Effects of auriculotherapy on muscle fatigue: A randomized crossover trial.

OBJECTIVE: This study aimed investigate the effect of auriculotherapy on exercise-induced muscle fatigue, isometric torque production, and surface electromyographic activity (EMG). METHODS: Design: Randomized Crossover Trial. The sample consisted of 18 males' volunteers who exercised at least twice a week. THE SAMPLE WAS RANDOMLY ASSIGNED TO TWO GROUPS: Placebo Group (n = 9) and Treated Group (n = 9), and after seven days, the groups were crossed. The data analysis included 18 participants in each group. MAIN OUTCOME MEASURE: The muscle fatigue index, force production rate, and EMG of the quadriceps were used for evaluation. The evaluation moments included baseline pre-fatigue, baseline post-fatigue, 48 h post-intervention pre-fatigue, and 48 h post-intervention post-fatigue. Mixed two-way test ANOVA was used to compare times and groups. RESULTS: The fatigue index for peak torque and work showed no significant effect on time, groups, or interaction (p > 0.05). However, for isometric torque, force production rate, and EMG median frequency and average, the results indicate a positive change in values over time (p < 0.05) (with little practical relevance), with no differences observed between the groups or interaction (p > 0.05). CONCLUSIONS: In conclusion, auriculotherapy had no effect on exercise-induced muscle fatigue, isometric torque production, and surface electromyographic activity.

Validation of a Single-Session Protocol to Determine the Load-Velocity Profile and One-Repetition Maximum for the Back Squat Exercise.

ABSTRACT: Gomes, M, Fitas, A, Santos, P, Pezarat-Correia, P, and Mendonca, GV. Validation of a single session protocol to determine the load-velocity profile and one-repetition maximum for the back squat exercise. J Strength Cond Res XX(X): 000-000, 2024-We investigated whether a single session of absolute incremental loading is valid to obtain the individual load-velocity profile (LVP) and 1 repetition maximum (1RM) for the free-weight parallel back squat. Twenty strength-trained male subjects completed 3 testing sessions, including a baseline 1RM session and 2 LVP sessions (LVPrel based on incremental relative loads and LVPabs based on absolute load increments until 1RM). The 1RM load was compared between the baseline and LVPabs. The load at zero velocity (load-axis intercept [L0]), maximal velocity capacity (velocity-axis intercept [V0]), slope, and area under the load-velocity relationship line (Aline) were compared between the LVPrel and LVPabs using equivalence testing through 2 one-sided t-tests. Measurement accuracy was calculated using the absolute percent error. The 1RM measured at baseline and LVPabs was equivalent and presented a low absolute percent error (1.2%). The following LVP parameters were equivalent between LVPrel and LVPabs: 1RM, L0, and Aline because the mean difference between sessions was close to zero and the Bland-Altman limits of agreement (1RM:5.3 kg; L0:6.8 kg; Aline: 9.5 kg·m-1·s-1) were contained within the a priori defined ± equivalent margins (5% for 1RM and L0 and 10% for Aline). The aforementioned variables presented a low absolute percent error. However, slope and V0 were not equivalent between sessions. In conclusion, a single session of absolute incremental loading is a valid approach to obtain the L0 and Aline of the individual LVP and 1RM, and can be used to efficiently track the magnitude of neuromuscular adaptations throughout the training cycles for the free-weight back squat.

Prediction of One Repetition Maximum in Free-Weight Back Squat Using a Mixed Approach: The Combination of the Individual Load-Velocity Profile and Generalized Equations.

