Factors associated with the quality of life of mothers of preterm infants with very low birth weight: a 3-year follow-up study.

AIM: To analyze possible factors associated with the quality of life (QoL) of mothers of preterm infants with very low birth weight (VLBW) during the first 3 years after delivery. METHODS: The World Health Organization Quality of Life (WHOQOL)-bref scores were compared and correlated with maternal and infant-related sociodemographic and clinical variables at maternal discharge (T0) and at 6 (T1), 12 (T2), 24 (T3), and 36 (T4) months after delivery. Multiple linear regression models were fitted to investigate the effect of these variables on the mothers' QoL. RESULTS: The WHOQOL-BREF physical domain scores were higher at T1 and T2 compared to T0 (p = 0.013). Maternal variables that contributed to maternal QoL scores (p < 0.05) were stable marital union (b = 13.60; T0), family income (b = -12.75; T3), Evangelical religion (b = 8.11; T4), and beck depression inventory (BDI) score (-1.42 ≤ b ≤ -0.36; T0, T1, T2, T3, and T4). Infants' variables that most affected maternal QoL (p < 0.05) were posthemorrhagic hydrocephalus (PHH) (-18.84 ≤ b ≤ -10.05; T1, T2, and T4), bronchopulmonary dysplasia (BPD) (b = -7.41; T2), female gender (b = 8.09; T2), and SNAPPE severity score (b = -0.23; T3). CONCLUSION: Mothers of preterm infants with VLBW exhibited transient improvements in physical well-being during the first year after delivery. The presence of depressive symptoms in mothers and the diagnosis of PHH or BPD were negatively associated with QoL. Social, religious, and economic aspects were also important factors for the QoL of mothers of preterm infants with VLBW.

Cardiac vagal index does not explain age-independent maximal heart rate.

Cardiac vagal tone (CVT), a key determinant of resting heart rate (HR), is progressively withdrawn with incremental exercise and nearly abolished at maximal effort. While maximal HR decreases with age, there remains a large interindividual variability of results for any given age. In the present study, we hypothesized that CVT does not contribute to age-independent maximal HR. Data were obtained from 1 000 (39±14 years old) healthy subjects (719 men) who were not taking medications affecting CVT or maximal HR performed a clinically normal and truly maximal cardiopulmonary exercise testing. CVT was estimated using the cardiac vagal index (CVI), a dimensionless ratio obtained by dividing 2 cardiac cycle durations--end of exercise and pre-exercise--, reflecting HR increases during a 4-s unloaded cycling test (a vagally-mediated response). Maximal HR was expressed as % of that predicted by age (208-0.7 × age (years)). Linear regression analyses identified that CVI can explain only 1% of the % age-predicted maximal HR variability with a high standard error of estimate (~6.3%), indicating the absence of a true physiological cause-effect relationship. In conclusion, the influence of CVI on % of age-predicted maximal HR is null in healthy subjects, suggesting distinct physiological mechanisms and potential clinical complementary role for these exercise-related variables.

A pre-season comparison of aerobic fitness and flexibility of younger and older professional soccer players.

Aerobic fitness and flexibility generally present age-related decreases, yet the influence of age on these variables in soccer players is still unknown. We obtained oxygen consumption (VO(2)) and heart rate (HR) at 12 km · h (- 1), anaerobic threshold and maximum intensities, and athletes' flexibility profiles using Flexitest (FLX). Pre-season data (2005-2011) from the 2 extreme age terciles (n=54) - YOUNGER (17-22 years old) and OLDER (27-36 years old) - of a group of 162 players from an elite Brazilian soccer club were compared. The effects of aging were also assessed by contrasting VO(2), HR and FLX linear regressions - slope and intercept - vs. age-predicted and reference values. The results were similar between the YOUNGER and OLDER terciles for VO(2max), at 62.7 ± 6.1 vs. 63.2 ± 6.2 mL · kg (- 1) · min (- 1), respectively (p=0.67), effect size (ES)=0.08, and for FLX, at 43 ± 5.9 vs. 41 ± 6.0, respectively (p=0.11, ES=0.34); the YOUNGER tercile exhibited higher values for HRmax than the OLDER tercile, at 194 ± 8.1 vs. 189 ± 8.8 b · min (- 1), (p<0.01, ES=0.59). Players in the OLDER tercile did not present an age-predicted decrease in VO(2max), whereas HRmax and FLX diminished with age as predicted. We conclude that, at least for these variables, younger and older players were effectively identical in their pre-season levels of conditioning.

