A simplified minimal residual disease polymerase chain reaction method at early treatment points can stratify children with acute lymphoblastic leukemia into good and poor outcome groups

Background Minimal residual disease is an important independent prognostic factor in childhood acute lymphoblastic leukemia. The classical detection methods such as multiparameter flow cytometry and real-time quantitative polymerase chain reaction analysis are expensive, time-consuming and complex, and require considerable technical expertise. Design and Methods We analyzed 229 consecutive children with acute lymphoblastic leukemia treated according to the GBTLI-99 protocol at three different Brazilian centers. Minimal residual disease was analyzed in bone marrow samples at diagnosis and on days 14 and 28 by conventional homo/heteroduplex polymerase chain reaction using a simplified approach with consensus primers for IG and TCR gene rearrangements. Results At least one marker was detected by polymerase chain reaction in 96.4%, of the patients. By combining the minimal residual disease results obtained on days 14 and 28, three different prognostic groups were identified: minimal residual disease negative on days 14 and 28, positive on day 14/negative on day 28, and positive on both. Five-year event-free survival rates were 85%, 75.6%,, and 27.8%, respectively (p<0.0001). The same pattern of stratification held true for the group of intensively treated children. When analyzed in other subgroups of patients such as those at standard and high risk at diagnosis, those with positive B-derived CD10, patients positive for the TEL/AML1 transcript, and patients in morphological remission on a day 28 marrow, the event-free survival rate was found to be significantly lower in patients with positive minimal residual disease on day 28. Multivariate analysis demonstrated that the detection of minimal residual disease on day 28 is the most significant prognostic factor. Conclusions This simplified strategy for detection of minimal residual disease was feasible, reproducible, cheaper and simpler when compared with other methods, and allowed powerful discrimination between children with acute lymphoblastic leukemia with a good and poor outcome.

Rest energy expenditure is decreased during the acute as compared to the recovery phase of sepsis in newborns

Background: Little is known with respect to the metabolic response and the requirements of infected newborns. Moreover, the nutritional needs and particularly the energy metabolism of newborns with sepsis are controversial matter. In this investigation we aimed to evaluate the rest energy expenditure (REE) of newborns with bacterial sepsis during the acute and the recovery phases. Methods: We studied nineteen neonates (27.3 +/- 17.2 days old) with bacterial sepsis during the acute phase and recovery of their illness. REE was determined by indirect calorimetry and VO(2) and VCO(2) measured by gas chromatography. Results: REE significantly increased from 49.4 +/- 13.1 kcal/kg/day during the acute to 68.3 +/- 10.9 kcal/kg/day during recovery phase of sepsis (P < 0.01). Similarly, VO(2) (7.4 +/- 1.9 vs 10 +/- 1.5 ml/kg/min) and VCO(2) (5.1 +/- 1.7 vs 7.4 +/- 1.5 ml/kg/min) were also increased during the course of the disease (P < 0.01). Conclusion: REE was increased during recovery compared to the sepsis phase. REE of septic newborns should be calculated on individualized basis, bearing in mind their metabolic capabilities.

Low urinary 6-sulphatoxymelatonin concentrations in acute migraine

Substantial evidence points to melatonin as playing a role in the regulation of circadian rhythms, sleep, and headache disorders. The objective of the study was to assess 6-sulphatoxymelatonin (aMT6s) levels in a large consecutive series of patients with migraine, comparing with controls. A total of 220 subjects were evaluated-146 had migraine and 74 were control subjects. Urinary samples were collected into the same plastic container since 8:00 p.m. to 8:00 a.m. of the next day (12-h period) and aMT6s was measured with quantitative ELISA technique. Among patients with migraine, 53% presented pain on the day of the urine samples collection. Their urinary aMT6s concentration was significantly lower than in the urine of patients without pain [14.0 +/- 7.3 vs. 49.4 +/- 19.0; t(143) = -15.1; 95% CI = -40.0 to -30.8; P<0.001]. There was no significant difference in the aMT6s concentration of patients with migraine without pain on the day of their urine samples collection and controls [49.4 +/- 19.0 vs. 42.5 +/- 27.9; t(140) = 1.7; 95% CI = -1.2 to 14.8; P = 0.094]. To our knowledge, this is the first study to demonstrate reduction in melatonin levels during attacks in episodic and chronic migraine.

