The Sleep Parameters of Paralympic Athletes: Characteristics and Assessment Instruments.

CONTEXT: Sleep serves many important functions for athletes, particularly in the processes of learning, memory, recovery, and cognition. OBJECTIVES: Define the sleep parameters of Paralympic athletes and identify the instruments used to assess and monitor sleep Paralympic athletes. EVIDENCE ACQUISITION: This systematic review was carried out based on the PRISMA guidelines. The survey was conducted in April 2020, the searches were carried out again in September 2021 to check whether there were new scientific publications in the area of sleep and Paralympic sport, searches were performed in the following databases: PubMed, Web of Science, Scopus, SPORTDiscus, Virtual Health Library (BIREME), and SciELO. This systematic review has included studies that investigated at least one of the following sleep parameters: total sleep time, sleep latency, sleep efficiency, number of awakenings, quality of sleep, daytime sleepiness, and chronotype; the participants were comprised of athletes with disabilities. Studies published at any time in English, Portuguese, and Spanish, were included. EVIDENCE SYNTHESIS: Data extraction and study selection were performed by 2 researchers independently, and a third author was consulted as necessary. The search returned a total of 407 studies. Following the screening based on exclusion and inclusion criteria, a total of 13 studies were considered. Paralympic athletes have a low amount (7.06 h) of sleep with poor quality and sleep latency (28.05 min), and 57.2% have daytime sleepiness, with the majority belonging to the indifferent chronotype (53, 5%). Moreover, 11 studies assess sleep using subjective instruments (questionnaires), and 2 studies used an objective instrument (actigraphy). CONCLUSIONS: Sleep disorders are common among Paralympic athletes, poor sleep quality and quantity, and high rates of daytime sleepiness. Subjective methods are most commonly used to assess sleep.

Metabolic, physiological and anatomical responses of soybean plants under water deficit and high temperature condition.

Water deficit (WD) combined with high temperature (HT) is the major factor limiting agriculture worldwide, and it is predicted to become worse according to the current climate change scenario. It is thus important to understand how current cultivated crops respond to these stress conditions. Here we investigated how four soybean cultivars respond to WD and HT isolated or in combination at metabolic, physiological, and anatomical levels. The WD + HT increased the level of stress in soybean plants when compared to plants under well-watered (WW), WD, or HT conditions. WD + HT exacerbates the increases in ascorbate peroxidase activity, which was associated with the greater photosynthetic rate in two cultivars under WD + HT. The metabolic responses to WD + HT diverge substantially from plants under WW, WD, or HT conditions. Myo-inositol and maltose were identified as WD + HT biomarkers and were connected to subnetworks composed of catalase, amino acids, and both root and leaf osmotic potentials. Correlation-based network analyses highlight that the network heterogeneity increased and a higher integration among metabolic, physiological, and morphological nodes is observed under stress conditions. Beyond unveiling biochemical and metabolic WD + HT biomarkers, our results collectively highlight that the mechanisms behind the acclimation to WD + HT cannot be understood by investigating WD or HT stress separately.

Searching for biomarkers of early detection of 2,4-D effects in a native tree species from the Brazilian Cerrado biome.

Biodiversity in the Brazilian Cerrado biome has been declining sharply with the continued expansion of agriculture and the excessive use of herbicides. Thus, the aim of this study was to evaluate the morphophysiological and biochemical responses in Dipteryx alata plants to various doses of the herbicide 2,4-D. Specific biomarkers that characterize the phytoindicator potential of this species were determined. Gas exchange, chlorophyll a fluorescence, photosynthetic pigments, and the activities of antioxidant enzymes and cellulase were performed after 24, 96 and/or 396 hours after 2,4-D application (HAA). The herbicide caused higher antioxidant enzymatic activity 24 HAA and damage to the photosynthetic machinery after 96 HAA. Reduction in gas exchange, chlorophyll content, and photochemical traits were observed. Increased respiratory rates, non-photochemical quenching, and carotenoid concentrations in 2,4-D-treated plants were important mechanisms in the defense against the excess energy absorbed. Furthermore, the absence of leaf symptoms suggested tolerance of D. alata to 2,4-D. Nevertheless, changes in the photosynthetic and biochemical metabolism of D. alata are useful as early indicators of herbicide contamination, especially in the absence of visual symptoms. These results are important for early monitoring of plants in conserved areas and for preventing damage to sensitive species.

