Long-Term Outcome and Prognostic Factors of Juvenile Dermatomyositis: A Multinational, Multicenter Study of 490 Patients

Objective. To investigate the long-term outcome and prognostic factors of juvenile dermatomyositis (DM) through a multinational, multicenter study.Methods. Patients consisted of inception cohorts seen between 1980 and 2004 in 27 centers in Europe and Latin America. Predictor variables were sex, continent, ethnicity, onset year, onset age, onset type, onset manifestations, course type, disease duration, and active disease duration. Outcomes were muscle strength/endurance, continued disease activity, cumulative damage, muscle damage, cutaneous damage, calcinosis, lipodystrophy, physical function, and health-related quality of life (HRQOL).Results. A total of 490 patients with a mean disease duration of 7.7 years were included. At the cross-sectional visit, 41.2-52.8% of patients, depending on the instrument used, had reduced muscle strength/endurance, but less than 10% had severe impairment. Persistently active disease was recorded in 41.2-60.5% of the patients, depending on the activity measure used. Sixty-nine percent of the patients had cumulative damage. The frequency of calcinosis and lipodystrophy was 23.6% and 9.7%, respectively. A total of 40.7% of the patients had decreased functional ability, but only 6.5% had major impairment. Only a small fraction had decreased HRQOL. A chronic course, either polycyclic or continuous, consistently predicted a poorer outcome. Mortality rate was 3.1%.Conclusion. This study confirms the marked improvement in functional outcome of juvenile DM when compared with earlier literature. However, many patients had continued disease activity and cumulative damage at followup. A chronic course was the strongest predictor of poor prognosis. These findings highlight the need for treatment strategies that enable a better control of disease activity over time and the reduction of nonreversible damage.

Fatores de riscos associados à ocorrência de helmintos gastrintestinais em cabras leiteiras mantidas em sistema de pastejo

Infection due to the gastrointestinal nematodes can negatively interact with the productive performance of dairy goats, and in some cases can induce mortality in the flocks. The objective was to study the influence of season, parturition order, postpartum, lactation and breed standard on the population of helminths in dairy goats. 31 goats were used, with 15 Saanen and 16 F1 (1/2 Boer + 1/2 Saanen). of these, 13 were from the 1st lactation and 18 from the 2nd or more lactations. The highest fecal egg counts occurred during the summer and spring, with FEC in Saanen higher (p < 0.01) than in F1 animals (1/2 Boer + 1/2 Saanen). The animals with 1st lactation showed higher FEC (p < 0.004) than the animals in 2nd or more lactation. During the peripartum the largest FEC for both breeds standards were in the week of the birth (p < 0.05), followed by post-partum and pre-partum. In peripartum the Saanen goats showed higher FEC (p < 0.02) than the F1 and primiparous (p < 0.008) in relation to pluriparous. F1 animals are resistant to helminthes when compared to Saanen animals, demonstrating that crossing of resistant breeds with high production breeds is a viable alternative to increase productivity without compromising the parasitary stability of the herd. The peripartum period is a risk factor associated to the occurrence of gastrointestinal helminths, especially in Saanen goats from first lactation.

Effect of an acute β-adrenergic blockade on exercise intensity corresponding to the lactate minimum

β-Adrenoreceptor blockade is reported to impair endurance, power output and work capacity in healthy subjects and patients with hypertension. The purpose of this study was to investigate the effect in eighth athletic males of an acute β-adrenergic blockade with propranolol on their individual power output corresponding to a defined lactate minimum (LM). Eight fit males (cyclist or triathlete) performed a protocol to determine the power output corresponding to their individual LM (defined from an incremental exercise test after a rapidly induced exercise lactic acidosis). This protocol was performed twice in a double-blind randomized order by each athlete first ingesting propranolol (80mg) and in a second trial a placebo, 120 minutes respectively prior to the test sequence. The blood lactate concentration obtained 7 minutes after anaerobic exercise (a Wingate test) was significantly lower after acute β-adrenergic blockade (8.6 ± 1.6mM) than under the placebo condition (11.7 ± 1.6mM). The work rate at the LM was lowered from 215.0 ± 18.6 to 184.0 ± 18.6 watts and heart rate at the LM was reduced from 165 ± 1.5 to 132 ± 2.2 beats/minute as a result of the blockade. There was a non-significant correlation (r = 0.29) between the power output at the LM with and without acute β-adrenergic blockade. In conclusion, since the intensity corresponding to the LM is related to aerobic performance, the results of the present study, are able to explain in part, the reduction in aerobic power output produced during β-adrenergic blockade.

