Nasal polyposis : more than a chronic inflammatory disorder : a disease of mechanical dysfunction : the São Paulo position

Introduction The importance of our study lies in the fact that we have demonstrated the occurrence of mechanical dysfunction within polypoid tissues, which promotes the development of polyps in the nasal cavity. Objective To change the paradigm of nasal polyposis (NP). In this new conception, the chronic nasal inflammatory process that occurs in response to allergies, to pollution, to changes in the epithelial barrier, or to other factors is merely the trigger of the development of the disease in individuals with a genetic predisposition to an abnormal tissue remodeling process, which leads to a derangement of the mechanical properties of the nasal mucosa and, consequently, allows it to grow unchecked. Data Synthesis We propose a fundamentally new approach to intervening in the pathological process of NP, addressing biomechanical properties, fluid dynamics, and the concept of surface tension. Conclusion The incorporation of biomechanical knowledge into our understanding of NP provides a new perspective to help elucidate the physiology and the pathology of nasal polyps, and new avenues for the treatment and cure of NP

Long term mortality of deep sternal wound infection after coronary artery bypass surgery Mortalidade em longo prazo da infecção esternal profunda após cirurgia de revascularização do miocárdio

BACKGROUND: Deep sternal wound infection and mediastinitis determine high in-hospital mortality. International studies show that these patients are also at increased cardiovascular mortality risk in long-term follow-up. However, data are scarce and there is no national data. OBJECTIVES: The aim of this study is to evaluate the mortality and incidence of cardiovascular events in long-term follow-up of patients suffering from deep sternal wound infection and mediastinitis. METHODS: Case-control study, matched by propensity score in a 1:1 proportion, in patients submitted to coronary artery bypass grafting between 2005 and 2008 at the Institute Dante Pazzanese of Cardiology (São Paulo, SP, Brazil). The primary outcome was death. As a secondary outcome, we analyzed the composite event of myocardial infarction, new revascularization, stroke or death. RESULTS: Of 1975 patients, 114 developed one of the infections. During the mean follow up of 3.6 years, deep sternal wound infection and mediastinitis increased the risk of death by 8.26 (95% CI 1.88-36.29, P = 0.005) and the incidence of combined end point by 2.61 (95% CI 1.2-5.69, P = 0.015). The Kaplan-Meier curves for both outcomes demonstrated that the greatest risk occurs in the first six months, followed by a period of stabilization and further increase in the incidence of events after 4 years of hospital discharge. The similarity between the curves of primary and secondary outcomes may be consequent to the predominance of death on the combined cardiovascular events. CONCLUSION: The presence of deep sternal wound infection or mediastinitis increased mortality in long-term follow-up in this sample of the Brazilian population according to the same pattern displayed by the developed countries.<br>INTRODUÇÃO: A infecção esternal profunda e a mediastinite determinam elevada mortalidade intra-hospitalar. Estudos prévios demonstram que esses pacientes também apresentam maior mortalidade cardiovascular em longo prazo. No entanto, os dados são escassos para o Brasil. OBJETIVO: O objetivo deste estudo é avaliar a mortalidade e a incidência de eventos cardiovasculares em longo prazo em pacientes acometidos de infecção esternal profunda e mediastinite. MÉTODOS: Estudo de caso-controle com pareamento 1:1 por meio de propensity score, em pacientes submetidos à cirurgia de revascularização do miocárdio entre 2005 e 2008, no Instituto Dante Pazzanese de Cardiologia (São Paulo, SP, Brasil). O desfecho primário avaliado foi óbito. Como desfecho secundário, analisou-se o composto de infarto agudo do miocárdio, nova revascularização miocárdica, acidente vascular encefálico ou óbito. RESULTADOS: De 1975 pacientes avaliados, 114 desenvolveram infecção esternal profunda ou mediastinite. Durante o seguimento médio de 3,6 anos, as infecções conferiram razão de risco de óbito de 8,26 (IC 95% 1,88-36,29, P = 0,005), tendo sido a razão de risco de desfecho combinado de 2,61 (IC 95% 1,2-5,69, P = 0,015). A curva de Kaplan-Meier para ambos os desfechos demonstra que o maior risco ocorre nos primeiros 6 meses, seguindo-se um período de estabilização e novo aumento na incidência de eventos após 4 anos da alta hospitalar. A semelhança entre as curvas dos desfechos primário e secundário pode ser consequente à predominância do óbito sobre os demais eventos cardiovasculares. CONCLUSÃO: A presença de infecção esternal profunda ou de mediastinite aumentou a mortalidade em longo prazo nesta amostra da população brasileira, de acordo com o mesmo padrão exibido nos países desenvolvidos