Was postponing the tokyo 2020 olympic and paralympic games a correct decision? / O adiamento dos jogos olímpicos e paralímpicos de tóquio 2020 foi uma decisão correta? / ¿la postergación de los juegos olímpicos y paralímpicos de tokio 2020 fue una decisión correcta?

ABSTRACT In December 2019, Wuhan, in China, attracted international attention due to a pneumonia outbreak caused by the new coronavirus (2019-nCoV). Infection by 2019-nCoV is more likely in elderly people with comorbidities or with associated chronic diseases. Due to the high transmission rate among humans, this disease is rapidly disseminated, which led to several events being canceled, including the Tokyo 2020 Olympic and Paralympic Games. The aim of this article is to discuss the risk factors for Olympic and Paralympic athletes, as well as for spectators, that justify the decision to postpone the Tokyo Games 2020. Regular physical exercise is associated with health and the prevention of chronic diseases. Although athletes generally appear to be healthy and physically fit, this may not be true. The immune system, which protects the organism from invasive microorganisms, can be affected by the duration and quality of sleep, as well as by physical exercise which influences the quality of the immune response. High volumes of high-intensity physical exercise, as well as changes in sleep patterns during the pre-competition period and the impacts of jet lag on athletes traveling for the Tokyo Games in 2020 may lead to immune system suppression, making these groups more vulnerable to infection by 2019-nCoV. Moreover, during the period planned for the games in 2020 the pandemic may be subsiding in some countries and increasing in others, and this was also taken into consideration as a risk factor. Hence, the decision taken to postpone the Tokyo 2020 Olympic and Paralympic Games until 2021 due to the 2019-nCoV was the correct one, and was extremely important to protect the health of Olympic and Paralympic athletes, as well as spectators. Level of evidence V; expert opinion .

RESUMO Em dezembro de 2019, Wuhan, na China, despertou atenção internacional devido a um surto de pneumonia causada pelo novo coronavírus (2019-nCoV). A infecção pelo 2019-nCoV é mais provável em pessoas idosas com comorbidades ou com doenças crônicas associadas. Em virtude da alta taxa de transmissão entre humanos, essa doença tem disseminação rápida, o que fez com que diversos eventos fossem cancelados, dentre eles os Jogos Olímpicos e Paralímpicos de Tóquio 2020. Nesse sentido, o objetivo deste artigo é discutir fatores de risco dos atletas olímpicos e paralímpicos, bem como dos espectadores, que justificam a decisão de adiamento dos Jogos de Tóquio 2020. A prática de exercício físico regular é associada à saúde e à prevenção de doenças crônicas. Embora normalmente pareça que os atletas estão em boa forma e são saudáveis, isso pode não ser verdade. O sistema imunológico, que protege o organismo de microrganismos invasores, pode ser afetado pela quantidade e qualidade do sono, assim como pela prática de exercício físico que influencia a qualidade da resposta imunológica. A prática de exercícios de alta intensidade e grande volume, além das alterações do sono no período pré-competitivo e os impactos do jet lag dos atletas que viajariam para os Jogos de Tóquio no ano de 2020 podem levar à supressão do sistema imunológico, deixando esses grupos mais vulneráveis à contaminação pelo 2019-nCoV. Além disso, no período previsto de ocorrência dos jogos em 2020 a pandemia poderia estar em regressão em alguns países e ascensão em outros, e isso também foi levado em consideração como um fator de risco. Nesse sentido, a tomada de decisão de adiar os Jogos Olímpicos e Paralímpicos de Tóquio 2020 para o ano de 2021 devido ao 2019-nCoV foi correta e de extrema importância para preservar a saúde dos atletas olímpicos e paralímpicos, bem como dos expectadores. Nível de evidência V; opinião do especialista .

