Reliability of the Heart Rate Variability Threshold using Visual Inspection and Dmax Methods.

The purpose of this study was to compare heart rate variability threshold (HRVT) in 6 incremental tests and test its reproducibility using visual inspection and Dmax methods for root mean square of successive differences between the adjacent normal R-R intervals (RMSSD), standard deviation of the normal RR interval (SDNN) and standard deviation of instantaneous beat-to-beat variability (SD1). 12 adult males performed an incremental test to volitional fatigue on a cycle simulator during 6 visits to the laboratory. The initial test load was 25 W, and the intensity was increased by 25 W every 3 min until volitional fatigue set in. The HRV during the incremental test was analyzed using the RMSSD, SDNN and SD1 indices and the determination of HRVT was performed using 2 methods: visual inspection and Dmax. The results demonstrated that the SD1 and RMSSD indices, determined by the visual inspection method, presented the highest reproducibility of HRVT when compared with the other indices and methods. We concluded that the best method for determining HRVT was the technique using the point of stabilization by visual inspection in the SD1 and RMSSD indices during the incremental test, due to its high reproducibility, lower coefficient of variation and increment size.

Evaluation of the Best-designed Graded Exercise Test to Assess Peak Treadmill Speed.

This study examined the influence of different speed increments during treadmill exercise tests on peak treadmill speed (Vpeak) and its relationship with a 1-h treadmill running performance. 18 male recreational and amateur runners (10-km running pace: 10-15 km·h(-1)) performed, in an alternate order, 3 continuous incremental exercise tests with different speed increments (0.5, 1.0 and 2.0 km·h(-1)) on a motorized treadmill to determine Vpeak. Thereafter they undertook a 1-h time trial on a treadmill. Vpeak was determined as either (a) the highest speed that could be maintained for a complete minute (Vpeak-60 s), (b) the speed of the last complete stage (Vpeak-C), or (c) the speed of the last complete stage added to the product of the speed increment and the completed fraction of the incomplete stage (Vpeak-P). The Vpeak values were highly influenced by the different speed-incremented rates and the Vpeak-P determined during the protocol comprising speed increments of 1 km·h(-1) presented the highest correlation with 1-h time trial performance (r=0.89). The results suggest that a protocol with speed increments comprising 1 km·h(-1) and with a 3-min stage duration should be used as standard for the determination of Vpeak to assess aerobic fitness and predict endurance performance in recreational runners. Furthermore, the Vpeak-P should be used for the determination of Vpeak.

Máxima velocidade aeróbia calculada pelo custo da frequência cardíaca: relação com a performance / Velocidad aeróbica máxima calculada por el costo del ritmo cardíaco: relación con el rendimiento / Maximal aerobic speed calculated by heart rate cost: relationship with performance

Objetivos. Comparar a máxima velocidade aeróbia (MVA) calculada pelo custo de oxigênio (vVO2max) e o custo da frequência cardíaca (vFCmax) com a medida direta da MVA (Vpico) e verificar a relação entre a vFCmax e a performance em provas de 10 e 15 km de corredores recreacionais de meia idade. Método. Participaram 21 corredores (idade: 30‐49 anos), subdivididos em 2 grupos a partir da idade (G1 e G2). Os participantes foram submetidos a um teste incremental contínuo máximo em laboratório para determinação do consumo máximo de oxigênio. A MVA foi determinada a partir das propostas apresentadas na literatura com base no vVO2max e no vFCmax. Além disso, foram realizadas 2 performances em pista de atletismo (10 e 15 km). Resultados. A menor diferença entre as médias observada para a Vpico foi em relação à vFCmax de Lacour et al. (0,0 km h–1; p > 0,05). A maior diferença foi em relação à vFCmax de Di Prampero (1,55 km h–1; p < 0,05). O mesmo padrão de diferenças foi observado quando analisado o G1 e G2. A vFCmax determinada a partir de 2 diferentes métodos propostos na literatura se correlacionou com as provas de 10 e 15 km (0,55 ≤ r ≤ 0,82; p < 0,05). Conclusões. A vFCmax em corredores recreacionais de meia idade tem elevada relação com as performances de 10 e 15 km e não foi diferente da Vpico (para vFCmax de Lacour et al.), apresentando resultados semelhantes aos observados pelos métodos baseados no custo de oxigênio (AU)

