Retinal microvascular abnormalities, cotton wool-like lesions, and macular edema following COVID-19 in a patient previously vaccinated with AstraZeneca and idiopathic myopathy.

In this case study, the authors describe peculiar bilateral cotton wool-like retinal lesions associated with macular edema in a patient with COVID-19 who was vaccinated with a single dose of AstraZeneca one month earlier. This patient had no pulmonary or systemic cardiovascular complications from COVID-19, as reported in other papers that found retinal lesions. However, the patient was diagnosed with idiopathic myopathy when discovering the SARS-CoV-2 infection. The patient was a 22-year-old white female with no previous history of morbidity, complaining of blurred vision in both eyes seven days after testing positive for SARS-CoV-2 by PCR (using nasal and oral swab) and confirmed through ELISA blood test (IgM positive). There was no ancillary test revealing diabetes mellitus. The patient presented with scattered whitish cotton wool-like lesions and a few hemorrhages on the posterior pole in fundus examination. On spectral domain optical coherence tomography (SD-OCT), there were hyperreflective lesions in the nerve fiber layer, ganglion cell layer, inner nuclear layer, and inner and outer plexiform layers at the site corresponding to the whitish cotton wool-like lesions in the posterior fundus photos. Moreover, the macula of both eyes had intraretinal and subretinal fluid, reversible with corticosteroid therapy. In conclusion, COVID-19 has been associated with capillary disorders at different target sites such as retina, lungs, and central nervous system. Similarly, vaccination against SARS-CoV-2 has been linked to retinal complications in the literature; however, cotton wool-like lesions have not yet been reported. There are many questions yet to be answered about the implications of COVID-19 infection and its vaccines.

BRCAness as a Biomarker of Susceptibility to PARP Inhibitors in Glioblastoma Multiforme.

Glioblastoma multiforme (GBM) is the most common primary brain cancer. GBMs commonly acquire resistance to standard-of-care therapies. Among the novel means to sensitize GBM to DNA-damaging therapies, a promising strategy is to combine them with inhibitors of the DNA damage repair (DDR) machinery, such as inhibitors for poly(ADP-ribose) polymerase (PARP). PARP inhibitors (PARPis) have already shown efficacy and have received regulatory approval for breast, ovarian, prostate, and pancreatic cancer treatment. In these cancer types, after PARPi administration, patients carrying specific mutations in the breast cancer 1 (BRCA1) and 2 (BRCA2) suppressor genes have shown better response when compared to wild-type carriers. Mutated BRCA genes are infrequent in GBM tumors, but their cells can carry other genetic alterations that lead to the same phenotype collectively referred to as 'BRCAness'. The most promising biomarkers of BRCAness in GBM are related to isocitrate dehydrogenases 1 and 2 (IDH1/2), epidermal growth factor receptor (EGFR), phosphatase and tensin homolog (PTEN), MYC proto-oncogene, and estrogen receptors beta (ERß). BRCAness status identified by accurate biomarkers can ultimately predict responsiveness to PARPi therapy, thereby allowing patient selection for personalized treatment. This review discusses potential biomarkers of BRCAness for a 'precision medicine' of GBM patients.

Return to Sports after ACL Reconstruction with Resection or Remnant-Preserving Technique.

Objectives To analyze the results of anterior cruciate ligament (ACL) reconstruction with remnant-preserving versus remnant-resecting technique, concerning the return to pre-lesion activity level. Methods The present retrospective cohort study has assessed adults > 18 years old who underwent ACL anatomical reconstruction between 2010 and 2014. The main outcomes assessed were: level of physical activity (4-point scale), sports participation rate, ACL rerupture defined as documented lesion requiring revision surgery and the numeric pain scale rate (NPSR). Results A total of 83 individuals were included in the study, with a mean age of 31.8 years old and follow-up mean time of 4.2 years after the surgery. A total of 34 patients underwent ACL reconstruction with remnant-preserving technique, and 49 without remnant preservation. No statistically significant difference was found between groups in all outcomes assessed: level of physical activity before the lesion and after the surgery, ACL rerupture rates and postoperative pain level. Subgroup analysis has shown a statistically significant decrease in the activity level in both groups. The most practiced sport was football; 72% of patients in the remnant group have resumed football activity versus 52.6% of the control group. Conclusion Based in these findings, the comparison between ACL reconstruction with remnant preserving technique and remnant resecting technique has shown no differences concerning the return to prelesion activity level.

