Rodrigo Della Méa Plentz

Continuous positive airway pressure reduces blood pressure in patients with obstructive sleep apnea; a systematic review and meta-analysis with 1000 patients

Background: Obstructive sleep apnea (OSA) may lead to the development of hypertension and therapy with continuous positive airway pressure (CPAP) can promote reduction in blood pressure. Objective: The objective of this study is to review systematically the effects of CPAP on blood pressure in patients with OSA. Methods: The search was conducted in the following databases, from their beginning until February 2013: MEDLINE, Embase, Cochrane CENTRAL, Lilacs and PEDro. In addition, a manual search was performed on references of published studies. Randomized clinical trials (RCTs) that used CPAP compared with placebo CPAP or subtherapeutic CPAP for treatment of patients with OSA and that evaluated office SBP and DBP and 24-h ambulatory blood pressure were selected. Results: Sixteen RCTs were included among 3409 publications, totaling 1166 patients. The use of CPAP resulted in reductions in office SBP [−3.20 mmHg; 95% confidence interval (CI) −4.67 to −1.72] and DBP (−2.87 mmHg; 95% CI −5.18 to −0.55); in night-time SBP (−4.92 mmHg; 95% CI −8.70 to −1.14); in mean 24-h blood pressure (−3.56 mmHg; 95% CI −6.79 to −0.33), mean night-time blood pressure (−2.56 mmHg; 95% CI −4.43 to −0.68) and 24-h DBP (−3.46 mmHg; 95% CI −6.75 to −0.17). However, no significant change was observed in daytime SBP (−0.74 mmHg; 95% CI −3.90 to 2.41) and daytime DBP (−1.86 mmHg; 95% CI −4.55 to 0.83). Conclusion: Treatment with CPAP promoted significantly but small reductions in blood pressure in individuals with OSA. Further studies should be performed to evaluate the effects of long-term CPAP and the impact on cardiovascular risk.

The effects of periodized concurrent and aerobic training on oxidative stress parameters, endothelial function and immune response in sedentary male individuals of middle age.

The vascular endothelium plays a key role in arterial wall homeostasis by preventing atherosclerotic plaque formation. A primary causal factor of endothelial dysfunction is the reactive oxygen species. Aerobic exercise is ascribed as an important adjuvant therapy in endothelium‐dependent cardiovascular disease. However, little is known about the effects of concurrent (aerobic + strength) training on that. For a comparison of the effects of aerobic and concurrent physical training on endothelial function, oxidative stress parameters and the immunoinflammatory activity of monocytes/macrophages, 20 adult male volunteers of middle age were divided into a concurrent training (CT) programme group and an aerobic training group. The glutathione disulphide to glutathione ratio (GSSG/GSH) and plasma lipoperoxide (LPO) levels, as well as flow‐mediated dilation (FMD), monocyte/macrophage functional activity (zymosan phagocytosis), body lipid profiles, aerobic capacity (maximal oxygen uptake) and strength parameters (one‐repetition maximum test), were measured before and after the exercise training programmes. The CT exhibited reduced acute effects of exercise on the GSSG/GSH ratio, plasma LPO levels and zymosan phagocytosis. The CT also displayed improved lipid profiles, glycaemic control, maximal oxygen uptake and one‐repetition maximum test values. In both the aerobic training and the CT, training improved the acute responses to exercise, as inferred from a decrease in the GSSG/GSH ratios. The aerobic sessions did not alter basal levels of plasma LPO or macrophage phagocytic activity but improved FMD values as well as lipid profiles and glycaemic control. In summary, both training programmes improve systemic redox status and antioxidant defences. However, the aerobic training was more efficient in improving FMD in the individuals studied. Copyright

Effects of Electrical Stimulation in Spastic Muscles After Stroke Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background and Purpose— Neuromuscular electric stimulation (NMES) has been used to reduce spasticity and improve range of motion in patients with stroke. However, contradictory results have been reported by clinical trials. A systematic review of randomized clinical trials was conducted to assess the effect of treatment with NMES with or without association to another therapy on spastic muscles after stroke compared with placebo or another intervention. Methods— We searched the following electronic databases (from inception to February 2015): Medline (PubMed), EMBASE, Cochrane Central Register of Controlled Trials and Physiotherapy Evidence Database (PEDro). Two independent reviewers assessed the eligibility of studies based on predefined inclusion criteria (application of electric stimulation on the lower or upper extremities, regardless of NMES dosage, and comparison with a control group which was not exposed to electric stimulation), excluding studies with <3 days of intervention. The primary outcome extracted was spasticity, assessed by the Modified Ashworth Scale, and the secondary outcome extracted was range of motion, assessed by Goniometer. Results— Of the total of 5066 titles, 29 randomized clinical trials were included with 940 subjects. NMES provided reductions in spasticity (−0.30 [95% confidence interval, −0.58 to −0.03], n=14 randomized clinical trials) and increase in range of motion when compared with control group (2.87 [95% confidence interval, 1.18–4.56], n=13 randomized clinical trials) after stroke. Conclusions— NMES combined with other intervention modalities can be considered as a treatment option that provides improvements in spasticity and range of motion in patients after stroke. Clinical Trial Registration Information— URL: http://www.crd.york.ac.uk/PROSPERO. Unique identifier: CRD42014008946.

