Search

Background: Plasma proteins are critical mediators of cardiovascular processes and are the targets of many drugs. Previous efforts to characterize the genetic architecture of the plasma proteome have been limited by a focus on individuals of European descent and leveraged genotyping arrays and imputation. Here we describe whole genome sequence analysis of the plasma proteome in individuals with greater African ancestry, increasing our power to identify novel genetic determinants. Methods: Proteomic profiling of 1301 proteins was performed in 1852 Black adults from the Jackson Heart Study using aptamer-based proteomics (SomaScan). Whole genome sequencing association analysis was ascertained for all variants with minor allele count ≥5. Results were validated using an alternative, antibody-based, proteomic platform (Olink) as well as replicated in the Multi-Ethnic Study of Atherosclerosis and the HERITAGE Family Study (Health, Risk Factors, Exercise Training and Genetics). Results: We identify 569 genetic associations between 479 proteins and 438 unique genetic regions at a Bonferroni-adjusted significance level of 3.8×10 -11 . These associations include 114 novel locus-protein relationships and an additional 217 novel sentinel variant-protein relationships. Novel cardiovascular findings include new protein associations at the APOE gene locus including ZAP70 (sentinel single nucleotide polymorphism [SNP] rs7412-T, β=0.61±0.05, P =3.27×10 -30 ) and MMP-3 (β=-0.60±0.05, P =1.67×10 -32 ), as well as a completely novel pleiotropic locus at the HPX gene, associated with 9 proteins. Further, the associations suggest new mechanisms of genetically mediated cardiovascular disease linked to African ancestry; we identify a novel association between variants linked to APOL1-associated chronic kidney and heart disease and the protein CKAP2 (rs73885319-G, β=0.34±0.04, P =1.34×10 -17 ) as well as an association between ATTR amyloidosis and RBP4 levels in community-dwelling individuals without heart failure. Conclusions: Taken together, these results provide evidence for the functional importance of variants in non-European populations, and suggest new biological mechanisms for ancestry-specific determinants of lipids, coagulation, and myocardial function.

Introdução: Alterações em parâmetros da composição corporal são considerados fatores de risco à saúde. Com isso, programas de exercício físico como o Cross Training surgem como alternativa para reduzir fatores de risco à saúde, em especial a composição corporal dos praticantes. Objetivo: Verificar se existe diferença entre dois protocolos diferentes de Cross Training sobre a composição corporal e aptidão física de jovens ativos. Métodos: Sessenta adultos foram submetidos a dez semanas de dois programas de Cross Training, organizados em circuito agrupado (CTG: n = 26; idade: 26 ± 7 anos; massa corporal 68 ± 11 kg; IMC 24 ± 3 kg/m2) e alternado (CTA: n = 29; idade 27 ± 8 anos; massa corporal 69 ± 10 kg; IMC 25 ± 4 kg/cm2). Antes e após o período de intervenção, os indivíduos foram avaliados em parâmetros composição corporal e aptidão física. Massa corporal e adiposa foram avaliadas por meio de análise de impedância bioelétrica (BIA). A verificação da aptidão física foi realizada por meio da força muscular isométrica máxima (isometric deadlift e Handgrip test) e aptidão cardiorrespiratória (yoyo intermitente recovery test-IR2). Análise de variância (ANOVA 2x2) com medidas repetidas, seguido por post hoc test de Bonferroni foram utilizados para comparação de médias e detecção de diferenças entre os protocolos, adotando p ≤ 0,05 para significância estatística. Percentual de mudança e tamanho do efeito também foram calculados para cada variável dependente. Resultados: Após o período de intervenção ambos protocolos de treinamento apresentaram diferença estatisticamente significante em relação ao tempo em parâmetros da composição corporal (massa muscular: p ≤ 0,001 e massa adiposa: p ≤ 0,001) e aptidão cardiorrespiratória (p ≤ 0,01) para ambos os grupos. Em relação a força isométrica máxima, o CTG apresentou diferença significativa quando comparado com o momento inicial (Handgrip: p = 0,02; Deadlift: p = 0,03), fato observado no grupo CTA somente no Deadlift (p = 0,05), (Handgrip: p = 0,08). Quando confrontados entre si, os grupos não apresentaram diferença estatisticamente significativa em nenhuma comparação. Conclusão: Ambos protocolos de treinamento foram eficazes para melhora dos parâmetros de composição corporal e aptidão cardiorrespiratória em jovens adultos.