Efeito agudo do alongamento estático sobre o desempenho na resistência de força em homens treinados: estudo piloto

O alongamento ativo-estático não é indicado previamente ao exercício de força por induzir ao um menor desempenho. No entanto, não se sabe se o mesmo ocorre no exercício de resistência de força (RF). Deste modo, o objetivo do estudo foi verificar o efeito agudo do alongamento ativo-estático sobre o desempenho na RF em homens treinados. Para tanto, a amostra foi composta por cinco homens (24,6±3,58 anos) fisicamente ativos e com experiência prévia em musculação (≥ seis meses) que foram submetidos ao teste de uma repetição máxima (1RM) no supino horizontal (SH) e cadeira extensora de joelhos (CE), e duas sessões experimentais: 1) sessão de exercício de RF com 50% de 1RM até a falha concêntrica no SH e, em seguida, na CE (intervalo de 10min) sem alongamento prévio; e 2) igualmente à primeira sessão, no entanto, com alongamento ativo-estático com amplitude máxima por 30s previamente ao exercício. A normalidade foi verificada pelo teste de Shapiro-Wilk e o teste de Wilcoxon foi aplicado para comparação entre as sessões. A sessão com alongamento prévio ao exercício promoveu menor (p<0,05) desempenho no SH. Não houve diferença (p=0,063) do desempenho entre as sessões na CE. Em conclusão, o alongamento ativo-estático realizado antes do exercício de RF provoca diminuição no desempenho durante o exercício de membros superiores, por outro lado, não modifica o desempenho no exercício de membros inferiores em homens treinados. ABSTRACTAcute effects of static stretching on strength endurance performance in trained men: pilot studyThe static active stretching is not recommended before strength exercise because it induces a poor performance. However, it is not clear if this form of stretching can also induce a poor performance in strength endurance (SE) exercises. Therefore, the main objective of this study was to investigate the acute effects of the static active stretching on SE performance in trained men. The sample was composed by five physically active men (24.6±3.58 years) with previous experience in strength training (≥ six months), who were submitted to one-repetition maximum test (1RM) on bench press (BP) and leg extension machine (LEM), and two experimental sessions: 1) session SE exercise on 50% of 1RM until concentric failure on the BP followed by the same amount in the LEM (10min of resting time) without previous stretching in both exercises; 2) second session following the same pattern of the first session; although, it was added a full range-of-motion 30-second static active stretching before the exercise. The normality was analyzed by the Shapiro-Wilk test, and the Wilcoxon test was applied to compare the sessions. The session with stretching before the exercise resulted in a poor (p<0.05) performance in BP. There was no difference (p=0.063) between the sessions in the LEM. In conclusion, the static active stretching before the SE exercise resulted in a decreased performance during the upper limbs exercise. On the other hand, it did not affect the lower limbs exercise performance in trained men

Nasal polyposis : more than a chronic inflammatory disorder-A disease of mechanical dysfunction : the Sao Paulo Position

Introduction The importance of our study lies in the fact that we have demonstrated the occurrence of mechanical dysfunction within polypoid tissues, which promotes the development of polyps in the nasal cavity. Objective To change the paradigm of nasal polyposis (NP). In this new conception, the chronic nasal inflammatory process that occurs in response to allergies, to pollution, to changes in the epithelial barrier, or to other factors is merely the trigger of the development of the disease in individuals with a genetic predisposition to an abnormal tissue remodeling process, which leads to a derangement of the mechanical properties of the nasal mucosa and, consequently, allows it to grow unchecked. Data Synthesis We propose a fundamentally new approach to intervening in the pathological process of NP, addressing biomechanical properties, fluid dynamics, and the concept of surface tension. Conclusion The incorporation of biomechanical knowledge into our understanding of NP provides a new perspective to help elucidate the physiology and the pathology of nasal polyps, and new avenues for the treatment and cure of NP