Haematological effect of pulsed ultrasound in acute muscular inflammation in rats.

OBJECTIVE To evaluate the effect of low-intensity pulsed ultrasound (LIPUS) on the haematological dynamics of an acute inflammatory process after an iatrogenic muscular lesion. DESIGN Controlled laboratory study. SETTING Research laboratory. PARTICIPANTS Eighteen male Wistar rats (weight 350 to 450g) were submitted to surgical incision in the biceps femoris muscle (approximately 50%), and subsequently subdivided into control (n=9) and LIPUS (n=9) groups. INTERVENTION Ultrasound (1.0MHz) was applied at the lesion site in the pulsed mode (2ms on, 8ms off) at 0.4W/cm(2) for 3 minutes at 1, 8 and 24 hours post-surgery. MAIN OUTCOME MEASURES In these periods, blood was collected through venepuncture of the retro-orbital plexus and evaluated for different types of leukocytes and erythrocytes. RESULTS LIPUS reduced the total leukocyte count at 1, 8 and 24 hours post-surgery (1 hour, control 9017.2±481×10(3)/mm(3) vs LIPUS 6189.8±450×10(3)/mm(3); 8 hours, control 8078.2±501×10(3)/mm(3) vs LIPUS 5371.3±378×10(3)/mm(3); 24 hours, control 8192.3±646×10(3)/mm(3) vs LIPUS 6059.1±503×10(3)/mm(3); P<0.001). The monocyte count was reduced at 8 and 24 hours post-surgery (8 hours, control 815.5±126×10(3)/mm(3) vs LIPUS 375.4±70×10(3)/mm(3); 24 hours, control 875.3±124×10(3)/mm(3) vs LIPUS 564.7±56×10(3)/mm(3); P<0.001). The number of segmented neutrophils was only reduced at 1 hour post-surgery (control 5033.1±397×10(3)/mm(3) vs LIPUS 3594.8±191×10(3)/mm(3); P=0.006), and the lymphocyte count was only reduced at 8 hours post-surgery (control 4759.7±459×10(3)/mm(3) vs LIPUS 2584.1±356×10(3)/mm(3); P=0.003). Changes were not observed in the concentrations of young neutrophils, polibocytes and erythrocytes. CONCLUSION LIPUS reduced aspects of the inflammatory process following an acute incisional muscular lesion.

Reversal of postprandial endothelial dysfunction by cyclooxygenase inhibition in healthy volunteers.

The aim of this study was to evaluate the role of cyclooxygenase (COX) in venous vascular reactivity changes after an oral lipid overload (OLO). Venous endothelial function (dorsal hand vein technique) was evaluated in fasting, 30 minutes after COX inhibition (aspirin-fasting), 2 to 4 hours after an OLO (1000 kcal, 58% fat), and again after COX inhibition (aspirin-OLO, 600 mg/200 mL water) in 10 healthy adults (age, 28.1 ± 1.3 years; body mass index, 22.3 ± 0.6 kg/m2). Fasting, 2- to 4-hour post-OLO, and 60-minute postaspirin plasma glucose, insulin, and lipids were also evaluated. The OLO increased triglycerides and insulin, reduced low-density lipoprotein and high-density lipoprotein, but glycemia and total cholesterol remained unchanged. There were no metabolic differences between OLO and aspirin-OLO. In fasting, aspirin reduced acetylcholine-induced venodilation (107.0% ± 14% versus 57.3% ± 11%; P < 0.001). Vascular reactivity was blunted after the OLO (phenylephrine dose: 0.3 ± 0.2 fasting versus 1.9 ± 0.8 nmol/min after OLO; P < 0.001) and was partially corrected by aspirin (0.4 ± 0.2; P < 0.001). Similar changes were observed in maximum venodilation after acetylcholine (107.0% ± 14% fasting versus 60.4% ± 9% after OLO, P < 0.001; aspirin-OLO: 95.9% ± 6%; P < 0.001). The responses to sodium nitroprusside remained unchanged during the study. We conclude that the OLO reduction in the endothelium-dependent venoconstriction and venodilation is partially the result of the action of COX.

Effects of Exercise on Inflammatory, Oxidative and Neurotrophic Biomarkers on Cognitively Impaired Individuals Diagnosed with Dementia or Mild Cognitive Impairment: A Systematic Review and Meta-Analysis.

