Frailty is an important and complex phenomenon in the fields of geriatrics and gerontology and a highly relevant topic. Frailty syndrome (FS) is a multidimensional clinical condition characterized by loss of physiolog...Frailty is an important and complex phenomenon in the fields of geriatrics and gerontology and a highly relevant topic. Frailty syndrome (FS) is a multidimensional clinical condition characterized by loss of physiological and cognitive reserves across multiple organ systems. The Fried frailty phenotype is the main model used to categorize FS. Recent studies have shown an association between anemia, low hemoglobin concentration and frailty. This study aimed to assess the association between FS and anemia in community-dwelling elderly. An observational cross-sectional design was used, with 308 elderly subjects. Most participants were women (78.2%) between 60 and 69 years old (50.6%). The average schooling level was 9.7 years. Anemia was detected in 9.7% of participants. The frequency of frailty, pre-frailty and non-frailty was 8.2, 74.0 and 17.8%, respectively. The multivariate ordinal logistic regression model identified low levels of brain-derived neurotrophic factor (BDNF) (OR = 0.9, 95% CI = 0.9;0.9) as risk factor associated with FS. No significant association was found between frailty and anemia. Moreover, FS may be influenced by low schooling levels, despite the non-significant result obtained in the statistical model. These findings contribute to elucidating other factors associated with FS, especially in community-dwelling elderly.展开更多
BACKGROUND Systemic autoimmune rheumatic diseases(SARDs)are a group of diseases with multiorgan involvement and a high prevalence of chronic pain and fatigue.Patients with SARDs and post-coronavirus disease 2019(COVID...BACKGROUND Systemic autoimmune rheumatic diseases(SARDs)are a group of diseases with multiorgan involvement and a high prevalence of chronic pain and fatigue.Patients with SARDs and post-coronavirus disease 2019(COVID-19)syndrome experience aggravation of symptoms.In this context,it is essential to establish strategies to reduce chronic pain and fatigue and improve quality of life.AIM To assess the efficacy of transcranial direct current stimulation(tDCS)for the treatment of fatigue and pain-associated post-COVID-19 syndrome in patients with SARDs.METHODS This study included nine patients with different types of SARDs.All patients had reverse transcription-polymerase chain reaction(RT-PCR)test confirmed COVID-19 as well as significant,persistent fatigue and pain that began to worsen after infection.Anodal tDCS was administered in five daily sessions(2mA,20 min).Concomitantly,patients were involved in aerobic exercise program.All participants were evaluated using specific questionnaires and strength assessment by handgrip and physical function by timed-up-and-go test and sit-to-stand test at baseline(within one week before tDCS protocol),and one week after tDCS protocol.During all procedures,the patients’treatments remained unchanged.RESULTS The sample comprised eight women and one man with a mean age of 48.7±9.6 years.After the tDCS protocol,pain and fatigue significantly improved on the visual analog scale(P<0.05).The physical function also improved 9.5±2.7 vs 6.8±0.8(P=0.001)for timed-up-go-test and 10.3±3.7 vs 15.1±4.0(P=0.037)for sit-to-stand test.None of the patients experienced any adverse events.CONCLUSION The present study showed that tDCS in combination with aerobic exercise was effective in improving physical function,and reducing fatigue/pain in SARDs patients with post-COVID-19 syndrome.展开更多
Macro and microvascular disease are the main cause of morbi-mortality in type 1 diabetes(T1DM).Although there is a clear association between endothelial dysfunction and atherosclerosis in type 2 diabetes,a cause-effec...Macro and microvascular disease are the main cause of morbi-mortality in type 1 diabetes(T1DM).Although there is a clear association between endothelial dysfunction and atherosclerosis in type 2 diabetes,a cause-effect relationship is less clear in T1 DM.Although endothelial dysfunction(ED) precedes atherosclerosis,it is not clear weather,in recent onset T1 DM,it may progress to clinical macrovascular disease.Moreover,endothelial dysfunction may either be reversed spontaneously or in response to intensive glycemic control,long-term exercise training and use of statins.Acute,long-term and post-prandial hyperglycemia as well as duration of diabetes and microalbuminuria are all conditions associated with ED in T1 DM.The pathogenesis of endothelial dysfunction is closely related to oxidative-stress.NAD(P)H oxidase over activity induces excessive superoxide production inside the mitochondrial oxidative chain of endothelial cells,thus reducing nitric oxide bioavailability and resulting in peroxynitrite formation,a potent oxidant agent.Moreover,oxidative stress also uncouples endothelial nitric oxide synthase,which becomes dysfunctional,inducing formation of superoxide.Other important mechanisms are the activation of both the polyol and protein kinase C pathways as well as the presence of advanced glycation end-products.Future studies are needed to evaluate the potential clinical applicability of endothelial dysfunction as a marker for early vascular complications in T1 DM.展开更多
