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Patients experiencing a cerebrovascular event are vulnerable to declining nutritional status, hindering rehabilitation. This study aims to analyze the association between malnutrition risk and hospital rehabilitation indicators in ischemic stroke survivors (ISS). This analytical study examined medical records of 160 adult patients (69.3 ± 13 years). Undernutrition risk (UR; independent variable) and rehabilitation indicators (dependent variables) like hospital stay, clinical outcome, functionality, stroke severity, food intake, mobility (bedridden), mechanical ventilation, and enteral nutrition were assessed. Data were dichotomized, and the chi-square test identified associations (p ≤ 0.05), followed by Poisson regression for prevalence ratios. Patients at UR had 2-fold higher risk of death (95% confidence interval [CI], 0.99-4.79), 1.8-fold higher risk of high stroke severity (95% CI, 1.06-3.11), 76% higher chance of being bedridden (95% CI, 1.28-2.44), and 3-fold higher risk of mechanical ventilation (95% CI, 1.20-9.52). UR in hospitalized ISS is associated with deteriorating rehabilitation indicators, including mobility, decreased food intake, mechanical ventilation use, and neurological deficit, indicating an increased mortality risk post-stroke., Competing Interests: Conflict of Interest: The authors have no potential conflicts of interest to disclose., (Copyright © 2024. Korean Society for Neurorehabilitation.)

Color stability is among the most frequent causes of restoration failures, and influences surface properties., Aim: The aim of this study was to investigate the influence of pigment solutions on low-shrinkage and conventional composites regarding changes in the physical properties of composite surfaces., Materials and Method: Specimens of four composites (Filtek Z350 XT, Point 4, N'Durance and Venus Diamond) were randomly distributed into three groups to be submitted to each of three pigment solutions (red wine, tomato sauce and coffee) in fifteen-minute daily cycles, for twenty-eight days. There were 12 groups altogether (n = 10). Color, surface roughness and hardness tests were performed. Statistical analysis includedAnalysis of variance (ANOVA) and Tukey's significance test (a = 0.05)., Results: Color changes caused by the solutions did not differ significantly among Filtek Z350 XT, Venus Diamond and N'Durance. Hardness decreased significantly in Filtek Z350 XT and Venus Diamond after chemical challenge with each solution. For the composite independent factor, roughness was highest in Venus Diamond, followed by Filtek Z350 XT, Point 4 and N'Durance., Conclusions: Treatment with different pigment solutions (red wine, tomato sauce or coffee) increased stainability and decreased hardness of both low-shrinkage and conventional composites, while roughness was unaffected., Competing Interests: The authors declare no potential conflicts of interest regarding the research, authorship, and/or publication of this article.