Return to Sports after ACL Reconstruction with Resection or Remnant-Preserving Technique / Retorno ao esporte após reconstrução do LCA com ressecção ou preservação do remanescente

Abstract Objectives To analyze the results of anterior cruciate ligament (ACL) reconstruction with remnant-preserving versus remnant-resecting technique, concerning the return to pre-lesion activity level. Methods The present retrospective cohort study has assessed adults > 18 years old who underwent ACL anatomical reconstruction between 2010 and 2014. The main outcomes assessed were: level of physical activity (4-point scale), sports participation rate, ACL rerupture defined as documented lesion requiring revision surgery and the numeric pain scale rate (NPSR). Results A total of 83 individuals were included in the study, with a mean age of 31.8 years old and follow-up mean time of 4.2 years after the surgery. A total of 34 patients underwent ACL reconstruction with remnant-preserving technique, and 49 without remnant preservation. No statistically significant difference was found between groups in all outcomes assessed: level of physical activity before the lesion and after the surgery, ACL rerupture rates and postoperative pain level. Subgroup analysis has shown a statistically significant decrease in the activity level in both groups. The most practiced sport was football; 72% of patients in the remnant group have resumed football activity versus 52.6% of the control group. Conclusion Based in these findings, the comparison between ACL reconstruction with remnant preserving technique and remnant resecting technique has shown no differences concerning the return to prelesion activity level.

Resumo Objetivo Analisar os resultados da reconstrução do ligamento cruzado anterior (LCA) com preservação do remanescente, comparada à técnica convencional, no retorno do paciente ao nível de atividade física pré-lesão. Métodos Estudo transversal retrospectivo, que avaliou indivíduos adultos submetidos à reconstrução anatômica do LCA no período de 2010 a 2014. Os desfechos analisados foram: nível de atividade física, taxa retorno ao esporte, relesão do LCA definida como lesão documentada que necessite de nova reconstrução ligamentar, e dor pela escala numérica de dor (EVN). Resultados Foram incluídos 83 indivíduos com média de 31,8 anos de idade e seguimento médio de 4,2 anos após a cirurgia, 34 submetidos à reconstrução do LCA com preservação do remanescente, e 49 à convencional. Não houve diferença estatisticamente significativa entre os grupos na frequência de atividade física pré-lesão e pós-operatória, na taxa de relesão do LCA reconstruído e na intensidade da dor no pós-operatório. Na análise intragrupos, houve uma queda estatisticamente significativa na frequência da prática de atividade física pós-operatória para ambos os grupos em comparação ao nível pré-lesão. O tipo de esporte mais praticado foi o futebol, onde 72% pacientes do grupo remanescente retornaram ao esporte comparado a 52,6% do grupo controle; porém, essa diferença não foi estatisticamente significante. Conclusão Não foi possível observar diferenças entre os pacientes submetidos às técnicas cirúrgicas de reconstrução LCA com e sem a preservação do remanescente em relação ao retorno ao esporte, frequência de atividade física e intensidade da dor. Estudos futuros prospectivos são necessários.

Blood cardiac biomarkers responses are associated with 24 h ultramarathon performance.

PURPOSE: Clinical significance of cardiac biomarkers response in ultra-endurance runners are not completely elucidated because events vary in distance/duration and competitors modulate running intensity according to individual running capacity. The aim of this study was to examine the relationship between self-selected exercise intensity with cardiac biomarkers comparing experienced (EXP, N = 11) and novice (NOV, N = 14) runners able to finish a 24h ultramarathon (24UM) with significant differences in performance. METHODS: Cardiac biomarkers (i.e. CKMB/totalCK, cTnT and NT-proBNP), inflammatory markers (i.e. leukocytes and CRP) and cortisol were analyzed before and after a 24UM. RESULTS: EXP finished the race with significant (p < 0.05) longer distance than NOV (158.8 ± 15.8 vs 116.8 ± 10.3 Km). Two-way mixed ANOVA showed significant time × performance level interaction with greater increase of cTnT (F(1,23) = 6.18, p = 0.021), NT-proBNP (F(1,23) = 9.27, p = 0.006) and cortisol (F(1, 23) = 5.13, p = 0.03) in the EXP group. CKMB/totalCK (F(1, 23) = 71.90, p < 0.0001) decreased while leukocytes (F(1, 23) = 100.06, p < 0.0001) and CRP (F(1, 23) = 93.37, p < 0.0001) increased in both groups (main effect of time). Correlations were found between 24UM distance and cortisol (r = 0.58; p = 0.002), CKMB (r = 0.47; p = 0.017), cTnT (r = 0.44; p = 0.027) or NT-proBNP (r = 0.56; p = 0.003). Cortisol and NT-proBNP were also significantly correlated (r = 0.51; p = 0.01). CONCLUSIONS: Although there is no clear evidence of cardiac risk when comparing cardiac biomarkers levels with clinical cut-off values, cardiac biomarkers are associated with running performance and pituitary-adrenocortical system response. In EXP runners, higher levels of cardiac biomarkers and cortisol suggest a more hemodynamically challenged heart during prolonged endurance exercise.

