Effects of Foot Orthoses on Pain and the Prevention of Lower Limb Injuries in Runners: Systematic Review and Meta-Analysis.

CONTEXT: A variety of approaches have been proposed to prevent lower limb injuries in runners. However, the evidence for the effectiveness of interventions to reduce lower limb pain and injury after intensive running is very weak. OBJECTIVE: The authors performed a systematic review to investigate the effects of foot orthoses on pain and the prevention of lower limb injuries in runners. EVIDENCE ACQUISITION: The authors searched the MEDLINE/PubMed, Physiotherapy Evidence Database, Scielo, and Cochrane Central (from inception to February 2022) databases for randomized controlled trials that evaluated the effects of foot orthoses in runners. The authors then calculated mean differences and 95% confidence intervals from these trials. Heterogeneity was assessed using the I2 test. Furthermore, the authors compared the criteria between runners with foot orthoses and ones with no intervention (control group). EVIDENCE SYNTHESIS: Twelve studies (5321 runners) met our review criteria. The control and the foot orthoses group sustained 721 (37%) and 238 (24%) injuries, respectively. Compared with the control group, the use of foot orthoses resulted in a significant reduction in lower limb injury risk (risk ratio = 0.6; 95% confidence interval, 0.5-0.7; P = .00001, I2 = 54%; 7 studies, N = 2983: moderate-quality evidence). Moreover, the foot orthoses group corresponded to a 40% reduction in the risk of developing lower limb injuries. CONCLUSIONS: The use of foot orthoses may help reduce the incidence of lower limb injuries and pain in runners.

Coalescent-Based Species Delimitation in Herbaceous Bamboos (Bambusoideae, Olyreae) from Eastern Brazil: Implications for Taxonomy and Conservation in a Group with Weak Morphological Divergence Coupled with Low Genetic Diversity.

Species delimitation in herbaceous bamboos has been complex and, in some genera, a great part of its diversity has been confirmed only based on genetic information, as is the case of the genus Raddia. It includes nine species, all occurring in Brazil, but only R. portoi predominates in dry forests of the Northeast associated with the Caatinga phytogeographic domain. This species is morphologically close to R. angustifolia, which is known for a single location in the Atlantic Forest in Southern Bahia, and is considered to be threatened by extinction. Besides problems with taxonomic focus, actions for its conservation are complicated because it is not certain if it must be considered an independent species or included in the more widespread R. portoi. In this study, we used coalescent multispecies (MSC) theory approaches combined with genetic structure analyses in an attempt to delimit these two species. Different analyses were congruent and the species delimitation using MSC inferred distinct lineages supporting their recognition as two species. These results solved the taxonomic doubts and also showed the power of these approaches to delimit species as lineages, even in groups with weak morphological divergence and low genetic variability, and also impacting our knowledge for conservation purposes.

O ECG NA MULHER HIPERTENSA, QUAL O MELHOR CRITÉRIO DE VOLTAGEM? / THE ECG IN HYPERTENSIVE WOMEN, WHAT IS THE BEST VOLTAGE CRITERIA?

Segundo a Diretriz Brasileira de Hipertensão Arterial 2020, hipertensão arterial (HA) é uma doença crônica não transmissível (DCNT) definida por níveis pressóricos, em que os benefícios do tratamento não medicamentoso e/ou medicamentoso superam os riscos; e a falta de tratamento evolui com lesão de órgão alvo, como a hipertrofia ventricular esquerda. Neste estudo avaliamos a literatura no tocante à acurácia dos critérios eletrocardiográficos para diagnóstico de hipertrofia ventricular esquerda (HVE) e por conta das diferenças entre homens e mulheres, isso constitui um grande desafio. Dentre os fatores que mais interferem no critério sensibilidade, destacam-se a massa cardíaca e o sexo, sendo a sensibilidade do ECG maior com o aumento da massa ventricular e no sexo masculino, segundo Colossimo e Povoa. No estudo de Gasperin, onde foram utilizados critérios de voltagem, observou-se que o critério de Cornell nas mulheres foi de maior sensibilidade, de 54,90%, com alta especificidade de 81,60%. Quando a sensibilidade do critério de Cornell foi comparada à de Sokolow-Lyon-Rappaport, o segundo em sensibilidade, foi de 41,18%; sem significância estatística entre os dois. A detecção precoce da HVE tem importância prognóstica, já discutida em vários trabalhos e seus critérios de validação, um constante desafio. Definir critérios específicos em mulheres torna-se necessário para maior acurácia diagnóstica e abordagem precoce para intervenções terapêuticas sejam medicamentosas ou não. Conclui-se que o critério eletrocardiográfico de Cornell foi o método com maior sensibilidade nas mulheres, nesta revisão. São necessários estudos com análises especificas para o sexo feminino, considerando suas diferenças anatômicas e antropométricas e possivelmente ajustadas à população brasileira. Torna-se uma limitação desta análise, a lacuna resultante do pequeno número de dados e poucos estudos publicados sobre o tema.