BACKGROUND: Asthma is a common respiratory disorder with a highly heterogeneous nature that remains poorly understood. The objective was to use whole genome sequencing (WGS) data to identify regions of common genetic variation contributing to lung function in individuals with a diagnosis of asthma. METHODS: WGS data were generated for 1,053 individuals from trios and extended pedigrees participating in the family-based Genetic Epidemiology of Asthma in Costa Rica study. Asthma affection status was defined through a physician’s diagnosis of asthma, and most participants with asthma also had airway hyperresponsiveness (AHR) to methacholine. Family-based association tests for single variants were performed to assess the associations with lung function phenotypes. RESULTS: A genome-wide significant association was identified between baseline FEV(1)/FVC ratio and a single-nucleotide polymorphism in the top hit cysteine-rich secretory protein LCCL domain-containing 2 (CRISPLD2) (rs12051168; P = 3.6 × 10(−8) in the unadjusted model) that retained suggestive significance in the covariate-adjusted model (P = 5.6 × 10(−6)). Rs12051168 was also nominally associated with other related phenotypes: baseline FEV(1) (P = 3.3 × 10(−3)), postbronchodilator (PB) FEV(1) (7.3 × 10(−3)), and PB FEV(1)/FVC ratio (P = 2.7 × 10(−3)). The identified baseline FEV(1)/FVC ratio and rs12051168 association was meta-analyzed and replicated in three independent cohorts in which most participants with asthma also had confirmed AHR (combined weighted z-score P = .015) but not in cohorts without information about AHR. CONCLUSIONS: These findings suggest that using specific asthma characteristics, such as AHR, can help identify more genetically homogeneous asthma subgroups with genotype-phenotype associations that may not be observed in all children with asthma. CRISPLD2 also may be important for baseline lung function in individuals with asthma who also may have AHR.

Sports performance is a multifactorial trait that can be associated with individual and environmental characteristics. In this study, the sample comprised 35 male runners, enrolled in the “InTrack” project. Information regarding variables related to runners’ training was obtained via an online questionnaire, while anthropometric and body composition variables, as well as physical fitness components (muscular power, isometric strength, local muscular endurance, agility, and aerobic capacity) were measured, and a global physical fitness score (based on physical fitness components measured) was computed. The Weltman test (3200 m) was used to estimate runners’ pace and their stride frequency. Linear regression was used, taking the running pace as dependent variable. The final model, comprising biological, physical fitness, spatiotemporal, and training variables, explained 86% of the running performance variance. Muscular power (β = −1.02, 95% CI = (−1.69)–(−0.35)), abdominal muscle endurance (β = −4.81, 95% CI = (−7.52)–(−2.10)), isometric strength (β = −422.95, 95% CI = (−689.65)–(−156.25)), global physical fitness (β = 27.14, 95% CI = 9.52–45.03), and stride frequency (β = −2.99, 95% CI = (−4.29)–(−1.69)) were significantly associated with performance, meaning that better results in tests and increasing the stride frequency leads to better performance. Individual characteristics and physical fitness components were demonstrated to be significant predictors for running performance.

The use of technology has increased tremendously, by means of more reliable, smaller, more accessible and specially more user-friendly devices, which provide a wider range of features, and promote significant benefits for the population and health professionals. It is in this context that monitors and apps for heart rate (HR) measurement have emerged. HR is a clinical vital sign of diagnostic and prognostic importance. In response to body movement, HR tends to increase, in a direct relationship with the intensity of exercise. HR was primarily measured by the count of arterial pulse, and recently, HR can be precisely measured by monitors, bracelets and smartphone apps capable to perform real-time measurements and storage of data. This paper aimed to make a brief and updated review on the theme, providing a broader view of advantages and limitations of these resources for HR measurement in exercise. HR monitors and apps use basically two types of technology, optical sensor (photoplethysmography) and electrical signal from the heart. In general, these devices have shown good accuracy in measuring HR and HR variability at rest, but there are differences between brands and models considering the type, mode and intensity of exercise. HR measurements by monitors and smartphone apps are simple, accessible and may help cardiologists in the monitoring of the intensity of aerobic exercise, focusing on health promotion and on primary and secondary prevention of cardiovascular diseases.