Osteochondritis dissecans of the trochlea: case report / Osteocondrite dissecante da tróclea: relato de caso

ABSTRACT The authors report a rare case of osteochondritis dissecans of the trochlea. The treatment of these lesions, in which the osteochondral fragment is not viable, is difficult and often limited in Brazil. A clinical case is presented with functional and radiological outcomes after treatment with microfracture technique, bone graft, and collagen membrane coverage.

RESUMO Os autores relatam um caso raro de osteocondrite dissecante de tróclea. O tratamento dessas lesões com inviabilidade do fragmento osteocondral é difícil e muitas vezes limitado no nosso meio. Os autores apresentam resultados clínicos e radiológicos após o tratamento com a técnica de microfratura, enxertia óssea e cobertura com membrana de colágeno.

Osteochondritis dissecans of the trochlea: case report.

The authors report a rare case of osteochondritis dissecans of the trochlea. The treatment of these lesions, in which the osteochondral fragment is not viable, is difficult and often limited in Brazil. A clinical case is presented with functional and radiological outcomes after treatment with microfracture technique, bone graft, and collagen membrane coverage.

Os autores relatam um caso raro de osteocondrite dissecante de tróclea. O tratamento dessas lesões com inviabilidade do fragmento osteocondral é difícil e muitas vezes limitado no nosso meio. Os autores apresentam resultados clínicos e radiológicos após o tratamento com a técnica de microfratura, enxertia óssea e cobertura com membrana de colágeno.

Anatomic Posterolateral Corner Reconstruction With Autografts.

Anatomic posterolateral corner reconstruction reproduces 3 main structures: the lateral collateral ligament, the popliteofibular ligament, and the popliteus tendon. The LaPrade technique reproduces all 3 main stabilizers. However, it requires a long graft, limiting its indication to clinical settings in which allograft tissue is available. We propose a surgical procedure that is a modification of the LaPrade technique using the same tunnel placement, hamstring autografts, and biceps augmentation when necessary. It relies on artificial graft lengthening provided by the loop of the suspensory fixation device fixed at the anterior tibial cortex. The final reconstruction reproduces the popliteus tendon with the bulkiest end of the semitendinosus; the popliteofibular ligament with a strand of the semitendinosus and a strand of the gracilis; and the lateral collateral ligament with a strand of the semitendinosus and a strand of the gracilis, which can also be augmented with a biceps strip.

Specific warm-up exercise is the best for vertical countermovement jump in young volleyball players

Abstract We evaluated the effect of performing various distinct warm-up exercises on vertical countermovement jump (VCMJ) performance. Eight volleyball players (age 15.4 ± 0.5 yrs) performed five different warm-up activities (in a counterbalanced, randomized crossover study) over five days, at 24-h intervals: stretching (4 × 30 s, 30 s between sets), cycloergometer (5 min at 50 W + 5 min at 100 W), resistance exercise (leg press 45°, 3 × 5 repetitions maximum, 3-min pause between sets), specific vertical jumping (4 × 10 VCMJ, 2-min pause between sets), and no warm-up at all (control condition). Beginning 3 min after their warm-up, the players performed 3 attempts (at intervals of 3 min) of VCMJ (on a contact carpet), and each player's best jump was considered in the analysis. All warm-up activities presented higher VCMJ performance (p< 0.05) than the control condition, with the exception of stretching. Vertical jumping revealed a large effect size(0.8) than other interventions. We conclude that in practical terms, vertical jumps are the best warm-up exercise (when applied by itself) to acutely improve VCMJ performance in volleyball players, but that other exercises can make a complementary contribution.

Anterior cruciate ligament - updating article.

This updating article on the anterior cruciate ligament (ACL) has the aim of addressing some of the most interesting current topics in this field. Within this stratified approach, it contains the following sections: ACL remnant; anterolateral ligament and combined intra and extra-articular reconstruction; fixation devices; and ACL femoral tunnel creation techniques.

