Vitamin D Status and Longitudinal Changes in Body Composition in Patients with Chronic Obstructive Pulmonary Disease - A Prospective Observational Study.

Background: Alterations in body weight and composition are common in patients with chronic obstructive pulmonary disease (COPD) and are independent predictors for morbidity and mortality. Low vitamin D status is also more prevalent in patients with COPD compared to controls and has been related to lower lung function, muscle atrophy and impaired musculoskeletal function. This study aimed to evaluate the association between vitamin D levels and status with body composition (BC), as well as with its changes over time. Patients and Methods: Patients with COPD and controls without COPD, participating in the Individualized COPD Evaluation in relation to Ageing (ICE-Age) study, a prospective observational study, were included. Plasma 25-hydroxyvitamin D (25(OH)D) was measured at baseline and BC was measured by dual-energy X-ray absorptiometry scan, at baseline and after two years of follow-up. Multiple linear regression analyses were performed to assess the relationships between 25(OH)D (nmol/l) and longitudinal changes in BMI, fat-free mass index (FFMI), fat mas index (FMI) and bone mineral density (BMD). Results: A total of 192 patients with COPD (57% males, mean ± SD age, 62 ± 7, FEV1, 49 ± 16% predicted) and 199 controls (45% males, mean ± SD age 61 ± 7) were included in this study. Vitamin D levels were significantly lower in patients with COPD (64 ± 26 nmol/L, 95% CI 60-68 nmol/L versus 75 ± 25 nmol/L, 95% CI 72-79 nmol/L) compared to controls. Both patients and controls presented a significant decline in FFMI and T-score hip, but vitamin D level or status did not determine differences in BC or changes in BC over time in either COPD or controls. Conclusion: Vitamin D status was not associated with BC or longitudinal changes in BC. However, vitamin D insufficiency and low BMD were more prevalent in patients with COPD compared to controls.

Accurate Prediction Equations for Ventilatory Thresholds in Cardiometabolic Disease When Gas Exchange Analysis is Unavailable: Development and Validation.

AIMS: To develop and validate equations predicting heart rate (HR) at the first and second ventilatory thresholds (VTs) and an optimized range-adjusted prescription for patients with cardiometabolic disease (CMD). To compare their performance against guideline-based exercise intensity domains. METHODS: Cross-sectional study involving 2,868 CMD patients from nine countries. HR predictive equations for first and second VTs (VT1, VT2) were developed using multivariate linear regression with 975 cycle-ergometer cardiopulmonary exercise tests (CPET). 'Adjusted' percentages of peak HR (%HRpeak) and HR reserve (%HRR) were derived from this group. External validation with 1,893 CPET (cycle-ergometer or treadmill) assessed accuracy, agreement, and reliability against guideline-based %HRpeak and %HRR prescriptions using mean absolute percentage error (MAPE), Bland-Altman analyses, intraclass correlation coefficients (ICC). RESULTS: HR predictive equations (R²: 0.77 VT1, 0.88 VT2) and adjusted %HRR (VT1: 42%, VT2: 77%) were developed. External validation demonstrated superiority over widely used guideline-directed intensity domains for %HRpeak and %HRR. The new methods showed consistent performance across both VTs with lower MAPE (VT1: 7.1%, VT2: 5.0%), 'good' ICC for VT1 (0.81, 0.82) and 'excellent' for VT2 (0.93). Guideline-based exercise intensity domains had higher MAPE (VT1: 6.8%-21.3%, VT2: 5.1%-16.7%), 'poor' to 'good' ICC for VT1, and 'poor' to 'excellent' for VT2, indicating inconsistencies related to specific VTs across guidelines. CONCLUSION: Developed and validated HR predictive equations and the optimized %HRR for CMD patients for determining VT1 and VT2 outperformed the guideline-based exercise intensity domains and showed ergometer interchangeability. They offer a superior alternative for prescribing moderate intensity exercise when CPET is unavailable.

Equations to predict heart rate at ventilatory thresholds were developed and externally validated, offering a new perspective when a cardiopulmonary exercise test is unavailable to accurately determine the aerobic exercise intensity domains. Additionally, an adjusted range for exercise intensity prescription based on the percentage of heart rate reserve (%HRR) was provided, utilizing a large sample from eight countries. The proposed equations and the range-adjusted %HRR significantly outperformed the guideline-directed methods for determining exercise intensity, exhibiting higher accuracy, agreement, and reliability. Exercise intensity prescription based on the percentage of heart rate peak showed higher errors, raising concerns about its clinical applicability. Our study may enhance the efficacy of exercise training and physical activity advice when gas exchange analysis is unavailable, potentially leading to improved clinical outcomes, even in low-resource settings. Employing these approaches in research could facilitate more tailored and consistent interventions, introducing a contemporary perspective for studies comparing exercise intensity prescriptions.

Effects of blood flow restriction therapy in patients with knee osteoarthritis: protocol for an overview of systematic reviews.