ABSTRACT: Fitas, A, Santos, P, Gomes, M, Pezarat-Correia, P, Schoenfeld, BJ, and Mendonca, GV. Prediction of one repetition maximum in free-weight back squat using a mixed approach: the combination of the individual load-velocity profile and generalized equations. J Strength Cond Res 38(2): 228-235, 2024-We aimed to develop a mixed methods approach for 1 repetition maximum (1RM) prediction based on the development of generalized equations and the individual load-velocity profile (LVP), and to explore the validity of such equations for 1RM prediction. Fifty-seven young men volunteered to participate. The submaximal load-velocity relationship was obtained for the free-weight parallel back squat. The estimated load at 0 velocity (LD0) was used as a single predictor, and in combination with the slope of the individual LVP, to develop equations predictive of 1RM. Prediction accuracy was determined through the mean absolute percent error and Bland-Altman plots. LD0 was predictive of 1RM ( p < 0.0001), explaining 70.2% of its variance. Adding the slope of the LVP to the model increased the prediction power of 1RM to 84.4% ( p < 0.0001). The absolute percent error between actual and predicted 1RM was lower for the predictions combining LD0 and slope (6.9 vs. 9.6%). The mean difference between actual and estimated 1RM was nearly zero and showed heteroscedasticity for the LD0 model, but not for the combined model. The limits of agreement error were of 31.9 and 23.5 kg for LD0 and LD0 combined with slope, respectively. In conclusion, the slope of the individual LVP adds predictive value to LD0 in 1RM estimation on a group level and avoids error trends in the estimation of 1RM over the entire spectrum of muscle strength. However, the use of mixed methods does not reach acceptable accuracy for 1RM prediction of the free-weight back squat on an individual basis.

Changes in lung function in adolescents with substance use disorders: an exploratory study.

OBJECTIVE: To compare lung function between adolescents with and without substance use disorder (SUD). METHODS: This was an observational, cross-sectional exploratory study. The sample consisted of 16 adolescents with SUD and 24 age-matched healthy controls. The adolescents in the clinical group were recruited from a psychiatric inpatient unit for detoxification and rehabilitation; their primary diagnosis was SUD related to marijuana, cocaine, or polysubstance use. Questionnaires and pulmonary function tests were applied for clinical evaluation. RESULTS: We found that FVC, FEV1, and their percentages of the predicted values were significantly lower in the adolescents with SUD than in those without. Those differences remained significant after adjustment for BMI and the effects of high levels of physical activity. The largest effect size (Cohen's d = 1.82) was found for FVC as a percentage of the predicted value (FVC%), which was, on average, 17.95% lower in the SUD group. In addition, the years of regular use of smoked substances (tobacco, marijuana, and crack cocaine) correlated negatively with the FVC%. CONCLUSIONS: This exploratory study is innovative in that it demonstrates the early consequences of smoked substance use for the lung health of adolescents with SUD.

Intrastromal Corneal Ring Segment Implantation in a Patient with the Bowman Layer Inlay Transplantation for Keratoconus.

Keratoconus (KC) is a bilateral ectatic corneal disease which results in changes in the corneal architecture and can lead to severe visual impairment. Treatment options depend on the stage of the disease, and they aim either at improving vision or arrest progression. The Bowman layer transplantation (BLT) is a recent surgical option in patients with KC and may postpone corneal transplantation in some patients. We present a case of a 22-year-old patient with a 10-year follow-up history of progressing KC. A first attempt for an intracorneal ring segment (ICRS) implantation when he was 13 years old was unsuccessful due to a superficially implanted segment. At that time, collagen cross-linking was unavailable, and his young age raised concerns about performing a penetrating keratoplasty/lamellar keratoplasty. A BLT was performed with further ICRS implantation with relative disease stability and visual improvement. ICRS implantation in KC patients with BLT has not previously been described in literature and can be an option in selected patients.

Case Report: Alternaria alternata keratitis.

Background: Alternaria spp are ubiquitous pigmented filamentous fungi that can cause opportunistic human infections. These molds can be found in healthy individuals and the most frequently observed clinical manifestations are skin infections, ocular mycosis, rhinosinusitis, among others. Immunosuppression (both local and systemic) as well as contact or trauma with contaminated matter are important risk and predisposing factors for ocular mycosis. Accurate diagnosis with microscopy and culture is crucial since infections by filamentous fungi are sight-threatening, and clinically indistinguishable from bacterial disease. In general terms, conventional antifungal drugs are effective. Case Presentation: We report a case of Alternaria alternata keratitis after ocular trauma with biological material in a 44-year-old man's functional single eye, which had a good clinical and functional evolution after topical therapy with voriconazole. Conclusion: This case accounts the importance of thinking about other etiological diagnoses in infectious keratitis refractory to the established therapy and with a history of trauma with biological material.

Descemet Stripping Without Endothelial Keratoplasty in Early-Stage Central Fuchs Endothelial Dystrophy: Long-term Results.