Este artigo de atualização sobre ligamento cruzado anterior (LCA) visa abordar alguns dos tópicos mais interessantes e atuais sobre o tema. Dentro dessa abordagem estratificada incluem-se as seguintes seções: remanescente do LCA; ligamento anterolateral e reconstruções extra-articulares combinadas a intra-articulares; dispositivos de fixação; técnicas de confecção do túnel femoral.

Anterior cruciate ligament - updating article / Ligamento cruzado anterior - Artigo de atualização

ABSTRACT This updating article on the anterior cruciate ligament (ACL) has the aim of addressing some of the most interesting current topics in this field. Within this stratified approach, it contains the following sections: ACL remnant; anterolateral ligament and combined intra and extra-articular reconstruction; fixation devices; and ACL femoral tunnel creation techniques.

RESUMO Este artigo de atualização sobre ligamento cruzado anterior (LCA) visa abordar alguns dos tópicos mais interessantes e atuais sobre o tema. Dentro dessa abordagem estratificada incluem-se as seguintes seções: remanescente do LCA; ligamento anterolateral e reconstruções extra-articulares combinadas a intra-articulares; dispositivos de fixação; técnicas de confecção do túnel femoral.

Anterior cruciate ligament reconstruction: how do we perform it? Brazilian orthopedic surgeons' preference.

PURPOSE: We evaluated current trends and common practice of Brazilian orthopedic surgeons while selecting approaches for anterior cruciate ligament (ACL) reconstruction surgery. METHODS: Orthopedic surgeons (n = 191) completed a survey consisting of seven questions regarding their profiles and preference for ACL reconstruction techniques. RESULTS: Most surgeons were from Southeast Brazil (56.6%) and had specialized in knee surgery (79.5%); most participants (55.1%) had worked in this field for > five years, and 46.8% had performed >50 ACL reconstructions. Further, 93.1% respondents preferred the hamstring graft. Analysis of preference for the femoral tunnel approach in terms of years of experience showed that surgeons with ten to 15 years' experience preferred the transtibial approach; those with < five years of experience, the transportal technique; those with >15 years' experience, the two-incision technique. CONCLUSIONS: Surgeons' preferences for ACL reconstruction are variable, and are influenced by learning time and availability of tools rather than research evidence.

Is it safe the empirical distal femoral resection angle of 5 to 6 of valgus in the Brazilian geriatric population? / É seguro o corte femoral distal em artroplastia total do joelho com 5° a 6° de valgo empiricamente na população geriátrica brasileira?

OBJECTIVE: The purpose of this study is to determine if there is a safe distal femoral resection angle to restore the normal axial alignment of the limb in total knee arthroplasty (TKA) in the Brazilian geriatric population with knee arthrosis. METHOD: This study analyzed 99 pre-operative hip-knee-ankle radiographs of osteoarthritic knees of 66 patients (54 women, 12 men) with knee osteoarthritis. The distal femoral cut angle was determined based on the femoral mechanical-anatomical angle (FMA). Mean, median and standard deviation measurements of the distal femoral cut angle were calculated, differentiated by gender and side. The mean result of the distal femoral resection angle was compared to 5.7°, the mean average angle of previous and similar study based on European population of patients with knee arthrosis. RESULTS: The mean average of the distal femoral resection angle of the study was 6.05 (range 3-9°). The distribution of this angle between genders showed a slight superior average of the male population (6.17°) compared to the female (6.02°), but with no statistically significant difference (p = 0.726). There was no statistically significant difference (p = 0.052) between the mean average of this study (6.05°) compared to the mean average of the literature (5.7°). However, considering 3° as the limit of acceptable error in the coronal plane, this empirical femoral resection angle would not be appropriated for 19.7% of the population. CONCLUSION: The distal femoral resection angle of 5-6° is not completely safe for the Brazilian geriatric population. .