Background: Osteoarthritis (OA) is the most common and prevalent musculoskeletal disease associated with population aging, negatively impacting function and quality of life. A consequence of knee OA is quadriceps muscle weakness. Musculoskeletal rehabilitation using low load exercises, associated with Blood Flow Restriction (BFR) may be a useful alternative to high load exercises when those cannot be tolerated. Several systematic reviews have reported inconclusive results due to discrepancies in study findings, heterogeneity of results, evaluated time points, and research questions explored. Objective: To perform an overview of systematic reviews with meta-analyses, synthesizing the most recent evidence on the effects of muscle strength training with BFR for knee OA. Methodology: Systematic reviews that include primary controlled and randomized clinical trials will be considered for inclusion. Articles will be considered only if they present a clear and reproducible methodological structure, and when they clearly demonstrate that a critical analysis of the evidence was carried out using instrumented analysis. Narrative reviews, other types of review, overviews of systematic reviews, and diagnostic, prognostic and economic evaluation studies will be excluded. Studies must include adults aged 40 years and older with a diagnosis of knee OA. Two authors will perform an electronic search with guidance from an experienced librarian. The following databases will be searched: PubMed via MEDLINE, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), PEDro, Cumulative Index to Nursing and Allied Health Literature (CINAHL) via EBSCO host, Web of Science, and the gray literature. The search strategy used in the databases will follow the acronym PICOS (population, intervention, comparison, outcome, and study design). Screening (i.e., titles and abstracts) of studies identified by the search strategy will be selected using Rayyan (http://rayyan.qcri.org). The quality assessment will be performed using the "Assessment of Multiple Systematic Reviews" (AMSTAR-2) tool. Systematic Review Registration: PROSPERO, CRD42022367209.

What motivates heart transplantation patients to exercise and engage in physical activity? A network analysis.

AIMS: After heart transplantation (HTx), increments in physical activity (PA) are strongly recommended. However, participation rates in exercise-based cardiac rehabilitation and engagement in PA are insufficient in many patients. Hence, this study aimed to explore the central factors and the interconnections among distinct types of motivation to exercise, PA, sedentary time, psychosomatic, diet, and activity limitation characteristics in post-HTx patients. METHODS AND RESULTS: This is a cross-sectional study involving 133 post-HTx patients (79 men, mean age 57 ± 13 years, mean time from transplantation 55 ± 42 months) recruited from an outpatient clinic in Spain. The patients were asked to fill in questionnaires measuring self-reported PA, motivation to exercise, kinesiophobia, musculoskeletal pain, quality of sleep, depression, functional capacity, frailty, sarcopenia risk, and diet quality. Two network structures were estimated: one network including PA and one network including sedentary time as nodes. The relative importance of each node in the network structures was determined using centrality analyses. According to the strength centrality index, functional capacity and identified regulation (subtypes of motivation to exercise) are the two most central nodes of the network (strength: z-score = 1.35-1.51). Strong and direct connections emerged between frailty and PA and between sarcopenia risk and sedentary time. CONCLUSION: Functional capacity and autonomous motivation to exercise are the most promising targets of interventions to improve PA levels and sedentary time in post-HTx patients. Furthermore, frailty and sarcopenia risk were found to mediate the effects of several other factors on PA and sedentary time.

Combined Exercise Training and Nutritional Interventions or Pharmacological Treatments to Improve Exercise Capacity and Body Composition in Chronic Obstructive Pulmonary Disease: A Narrative Review.

Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease that is associated with significant morbidity, mortality, and healthcare costs. The burden of respiratory symptoms and airflow limitation can translate to reduced physical activity, in turn contributing to poor exercise capacity, muscle dysfunction, and body composition abnormalities. These extrapulmonary features of the disease are targeted during pulmonary rehabilitation, which provides patients with tailored therapies to improve the physical and emotional status. Patients with COPD can be divided into metabolic phenotypes, including cachectic, sarcopenic, normal weight, obese, and sarcopenic with hidden obesity. To date, there have been many studies performed investigating the individual effects of exercise training programs as well as nutritional and pharmacological treatments to improve exercise capacity and body composition in patients with COPD. However, little research is available investigating the combined effect of exercise training with nutritional or pharmacological treatments on these outcomes. Therefore, this review focuses on exploring the potential additional beneficial effects of combinations of exercise training and nutritional or pharmacological treatments to target exercise capacity and body composition in patients with COPD with different metabolic phenotypes.

Cohesion depends on kinship but no permanent leadership in larval societies of a Neotropical butterfly.