PURPOSE: The purpose of this study was to report long-term results of Descemet stripping without endothelial keratoplasty (DWEK) associated with phacoemulsification in patients with early-stage central Fuchs endothelial corneal dystrophy. METHODS: This is a retrospective study, including all patients submitted to DWEK associated with cataract surgery with a minimum follow-up of 24 months. Included patients had central confluent guttae confirmed with specular microscopy, a clear peripheral endothelium (with a peripheral endothelial count >1500 cells/mm 2 ), and a central pachymetry <600 µm. The main end points were the presence of a clear cornea and time that was needed to achieve transparency, best-corrected visual acuity in logMAR, endothelial central cell count (ECC), and central pachymetry. RESULTS: A total of 22 eyes were included with a mean follow-up of 40.8 ± 10.5 months. At baseline, mean central pachymetry was 536 ± 34 mm and 6 eyes had countable ECC (mean 1138 ± 190 cells/mm 2 ). Twenty eyes (90.9%) achieved good corneal transparency 3.2 ± 1.1 months after surgery. There was a significant improvement in logMAR best-corrected visual acuity compared with baseline (0.13 ± 0.10 vs. 0.48 ± 0.24, respectively, P < 0.001). Endothelial central repopulation was observed in all successful cases. Twelve months after DWEK, ECC was 1449 ± 344 cells/mm 2 and 1393 ± 450 cells/mm 2 at the end of follow-up, without a significant decrease between this period ( P = 0.081). Only 2 eyes (9.1%) did not achieve corneal transparency and were submitted to an endothelial keratoplasty. CONCLUSIONS: According to our results, DWEK is a safe and effective procedure in selected cases of early-stage central Fuchs endothelial corneal dystrophy. This seems to be a promising technique, delaying or avoiding endothelial transplantation.

Predictive Equations to Estimate Relative Load Based on Movement Velocity in Males and Females: Accuracy of Estimation for the Smith Machine Concentric Back Squat.

ABSTRACT: Mendonca, GV, Fitas, A, Santos, P, Gomes, M, and Pezarat-Correia, P. Predictive equations to estimate relative load based on movement velocity in males and females: accuracy of estimation for the Smith machine concentric back squat. J Strength Cond Res 37(8): 1559-1565, 2023-We sought to determine the validity of using the Smith machine bar velocity to estimate relative load during the concentric back squat performed by adult male and female subjects. Thirty-two subjects (16 men: 23.3 ± 3.8 and 16 women: 26.1 ± 2.7 years) were included. The load-velocity relationship was extracted for all subjects individually. Mean concentric velocity (MCV), combined with sex, was used to develop equations predictive of relative load (% one repetition maximum [1RM]). Prediction accuracy was determined with the mean absolute percent error and Bland-Altman plots. Relative strength was similar between the sexes. However, male subjects exhibited faster concentric MCV at 1RM ( p < 0.05). Mean concentric velocity and the sex-by-MCV interaction were both significant predictors of %1RM ( p < 0.0001), explaining 89% of its variance. The absolute error was similar between the sexes (men: 9.4 ± 10.0; women: 8.4 ± 10.5, p > 0.05). The mean difference between actual and predicted %1RM in Bland-Altman analysis was nearly zero in both sexes and showed no heteroscedasticity. The limits of agreement in both men and women were of approximately ±15%. Taken together, it can be concluded that sex should be taken into consideration when aiming at accurate prescription of relative load based on movement velocity. Moreover, predicting relative load from MCV and sex provides an error of approximately 10% in assessments of relative load in groups of persons. Finally, when used for individual estimations, these equations may implicate a considerable deviation from the actual relative load, and this may limit their applicability to training conditions in which extreme accuracy is required (i.e., more advanced lifters and athletes).

Squamous Cell Carcinoma of the Conjunctiva in a Patient With Previous Squamous Cell Carcinoma of the Lower Lip.