OBJETIVO: Determinar se existe um ângulo seguro para o corte femoral distal, para que o membro resulte alinhado após uma artroplastia total de joelho (ATJ), na população geriátrica brasileira com gonartrose. MÉTODO: Foram feitas radiografias panorâmicas de 99 membros inferiores em 66 pacientes consecutivos (54 mulheres e 12 homens) portadores de gonartrose do joelho. O ângulo do corte femoral distal foi determinado pelo encontro entre o eixo mecânico femoral (EMF) e o eixo anatômico femoral (EAF). Foram calculados os valores da média, o desvio padrão e a mediana do ângulo do corte femoral distal desses pacientes diferenciados por sexo e lado. O valor médio do ângulo de corte do fêmur distal ideal aqui obtido foi comparado com o valor médio de 5,7 obtido em estudo prévio semelhante a esse feito com populações europeias de pacientes osteoartríticos submetidos a ATJ. RESULTADOS: A média do ângulo formado pelos EAF × EMF, considerado o ângulo do corte femoral distal em uma ATJ, do grupo estudado foi de 6,05 (variação de 3° a 9°). A distribuição desse ângulo entre os sexos evidenciou uma média discretamente superior entre os homens (6,17°) em comparação com as mulheres (6,02°), porém sem significância estatística (p = 0,726). Não houve diferença estatística (p = 0,052) entre o valor médio obtido na amostra atual (6,05 - DP 1,27) com o valor médio obtido na literatura (5,7°). Entretanto, se considerarmos aceitável um erro de 3° no plano coronal, 19,7% da população operada se encontrariam fora dessa faixa aceitável se optarmos pelo corte femoral empírico de acordo com o instrumental. CONCLUSÃO: O corte femoral distal na ATJ em 5° ou 6° de valgo não é ...

Is it safe the empirical distal femoral resection angle of 5° to 6° of valgus in the Brazilian geriatric population?

OBJECTIVE: The purpose of this study is to determine if there is a safe distal femoral resection angle to restore the normal axial alignment of the limb in total knee arthroplasty (TKA) in the Brazilian geriatric population with knee arthrosis. METHOD: This study analyzed 99 pre-operative hip-knee-ankle radiographs of osteoarthritic knees of 66 patients (54 women, 12 men) with knee osteoarthritis. The distal femoral cut angle was determined based on the femoral mechanical-anatomical angle (FMA). Mean, median and standard deviation measurements of the distal femoral cut angle were calculated, differentiated by gender and side. The mean result of the distal femoral resection angle was compared to 5.7°, the mean average angle of previous and similar study based on European population of patients with knee arthrosis. RESULTS: The mean average of the distal femoral resection angle of the study was 6.05 (range 3-9°). The distribution of this angle between genders showed a slight superior average of the male population (6.17°) compared to the female (6.02°), but with no statistically significant difference (p = 0.726). There was no statistically significant difference (p = 0.052) between the mean average of this study (6.05°) compared to the mean average of the literature (5.7°). However, considering 3° as the limit of acceptable error in the coronal plane, this empirical femoral resection angle would not be appropriated for 19.7% of the population. CONCLUSION: The distal femoral resection angle of 5-6° is not completely safe for the Brazilian geriatric population.

OBJETIVO: Determinar se existe um ângulo seguro para o corte femoral distal, para que o membro resulte alinhado após uma artroplastia total de joelho (ATJ), na população geriátrica brasileira com gonartrose. MÉTODO: Foram feitas radiografias panorâmicas de 99 membros inferiores em 66 pacientes consecutivos (54 mulheres e 12 homens) portadores de gonartrose do joelho. O ângulo do corte femoral distal foi determinado pelo encontro entre o eixo mecânico femoral (EMF) e o eixo anatômico femoral (EAF). Foram calculados os valores da média, o desvio padrão e a mediana do ângulo do corte femoral distal desses pacientes diferenciados por sexo e lado. O valor médio do ângulo de corte do fêmur distal ideal aqui obtido foi comparado com o valor médio de 5,7 obtido em estudo prévio semelhante a esse feito com populações europeias de pacientes osteoartríticos submetidos a ATJ. RESULTADOS: A média do ângulo formado pelos EAF × EMF, considerado o ângulo do corte femoral distal em uma ATJ, do grupo estudado foi de 6,05 (variação de 3o a 9o). A distribuição desse ângulo entre os sexos evidenciou uma média discretamente superior entre os homens (6,17o) em comparação com as mulheres (6,02o), porém sem significância estatística (p = 0,726). Não houve diferença estatística (p = 0,052) entre o valor médio obtido na amostra atual (6,05 - DP 1,27) com o valor médio obtido na literatura (5,7°). Entretanto, se considerarmos aceitável um erro de 3° no plano coronal, 19,7% da população operada se encontrariam fora dessa faixa aceitável se optarmos pelo corte femoral empírico de acordo com o instrumental. CONCLUSÃO: O corte femoral distal na ATJ em 5° ou 6° de valgo não é completamente seguro para a população geriátrica brasileira.