According to the Brazilian Guidelines on Hypertension 2020, hypertension (AH) is a chronic non-communicabledisease (NCD) defined by blood pressure levels, in which the benefits of non pharmacologic and/or pharmacologic therapy out weigh The risks; and lack of treatment evolves with target-organ damage such as left ventricular hypertrophy. In this study, we evaluated the literature regarding the accuracy of the electrocardiographic criteria for the diagnosis of left ventricular hypertrophy (LVH) and, due to the differences between men and women, this represents a great challenge. Among the factors that most interfere with the sensitivity criterion, cardiac mass and gender stand out, with ECG sensitivity being greater with the increase in ventricular mass and in males, according to Colossimo and Povoa. In the study by Gasperin, where voltage criteria were used, it was observed that the Cornell criterion in women was more sensitive, 54.90%, with a high specificity of 81.60%. When the sensitivity of the Cornell criterion was compared to theSokolow-Lyon-Rappaport criterion, the latter in sensitivity was 41.18%; with no statistical significance between the two. The early detection of LVH hás prognostic importance, already discussed in several works and its validation criteria, a Constant challenge. Defining specific criteria in women becomes necessary for greater diagnostic accuracy and a nearly approach to therapeutic interventions, whether drug-related or not. It is concluded that the Cornell electrocardiographic criterion was the method with the greatest sensitivity in women in this review. However, studies with specific analyzes for females are still needed, considering their anatomical and anthropometric differences and possibly adjusted to the Brazilian population. The gap resulting from the small amount of data and few published studies on the subject becomes a limitation of this analysis

Effects of Exercise Interventions on Aerobic Capacity and Health-Related Quality of Life in People Living With HIV/AIDS: Systematic Review and Network Meta-Analysis.

OBJECTIVE: Exercise is a recommended component of care for people living with HIV/AIDS; however, it is unclear which type of exercise is most effective. The purpose of this study was to investigate the relative effects of different types of exercise interventions on aerobic capacity measured by peak oxygen consumption (peak VO2) and health-related quality of life (HRQoL) in this population. METHODS: For this systematic review and indirect-comparisons meta-analysis (network meta-analysis), different electronic databases were searched up to February 2020 for randomized controlled trials that evaluated the effects of different types of exercise interventions on peak VO2 and HRQoL of people living with HIV/AIDS. Mean differences, standardized mean difference (SMD), and 95% CI were calculated. Fixed- and random-effects Bayesian network meta-analysis were used to compare the relative effectiveness of the different exercise interventions. RESULTS: Forty studies met the study criteria, reporting on a total of 1518 patients. When comparing the exercise interventions with usual care (control group) for the peak VO2 outcome, combined aerobic and resistance exercise was the highest ranked exercise intervention with an SMD of 4.2 (95% CI = 2.5 to 5.9), followed by aerobic exercise (SMD = 3.1; 95% CI = 1.4 to 5.1). Compared with aerobic exercise, resistance training, and yoga, combined aerobic and resistance exercise was the best exercise intervention to promote improvement on physical function, general health, mental health, and energy/vitality domains HRQoL. CONCLUSION: The combined aerobic and resistance exercise was the highest ranked exercise intervention to improve peak VO2 and HRQoL. Combined aerobic and resistance exercise should be considered as a component of care for people living with HIV/AIDS.