Social Networks Shape the Transmission Dynamics of Hepatitis C Virus

Hepatitis C virus (HCV) infects 170 million people worldwide, and is a major public health problem in Brazil, where over 1% of the population may be infected and where multiple viral genotypes co-circulate. Chronically infected individuals are both the source of transmission to others and are at risk for HCV-related diseases, such as liver cancer and cirrhosis. Before the adoption of anti-HCV control measures in blood banks, this virus was mainly transmitted via blood transfusion. Today, needle sharing among injecting drug users is the most common form of HCV transmission. Of particular importance is that HCV prevalence is growing in non-risk groups. Since there is no vaccine against HCV, it is important to determine the factors that control viral transmission in order to develop more efficient control measures. However, despite the health costs associated with HCV, the factors that determine the spread of virus at the epidemiological scale are often poorly understood. Here, we sequenced partial NS5b gene sequences sampled from blood samples collected from 591 patients in Sao Paulo state, Brazil. We show that different viral genotypes entered Sao Paulo at different times, grew at different rates, and are associated with different age groups and risk behaviors. In particular, subtype 1b is older and grew more slowly than subtypes 1a and 3a, and is associated with multiple age classes. In contrast, subtypes 1a and 3b are associated with younger people infected more recently, possibly with higher rates of sexual transmission. The transmission dynamics of HCV in Sao Paulo therefore vary by subtype and are determined by a combination of age, risk exposure and underlying social network. We conclude that social factors may play a key role in determining the rate and pattern of HCV spread, and should influence future intervention policies.

Hepatitis B Infection Is Associated with Asymptomatic Malaria in the Brazilian Amazon

Background: Areas that are endemic for malaria are also highly endemic for hepatitis B virus (HBV) infection. Nevertheless, it is unknown whether HBV infection modifies the clinical presentation of malaria. This study aimed to address this question. Methodology and Findings: An observational study of 636 individuals was performed in Rondonia, western Amazon, Brazil between 2006 and 2007. Active and passive case detections identified Plasmodium infection by field microscopy and nested Polymerase Chain Reaction (PCR). HBV infections were identified by serology and confirmed by real-time PCR. Epidemiological information and plasma cytokine profiles were studied. The data were analyzed using adjusted multinomial logistic regression. Plasmodium-infected individuals with active HBV infection were more likely to be asymptomatic (OR: 120.13, P < 0.0001), present with lower levels of parasitemia and demonstrate a decreased inflammatory cytokine profile. Nevertheless, co-infected individuals presented higher HBV viremia. Plasmodium parasitemia inversely correlated with plasma HBV DNA levels (r=-0.6; P=0.0003). Conclusion: HBV infection diminishes the intensity of malaria infection in individuals from this endemic area. This effect seems related to cytokine balance and control of inflammatory responses. These findings add important insights to the understanding of the factors affecting the clinical outcomes of malaria in endemic regions.

VEGF Promotes Malaria-Associated Acute Lung Injury in Mice

The spectrum of the clinical presentation and severity of malaria infections is broad, ranging from uncomplicated febrile illness to severe forms of disease such as cerebral malaria (CM), acute lung injury (ALI), acute respiratory distress syndrome (ARDS), pregnancy-associated malaria (PAM) or severe anemia (SA). Rodent models that mimic human CM, PAM and SA syndromes have been established. Here, we show that DBA/2 mice infected with P. berghei ANKA constitute a new model for malaria-associated ALI. Up to 60% of the mice showed dyspnea, airway obstruction and hypoxemia and died between days 7 and 12 post-infection. The most common pathological findings were pleural effusion, pulmonary hemorrhage and edema, consistent with increased lung vessel permeability, while the blood-brain barrier was intact. Malaria-associated ALI correlated with high levels of circulating VEGF, produced de novo in the spleen, and its blockage led to protection of mice from this syndrome. In addition, either splenectomization or administration of the anti-inflammatory molecule carbon monoxide led to a significant reduction in the levels of sera VEGF and to protection from ALI. The similarities between the physiopathological lesions described here and the ones occurring in humans, as well as the demonstration that VEGF is a critical host factor in the onset of malaria-associated ALI in mice, not only offers important mechanistic insights into the processes underlying the pathology related with malaria but may also pave the way for interventional studies.