Squamous cell carcinoma (SCC) of the conjunctiva is a rare malignancy that is part of the spectrum of ocular surface squamous neoplasia (OSSN). Numerous non-modifiable and modifiable risk factors, such as male sex, age, cigarette smoking, and immunosuppression, have been identified. Any lesion of the conjunctiva requires a differential diagnosis between benign and malignant diseases, and all suspicious lesions should be biopsied. We present a case of SCC of the conjunctiva in a former smoker with multiple risk factors, including a previous SCC of the lower lip. Metastatic tumors rarely occur in the conjunctiva, but due to our patient's medical history, the exclusion of metastasis from the previous primary tumor was performed through whole-body imaging restaging.  The patient underwent a no-touch wide resection, followed by adjuvant topical chemotherapy with 5-fluorouracil (5-FU). After finishing treatment, the patient continues to attend regular ophthalmology and oncology appointments. Increasing population awareness of modifiable risk factors for OSSN is essential. Misdiagnosis can lead to a loss of time in treatment and progression of the disease.

Changes in lung function in adolescents with substance use disorders: an exploratory study / Alterações da função pulmonar em adolescentes com transtornos relacionados ao uso de substâncias: estudo exploratório

ABSTRACT Objective: To compare lung function between adolescents with and without substance use disorder (SUD). Methods: This was an observational, cross-sectional exploratory study. The sample consisted of 16 adolescents with SUD and 24 age-matched healthy controls. The adolescents in the clinical group were recruited from a psychiatric inpatient unit for detoxification and rehabilitation; their primary diagnosis was SUD related to marijuana, cocaine, or polysubstance use. Questionnaires and pulmonary function tests were applied for clinical evaluation. Results: We found that FVC, FEV1, and their percentages of the predicted values were significantly lower in the adolescents with SUD than in those without. Those differences remained significant after adjustment for BMI and the effects of high levels of physical activity. The largest effect size (Cohen's d = 1.82) was found for FVC as a percentage of the predicted value (FVC%), which was, on average, 17.95% lower in the SUD group. In addition, the years of regular use of smoked substances (tobacco, marijuana, and crack cocaine) correlated negatively with the FVC%. Conclusions: This exploratory study is innovative in that it demonstrates the early consequences of smoked substance use for the lung health of adolescents with SUD.

RESUMO Objetivo: Comparar a função pulmonar de adolescentes com e sem transtornos relacionados ao uso de substâncias (TUS). Métodos: Trata-se de um estudo exploratório transversal observacional. A amostra foi composta por 16 adolescentes com TUS e 24 controles saudáveis emparelhados pela idade. Os adolescentes do grupo clínico foram recrutados em uma unidade de internação psiquiátrica para desintoxicação e reabilitação; seu diagnóstico primário era o de TUS (maconha, cocaína ou polissubstâncias). Foram aplicados questionários e testes de função pulmonar para a avaliação clínica. Resultados: A CVF, o VEF1 e seus valores em porcentagem do previsto foram significativamente mais baixos nos adolescentes com TUS do que naqueles sem TUS. Essas diferenças permaneceram significativas após os ajustes para levar em conta o IMC e os efeitos de altos níveis de atividade física. O maior tamanho de efeito (d de Cohen = 1,82) foi o observado em relação à CVF em porcentagem do previsto (CVF%), que foi, em média, 17,95% menor no grupo TUS. Além disso, os anos de uso regular de substâncias fumadas (tabaco, maconha e crack) correlacionaram-se negativamente com a CVF%. Conclusões: Este estudo exploratório é inovador na medida em que demonstra as consequências precoces do uso de substâncias fumadas para a saúde pulmonar de adolescentes com TUS.

Neuromuscular Impact of Acute Hypertrophic Resistance Loading with And Without Blood-Flow Restriction.

Exploring acute neuromuscular fatigue induced by different modalities of resistance exercise would help understand the adaptation subsequent to specific training programs. Therefore, we investigated the acute impact of high-intensity and low-intensity blood flow-restricted resistance exercise on the development of explosive torque throughout the torque-time curve. Seventeen healthy, young participants were included in a randomized, counterbalanced within-subjects design study, in which participants underwent two experimental conditions, separated by a 1-wk period. Low-intensity blood-flow restricted exercise and high-intensity resistance exercise were performed using dynamic elbow flexion at 20 and 75% of 1 repetition maximum, respectively. Maximal voluntary contraction (MVC) and the sequential rate of torque development (absolute and relative) were measured before and after exercise. Both protocols elicited a similar decrement in MVC (~ 25%) and in the peak rate of torque development after exercise (~ 45%). The absolute rate of torque development (0-50 and 50-100 ms) was also reduced (p<0.05) similarly between conditions. After normalizing torque values to MVC, this was only sustained for the rate of torque development 0-50ms (p<0.05). We found that both exercise protocols induced similar acute attenuation of the absolute rate of torque development up to the first 100 ms of MVC. We also demonstrated that the reduction in the rate of torque development between 50-100ms (in both protocols) was largely explained by an acute deficit in muscle strength post-exercise. Conversely, the impact of each protocol on the first 50ms of muscle torque did not depend on lower levels of muscle strength after exercise.