Atrial fibrillation in endurance-trained athletes.

BACKGROUND: Endurance exercise training produces multiple cardiac adaptations including changes in electrophysiological function that may make endurance-trained athletes more vulnerable to atrial fibrillation (AF). This possible association is not recognised by many practising cardiologists and sports physicians. Consequently, we performed a literature review to examine the relationship between atrial fibrillation and endurance exercise training among athletes. PubMed was searched from January 1960 through December 2008 to identify articles examining the relationship between endurance exercise training and AF. RESULTS: Evidence suggests that athletes are at increased risk for development of AF. Possible factors increasing AF in this population include increased parasympathetic tone, reduced sympathetic tone, increased atrial size and increased inflammation. DISCUSSION: Suggested management of AF in athletes should follow similar principles to those used to manage AF in the general population.

Psychotria hoffmansegiana (Willd ex Roem. & Schult.) Mull. Arg. and Palicourea marcagravii st. Hil. (Rubiaceae): potential for forming soil seed banks in a brazilian Cerrado.

The germinability of artificially buried Psychotria hoffmansegiana and Palicourea marcagravii seeds in Cerrado soil was tested, with the aim of evaluating whether dispersed seeds may be able to form a soil seed bank. The assays were carried out at a Cerrado Reserve in São Paulo State, Brazil. Seed samples were placed in nylon bags and buried at two different depths and in two different sites. Samples were periodically exhumed and germination tests were performed with both exhumed and dry stored seeds. In general, soil storage favoured seed survival and germination when compared to dry stored seeds. The seed germination was little affected by soil depth and by burial environment. Seeds of both species remained viable for at least 13 months, considering the time lapse between the collection and the end of the germination tests. It was suggested that both species can potentially form a persistent soil seed bank in Cerrado.

Storage in cerrado soil and germination of Psychotria vellosiana (Rubiaceae) seeds.

The regeneration of plant communities from seed depends, to a large extent, on the capacity of the seed remaining viable in the soil. The viability and germination of artificially buried Psychotria vellosiana seeds in cerrado soil were studied, with the purpose of discovering some physio-ecological aspects of dispersed seeds and evaluating their potential to constitute a soil seed bank. Seed samples were placed in nylon envelopes and buried in the soil of a Cerrado reserve at two different depths and sites. Buried seeds were retrieved periodically and tested for germination along with dry-stored seeds. In general, there was a reduction in seed germination with storage time, both in soil and dry stored conditions, and in some assays exhumed seeds germinated faster than dry stored ones. In general the soil storage favoured seed viability of ungerminated seeds as compared to dry stored ones, with the seeds remaining partially viable after 10 months of storage. The lack of germination of viable seeds suggests that seeds showed true dormancy and/or required an extended time to germinate. It was observed that some seeds had germinated while buried and such in situ germination tended to increase with rainfall. The water availability in the soil might be a limiting factor for successful germination of P. vellosiana in the field, and the seeds may constitute a persistent soil seed bank in the cerrado as dispersed seeds remain viable in the soil until the following period of seed dispersal.

Adult women with mitral valve prolapse are more flexible.