Background There are a limited number of tests for the assessment of shoulder and pelvic girdle stability. Reliable instruments are important to evaluate movement dysfunction at these joints in order to provide more objective parameters. Objective To evaluate the inter-day reliability of the Upper Body Test in young adults. Methods A reliability study was carried out with three assessments of the shoulder and pelvic girdle stability within 48-h intervals (Monday, Wednesday, and Friday). The OctoBalance® platform was used to perform the Upper Body Test in 31 active young adults (24.5 ± 8 years). Intraclass Correlation Coefficient (ICC2,2) two-way mixed model, Coefficient of Variation, and Bland–Altman plots were used to verify the reliability of the test. The standard error of measurement (SEM) and the minimum detectable difference (MDD95%) were calculated for clinical applicability. Results The Intraclass Correlation Coefficient ranged from 0.87 to 0.94 – Featuring a mean difference of 0.89 (95%CI = −0.19–1.97) to left and 0.95 (95%CI = −0.38–2.27) for the right side, with a low variation coefficient (3.31–5.91%) between the second and third days of assessment. There was a statistically significant difference between the first assessment day and the other test sessions. The Bland–Altman analyses revealed low bias with scores within the limits of agreement. Minimum detectable difference scores were between 4.02 and 5.10, and standard error of measurement between 1.75 and 2.72, depending on the movement side. Conclusion The Upper Body Test presented good inter-day reliability for assessing the stability of the shoulder and pelvic girdle in young active healthy adults.

Resumo Objetivo: Avaliar os efeitos do treinamento de força sobre as hipertrofias renal e cardíaca induzida pela hipertensão renovascular em ratos. Método: Dezoito ratos Wistar foram divididos em três grupos: Sham, hipertenso (2K1C) e hipertenso treinado (2K1C-TR). Os animais foram induzidos a hipertensão renovascular através da ligadura da artéria renal esquerda. O treinamento de força foi iniciado quatro semanas após a indução da hipertensão renovascular, teve duração de 12 semanas e foi realizado a 70% de uma repetição máxima. Ao final foi medida pressão arterial, frequência cardíaca e parâmetros das hipertrofias renal e cardíaca. Resultados: O treinamento de força promoveu a redução da frequência cardíaca (p=0.0025) e da pressão arterial (p=0.01). Além disso, o treinamento diminuiu as massas absolutas do rim (p=0.0001) e coração (p=0.006), e os índices de hipertrofias renal e cardíaca, tanto normalizado pela massa corporal dos animais (p=0.0001 e p=0.001, respectivamente) como normalizado pelo comprimento da tíbia (p=0.004 e p=0.0004, respectivamente). Conclusão: O treinamento de força tem efeitos benéficos na hipertensão renovascular em animais, sendo capaz de reduzir a pressão arterial e a frequência cardíaca, além de atenuar o desenvolvimento das hipertrofias renal e cardíaca em ratos com hipertensão renovascular. Resumen Objetivo: Evaluar los efectos del entrenamiento de fuerza sobre las hipertrofias renal y cardíaca inducidas por la hipertensión renovascular en ratas. Método: Dieciocho ratas se dividieron en tres grupos: simulado, hipertenso (2R1C) e hipertenso entrenado (2R1C-TR). Los animales fueron inducidos a la hipertensión renovascular a través de la ligadura de la arteria renal izquierda. El entrenamiento de fuerza se inició cuatro semanas después de la inducción de la hipertensión renovascular, duró 12 semanas y se realizó al 70% de una repetición máxima. Al final se midió la presión arterial, la frecuencia cardiaca y los parámetros de las hipertrofias renal y cardíaca. Resultados: El entrenamiento de fuerza promovió la reducción de la frecuencia cardíaca (p=0.0025) y la presión arterial (p=0.01). Además el entrenamiento disminuyó las masas absolutas de los riñones (p=0.0001) y el corazón (p=0.006), y los índices de hipertrofias renal y cardíaca, tanto normalizado por la masa corporal de los animales (p=0.0001 e p=0.001, respectivamente) como normalizado por la longitud de la tibia (p=0.004 e p=0.0004, respectivamente). Conclusión: El entrenamiento de fuerza tiene efectos beneficiosos en la hipertensión renovascular en animales, siendo capaz de reducir la presión arterial y la frecuencia cardíaca, además de atenuar el desarrollo de las hipertrofias renal y cardíaca en ratas con hipertensión renovascular. Abstract Objective: To evaluate the effects of strength training on renal and cardiac hypertrophy induced by the renovascular hypertension in rats. Method: Eighteen male rats were divided into three groups: sham, hypertensive (2K1C) and trained hypertensive (2K1C-TR). The animals were induced to renovascular hypertension through ligation of the left renal artery. Strength training was initiated four weeks after the induction of renovascular hypertension, had the duration of 12 weeks and was performed at 70% of one maximum repetition. At the end, it was measured blood pressure, heart rate and parameters of renal and cardiac hypertrophies. Results: Strength training promoted reduction in heart rate (p=0.0025) and blood pressure (p=0.01). In addition, training decreased the absolute masses of the kidney (p=0.0001) and heart (p=0.006), and the indexes of renal and cardiac hypertrophy, both normalized by the body mass of the animals (p=0.0001 e p=0.001, respectively) and by the length of the tibia (p=0.004 e p=0.0004, respectively). Conclusion: Strength training has beneficial effects on renovascular hypertension in animals, being able to reduce blood pressure and heart rate, attenuating the development of renal and cardiac hypertrophies in rats with renovascular hypertension.