Maximal lactate steady state in rats submitted to swimming exercise

The higher concentration during exercise at which lactate entry in blood equals its removal is known as 'maximal lactate steady state' (MLSS) and is considered an important indicator of endurance exercise capacity. The aim of the present study was to determine MLSS in rats during swimming exercise. Adult male Wistar rats, which were adapted to water for 3 weeks, were used. After this, the animals were separated at random into groups and submitted once a week to swimming sessions of 20 min, supporting loads of 5, 6, 7, 8, 9 or 10% of body wt. for 6 consecutive weeks. Blood lactate was determined every 5 min to find the MLSS. Sedentary animals presented MLSS with overloads of 5 and 6% at 5.5 mmol/l blood lactate. There was a significant (P < 0.05) increase in blood lactate with the other loads. In another set of experiments, rats of the same strain, sex and age were submitted daily to 60 min of swimming with an 8% body wt. overload, 5 days/week, for 9 weeks. The rats were then submitted to a swimming session of 20 min with an 8% body wt. overload and blood lactate was determined before the beginning of the session and after 10 and 20 min of exercise. Sedentary rats submitted to the same acute exercise protocol were used as a control. Physical training did not alter the MLSS value (P < 0.05) but shifted it to a higher exercise intensity (8% body wt. overload). Taken together these results indicate that MLSS measured in rats in the conditions of the present study was reproducible and seemed to be independent of the physical condition of the animals. © 2001 Elsevier B.V. All rights reserved.

Oxygen uptake kinetics and time to exhaustion in cycling and running: A comparison between trained and untrained subjects

The objective of the present study was to compare pulmonary gas exchange kinetics (VO 2 kinetics) and time to exhaustion (Tlim) between trained and untrained individuals during severe exercise performed on a cycle ergometer and treadmill. Eleven untrained males in running (UR) and cycling (UC), nine endurance cyclists (EC), and seven endurance runners (ER) were submitted to the following tests on separate days: (i) incremental test for determination of maximal oxygen uptake (VO 2max) and the intensity associated with the achievement of VO 2max (IVO 2max) on a mechanical braked cycle ergometer (EC and UC) and on a treadmill (ER and UR); (ii) all-out exercise bout performed at IVO 2max to determine the time to exhaustion at IVO 2max (Tlim) and the time constant of oxygen uptake kinetics (τ). The τ was significantly faster in trained group, both in cycling (EC = 28.2 ± 4.7 s; UC = 63.8 ± 25.0 s) and in running (ER = 28.5 ± 8.5 s; UR = 59.3 ± 12.0 s). Tlim of untrained was significantly lower in cycling (EC = 384.4 ± 66.6 s vs. UC; 311.1 ± 105.7 s) and higher in running (ER = 309.2 ± 176.6 s vs. UR = 439.8 ± 104.2 s). We conclude that the VO 2 kinetic response at the onset of severe exercise, carried out at the same relative intensity is sensitive to endurance training, irrespective of the exercise type. The endurance training seems to differently influence Tlim during exercise at IVO 2max in running and cycling. © 2003 Taylor & Francis Ltd.

Comparação entre o desempenho motor de hommes e mulheres em séries múltiplas de exercícios com pesos

The magnitude of men and women's neuromuscular, metabolic, and morphologic responses seems to be quite different even when both are submitted to exercise protocols using similar weight exercises protocols. However, differences in the motor performance between men and women have been predominantly reported in protocols based on isometric and isokinetic contractions. Thus, this study aimed to analyze men and women's behavior during multiple sets of weight exercises achieving the exhaustion, and later verifying possible differences as to the physical performance between genders using weights with similar intensity. For this, 83 subjects (50 men, and 33 women), 48 hours after being submitted to 1-RM tests in bench press, squat and arm curl performed a protocol composed by four sets at 1-RM 80% up to achieving the exhaustion in each of three exercises to evaluate the endurance ability to the fatigue in different muscular groups. It was used the ANOVA and ANCOVA for repeated measurements, followed by the Tukey's post hoc test, where P < 0.05 to the data treatment. It was verified a significant fall in the performance both in men and in women since the first up to the fourth sets of every exercise investigated (P < 0.01). Although the fatigue magnitude was higher in men in all the three exercises, the effect on the gender was only identified in the arm curl exercise (P < 0.01). The results of this study indicated that men and women presented quite different behavior in multiple sets of weight exercises, and women presented a more stable performance and a higher endurance ability to the fatigue in the arm curl as well.