BACKGROUND: Mitral valve prolapse (MVP) is common in women. Other clinical features such as flexibility and hyperlaxity are often associated with MVP, as there is a common biochemical and histological basis for collagen tissue characteristics, range of joint motion, and mitral leaflet excursion. OBJECTIVE: To confirm whether adult women with MVP are more flexible and hypermobile than those without. METHODS: Data from 125 women (mean age 50 years), 31 of them with MVP, were retrospectively analysed with regard to clinical and kinanthropometric aspects. Passive joint motion was evaluated in 20 body movements using Flexitest and three laxity tests. Flexitest individual movements (0 to 4) and overall Flexindex scores were obtained in all subjects by the same investigator. RESULTS: Women with MVP were lighter, less endomorphic and mesomorphic, and more linear. The Flexindex was significantly higher in the women with MVP, both absolute (48 (1.6) v 41 (1.3); p<0.01) and centile for age (67 v 42; p<0.01) values. In 13 out of 20 movements, the Flexitest scores were significantly higher for the women with MVP. Signs of hyperlaxity were about five times more common in these women: 74% v 16% (p<0.01). Scores of 0 and 1 in elbow extension, absence of hyperlaxity, and a Flexindex centile below 65 were almost never found in women with MVP. CONCLUSION: Flexitest, alone or combined with hyperlaxity tests, may be useful in the assessment of adult women with MVP.

Acute hemodynamic and electrocardiographic responses to a session of inspiratory muscle training in cardiopulmonary rehabilitation.

BACKGROUND: Inspiratory muscle training (IMT) has been shown to generate significant benefits in different clinical conditions; however, there is scarce information regarding acute clinical and hemodynamic effects. AIM: The aim of this study was to evaluate clinical, hemodynamic and electrocardiographic responses during a single short IMT session in patients enrolled in cardiopulmonary rehabilitation program (CRP). DESIGN: Cross-sectional study. SETTING: Patients referred and regularly attending a non-hospital based medically-supervised exercise program. POPULATION: One hundred and sixty patients patients who regularly performed inspiratory muscle training METHODS: A convenience sample of 21 elderly patients (16 men; 60-87 years of age) had an ECG continuously recorded and heart rate (HR) and blood pressure (BP) measured before, during and one-minute after a single IMT session - two sets of 15 cycles with one-minute interval. RESULTS: Comparing values obtained before, during second set and one-minute after IMT, no differences were found to HR (bpm) - 68±2 vs. 70±2 vs. 66±3 (P=0.05) and in systolic and diastolic BP (mm Hg) values, respectively, - 105±3 vs. 111±4 vs. 108±3 (P=0.06) and - 68±2 vs. 72±3 vs. 68±2 (P=0.14); (before, during second set and one-minute after TMI). During IMT, seven (33%) of patients presented minor cardiac arrhythmias, most of them isolated premature ventricular contractions. Additionally, no abnormal signs or symptoms were found. CONCLUSION: Apart of minor and clinically irrelevant ECG abnormalities seen in 1/3 of the patients, a short IMT session did not induce significant hemodynamic responses or relevant clinical abnormalities. Based on these results, for elderly patients involved in CPR, IMT seems to be clinically safe and continuous ECG monitoring did not seem to add significant or relevant information. CLINICAL REHABILITATION IMPACT: For elderly patients participating in CPR, short IMT sessions do not induce major hemodynamic responses and seem to be clinically safe. This is potentially useful information if IMT is to be prescribed in home-based programs.

Neural pathways to lower urinary tract identified by retrograde axonal transport of horseradish peroxidase.

A new technique for tracing nerve fibers supplying specific organs by retrograde axonal transport of the enzyme horseradish peroxidase (HRP) was used to determine the innervation of various segments of the lower urinary tract. HRP was injected at the level of the bladder neck, postprostatic urethral segment, pelvic nerve, pudendal nerve, and pelvic floor musculature to determine precise nerve supply to each site, as well as possible overlap. The technique determines the exact spinal level of innervation, as well as the number of nuclei directly related to the motor neuron axons supplying innervation to each particular site. Representation of these nuclei at various levels of the spinal cord was shown in various serial sections obtained after the injection of HRP. This technique is accurate and precise; it is valuable in establishing exact neural anatomic connections between the central nervous system and target organs.

Urinary striated sphincter: what is its nerve supply?

Innervation of the voluntary urinary sphincter continues to be a controversial subject. Using retrograde axonal transport techniques to determine the exact nerve supply to the external sphincter has been successful in clarifying this controversy. 1-5 Tracing the transport of horseradish peroxidase (HRP) injected in the voluntary external sphincter and that injected directly in the cut end of the pudendal nerve was done. Transport from both sides ended in the same neurons in the dorsolateral column, thus labelling and identifying the pudendal nucleus which is the motor center for the voluntary urinary sphincter.

