Cardiorespiratory fitness, balance and walking improvements in an adolescent with cerebral palsy (GMFCS II) and autism after motor-assisted elliptical training

Purpose: To quantify the impact of motor-assisted elliptical (ICARE) training on cardiorespiratory fitness, balance and walking function of an adolescent with walking limitations due to cerebral palsy. Materials and methods: A thirteen-year-old boy with hemiplegic cerebral palsy (Gross Motor Function Classification System II) and autism participated. Peak oxygen consumption (peak VO2, primary outcome measure), oxygen cost of walking, Pediatric Balance Scale (PBS), modified Timed Up and Go (mTUG), 2-Minute Walk Test (2MWT), and gait characteristics (speed, cadence, step length, single support time) were assessed prior to and after completion of 24 sessions of moderate- to vigorous- intensity ICARE training. The goal was to engage the participant in 3 weekly sessions for 8 weeks with progressively challenging training parameters (speed, time overriding the motor’s assistance, step length). Results: From pre- to post-intervention, improvements were detected for peak VO2 (27.2 vs. 40.2 ml/ kg/min), oxygen cost (0.24 vs. 0.17 ml/kg/m at 1.52 m/s), PBS (47 vs. 55), mTUG (8.5 vs. 7.1 seconds), 2MWT (76.8 vs. 128.3 meters). Though not all displayed clinically significant changes, self-selected and fast walking speeds improved. Conclusions: Fitness, balance and walking improvements were achieved by an adolescent with cerebral palsy and autism after participating in a moderate- to vigorous-intensity exercise

Facile synthesis of mononuclear early transition-metal complexes of κ3cyclo-tetrametaphosphate ([P4O12]4−) and cyclo-trimetaphosphate ([P3O9]3−)

We herein report the preparation of several mononuclear-metaphosphate complexes using simple techniques and mild conditions with yields ranging from 56% to 78%. Treatment of cyclo-tetrametaphosphate ([TBA]4[P4O12]·5H2O, TBA = tetra-n-butylammonium) with various metal sources including (CH3CN)3Mo(CO)3, (CH3CN)2Mo(CO)2(η3-C3H5)Cl, MoO2Cl2(OSMe2)2, and VOF3, leads to the clean and rapid formation of [TBA]4[(P4O12)Mo(CO)3]·2H2O, [TBA]3[(P4O12)Mo(CO)2(η3-C3H5)], [TBA]3[(P4O12)MoO2Cl] and [TBA]3[(P4O12)VOF2]·Et2O salts in isolated yields of 69, 56, 68, and 56% respectively. NMR spectroscopy, NMR simulations and single crystal X-ray studies reveal that the [P4O12]4− anion behaves as a tridentate ligand wherein one of the metaphosphate groups is not directly bound to the metal. cyclo-Trimetaphosphate-metal complexes were prepared using a similar procedure i.e., treatment of [PPN]3[P3O9]·H2O (PPN = bis(triphenylphosphine)iminium) with the metal sources (CH3CN)2Mo(CO)2(η3-C3H5)Cl, MoO2Cl2(OSMe2)2, MoOCl3, VOF3, WOCl4, and WO2Cl2(CH3CN)2 to produce the corresponding salts, [PPN]2[(P3O9)Mo(CO)2(η3-C3H5)], [PPN]2[(P3O9)MoO2Cl], [PPN]2[(P3O9)MoOCl2], [PPN]2[(P3O9)VOF2]·2CH2Cl2, and [PPN]2[(P3O9)WO2Cl] in isolated yields of 78, 56, 75, 59, and 77% respectively. NMR spectroscopy, NMR simulations and single-crystal X-ray studies indicate that the trianionic ligand [P3O9]3− in these complexes also has κ3 connectivity.Eni S.p.A. (Firm)Eni-MIT Solar Frontiers Center (Program

Profile of micronucleus frequencies and DNA damage in different species of fish in a eutrophic tropical lake

Lake Paranoá is a tropical reservoir for the City of Brasilia, which became eutrophic due to inadequate sewage treatment associated with intensive population growth. At present, two wastewater treatment plants are capable of processing up to 95% of the domestic sewage, thereby successfully reducing eutrophization. We evaluated both genotoxic and cytotoxic parameters in several fish species (Geophagus brasiliensis, Cichla temensis, Hoplias malabaricus, Astyanax bimaculatus lacustres, Oreochromis niloticus, Cyprinus carpio and Steindachnerina insculpita) by using the micronucleus (MN) test, the comet assay and nuclear abnormality assessment in peripheral erythrocytes. The highest frequencies of MN were found in Cichla temensis and Hoplias malabaricus, which were statistically significant when compared to the other species. However, Steindachnerina insculpita (a detritivorous and lake-floor feeder species) showed the highest index of DNA damage in the comet assay, followed by C. temensis (piscivorous). Nuclear abnormalities, such as binucleated, blebbed, lobed and notched cells, were used as evidence of cytotoxicity. Oreochromis niloticus followed by Hoplias malaricus, ominivorous/detritivotous and piscivorous species, respectively, presented the highest frequency of nuclear abnormalities, especially notched cells, while the herbivorous Astyanax bimaculatus lacustres showed the lowest frequency compared to the other species studied. Thus, for biomonitoring aquatic genotoxins under field conditions, the food web should also be considered

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Regional differences in clinical care among patients with type 1 diabetes in Brazil: Brazilian Type 1 Diabetes Study Group