Motor skill acquisition during a balance task as a process of optimization of motor primitives.

It has been argued that the central nervous system relies on combining simple movement elements (i.e. motor primitives) to generate complex motor outputs. However, how movement elements are generated and combined during the acquisition of new motor skills is still a source of debate. Herein, we present results providing new insights into the role of movement elements in the acquisition of motor skills that we obtained by analysing kinematic data collected while healthy subjects learned a new motor task. The task consisted of playing an interactive game using a platform with embedded sensors whose aggregate output was used to control a virtual object in the game. Subjects learned the task over multiple blocks. The analysis of the kinematic data was carried out using a recently developed technique referred to as "movement element decomposition." The technique entails the decomposition of complex multi-dimensional movements in one-dimensional elements marked by a bell-shaped velocity profile. We computed the number of movement elements during each block and measured how closely they matched a theoretical velocity profile derived by minimizing a cost function accounting for the smoothness of movement and the cost of time. The results showed that, in the early stage of motor skill acquisition, two mechanisms underlie the improvement in motor performance: 1) a decrease in the number of movement elements composing the motor output and 2) a gradual change in the movement elements that resulted in a shape matching the velocity profile derived by using the above-mentioned theoretical model.

Adenoid Cystic Carcinoma of the Trachea: A Case Report.

BACKGROUND Adenoid cystic carcinoma of trachea (ACCT) is an unusual low-grade tumor from the tracheal and bronchial wall glands. The histological structure and biological behavior of ACCT are similar to that of tumors found in the salivary glands. ACCT occurs most commonly in the upper trachea, being found in the articular cartilage in the posterior aspect of the trachea. CASE REPORT We describe the case of a 62-year-old male ex-smoker 25 years/pack (abstinence 20 years ago), who began with mild dyspnea 2 years ago, with intense evolution and cough. He was evaluated as an outpatient and was treated for sinusitis and later bronchitis after pulmonary function tests. With the worsening of the aforementioned symptoms, he sought prompt care, with hospitalization and computed tomography (CT) of the chest being indicated, showing an expansive lesion in the anterior wall of the trachea with an extension of approximately 3.1 cm, ending at the level of the carina, measuring 3.4×2.8 cm, with moderate stenosis of the tracheal lumen, with an exophytic component to the mediastinum. Bronchoscopy of the lesion was done, and later immunohistochemistry showed a probable pleomorphic adenoma. However, in a new analysis, after the removal of the surgical specimen, it was observed that it was a ACCT. CONCLUSIONS ACCT is a rare tumor that should be diagnosed as soon as possible in order to ensure its best prognosis. Moreover, it is evident that the analysis of the surgical specimen is sovereign to immunohistochemistry with regard to histological typing.

Complex Upper-Limb Movements Are Generated by Combining Motor Primitives that Scale with the Movement Size.

The hand trajectory of motion during the performance of one-dimensional point-to-point movements has been shown to be marked by motor primitives with a bell-shaped velocity profile. Researchers have investigated if motor primitives with the same shape mark also complex upper-limb movements. They have done so by analyzing the magnitude of the hand trajectory velocity vector. This approach has failed to identify motor primitives with a bell-shaped velocity profile as the basic elements underlying the generation of complex upper-limb movements. In this study, we examined upper-limb movements by analyzing instead the movement components defined according to a Cartesian coordinate system with axes oriented in the medio-lateral, antero-posterior, and vertical directions. To our surprise, we found out that a broad set of complex upper-limb movements can be modeled as a combination of motor primitives with a bell-shaped velocity profile defined according to the axes of the above-defined coordinate system. Most notably, we discovered that these motor primitives scale with the size of movement according to a power law. These results provide a novel key to the interpretation of brain and muscle synergy studies suggesting that human subjects use a scale-invariant encoding of movement patterns when performing upper-limb movements.

High value added lipids produced by microorganisms: a potential use of sugarcane vinasse.