Although the effects of physical exercise (PE) on cognitive function in dementia and mild cognitive impairment (MCI) have been largely studied, its biochemical effect is still poorly explored. The aim of this systematic review is to investigate the effects of PE on inflammatory, oxidative and neurotrophic biomarkers of subjects with MCI or dementia. Six electronic databases, (Pubmed, Cochrane Central, Embase, PEDro, PsycINFO and SportDiscus) were searched for randomized controlled trials assessing the effects of PE on serum/plasma biomarkers of elderly with MCI or dementia. After selection process, eight studies were included. Meta-analysis was performed by comparison of changes from baseline, using the random effects method. Meta-analysis showed a significant effect of aerobic exercise on IL-6 and TNF-α decrease and positive effects on BDNF expression. As only one study was included with oxidative biomarker assessment, the effects of PE on oxidative process remains unclear. Finally, even though it was possible to observe positive effects of PE on some biomarkers of MCI and dementia individuals, current evidence does not allow drawing specific practical recommendations such as type, frequency, intensity or duration of PE in these population. Further researches aiming to estimate the PE effectiveness on biomarkers of MCI and AD are needed.

An initial study on the effect of functional electrical stimulation in erectile dysfunction: a randomized controlled trial

Erectile dysfunction (ED) affects approximately 150 million men worldwide. Functional electrical stimulation (FES) therapy has shown a high regenerative capacity for smooth muscle cells and, therefore, is being increasingly adopted. FES can be a beneficial treatment option when the cause of ED is related to degeneration of cavernous smooth muscle. To evaluate the impact of FES on erectile function in men with erectile dysfunction. Twenty-two patients with ED participated in this randomized clinical trial. Participants were randomly assigned to two groups: intervention (IG) or control (CG). IG participants underwent FES therapy (50 Hz/500 µs) for a total of 4 weeks, divided into two weekly sessions lasting 15 min each, with intensity lower than the motor threshold. CG participants were treated with placebo FES and followed the same routine as the IG. Erectile function was assessed by the validated International Index of Erectile Function (IIEF-5) and Erection Hardness Score (EHS), applied before and after treatment, and quality of life, by the WHOQOL questionnaire. Statistically significant differences in IIEF-5 and EHS were found between the IG and CG after treatment (p <  0.05), as well as a within-group difference in the IG when comparing the post-treatment periods (p < 0.0001) The WHOQOL revealed a significant difference between CG and IG after treatment (p < 0.05), as well as a within-group difference in the IG after treatment (p < 0.0001), except in the Environment domain, in which there was no difference between the pre- and post-treatment periods (50.9 ± 2.8 pre vs. 52.3 ± 3.1 post). This trial showed that FES therapy may improve erectile function and quality of life in men with ED.

Effects of High-Intensity Inspiratory Muscle Training Associated withAerobic Exercise in Patients Undergoing CABG: Randomized ClinicalTrial

Objective Evaluate the interaction between high-intensity inspiratory muscle training (IMT) and aerobic exercise on physical capacity, respiratory muscle strength, peripheral muscle strength, and quality of life of patients who underwent coronary artery bypass grafting (CABG). Methods Twenty-four patients underwent CABG were randomized into two groups. During 36 sessions, one group received IMT associated with aerobic exercise and the other group received only aerobic exercise. Primary outcome was the distance in the six-minute walk distance (6MWD) test. Secondary outcomes included respiratory muscle strength, peripheral muscle strength, and quality of life. Measures were taken at the baseline, at the 12th session, the 24th session, and 36th session. Results Baseline characteristics were similar between the groups. There was no statistically significant difference between the two groups in any outcome [6MWD - P=0.935; peak oxygen consumption (PeakVO2) - P=0.853; maximal inspiratory pressure (MIP) - P=0.243; maximal expiratory pressure (MEP) - P=0.268; sitting-rising test (SRT) - P=0.212], but there was interaction in MIP (P=0.000) and all outcomes improved in the two groups (6MWD - P=0.000; PeakVO2 - P=0.000; MIP - P=0.000; MEP - P=0.000; SRT - P=0.000). Conclusion There was an improvement of all outcomes in both groups, but IMT was not able to provide additional benefits. The use of this combination should be used with caution to not generate higher costs in the rehabilitation process of these patients.

Commentary: Exercise-dependent BDNF as a Modulatory Factor for the Executive Processing of Individuals in Course of Cognitive Decline. A Systematic Review

Citation: Stigger F, Marcolino MAZ and Plentz RDM (2017) Commentary: Exercise-dependent BDNF as a Modulatory Factor for the Executive Processing of Individuals in Course of Cognitive Decline. A Systematic Review. Front. Psychol. 8:1858. doi: 10.3389/fpsyg.2017.01858 Commentary: Exercise-dependent BDNF as a Modulatory Factor for the Executive Processing of Individuals in Course of Cognitive Decline. A Systematic Review

Acute effects of functional electrical stimulation and inspiratory muscle training in patients with heart failure: a randomized crossover clinical trial

baroreflex and chemoreflex.5 Treatment is currently based on pharmacological and non-pharmacological therapies for the autonomic changes, such as exercise training,6 functional electrical stimulation (FES)7,8 and inspiratory muscle training (IMT).9 A meta-analysis analyzed the effects of FES in patients with HF, showing increased peak oxygen uptake (VO2 peak) 10 and 6-min walking distance in comparison with the control group.7,11 Similarly, the effect of IMT on these patients shows improvements in functional capacity,9,11 respiratory Introduction