Déficit bilateral em exercício multiarticular para membros superiores / Bilateral deficit in multiarticular exercise for upper extremities

A força muscular é um componente importante para a atividade física e para o desempenho das tarefas da vida diária. Um fenômeno observado geralmente é que a capacidade de geração de força máxima está comprometida quando os membros homólogos se contraem bilateralmente. Esse fenômeno é chamado de déficit bilateral. Assim, objetivou-se comparar a atividade elétrica do músculo deltoide, porção medial durante contrações unilaterais e bilaterais em um aparelho multiarticular de desenvolvimento articulado convergente, com 90% da carga voluntária máxima (CVM), em nove homens com idades entre 20 e 30 anos, estatura 174 ± 5cm e massa corporal 78 ± 15kg. Os sinais mioelétricos foram captados através da colocação de eletrodos ativos de superfície diferenciais da EMG System do Brasil, um eletrodo de referência (terra) e um módulo condicionador de sinais (eletromiógrafo), que forneceu dados numéricos em RMS (raiz quadrada da média) para análise dos resultados. Cada sinal coletado captou apenas a fase concêntrica do movimento e o mesmo teve duração de três segundos. Os resultados evidenciaram que durante exercício bilateral e unilateral com 90% da CVM, a atividade elétrica do membro não dominante predominou significativamente sobre o dominante (p = 0,018). Quando somados os valores obtidos no trabalho do membro dominante com aqueles obtidos com o membro não dominante no exercício bilateral (2.231 ± 504µv) e comparados com os valores obtidos no trabalho unilateral (2.663 ± 701µv), o déficit bilateral foi encontrado (p = 0,018). De acordo com nosso estudo, verificamos que o fenômeno do déficit bilateral se faz presente para o músculo deltoide médio no exercício multiarticular de desenvolvimento articulado convergente em indivíduos familiarizados em exercícios resistidos.

Muscular strength is an important component for physical activity and performance of activities of daily living. A phenomenon usually observed is that the capacity of generating maximum strength is compromised when the homologous extremities bilaterally contract. This phenomenon is called bilateral deficit. Thus, the aim of this work was to compare the electrical activity of the deltoid muscle, medial portion, during unilateral and bilateral contractions in a multiarticular machine of convergent articulated development, with 90% of maximum voluntary load (mvl), in nine men aged between 20 and 30 years, stature of 174 ± 5cm and body mass of 78 ± 15 kg. The myoelectrical signals were obtained through placement of differential active surface electrodes by EMG System of Brazil, a reference electrode (ground) and a signal conditioner module (electromyograph), which provided numerical data in RMS (root median square) for results analysis. Each signal collected picked only the concentric phase of the movement and it had duration of three seconds. The results evidenced that during bilateral and unilateral exercise with 90% of MVL, the electric activity of the non-dominant extremity was significantly higher than in the dominant one (p = 0.018). When the values obtained in the work of dominant extremity are summed with the work of non-dominant extremity in the bilateral exercise (2.231 ± 504µv) and compared with the values obtained in the unilateral work (2.663 ± 701µv), bilateral deficit was found (p = 0.018). According to our study, it was verified that the bilateral defict phenomenon is present in the medium deltoid muscle in the multiarticular exercise of convergent articulated development in individuals familiarized with resistance exercises.

Estudo eletromiográfico dos músculos deltoide, peitoral maior e tríceps braquial de nadadores durante contrações bilaterais realizadas em exercício multiarticular com cargas variadas / Electromyographic study of the deltoid, pectoralis major and triceps brachial muscles in swimmers during bilateral contractions performed in multi-joint exercise with different loads