RESUMEN En diciembre de 2019, Wuhan, en China, despertó la atención internacional debido a un brote de neumonía causada por el nuevo coronavirus (2019-nCoV). La infección por el 2019-nCoV es más probable en personas de la tercera edad con comorbidades o con enfermedades crónicas asociadas. En virtud de la alta tasa de transmisión entre humanos, esta enfermedad tiene diseminación rápida, lo que hizo con que diversos eventos fuesen cancelados, entre ellos los Juegos Olímpicos y Paralímpicos de Tokio 2020. En ese sentido, el objetivo de este artículo es discutir factores de riesgo de los atletas olímpicos y paralímpicos, bien como de los espectadores, que justifican la decisión de postergación de los Juegos de Tokio 2020. La práctica de ejercicios físicos de forma regular está asociada a la salud y a la prevención de enfermedades crónicas. Aunque normalmente parezca que los atletas están en buena forma y son saludables, eso puede no ser verdad. El sistema inmunológico, que protege el organismo de microorganismos invasores, puede ser afectado por la cantidad y calidad del sueño, así como por la práctica de ejercicios físicos que influencia la calidad de la respuesta inmunológica. La práctica de ejercicios de alta intensidad y gran volumen, además de las alteraciones del sueño en el período precompetitivo y los impactos del jet lag de los atletas que viajarían para los Juegos de Tokio en el año 2020 pueden llevar a la supresión del sistema inmunológico, dejando a esos grupos más vulnerables a la contaminación por el 2019-nCoV. Además, en el período previsto de ocurrencia de los juegos en 2020 la pandemia podría estar en regresión en algunos países y ascensión en otros, y eso también fue llevado en consideración como un factor de riesgo. En ese sentido, la toma de decisión de postergar los Juegos Olímpicos y Paralímpicos de Tokio 2020 para el año 2021 debido al 2019-nCoV fue correcta y de extrema importancia para preservar la salud de los atletas olímpicos y paralímpicos, bien como de los espectadores. Nivel de evidencia V; opinión del especialista .

Dipteryx alata, a tree native to the Brazilian Cerrado, is sensitive to the herbicide nicosulfuron.

The expansion of land use for agricultural interests and the excessive use of herbicides are among the causes of biodiversity losses in the Brazilian Cerrado biome. Therefore, we aimed to test the hypothesis that Dipteryx alata Vogel, a common species in this biome, is sensitive to nicosulfuron because of its high phytotoxicity. We evaluated physiological, biochemical and morphological responses in D. alata plants exposed to increasing doses of the herbicide. Young plants were transplanted to 10 L pots containing substrate composed of soil and sand (2:1) after fertilization. After an acclimation period, the following doses of nicosulfuron were applied: 0 (control), 6, 12, 24, 48, and 60 g a.e. ha-1. The experiment was conducted in a randomized block design factorial scheme with six doses of nicosulfuron, three evaluation times, and five replicates per treatment. The effects of the herbicide were assessed by measuring gas exchange, chlorophyll a fluorescence, photosynthetic pigments, membrane permeability, antioxidant enzymes and acetolactate synthase. Nicosulfuron altered the photosynthetic machinery and enzymatic metabolism of D. alata. Reductions in physiological traits, increased catalase and ascorbate peroxidase activities, enhanced malondialdehyde concentrations rate of electrolyte leakage and decreased acetolactate synthase activity in response to nicosulfuron all suggest that D. alata is sensitive to this herbicide.

Association Between Hormonal Status, Stress, Recovery, and Motivation of Paralympic Swimmers.