Maximal lactate steady state in running rats

The higher concentration during exercise at which lactate entry in blood equals its removal is known as maximal lactate steady state (MLSS) and is considered an important indicator of endurance exercise capacity. The aim of the present study was to determine MLSS in running rats. Adult male Wistar sedentary rats, which were selected and adapted to treadmill running for three weeks, were used. After becoming familiarized with treadmill running, the rats were submitted to five exercise tests at 15, 20, 25, 30 and 35 m/min velocities. The velocity sequence was distributed at random. Each test consisted of continuous running for 25 min at one velocity or until the exhaustion. Blood lactate was determined at rest and each 5 min of exercise to find the MLSS. The running rats presented MLSS at the 20 m/min velocity, with blood lactate of 3.9±1.1 mmol/L. At the 15 m/min velocity, the blood lactate also stabilized, but at a lower concentration (3.2±1.1 mmol/L). There was a progressive increase in blood lactate concentration at higher velocities, and some animals reached exhaustion between the 10 th and 25 th minute of exercise. These results indicate that the protocol of MLSS can be used for determination of the maximal aerobic intensity in running rats.

Dynamic and isometric protocols of knee extension: Effect of fatigue on the EMG signal

The objective of this study was to analyze the electromyographic (EMG) signal behavior of rectus femoris (RF), vastus medialis (VM), vastus lateralis (VL) and biceps femoris (caput longum) (BFCL) from nine women during fatiguing dynamic and isometric knee extensions tests and to determine their EMGFT (Electromyographic Fatigue Threshold). Surface electrodes, biological signal acquisition module, analogical-digital converter board and specific software were used. The RMS (Root Mean Square) values obtained from concentric phase (80 to 30 degrees) of the dynamic knee extension andfrom isometric contraction were correlated with time on each load by linear regression analysis. The respective slopes were correlated with the correspondent load to determine the EMGFT. Force (Kgf) and median frequency - MF (Hz) obtained during MIVC (Maximal Isometric Voluntary Contraction) performed before and after the fatiguing tests were calculated in Matlab environment. The results demonstrated that the endurance time decreases with higher loads the EMG amplitude increase with time and was greater at higher loads, between muscles in dynamic exercise the RF and VL showed higher slopes, and in isometric exercise the VL showed the same behavior The EMGFT values were similar in both exercises; the force values predominantly decreased after fatiguing tests; however the MF only decreased after some loads. The protocols proposed allowed standardizing protocols at least to induce the fatigue process and to determine the EMGFT as an endurance indicative, which may be used to evaluate the effectiveness of rehabilitative or training interventions indicated to reduce muscle weakness and fatigue.

Effects of taper on swimming force and swimmer performance after an experimental ten-week training program

Papoti, M., L.E.B. Martins, S.A. Cunha, A.M. Zagatto, and C.A. Gobatto. Effects of taper on swimming force and swimmer performance after an experimental ten-week training program. J. Strength Cond. Res. 21(2):538-542. 2007.- The purpose of this research was to examine how an 11-day taper after an 8.5-week experimental training cycle affected lactate levels during maximal exercise, mean force, and performance in training swimmers, independent of shaving, psychological changes, and postcompetition effects. Fourteen competition swimmers with shaved legs and torsos were recruited from the São Paulo Aquatic Federation. The training cycle consisted of a basic training period (endurance and quality phases) of 8.5 weeks, with 5,800 m·d -1 mean training volume and 6 d·wk -1 frequency; and a taper period (TP) of 1.5 weeks' duration that incorporated a 48% reduction in weekly volume without altering intensity. Attained swimming force (SF) and maximal performance over 200m maximal swim (Pmax) before and after taper were measured. After taper, SF and Pmax improved 3.6 and 1.6%, respectively (p < 0.05). There were positive correlations (p < 0.05) between SF and Pmax before (r = 0.86) and after (r = 0.83) the taper phase. Peak lactate concentrations after SF were unaltered before (6.79 ± 1.2 mM) and after (7.15 ± 1.8 mM) TP. Results showed that TP improved mean swimming velocity, but not in the same proportion as force after taper, suggesting that there are other factors influencing performance in faster swimming. © 2007 National Strength & Conditioning Association.