This review aims to present an innovative concept of high value added lipids produced by heterotrophic microorganisms, bacteria and fungi, using carbon sources, such as sugars, acids and alcohols that could come from sugarcane vinasse, which is the main byproduct from ethanol production that is released in the distillation step. Vinasse is a rich carbon source and low-cost feedstock produced in large amounts from ethanol production. In 2019, the Brazilian Ministry of Agriculture, Livestock and Food Supply estimates that growth of ethanol domestic consumption will be 58.8 billion liters, more than double the amount in 2008. This represents the annual production of more than 588 billion liters of vinasse, which is currently used as a fertilizer in the sugarcane crop, due to its high concentration of minerals, mainly potassium. However, studies indicate some disadvantages such as the generation of Greenhouse Gas emission during vinasse distribution in the crop, as well as the possibility of contaminating the groundwater and soil. Therefore, the development of programs for sustainable use of vinasse is a priority. One profitable alternative is the fermentation of vinasse, followed by an anaerobic digester, in order to obtain biomaterials such as lipids, other byproducts, and methane. Promising high value added lipids, for instance carotenoids and polyunsaturated fatty acids (PUFAS), with a predicted market of millions of US$, could be produced using vinasse as carbon source, to guide an innovative concept for sustainable production. Example of lipids obtained from the fermentation of compounds present in vinasse are vitamin D, which comes from yeast sucrose fermentation and Omega 3, which can be obtained by bacteria and fungi fermentation. Additionally, several other compounds present in vinasse can be used for this purpose, including sucrose, ethanol, lactate, pyruvate, acetate and other carbon sources. Finally, this paper illustrates the potential market and microbial processes, using microorganisms, for lipid production.

The use of novel packing material for improving methane oxidation in biofilters.

The use of biofilters (working bed volume of 7.85 L) for the oxidation of CH4 at low concentrations (from 0.17%v/v to 3.63%v/v, typically in waste gas from anaerobic sewage treatment) was investigated and four empty bed residence times were tested (in min): 42.8, 29.5, 19.6, and 7.4. Mixtures of organic (composted leaves) and three non-organic materials (sponge-based material - SBM, blast furnace slag - BFS, and expanded vermiculite - ExpV) were used as packing media. Along 188 operational days after the steady state was reached (95 days for start-up), the CH4 mineralization decreased while the inlet loads gradually increased from 3.0 ± 0.8 gCH4 m(-3) h(-1) to 148.8 ± 4.4 gCH4 m(-3) h(-1). The biofilter packed with ExpV showed the best results, since the CH4 conversions decreased from 95.0 ± 5.0% to 12.7 ± 3.7% as a function of inlet concentration, compared to the other two biofilters (SBM and BFS) which showed CH4 conversions decreasing from 56.0 ± 5.4% to 3.5 ± 1.2% as a function of inlet concentration. The methanotrophic activity of biomass taken from ExpV biofilter was three times higher than the activity of biomass from the other two biofilters. Taken together, these results suggested that ExpV provides an attractive environment for microbial growth, besides the mechanical resistance provided to the whole packing media, showing the potential to its use in biofiltration of diffuse CH4 emissions.

Video-assisted thoracic sympathectomy in the treatment of primary hyperhidrosis: a retrospective study of 521 cases comparing different levels of ablation.

OBJECTIVE: To compare different levels of ablation in terms of the degree of patient satisfaction and extent of postoperative reflex sweating in sympathectomized patients. METHODS: A retrospective study involving 521 patients with primary hyperhidrosis, submitted to thoracic sympathectomy at the Monte Sinai Hospital and University Hospital of the Federal University of Juiz de Fora, from January of 2001 to December 2005. All patients were submitted to thermal ablation of the sympathetic stem and were divided into three groups: up to T2 (group I, n = 162); up to T3 (group II, n = 65); and up to T4 (group III, n = 294). RESULTS: Optimal postoperative control of palmar/axillary hyperhidrosis was achieved in, respectively, 94/82% of the patients of group I, 89/89% of those in group II and 80/80% of those in group III. Postoperative reflex sweating was observed in 67% of the patients in groups I and II, compared with 61.29% of those in group III. Severe reflex sweating occurred in 32% of the group I patients, 9% of the group II patients and 4% of the group III patients. CONCLUSION: Sympathectomy provided excellent patient satisfaction and a low incidence of complications. There was no significant difference between the levels of ablation in terms of reflex sweating, although the intensity of this complication decreased when lower levels of blockage, principally at the T4 level, were employed.