Sure-thing vs. probabilistic charitable giving: Experimental evidence on the role of individual differences in risky and ambiguous charitable decision-making.

Charities differ, among other things, alongside the likelihood that their interventions succeed and produce the desired outcomes and alongside the extent that such likelihood can even be articulated numerically. In this paper, we investigate what best explains charitable giving behaviour regarding charities that have interventions that will succeed with a quantifiable and high probability (sure-thing charities) and charities that have interventions that only have a small and hard to quantify probability of bringing about the desired end (probabilistic charities). We study individual differences in risk/ambiguity attitudes, empathy, numeracy, optimism, and donor type (warm glow vs. pure altruistic donor type) as potential predictors of this choice. We conduct a money incentivised, pre-registered experiment on Prolific on a representative UK sample (n = 1,506) to investigate participant choices (i) between these two types of charities and (ii) about one randomly selected charity. Overall, we find little to no evidence that individual differences predict choices regarding decisions about sure-thing and probabilistic charities, with the exception that a purely altruistic donor type predicts donations to probabilistic charities when participants were presented with a randomly selected charity in (ii). Conducting exploratory equivalence tests, we find that the data provide robust evidence in favour of the absence of an effect (or a negligibly small effect) where we fail to reject the null. This is corroborated by exploratory Bayesian analyses. We take this paper to be contributing to the literature on charitable giving via this comprehensive null-result in pursuit of contributing to a cumulative science.

Effects of surgical masks on the responses to constant work-rate cycling performed at different intensity domains.

We aimed at examining the impact of wearing surgical face masks on exercise performance. Thirty-two healthy adults (16 males and 16 females) completed a graded exercise test to measure peak oxygen uptake (VO2peak ) and the ventilatory threshold (VT). Then, on separate days, all participants performed resting and standardized protocols (moderate intensity: 25% infra-VT; severe intensity: 25% supra-VT) on two different conditions (with and without a surgical mask). The use of masks reduced both VO2 and minute ventilation during moderate and severe exercise (p < 0.0001), and this effect was particularly pronounced during severe exercise. Time to exhaustion was also shortened by ~10% on the face mask condition (p = 0.014). In contrast, neither heart rate nor the respiratory exchange ratio was affected by masking. The submaximal VO2 was similar between the two epochs of analysis obtained during moderate cycling (i.e. 3-6 min vs. 7-10 min) and this occurred similarly between conditions. In conclusion, the impact of the surgical masks on exercise capacity is particularly pronounced during severe exercise performed at constant work rate. Ultimately, this may implicate a considerable impairment of structured or even unstructured strenuous physical activity. Clinical Trials registration number: NCT04963049.

Sex differences in muscle fatigue following isokinetic muscle contractions.

Muscle fatigue is a limiting factor of human performance. It is unclear whether sex-based differences in fatigability exist during dynamic exercise of varying velocities of contraction. We aimed at exploring sex differences in muscle fatigue elicited by maximal isokinetic muscle contractions performed at different angular velocities. Twenty-six healthy participants (13 men: 23.2 ± 1.5; 13 women: 21.9 ± 3.0 years) were tested for concentric knee-extension at slow, moderate and fast angular isokinetic velocity (60, 180 and 300º.s-1, respectively), on non-consecutive days. The impact of sex on fatigue resistance and consecutive recovery for each isokinetic condition was explored by calculating the percent change in maximal voluntary isometric contraction (MVIC) and in rate of torque development (RTD), from pre- to post-isokinetic exercise (30 repetitions). The isokinetic fatigue index was also determined. No sex differences were obtained in response to isokinetic contractions completed at 60º.s-1. After performing muscle contractions at 300º.s-1, women had a significantly greater loss in MVIC than men (- 18.4 ± 5.5 vs. - 12.9 ± 3.8%; p = 0.009) and larger decreases in work output during isokinetic exercise (- 34.2 ± 8.9 vs - 27.5 ± 10.6%; p = 0.017). Recovery of initial MVIC strength was greater for women post-exercise at 180º.s-1 (15.6 ± 4.1% vs. 6.7 ± 9.5; p = 0.003). No differences were found between sexes in any condition for RTD from pre- to post-fatigue. These results suggest the presence of a sexually dimorphic fatigability in response to dynamic (isokinetic) contractions favouring men at higher absolute velocities of contraction.

