EFEITO AGUDO DA CORRIDA COM OS PÉS DESCALÇO SOBRE AS COMPONENTES ANTEROPOSTERIOR E MEDIOLATERAL DA FORÇA DE REAÇÃO DO SOLO

This study investigated the short-term effects of barefoot running on selected parameters of the anteroposterior and mediolateral components of the Ground Reaction Force (GRF) in runners used to wearing athletic shoes. Seventy-one recreational runners, inexperienced in barefoot running, ran at a self-selected speed for a distance of 9 meters on a fixed floor equipped with force platforms, under two conditions: shod and barefoot. The braking and acceleration peaks of the anteroposterior component, as well as the minimum and maximum peaks of the mediolateral component were obtained. The braking peak was lower, while the acceleration peak was higher in barefoot running. In contrast, the magnitude of both the minimum and maximum peaks were greater in the barefoot condition. In summary, barefoot running acutely alters selected parameters of the anteroposterior and mediolateral components of the FRS related to the overload and performance of runners used to wearing sports shoes.Este estudio investigó el efecto agudo de correr descalzo en parámetros seleccionados de los componentes anteroposterior y mediolateral de la fuerza de reacción del suelo (FRS) en corredores acostumbrados a usar calzado deportivo. Setenta y un corredores recreativos, sin experiencia en correr descalzo, corrieron a una velocidad autoseleccionada por una distancia de 30 pies en un piso fijo equipado con plataformas de fuerza, bajo dos condiciones: zapatos y descalzo. Se obtuvieron los picos de frenado y aceleración de la componente anteroposterior, así como los picos mínimos y máximos de la componente mediolateral. El pico de frenado fue menor, mientras que el pico de aceleración fue mayor al correr descalzo. Por el contrario, la magnitud de los picos tanto mínimo como máximo fue mayor en la condición de descalzo. En resumen, correr descalzo altera de forma aguda parámetros seleccionados de los componentes anteroposterior y mediolateral del FRS relacionados con la sobrecarga y el rendimiento de los corredores acostumbrados a llevar calzado deportivo.Este estudo investigou o efeito agudo da corrida descalço sobre parâmetros selecionados das componentes anteroposterior e mediolateral da Força de Reação do Solo (FRS) em corredores habituados ao uso do calçado esportivo. Setenta e um corredores recreacionais, inexperientes em corrida descalço, correram em velocidade auto-selecionada por uma distância de 9 metros em piso fixo equipado com plataformas de força, sob duas condições: calçados e descalços. Os picos de frenagem e aceleração da componente anteroposterior, bem como os picos mínimo e máximo da componente mediolateral foram obtidos. O pico de frenagem foi menor, enquanto o pico de aceleração foi maior na corrida descalço. Em contrapartida, a magnitude de ambos os picos mínimo e máximo foram maiores na condição descalço. Em síntese, a corrida descalço altera agudamente parâmetros selecionados das componentes anteroposterior e mediolateral da FRS relacionados à sobrecarga e ao desempenho de corredores habituados ao uso do calçado esportivo