Background\ud To determine the characteristics of clinical care offered to type 1 diabetic patients across the four distinct regions of Brazil, with geographic and contrasting socioeconomic differences. Glycemic control, prevalence of cardiovascular risk factors, screening for chronic complications and the frequency that the recommended treatment goals were met using the American Diabetes Association guidelines were evaluated.\ud \ud Methods\ud This was a cross-sectional, multicenter study conducted from December 2008 to December 2010 in 28 secondary and tertiary care public clinics in 20 Brazilian cities in north/northeast, mid-west, southeast and south regions. The data were obtained from 3,591 patients (56.0% females and 57.1% Caucasians) aged 21.2 ± 11.7 years with a disease duration of 9.6 ± 8.1 years (<1 to 50 years).\ud \ud Results\ud Overall, 18.4% patients had HbA1c levels <7.0%, and 47.5% patients had HbA1c levels ≥ 9%. HbA1c levels were associated with lower economic status, female gender, age and the daily frequency of self-blood glucose monitoring (SBGM) but not with insulin regimen and geographic region. Hypertension was more frequent in the mid-west (32%) and north/northeast (25%) than in the southeast (19%) and south (17%) regions (p<0.001). More patients from the southeast region achieved LDL cholesterol goals and were treated with statins (p<0.001). Fewer patients from the north/northeast and mid-west regions were screened for retinopathy and nephropathy, compared with patients from the south and southeast. Patients from the south/southeast regions had more intensive insulin regimens than patients from the north/northeast and mid-west regions (p<0.001). The most common insulin therapy combination was intermediate-acting with regular human insulin, mainly in the north/northeast region (p<0.001). The combination of insulin glargine with lispro and glulisine was more frequently used in the mid-west region (p<0.001). Patients from the north/northeast region were younger, non-Caucasian, from lower economic status, used less continuous subcutaneous insulin infusion, performed less SBGM and were less overweight/obese (p<0.001).\ud \ud Conclusions\ud A majority of patients, mainly in the north/northeast and mid-west regions, did not meet metabolic control goals and were not screened for diabetes-related chronic complications. These results should guide governmental health policy decisions, specific to each geographic region, to improve diabetes care and decrease the negative impact diabetes has on the public health system.We thank Mrs. Karianne Aroeira Davidson, Mrs. Anna Maria Ferreira, Mrs. Elisangela Santos and Sandro Sperandei for their technical assistance.This work was supported by grants from Farmanguinhos/Fundação Oswaldo Cruz/National Health Ministry, the Brazilian Diabetes Society, Fundação do Amparo à Pesquisa do Estado do Rio de Janeiro, and Conselho Nacional de Desenvolvimento Científico e Tecnológico do Brasil

Frontal plane comparison between drop jump and vertical jump: Implications for the assessment of ACL risk of injury

The potential to use the vertical jump (VJ) to assess both athletic performance and risk of anterior cruciate ligament (ACL) injury could have widespread clinical implications since VJ is broadly used in high school, university, and professional sport settings. Although drop jump (DJ) and VJ observationally exhibit similar lower extremity mechanics, the extent to which VJ can also be used as screening tool for ACL injury risk has not been assessed. This study evaluated whether individuals exhibit similar knee joint frontal plane kinematic and kinetic patterns when performing VJs compared with DJs. Twenty-eight female collegiate athletes performed DJs and VJs. Paired t-tests indicated that peak knee valgus angles did not differ significantly between tasks (p = 0.419); however, peak knee internal adductor moments were significantly larger during the DJ vs. VJ (p \u3c 0.001). Pearson correlations between the DJ and VJ revealed strong correlations for knee valgus angles (r = 0.93, p \u3c 0.001) and for internal knee adductor moments (r = 0.82, p \u3c 0.001). Our results provide grounds for investigating whether frontal plane knee mechanics during VJ can predict ACL injuries and thus can be used as an effective tool for the assessment of risk of ACL injury in female athletes

Feasibility of motor-assisted elliptical to improve walking, fitness and balance following pediatric acquired brain injury: A case series

Purpose: Walking, fitness, and balance deficits are common following acquired brain injury (ABI). This study assessed feasibility, acceptability, and usefulness of a modified motor-assisted elliptical (ICARE) in addressing walking, fitness, and balance deficits in children with chronic ABIs. Methods: Three children (\u3e 5 years post-ABI) completed 24 ICARE exercise sessions (exercise time, speed, and time overriding motor-assistance gradually increased) to promote mass repetition of gait-like movements and challenge cardiorespiratory fitness. Parents’ and children’s perceptions of ICARE’s safety, comfort, workout, and usability were assessed. Cardiovascular response, gait and balance outcomes were assessed. Results: No adverse events occurred. Parent’s Visual Analogue Scale (VAS) scores of perceived device safety (range 80–99), workout (range 99–100), and usability (range 75–100) were high, while comfort were 76–80 given commercial harness fit and arm support. Children’s VAS scores all exceeded 89. Comfortable walking velocity, 2-Minute Walk Test, fitness, and Pediatric Balance Scale scores improved post-training, with many outcomes surpassing established minimal clinically important differences. Conclusion: Following engagement in moderate- to vigorous-intensity exercise promoting repetitive step-like movements on a specially adapted motor-assisted elliptical, three children with chronic ABI demonstrated improvements in walking, fitness and balance. Future research in community-based environments with a larger cohort of children with ABI is needed