Organs whose source is the mesoderm lineage contain a subpopulation of stem cells that are able to differentiate among mesodermal derivatives (chondrocytes, osteocytes, adipocytes). This subpopulation of adult stem ce...Organs whose source is the mesoderm lineage contain a subpopulation of stem cells that are able to differentiate among mesodermal derivatives (chondrocytes, osteocytes, adipocytes). This subpopulation of adult stem cells, called “mesenchymal stem cells” or “mesenchymal stromal cells (MSCs)”, contributes directly to the homeostatic maintenance of their organs;hence, their senescence could be very deleterious for human bodily functions. MSCs are easily isolated and amenable their expansion in vitro because of the research demanding to test them in many diverse clinical indications. All of these works are shown by the rapidly expanding literature that includes many in vivo animal models. We do not have an in-depth understanding of mechanisms that induce cellular senescence, and to further clarify the consequences of the senescence process in MSCs, some hints may be derived from the study of cellular behaviour in vivo and in vitro, autophagy, mitochondrial stress and exosomal activity. In this particular work, we decided to review these biological features in the literature on MSC senescence over the last three years.展开更多
Introduction: Mental exercise using the mirror therapy (MT) improves the retention of newly acquired skills and the performance of sequential motor skills in subjects with post-stroke hemiparesis. Objectives: The stud...Introduction: Mental exercise using the mirror therapy (MT) improves the retention of newly acquired skills and the performance of sequential motor skills in subjects with post-stroke hemiparesis. Objectives: The study aimed to analyze the mirror therapy effect on the range of motion and the lower limb functionality in post-stroke hemiparesis subjects. Materials and Methods: Eleven participants with hemiparesis in the lower limb were subjected to the 10 sessions of a MT protocol. The interventions were three times per week per 30 minutes each day. Evaluation of active and passive ankle goniometry (dorsiflexion and eversion movements);Ascent and Descent Ladder Rate (ADLR);Time Up and Go test (TUG test);EFEI scale;and FAAM scale were performed. The data were collected before and after the intervention using MT, and then statistically compared. Results: The MT improved significantly (p < 0.01) the range of motion of the paretic lower limb both evaluated by active and passive ankle goniometry. An increase in the speed of gait and other functional tasks related to the paretic lower limbs were found through the TUG and ADLR tests. It also demonstrated a positive influence on the functionality of the paretic lower limb motor control through the analysis of the scores in the FAAM and EFEI scales. Conclusion: It is concluded that the MT therapy can help the patients with post-stroke hemiparesis in the improvement of several functions. Probably, the mirror therapy would aid in the repair of the injuries in the cortical areas.展开更多
BACKGROUND The prevalence of chronic obstructive pulmonary disease(COPD)is increasing worldwide,and at the same time it is associated with increased mortality and reduced quality of life.Efforts to build sustainable r...BACKGROUND The prevalence of chronic obstructive pulmonary disease(COPD)is increasing worldwide,and at the same time it is associated with increased mortality and reduced quality of life.Efforts to build sustainable rehabilitation approaches to COPD treatment and prevention are crucial.The system of long-term pulmonary rehabilitation care is insufficient.The main reasons for the absence of these outpatient programs are the lack of experience,the lack of interest of insurance companies in secondary prevention programs,and the lack of healthcare facilities in large geographical areas.The possibility of at-home pulmonary rehabilitation models(telemonitoring and telecoaching)could solve this problem.CASE SUMMARY A 71-year-old man with severe COPD,Global Initiative for Obstructive Lung Diseases stage 3 underwent an 8-wk remotely monitored inspiratory muscle training with a device based on the test of incremental respiratory endurance method.Spirometry,body plethysmography,test of incremental respiratory endurance examination,6-min walking test,body mass index,airflow obstruction,dyspnea,exercise capacity index,and subjective perception of dyspnea were performed as part of the initial and final examination.The patient performed training at home,and the physiotherapist monitored the patient remotely through a web application that allowed the physiotherapist to evaluate all training parameters in real-time and respond to any problems.After 8 wk of home training,there was a significant increase in all monitored values:maximal inspiratory pressure,a novel parameter sustained maximal inspiratory pressure,forced expiratory volume in 1 s,total lung capacity,forced vital capacity,peak expiratory flow,and inspiratory capacity.There was also an improvement in the perception of dyspnea according to the COPD Assessment Test and a modified Medical Research Council Breathlessness Scale,an increase in exercise tolerance according to the 6-min walking test,and a decrease in the exercise capacity index as a predictor of prognosis.CONCLUSION Respiratory telerehabilitation was greatly beneficial in a cooperative patient with COPD and may represent an alternative therapeutic approach to the increasing incidence of all lung diseases.展开更多