COMPARAÇÃO BIOMECÂNICA DA CORRIDA ENTRE INDIVÍDUOS COM DIFERENTES NÍVEIS DE FORÇA DE MEMBROS INFERIORES

Running is a practice widely used by those who aim to maintain or improve their physical fitness. Strength training has been recommended to increase performance and reduce injury risk in runners, however, the relationship between muscle strength and running mechanics still requires a better understanding. The aim of the present study was to compare the running biomechanics among bodybuilders, with different levels of absolute strength in the back squat. Initially, 24 volunteers participated in the study. Based on the 10RM absolute strength in the back squat, the volunteers were divided into tertiles: upper strength group (GFS), lower strength group (GFI) and medium strength group. For comparison of running mechanics, GFS and GFI were gained. Dynamic and kinematic parameters were collected during treadmill running. There were no differences between groups for any of the investigated variables. Keywords: Running mechanics; Muscle strength; Locomotion.Correr es una práctica muy utilizada por quienes tienen como objetivo mantener o mejorar su forma física. El entrenamiento de fuerza se ha recomendado como una forma de aumentar el rendimiento y reducir el riesgo de lesiones en los corredores, sin embargo, la relación entre la fuerza muscular y la mecánica de carrera aún requiere una mejor comprensión. El objetivo del presente estudio fue comparar la biomecánica de la carrera entre culturistas, con diferentes niveles de fuerza absoluta en la sentadilla. Inicialmente, participaron en el estudio 24 voluntarios. Con base en la fuerza absoluta de 10RM en la sentadilla, los voluntarios se dividieron en terciles: grupo de fuerza superior (GFS), grupo de fuerza inferior (GFI) y grupo de fuerza media. Para comparar la mecánica de la carrera, se obtuvieron GFS y GFI. Los parámetros dinámicos y cinemáticos se recopilaron durante la carrera en cinta. No hubo diferencias entre los grupos para ninguna de las variables investigadas. Palabras clave: mecánica de carrera; Fuerza muscular; Locomoción.A corrida é uma prática largamente utilizada por aqueles que almejam manter ou aprimorar a aptidão física. O treinamento de força tem sido recomendado como forma de aumentar o desempenho e reduzir o risco de lesão em praticantes de corrida, no entanto, a relação entre força muscular e mecânica da corrida ainda necessita de melhor compreensão. O objetivo do presente estudo foi comparar a biomecânica da corrida entre indivíduos praticantes de musculação, com diferentes níveis de força absoluta no agachamento. Inicialmente participaram do estudo 24 voluntários. Baseado na força absoluta em 10RM no agachamento, os voluntários foram divididos em tercis: grupo de força superior (GFS), grupo de força inferior (GFI) e grupo de força mediana. Para comparação da mecânica da corrida foram analisados o GFS e GFI. Foram coletados parâmetros dinâmicos e cinemáticos durante corrida em esteira. Não se observou diferenças entre os grupos para nenhuma das variáveis investigadas. Palavras-chave: Mecânica da corrida; Força muscular; Locomoção

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.

Effects of alirocumab on types of myocardial infarction: insights from the ODYSSEY OUTCOMES trial

Aims  The third Universal Definition of Myocardial Infarction (MI) Task Force classified MIs into five types: Type 1, spontaneous; Type 2, related to oxygen supply/demand imbalance; Type 3, fatal without ascertainment of cardiac biomarkers; Type 4, related to percutaneous coronary intervention; and Type 5, related to coronary artery bypass surgery. Low-density lipoprotein cholesterol (LDL-C) reduction with statins and proprotein convertase subtilisin–kexin Type 9 (PCSK9) inhibitors reduces risk of MI, but less is known about effects on types of MI. ODYSSEY OUTCOMES compared the PCSK9 inhibitor alirocumab with placebo in 18 924 patients with recent acute coronary syndrome (ACS) and elevated LDL-C (≥1.8 mmol/L) despite intensive statin therapy. In a pre-specified analysis, we assessed the effects of alirocumab on types of MI. Methods and results  Median follow-up was 2.8 years. Myocardial infarction types were prospectively adjudicated and classified. Of 1860 total MIs, 1223 (65.8%) were adjudicated as Type 1, 386 (20.8%) as Type 2, and 244 (13.1%) as Type 4. Few events were Type 3 (n = 2) or Type 5 (n = 5). Alirocumab reduced first MIs [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.77–0.95; P = 0.003], with reductions in both Type 1 (HR 0.87, 95% CI 0.77–0.99; P = 0.032) and Type 2 (0.77, 0.61–0.97; P = 0.025), but not Type 4 MI. Conclusion  After ACS, alirocumab added to intensive statin therapy favourably impacted on Type 1 and 2 MIs. The data indicate for the first time that a lipid-lowering therapy can attenuate the risk of Type 2 MI. Low-density lipoprotein cholesterol reduction below levels achievable with statins is an effective preventive strategy for both MI types.For complete list of authors see http://dx.doi.org/10.1093/eurheartj/ehz299</p

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation.