In gregarious species, coordinated responses to environmental stimuli are important for a successful habitat and/or food selection. In this sense, maintenance of group cohesion after stochastic disturbances and during collective movements is expected to be advantageous, as is the existence of group leaders. Through laboratory experiments, we examined whether clusters of early instars of Mechanitis polymnia casabranca have both leaders and followers, as well as whether larvae are able to reaggregate depending on neighbors' degree of kinship. In the leadership experiment, clusters of second and third instars were placed in a trail arena having a stimulus leaf at its ending point. Every larva moving ahead from the group was recorded as a leader, and the remaining ones were followers. We also examined whether leaders were temporary or permanent. Of the 195 larvae tested, 22 were permanent leaders (11.28%), 71 larvae were assigned as temporary leaders (36.41%), and 102 larvae never behaved as leaders (52.31%). In the larval cohesion experiment, three treatments were assigned: (i) sibling larvae reared and tested together, (ii) sibling larvae separated after eclosion and tested together, and (iii) non-sibling larvae reared separated and tested together. Sibling larvae reaggregated significantly more compared to non-siblings, regardless of whether they were reared together or separately. Our results show that early instars of M. polymnia casabranca from the same egg cluster are able to recompose aggregations after disrupting disturbances and that group decision-making is mostly dependent on transient leaders.

Study of the roles of caspase-3 and nuclear factor kappa B in myenteric neurons in a P2X7 receptor knockout mouse model of ulcerative colitis.

BACKGROUND: The literature indicates that the enteric nervous system is affected in inflammatory bowel diseases (IBDs) and that the P2X7 receptor triggers neuronal death. However, the mechanism by which enteric neurons are lost in IBDs is unknown. AIM: To study the role of the caspase-3 and nuclear factor kappa B (NF-κB) pathways in myenteric neurons in a P2X7 receptor knockout (KO) mouse model of IBDs. METHODS: Forty male wild-type (WT) C57BL/6 and P2X7 receptor KO mice were euthanized 24 h or 4 d after colitis induction by 2,4,6-trinitrobenzene sulfonic acid (colitis group). Mice in the sham groups were injected with vehicle. The mice were divided into eight groups (n = 5): The WT sham 24 h and 4 d groups, the WT colitis 24 h and 4 d groups, the KO sham 24 h and 4 d groups, and the KO colitis 24 h and 4 d groups. The disease activity index (DAI) was analyzed, the distal colon was collected for immunohistochemistry analyses, and immunofluorescence was performed to identify neurons immunoreactive (ir) for calretinin, P2X7 receptor, cleaved caspase-3, total caspase-3, phospho-NF-κB, and total NF-κB. We analyzed the number of calretinin-ir and P2X7 receptor-ir neurons per ganglion, the neuronal profile area (µm²), and corrected total cell fluorescence (CTCF). RESULTS: Cells double labeled for calretinin and P2X7 receptor, cleaved caspase-3, total caspase-3, phospho-NF-κB, or total NF-κB were observed in the WT colitis 24 h and 4 d groups. The number of calretinin-ir neurons per ganglion was decreased in the WT colitis 24 h and 4 d groups compared to the WT sham 24 h and 4 d groups, respectively (2.10 ± 0.13 vs 3.33 ± 0.17, P < 0.001; 2.92 ± 0.12 vs 3.70 ± 0.11, P < 0.05), but was not significantly different between the KO groups. The calretinin-ir neuronal profile area was increased in the WT colitis 24 h group compared to the WT sham 24 h group (312.60 ± 7.85 vs 278.41 ± 6.65, P < 0.05), and the nuclear profile area was decreased in the WT colitis 4 d group compared to the WT sham 4 d group (104.63 ± 2.49 vs 117.41 ± 1.14, P < 0.01). The number of P2X7 receptor-ir neurons per ganglion was decreased in the WT colitis 24 h and 4 d groups compared to the WT sham 24 h and 4 d groups, respectively (19.49 ± 0.35 vs 22.21 ± 0.18, P < 0.001; 20.35 ± 0.14 vs 22.75 ± 0.51, P < 0.001), and no P2X7 receptor-ir neurons were observed in the KO groups. Myenteric neurons showed ultrastructural changes in the WT colitis 24 h and 4 d groups and in the KO colitis 24 h group. The cleaved caspase-3 CTCF was increased in the WT colitis 24 h and 4 d groups compared to the WT sham 24 h and 4 d groups, respectively (485949 ± 14140 vs 371371 ± 16426, P < 0.001; 480381 ± 11336 vs 378365 ± 4053, P < 0.001), but was not significantly different between the KO groups. The total caspase-3 CTCF, phospho-NF-κB CTCF, and total NF-κB CTCF were not significantly different among the groups. The DAI was recovered in the KO groups. Furthermore, we demonstrated that the absence of the P2X7 receptor attenuated inflammatory infiltration, tissue damage, collagen deposition, and the decrease in the number of goblet cells in the distal colon. CONCLUSION: Ulcerative colitis affects myenteric neurons in WT mice but has a weaker effect in P2X7 receptor KO mice, and neuronal death may be associated with P2X7 receptor-mediated caspase-3 activation. The P2X7 receptor can be a therapeutic target for IBDs.

Effects of experimental ulcerative colitis on myenteric neurons in P2X7-knockout mice.

