Comparison of Noninvasive Measurements of Intracranial with Tap Test Results in Patients with Idiopathic Normal Pressure Hydrocephalus.

Background: Normal pressure hydrocephalus is a disease directly related to the change in intracranial compliance and consequent repercussions in the brain parenchyma. Invasive monitoring of such parameters proves to be reliable especially for prognosis in neurocritical patients; however, it is not applicable in an outpatient service setting. The present study describes the comparison between the tap test results and the parameters obtained with a non-invasive sensor for monitoring intracranial compliance in patients with suspected NPH. Methods: Twenty-eight patients were evaluated before and after lumbar puncture of 50mL of CSF (the tap test), comprising clinical assessment, magnetic resonance imaging, physical therapy assessment using the Timed Up and Go test, Dynamic Gait Index, BERG test, neuropsychological assessment, and recording of non-invasive intracranial compliance data using the Brain4care® device in three different positions (lying, sitting, and standing) for 5 min each. The tap test results were compared to the Time to Peak and P2/P1 ratio parameters obtained by the device. Results: The group that had a positive Tap test result presented a median P2/P1 ratio greater than 1.0, suggesting a change in intracranial compliance. In addition, there was also a significant difference between patients with positive, negative, and inconclusive results, especially in the lying position. Conclusion: A non-invasive intracranial compliance device when used with the patient lying down and standing up obtained parameters that suggest correspondence with the result of the tap test.

Noninvasive intracranial pressure real-time waveform analysis monitor during prostatectomy robotic surgery and Trendelenburg position: case report.

Both robotic surgery and head-down tilt increase intracranial pressure by impairing venous blood outflow. Prostatectomy is commonly performed in elderly patients, who are more likely to develop postoperative cognitive disorders. Therefore, increased intracranial pressure could play an essential role in cognitive decline after surgery. We describe a case of a 69-year-old male who underwent a robotic prostatectomy. Noninvasive Brain4careTM intraoperative monitoring showed normal intracranial compliance during anesthesia induction, but it rapidly decreased after head-down tilt despite normal vital signs, low lung pressure, and adequate anesthesia depth. We conclude that there is a need for intraoperative intracranial compliance monitoring since there are major changes in cerebral compliance during surgery, which could potentially allow early identification and treatment of impaired cerebral complacency.

Noninvasive Intracranial Pressure Monitoring in Chronic Stroke Patients with Sedentary Behavior: A Pilot Study.

OBJECTIVE: This study aimed to correlate the P2/P1 ratio of intracranial pressure waveforms with sedentary behavior during the chronic stage of stroke. MATERIALS AND METHODS: Eight patients from São Carlos, Brazil, who had hemiparesis and stroke onset within the previous 6 months, participated in this study. To monitor their intracranial pressure, we used noninvasive Brain4Care® intracranial pressure monitoring during a postural change maneuver involving 15 min in a supine position and 15 min in an orthostatic position. The patients' sedentary behavior was continually monitored at home using a StepWatch Activity Monitor™ for 1 week. Moreover, the patients completed the International Physical Activity Questionnaire before and after using the StepWatch Activity Monitor™. RESULTS: In the supine and orthostatic positions, the P2/P1 ratios were 0.84 ± 0.14 and 0.98 ± 0.17, respectively. The percentage of time spent in inactivity was 71 ± 11%, and the number of steps walked per day was 4220 ± 2239. We found a high positive correlation (r = 0.881, p = 0.004) between the P2/P1 ratio and the percentage of time spent in inactivity. CONCLUSION: This preliminary study showed a correlation between sedentary behavior and cerebral compliance. Thus, monitoring of intracranial pressure during the late stage of a stroke could guide the clinician's treatment to reduce sedentary behavior and the risks of recurrent stroke and cardiovascular diseases.

Serum Myeloperoxidase, C-reactive Protein and α1-acid Glycoprotein: Insights about Cardiovascular Risk in End-stage Renal Disease.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death in patients with end-stage renal disease (ESRD). Elevated serum concentrations of myeloperoxidase (MPO) are associated with an increased risk of developing CVD. The objective of this study was to evaluate serum MPO levels, as well as other laboratory parameters, in individuals with ESRD, with and without CVD, undergoing hemodialysis. METHODS: 80 volunteers were admitted, divided into the following groups: control group (CON): 20 individuals without chronic kidney disease (CKD); ESRD group: 45 individuals with CKD stage V and ESRD/CVD group: 15 individuals with CKD stage V and with CVD. The following biomarkers were evaluated: MPO, High sensitivity C-reactive protein (hs-CRP) and α1-acid glycoprotein, following the manufacturer's guidelines in the package inserts. The data were processed through the statistical software SPSS 20.0®. RESULTS: The level of MPO for the CON group was 84 ng/mL (73-87 ng/mL), for the ESRD group 77 ng/mL (11-89 ng/mL) and for the ESRD/CVD group 21 ng/mL (8-47 ng/mL), with a significant statistical difference of the ESRD/CVD group from the CON and ESRD groups (p<0.001). For the parameters hs-CRP and α1-acid glycoprotein a statistical difference between the ESRD and ESRD/CVD groups from the CON group (p<0.0001) was observed, but not between the ESRD and ESRD/CVD groups. CONCLUSION: It is suggested that further studies should be performed to define the potential role of MPO as a cardiovascular risk marker for patients with ESRD on hemodialysis.