Pulmonary amyloidosis: radiographic finding of nodular opacities in a heavy smoker.

Pulmonary amyloidosis is a rare disease, characterized by extracellular deposition of fibrillary protein in the lungs. Amyloidosis is a generic term for a heterogeneous group of diseases, including Alzheimer's disease and type 2 diabetes mellitus. In the respiratory system, it appears in various forms: tracheobronchial; nodular pulmonary; and alveolar septal (diffuse parenchymal). We present the case of a woman who was a 20 pack-year smoker and had nodular pulmonary amyloidosis, as diagnosed through tests performed prior to laparoscopic cholecystectomy.

Simpatectomia torácica por videotoracoscopia para tratamento da hiperidrose primária: estudo retrospectivo de 521 casos comparando diferentes níveis de ablação / Video-assisted thoracic sympathectomy in the treatment of primary hyperhidrosis: a retrospective study of 521 cases comparing different levels of ablation

OBJETIVO: Comparar grau de satisfação dos pacientes simpatectomizados e presença de sudorese reflexa, de acordo com diferentes níveis de ablação. MÉTODOS: Estudo retrospectivo de 521 pacientes com hiperidrose primária, submetidos à simpatectomia torácica no Hospital Monte Sinai e Hospital Universitário da Universidade Federal de Juiz de Fora - UFJF, de janeiro de 2001 a dezembro de 2005. Grupo I (n = 162): termoablação do tronco simpático, tendo T2 como nível mais cranial da ressecção, independentemente de outros níveis seccionados caudalmente. Grupo II (n = 65): termoablação do tronco simpático, tendo T3 como nível mais alto. Grupo III (n = 294): termoablação do tronco simpático, tendo T4 como nível mais alto. RESULTADOS: Pós-operatório ótimo no controle da hiperidrose palmar/axilar em, respectivamente, 94/82 por cento dos pacientes do grupo I, 89/89 por cento do grupo II e 80/80 por cento do grupo III. Sudorese reflexa em 67 por cento dos pacientes dos grupos I e II, caindo para 61,29 por cento no grupo III devido à maior termoablação a partir de T4. Ocorreu sudorese reflexa severa em 32 por cento dos pacientes do grupo I, 9 por cento do grupo II e 4 por cento do grupo III. CONCLUSÃO: A simpatectomia propiciou excelente grau de satisfação e baixo índice de complicações. Não houve diferença na incidência de sudorese reflexa com diferentes níveis seccionados; porém, a intensidade desta complicação se mostrou menor quando optamos por níveis de bloqueio mais baixos, principalmente T4.

OBJECTIVE: To compare different levels of ablation in terms of the degree of patient satisfaction and extent of postoperative reflex sweating in sympathectomized patients. METHODS: A retrospective study involving 521 patients with primary hyperhidrosis, submitted to thoracic sympathectomy at the Monte Sinai Hospital and University Hospital of the Federal University of Juiz de Fora, from January of 2001 to December 2005. All patients were submitted to thermal ablation of the sympathetic stem and were divided into three groups: up to T2 (group I, n = 162); up to T3 (group II, n = 65); and up to T4 (group III, n = 294). RESULTS: Optimal postoperative control of palmar/axillary hyperhidrosis was achieved in, respectively, 94/82 percent of the patients of group I, 89/89 percent of those in group II and 80/80 percent of those in group III. Postoperative reflex sweating was observed in 67 percent of the patients in groups I and II, compared with 61.29 percent of those in group III. Severe reflex sweating occurred in 32 percent of the group I patients, 9 percent of the group II patients and 4 percent of the group III patients. CONCLUSION: Sympathectomy provided excellent patient satisfaction and a low incidence of complications. There was no significant difference between the levels of ablation in terms of reflex sweating, although the intensity of this complication decreased when lower levels of blockage, principally at the T4 level, were employed.