This study aimed to investigate the distal colon myenteric plexus and enteric glial cells (EGCs) in P2X7 receptor-deficient (P2X7-/-) animals after the induction of experimental ulcerative colitis. 2,4,6-Trinitrobenzene sulfonic acid (TNBS) was injected into the distal colon of C57BL/6 (WT) and P2X7 receptor gene-deficient (P2X7-/-, KO) animals. Distal colon tissues in the WT and KO groups were analyzed 24 h and 4 days after administration. The tissues were analyzed by double immunofluorescence of the P2X7 receptor with neuronal nitric oxide synthase (nNOS)-immunoreactive (ir), choline acetyltransferase (ChAT)-ir, and PGP9.5 (pan neuronal)-ir, and their morphology was assessed by histology. The quantitative analysis revealed 13.9% and 7.1% decreases in the number of P2X7 receptor-immunoreactive (ir) per ganglion in the 24 h-WT/colitis and 4 day-WT/colitis groups, respectively. No reduction in the number of nNOS-ir, choline ChAT-ir, and PGP9.5-ir neurons per ganglion was observed in the 4 day-KO/colitis group. In addition, a reduction of 19.3% in the number of GFAP (glial fibrillary acidic protein)-expressing cells per ganglion was found in the 24 h-WT/colitis group, and a 19% increase in the number of these cells was detected in the 4 day-WT/colitis group. No profile area changes in neurons were observed in the 24 h-WT and 24 h-KO groups. The 4 day-WT/colitis and 4 day-KO/colitis groups showed increases in the profile neuronal areas of nNOS, ChAT, and PGP9.5. The histological analysis showed hyperemia, edema, or cellular infiltration in the 24 h-WT/colitis and 4 day-WT/colitis groups. Edema was observed in the 4 day-KO/colitis group, which showed no histological changes compared with the 24 h-KO/colitis group. We concluded that ulcerative colitis differentially affected the neuronal classes in the WT and KO animals, demonstrating the potential participation and neuroprotective effect of the P2X7 receptor in enteric neurons in inflammatory bowel disease.

Incidence of cardioembolic stroke related to atrial fibrillation in Joinville, Brazil.

BACKGROUND: Atrial fibrillation (AF) is an important cause of cardioembolic stroke, and population aging has increased its prevalence. OBJECTIVE: To evaluate the incidence of cardioembolic stroke caused by AF in the city of Joinville, Brazil, as well as previous diagnoses and use of medication. METHODS: Between 2017 and 2020 we extracted data from the population-based Joinville Stroke Registry. Demographic characteristics, diagnosis of AF, and patterns of medication use were collected, and the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) system was used to classify the etiology. RESULTS: There were 3,303 cases of ischemic stroke, 593 of which were cardioembolic, and 360 had AF. Of the patients with AF, 258 (71.6%) had a previous diagnosis of the disease, and 102 (28.3%) were newly diagnosed after the stroke. Among patients with a previously-diagnosed AF, 170 (47.2%) were using anticoagulants, and 88 (24.4%) were using other medications. CONCLUSION: During the analyzed period, ischemic stroke caused by AF was a significant burden on the population of Joinville, and a considerable number of patients had undiagnosed or untreated AF.

ANTECEDENTES: A fibrilação atrial (FA) é uma importante causa de acidente vascular cebebral (AVC) cardioembólico, e o envelhecimento populacional aumentou a sua prevalência. OBJETIVO: Avaliar a incidência de AVC cardioembólico causado por FA em Joinville, além dos diagnósticos prévios e do uso de medicamentos. MéTODOS: Entre 2017 e 2020, foram extraídos dados do registro de base populacional de AVC de Joinville. Características demográficas, diagnóstico de FA e padrões de uso de medicamentos foram coletados, e o sistema Trial of ORG 10172 in Acute Stroke Treatment (TOAST) foi utilizado para classificar a etiologia. RESULTADOS: Houve 3.303 casos de AVC isquêmico, sendo 593 cardioembólicos e 360 com FA. Dos pacientes com FA, 258 (71,6%) tinham diagnóstico prévio da doença, e 102 (28,3%) foram recém-diagnosticados após o AVC. Entre os pacientes com FA previamente diagnosticada, 170 (47,2%) estavam em uso de anticoagulante, e 88 (24,4%), em uso de outra medicação. CONCLUSãO: Durante o período analisado, o AVC isquêmico causado por FA foi um ônus significativo para a população de Joinville, e um número considerável de pacientes apresentava FA não diagnosticada ou não tratada.

Frequency and Functional Consequences of Low Appendicular Lean Mass and Sarcopenic Obesity in Patients with Asthma Referred for Pulmonary Rehabilitation.

