que se estende desde a linha Z até a linha M. Em razão de sua localização, representa um importante sensor biomecânico com um papel fundamental na manutenção da integridade estrutural do sarcômero. A titina funciona como uma "mola bidirecional" que regula o comprimento sarcomérico e realiza ajustes adequados da tensão passiva sempre que o comprimento varia. Dessa forma, não só determina a rigidez ventricular e a função diastólica, como também influencia a função cardíaca sistólica, modulando o mecanismo de Frank-Starling. O miocárdio expressa duas isoformas dessa macromolécula: a N2B, mais rígida, e a isoforma N2BA, mais complacente. As alterações na expressão relativa das duas isoformas da titina ou alterações do seu estado de fosforilação têm sido implicadas na fisiopatologia de várias doenças como a insuficiência cardíaca diastólica, a cardiomiopatia dilatada, a cardiomiopatia isquêmica e a estenose aórtica. Neste artigo pretende-se descrever sumariamente a estrutura e localização da titina, a sua relação com diferentes cardiomiopatias, e compreender de que forma as alterações dessa macromolécula influenciam a fisiopatologia da insuficiência cardíaca diastólica, salientando o potencial terapêutico da manipulação dessa macromolécula.

Titin is a giant sarcomeric protein that extends from the Z-line to the M-line. Due to its location, it represents an important biomechanical sensor, which has a crucial role in the maintenance of the sarcomere structural integrity. Titin works as a "bidireactional spring" that regulates the sarcomeric length and performs adequate adjustments of passive tension whenever the length varies. Therefore, it determines not only ventricular rigidity and diastolic function, but also systolic cardiac function, modulating the Frank-Starling mechanism. The myocardium expresses two isoforms of this macromolecule: the N2B, more rigid and the isoform N2BA, more compliant. The alterations in the relative expression of the two titin isoforms or alterations in their state of phosphorylation have been implicated in the pathophysiology of several diseases, such as diastolic heart failure, dilated cardiomyopathy, ischemic cardiomyopathy and aortic stenosis. The aim of this study is to describe, in brief, the structure and location of titin, its association with different cardiomyopathies and understand how alterations in this macromolecule influence the pathophysiology of diastolic heart failure, emphasizing the therapeutic potential of the manipulation of this macromolecule.

La titina es una proteína sarcomérica gigante que se extiende desde la línea Z hasta la línea M. En razón de su ubicación, representa un importante sensor biomecánico con un papel fundamental en la manutención de la integridad estructural del sarcómero. La titina funciona como un "resorte bidireccional" que regula el largo sarcomérico y realiza ajustes adecuados de la tensión pasiva siempre que ese largo varía. De esa forma, no sólo determina la rigidez ventricular y la función diastólica, sino también influye en la función cardíaca sistólica, modulando el mecanismo de Frank-Starling. El miocardio expresa dos isoformas de esa macromolécula: la N2B, más rígida, y la isoforma N2BA, más complaciente. Las alteraciones en la expresión relativa de las dos isoformas de la titina o alteraciones de su estado de fosforilación han sido implicadas en la fisiopatología de varias enfermedades como la insuficiencia cardíaca diastólica, la cardiomiopatía dilatada, la cardiomiopatía isquémica y la estenosis aórtica. Este artículo pretende describir sumariamente la estructura y ubicación de la titina, su relación con diferentes cardiomiopatías, y comprender de qué forma las alteraciones de esa macromolécula influyen en la fisiopatología de la insuficiencia cardíaca diastólica, destacando el potencial terapéutico de la manipulación de esa macromolécula.

Tratamento da síndrome da apnéia obstrutiva do sono e do ronco por meio do aparelho reposicionador mandíbulo-lingual: Avaliaçäo dos resultados por exames polissonográficos e de imagens obtidas por ressonância magnética / Obstructive sleep apnea syndrome and snoring treatment with mandibular-lingual-repositioning device-MLRD: Polysomnographic and magnetic resonance image outcome

A síndrome da apnéia obstrutiva do sono (SAOS) é uma afecçäo incapacitante com alto grau de morbidade e relacionada igualmente com um alto índice de mortalidade. Ultimamente, o uso de aparelhos bucais (AB) no tratamento da SAOS e roncos primários tem merecido a atençäo das especialidades da área devido à sua aceitabilidade pelo paciente e sua eficiência para os casos de SAOS leve-moderada, além de alguns casos graves. A dificuldade de receptividade para outros tratamentos (cirurgia e aparelhos de pressäo positiva (nasal CPAP - Continuous Positive Airway Pressure) no nosso meio torna o uso dos AB uma alternativa terapêutica de alta validade porque säo menos dispendiosos, näo invasivos, reversíveis e bem aceitos. Neste trabalho foi realizada uma verificaçäo da eficiência do Aparelho Reposicionador Mandíbulo Lingual (ARML) no tratamento de 9 pacientes, sob os seguintes parâmetros: Indice de apnéia e hipopnéia (IAH), saturaçäo da oxihemoglobina do sangue arterial (Sat O² min.), quantificaçäo da sonolência diurna medida pela "Escala de Sonolência de Epworth" (ESE), obtençäo de imagens de ressonância magnética, que permitiram o cálculo dos volumes das vias aéreas superiores (VAS). Estes exames foram efetuados antes (controle) e após o uso do ARML. Aplicado o teste "t" de Student unicaudal para média de amostras emparelhadas, verificou-se uma diminuiçäo do IAH de, em média 26,3 para 17,8 eventos por hora; um aumento na Sat O² min. de 80 por cento para 86 por cento, em média; a sonolência diurna, medida pela ESE diminuiu de 16 para 7,8 pontos. Com relaçäo ao volume das VAS só houve um aumento significativo no segmento considerado orofaringe retropalatina. Concluiu-se que o ARML é eficiente para o tratamento de SAOS leve e moderada principalmente quando a obstruçäo está localizada na regiäo de orofaringe retropalatina, e que a ressonância é um método eficaz para a observaçäo dos volumes das VAS

Mandibular-lingual repositioning device - MLRD: preliminary results of 8 patients with obstructive sleep apnea syndrome - OSAS

Dental devices have been employed in the treatment of snoring and obstructive sleep apnea syndrome (OSAS) of mild to moderate degrees. The authors disclose the preliminary results in 8 patients with clinically diagnosed obstructive sleep apnea polisomnographically confirmed and treated with a dental device (Mandibular-Lingual Repositioning Device - MLRD) developed by one of the authors (RCB). Cephalometrics was performed before usage of MLRD, Epworth Sleepiness Scale (ESS) tests were conducted before and after the MLRD and a questionnaire that subjectively qualified the Overall Subjective Improvement of the patient (OSI) was filled out. The tests were repeated 4 weeks after the application of the MLRD. The average subjective overall improvement was 73.75 percent and the Epworth Sleepiness Scale was 13.88 (pre - MLRD) and 6.63 (post - MLRD) representing a significant statistical variation (p=0.05). The authors discuss probable factors involved in the improvement of the subjective measurements of excessive sleepiness.