Objetivo: Comparar la velocidad aeróbica máxima (VAM), calculada a través del costo de oxígeno (vVO2max) y del costo de la frecuencia cardíaca (vFCmáx), con la medida directa de la VAM (Vpico) y verificar la relación entre la vFCmax y la performance de 10 e 15 km de corredores recreativos de mediana edad. Método: Participaron 21 corredores recreativos (edades: 30-49 años) subdivididos en 2 grupos por edad (G1 y G2). Los participantes se sometieron a un test incremental continuo máximo en laboratorio para la determinación del consumo máximo de oxígeno. La MVA fue determinada a través de las propuestas presentadas en la literatura basada en el vVO2max y el vFCmáx. Además, se realizaron 2 pruebas en pista de atletismo (10 e 15 km). Resultados: La menor diferencia entre las medias observadas para la Vpico fue en relación con la vFCmax de Lacour et al. (0,0 km h-1; p > 0,05). La mayor diferencia fue en relación con la vFCmax de Di Prampero (1,55 km h-1; p < 0,05). El mismo patrón de diferencias fue observado cuando se analizaron el G1 y G2. La vFCmáx determinada a través de 2 distintos métodos propuestos en la literatura se correlacionó con las pruebas de 10 y 15 km (0,55 ≤ r ≤ 0,82; p < 0,05). Conclusiones: La vFCmáx, en corredores recreativos de mediana edad, tiene alta correlación con las pruebas de 10 y 15 km y no fue diferente de la Vpico (para vFCmáx de Lacour et al.), presentando resultados similares a los observados por los métodos basados en el costo de oxígeno

Objectives. To compare maximal aerobic speed (MAS) calculated by oxygen cost (vVO2max) and heart rate cost (vHRmax) with the direct measurement of MAS (Vpeak) and to verify the relationship between vHRmax and 10‐ and 15‐km performance in middle‐age recreationally runners. Method. Twenty one recreationally runners participated in this study (age: 30 to 49 years), allocated in two groups according to age (G1 and G2). Participants were submitted to an incremental continuous test of maximal effort in laboratory to determine maximal oxygen uptake. MAS was determined according to proposes presented in literature based on vVO2max and vHRmax. Besides, it was performed two performances in field track (10 and 15 km). Results. The lowest difference between the mean values observed and Vpeak was in relation to vHRmax from Lacour et al. (0.0 km h–1; p > 0.05). The highest was in relation to vHRmax from di Prampero (1.55 km h–1; p < 0.05). The same pattern of differences was observed when G1 and G2 were analyzed. The vHRmax determined according to two different methods presented in literature showed to be correlated with 10 and 15 km performances (0.55 ≤ r ≤ 0.82; p < 0.05). Conclusions. The vHRmax in middle‐aged recreational runners has elevated correlation with 10 and 15 km performances and was not different from Vpeak (to vHRmax from Lacour et al.) showing similar results than the method based on oxygen cost (AU)

Relationship between heart rate deflection point determined by Dmax method and 10-km running performance in endurance recreationally-trained female runners.

AIM: The aim of this paper was to verify the relationship between the speed at heart rate deflection point based on Dmax method (sHRDPDmax) with 10-km running performance and the speed at lactate threshold calculated with Dmax method (sLTDmax) in endurance recreationally-trained female runners. We also aim to examine the influence of exponential-plus-constant and third-order polynomial regression models and the influence of the heart rate points (model with initial HR points above 140 b·min(-1) versus model with all HR points) on the determination of the sHRDPDmax. METHODS: Thirteen endurance recreationally-trained female runners were recruited. Participants performed a discontinuous incremental exercise tests initiating at 7 km·h(-1) with 1 km·h(-1) increments each 3 min to determine sHRDPDmax and sLTDmax according to two adjustments: 1) exponential-plus-constant regression model (sHRDPexp and sLTexp); 2) third-order polynomial regression model (sHRDPpol and sLTpol). The sHRDPDmax was also calculated based on HR points above 140 b·min(-1) (sHRDPexp>140 and sHRDPpol>140). Each participant performed a 10-km running performance (s10km). RESULTS: Only the sHRDPexp and sHRDPexp>140 correlated with s10km (sHRDPexp, r=0.87; sHRDPexp>140, r=0.76) and showed higher correlations than the sHRDPpol and sHRDPpol>140 with sLTDmax. The sHRDPexp presented higher correlation with sLTexp than sHRDPexp>140, however sHRDPexp>140 better correlated with sLTpol than sHRDPexp. Furthermore, sHRDPpol>140 demonstrated higher correlations with sLTexp and sLTpol than sHRDPpol. CONCLUSION: The determination of sHRDPDmax according to different initial HR point and its correlation with sLTDmax is influenced by the regression model. Further, only sHRDPexp and sHRDPexp>140 were predictors of endurance performance. However, despite the high correlations, the deflection point very often occurred around the midpoint between initial and final speeds during the incremental test suggesting that the exponential-plus-constant may not be an appropriate regression curve.