Heart rate transient at the onset of active and passive dynamic exercise.

At the onset of dynamic exercise there is an almost instantaneous heart rate (HR) acceleration caused by neural activation of central motor areas (central command) and stimulation of mechanoreceptors located in the moving limbs. Aiming to identify the independent contribution of the peripheral mechanism to the initial HR response to exercise, 29 subjects performed two 4-s bouts of unloaded cycling (active (AEx) and passive (PEx)) on an adapted commercial tandem bicycle. PEx was accomplished by having a staff member pedal while sitting on the rear seat. The HR was continuously measured from electrocardiographic tracings. Records of electromyography (EMG) were obtained in a small sample of subjects during the exercise tasks. The number of pedal rotations was very similar (mean +/- SE) (AEx = 7.4 +/- 0.3, PEx = 7.5 +/- 0.2, P = 0.455), determining significant HR changes (P < 0.001) that were similar in the two types of exercise (AEx from 92 to 125 bpm: 35.9% increase; PEx from 87 to 111 bpm: 27.6% increase; P = 0.185). Contrasting to AEx, no muscle contraction was observed by EMG during PEx, suggesting that central command was absent. We concluded that independent activation of mechanoreceptors can promote HR acceleration at the onset of dynamic exercise.

Skeletal muscle function and body composition of patients with hyperthyroidism.

The purpose of this study was to determine whether the improvement in muscle performance after treatment of hyperthyroidism is only a result of an increased muscle mass or if it also depends on the improvement of intrinsic contractile function. Nine patients with Graves' disease were evaluated 1) at the time of diagnosis, 2) after 1 wk of monotherapy with propranolol, and 3) after the euthyroid state had been achieved with antithyroid drugs. At each evaluation the patients were submitted, on the dominant side, to anthropometric measurements and to skeletal muscle function tests to determine the maximal static voluntary contraction (MAX) and endurance (END); "endurance" is defined as the time limit at maintaining 30% of MAX. Three movements were tested: hip flexion, ankle dorsiflexion, and handgrip. Body weight changed from 53.4 +/- 3.2 to 58.2 +/- 2.9 kg (P = 0.004) and the sum of skinfold-corrected limb circumferences changed from 90.7 +/- 3.1 to 94.4 +/- 3.1 cm (P = 0.017). MAX and END of all movements increased at the end of the study even if adjusted for the sum of skinfold-corrected limb circumferences: Hip flexion: MAX 20.60 +/- 3.32 to 31.26 +/- 5.07 g.cm-1, END 0.43 +/- 0.18 to 1.18 +/- 0.42 kg.s-1.cm-1. Ankle dorsiflexion: MAX 12.34 +/- 1.97 to 26.88 +/- 2.46 g.cm-1, END 0.97 +/- 0.28 to 2.50 +/- 0.58 kg.s-1.cm-1; Handgrip: MAX: 2.20 +/- 0.23 to 2.9 +/- 0.2 g.cm-1, END 0.13 +/- 0.01 to 0.20 +/- 0.02 kg.s-1.cm-1. In conclusion, improved muscle performance resulting from the treatment of hyperthyroidism is a consequence of an enhanced intrinsic muscle function as well as a greater muscle mass.

Cardiovascular responses to active and passive cycling movements.

Ten healthy subjects were evaluated at rest and at 5 min of unloaded active (AC) and passive (PC) cycling. Passive limb movements were accomplished using a tandem bicycle with a second rider performing the movements. We measured heart rate (HR), mean arterial pressure (MAP), cardiac output (CO), oxygen uptake (VO2), rating of perceived exertion (RPE), and electrical activity (EMG) of lower limbs muscles. Values for stroke volume (SV) and peripheral vascular resistance (PVR) were calculated. EMG, RPE, and VO2 were higher during AC than during PC (P < 0.001). CO increased during both modes of cycling, but during AC it resulted from a HR acceleration (73 +/- 2 at rest to 82 +/- 2 beats.min-1 at 60 rpm; P < 0.001) with no change in SV whereas during PC, SV increased from rest (65 +/- 4 at rest to 71 +/- 3 ml at 60 rpm; P = 0.003) along with no change in HR. PVR remained constant during PC, but decreased by 13% during AC (P < 0.001) and MAP increased only during PC (93 +/- 2 at rest to 107 +/- 2 mm Hg at 60 rpm). These results supports the concept that central command determines the HR response to dynamic exercise. The increase in SV and consequently in MAP during PC was probably due to increased venous return and/or to muscle mechanoreceptor-evoked increased myocardial contractility.