This paper presents an overview of the state of the art about the late effects of ionizing radiation on skeletal muscle, helping new research and showing unexplored areas. For this, it was evaluated the interest repor...This paper presents an overview of the state of the art about the late effects of ionizing radiation on skeletal muscle, helping new research and showing unexplored areas. For this, it was evaluated the interest reported by the scientific literature regarding the late effects in skeletal muscle resulting from exposure to ionizing radiation. Original and experimental papers mainly containing the key expressions “ionizing radiation” and “effects on skeletal muscle” were searched in computerized databases, and published in any language. Only 33 papers matched the search criteria. Analyzing the investigated radioinduced biological effects in those contributions, four topics were identified as being of major interest: 1) alterations in cellular metabolism and protein degradation;2) repercussions on satellite cells;3) formation of fibrosis and muscle atrophy;4) tissue regeneration. It was verified that no study evaluated possible late effects related to either morphology or properties of skeletal muscles after an exposure to ionizing radiation. Several aspects do not make possible a successful replication;all experiments of eligible group of articles are discussed, such as, lack of raw data, use of no sound methodology and inappropriate statistical technique. Briefly, the subject of this review is an open field of research.展开更多
Objective: The purpose of this study was to investigate the presence of postural imbalances, which can interfere with the mandible position and affect the actions of the stomatognathic system. Materials and Methods: F...Objective: The purpose of this study was to investigate the presence of postural imbalances, which can interfere with the mandible position and affect the actions of the stomatognathic system. Materials and Methods: Forty men, aged between 23 to 29 years, were selected and divided into two groups: Group I comprised 20 healthy individuals with no clinical postural change diagnosis;Group II, 20 individuals who had ACL surgical, unilateral with patellar tendon graft, paired individual to individual (age and weight). All of them were submitted to an electromyography in different clinical conditions. In addition, a condylar biomechanical assessment was performed through videogrametry. Results: In electromyography and videogrametry, a normal standard biomechanical was observed for both groups, however, Group GII—Ligamentplasty presented an inhibition of the masticatory muscles and decreased joint kinesthetic. Conclusion: Based on the results obtained, it was concluded that after the reconstruction of the ACL, individuals presented changes in the stomatog-nathic system.展开更多
文摘Frailty is an important and complex phenomenon in the fields of geriatrics and gerontology and a highly relevant topic. Frailty syndrome (FS) is a multidimensional clinical condition characterized by loss of physiological and cognitive reserves across multiple organ systems. The Fried frailty phenotype is the main model used to categorize FS. Recent studies have shown an association between anemia, low hemoglobin concentration and frailty. This study aimed to assess the association between FS and anemia in community-dwelling elderly. An observational cross-sectional design was used, with 308 elderly subjects. Most participants were women (78.2%) between 60 and 69 years old (50.6%). The average schooling level was 9.7 years. Anemia was detected in 9.7% of participants. The frequency of frailty, pre-frailty and non-frailty was 8.2, 74.0 and 17.8%, respectively. The multivariate ordinal logistic regression model identified low levels of brain-derived neurotrophic factor (BDNF) (OR = 0.9, 95% CI = 0.9;0.9) as risk factor associated with FS. No significant association was found between frailty and anemia. Moreover, FS may be influenced by low schooling levels, despite the non-significant result obtained in the statistical model. These findings contribute to elucidating other factors associated with FS, especially in community-dwelling elderly.
基金Supported by Fundação de AmparoàPesquisa do Estado de São Paulo(FAPESP)#2020/10691-4 to AMS,#2019/11776-6 to SKS,#2019/12155-5 to RGM,#2019/11367-9 to IBPBConselho Nacional de Desenvolvimento Científico e Tecnológico(CNPq)#303379/2018-9 to SKSFaculdade de Medicina da USP to SKS.