An evaluation of immune system cell infiltrate in the cervical stroma of patients with grade III cervical intraepithelial neoplasia after treatment with intralesional alpha-2B interferon.

The aim of this study was to characterize infiltrating immune cells in cervical stroma biopsy samples from patients diagnosed with cervical intraepithelial neoplasias (CINs) who were treated with IFN-alpha 2b. The authors studied 13 volunteers who were diagnosed with Cervical intraepithelial neoplasia CIN II or III and who received intra-lesional treatment with IFN-alpha 2b. They collected pre- and post-treatment biopsies from each patient. They also examined the slides under a common optical microscope with a X400 lens for biopsy sample sections that were labeled with immunohistochemistry for T lymphocyte, B lymphocyte, natural killer cell, macrophage, iNOS, and perforin markers. The presence of immune response cells in the lesion was observed after treatment with intralesional IFN-alpha 2b in patients with CIN II/III changes, a reduction in CD4+ and CD8+ T lymphocyte infiltration in the women who responded well to treatment. However, there was a significant increase in these markers in samples from women who did not respond to treatment. Nonetheless, immunotherapy with IFN-alpha 2b administered intralesionally in patients with CIN II/III yields favorable results in patients who do not smoke.

Immune response and immunotherapy in intraepithelial and invasive lesions of the uterine cervix.

Infection with the human papillomavirus virus (HPV) induces innate and acquired immune responses in the cervical stroma, which are a delicate, balanced and generally unpredictable immunological defense. Because of the immunological breaks that the HPV virus causes, eradication of infected cells does not occur, potentially leading to development of intraepithelial and invasive lesions. Advances in our understanding of the immune system and in the definition of antigens in tumor cells has led to many new treatment strategies. As a result, immunotherapy has the potential to be the most specific treatment for tumors, and one that requires elaboration. Recently, immunotherapy with interferon and dendritc cells has been used on intrapepithelial and invasive cervical lesions with promising results.

The Dmax is highly related to performance in middle-aged females.

The present study examined whether the running speed at the lactate threshold estimated by the maximal deviation method (LT (Dmax)) is highly correlated and in agreement with 10-km road race performance (S (10 km)) in middle-aged female runners. Additionally, the LT (Dmax) was compared with the visual detection of the inflection point (LT (Visual)), the fixed lactate level of 4 mmol.L (-1) (LT (4)) and the peak speed (S (peak)) in relation to performance. Sixteen middle-aged, recreational female runners performed a discontinuous, incremental treadmill test. The initial speed was set at 7 km.h (-1), and this speed was increased every 3 min by 1 km.h (-1) with a 30-s rest between the stages used for earlobe capillary blood sample collection. All of the participants took part in the same local 10-km road race, and S (10 km) mean speed was calculated. The speeds (mean ± SD) were 10.5 ± 1.0 (S (10 km)), 10.5 ± 1.0 (LT (Visual)), 10.9 ± 0.9 (LT (Dmax)), 11.4 ± 1.3 (LT (4)) and 13.5 ± 1.1 km.h (-1) (S (peak)). The LT (Dmax) had the narrowest limits of agreement (0.3 ± 0.4 km.h (-1)) and was the most highly correlated with the S (10 km) ( R=0.98), followed by the S (peak) ( R=0.95), LT (4) ( R=0.85) and LT (Visual) ( R=0.81). In conclusion, the LT (Dmax) should be more widely used to estimate long-distance performance and to verify improvements in training.