Choroidal neovascularization secondary to pathological myopia-macular Bruch membrane defects as prognostic factor to anti-VEGF treatment.

PURPOSE: To evaluate the prevalence and visual outcomes of macular Bruch membrane (BM) defects in patients treated with anti-vascular endothelial growth factors (VEGF) for choroidal neovascularization secondary to pathological myopia (mCNV). METHODS: Single-center retrospective observational case series of 68 eyes from 62 patients with mCNV treated with one anti-VEGF injection followed by a pro re nata (1 + PRN) regimen. A minimum follow-up of 6 months was defined. Chorioretinal atrophy was assessed by fundus examination, fluorescein angiography, and SD-OCT. RESULTS: Median follow-up was 28.5 (range 6-89) months with a median number of 5 anti-VEGF injections. At baseline, 27.9% of eyes had macular BM defects increasing to 36.8% during follow-up (p<0.001). Eyes without macular BM defects at the baseline had higher BCVA at the last observation than patients with BM defects (p=0.003). An increase of 5 or more ETDRS letters was more frequent in eyes without BM defects (p=0.001). At the end of follow-up, mCNV-related macular atrophy was present in 44.1%; out of which, 83.3% presented macular BM defects (p<0.001). Eyes with mCNV-related macular atrophy without BM defects had a significant increase of best-corrected visual acuity compared with eyes with mCNV-related macular atrophy and BM defect (p=0.002). CONCLUSIONS: Macular Bruch membrane defects are often seen in mCNV and have a significant impact in visual acuity and prognosis. Eyes with macular BM defects have a poorer response and worse visual outcomes after anti-VEGF therapy.

Keratitis by Scopulariopsis brevicaulis Fungus After LASIK - A Case Report.

PURPOSE: To describe a rare case of an interface filamentous fungal keratitis and its successful clinical approach and management. PATIENTS AND METHODS: Retrospective case report. Analysis of the patient's clinical records. RESULTS: A healthy 30-year-old woman presenting with complaints of blurred vision, photophobia and intense pain, was previously diagnosed with a suspected unilateral diffuse lamellar keratitis after laser in situ keratomileusis surgery, and accordingly treated with a scheme of oral and subconjunctival corticosteroids. Due to worsening of symptoms, the patient was later referred to our ophthalmology department. Upon examination, a corneal infiltration was observed and a fungal infection was suspected. Treatment with fortified Voriconazole (1%) was initiated and both topical and oral corticosteroids were tapered. The infiltrate resolved after 6 weeks of antifungal topical treatment. Scopulariopsis brevicaulis was isolated on culture media. At the end of follow-up, the uncorrected distance visual acuity was 20/20 with mild scarring. CONCLUSION: Scopulariopsis brevicaulis can be associated with post-laser in situ keratomileusis interface infection. A quick intervention may dictate a good outcome, when combining early suspicion and microbiological diagnosis, and an appropriate conservative management. Furthermore, Voriconazole seems to be effective and safe in the treatment of such cases.

Asymmetric Thickness Intracorneal Ring Segments for Keratoconus.