O objetivo deste trabalho foi comparar a atividade elétrica do músculo deltoide (porção média), peitoral maior (porção clavicular) e tríceps braquial (cabeça longa) durante contração bilateral realizada num aparelho multiarticular de desenvolvimento articulado convergente, com 40% e 80% da carga voluntária máxima (CVM), em 11 nadadores do gênero masculino (idades entre 15 e 23 anos, peso 70 ± 4kg, estatura 183 ± 6cm e tempo de prática do esporte de 10 ± 4 anos) treinados em exercícios resistidos. Os sinais eletromiográficos (EMG) foram captados através da colocação de eletrodos ativos de superfície diferenciais de ganho de 20 vezes, composto por duas barras retangulares paralelas da EMG System do Brasil, um eletrodo de referência (terra), e um módulo condicionador de sinais (eletromiógrafo), com aquisição simultânea de até oito canais diferenciais, filtro com faixa de passagem de 20Hz a 5Hz, estágio amplificador ajustável, possibilitando ganhos entre 100 e 4.960 vezes, impedância de entrada de canais de 10GΩ em módulos diferencial e CMRR de 93db a 60Hz, e um sistema de aquisição de dados (Alc-EMG) que forneceu dados numéricos em RMS (raiz quadrada da média) para análise dos resultados. Cada sinal coletado captou apenas a fase concêntrica do movimento e o mesmo teve duração de três segundos. Diante dos resultados (teste U de Mann-Whitney, Friedman e Wilcoxon) conclui-se que, em termos práticos de prescrição e periodização do treinamento neuromuscular, as contrações bilaterais realizadas no aparelho desenvolvimento articulado convergente são eficientes visando recrutamento (80% > 40%) dos músculos deltoide médio, peitoral maior (porção clavicular) e tríceps braquial (cabeça longa), sendo evidenciadas diferenças entre o membro dominante e o não dominante apenas para o tríceps braquial dominante com a carga de 80% da CVM nestes atletas nadadores com histórico de treinamento com pesos.

The objective of this study was to compare the electrical activity of the deltoid (middle portion), pectoralis major (clavicular portion) and triceps (long head) muscles during bilateral contraction performed in a multi-articulated joint shoulder-press convergent machine with 40% and 80% maximum voluntary load (MVL) in 11 male swimmers (15 to 23 years, 70 ± 4 kg, 183 ± 6 cm and 10 ± 4 years time practice in sport), trained in resistance exercise. Electromyographic signals (EMG) were obtained by placing surface active differential electrodes (20x gain), composed of two parallel rectangular bars (EMG System, Brazil®). A data acquisition system (EMG-Alc) which provided numerical data in RMS (Root Mean Square) to analyze the signals composed by a reference electrode (ground) and a signal conditioning module (EMG) with simultaneous acquisition of up to 8 differential channels (band-pass filter 5-20 Hz), adjustable amplifier stage, allowing gains between 100 and 4960 times, channel input impedance 10GΩ in differential modules and CMRR of 93 dB/60 Hz was used. Only the concentric phase (3 seconds duration) in each EMG signal collected was recorded. After the tests (Mann-Whitney U test, Friedman and Wilcoxon) were applied, it was concluded that for prescription and periodization of the neuromuscular training, bilateral contractions performed in the shoulder-press apparatus are efficient at aiming muscular recruitment (80%> 40% ) of middle portion of the deltoid, pectoralis major (clavicular portion), and triceps brachii (long head) muscles, evidencing differences between dominant and non-dominant limbs only for the dominant brachial triceps in 80% of MVL in swimmers trained in resistance exercises.

Complicações das endopróteses em pacientes com tumores ósseos do joelho / Endoprostheses-related complications in patients with bone tumors of the knee

As endopróteses não convencionais (ENC) são frequentemente utilizadas na ortopedia oncológica. As complicações do procedimento é motivo de pesquisa, pois há a instituição deste em população jovem e com grande potencial de sobrevida. Nós conduzimos uma revisão da literatura com o objetivo de buscar a melhor evidência científica relativa ao tema. A pesquisa englobou as bases: MEDLINE, EMBASE, CINAHL e o Registro Central Cochrane de ensaios clínicos randomizados (ECR), objetivando identificar estudos reportando complicações, e a substituição ou não da superfície articular da patela. Os estudos foram selecionados de acordo com a melhor qualidade metodológica existente para o assunto. Cento e quarenta e seis (146) estudos foram avaliados. Nenhum ERC foi encontrado. Realizamos uma avaliação qualitativa e quantitativa dos trabalhos encontrados (níveis de evidência IV e V). Utilizou-se o teste de U de Mann-Whitney para a análise estatística. Os resultados apontam para a necessidade de produção de novos estudos, para que se possa chegar a uma conclusão mais sólida. Pode-se considerar altas as taxas de complicações pós ENC, a despeito da baixa qualidade dos estudos, conforme demonstra os estudos existentes na literatura.

Non-conventional endoprostheses (NCE) are frequently used in orthopedic oncology. The complications associated with this procedure have prompted research, due to the fact that it is commonly performed on young patients, with a higher survival rate. We conducted a systematic review of the literature, searching for the best scientific evidence on the subject. The research was carried out in the following databases: MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of randomized controlled trials (CCTR), seeking to identify studies that report complications, and compare patellar resurfacing versus retention. The studies were selected according to the best methodological quality that exists for the subject. One hundred and forty six (146) studies were evaluated. No randomized clinical trial was found. We conducted a qualitative and quantitative evaluation of the work found (evidence levels IV and V). We used the Mann-Whitney U test for the statistical analysis. The results indicate a need for further studies that will enable us to reach a more solid conclusion. The rate of complications after NCE can be considered high, despite the low quality of the studies, as demonstrated by the studies that exist in the literature.