OBJECTIVES: To provide an accurate, web-based tool for stratifying patients with atrial fibrillation to facilitate decisions on the potential benefits/risks of anticoagulation, based on mortality, stroke and bleeding risks. DESIGN: The new tool was developed, using stepwise regression, for all and then applied to lower risk patients. C-statistics were compared with CHA2DS2-VASc using 30-fold cross-validation to control for overfitting. External validation was undertaken in an independent dataset, Outcome Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). PARTICIPANTS: Data from 39 898 patients enrolled in the prospective GARFIELD-AF registry provided the basis for deriving and validating an integrated risk tool to predict stroke risk, mortality and bleeding risk. RESULTS: The discriminatory value of the GARFIELD-AF risk model was superior to CHA2DS2-VASc for patients with or without anticoagulation. C-statistics (95% CI) for all-cause mortality, ischaemic stroke/systemic embolism and haemorrhagic stroke/major bleeding (treated patients) were: 0.77 (0.76 to 0.78), 0.69 (0.67 to 0.71) and 0.66 (0.62 to 0.69), respectively, for the GARFIELD-AF risk models, and 0.66 (0.64-0.67), 0.64 (0.61-0.66) and 0.64 (0.61-0.68), respectively, for CHA2DS2-VASc (or HAS-BLED for bleeding). In very low to low risk patients (CHA2DS2-VASc 0 or 1 (men) and 1 or 2 (women)), the CHA2DS2-VASc and HAS-BLED (for bleeding) scores offered weak discriminatory value for mortality, stroke/systemic embolism and major bleeding. C-statistics for the GARFIELD-AF risk tool were 0.69 (0.64 to 0.75), 0.65 (0.56 to 0.73) and 0.60 (0.47 to 0.73) for each end point, respectively, versus 0.50 (0.45 to 0.55), 0.59 (0.50 to 0.67) and 0.55 (0.53 to 0.56) for CHA2DS2-VASc (or HAS-BLED for bleeding). Upon validation in the ORBIT-AF population, C-statistics showed that the GARFIELD-AF risk tool was effective for predicting 1-year all-cause mortality using the full and simplified model for all-cause mortality: C-statistics 0.75 (0.73 to 0.77) and 0.75 (0.73 to 0.77), respectively, and for predicting for any stroke or systemic embolism over 1 year, C-statistics 0.68 (0.62 to 0.74). CONCLUSIONS: Performance of the GARFIELD-AF risk tool was superior to CHA2DS2-VASc in predicting stroke and mortality and superior to HAS-BLED for bleeding, overall and in lower risk patients. The GARFIELD-AF tool has the potential for incorporation in routine electronic systems, and for the first time, permits simultaneous evaluation of ischaemic stroke, mortality and bleeding risks. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF (NCT01090362) and for ORBIT-AF (NCT01165710)

Iron Behaving Badly: Inappropriate Iron Chelation as a Major Contributor to the Aetiology of Vascular and Other Progressive Inflammatory and Degenerative Diseases

The production of peroxide and superoxide is an inevitable consequence of aerobic metabolism, and while these particular "reactive oxygen species" (ROSs) can exhibit a number of biological effects, they are not of themselves excessively reactive and thus they are not especially damaging at physiological concentrations. However, their reactions with poorly liganded iron species can lead to the catalytic production of the very reactive and dangerous hydroxyl radical, which is exceptionally damaging, and a major cause of chronic inflammation. We review the considerable and wide-ranging evidence for the involvement of this combination of (su)peroxide and poorly liganded iron in a large number of physiological and indeed pathological processes and inflammatory disorders, especially those involving the progressive degradation of cellular and organismal performance. These diseases share a great many similarities and thus might be considered to have a common cause (i.e. iron-catalysed free radical and especially hydroxyl radical generation). The studies reviewed include those focused on a series of cardiovascular, metabolic and neurological diseases, where iron can be found at the sites of plaques and lesions, as well as studies showing the significance of iron to aging and longevity. The effective chelation of iron by natural or synthetic ligands is thus of major physiological (and potentially therapeutic) importance. As systems properties, we need to recognise that physiological observables have multiple molecular causes, and studying them in isolation leads to inconsistent patterns of apparent causality when it is the simultaneous combination of multiple factors that is responsible. This explains, for instance, the decidedly mixed effects of antioxidants that have been observed, etc...Comment: 159 pages, including 9 Figs and 2184 reference