Background In leprosy, sensory function of nerves is evaluated with monofilaments test and the motor function with voluntary muscle test, however electroneuromyography is considered as the gold-standard tool. Objectives This study aimed: i) to evaluate the correlation between clinical tests and electroneuromyography for the diagnosis of leprosy neuropathy; and ii) to identify the prevalence of leprosy neuropathy and the most compromised peripheral nerves in leprosy. Methods We analysed the data from a nested case-control study that identified 166 patients diagnosed with leprosy neuropathy confirmed by electromyography. This study was designed for an analysis of correlation between the diagnostic tests. Results The most prevalent type of the neural damage was the sensory and motor multiple mononeuropathy, observed in 62 (37.3%) cases. The highest prevalence was the ulnar nerve in 67 (40.3%) cases. Agreement specified by nerves was moderate, ranging from k = 0.58 in the deep peroneal nerve to k = 0.41 in the posterior tibial nerve). Overall agreement between the clinical tests and electroneuromyography was very poor. Monofilaments test with k = 0.02 (95% CI 0.00-0.12) and voluntary muscle test with 0.16 (95% CI 0.04 to 0.28, P = 0.01). Conclusions There is a low to moderate correlation between clinical tests (monofilaments and voluntary muscle tests) and the electroneuromyography examination. The most prevalent type of neural impairment was the sensory and motor multiple mononeuropathy, and the most affected nerve was the ulnar.

AIMS This study aimed to verify th erelation ship between of anthropometric and physical performance variables with game-related statistics in professional elite basketball players during a competition. METHODS Eleven male basketball players were evaluated during 10 weeks in two distinct moments (regular season and playoffs). Overall, 11 variables of physical fitness and 13 variables of game-related statistics were analysed. RESULTS The following significant Pearson’scorrelations were found in regular season: percentage of fat mass with assists (r = -0.62) and steals (r = -0.63); height (r = 0.68), lean mass (r = 0.64), and maximum strength (r = 0.67) with blocks; squat jump with steals (r = 0.63); and time in the T-test with success ful two-point field-goals (r = -0.65), success ful free-throws (r = -0.61), and steals (r = -0.62). However, in playoffs, only stature and lean mass maintained these correlations (p ≤ 0.05). CONCLUSIONS The anthropometric and physical characteristics of the players showed few correlations with the game-related statistics in regular season, and these correlations are even lower in the playoff games of a professional elite Champion ship, wherefore, not being good predictors of technical performance.