Efeitos do treinamento pliométrico na força explosiva e potência de meninas púberes praticantes de voleibol / Effects of plyometric training on explosive strength and power in pubescent girls volleyball players

O objetivo do estudo foi avaliar os efeitos do treinamento pliométrico (TP) sobre a força explosiva (FE) e a potência (PT) de membros inferiores em 72 meninas púberes, praticantes de voleibol, idades 12,18±1,27 anos, Estatura 1,56±0,08 m, % de gordura 24,32±6,7 e massa corporal =48,18±11,28 kg. Todas se encontravam no estágio de maturação púbere, segundo método de Tanner. A amostra foi dividida em dois grupos: Grupo Controle - GC n=48 que realizou 3 sessões semanais de voleibol, e Grupo Experimental - GE n=24, que realizou além das 3 sessões semanais de voleibol, mais 3 sessões semanais de TP durante 8 semanas, as sessões constavam de multisaltos, saltos sobre barreiras e saltos profundos com alturas entre 20 e 60 cm, as avaliações da FE e PT. Para controle da FE e da PT foram utilizados os seguintes procedimentos: SJ (Squat jump), CMJ (Counter Moviment Jump) e DJ (Drop Jump). O GE apresentou uma melhora de 0,59 cm no SJ (19,12 ± 4,03 ­ 19,71 ± 3,93) o que representa um aumento de 3,08%, enquanto que no CMJ o aumento foi de 0,64 cm (19,88 ± 3,76 ­ 20,52 ± 4,26) que significa uma melhora de 3,21% entre o pré e o pós treinamento. Os resultados do GE apresentaram melhoras não significativas, o que demonstra uma tendência positiva do TP sobre a FE e a PT em meninas púberes praticantes de voleibol...(AU)

The aim of this study was to evaluate the effects of plyometric training (PT) on explosive strength 1 and power (PR) of the lower limbs in 72 pubertal girls volleyball players aged 12.18 ± 1.27 years, Height 1.56 ± 008 m, body fat 24.32 ± 6.77 and body mass = 48.18 ± 11.28 kg. All were in stage of pubertal maturation in the stage of pubertal maturation according to the method Tanner. Divided into two groups: Control Group - CG n = 48, held three sessions per week of volleyball and Experimental Group - EG n = 24, which held in addition of 3 weekly sessions of volleyball, more 3 weekly sessions of PT during 8 weeks, that comprised the multi jump, jump over hurdle and drop jumps with heights between 20 cm and 60 cm, the assessments of ES and PR occurred pre and post-training with an interval of 8 weeks. To assess the ES and PR the following procedures were used: SJ (squat jump), CMJ (Counter Movement Jump) and DJ (Drop Jump). The EG presented an improvement of 0.59 cm in SJ (19.12 ± 4.03 - 19.71 ± 3.93) which represents an increase of 3.08%, while in the CMJ the increase was 0.64 cm (19.88 ± 3.76 - 20.52 ± 4.26) which means an improvement of 3.21% between the pre and post training. The results of the GE presented improvements were not significant, which shows a positive effect of PT on the ES and PR in the pubertal girls practicing volleyball...(AU)

Variabilidade da frequência cardíaca com a mudança postural na insuficiência cardíaca crônica / Heart rate variability in patients with chronic heart failure after postural changes