INTRODUCTION: One of the most prominent extrapulmonary manifestations in patients with chronic respiratory disease is changes in body weight and composition. However, the frequency and functional consequences of low appendicular lean mass (ALM) or sarcopenic obesity (SO) in patients with asthma are largely unknown. Therefore, the aim of the current study was to assess the frequency and functional consequences of low appendicular lean mass index (ALMI) and SO in patients with asthma. METHODS: A retrospectively analyzed cross-sectional study was conducted in 687 patients with asthma (60% female, 58 ± 13 years, FEV1 76 ± 25% pred) referred for comprehensive pulmonary rehabilitation (PR). Body composition, pulmonary function, exercise capacity, quadriceps muscle function, and quality of life were assessed. Patients were classified as presenting low ALMI according to the 10th percentiles of age-sex-body mass index (BMI)-specific reference values and as having SO according to the diagnostic procedure proposed by the 2022 ESPEN/EASO consensus. In addition, clinical outcomes between patients with normal and low ALMI or with and without SO were compared. RESULTS: The frequency of patients classified as low ALMI was 19%, whereas 45% of the patients were obese. Among the obese patients, 29% had SO. In patients with normal weight, those with low ALMI were younger and had worse pulmonary function, exercise capacity and quadriceps muscle function than those with normal ALMI (all p < 0.05). Overweight patients with low ALMI presented poorer pulmonary function and quadriceps muscle function (both strength and total work capacity). In obese class I patients, those with low ALMI showed lower quadriceps strength and maximal oxygen uptake acquired during cardiopulmonary exercise testing. Both male and female patients with SO showed lower quadriceps muscle function and reduced maximal exercise capacity compared to non-SO asthma patients. CONCLUSION: Approximately one in five asthma patients presented low ALM when age-sex-BMI-specific ALMI cutoffs were applied. Obesity is common among patients with asthma referred for PR. Among the obese patients, a significant proportion presented SO. Low ALM and SO were associated with worse functional outcomes.

MRI-based radiomic score increased mrTRG accuracy in predicting rectal cancer response to neoadjuvant therapy.

PURPOSE: To develop a magnetic resonance imaging (MRI)-based radiomics score, i.e., "rad-score," and to investigate the performance of rad-score alone and combined with mrTRG in predicting pathologic complete response (pCR) in patients with locally advanced rectal cancer following neoadjuvant chemoradiation therapy. METHODS: This retrospective study included consecutive patients with LARC who underwent neoadjuvant chemoradiotherapy followed by surgery from between July 2011 to November 2015. Volumes of interest of the entire tumor on baseline rectal MRI and of the tumor bed on restaging rectal MRI were manually segmented on T2-weighted images. The radiologist also provided the ymrTRG score on the restaging MRI. Radiomic score (rad-score) was calculated and optimal cut-off points for both mrTRG and rad-score to predict pCR were selected using Youden's J statistic. RESULTS: Of 180 patients (mean age = 63 years; 60% men), 33/180 (18%) achieved pCR. High rad-score (> - 1.49) yielded an area under the curve (AUC) of 0.758, comparable to ymrTRG 1-2 which yielded an AUC of 0.759. The combination of high rad-score and ymrTRG 1-2 yielded a significantly higher AUC of 0.836 compared with ymrTRG 1-2 and high rad-score alone (p < 0.001). A logistic regression model incorporating both high rad-score and mrTRG 1-2 was built to calculate adjusted odds ratios for pCR, which was 4.85 (p < 0.001). CONCLUSION: Our study demonstrates that a rectal restaging MRI-based rad-score had comparable diagnostic performance to ymrTRG. Moreover, the combined rad-score and ymrTRG model yielded a significant better diagnostic performance for predicting pCR.

Incidence of cardioembolic stroke related to atrial fibrillation in Joinville, Brazil / Incidência de acidente vascular encefálico relacionado à fibrilaçao atrial em Joinville, Brasil

Abstract Background Atrial fibrillation (AF) is an important cause of cardioembolic stroke, and population aging has increased its prevalence. Objective To evaluate the incidence of cardioembolic stroke caused by AF in the city of Joinville, Brazil, as well as previous diagnoses and use of medication. Methods Between 2017 and 2020 we extracted data from the population-based Joinville Stroke Registry. Demographic characteristics, diagnosis of AF, and patterns of medication use were collected, and the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) system was used to classify the etiology. Results There were 3,303 cases of ischemic stroke, 593 of which were cardioembolic, and 360 had AF. Of the patients with AF, 258 (71.6%) had a previous diagnosis of the disease, and 102 (28.3%) were newly diagnosed after the stroke. Among patients with a previously-diagnosed AF, 170 (47.2%) were using anticoagulants, and 88 (24.4%) were using other medications. Conclusion During the analyzed period, ischemic stroke caused by AF was a significant burden on the population of Joinville, and a considerable number of patients had undiagnosed or untreated AF.

Resumo Antecedentes A fibrilação atrial (FA) é uma importante causa de acidente vascular cebebral (AVC) cardioembólico, e o envelhecimento populacional aumentou a sua prevalência. Objetivo Avaliar a incidência de AVC cardioembólico causado por FA em Joinville, além dos diagnósticos prévios e do uso de medicamentos. Métodos Entre 2017 e 2020, foram extraídos dados do registro de base populacional de AVC de Joinville. Características demográficas, diagnóstico de FA e padrões de uso de medicamentos foram coletados, e o sistema Trial of ORG 10172 in Acute Stroke Treatment (TOAST) foi utilizado para classificar a etiologia. Resultados Houve 3.303 casos de AVC isquêmico, sendo 593 cardioembólicos e 360 com FA. Dos pacientes com FA, 258 (71,6%) tinham diagnóstico prévio da doença, e 102 (28,3%) foram recém-diagnosticados após o AVC. Entre os pacientes com FA previamente diagnosticada, 170 (47,2%) estavam em uso de anticoagulante, e 88 (24,4%), em uso de outra medicação. Conclusão Durante o período analisado, o AVC isquêmico causado por FA foi um ônus significativo para a população de Joinville, e um número considerável de pacientes apresentava FA não diagnosticada ou não tratada.