ACUTE EFFECT OF A BALLISTIC AND A STATIC STRETCHING EXERCISE BOUT ON FLEXIBILITY AND MAXIMAL STRENGTH

Bacurau, RFP, Monteiro, GA, Ugrinowitsch C, Tricoli, V, Cabral, LF, Aoki, MS. Acute effect of a ballistic and a static stretching exercise bout on flexibility and maximal strength. J Strength Cond Res 23(1): 304-308, 2009-Different stretching techniques have been used during warm-up routines. However, these routines may decrease force production. The purpose of this study was to compare the acute effect of a ballistic and a static stretching protocol on lower-limb maximal strength. Fourteen physically active women (169.3 +/- 8.2 cm; 64.9 +/- 5.9 kg; 23.1 +/- 3.6 years) performed three experimental sessions: a control session (estimation of 45 degrees leg press one-repetition maximum [1RM]), a ballistic session (20 minutes of ballistic stretch and 45 degrees leg press 1RM), and a static session (20 minutes of static stretch and 45 degrees leg press 1RM). Maximal strength decreased after static stretching (213.2 +/- 36.1 to 184.6 +/- 28.9 kg), but it was unaffected by ballistic stretching (208.4 +/- 34.8 kg). In addition, static stretching exercises produce a greater acute improvement in flexibility compared with ballistic stretching exercises. Consequently, static stretching may not be recommended before athletic events or physical activities that require high levels of force. On the other hand, ballistic stretching could be more appropriate because it seems less likely to decrease maximal strength.

Acute physiological responses to different circuit training protocols

Aim. The purpose of present study was to compare the acute physiological responses to a circuit weight training with the responses to a combined circuit training (weight training and treadmill run). Methods. The sample consisted of 25 individuals at an average state of training, 10 men and 15 female, between 18 and 35 year old. There were selected 60 second sets of resistance exercises to the circuit weight training (CWT). Whereas in the combined circuit training (CCT), the subjects spent 30 seconds on the same resistance exercises and 30 seconds running on the treadmill. The rest intervals between the sets lasted 15 seconds. The analysis of variance (ANOVA) with 5% significance level was utilized to the statistical analysis of the results. Results. Comparing circuit training protocols, it was noted that CCT elicits a higher relative and absolute <(V)over dot>O(2) and energy expenditure values than CWT for both genders (P<0.05). Regarding inter-gender comparison, males showed higher absolute and relative <(V)over dot>O(2) and absolute energy expenditure values for both CWT and CCT than females (P<0.05). Females showed a significant greater % <(V)over dot>O(2max) value for both CWT and CCT. Due to the experimental conditions used to state both circuit training bouts (CWT and CCT), the <(V)over dot>O(2) rate found was higher than the values reported by previous studies which used heavier weight lift. Conclusion. CCT seems adequate to produce cardiovascular improvements and greater energy expenditure for both men and women, while CWT group classes are sufficient only for unfit women.

Hydration and N-acetylcysteine in acute renal failure caused by iodinated contrast medium: an experiment with rats

Background: The involvement of nephrotoxic agents in acute renal failure (ARF) has increased over the last few decades. Among the drugs associated with nephrotoxic ARF are the radiologic contrast media whose nephrotoxic effects have grown, following the increasing diagnostic use of these agents. Methods: We evaluated the effect of iodinated contrast (IC) medium, administered in combination, or not, with hyperhydration or N-acetylcysteine (NAC), on creatinine clearance, production of urinary peroxides and renal histology of rats. Adult Wistar rats treated for 5 days were divided into the following groups: control (saline, 3 ml/kg/day, intraperitoneally [i.p.]), IC (sodium iothalamate meglumine, 3 ml/kg/day i.p.), IC + water (12 mL water, orally + IC, 3 ml/kg/day i.p. after 1 hour), IC + NAC (NAC, 150 mg/kg/day, orally + IC, 3 ml/kg/day i.p. after 1 hour) and IC + water + NAC. Results: IC medium reduced renal function, with maintenance of urinary flow. Hyperhydration did not reduce the nephrotoxic effect of the IC agent, which was observed in the group IC + NAC. The combination of hyperhydration and NAC had no superior protective effect compared with NAC alone. An increase in urinary peroxides was observed in the IC group, with NAC or water or the combination of both reducing this parameter. Histopathologic analysis revealed no significant alterations. Conclusions: In summary, given 5 days previously, NAC was found to be more effective than hyperhydration alone in the prevention of contrast-induced acute renal failure.

