Tai Chi Chuan for Cardiac Rehabilitation in Patients with Coronary Arterial Disease

Background:Several studies have shown that Tai Chi Chuan can improve cardiac function in patients with heart disease.Objective:To conduct a systematic review of the literature to assess the effects of Tai Chi Chuan on cardiac rehabilitation for patients with coronary artery disease.Methods:We performed a search for studies published in English, Portuguese and Spanish in the following databases: MEDLINE, EMBASE, LILACS and Cochrane Register of Controlled Trials. Data were extracted in a standardized manner by three independent investigators, who were responsible for assessing the methodological quality of the manuscripts.Results:The initial search found 201 studies that, after review of titles and abstracts, resulted in a selection of 12 manuscripts. They were fully analyzed and of these, nine were excluded. As a final result, three randomized controlled trials remained. The studies analyzed in this systematic review included patients with a confirmed diagnosis of coronary artery disease, all were clinically stable and able to exercise. The three experiments had a control group that practiced structured exercise training or received counseling for exercise. Follow-up ranged from 2 to 12 months.Conclusion:Preliminary evidence suggests that Tai Chi Chuan can be an unconventional form of cardiac rehabilitation, being an adjunctive therapy in the treatment of patients with stable coronary artery disease. However, the methodological quality of the included articles and the small sample sizes clearly indicate that new randomized controlled trials are needed in this regard.

South American Guidelines for Cardiovascular Disease Prevention and Rehabilitation

In this document, the Inter-American Committee of Cardiovascular Prevention and Rehabilitation, together with the South American Society of Cardiology, aimed to formulate strategies, measures, and actions for cardiovascular disease prevention and rehabilitation (CVDPR). In the context of the implementation of a regional and national health policy in Latin American countries, the goal is to promote cardiovascular health and thereby decrease morbidity and mortality. The study group on Cardiopulmonary and Metabolic Rehabilitation from the Department of Exercise, Ergometry, and Cardiovascular Rehabilitation of the Brazilian Society of Cardiology has created a committee of experts to review the Portuguese version of the guideline and adapt it to the national reality. The mission of this document is to help health professionals to adopt effective measures of CVDPR in the routine clinical practice. The publication of this document and its broad implementation will contribute to the goal of the World Health Organization (WHO), which is the reduction of worldwide cardiovascular mortality by 25% until 2025. The study group's priorities are the following: • Emphasize the important role of CVDPR as an instrument of secondary prevention with significant impact on cardiovascular morbidity and mortality; • Join efforts for the knowledge on CVDPR, its dissemination, and adoption in most cardiovascular centers and institutes in South America, prioritizing the adoption of cardiovascular prevention methods that are comprehensive, practical, simple and which have a good cost/benefit ratio; • Improve the education of health professionals and patients with education programs on the importance of CVDPR services, which are directly targeted at the health system, clinical staff, patients, and community leaders, with the aim of decreasing the barriers to CVDPR implementation.

Regent advances in the study of the mineral nutrition of cotton in Brazil

Due to the great economic importance of the cotton crop to Brazil, a systematic series of research work has been carried out in recent years dealing with its mineral nutrition an fertilization. A summary of recent finding is given in the following sections.

Studies on the mineral nutrition and fertilization of the passion fruit plant (Passiflora edulis f. flavicarpa): II - placement of fertilizer phosphorus

A localização do superfosfato (marcado com P32) no maracujá em produção foi estudada em condições de plantação comercial. Verificou-se que as aplicações em sulcos circulares ou faixas superficiais ao redor da planta tem eficiência equivalente sendo esses métodos três vezes superiores à localização do adubo em furos no solo. A pulverização foliar, por sua vez, mostrou-se 20 vezes mais eficiente que a aplicação no solo de acordo com os dois primeiros métodos.