Purpose: The present study aimed to investigate associations between hormonal profile (cortisol and testosterone) and the psychobiological aspects of Paralympic athletes during a competitive season. Method: Male Brazilian Paralympic swimmers (n = 11) were evaluated in three Training Camps (TC) during the cycle of training for the Paralympic Games RIO 2016. Questionnaires were used for data collection of stress and recovery, motivation in sport and hormonal status was assessed by salivary samples of cortisol ([Csal]) and testosterone ([Tsal]) concentrations. The Friedman test was used to identify overall significant differences at the three TC for each variable. When the overall p value indicated statistical significance (p < .05), a post hoc Wilcoxon signed-rank test for paired data was used to compare pairs of TC. The Spearman correlation was used to identify associations between the hormonal profile and the psychobiological aspects. Results: There was an association between the [Csal] and the "Conflicts/Pressure" sub-scale (r = 0.60; p = .04) in TC1 and the "Lack of Energy" subscale (r = 0.63; p = .03) in TC2. In the TC3, there were correlations between [Tsal] and "To Know" intrinsic motivation (r = 0.83, p < .01), "Objectives"(r = 0.66, p < .02), "Experiences" (r = 0.65, p < .02) and "Amotivation" (r = -0.70, p = .01). There were also associations between the [Tsal] and the "Social Recovery" (r = 0.77, p < .01), "General Wellness" (r = 0.73, p < .01), "Sleep Quality" (r = 0.63, p = .03) and "Self-efficacy" (r = 0.60, p = .05) subscales. In TC3, there was an association between [Tsal] and the "Success" (r = 0.61, p = .04), "Sleep Quality" (r = 0.62, p = .03), "Personal Accomplish" (r = 0.82, p < .01), "Self-efficacy" (r = 0.82, p < .05), "Self-regulation" (r = 0.85, p < .01) and "Physical Recovery" (r = 0.80, p < .01) subscales. The data demonstrate associations between biomarkers (salivary testosterone and cortisol) and psychobiological domains of Paralympic swimmers.

Laryngeal Mask Airway Versus Other Airway Devices for Anesthesia in Children With an Upper Respiratory Tract Infection: A Systematic Review and Meta-analysis of Respiratory Complications.

There is an association between upper respiratory tract infection (URTI) and an increased incidence of perioperative respiratory adverse events (PRAEs), which is a major risk for morbidity during pediatric anesthesia. The aim of the present study was to compare the risk of PRAEs among different airway devices during anesthesia in children with a URTI. A systematic review according to the Cochrane Handbook and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. Only randomized clinical trials evaluating anesthesia in children with a URTI and who were submitted to any of the airway devices were included. From 1030 studies identified, 5 randomized clinical trials were included in the final analysis. There were no statistical differences between laryngeal mask airway (LMA®) and endotracheal tube (ETT) regarding breath holding or apnea (risk ratio [RR], 0.82; 95% confidence interval [CI], 0.41-1.65), laryngospasm (RR, 0.74; 95% CI, 0.18-2.95), and arterial oxygen desaturation (RR, 0.44; 95% CI, 0.16-1.17). The quality of evidence was low for the first outcome and very low for the 2 other outcomes, respectively. The LMA use produced a significant reduction of cough (RR, 0.75; 95% CI, 0.58-0.96, low quality of evidence) compared with ETT. The ideal airway management in children with a URTI remains obscure given that there are few data of perioperative respiratory complications during anesthesia. This systematic review demonstrates that LMA use during anesthesia in children with URTI did not result in decrease of the most feared PRAEs. However, LMA was better than ETT in reducing cough. Further research is needed to define the risks more clearly because cough and laryngospasm have similar triggers, and both bronchospasm and laryngospasm trigger cough.

Ultrasound as a safe and reliable guidance for subarachnoid puncture in rabbits.

PURPOSE:: To evaluate a model for studying the toxicity in nervous tissue and meninges using ultrasound to guide needle insertion into the subarachnoid space of rabbits, with the objective of avoiding injuries triggered by the puncture and by intraneural injection of solutions. METHODS:: Forty-five adult female rabbits were divided into 3 groups (G): G1 underwent subarachnoid puncture, G2 underwent subarachnoid injection of saline solution and G3 underwent subarachnoid injection of 0.5% hyperbaric bupivacaine. A needle was inserted into the S1-S2 subarachnoid space guided by ultrasound. The sensitivity and motility of the animals were evaluated for 3 days, after which the animals were sacrificed for removal of lumbar and sacral portions of the spinal cord for histological examination by light microscopy and immunohistochemistry. RESULTS:: All animals had motor function and pain sensitivity on the evaluation period. No animal had complication during or after the procedures. CONCLUSION:: Ultrasound is a useful and safe method for the correct identification of the subarachnoid space of rabbits.