The objective of the present study is to evaluate and compare the effect of a nutritional intervention between adolescent and adult. In a before and after quasi-experimental clinical study, 32 athletes (21 adults, age range 20–32 years; 11 adolescents, age range: 12–19 years) participated in a nutritional counselling consisting of four consultations separated by an interval of 45 to 60 days. The athlete’s eating behaviour, body composition and nutrition knowledge were evaluated at the beginning and at the end of the protocol. Both groups increased lean body mass and nutritional knowledge. Adolescents increased their mid-arm muscle circumference and improved meal frequency, and daily water intake. Athletes of both groups improved their ingestion of vegetables and fruits and decreased the ingestion of sweets and oils. Adolescents showed a higher prevalence of individuals that remained within or approached to the recommendations of sweets. This is the first study to evaluate and compare the effect of a nutritional intervention between adolescent and adult athletes body composition, eating behaviour and nutritional knowledge. The nutritional counselling has been effective in promoting beneficial changes on the athlete’s eating behaviour, nutritional knowledge and body composition, however, some healthy changes were only experienced by adolescents, especially in the frequency of meals and the intake of sweets.

Introduction: Leprosy, still considered a public health problem in many countries, among them Brazil, causes multiple sensory and/or motor signs and symptoms of the peripheral nervous system (SMSSPNS). This study aimed to analyze a pretreatment neurological profile of patients with leprosy. Methods: Cross-sectional study, whose participants 400 patients diagnosed with leprosy. Data collection took place through the collection from medical records and clinical examination of patients. It determined the frequency distribution of SMSSPNS, thickening of the nerves and committed peripheral nerves (PNC) as well as the sex and the average age. Results: Over 93% of the patients presented at least 1 (one) sensory symptom, and hypoesthesia was the most prevalent among them. 59% displayed motor dysfunction and a 50.25% rate of neural thickening. Hypoesthesia had a higher prevalence among individuals whose symptoms appeared more than 12 (twelve) months ago (58.86%, p = 0.018), and there was no association between other SMSSPNS and the disease’s time of onset; or between SMSSPNS and CPN, according to the leprosy forms. The most affected nerve is the sensory-motor ulnar (57.48%). Conclusion: The most frequent alterations were categorized as sensitives, including hypoesthesia (with a higher prevalence in comparison to when it first appeared, more than 12 months ago) and impairment of the sensory-motor ulnar nerve.

Pure neural leprosy (PNL) is often difficult to diagnose when acid-fast bacilli (AFB) cannot be detected. We undertook the present study to evaluate use of the polymerase chain reaction (PCR) in diagnosing PNL. Fifty-eight patients (41 men and 17 women) suspected of pure neural leprosy (PNL) were examined. Patients were classified as borderline tuberculoid (BT, 40 cases) and polar tuberculoid (TT, 18 cases) types. Nerve biopsy was performed and was positive for AFB in 20 patients (all BT patients), i.e., 34.5% of total cases. DNA was extracted from the nerve biopsy samples and amplified using PCR for a specific repeated sequence of DNA from Mycobacterium leprae. PCR analysis was positive in the nerve samples from 29 patients (50%), 27 of the BT type, and 2 of the TT type patients. Further, PCR analysis was positive in 14 of 38 cases that were negative for AFB by nerve biopsy, of which 12 were of the BT type and 2 the TT type. PCR analysis proved to be a useful method to investigate pure neural leprosy, enabling confirmation of the diagnosis in more than a third of the cases that were negative for AFB by nerve biopsy.