Studies on the mineral nutrition and fertilization of the passion fruit plant (Passiflora edulis F. flavicarpa): II. placement of fertilizer phosphorus

1. Tagged superphosphate was applied to 2.5 year old passion fruit plants from a commercial plantation established in a sandy loam. 2. 100 grams of the fertilizer were distributed in the following ways: in a circular furrow 20 cm around the plant 40 cm from the stems; in a circular strip 10 cm wide, 40 cm from the stems; in six holes around the plants, 40 cm from the stems 20 cm deep, 2.5 cm in diameter. 3. 10 grams of the fertilizer in 11 of water were sprayed to the leaves. 4. Three weeks after the treatments were made, leaf samples were taken for analysis. 5. Determinations of specific activities both in the leaves and in the fertilizer used have shown that R in the plant was derived from the superphosphate in the following relative proportions (by making the first treatment equal to 100): circular furrow = 100; circular strip = 120; holes = 30; foliar spray = 230.

Development and current use of parenteral nutrition in critical care - an opinion paper.

Critically ill patients depend on artificial nutrition for the maintenance of their metabolic functions and lean body mass, as well as for limiting underfeeding-related complications. Current guidelines recommend enteral nutrition (EN), possibly within the first 48 hours, as the best way to provide the nutrients and prevent infections. EN may be difficult to realize or may be contraindicated in some patients, such as those presenting anatomic intestinal continuity problems or splanchnic ischemia. A series of contradictory trials regarding the best route and timing for feeding have left the medical community with great uncertainty regarding the place of parenteral nutrition (PN) in critically ill patients. Many of the deleterious effects attributed to PN result from inadequate indications, or from overfeeding. The latter is due firstly to the easier delivery of nutrients by PN compared with EN increasing the risk of overfeeding, and secondly to the use of approximate energy targets, generally based on predictive equations: these equations are static and inaccurate in about 70% of patients. Such high uncertainty about requirements compromises attempts at conducting nutrition trials without indirect calorimetry support because the results cannot be trusted; indeed, both underfeeding and overfeeding are equally deleterious. An individualized therapy is required. A pragmatic approach to feeding is proposed: at first to attempt EN whenever and as early as possible, then to use indirect calorimetry if available, and to monitor delivery and response to feeding, and finally to consider the option of combining EN with PN in case of insufficient EN from day 4 onwards.

Enteral versus parenteral nutrition: comparison of energy metabolism in healthy subjects.

Continuous respiratory exchange measurements were performed on 10 healthy young women for 1 h before, 3 h during, and 3 h after either parenteral (iv) or intragastric (ig) administration of a nutrient mixture (52% glucose, 18% amino acid, and 30% lipid energy) infused at twice the postabsorptive resting energy expenditure (REE). REE rose from 0.98 +/- 0.02 (iv) and 0.99 +/- 0.02 kcal/min (ig) postabsorptively to 1.13 +/- 0.03 (iv) and 1.13 +/- 0.02 kcal/min (ig), resulting in nutrient-induced thermogenesis of 10 +/- 0.6 and 9.3 +/- 0.9%, respectively, when related to the metabolizable energy. The respiratory quotient rose from preinfusion values of 0.81 +/- 0.02 (iv) and 0.80 +/- 0.01 (ig) to 0.86 +/- 0.01 (iv) and 0.85 +/- 0.01 (ig). After nutrient administration the respiratory quotient fell significantly to below the preinfusion values. Plasma glucose and insulin concentrations rose during nutrient administration but were higher during the intravenous route. It is concluded that, although the response time to intragastric administration was delayed, the thermic effects and overall substrate oxidations were comparable during intravenous or intragastric administration, albeit, at lower plasma glucose and insulin concentrations via the intragastric route.

Nouvelles pistes pour la réhabilitation respiratoire dons la bronchopneumopathie chronique obstructive (BPCO) [New perspectives for respiratory rehabilitation in COPD].

COPD is associated with some skeletal muscle dysfunction which contributes to a poor exercise tolerance. This dysfunction results from multiple factors: physical inactivity, corticosteroids, smoking, malnutrition, anabolic deficiency, systemic inflammation, hypoxia, oxidative stress. Respiratory rehabilitation is based on exercise training and allows patients with COPD to experience less dyspnoea, and to improve their exercise tolerance and quality of life. Not all patients, however, benefit from rehabilitation. Acknowledging the different factors leading to muscular dysfunction allows one to foresee new avenues to improve efficacy of exercise training in COPD.