Ultrasound as a safe and reliable guidance for subarachnoid puncture in rabbits

Abstract Purpose: To evaluate a model for studying the toxicity in nervous tissue and meninges using ultrasound to guide needle insertion into the subarachnoid space of rabbits, with the objective of avoiding injuries triggered by the puncture and by intraneural injection of solutions. Methods: Forty-five adult female rabbits were divided into 3 groups (G): G1 underwent subarachnoid puncture, G2 underwent subarachnoid injection of saline solution and G3 underwent subarachnoid injection of 0.5% hyperbaric bupivacaine. A needle was inserted into the S1-S2 subarachnoid space guided by ultrasound. The sensitivity and motility of the animals were evaluated for 3 days, after which the animals were sacrificed for removal of lumbar and sacral portions of the spinal cord for histological examination by light microscopy and immunohistochemistry. Results: All animals had motor function and pain sensitivity on the evaluation period. No animal had complication during or after the procedures. Conclusion: Ultrasound is a useful and safe method for the correct identification of the subarachnoid space of rabbits.

Assessment of Body Composition and Sport Performance of Brazilian Paralympic Swim Team Athletes.

CONTEXT: Body-composition assessments of high-performance athletes are very important for identifying physical performance potential. Although the relationship between the kinanthropometric characteristics and performance abilities of Olympic swimmers is extremely important, this subject is not completely understood for Paralympic swimmers. OBJECTIVE: To investigate the relationship between body composition and sport performance in Brazilian Paralympic swimmers 6 mo after training. DESIGN: Experimental pre/posttest design. SETTING: Research laboratory and field evaluations of swimming were conducted to verify the 50-m freestyle time of each athlete. PARTICIPANTS: 17 Brazilian Paralympic swim team athletes (12 men, 5 women). MAIN OUTCOME MEASURES: Body-composition assessments were performed using a BOD POD, and swimming performance was assessed using the 50-m freestyle, which was performed twice: before and after 6 mo of training. RESULTS: Increased lean mass and significantly reduced relative fat mass and swimming time (P < .05) were observed 6 mo after training. Furthermore, a positive correlation between body-fat percentage and performance (r = .66, P < .05) was observed, but there was no significant correlation between body density and performance (r = -.14, P > .05). CONCLUSIONS: After a 6-mo training period, Paralympic swimmers presented reduced fat mass and increased lean body mass associated with performance, as measured by 50-m freestyle time. These data suggest that reduced fat-mass percentage was significantly correlated with improved swimming performance in Paralympic athletes.

Analysis of the body composition of Paralympic athletes: Comparison of two methods.

Body composition is a physiological variable associated with physical activity and, in some cases, is related to athletic performance. Our objectives were to describe the body composition of participants in three distinct Paralympic sports and to compare the values of body density and estimated body fat obtained from the Paralympic athletes on the National Team by air-displacement plethysmography (ADP) and by the anthropometric method (skinfolds (SFs)). The sample consisted of 70 volunteers of both genders. The body composition of the volunteers was evaluated using the ADP in a Bod Pod(®) and seven SFs. There were no significant differences between the values obtained by ADP and SF for body fat percentage (p = .58) and body density (p = .49). Analysis by Bland-Altman plots showed mean differences of 0.56 ± 4.94 (-9.12-10.23) and -0.0017 ± 0.0113 (-0.024-0.020) for body fat percentage and body density, respectively. In conclusion, body composition analyses of Paralympic athletes by the ADP and SF methods show similar results, and ADP should be used as the first option when available. When the use of ADP is not possible, estimating body density and fat percentage by SF is a viable alternative for Paralympic athletes when future comparisons will use the same analysis method.