Objetivou-se analisar o estilo de vida de acadêmicos de Educação Física de uma universidade pública do estado de Sergipe, Brasil. A amostra probabilística foi de 217 alunos da Universidade Federal de Sergipe com 20,6 (±3,1) anos de idade, sendo 105 da licenciatura e 112 do bacharelado. Da amostra analisada, 3,3% (IC95%: 0,9-1,6) apresentou um estilo de vida inadequado. A maior parte dos alunos, 57,4% (IC95%: 50,7-64,0), não atendeu as recomendações para atividade física. Estudantes da licenciatura estavam mais inadequados que os do bacharelado no conjunto do estilo de vida global e nas condutas de sono, cinto de segurança, estresse e sexo seguro. Os achados contribuem para que a universidade elabore campanhas e programas de extensão no campus para promoção do estilo de vida saudável. The objective was to analyze the lifestyle in Physical Education students at a public university in Sergipe, Brazil. The random sample was 217 students at Federal University of Sergipe, 20.6 (± 3.1) years old, with 105 of the graduate and 112 of the bachelor. The prevalence of inappropriate lifestyle was 3.3% (95%CI: 0.9-1.6) among the students studied. Most students, 57.4% (95%CI: 50.7 -64.0), didn't meet recommendations for physical activity. The graduate students were more inadequate than bachelor's students in the global lifestyle and in the sleep, safety belt, stress and safe sex behaviors. The findings contribute to the university to develop campaigns and outreach programs on campus to promote healthier lifestyle. Se tuvo como objetivo analizar el estilo de vida de los estudiantes de Educación Física en una universidad pública en Sergipe, Brasil. La muestra aleatoria de 217 estudiantes de la Universidad Federal de Sergipe con 20.6 (± 3.1) años de edad, siendo 105 estudiantes de graduación e 112 de bachillerato. El estudio demonstró que 3.3% (IC 95%: 0,9 - 1,6) tenía un estilo de vida inadecuado. La mayoría de los estudiantes, 57,4% (IC 95%: 50,7 - 64,0), no cumplir con las recomendaciones de actividad física. Los estudiantes de graduación fueron más inadecuados que el bachillerato en todo el estilo de vida global y en el comportamiento del sueño, estrés, cinturón de seguridad y sexo seguro. Los resultados contribuyen a la universidad para desarrollar campañas y programas de extensión en el campus para promover el saludable estilo de vida.

Regular physical exercise tends to benefit people with fibromyalgia syndrome (FMS). The effects have been observed regarding aerobic power and strength; however, results concerning flexibility have been controversial. In general, studies have evaluated specific joints or tests involving only a single body movement. The aim of this study was to compare the flexibility profile of FMS and asymptomatic women using a more comprehensive test protocol regarding the number of movements and joints involved. The sample consisted of 30 women divided into two groups: asymptomatic (n = 15; mean age: 50.2 ± 8.2 years; mean weight: 63.0 ± 9.6 kg; mean height: 157 ± 6 cm) and fibromyalgia (n = 15; mean age: 47.3 ± 9.4 years; mean weight: 61.9 ± 12.2 kg; mean height: 159 ± 7 cm). Flexibility was measured using the Flexitest, which was evaluated by the global index of flexibility (Flexindex), and the five indices of variability of joint mobility: intermovement (IVIM), interjoint (IVIA), flexion-extension (IVFE), between segment (IVES) and distal-proximal (IVDP). All of the indices were calculated based on the results of the 20 movements of the Flexitest. There was no difference between groups (44.4 ± 3.7 vs. 45.7 ± 4.1 points, for asymptomatic and fibromyalgia, respectively; p = 0.379; 95% confidence interval (CI): -4.2 to 1.6). Most of the sample (83%) showed an average level of flexibility based on reference values for gender and age. Only IVIM showed a significant difference between the groups. Asymptomatic and fibromyalgic women have similar overall levels of flexibility but with different profiles. Resumo Exercícios físicos em mulheres com síndrome de fibromialgia (SFM) têm apresentado efeitos na força e potência aeróbica, contudo, os resultados acerca da flexibilidade têm sido controversos. Além disso, os estudos têm avaliado articulações específicas ou testes que envolvam apenas um único movimento corporal. Objetivou-se comparar o perfil de flexibilidade global de mulheres acometidas pela SFM e assintomáticas a partir de um protocolo de teste mais abrangente quanto ao número de movimentos e articulações envolvidas. Participaram da pesquisa 30 mulheres divididas em dois grupos: assintomáticas (n = 15; 50,2 ± 8,2 anos; 63,0 ± 9,6 kg; 157 ± 6 cm) e fibromiálgicas (n = 15; 47,3 ± 9,4 anos; 61,9 ± 12,2 kg; 159 ± 7 cm). A flexibilidade medida pelo Flexiteste foi avaliada pelo índice global de flexibilidade (flexíndice) e pelos cinco índices de variabilidade da mobilidade articular: intermovimentos (IVIM), intra-articulação (IVIA), flexão-extensão (IVFE), entre segmentos (IVES) e distal-proximal (IVDP). Todos os índices foram calculados com base nos resultados dos 20 movimentos do flexiteste. Não houve diferença no flexíndice entre os grupos (44,4 ± 3,7 vs 45,7 ± 4,1 pontos, para assintomáticas e fibromiálgicas respectivamente; p=0,379; IC95% = -4,2 a 1,6). A maioria da amostra (83%) apresentou nível de flexibilidade considerado na média da população para o gênero feminino e para cada faixa etária específica. Entre os índices de variabilidade da mobilidade articular apenas o IVIM apresentou diferença significativa. Mulheres assintomáticas e fibromiálgicas apresentam níveis globais de flexibilidade similares, mas com perfis diferentes.