Impact of N-acetylcysteine (NAC) and calcium hydroxide intracanal medications in primary endodontic infection: a randomized clinical trial.

OBJECTIVES: This RCT investigated the impact of N-acetylcysteine (NAC) and calcium hydroxide [Ca(OH)2] intracanal medications (ICMs) in primary endodontic infection with apical periodontitis (PEIAP). MATERIALS AND METHODS: Thirty-six teeth with PEIAP were randomly divided into groups according to the ICM: NAC, Ca(OH)2 + saline solution (SSL), and Ca(OH)2 + 2% chlorhexidine-gel (2% CHX-gel) (all, n = 12). Root canal samples (RCSs) were collected before (s1) and after instrumentation (s2) and after 14 days of ICM (s3). Chemomechanical preparation (CMP) was performed with a Reciproc file and 2.5% NaOCl. Checkerboard DNA-DNA hybridization was used to assess 40 target bacteria species. RESULTS: At s1, bacterial DNA was detected in 100% of RCSs (36/36). All 40 bacterial species were found in PEIAP. The mean number of species per RCS was 17.92 ± 13.18. The most frequent bacteria were S. mitis (65%), E. nodatum (63%), E. faecalis (63%), F. nucl sp vicentii (58%), T. forsythia (58%), and F. periodonticum (56%). CMP reduced the mean number of species per RCS to 6.8 ± 2.36 (p < 0.05). At s3, the intragroup analysis revealed a broader antimicrobial activity for Ca (OH)2 + 2% CHX-gel and NAC than Ca(OH)2 + SSL (p < 0.05). NAC eliminated 8/12 bacteria species resistant to both Ca (OH)2 ICMs, including P. micra, P. nigrescens, T. denticola, A. israelii, P. endodontalis, P. acnes, C. ochracea, and E. corrodens. CONCLUSIONS: Ca (OH)2 + 2% chlorhexidine gel (2% CHX gel) showed a greater bacterial elimination over the number of bacterial species; however, NAC eliminated 8/12 bacteria species resistant to both Ca (OH)2 ICMs (RBR-3xbnnn). CLINICAL RELEVANCE: The use of intracanal medication with a broad antimicrobial activity can optimize root canal disinfection. Ca(OH)2 + 2% CHX gel and NAC showed a broader antimicrobial activity than Ca(OH)2 + SSL against endodontic pathogens in primary root canal infection. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (REBEC), No. RBR-3xbnnn.

Differential Impact of Low Fat-Free Mass in People With COPD Based on BMI Classifications: Results From the COPD and Systemic Consequences-Comorbidities Network.

BACKGROUND: Alterations in body composition, including a low fat-free mass index (FFMI), are common in patients with COPD and occur regardless of body weight. RESEARCH QUESTION: Is the impact of low FFMI on exercise capacity, health-related quality of life (HRQL), and systemic inflammation different among patients with COPD stratified in different BMI classifications? STUDY DESIGN AND METHODS: We analyzed baseline data of patients with COPD from the COPD and Systemic Consequences-Comorbidities Network (COSYCONET) cohort. Assessments included lung function, bioelectrical impedance analysis, 6-min walk distance (6MWD), HRQL, and inflammatory markers. Patients were stratified in underweight, normal weight (NW), preobese, and obese according to BMI and as presenting low, normal, or high FFMI using 25th and 75th percentiles of reference values. Linear mixed models were used to investigate the associations between fat-free mass (FFM) and fat mass with secondary outcomes in each BMI group. RESULTS: Two thousand one hundred thirty-seven patients with COPD (Global Initiative for Chronic Obstructive Lung Disease stages 1-4; 61% men; mean ± SD age, 65 ± 8 years; mean ± SD FEV1, 52.5 ± 18.8% predicted) were included. The proportions of patients in underweight, NW, preobese, and obese groups were 12.3%, 31.3%, 39.6%, and 16.8%, respectively. The frequency of low FFMI decreased from lower to higher BMI groups (underweight, 81%; NW, 53%; preobese, 42%; and obese, 39%). FFM was associated with the 6MWD in the underweight group, even when adjusting for a broad set of covariates (P < .05). HRQL was not associated with FFM after adjustment for lung function or dyspnea (P > .32). Fat mass was associated with higher systemic inflammation in the NW and preobese groups (P < .05). INTERPRETATION: In patients with COPD with lower weight, such as underweight patients, higher FFMI is associated independently with better exercise capacity. In contrast, in preobese and obese patients with COPD, a higher FFMI was not consistently associated with better outcomes.