Vagal activity: effect of age, sex and physical activity pattern.

Heart rate response to a short (4 s) bicycle exercise test during maximal inspiratory apnea was used to assess vagal activity (VA). This study aims to evaluate the role of age, sex and physical activity pattern on VA. A total of 148 subjects, divided into athletes (N = 90) and non-athletes (N = 58) were tested. No correlation was found between age (range from 15 to 42 years) and VA in the male and female athletes (P greater than 0.05). No gender effect could be identified. In spite of a slight tendency toward higher VA in athletes, no significant differences could be found between the two groups.

Relative roles of the sympathetic and parasympathetic systems in the 4-s exercise test.

To evaluate the relative influence of the two branches of the autonomic nervous system on the 4-s exercise test which measures heart rate acceleration at the onset of exercise, 6 healthy male subjects performed the 4-s test under sympathetic blockade with propranolol, parasympathetic blockade with atropine and dual blockade. The magnitude of the 4-s test results (means +/- SD) was significantly different only between the conditions with and without atropine (1.04 +/- 0.03 vs 1.53 +/- 0.33, respectively), with no differences between the control (1.60 +/- 0.25) and the test under sympathetic blockade (1.51 +/- 0.33). These results support the conclusion that the 4-s exercise test is a specific method for the evaluation of parasympathetic activity.

Cyclophosphamide and inhibition of renal compensatory hypertrophy.

The objective of the present study was to determine whether cyclophosphamide inhibits nephrectomy-induced compensatory renal hypertrophy directly or indirectly owing to the reduced food intake caused by the drug. We measured kidney weight and renal water, protein, deoxyribonucleic acid (DNA), and ribonucleic acid (RNA) content and the renal RNA/DNA ratio in 72 rats distributed into groups as follows: left nephrectomized/cyclophosphamide-treated rats; left nephrectomized/saline treated rats; left nephrectomized rats submitted to food restriction and treated with saline; and left sham-nephrectomized rats treated with saline. An additional group of 12 rats was studied to obtain the initial values of the parameters. The parameters were also measured 1, 2 and 3 weeks after left nephrectomy or sham-operation. Cyclophosphamide was given once a week intraperitoneally at the dosage of 60 mg/kg body weight in saline. Corresponding volumes of saline were given to control animals. At the end of the 1st week all nephrectomized groups of rats showed some degree of renal compensatory growth. However, no significant differences in kidney weight, protein or RNA content were detected between controls, cyclophosphamide-treated rats, and animals submitted to food restriction at the end of the 2nd and 3rd week. We conclude that cyclophosphamide inhibits but does not abolish compensatory renal hypertrophy after uninephrectomy in the young rat and this inhibition is mediated primarily through the reduced food intake caused by the drug.

[Criteria for electrocardiographic diagnosis of vagotonia. Is there a consensus in the opinion of specialists?]. / Critérios para o diagnóstico eletrocardiográfico de vagotonia. Existe consenso na opinião de especialistas?

PURPOSE: To identify the most important criteria for the ECG diagnosis of vagotonia in the opinion of cardiologists. METHODS: A written questionnaire was applied to 40 cardiologists attending the 9th Brazilian Congress of Cardiac Arrhythmias (S. José do Rio Preto, SP, 1992). The sample represented approximately 15% of all participants and was intentionally biased to include 70% of the invited speakers and free communications presenters, and to exclude non-medical professionals, aiming to enhance the validity of the answers. It was divided in two parts: the first, with spontaneous response, answered without knowledge of the following; and the second, where a list of ECG criteria obtained in the literature was presented to the respondent in a random order. In both parts, the specialists were requested to attribute an order of importance for each criterion. RESULTS: In the 1st part, 35 different criteria were cited, but only 3 were assigned by more than 25% of the sample: sinus bradycardia (95%), tall and peaked T waves (30%) and early repolarization (27.5%). In the 2nd part, the best classified criterion was sinus bradycardia, followed by J point elevation and ST segment elevation. CONCLUSION: Among cardiologists with a interest in electrocardiography and cardiac arrhythmias, apart of sinus bradycardia, there is no clear consensus concerning to the group of criteria to identify vagotonia in the standard 12-lead ECG. Further research is necessary to objectively validate the main criteria herein identified.