Parâmetros fisiológicos do desempenho de cavalos de alta performance hidratados voluntariamente com água ou solução isotônica contendo carboidrato

During eight weeks, in summer, four endurance trained high performance horses were worked in resistence exercise, recieving two different types of hydratatio, water or an isotonic solution containing carbohydrates, with the objective to compare their performance physiological parameters. Only the RT (rectal temperature), HR (heart rate), RR (respiratory rate), weight, total protein, glucose, the electrolytes K, Ca and the muscular enzyme CK presented distance effect. The others parameters evaluated, there weren't any identified effects of treatment and of the interaction between distance and treatments, with a significancy level of 5%, and it was concluded that the isotonic solution containing carbohydrate didn't have any significant influence on the animal's performance when compared to water.

Efeito de um mês de destreinamento sobre a aptidão física relacionada à saúde em programa de mudança de estilo de vida

Physical exercise induces hemodynamic/ventilatory and neuromuscular adaptations that can be reverted with interruption of the training program. The aim of the present study was to evaluate the effect of detraining on physical fitness related to health. Forty-four healthy subjects, both male and female, aged 57.6±8.9 years performed the 'Mexa-se Pró-Saúde' protocol with nutritional orientation and supervised physical exercises for nine months. The program consisted of aerobic, localized muscular endurance and flexibility exercises, with duration 80 minutes/session, five days/week. Only subjects who participated in the program for more than three days/week have been selected. The detraining period was one month. Weight (kg) and height (m) were measured and the body mass index (BMI) calculated. Additionally, motors tests to evaluate the flexibility (FLEX), strength of lower limbs (SLL) and upper limbs (SUL), and maximal oxygen uptake (VO2máx) were conducted in the beginning of the study (MI), after nine months of practicing (MT) and after detraining period (MD). ANOVA (p<0.05) and Tukey test to show the difference between groups when it evidence were used for statistical treatment. The results showed that the gains of 22% and 7% on SLL and VO2máx respectively, obtained with the training, have not changed during the detraining period; however, the flexibility gain of 8% returned back to baseline after the detraining period. BMI and SUL did not change during the study. Although the lower limbs strength gains and maximal oxygen uptake obtained have been kept, one month of detraining was enough for losing the flexibility acquired.

Subjective, cardiovascular and EMG spectral recovery after lumbar extension exhaustion test

The purpose of this randomized study was to evaluate EMG spectral, subjective and cardiovascular recovery parameters after isometric lumbar extension contractions. Ten healthy women performed isometric lumbar extensions until exhaustion with 5%, 10%, 15% and 20% of maximal voluntary isometric contraction on 4 different days (random order). One baseline five second contraction was performed before the fatiguing task which was followed by eight submaximal five second extension contractions (until 20 minutes after the end of the fatiguing task) at the same intensity as the trial to evaluate muscle recovery. EMG (Median Frequency, Peak Power, Peak Power Frequency, Total Power and Zero-crossing Rate) and cardiovascular variables did not demonstrate any statistical difference between the 5-second contractions (p > 0.05) performed before and after the fatiguing task, showing a quick EMG recovery. However, the data analysis showed that the perceived effort variable had not recovered even 10 minutes after the fatigue contraction (p < 0.05). Our results represent a data basis for future comparisons and since subjective felling can affect performance, this study shows the importance of its analysis, since the subjective effort rate was not fully recovered after 10 minutes the end of the exhaustion contraction. © 2008 IOS Press. All rights reserved.