文摘BACKGROUND Systemic autoimmune rheumatic diseases(SARDs)are a group of diseases with multiorgan involvement and a high prevalence of chronic pain and fatigue.Patients with SARDs and post-coronavirus disease 2019(COVID-19)syndrome experience aggravation of symptoms.In this context,it is essential to establish strategies to reduce chronic pain and fatigue and improve quality of life.AIM To assess the efficacy of transcranial direct current stimulation(tDCS)for the treatment of fatigue and pain-associated post-COVID-19 syndrome in patients with SARDs.METHODS This study included nine patients with different types of SARDs.All patients had reverse transcription-polymerase chain reaction(RT-PCR)test confirmed COVID-19 as well as significant,persistent fatigue and pain that began to worsen after infection.Anodal tDCS was administered in five daily sessions(2mA,20 min).Concomitantly,patients were involved in aerobic exercise program.All participants were evaluated using specific questionnaires and strength assessment by handgrip and physical function by timed-up-and-go test and sit-to-stand test at baseline(within one week before tDCS protocol),and one week after tDCS protocol.During all procedures,the patients’treatments remained unchanged.RESULTS The sample comprised eight women and one man with a mean age of 48.7±9.6 years.After the tDCS protocol,pain and fatigue significantly improved on the visual analog scale(P<0.05).The physical function also improved 9.5±2.7 vs 6.8±0.8(P=0.001)for timed-up-go-test and 10.3±3.7 vs 15.1±4.0(P=0.037)for sit-to-stand test.None of the patients experienced any adverse events.CONCLUSION The present study showed that tDCS in combination with aerobic exercise was effective in improving physical function,and reducing fatigue/pain in SARDs patients with post-COVID-19 syndrome.
文摘Macro and microvascular disease are the main cause of morbi-mortality in type 1 diabetes(T1DM).Although there is a clear association between endothelial dysfunction and atherosclerosis in type 2 diabetes,a cause-effect relationship is less clear in T1 DM.Although endothelial dysfunction(ED) precedes atherosclerosis,it is not clear weather,in recent onset T1 DM,it may progress to clinical macrovascular disease.Moreover,endothelial dysfunction may either be reversed spontaneously or in response to intensive glycemic control,long-term exercise training and use of statins.Acute,long-term and post-prandial hyperglycemia as well as duration of diabetes and microalbuminuria are all conditions associated with ED in T1 DM.The pathogenesis of endothelial dysfunction is closely related to oxidative-stress.NAD(P)H oxidase over activity induces excessive superoxide production inside the mitochondrial oxidative chain of endothelial cells,thus reducing nitric oxide bioavailability and resulting in peroxynitrite formation,a potent oxidant agent.Moreover,oxidative stress also uncouples endothelial nitric oxide synthase,which becomes dysfunctional,inducing formation of superoxide.Other important mechanisms are the activation of both the polyol and protein kinase C pathways as well as the presence of advanced glycation end-products.Future studies are needed to evaluate the potential clinical applicability of endothelial dysfunction as a marker for early vascular complications in T1 DM.
基金Consellería de Cultura,Educación e Ordenación Universitaria,Xunta de Galicia(Spain)Fafián-Labora JA is recipient of a postdoctoral fellowship(ED481B 2017/117)
文摘Organs whose source is the mesoderm lineage contain a subpopulation of stem cells that are able to differentiate among mesodermal derivatives (chondrocytes, osteocytes, adipocytes). This subpopulation of adult stem cells, called “mesenchymal stem cells” or “mesenchymal stromal cells (MSCs)”, contributes directly to the homeostatic maintenance of their organs;hence, their senescence could be very deleterious for human bodily functions. MSCs are easily isolated and amenable their expansion in vitro because of the research demanding to test them in many diverse clinical indications. All of these works are shown by the rapidly expanding literature that includes many in vivo animal models. We do not have an in-depth understanding of mechanisms that induce cellular senescence, and to further clarify the consequences of the senescence process in MSCs, some hints may be derived from the study of cellular behaviour in vivo and in vitro, autophagy, mitochondrial stress and exosomal activity. In this particular work, we decided to review these biological features in the literature on MSC senescence over the last three years.
文摘Introduction: Mental exercise using the mirror therapy (MT) improves the retention of newly acquired skills and the performance of sequential motor skills in subjects with post-stroke hemiparesis. Objectives: The study aimed to analyze the mirror therapy effect on the range of motion and the lower limb functionality in post-stroke hemiparesis subjects. Materials and Methods: Eleven participants with hemiparesis in the lower limb were subjected to the 10 sessions of a MT protocol. The interventions were three times per week per 30 minutes each day. Evaluation of active and passive ankle goniometry (dorsiflexion and eversion movements);Ascent and Descent Ladder Rate (ADLR);Time Up and Go test (TUG test);EFEI scale;and FAAM scale were performed. The data were collected before and after the intervention using MT, and then statistically compared. Results: The MT improved significantly (p < 0.01) the range of motion of the paretic lower limb both evaluated by active and passive ankle goniometry. An increase in the speed of gait and other functional tasks related to the paretic lower limbs were found through the TUG and ADLR tests. It also demonstrated a positive influence on the functionality of the paretic lower limb motor control through the analysis of the scores in the FAAM and EFEI scales. Conclusion: It is concluded that the MT therapy can help the patients with post-stroke hemiparesis in the improvement of several functions. Probably, the mirror therapy would aid in the repair of the injuries in the cortical areas.