Spontaneous resolution of traumatic acute subdural haematomas: A systematic review / Resolución espontánea de hematoma subdural agudo traumático: una revisión sistemática

Introduction: Traumatic subdural haematomas often require emergency surgical evacuation. Spontaneous resolution of traumatic acute subdural haematomas (TASDH) is under-reported. Two patients are described with spontaneous resolution of TASDH correlating with previous reports. A discussion is presented on the clinical, pathological and radiological features of TASDH. Methods: A review of the literature was performed using PubMed (Medline), Embase, and Cochrane Library for similar cases. Results: A total 21 articles were included, involving 27 cases well detailed of TASDH with spontaneous resolution or neurological and radiological improvement in less than 24h. Conclusions: There are two main mechanisms for the spontaneous resolution of acute subdural haematomas: dilution in subarachnoid space and redistribution of the haematoma in the subdural space. The primary radiological characteristic of these lesions is a hypodense rim on the outer surface of the clot. Spontaneous resolution of TASDH is unusual. Clinical and radiological surveillance is essential for appropriate management of these patients (AU)

Introducción: Los hematomas subdurales agudos traumáticos (HSDAT) requieren tratamiento quirúrgico de urgencia. Muy raras veces se describen casos de resolución espontánea de HSDAT. Describimos 2 casos de resolución espontánea de HSDAT y revisamos la bibliografía pertinente. Se discuten los aspectos clínicos, patológicos y radiológicos de resolución espontánea de HSDAT. Métodos: Revisamos la literatura en Pubmed (Medline), Embase y Cochrane Library en busca de casos similares. Resultados: Se incluyeron 21 artículos con 27 casos bien detallados de HSDAT con resolución espontánea o mejora clínica y radiológica en 24h. Conclusiones: Existen 2 mecanismos principales para la resolución espontánea de hematomas subdurales agudos: la dilución en el espacio subaracnoideo y la redistribución del hematoma en el espacio subdural. La principal característica radiológica de estas lesiones es una cerco hipodenso en la superficie exterior del coágulo. La resolución espontánea de HSDAT es rara. La vigilancia clínica y radiológica es esencial para el manejo adecuado de estos pacientes (AU)

ATUAÇÃO DA FISIOTERAPIA NO ESPORTE PARALÍMPICO / ACTION OF PHYSIOTHERAPY IN PARALYMPIC SPORT / ACTUACIÓN DE LA FISIOTERAPIA EN EL DEPORTE PARALÍMPICO

Cada vez mais, atletas paralímpicos têm obtido resultados expressivos em importantes competições, bem como o aparecimento de lesões musculoesqueléticas tem aumentando nesses atletas e, com isso, a ação da fisioterapia passa a ser importante e vem ganhando espaço nessa área. O objetivo do presente estudo é demonstrar as principais lesões musculoesqueléticas e a atuação do fisioterapeuta no esporte paralímpico. Observou-se que existem vários artigos publicados sobre lesões musculoesqueléticas, relacionados com a deficiência e a modalidade praticada pelo atleta. No entanto, são pouco detalhados quanto à atuação do fisioterapeuta e quais seriam as possíveis contribuições desse profissional na avaliação, no monitoramento, na intervenção e na prevenção das lesões em atletas paralímpicos. Pode-se concluir que o fisioterapeuta é um profissional de extrema relevância para a reabilitação de lesões. Contudo, as informações sobre sua atuação no esporte paralímpico ainda são restritas no que se refere às áreas nas quais pode atuar e auxiliar o atleta paralímpico.

Increasingly, Paralympic athletes have been achieving impressive results in major competitions, but the occurrence of musculoskeletal injuries in these athletes is also increasing. As a result, the action of physiotherapy is becoming more important and more widespread in this field. The purpose of this study is to outline the main musculoskeletal injuries and the role of the physiotherapist in Paralympic sport. There have been several published articles on musculoskeletal injuries related to disability and the modality of sport practiced by the athlete. However, these give few details on the action of the physiotherapist, and the possible contributions of this professional to the assessment, monitoring, intervention, and prevention of injuries in Paralympic athletes. It can be concluded that the work of the physiotherapist is extremely important for the rehabilitation of injuries. However, information about their action in Paralympic sport, and the areas in which they can act and help the Paralympic athlete, is still limited.