Different kinesio taping tensions present similar benefits for postural control, dynamic balance, agility and instability sensation in individuals with chronic ankle instability: randomized clinical trial / Diferentes tensões de kinesio taping apresentam benefícios semelhantes para controle postural, equilíbrio dinâmico, agilidade e sensação de instabilidade em indivíduos com instabilidade crônica do tornozelo: ensaio clínico randomizado

Abstract Ankle sprain is the most common injury in the lower limbs of physically active individuals, and one of its complications is chronic ankle instability (CAI), for which Kinesio Taping (KT) can be an alternative treatment. The aim of this study was to compare two treatment protocols with KT at different tensions on postural control, dynamic balance, agility and instability in individuals with chronic ankle instability. This is a randomized clinical trial in which postural control was evaluated through the force platform, agility by the side Hop Test, dynamic balance by the modified Star Excursion balance Test, and application of the Cumberland Ankle Tool Instability and Foot and Ankle Outcome Score to assess self-reported instability and functional instability. An initial assessment was conducted, followed by 5 weeks of intervention with weekly applications of KT, and one week after the completion of the intervention, a reassessment was performed. 21 participants were distributed to the group KT with tension (KTT: n=11) and the group KT without tension (KTWT: n=10). KT improves postural control (anteroposterior velocity: p=0.006 and mediolateral: p<0.001; anteroposterior frequency: p<0.001 and mediolateral: p=0.043 of the area of the center of pressure), dynamic balance (p< 0.001), agility (p=0.001) and feeling of instability in individuals with ICT (p=0.001) for both groups. Only one variable, sports category of the FAOS-FOOT questionnaire showed significant change (p=0.008). KT, with or without tension, is able to improve postural control, balanced balance, postural control, and feelings of instability in young adults with ICT.

Resumo A entorse de tornozelo, uma lesão comum em indivíduos fisicamente ativos, frequentemente resulta em uma complicação chamada instabilidade crônica do tornozelo (ICT). A Kinesio Taping (KT) pode ser uma alternativa de tratamento para essa condição. O objetivo deste estudo foi comparar dois protocolos de tratamento com KT em diferentes tensões no controle postural, equilíbrio dinâmico, agilidade e instabilidade em indivíduos com instabilidade crônica do tornozelo. Trata-se de um ensaio clínico randomizado no qual o controle postural foi avaliado por meio da plataforma de força, a agilidade pelo side Hop Test, o equilíbrio dinâmico pelo Star Excursion balance Test modificado e para avaliar instabilidade funcional e autorrelatada aplicou-se o Foot and Ankle Outcome Score e o Cumberland Ankle Tool Instability. Foi realizada uma avaliação inicial, seguida de 5 semanas de intervenção com aplicações semanais de KT, e uma semana após o término da intervenção, foi realizada uma reavaliação. 21 participantes foram distribuídos para o grupo KT com tensão (KTT: n=11) e o grupo KT sem tensão (KTWT: n=10). KT melhora o controle postural (velocidade ântero-posterior: p=0,006 e médio-lateral: p<0,001; frequência anteroposterior: p<0,001 e médio-lateral: p=0,043 da área do centro de pressão), equilíbrio dinâmico (p<0,001), agilidade (p=0,001) e sensação de instabilidade em indivíduos com ICT (p=0,001) para ambos os grupos. Apenas uma variável, categoria esportiva, do questionário FAOS-FOOT apresentou alteração significativa (p=0,008). O KT, com ou sem tensão, é capaz de melhorar o controle postural, o equilíbrio equilibrado, o controle postural e a sensação de instabilidade em adultos jovens com ICT.

Antibiotic prophylaxis for percutaneous endoscopic gastrostomy in pediatric patients: a meta-analysis.

PURPOSE: To investigate if Antibiotic Prophylaxis (AP) can prevent wound and/or systemic infection in pediatric patients who underwent Percutaneous Endoscopic Gastrostomy (PEG). METHODS: PubMed, Embase, and Cochrane databases were searched for Randomized Controlled Trials (RCT) and Observational Studies that compared AP vs. no Intervention (NI) in children submitted to PEG. Odds ratios (OR) with 95% confidence intervals (CI) were pooled with random-effect models. Quality assessment and risk of bias were performed as outlined by Cochrane recommendations. RESULTS: Four studies, including one RCT, with a total of 568 patients were included, in which 230 (40.5%) individuals received AP. The use of AP during PEG reduced the incidence of systemic infection (OR 0.46; 95% CI 0.24-0.90; p = 0.02; I2 = 0). However, no statistical difference was found for wound infection (OR 0.85; 95% CI 0.43-1.69; p = 0.64; I2 = 12%) and for the composite outcome of any kind of infection (OR 0.74; 95% CI 0.13-4.06; p = 0.73; I2 = 67%). CONCLUSION: In this pooled analysis of 568 infants who underwent PEG, the use of AP reduced the incidence of systemic infection. Our results were compatible with findings obtained in the adult population. No differences were found regarding wound infection or the composite outcome of any kind of infection.

Use of different reference values for handgrip strength in individuals with COPD: analysis of agreement, discriminative capacity, and main clinical implications.