基金Ministry of Health of the Czech Republic(University Hospital Brno,65269705),No.NU21J-09-00004.
文摘BACKGROUND The prevalence of chronic obstructive pulmonary disease(COPD)is increasing worldwide,and at the same time it is associated with increased mortality and reduced quality of life.Efforts to build sustainable rehabilitation approaches to COPD treatment and prevention are crucial.The system of long-term pulmonary rehabilitation care is insufficient.The main reasons for the absence of these outpatient programs are the lack of experience,the lack of interest of insurance companies in secondary prevention programs,and the lack of healthcare facilities in large geographical areas.The possibility of at-home pulmonary rehabilitation models(telemonitoring and telecoaching)could solve this problem.CASE SUMMARY A 71-year-old man with severe COPD,Global Initiative for Obstructive Lung Diseases stage 3 underwent an 8-wk remotely monitored inspiratory muscle training with a device based on the test of incremental respiratory endurance method.Spirometry,body plethysmography,test of incremental respiratory endurance examination,6-min walking test,body mass index,airflow obstruction,dyspnea,exercise capacity index,and subjective perception of dyspnea were performed as part of the initial and final examination.The patient performed training at home,and the physiotherapist monitored the patient remotely through a web application that allowed the physiotherapist to evaluate all training parameters in real-time and respond to any problems.After 8 wk of home training,there was a significant increase in all monitored values:maximal inspiratory pressure,a novel parameter sustained maximal inspiratory pressure,forced expiratory volume in 1 s,total lung capacity,forced vital capacity,peak expiratory flow,and inspiratory capacity.There was also an improvement in the perception of dyspnea according to the COPD Assessment Test and a modified Medical Research Council Breathlessness Scale,an increase in exercise tolerance according to the 6-min walking test,and a decrease in the exercise capacity index as a predictor of prognosis.CONCLUSION Respiratory telerehabilitation was greatly beneficial in a cooperative patient with COPD and may represent an alternative therapeutic approach to the increasing incidence of all lung diseases.
文摘This paper presents an overview of the state of the art about the late effects of ionizing radiation on skeletal muscle, helping new research and showing unexplored areas. For this, it was evaluated the interest reported by the scientific literature regarding the late effects in skeletal muscle resulting from exposure to ionizing radiation. Original and experimental papers mainly containing the key expressions “ionizing radiation” and “effects on skeletal muscle” were searched in computerized databases, and published in any language. Only 33 papers matched the search criteria. Analyzing the investigated radioinduced biological effects in those contributions, four topics were identified as being of major interest: 1) alterations in cellular metabolism and protein degradation;2) repercussions on satellite cells;3) formation of fibrosis and muscle atrophy;4) tissue regeneration. It was verified that no study evaluated possible late effects related to either morphology or properties of skeletal muscles after an exposure to ionizing radiation. Several aspects do not make possible a successful replication;all experiments of eligible group of articles are discussed, such as, lack of raw data, use of no sound methodology and inappropriate statistical technique. Briefly, the subject of this review is an open field of research.
基金The authors wish to thank Fundacao de Amparo a Pesquisa do Estado de Sao Paulo-FAPESP(2010/07513-5)for financially supporting this research.
文摘Objective: The purpose of this study was to investigate the presence of postural imbalances, which can interfere with the mandible position and affect the actions of the stomatognathic system. Materials and Methods: Forty men, aged between 23 to 29 years, were selected and divided into two groups: Group I comprised 20 healthy individuals with no clinical postural change diagnosis;Group II, 20 individuals who had ACL surgical, unilateral with patellar tendon graft, paired individual to individual (age and weight). All of them were submitted to an electromyography in different clinical conditions. In addition, a condylar biomechanical assessment was performed through videogrametry. Results: In electromyography and videogrametry, a normal standard biomechanical was observed for both groups, however, Group GII—Ligamentplasty presented an inhibition of the masticatory muscles and decreased joint kinesthetic. Conclusion: Based on the results obtained, it was concluded that after the reconstruction of the ACL, individuals presented changes in the stomatog-nathic system.