Physical exercise inhibits cardiac vagal activity. To study the relationship between heart rate (HR) and respiratory pattern, we applied the 4-s exercise test (4sET) and measured cardiac vagal index (CVI) in 30 healthy subjects who served as their own controls, using the standard plus three additional variations, essentially respiratory, of the original protocol: (a) a maximum inspiratory apnea of 16 s, of which 8 s were in the pre-exercise phase (4sET(insp)); (b) free respiratory pattern (4sET(unc)); and (c) maximum expiratory apnea of 12 s (4sET(exp)). The respective results were expressed by the following CVIs: CVI(insp), CVI(unc) and CVI(exp). CVI was determined in a continuous digital ECG recording through a specific ratio of two RR interval durations. The results [(mean +/- SEM)] for the four different maneuvers were as follows: CVI (1.56 +/- 0.05), CVI(insp) (1.55 +/- 0.05), CVI(unc) (1.63 +/- 0.05) and CVI(exp) (1.37 +/- 0.02). ANOVA-Bonferroni significant differences were only found between CVI(exp) and CVI(insp) (P = 0.009), CVI(unc) (P0.001) and CVI (P = 0.003). Dividing our sample in terciles according to CVI values, those with lower CVI, showed an attenuation of biphasic HR response after a 15 s maximum inspiratory apnea. We conclude that cardiac vagal reflex seems to be influencing the biphasic HR response modulation after a 12 s inspiratory apnea as described in the original protocol of 4sET, and this appears to be the option that best discriminates the cardiac vagal reflex, with less variability in the maneuvers when subjects are divided in terciles.

OBJECTIVE: To test the operational viability of and validate the 4-second exercise test (4sET) protocol in the orthostatic position (ORTHO). METHODS: The ORTHO protocol, an alternative to the conventional protocol (CYCLO), was used. The ORTHO protocol consists of performing sudden exercise in the orthostatic position - accelerated stationary walking (alternate upward flexion of the thighs) - from the fourth to the eighth second of a 12-second maximum inspiratory apnea, instead of rapid cycling without load. The adimensional cardiac vagal index (CVI) was calculated using the ratio between the longest RR interval (RRB) - the one immediately before, or the first during exercise - and the shortest RR interval during exercise - usually the last (RRC) - measured on electrocardiographic tracings at a 10-ms resolution. Forty-seven individuals (40±17 years, 169±9 cm, 72±14 kg) of both sexes, healthy or unhealthy, randomly underwent 3 consecutive repetitions of the 2 protocols, the first being performed only to acquaint patients with the procedure. RESULTS: Although differences in the CVI were found in both protocols (1.48±0.04 vs 1.42±0.04; P