OBJECTIVE: To identify reference values for handgrip strength through a literature search and compare the agreement of reference values from Brazil with others for handgrip strength in a sample of COPD patients in Brazil, as well as to determine which set of reference values is more discriminative regarding differences in clinical characteristics between individuals with low handgrip strength and normal handgrip strength. METHODS: To identify reference values for handgrip strength, a literature search was performed; a retrospective cross-sectional analysis of baseline-only data from two unrelated studies was then performed. Individuals were evaluated for handgrip strength, peripheral muscle strength, respiratory muscle strength, pulmonary function, body composition, exercise capacity, dyspnea, and functional status. RESULTS: Of the 45 studies that were initially selected, 9 met the criteria for inclusion in the analysis, which included 99 COPD patients in Brazil (52% of whom were male with GOLD stage II-IV COPD). The prevalence of low handgrip strength varied across studies (from 9% to 55%), the set of reference values for handgrip strength in a sample of individuals in Brazil having classified 9% of the study sample as having low handgrip strength. The level of agreement between the reference values for a sample of individuals in Brazil and the other sets of reference values varied from weak to excellent. The reference values for a sample of individuals in Brazil showed the highest number of significantly different characteristics between individuals with low and normal handgrip strength. CONCLUSIONS: The level of agreement between national and international sets of reference values for handgrip strength varied from weak to excellent in COPD patients in Brazil. Reference values for handgrip strength with higher discriminative capacity are not necessarily those that identify more individuals as having low handgrip strength.

Adjunctive corticosteroid therapy in patients with pulmonary tuberculosis.

OBJECTIVES: In tuberculosis treatment, corticosteroids are used as adjuvants, especially in meningeal/pericardial tuberculosis. In other forms of the disease, especially in severe tuberculosis requiring mechanical ventilation, its use is controversial. The aim of the present study is to assess whether the use of corticosteroids in the treatment of pulmonary tuberculosis patients in mechanical ventilation is associated with in-hospital mortality. METHODS: This is a retrospective cohort study. Tuberculosis patients >18 years requiring mechanical ventilation, admitted to the emergency department or intensive care unit, were included. Data on corticosteroid use and mortality were collected. RESULTS: In total, 467 patients were included in the analysis; 399 used corticosteroids and 68 were noncorticosteroid users. The mortality rate was higher among corticosteroid users (59.9%) than in noncorticosteroid users (41.2%) (p=0.010). The total dose of corticosteroid in prednisone equivalents was not different between survivors and nonsurvivors (median [interquartile range]: 80 mg [5-56.6 mg] vs. 80 mg [50-135 mg]; p=0.881). CONCLUSIONS: Tuberculosis patients in mechanical ventilation who used corticosteroids had a higher mortality rate than those who did not use corticosteroids. The role of corticosteroids in pulmonary tuberculosis, especially in critically ill patients, remains unclear and needs further evaluation in prospective studies.

Long-term outcomes of percutaneous versus surgical revascularization in patients with diabetes and left main coronary artery disease: A meta-analysis of randomized controlled trials.

BACKGROUND: The efficacy and safety of percutaneous coronary interventions (PCI) relative to coronary artery bypass grafting (CABG) in patients with diabetes and unprotected left main coronary artery disease (LMCAD) are not well established. OBJECTIVES: To perform a meta-analysis evaluating the long-term outcomes after PCI with drug-eluting stents (DES), as compared with CABG, in patients with diabetes and unprotected LMCAD. METHODS: MEDLINE, Cochrane, and Embase were searched for randomized controlled trials (RCTs) that reported outcomes after PCI with DES versus CABG in unprotected LMCAD among patients with diabetes. To evaluate the long-term effects of these interventions, we restricted this analysis to studies with a minimum follow-up period of 3 years. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled with a random-effects model. Quality assessment and risk of bias were performed according to Cochrane recommendations. RESULTS: Four RCTs with a total of 1080 patients were included, 553 (51.2%) of whom underwent PCI. There was no difference for individual outcomes of all-cause mortality (RR: 1.21; 95% CI: 0.86-1.71; p = .27; I2 = 28%), cardiovascular death (RR 1.29; 95% CI: 0.76-2.18; p = .34; I2 = 0%), or myocardial infarction (MI) (RR: 0.94; 95% CI: 0.61-1.45; p = .79; I2 = 0%). However, the risk of stroke was reduced with PCI relative to CABG (RR: 0.41; 95% CI: 0.18-0.94; p = .04; I2 = 0%), whereas the risk of any repeat revascularization was higher in the PCI group (RR: 1.99; 95% CI: 1.44-2.75; p < .001; I2 = 0%). The risk of the composite outcome of all-cause mortality, MI, stroke, or repeat revascularization was higher after PCI compared with CABG (RR: 1.30; 95% CI: 1.09-1.56; p = .004; I2 = 0%). CONCLUSION: In this meta-analysis with more than 1000 patients with diabetes and unprotected LMCAD followed for a minimum of 3 years, the incidence of repeat revascularization was higher among those treated with PCI, whereas the risk of stroke was higher in patients treated with CABG.