Cada vez más, los atletas paralímpicos han logrado resultados expresivos en competiciones importantes, así como la aparición de lesiones musculoesqueléticas está aumentando en estos atletas y, por lo tanto, el papel de la fisioterapia se vuelve importante y se está volviendo más popular en esta área. El objetivo de este estudio es demostrar las principales lesiones musculoesqueléticas y el papel del fisioterapeuta en el deporte paralímpico. Se ha observado que hay varios artículos publicados sobre lesiones musculoesqueléticas relacionadas con la discapacidad y el deporte practicado por el atleta. Sin embargo, hay pocos detalles en cuanto a la actuación del fisioterapeuta y cuáles serían las posibles contribuciones de estos profesionales en la evaluación, el seguimiento, la intervención y la prevención de lesiones en los atletas paralímpicos. Se puede concluir que el fisioterapeuta es un profesional sumamente importante para la rehabilitación de lesiones. No obstante, la información sobre su actuación en el deporte paralímpico sigue restringida en relación con las áreas en que puede actuar y ayudar al atleta paralímpico.

Decompressive Hemicraniectomy in a South American Population--Morbidity and Outcomes Analysis.

BACKGROUND: Malignant cerebral artery strokes have a poor prognosis, with nearly 80% of mortality in some series despite intensive care. After a large randomized trial, decompressive hemicraniectomy has been performed more often in stroke patients. Here, we describe patients in a tertiary teaching hospital in Brazil, emphasizing the impact of age on outcomes. METHODS: A retrospective cohort of patients, with malignant strokes which received a decompressive hemicraniectomy, from paper and electronic medical records, from January 2010 to December 2013 was divided into two groups according to age. RESULTS: The final analysis included 60 patients. The overall mortality was higher among patients older than 60 yrs (67% vs. 41%; p = 0.039), whose group also had a worse outcome (76% with mRS 5 or 6) at 90 days (OR 3.91 CI95% 1.30-11.74), whereas only 24% had mRS of 0-4 (p = 0.015). All patients who presented with sepsis died (p = 0.003). The incidence of pulmonary infection was very high in the elderly group (76%) with significant intergroup differences (p = 0.027, OR 8.32 CI95% 0.70-98.48). CONCLUSIONS: Older patients present more commonly with infections, more disabilities and a higher mortality, highlighting very poor results in elderly population. These results should be proved with a South American trial, and if confirmed, it can impact on future decisions regarding decompressive craniectomy for acute ischemic stroke in our region.

Incremental exercise test for the evaluation of peak oxygen consumption in paralympic swimmers.

BACKGROUND: Peak oxygen consumption (VO2peak) is a fundamental parameter used to evaluate physical capacity. The objective of this study was to explore two types of incremental exercise tests used to determine VO2peak in four Paralympic swimmers: arm ergometer testing in the laboratory and testing in the swimming pool. METHODS: On two different days, the VO2peak values of the four athletes were measured in a swimming pool and by a cycle ergometer. The protocols identified the VO2peak by progressive loading until the volitional exhaustion maximum was reached. The results were analyzed using the paired Student's t-test, Cohen's d effect sizes and a linear regression. RESULTS: The results showed that the VO2peak values obtained using the swimming pool protocol were higher (P=0.02) than those obtained by the arm ergometer (45.8±19.2 vs. 30.4±15.5; P=0.02), with a large effect size (d=3.20). When analyzing swimmers 1, 2, 3 and 4 individually, differences of 22.4%, 33.8%, 60.1% and 27.1% were observed, respectively. CONCLUSIONS: Field tests similar to the competitive setting are a more accurate way to determine the aerobic capacity of Paralympic swimmers. This approach provides more sensitive data that enable better direction of training, consequently facilitating improved performance.