INSTRUMENTAÇÃO E CALIBRAÇÃO DO APARELHO REFORMER DO MÉTODO PILATES PARA ANÁLISES BIOMECÂNICAS

Acompanhando programas de exercício em voga nosúltimos anos, observa-se que o método Pilates destaca-se.  Na contramão da sua popularidade, verifica-sefalta de informações quantitativas para a prescrição e progressão dosexercícios do método, que são subsídios importantes, em especial, para areabilitação. Este estudo tem como objetivo primário construirduas plataformas de força extensométricas, de baixo custo, para serem adaptadasao aparelho Reformer, do métodoPilates – o mais utilizado dos aparelhos; o segundo, realizar a calibraçãodesses instrumentos e determinar sua acurácia. Esse instrumento foi construídopara medir forças vertical e horizontal de membros inferiores durante exercíciosem cadeia cinética fechada, sobre o aparelho Reformer. Esse instrumento foi calibrado e testado e pode serconsiderado um aparato promissor para análises biomecânicas

Prevalência de Lesões em Atletas de Voleibol de Diferentes Categorias

Este estudo investigou a prevalência de lesões em atletas de voleibol considerando as regiões anatômicas atingidas e os diagnósticos. A amostra foi composta por 299 sujeitos de ambos os sexos, participantes da fase estadual dos Jogos Abertos de Santa Catarina (categoria adulto) e Joguinhos Abertos de Santa Catarina (categoria infanto-juvenil). Os sujeitos foram divididos em dois grupos: o grupo 1 foi formando por 201 atletas da categoria infanto-juvenil e 98 atletas da categoria adulto integraram o grupo 2. Os dados foram obtidos através do questionário ‘Perfil do Campeão' da rede CENESP e analisados através da estatística descritiva e inferencial (teste qui-quadrado). Os resultados evidenciam a prevalência de lesões nos membros inferiores, com destaque para o tornozelo e joelho. Os diagnósticos mais citados foram entorses e tendinites. Os atletas do grupo 2 foram significativamente mais acometidos em relação aos atletas no grupo 1 (

GEN-O-MA project: an Italian network studying clinical course and pathogenic pathways of moyamoya disease—study protocol and preliminary results

Background: GENetics of mOyaMoyA (GEN-O-MA) project is a multicenter observational study implemented in Italy aimed at creating a network of centers involved in moyamoya angiopathy (MA) care and research and at collecting a large series and bio-repository of MA patients, finally aimed at describing the disease phenotype and clinical course as well as at identifying biological or cellular markers for disease progression. The present paper resumes the most important study methodological issues and preliminary results. Methods: Nineteen centers are participating to the study. Patients with both bilateral and unilateral radiologically defined MA are included in the study. For each patient, detailed demographic and clinical as well as neuroimaging data are being collected. When available, biological samples (blood, DNA, CSF, middle cerebral artery samples) are being also collected for biological and cellular studies. Results: Ninety-eight patients (age of onset mean ± SD 35.5 ± 19.6 years; 68.4% females) have been collected so far. 65.3% of patients presented ischemic (50%) and haemorrhagic (15.3%) stroke. A higher female predominance concomitantly with a similar age of onset and clinical features to what was reported in previous studies on Western patients has been confirmed. Conclusion: An accurate and detailed clinical and neuroimaging classification represents the best strategy to provide the characterization of the disease phenotype and clinical course. The collection of a large number of biological samples will permit the identification of biological markers and genetic factors associated with the disease susceptibility in Italy

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Biomechanical analysis of drop jump performed on land and in water with different immersion levels