Acute Streptococcus agalactiae endocarditis: Outcomes of early surgical treatment

The incidence of Streptococcus agalactiae is widely recognized as increasing in nonpregnant adults. This report describes a retrospective case series of S. agalactiae endocarditis at the Heart Institute of Sao Paulo, Brazil, between 2000 and 2006. Early diagnosis and valve surgery seem to have contributed to improved patient outcomes. (Heart Lung (R) 2010;39:331-334.)

Acute and chronic effects of exercise on inflammatory markers and B-type natriuretic peptide in patients with coronary artery disease

Few studies have prospectively addressed the effects of exercise in the inflammatory activity of patients with coronary artery disease (CAD). We sought to evaluate the consequences of an acute bout of exercise on inflammatory markers and BNP in untrained CAD patients before and after randomization to a training program. 34 CAD patients underwent a 50-min acute exercise session on a cycle-ergometer at 65% peak oxygen uptake before and after blood sampling. They were then randomized to a 4-month chronic exercise program (15 patients) or general lifestyle recommendations (19 patients), undergoing a new acute session of exercise after that. In the overall population, acute exercise caused a significant increase in C-reactive protein [CRP; 1.79 (4.49) vs. 1.94 (4.89) mg/L, P < 0.001], monokine induced by interferon-gamma [Mig; 351 (324) vs. 373 (330) pg/mL, P = 0.027] and vascular adhesion molecule-1 [VCAM-1; 226 (82) vs. 252 (110) pg/mL, P = 0.02]. After 4-months, in exercise-trained patients, there was a significant decrease in the inflammatory response provoked by the acute exercise compared to patients in the control group reflected by a significant decrease in the differences between rest and post-exercise levels of CRP [-0.29 (0.84) mg/L vs. -0.11 (0.21) mg/L, P = 0.05]. Resting BNP was also significantly lower in exercise-trained patients when compared to untrained controls [15.6 (16.2) vs. 9.7 (11.4) pg/mL, P = 0.04 and 19.2 (27.8) vs. 23.2 (27.5) pg/mL, P = 0.76; respectively]. Chronic exercise training might partially reverse the inflammatory response caused by acute exercise in CAD patients. These results suggest that regular exercise is an important nonpharmacological strategy to the improvement in inflammation in CAD patients.

Is acute supramaximal exercise capable of modulating lipoprotein profile in healthy men?

P>Background This study examined the effects of acute supramaximal exercise (similar to 115% VO(2max)) on the blood lipid profile for three different carbohydrate (CHO) storage levels (control, low and high). Methods Six male subjects were randomly divided into three different groups: control, low CHO and high CHO. These groups differed in the diet to which the subjects were submitted before each exercise session. The lipid profile [triglycerides (TG), very low-density lipoprotein (VLDL), high-density lipoprotein (HDL)-cholesterol, low-density lipoprotein (LDL)-cholesterol, TG/HDL-C ratio and total cholesterol) was determined at rest, immediately after exercise and 1 h after exercise bouts. Results The time to exhaustion was lower in the low CHO condition compared with the control and high CHO condition (3 center dot 59 +/- 0 center dot 72; 2 center dot 91 +/- 0 center dot 56; and 4 center dot 26 +/- 0 center dot 69 min; P < 0 center dot 05). The energy expenditure (control: 251 center dot 1 +/- 56 center dot 0 kJ; low CHO: 215 center dot 2 +/- 28 center dot 6 kJ; and high CHO: 310 center dot 4 +/- 64 center dot 9 kJ) was significantly different between the low and high CHO conditions (P < 0 center dot 05). There were no significant changes in the lipid profile for any of the experimental conditions (control, low and high; P < 0 center dot 05). Glucose and insulin levels did not show time-dependent changes in any of the conditions (P > 0 center dot 05). Conclusions These results indicate that a supramaximal exercise session has no significant effects on lipid metabolism.

Is acute static stretching able to reduce the time to exhaustion at power output corresponding to maximal oxygen uptake?