Regular physical exercise is an important factor to reduce the indexes of cardiovascular and all causes morbimortality. However, there is, apparently, additional and independent benefits of the regular practice of physical exercise and the improvement of the level of aerobic condition. Heart rate (HR) is mediated primarily by the direct activity of the autonomic nervous system (ANS), specifically through the sympathetic and parasympathetic branches activities over the sinus node autorhythmicity, with predominance of the vagal activity (parasympathetic) at rest, that is progressively inhibited since the onset of the exercise. The HR behavior has been widely studied during different conditions and protocols associated to the exercise. A reduction of the cardiac vagal tone (parasympathetic function) and consequently a diminished HR variability in rest, independently of the protocol of measurement used, is related to an autonomic dysfunction, chronic-degenerative diseases and increased mortality risk. Individuals with high levels of aerobic condition have a lower resting HR, along with a larger parasympathetic activity or smaller sympathetic activity, but it is not necessarily a direct consequence of the exercise training, as long as other inherent adaptations to the aerobic conditioning can influence the resting HR. The HR response in the onset of the exercise represents the integrity of the vagus nerve, and the HR recovery on the post-exercise transient also denotes important prognostic information; by the way, individuals that have a slow HR recovery in the first minute post-exercise have increased mortality risk. In conclusion, the physiological mechanisms modulating HR during or after an exercise program are not totally clear, and further studies are needed.

We report on the preliminary clinical and electrophysiological aspects of an in-patient possibly presenting epilepsia partialis continua (Koshevnikov). We discuss the different etiologies and emphasize on the possible idiopathic form in this case.

We report on the clinical characteristics of amyotrophic lateral sclerosis (ALS) in Fortaleza (Northeastern Brazil). For this, we analyzed retrospectively (from 1980 to 1999) 78 cases of ALS from the Service of Neurology of the University Hospital of Fortaleza diagnosed clinically and laboratorially (EMG, muscle biopsy, myelography, blood biochemistry, muscle enzymes and cranio-cervical X-ray). The results showed that they were mostly sporadic ALS (76/78), and they were divided into definite (n= 36), probable (n= 20), possible (n= 15) and suspected (n= 7), according to the level of diagnostic certainty. They were also subdivided into juvenile (n= 17), early-onset adult (n= 18), age-specific (n= 39) and late-onset (n= 4) groups. Clinically, they presented as initials symptoms, principally, asymmetrical (30/78) and symmetrical (24/78) weakness of extremities, besides bulbar signs, fasciculations, and atrophy. Curiously, pain as first symptom occurred in an expressive fashion (17/78). The predominant initial anatomic site, in this series, was the spinal cord, and mainly affecting the arms. As to the symptom accrual from region to region, this occurs more quickly in contiguous areas, and fasciculations are predominant when bulbar region was associated. Descrevemos as características clínicas da esclerose lateral amiotrófica (ELA) em Fortaleza (Nordeste Brasileiro). Para isso, fizemos uma análise retrospectiva (de 1980 a 1999) de 78 casos de ELA do Serviço de Neurologia do Hospital Universitário de Fortaleza, diagnosticados do ponto de vista clínico e laboratorial (EMG, biópsia de músculo, mielografia, análises hematológica e bioquímica, e raio X da junção crânio-cervical). Os resultados mostraram que esses casos eram principalmente da forma esporádica (76/78), e estes foram divididos, de acordo com o nível de certeza diagnóstica, em definidos (n= 36), prováveis (n= 20), possíveis (n= 15) e suspeitos (n= 7). Eles foram também subdivididos nos grupos juvenil (n= 17), adulto jovem (n= 18), idade-específico (n= 39) e tardio (n= 4). Clinicamente, os principais sintomas iniciais foram fraqueza assimétrica (38/78) e simétrica (24/78) das extremidades, além de sinais bulbares, fasciculações e atrofia. Curiosamente, dor como sintoma inicial ocorria de maneira expressiva (17/78). O local anatômico inicial predominante foi, nessa série, a medula espinhal, afetando principalmente os braços. O avanço regional de sintomas ocorreu mais rapidamente em áreas contíguas, e as fasciculações eram predominantes quando a região bulbar estava associada.