Introdução: A variabilidade da frequência cardíaca (VFC) é uma alternativa de baixo custo para a avaliação da modulação autonômica cardíaca que é relacionada com os indivíduos com insuficiência cardíaca (IC) crônica devido ao desequilíbrio simpático-vagal característico dessa patologia. Objetivo: Comparar a VFC de pacientes com IC crônica e indivíduos saudáveis na mudança da posição supina para sentado. Métodos: Dezenove indivíduos subdivididos em dois grupos: 10 pacientes com o diagnóstico de IC crônica (GI) com 62 ± 6 anos de idade e nove participantes saudáveis (GC) com 64 ± 5 anos. Os intervalos R-R foram captados através do eletrocardiograma nas posições supina e sentada, por 10 minutos em cada condição. Os dados foram analisados nos domínios do tempo e da frequência. Teste t de Student pareado ou de Wilcoxon foram usados para as comparações intragrupos. Nas comparações intergrupos foi aplicado o teste t não pareado ou de Mann Whitney (p <0,05). Resultados: Os indivíduos com IC crônica apresentaram menores valores do SDNN (sentado 18,4 ± 4,5 vs. 28,4 ± 7,6; supina 23,3 ± 5 vs. 32,1 ± 12,4) e do RMSSD (sentado 12,2 ± 2,6 vs. 20,0 ± 6,8; supina 14,5 ± 4,3 vs. 21,3 ± 10) quando comparados ao controle. Após a mudança postural, verificou-se alteração significativa somente no SDNN do grupo IC crônica (23,3 ± 5 vs. 18,4 ± 4,5). Conclusão: Os indivíduos do grupo IC crônica apresentaram VFC reduzida em comparação a indivíduos saudáveis da mesma idade, porém ainda assim foram capazes de realizar a modulação simpático-vagal após a mudança postural

Introduction: Heart rate variability (HRV) is a low-cost alternative for the evaluation of autonomic cardiac modulation, which is related to individuals with chronic heart failure (CHF) due to the sympathovagal imbalance that is characteristic of this pathology. Objective: to compare HRV in patients with CHF and healthy subjects after transition from a supine to a sitting position. Methods: We recruited 19 subjects, who were divided into two groups: 10 patients with a diagnosis of CHF (IG) aged 62 ± 6 years; and nine healthy participants (CG) aged 64 ± 5 years. The RR intervals were captured by electrocardiogram in the supine and sitting positions, for 10 minutes in each condition. The data were analyzed in the domains time and frequency. The paired Student-t or Wilcoxon tests were used for the intragroup comparisons. For the intergroup comparisons, the unpaired t-test or Mann Whitney tests were used (p<0.05). Results: The individuals with CHF showed lower SDNN values (sitting 18.4 ± 4.5 vs. 28.4 ± 7.6, and supine 23.3 ± 5 vs. 32.1 ± 12.4) and lower RMSSD values (sitting 12.2 ± 2.6 vs. 20.0 ± 6.8; and supine 14.5 ± 4.3 vs. 21.3 ± 10) when compared to the control. After the postural change, a significant change occurred only in the SDNN of the chronic CHF group (23.3 ± 5 vs. 18.4 ± 4.5). Conclusion: The individuals of the CHF group showed reduced HRV compared to healthy individuals of the same age, but were still able to perform sympathetic-vagal modulation after the change in posture

Validation of a New Minimally Invasive Intracranial Pressure Monitoring Method by Direct Comparison with an Invasive Technique.

In this chapter we present in vivo experiments with a new minimally invasive method of monitoring intracranial pressure (ICP). Strain gauge deformation sensors are externally glued onto the exposed skull. The signal from these sensors is amplified, filtered, and sent to a computer with appropriate software for analysis and data storage. Saline infusions into the spinal channel of rats were performed to produce ICP changes, and minimally invasive ICP and direct Codman intraparenchymal ICP were simultaneously acquired in six animals. The similarity between the invasive and minimally invasive methods in response to ICP increase was assessed using Pearson's correlation coefficient. It demonstrated good agreement between the two measures < r > = 0.8 ± 0.2, with a range of 0.31-0.99.

Validation of a New Noninvasive Intracranial Pressure Monitoring Method by Direct Comparison with an Invasive Technique.

The search for a completely noninvasive intracranial pressure (ICPni) monitoring technique capable of real-time digitalized monitoring is the Holy Grail of brain research. If available, it may facilitate many fundamental questions within the range of ample applications in neurosurgery, neurosciences and translational medicine, from pharmaceutical clinical trials, exercise physiology, and space applications. In this work we compare invasive measurements with noninvasive measurements obtained using the proposed new noninvasive method. Saline was infused into the spinal channel of seven rats to produce ICP changes and the simultaneous acquisition of both methods was performed. The similarity in the invasive and noninvasive methods of ICP monitoring was calculated using Pearson's correlation coefficients (r). Good agreement between measures < r > = 0.8 ± 0.2 with a range 0.28-0.96 was shown.

Comparison of PCR-enzyme-linked immunosorbent assay and real-time PCR assay for diagnosis of an unusual case of cerebral toxoplasmosis in a stem cell transplant recipient.

A PCR-enzyme-linked immunosorbent assay and a real-time PCR assay were compared for diagnosis and follow-up of cerebral toxoplasmosis in a stem cell transplant recipient. The sensitivity of detection was similar for both assays but was higher when the assays were performed on buffy coat rather than on whole blood or serum.