PURPOSE: To describe the anatomical and functional results of the implantation of asymmetric thickness intracorneal ring segments (AS-ICRS) in eyes with keratoconus and asymmetric/irregular astigmatism (type 2 - Duck - and type 3 - Snowman - phenotypes, Fernandez-Vega/Alfonso morphologic Keratoconus classification). MATERIALS AND METHODS: Retrospective observational study including 19 consecutive patients (21 eyes) with keratoconus who underwent manual implantation of the Keraring® Asymmetric ICRS (AS). Analysis included demographic and clinical data and Pentacam (Oculus®) measurements: topographic astigmatism; topographic flat meridian (K1), steepest meridian (K2) and the maximum keratometric point (Kmax); total root mean square (RMS) and high order RMS (HOA) aberrations and comatic Zernike coefficients (Z31;Z3-1) at 0º and 90º meridians. RESULTS: Overall mean age was 35.3±11.7 years and median follow-up was 7.1 months (range 6-12). At the end of follow-up, a significant improvement from baseline was achieved in both UDVA (0.24±0.22; p=0.017) and CDVA (0.21±0.17; p<0.001). Regarding topographic measurements, the greatest decrease was observed in K2 (2.76±1.9D; p<0.001) and astigmatism (1.97±1.5; p<0.001). Aberrometry analysis showed a reduction of 1.27±3.2µm in the total RMS (p=0.085), 0.24±0.9µm in HOA (p=0.227) and 0.78±0.5 (p<0.001) in the 90º component of comatic aberration. The procedure effects in the CDVA, topographic and aberrometric parameters were higher in type 2 cones without statistical significance (p>0.05 in all). CONCLUSION: Implantation of the Keraring® Asymmetric ICRS in keratoconus with asymmetric/irregular astigmatism allowed an improvement of several clinical, topographic and aberrometric parameters, with clinical efficacy and safety, with a tendency to a greater effect in the type 2 cones.

Exophiala Keratitis following Descemet Stripping Automated Endothelial Keratoplasty.

PURPOSE: To report a case with Exophiala spp. keratitis in a Portuguese patient. METHODS: A case report with deep corneal brown-pigmented infiltrates that developed 2 months after a Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) for pseudophakic bullous keratopathy. RESULTS: Diagnosis was established by positive direct examination and cultures from the surgically obtained corneal button. Slit-lamp images and anterior segment optical coherence tomography (AS-OCT) scans were obtained. CONCLUSION: This is the first described case of fungal keratitis caused by Exophiala spp. in Portugal and, to our knowledge, the first case following DSAEK in the literature.

Sex differences in soleus muscle H-reflex and V-wave excitability.

NEW FINDINGS: What is the central question of this study? How do H-reflex and V-wave excitability compare between men and women engaging in similar levels of physical activity?  What is the main finding and its importance? H-reflex excitability is lower in women than in men because of their greater level of antagonist co-activation during sustained plantar flexion isometric exercise. In addition, supraspinal drive is similar between men and women independently of their differences in H-reflex excitability and antagonist muscle co-activation. ABSTRACT: We compared H-reflex and V-wave excitability between men and women engaging in similar levels of physical activity. We also explored whether differences in antagonist muscle co-activation between sexes might partially explain sexual dimorphism in the excitability of the H-reflex and V-wave. Fifty-seven young participants were included (29 men: 21.7 ± 2.3 years; 28 women: 22.4 ± 3.3 years). Soleus M- and H-recruitment curves were constructed on a tonic background muscle activation. V-waves were elicited during maximal voluntary contraction (MVC). Besides being stronger than women, men achieved greater Hmax /Mmax values and presented a steeper slope of the ascending limb of the H-reflex recruitment curve (P < 0.05). The current intensity required to elicit Hmax was lower for men (P < 0.05). The co-activation of the tibialis anterior muscle during the sustained plantar flexions was greater in women (ratio between tibialis and soleus normalized EMG: 20.5 vs. 8.3%, P < 0.05). Covariance analysis showed that sexual dimorphism in H-reflex excitability was dissipated when controlling for antagonist co-activation. V-wave normalized amplitude was similar between sexes even after controlling for the effects of Hmax /Mmax and antagonist co-activation as covariates. Thus, women exhibit lower H-reflex excitability than men and this is dependent on their higher level of antagonist muscle co-activation. While sex differences in antagonist co-activation persist during MVCs, this is not the case for V-wave normalized amplitude. Thus, although the efficacy of the transmission between Ia afferent fibres to α-motoneurons is lower in women because of a greater level of antagonist co-activation, our findings are consistent with similar supraspinal drive between sexes.

Kounis Syndrome after Angioplasty of the Superficial Femoral Artery with Paclitaxel-Coated Balloon.

Drug-coated balloons are used widely as a form of endovascular treatment for peripheral arterial disease, to improve patency by reducing neointimal hyperplasia and restenosis. We present a rare case of acute coronary syndrome secondary to anaphylaxis after inflation of a paclitaxel-coated balloon used to treat a recurrent superficial femoral artery stenosis.