[Initial heart rate transient at dynamic exercise performed in apnea. Influence of the variation rate of previous lung volume]. / Transiente inicial de freqüência cardíaca no exercício dinâmico realizado em apnéia. Influência da taxa de variação do volume pulmonar precedente.

PURPOSE: To study the influence of inspiratory flow on the heart rate (HR) responses during the four-second exercise test (4sET) as a method to estimate cardiac vagal activity. METHODS: Fifteen healthy subjects performed the 4sET under two experimental situations: a) with maximal individual inspiratory flow (MIF) and b) with a slow inspiratory flow adjusted to reach total lung capacity in 4s (SIF). Vagal activity was estimated from B/C ratio obtained in ECG tracings, where B is the last R-R interval before the onset of exercise and C is the shortest R-R interval during exertion. RESULTS: Similar inspiratory capacities were reached, with significantly different inspiratory flows [mean (se)] [MIF = 2.23 (0.28) 1.s-1 and SIF = 0.59 (0.06) 1.s-1; t = 6.69; p < 0.0001]; as a result, it was observed a greater B/C ratio in MIF [1.36 (0.05)] as compared to SIF [1.13 (0.04); t = 4.42; p = 0.0006]. The inspiratory flow influenced HR responses in the 4sET. The biphasic transient induced by inspiration, with a HR acceleration followed by a relative bradycardia, has not been completed before exercise in the 4sET with SIF. CONCLUSION: Lower values of B/C in the 4sET with SIF seemed to be due to overlapping effects of apnea and exertion on HR during cycling. On the other hand, when the inspiration was performed at MIF, the oscillatory effect of respiration upon HR was completed before the onset of exercise. Therefore, the tachycardia observed during the 4sET performed after individual maximal inspiratory flow represents the isolated effect of dynamic exercise.

[Coronary risk factors in high-rank athletes]. / Fatores de risco coronariano em atletas de alto nível.

PURPOSE: To report the prevalence of coronary risk factors in elite athletes. METHODS: The prevalence of coronary risk factors was determined in 88 athletes (62 men and 26 women) who participate representing Brazil, in the Olympic Games at Seul in 1988, in the Project SEUL/COB/AMIL. The risk factors analyzed were: family history of coronary heart disease, hypercholesterolemia (total-cholesterol and subfractions), hypertension, glucose intolerance, smoking and left ventricle hypertrophy (LVH). We compared the mean values of total-cholesterol/HDL-cholesterol between men and women with unpaired Student's t Test. The distribution of risk factors prevalence by sex was analysed with the chi-square test. RESULTS: Family history of coronary heart disease was detected in 11 (12.5%) athletes. Smoking was found in 12 (13.6%) athletes. There was no one with hypertension or glucose intolerance. LVH was diagnosed with the echocardiogram, in 36 athletes (40.9%). Total-cholesterol mean was 172 +/- 36 mg/dl in men and 187 +/- 34 mg/dl in women. HDL-cholesterol mean was 46 +/- 10 mg/dl in men and 60 +/- 13 mg/dl in women. Total-cholesterol/HDL-cholesterol mean was 4.02 +/- 1.39 mg/dl in men and 3.21 +/- 0.74 mg/dl in women. The difference between total-cholesterol in mean and women was not statistically significant (p less than 0.05). HDL-cholesterol and total-cholesterol/HDL-cholesterol means were statistically different (p less than 0.05). Prevalence distribution of the number of risk factors by sex were not statistically different (p less than 0.05). CONCLUSION: The results shows how important is to look for coronary risk factors in elite athletes.