Disparities in Stroke Patient-Reported Outcomes Measurement Between Healthcare Systems in Brazil.

Introduction: Acute stroke interventions, such as stroke units and reperfusion therapy, have the potential to improve outcomes. However, there are many disparities in patient characteristics and access to the best stroke care. Thus, we aim to compare patient-reported outcome measures (PROMs) after stroke in two stroke centers representing the public and private healthcare systems in Brazil. Methods: PROMs through the International Consortium for Health Outcomes Measures (ICHOM) were assessed at 90 days after the stroke to compare two Brazilian hospitals in southern Brazil: a public university and a private stroke center, both with stroke protocols and stroke units. Results: When compared with the private setting (n = 165), patients from the public hospital (n = 175) were younger, had poorer control of risk factors, had more frequent previous strokes, and arrived with more severe strokes. Both hospitals had a similar percentage of IV thrombolysis treatment. Only 5 patients received mechanical thrombectomy (MT), all in the private hospital. Public hospital patients presented significantly worse outcomes at 3 months, including worse quality of life and functional dependence (60 vs. 48%, p = 0.03). Poor outcome, as measured by the mRS score, was significantly associated with older age, higher NIHSS score, and the presence of heart failure. However, the public practice was a strong predictor of any self-reported disability. Conclusion: Patients assisted at a good quality public stroke center with the same protocol used in the private hospital presented worse disability as measured by mRS and patient-reported outcome measures, with greater inability to communicate, dress, toilet, feed, and walk.

Efeito da distribuição da carga interna de treinamento no desempenho de salto vertical em uma pré-temporada de jogadores de voleibol de elite / Effect of the distribution of the internal load of training in vertical jump performance in a preseason of elite volleyball players

O objetivo deste estudo foi examinar os efeitos da distribuição da carga interna de treinamento no desempenho de salto vertical durante a pré-temporada em jogadores de voleibol. A amostra foi composta por 11 jogadores de voleibol da Superliga Masculina de Voleibol (26,4±5,7 anos; 96,6±9,0 kg; 197,6±7,8 cm; 8,1±2,8% de gordura). A pré-temporada foi composta por 11 semanas de treinamento, dividida em três etapas: Etapa 1, com duração de 6 semanas; Etapa 2, com duração de 3 semanas; Etapa 3, com duração de 2 semanas. A carga interna de treinamento foi avaliada em todas sessões de treinamento através da percepção subjetiva de esforço da sessão, as percepções subjetivas de fadiga foram avaliadas ao final de cada semana, por meio da escala de bem-estar e o salto vertical com contra movimento foi avaliado ao final de cada etapa. Os resultados mostraram maiores valores de carga interna de treinamento em Etapa 1 em comparação a Etapa 2 (p = 0,02) e Etapa 3 (p = 0,01), alterações no estado de bem-estar dos atletas durante as três etapas analisadas, considerando os indicadores fadiga (F = 13,1; p < 0,001), estresse (F = 23,8; p < 0,001), humor (F = 16,7; p < 0,001) e bem-estar total (F = 11,2; p < 0,001) e também alterações significativas no salto vertical com contra movimento nos diferentes momentos de avaliação (F = 7,2; p < 0,01). Conclui-se que a distribuição de carga interna de treinamento, juntamente com as capacidades físicas trabalhadas, contribui para que ocorresse melhoria do desempenho no salto vertical com contra movimento e também redução da percepção de fadiga ao final da pré-temporada. (AU)