This study aimed to analyze the immersion level effect on kinetic and kinematic characteristics of depth jumps performed on land and in water at different immersion levels. Participants were 26 young male volleyball and track and field athletes (18.2 ± 2.6 years, 1.87 ± 0.1 m in height, and 74.8 ± 9.0 kg body mass). The analyzed variables were the maximum vertical force on the eccentric and concentric sub-phases of contact and landing, the impulse on the eccentric and concentric sub-phases, contact time, eccentric and concentric contact time, and jump flight time. Depth jumps from 0.4 m were executed on land and at four different immersion levels (tibia s midpoint, tibia s lateral condyle, thigh s midpoint and anterior superior iliac spine). A force platform connected to a data acquisition system, a 2-D electrogoniometer and a synchronizing device were used for data collection. Data were processed through specific routines in Scilab 4.1.2 software. Mean values were calculated from three repetitions of each subject in each analyzed condition, and the immersion level effect was analyzed through tests for repeated measures and their respective post-hoc (p <0 05). Results indicate that the higher the immersion level, the lower the values of maximum vertical force on the eccentric and concentric sub-phases of contact and on landing. However, lower levels of immersion (tibia s midpoint and tibia s lateral condyle) were not sufficient to reduce these forces in most cases. Overall, significant reductions of these variables compared with the land execution occurred from the immersion level of the thigh s midpoint. The increase of the immersion level resulted in impulse reduction during eccentric sub-phase and in a longer duration of this phase. However no difference was found between land and water conditions for concentric impulse and contact time. Higher levels of immersion resulted in longer contact time and flight time duration. Therefore, according to these results, due differences between the two environments, aquatic plyometric training may not be adequate to fully replace the plyometric training on land. Despite, aquatic plyometrics present excellent possibilities for training depending on the training purpose, competitive season stage, or the rehabilitation process characteristics. In any of these cases it is necessary to consider the immersion levels, musculoskeletal conditions and individual anthropometrics characteristics.O objetivo deste estudo foi analisar o efeito da imersão sobre as características cinéticas e cinemáticas de saltos em profundidade realizados no solo e na água com diferentes níveis de imersão. Participaram da pesquisa 26 atletas de voleibol e atletismo, do sexo masculino (18,2 ± 2,6 anos; 1,87 ± 0,1 m de altura; e 74,8 ± 9,0 kg de massa corporal). Foram analisados os valores máximos da força vertical nas subfases excêntrica e concêntrica do contato e na aterrissagem, o impulso nas subfases excêntrica e concêntrica, o tempo de contato, o tempo de contato excêntrico e concêntrico e o tempo de voo durante a execução de saltos em profundidade máximos partindo de 0,4 m no solo e em quatro diferentes níveis de imersão (ponto médio da tíbia, côndilo lateral da tíbia, ponto médio da coxa e espinha ilíaca ântero-superior). Foi utilizada uma plataforma de força conectada a um sistema de aquisição de dados, um eletrogoniômetro 2-D e um sincronizador de sinais. Os dados foram processados através de rotinas específicas no software Scilab 4.1.2. Foram calculados valores médios das três repetições de cada sujeito em cada uma das condições de análise, e o efeito do nível de imersão foi analisado a partir de estatística descritiva e inferencial através de testes para medidas repetidas e seus respectivos post-hoc (p<0,05). Os resultados evidenciam menores valores de força máxima vertical nas subfases excêntrica e concêntrica da queda e na fase de aterrissagem com aumento do nível de imersão. No entanto, na maioria dos casos, níveis baixos de imersão (ponto médio da tíbia e côndilo lateral da tíbia) não foram suficientes para atenuar significativamente estas forças. Em geral, reduções significativas das forças ocorreram a partir do nível de imersão do ponto médio da coxa, em comparação ao solo. O aumento do nível de imersão ocasionou redução no impulso durante a subfase excêntrica e maior duração desta fase. Já para o impulso concêntrico e o tempo de contato concêntrico não foram encontradas diferenças entre a condição solo e as demais. Para o tempo de contato e para o tempo de voo foi constatado que maiores níveis de imersão ocasionam maiores valores dessas variáveis. Os resultados indicam que o treinamento pliométrico no ambiente aquático, devido às diferenças apresentadas entre as execuções dos saltos no solo e na água (nos quatro níveis de imersão analisados), não parece adequado para substituir integralmente a utilização deste método de treinamento em solo. Apesar disso, o treinamento de pliometria na água, por induzir reduções da FRS, apresenta excelentes possibilidades de utilização dependendo do objetivo do treinamento e do momento da temporada competitiva, sendo necessário considerar o nível de imersão, a condição musculoesquelética e as características antropométricas dos indivíduos.Coordenação de Aperfeiçoamento de Pessoal de Nível Superio