Samogin Lopes, FA, Menegon, EM, Franchini, E, Tricoli, V, and de M. Bertuzzi, RC. Is acute static stretching able to reduce the time to exhaustion at power output corresponding to maximal oxygen uptake? J Strength Cond Res 24(6): 1650-1656, 2010-This study analyzed the effect of an acute static stretching bout on the time to exhaustion (T(lim)) at power output corresponding to (V) over dotO(2)max. Eleven physically active male subjects (age 22.3 +/- 2.8 years, (V) over dotO(2)max 2.7 +/- 0.5 L . min(-1)) completed an incremental cycle ergometer test, 2 muscle strength tests, and 2 maximal tests to exhaustion at power output corresponding to (V) over dotO(2)max with and without a previous static stretching bout. The T(lim) was not significantly affected by the static stretching (164 +/- 28 vs. 150 +/- 26 seconds with and without stretching, respectively, p = 0.09), but the time to reach (V) over dotO(2)max (118 +/- 22 vs. 102 +/- 25 seconds), blood-lactate accumulation immediately after exercise (10.7 +/- 2.9 vs. 8.0 +/- 1.7 mmol . L(-1)), and oxygen deficit (2.4 +/- 0.9 vs. 2.1 +/- 0.7 L) were significantly reduced (p <= 0.02). Thus, an acute static stretching bout did not reduce T(lim) at power output corresponding to (V) over dotO(2)max possibly by accelerating aerobic metabolism activation at the beginning of exercise. These results suggest that coaches and practitioners involved with aerobic dependent activities may use static stretching as part of their warm-up routines without fear of diminishing high-intensity aerobic exercise performance.

Acute high-intensity exercise with low energy expenditure reduced LDL-c and total cholesterol in men

A reduction in LDL cholesterol and an increase in HDL cholesterol levels are clinically relevant parameters for the treatment of dyslipidaemia, and exercise is often recommended as an intervention. This study aimed to examine the effects of acute, high-intensity exercise (similar to 90% VO(2max)) and varying carbohydrate levels (control, low and high) on the blood lipid profile. Six male subjects were distributed randomly into exercise groups, based on the carbohydrate diets (control, low and high) to which the subjects were restricted before each exercise session. The lipid profile (triglycerides, VLDL, HDL cholesterol, LDL cholesterol and total cholesterol) was determined at rest, and immediately and 1 h after exercise bouts. There were no changes in the time exhaustion (8.00 +/- A 1.83; 7.82 +/- A 2.66; and 9.09 +/- A 3.51 min) and energy expenditure (496.0 +/- A 224.8; 411.5 +/- A 223.1; and 592.1 +/- A 369.9 kJ) parameters with the three varying carbohydrate intake (control, low and high). Glucose and insulin levels did not show time-dependent changes under the different conditions (P > 0.05). Total cholesterol and LDL cholesterol were reduced after the exhaustion and 1 h recovery periods when compared with rest periods only in the control carbohydrate intake group (P < 0.05), although this relation failed when the diet was manipulated. These results indicate that acute, high-intensity exercise with low energy expenditure induces changes in the cholesterol profile, and that influences of carbohydrate level corresponding to these modifications fail when carbohydrate (low and high) intake is manipulated.

Acute effects and postactivation potentiation in the special judo fitness test

Miarka, B, Del Vecchio, FB, and Franchini, E. Acute effects and postactivation potentiation in the special judo fitness test. J Strength Cond Res 25(2): 427-431, 2011-The purpose of this study was to compare the acute short-term effects of (1) plyometric exercise, (2) combined strength and plyometric exercise (contrast), and (3) maximum strength performance in the Special Judo Fitness Test (SJFT). Eight male judo athletes (mean +/- SD, age, 19 +/- 1 years; body mass, 60.4 +/- 5 kg; height, 168.3 +/- 5.4 cm) took part in this study. Four different sessions were completed; each session had 1 type of intervention: (a) SJFT control, (b) plyometric exercises + SJFT, (c) maximum strength + SJFT, and (d) contrast + SJFT. The following variables were quantified: throws performed during series A, B, and C; total number of throws; heart rate immediately and 1 minute after the test; and test index. Significant differences were found in the number of throws during series A: the plyometric exercise (6.4 +/- 0.5 throws) was superior (p < 0.05) to the control condition (5.6 +/- 0.5 throws). Heart rate 1 minute after the SJFT was higher (p < 0.01) during the plyometric exercise (192 +/- 8 bpm) than during the contrast exercise (184 +/- 9 bpm). The contrast exercise (13.58 +/- 0.72) resulted in better index values than the control (14.67 +/- 1.30) and plyometric exercises (14.51 +/- 0.54). Thus, this study suggests that contrast and plyometric exercises performed before the SJFT can result in improvements in the test index and anaerobic power of judo athletes, respectively.