Electroporation of vascular endothelial growth factor gene in a unipedicle transverse rectus abdominis myocutaneous flap reduces necrosis.

Necrosis in TRAM (transverse rectus abdominis myocutaneous) still occurs in flap breast reconstruction. Blood flow may be improved by vascular endothelial growth factor (VEGF), an endogenous protein that stimulates neovascularization. Experimental studies of gene therapy with plasmid vector expressing human VEGF (hVEGF) presented inadequate results. Low level of gene expression could be the cause. To prove that high level of VEGF gene expression can minimize necrosis of TRAM flap, electroporation of VEGF plasmid was tested.Forty-two adult, male, Wistar-EPM rats were randomly distributed in 6 groups of 7 animals and 50 microg of vectors were injected in the intradermal layer of TRAM flap donor region, by electroporation: LacZ (beta-galactosidase gene); CG (no substance injected and flap elevated); P2G (empty gT plasmid in area 2); PV2G (gT-VEGF165 in area 2); P4G (empty gT plasmid in area 4); PV4G (gT-VEGF165 in area 4). Five days after flap elevation, the animals were euthanized and the degree of necrosis was analyzed by histology and paper template method.Dermal X-gal staining after electroporation with pSV2lacZ proved high rate of gene transfer. Mean values of necrosis by the paper template method were: CG (74.5%), P2G (62.2%), PV2G (41.1%), P4G (76.6%), and PV4G (59%). Degree of necrosis, preservation of muscle layer, and degree of infiltrates seen by histology were in accordance with mean values of necrosis.Intradermal injection of gT-VEGF165 in area 2, by electroporation, was effective in reducing unipedicle TRAM flap necrosis, in rats.

Electromyographic study of the Rectus femoris and Biceps femoris (long head) muscles during bilateral isotonic contraction in a 45º leg press apparatus / Estudo eletromiográfico dos músculos Rectus femoris E Biceps femoris (cabeça longa) durante contração isotônica no aparelho leg press 45º

The aim of this study was to compare the bilateral electric activity of the rectus femoris (RF) and biceps femoris long head (BF) muscles during flexion and extension isotonic movements of the thigh and leg. Six men and six women accomplished all movements in 45° Leg Press apparatus with 30 per cent and 60 per cent of the maximum voluntary load (MVL). Electromyographic signs were captured using surface electrodes, recorded in a computerized electromyograph and analyzed in a system of data acquisition (Alc-EMG). The results demonstrated that the RF muscle showed greater electric activity than BF in both loads (30 per cent and 60 per cent MVL) and sides, regardless the sex. It can be concluded that in spite of the RF and BF muscles are in opposite ends of the hip and knee joints and are mentioned traditionally as antagonistic muscles, both muscles seem to act with synergism between themselves with predominance of the activation of the RF muscle on the BF muscle in both genders and studied loads in leg press 45graus execution. In addition, the electrical activity of these muscles is directly proportional to the load, independently of the sex.

O objetivo deste estudo é comparar a atividade elétrica bilateral dos músculos rectus femoris (RF) e cabeça longa do biceps femoris (BF) durante movimentos isotônicos de flexão e extensão da coxa e perna. Seis homens e seis mulheres realizaram todos os movimentos em um aparelho Leg Press 45º com 30 por cento e 60 por cento da carga voluntária máxima (CVM). Os sinais eletromiográficos foram captados usando eletrodos de superfície, registrados em um eletromiógrafo computadorizado e analisados em um sistema de aquisição de dados (Alc-EMG). Os resultados demonstram que o músculo RF mostra atividade elétrica maior em relação ao músculo BF em ambas as cargas (30 por cento e 60 por cento CVM) e lados, independente do sexo. Pode ser concluído que apesar dos músculos RF e BF estarem em extremidades opostas das articulações do quadril e joelho e serem mencionados como músculos antagônicos, ambos músculos parecem agir com sinergismo entres si, com predominância de ativação do músculo RF sobre o BF em ambos gêneros e cargas estudadas na execução do leg press 45º. Além disso, a atividade elétrica destes músculos é diretamente proporcional à carga, independente do sexo.