A Bio-Guided Fractionation to Assess the Inhibitory Activity of Calendula officinalis L. on the NF-B Driven Transcription in Human Gastric Epithelial Cells

Calendula officinalis L. has been largely known for its topical anti-inflammatory properties; however, there are no experimental evidences about its antiphlogistic effect at the gastric level. To investigate whether marigold might exert an activity against gastric inflammation, a CH 2 Cl 2 extract obtained from C. officinalis flowers was evaluated in vitro on the NF-B pathway. The lipophilic extract demonstrated a significant inhibitory effect on the NF-B driven transcription. The identification of active compounds was conducted by a bio-guided fractionation of the extract that afforded 16 fractions. Fraction J exhibited a concentration-dependent inhibitory activity on the NF-B driven transcription and significantly contributed to the antiphlogistic effect showed by CH 2 Cl 2 extract. The main components of fraction J were loliolide and the fucoside acetates of -eudesmol and viridiflorol. HPLC analysis of fractions D and E led to the identification and isolation of triterpene esters that showed a concentration-dependent inhibition of the NF-B driven transcription, with faradiol-3-myristate and the corresponding aglycone being the most active compounds. The present study provides some experimental evidences that Calendula officinalis L. may exert an anti-inflammatory activity on the gastric district by the inhibition of the NF-B system, identifying the compounds responsible, at least in part, for the observed effect

Antibodies against human cytomegalovirus late protein UL94 in the pathogenesis of scleroderma-like skin lesions in chronic graft-versus-host disease

Human cytomegalovirus (hCMV) infection and its reactivation correlate both with the increased risk and with the worsening of graft-versus-host disease (GVHD). Because scleroderma-like skin lesions can occur in chronic GVHD (cGVHD) in allogeneic stem-cell transplant (HCT) patients and hCMV is relevant in the pathogenesis of systemic sclerosis (SSc), we evaluated the possible pathogenetic link between hCMV and skin cGVHD. Plasma from 18 HCT patients was tested for anti-UL94 and/or anti-NAG-2 antibodies, identified in SSc patients, by direct ELISA assays. Both donors and recipients were anti-hCMV IgG positive, without autoimmune diseases. Patients\u2019 purified anti-UL94 and anti- NAG-2 IgG binding to human umbilical endothelial cells (HUVECs) and fibroblasts was performed by FACS analysis and ELISA test. HUVECs apoptosis and fibroblasts proliferation induced by patients\u2019 anti-NAG-2 antibodies were measured by DNA fragmentation and cell viability, respectively. About 11/18 patients developed cGVHD and all of them showed skin involvement, ranging from diffuse SSc-like lesions to limited erythema. Eight of eleven cGVHD patients were positive for anti-UL94 and/or anti-NAG-2 antibodies. Remarkably, 4/5 patients who developed diffuse or limited SSc-like lesions had antibodies directed against both UL94 and NAG-2; their anti-NAG-2 IgG-bound HUVECs and fibroblasts induce both endothelial cell apoptosis and fibroblasts proliferation, similar to that induced by purified anti-UL94 and anti-NAG-2 antibodies obtained from SSc patients. In conclusion, our data suggest a pathogenetic link between hCMV infection and scleroderma-like skin cGVHD in HCT patients through a mechanism of molecular mimicry between UL94 viral protein and NAG-2 molecule, as observed in patients with SSc