Unilateral Renal Haemangiopericytoma: Report of a Rare Tumour

RESUMEN: Los pericitos son células musculares lisas modificadas de los tubos capilares circundantes los cuales cambian el diámetro del lumen vascular. En este artículo relatamos un caso dehemangiopericitoma renal presente en una mujer de 78 años, quien manifestaba dolor abdominal. La ultrasonografía determinó una lesión sólida en la tercera porción del riñón izquierdo. La exploración abdominal de CT reveló una masa tumoral. Debido a la alta sospecha de neoplasia maligna, la paciente fue sometida a nefrectomía radical izquierda. La evaluación histopatológica confirmó el hemangiopericitoma, a través de inmunohistoquímica. La paciente sobrevive cinco años después de la nefrectomía radical.

Variaciones anatómicas entre el nervio isquiático y el músculo piriforme durante el período fetal humano / Anatomical variations between sciatic nerve and periform muscle during fetal period in human

El nervio isquiático, ramo del plexo sacro, abandona la pelvis pasando, generalmente, por debajo del músculo piriforme. Este nervio puede presentar variaciones en su relación con el músculo piriforme, entre ellas, las referidas a la división alta. Sin embargo, son pocos los trabajos que correlacionan esta división con variaciones anatómicas y su relación con el músculo piriforme, en fetos humanos. Con el propósito de verificar una posible asociación entre el trayecto y relaciones de ramos del nervio isquiático, fueron disecadas 100 regiones glúteas de fetos humanos. Se encontraron 3 tipos de variaciones entre el nervio isquiático y el músculo piriforme: en 8 casos (16,0 por ciento) el nervio fibular común pasó a través del músculo y el nervio tibial transcurrió por debajo de su margen inferior (Tipo I). En estos mismos casos se observó que 5 (62,5 por ciento) estaban a la izquierda y 3 a la derecha. En un caso (2,0 por ciento), el nervio fibular común hizo su trayecto por sobre el margen superior del músculo piriforme y el nervio tibial pasó por debajo de su margen inferior (Tipo II). Fue observado en el Tipo III,que el nervio isquiático perfora el músculo piriforme, no presentando ninguna división. El músculo piriforme mostró variaciones de fusión con el músculo glúteo mediano (lado derecho =2,0 por ciento) y con el músculo gemelo superior (lado derecho =24,0 por ciento e izquierdo =32,0 por ciento). Estos datos muestran que existe una equivalencia de variacion entre los trayectos y relaciones del nervio isquiático con el músculo piriforme en fetos y adultos. Las variaciones en el músculo piriforme no están asociadas con alteraciones funcionales en la biomecánica de la pelvis.

A rare variation in the high division of the sciatic nerve surrounding the superior gemellus muscle.

The sciatic nerve normally leaves the pelvis by passing through the greater sciatic foramen below piriformis. However, it may divide into its common fibular and tibial nerve components within the pelvis and its relationship with piriformis is variable. In this paper, we describe a new anatomical variation in which the common fibular nerve passed superior, and the tibial nerve inferior, to the superior gemellus muscle. Anatomical variations such as these may contribute to piriformis syndrome, coccygodynia and muscle atrophy.

Tabagismo entre academicos de Ribeirao Preto - USP. / Smoking habit among universitary students of Ribeirao Preto University of Sao Paulo

Os autores estudam a prevalencia de fumantes entre academicos de algumas Faculdades da USP (ligadas a area de saude) do Campus de Ribeirao Preto. De um total de 1327 academicos (sendo 491 da medicina; 304 da enfermagem; 201 da farmacia e 331 da odontologia) levantaram os dados atraves de um questionario em 1146 (ou seja 86,4% da populacao) sobre o habito de fumar e caracteristicas pessoais.Concluiram que: 1. a prevalencia instantanea de fumantes nesta populacao era de 26,9% (sendo de 28,4%; 20,7%; 36,1% e 28,4% respectivamente para academicos de medicina, enfermagem, farmacia e odontologia); 2. Ha pequena diferenca entre prevalencias observadas entre homens e mulheres, (exceto na farmacia); nos primeiros anos academicos as mulheres fumam mais que os homens; 3. a maioria dos academicos fumantes iniciaram com o habito antes dos 17-18 anos de idade; 4. os academicos destas 4 areas tem um gasto anual com cigarros de cerca de Cr$ 3.735.698,40, pagando por isso um tributo ao governo de Cr$ 2.614.988,88, oferecendo um lucro aos varejistas de Cr$ 410.926,82 e contribuem para as companhias produtoras com um valor de Cr$ 709.782,70