The effect of eccentric strength training on heart rate and on its variability during isometric exercise in healthy older men

The purpose of this study was to investigate if chronic eccentric strength training (ST) affects heart rate (HR) and heart rate variability (HRV) during sub-maximal isometric voluntary contractions (SIVC). The training group (TG) (9 men, 62 ± 2) was submitted to ST (12 weeks, 2 days/week, 2 - 4 sets of 8-12 repetitions at 75-80% peak torque (PT). The control group (CG) (8 men, 64 ± 4) did not perform ST. The HR and the HRV (RMSSD index) were evaluated during SIVC of the knee extension (15, 30 and 40% of PT). ST increased the eccentric torque only in TG, but did not change the isometric PT and the duration of SIVC. During SIVC, the HR response pattern and the RMSSD index were similar for both groups in pre- and post-training evaluations. Although ST increased the eccentric torque in the TG, it did not generate changes in HR or HRV. © Springer-Verlag 2008.

Glycogen storage and muscle glucose transporters (GLUT-4) of mice selectively bred for high voluntary wheel running

To examine the evolution of endurance-exercise behaviour, we have selectively bred four replicate lines of laboratory mice (Mus domesticus) for high voluntary wheel running ('high runner' or HR lines), while also maintaining four non-selected control (C) lines. By generation 16, HR mice ran ∼2.7-fold more than C mice, mainly by running faster (especially in females), a differential maintained through subsequent generations, suggesting an evolutionary limit of unknown origin. We hypothesized that HR mice would have higher glycogen levels before nightly running, show greater depletion of those depots during their more intense wheel running, and have increased glycogen synthase activity and GLUT-4 protein in skeletal muscle. We sampled females from generation 35 at three times (photophase 07:00 h-19:00 h) during days 5-6 of wheel access, as in the routine selection protocol: Group 1, day 5, 16:00 h-17:30 h, wheels blocked from 13:00 h; Group 2, day 6, 02:00 h-03:30 h (immediately after peak running); and Group 3, day 6, 07:00 h-08:30 h. An additional Group 4, sampled 16:00 h-17:30 h, never had wheels. HR individuals with the mini-muscle phenotype (50% reduced hindlimb muscle mass) were distinguished for statistical analyses comparing C, HR normal, and HR mini. HR mini ran more than HR normal, and at higher speeds, which might explain why they have been favored by the selective-breeding protocol. Plasma glucose was higher in Group 1 than in Group 4, indicating a training effect (phenotypic plasticity). Without wheels, no differences in gastrocnemius GLUT-4 were observed. After 5 days with wheels, all mice showed elevated GLUT-4, but HR normal and mini were 2.5-fold higher than C. At all times and irrespective of wheel access, HR mini showed approximately three-fold higher [glycogen] in gastrocnemius and altered glycogen synthase activity. HR mini also showed elevated glycogen in soleus when sampled during peak running. All mice showed some glycogen depletion during nightly wheel running, in muscles and/or liver, but the magnitude of this depletion was not large and hence does not seem to be limiting to the evolution of even-higher wheel running.

Stroke phases responses around maximal lactate steady state in front crawl

The objective of this study was to analyze changes in stroke rate (SR), stroke length (SL) and stroke phases (entry and catch, pull, push and recovery) when swimming at (MLSS) and above (102.5% MLSS) the maximal lactate steady state. Twelve endurance swimmers (21±8 year, 1.77±0.10m and 71.6±7.7kg) performed in different days the following tests: (1) 200- and 400-m all-out tests, to determine critical speed (CS), and; (2) 2-4 30-min sub-maximal constant-speed tests, to determine the MLSS and 102.5% MLSS. There was significant difference among MLSS (1.22±0.05ms-1), 102.5% MLSS (1.25±0.04ms-1) and CS (1.30±0.08ms-1). SR and SL were maintained between the 10th and 30th minute of the test swum at MLSS and have modified significantly at 102.5% MLSS (SR - 30.9±3.4 and 32.2±3.5cyclesmin-1 and SL - 2.47±0.2 and 2.38±0.2mcycle-1, respectively). All stroke phases were maintained at 10th and 30th minute at MLSS. However, the relative duration of propulsive phase B (pull) increased significantly at 102.5% MLSS (21.7±3.4% and 22.9±3.9%, respectively). Therefore, the metabolic condition may influence the stroke parameters (SR and SL) and stroke strategy to maintain the speed during swim tests lasting 30min. © 2010 Sports Medicine Australia.