Amiloidose pulmonar: relato de caso de achado radiológico da apresentação nodular em grande fumante / Pulmonary amyloidosis: radiographic finding of nodular opacities in a heavy smoker

A amiloidose pulmonar é uma doença rara, caracterizada pelo depósito extracelular de proteínas fibrilares no pulmão. Amiloidose é um termo genérico para grupos heterogêneos de doenças, incluindo doença de Alzheimer e diabetes mellitus tipo II. Apresenta-se no aparelho respiratório sob as formas traqueobrônquica, nodular pulmonar e septal alveolar (parenquimatosa difusa). Relata-se o caso de uma mulher, tabagista (20 anos/maço), portadora de amiloidose nodular pulmonar, diagnosticada através de exames pré-operatórios à realização de colecistectomia videolaparoscópica.

Pulmonary amyloidosis is a rare disease, characterized by extracellular deposition of fibrillary protein in the lungs. Amyloidosis is a generic term for a heterogeneous group of diseases, including Alzheimer's disease and type 2 diabetes mellitus. In the respiratory system, it appears in various forms: tracheobronchial; nodular pulmonary; and alveolar septal (diffuse parenchymal). We present the case of a woman who was a 20 pack-year smoker and had nodular pulmonary amyloidosis, as diagnosed through tests performed prior to laparoscopic cholecystectomy.

Pseudotumor inflamatório do pulmão / Inflammatory pseudotumor of the lung

O pseudotumor inflamatório de pulmão é uma afecção rara, e representa um dilema pela semelhança com processo maligno nos aspectos radiológicos, macroscópicos e patológicos. Relata-se o caso de um paciente com queixas respiratórias, que após propedêutica adequada foi submetido à toracotomia exploradora, com diagnóstico de pseudotumor confirmado pela imunohistoquímica. São discutidos dados referentes à história clínica, aspectos radiológicos, histopatológicos e cirúrgicos, além de formas de tratamento da condição.

Hemipelvectomia com reconstrução por retalho miocutâneo anterior de coxa: relato de caso e descrição da técnica cirúrgica / Hemipelvectomy utilizing an anterior myocutaneous flap: case report and surgical technique description

A hemipelvectomia com reconstrução usando-se retalho miocutâneo ântero-medial da coxa, é indicada para o tratamento dos sarcomas da região glútea e da porção proximal posterior da coxa. O grande defeito cirúrgico é coberto pelo retalho miocutâneo do músculo quadríceps femoral. O resultado da hemipelvectomia com reconstruçãopor retalho miocutâneo anterior de coxa é excelente, exceto pela dor fantasma e sensação do membro persistenteem alguns pacientes. As considerações quanto à reabilitação e ao risco de dor e membro fantasma são similares aos associados aos outros tipos de hemipelvectomias. Em virtude da rápida cicatrização vista neste tipo de retalho, a adaptação de uma prótese, quando requerida, pode ser mais precoce. No presente trabalho apresentamos um caso em que foi realizado este tipo de cirurgia, procedendo-se à descrição da técnica cirúrgica utilizada.

Tratamento cirúrgico de tumores malignos envolvendo ombro e membro superior: estudo de 10 casos / Surgical treatment of malignant tumors from the shoulder and upper limb: a study of 10 cases

Para alguns pacientes com neoplasias em região de ombro e/ ou membro superior, a desarticulação interescapulotorácica (Cirurgia de Berger) ou a desarticulação escápulo-umeral, embora radicais, são o tratamento cirúrgico de escolha. No entanto, em casos selecionados, a escapulectomia ou a cirurgia de Tikhoff-Linberg (ressecção interescapulotorácica supra-umeral) pode ser uma alternativa. Neste trabalho, avaliamos 10 pacientes submetidos às diversas cirurgias em região de ombro e membro superior, de 2000 a 2003, nos hospitais ASCOMCER, Oncológico e Dr. João Felício, de Juiz de Fora (MG), procedendo à discussão sobre a modalidade cirúrgica aplicada a cada caso, a relação entre tipo histológico, localização do tumor e/ ou comprometimento de feixe vásculo-nervoso com a indicação de uma ou outra cirurgia, a recorrência local ou sistêmica relacionada à técnica cirúrgica, a utilização de terapias neoadjuvantes e adjuvantes à cirurgia, o tempo de acompanhamento clínico sem indício de recidiva e óbitos.