The aim of this study was to examine the effects of internal training load distribution on vertical jump performance during preseason in volleyball players. The sample consisted of 11 volleyball players from a Men's Volleyball Superliga (26.4 ± 5.7 years, 96.6 ± 9.0 kg, 197.6 ± 7.8 cm, 8.1 ± 2.8% of fat). The pre-season consisted of 11 weeks of training, divided into three stages: Stage 1, lasting 6 weeks; Stage 2, lasting 3 weeks; Stage 3, lasting 2 weeks. The internal training load was evaluated in all training sessions through the session of rating perception of exertion, the subjective perceptions of fatigue were evaluated at the end of each week, through the well-being scale and the vertical jump with counter movement was evaluated at the end of each stage. The results showed higher internal training load values in Stage 1 compared to Stage 2 (p = 0.02) and Stage 3 (p = 0.01), changes in the athletes' state of well-being during the three stages analyzed, considering the fatigue indicators (F = 13.1; p < 0.001), stress (F = 23.8; p < 0.001), mood (F = 16.7; p < 0.001) and total well-being (F = 11.2; p < 0.001) and also significant changes in vertical jump with counter movement at different moments of assessment (F = 7.2; p < 0.01). It is concluded that the distribution of internal training load contributes to an improvement in performance in the vertical jump with counter movement and also a reduction in the perception of fatigue at the end of the pre-season. (AU)

Poly (lactide-co-glycolide) (PLGA) Scaffold Induces Short-term Nerve Regeneration and Functional Recovery Following Sciatic Nerve Transection in Rats.

Peripheral nerve injury is an important cause of incapability and has limited available treatment. Autologous donor nerve implant is the golden standard treatment, however, may cause secondary deficits. Stem cells show positive results in preclinical settings, preserving tissue and function. We tested the efficacy of stem cells derived from human exfoliated deciduous teeth seeded in poly (lactide-co-glycolide) scaffolds in sciatic nerve transection model. Seventy-two adult male Wistar rats had 7-mm nerve gap bridge using scaffolds with (or without) stem cells. Animals were randomly divided into: sham-operated; sham-operated without scaffold; sham-operated + scaffold + stem cells; sciatic transection + no treatment; sciatic transection + acellular scaffolds; sciatic transection + scaffold + stem cells. Sciatic Functional Index and Ladder Rung Walking tests were performed before (-1), 14 and 28 days after surgery. Morphometric nerve measurement and muscle weights were assessed. Scaffolds with stem cells improved function in Sciatic Functional Index. Acellular scaffold was effective, promoting functional recovery and nerve regeneration following nerve injury. Scaffolds provide better nerve regeneration and functional recovery after sciatic transection. Despite cell therapy promoting faster recovery after sciatic transection in the Sciatic Index Score, stem cells did not improve functional and morphological recovery after nerve injury. This is the first study testing the potential use of scaffolds combined with stem cells in the early stages after injury. Scaffolds with stem cells could accelerate nerve recovery and favor adjuvant therapies, evidencing the need for further studies to increase the knowledge about stem cells' mechanisms.

Home-Based Transcranial Direct Current Stimulation Device Development: An Updated Protocol Used at Home in Healthy Subjects and Fibromyalgia Patients.

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation (NIBS) method, which modulates the membrane potential of neurons in the cerebral cortex by a low-intensity direct current. tDCS is a low-cost technique with minimal adverse effects and easy application. This neurostimulation method has a promising future to improve pain therapy, treatment of neuropsychiatric disorders, and physical rehabilitation. Current studies demonstrate the benefits of using tDCS over consecutive multiple sessions. However, the daily displacement to the specialized centers, travel costs, and disruptions to daily activities are some of the difficulties faced by patients. Thus, to be more comfortable, easy-to-use, and not disrupt daily commitments, a home-based tDCS was designed. Therefore, the objective of this study was to evaluate the feasibility of a portable tDCS device for home use in healthy subjects and fibromyalgia patients. Despite increased tDCS use and a reasonably large body of research on the effects across a range of clinical conditions, there is a limited amount of research on developing secure devices that guarantee the dose and contain a block system to avoid excessive use. Therefore, we used a tDCS device with a security system to permit daily use for 20 minutes with a minimal interval of 12 hours between sessions. A programmer preconfigures the equipment, which has a neoprene cap that allows the electrode positions in any assembly, according to individualized protocols for treatments or research. After, researchers can assess the effectiveness of treatment, and its adherence using information kept in the device software. Results suggest that the device is feasible for home use, with proper monitoring of adherence and contact impedance. There were reports of a few adverse effects, which do not differ from those reported in the literature in studies with the treatment under direct supervision.