Objectives: The aim of the study was to describe the cost and factors associated with the hospitalization of patients undergoing heart transplantation., Methods: A cross-sectional, descriptive study with a quantitative approach developed at an important heart transplant center in southern Brazil. Twenty patients who had undergone transplantation during the period 2007 to 2016 were included in the study. Central tendency measures and values presented as mean ± SD or median and quartiles were calculated. Multiple linear regression was performed to verify the variables that interfered with the cost., Results: The cost of hospitalization of patients undergoing heart transplantation was $522,997.26 in Brazilian reals ($220,002.58 in US dollars). The Brazilian public health system was responsible for paying the hospital bill of all patients. Female sex, patients up to 40 years of age, and length of stay in the hospital units were variables that were related to the highest values for the hospital service. Clinical complications of the patients during the hospitalization period were also factors that were related to the greater length of stay in the hospitalization units, reflecting higher expenses for the health institution., Conclusions: There is a need for health managers to implement strategies that will minimize complications, such as health care-related infections, that can be prevented during hospitalization and to stimulate the allocation of resources in order to improve care and reduce hospital expenses., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: Several lines of evidence from the last decade support the connection between nutrition and epigenetic mechanisms. In the present study we evaluated the impact of the daily dietary intake of calories and the micronutrients vitamin A, D, B1, B2, B5, C, E, copper, calcium, phosphorus, iron, iodine, selenium, manganese, potassium and sodium on the global DNA methylation profile of blood cells from older individuals., Research Methods and Procedures: The study enrolled 126 physically independent elderly of both sexes (60 men and 66 women). For the molecular analysis, DNA samples were extracted from leukocytes and global DNA methylation was evaluated using a high throughput Elisa-based method. Correlations between global DNA methylation and the daily intake of calorie or micronutrients were evaluated using Prism5 GraphPad Software., Results: A statistically significant correlation was observed between global DNA methylation and the daily caloric value (p=0.019, r=-0.21), and the intake of vitamin A (p=0.03, r=-0.18), Vitamin E (p=0.027, r=-0.20) and copper (p=0.04, r=-0.18). No correlation was observed between global DNA methylation and the daily intake of vitamin D, B1, B2, B5, C, calcium, phosphorus, iron, iodine, selenium, manganese and potassium (p>0.05)., Conclusion: Our data demonstrate that the daily intake of calories or the micronutrients vitamin A, vitamin E and copper can potentially modulate the global DNA methylation profile of leukocytes in older adults and corroborate the notion of nutritional influences on epigenetic mechanisms., Competing Interests: The authors declare that they have no conflict of interest

Background: The terms sedentary behavior and physical inactivity have been confusingly mixed. Although the association between physical inactivity and mortality has been shown previously in subjects with COPD, this association had not yet been investigated with regard to sedentarism. The aim of this work was to investigate the impact of sedentary behavior on mortality of subjects with COPD and to propose a cutoff point of sedentarism with prognostic value., Methods: In this retrospective cohort study, sedentary behavior was assessed with 2 activity monitors (DynaPort and Sensewear armband) in 101 subjects with COPD from 2006 to 2011. Vital status was then ascertained in 2015. The following 6 variables of sedentary behavior were analyzed: average of metabolic equivalent of task (MET)/d (reflecting intensity); time spent/d lying, sitting, and lying + sitting (reflecting duration of sedentary postures); and time spent/d in activities requiring <1.5 MET and <2 MET (reflecting intensity and duration of sedentary time). Cutoff points for sedentarism and their respective prognostic values were investigated for each variable., Results: Forty-one subjects (41%) died over a median (interquartile range) follow-up period of 62 (43-88) months. After adjusting for potential confounders in the Cox regression model, cutoff points from variables that combine duration of sedentary time and intensity <1.5 MET or <2 MET were associated with the increased risk of mortality. The strongest independent cutoff for predicting mortality was ≥8.5 h/d spent in sedentary activities <1.5 MET (area under the curve 0.76; hazard ratio 4.09, 95% CI 1.90-8.78; P < .001)., Conclusions: Sedentary behavior was an independent predictor of mortality in subjects with COPD, even adjusting for moderate-to-vigorous physical activity and a number of other variables. Mortality was higher in subjects with COPD who spend ≥8.5 h/d in activities requiring <1.5 MET. These findings may open room for future studies aiming at decreasing sedentary time as a promising strategy to reduce mortality risk in subjects with COPD., (Copyright © 2017 by Daedalus Enterprises.)

Purpose: To investigate the influence of the presence of Temporomandibular Disorders (TMD) on postural balance in elderly individuals., Methods: The study sample consisted of 150 elderly: 103 women (67.7±5.0 years) and 47 men (69.3±5.5 years). Evaluation of the presence and severity of TMD included an anamnesis questionnaire, an evaluation of the temporomandibular joint (TMJ), and a muscular examination, which allowed the division of the elderly into 2 groups: G1 (experimental, n=95), with TMD; G2 (control, n=55), without TMD. Postural balance was assessed by means of the one-leg stance test (OLST) on a force platform (BIOMEC400), thus permitting the following measurements: center of foot pressure (COP); mean sway velocity (MV) and frequency (MF) of COP in both the anteroposterior (VAP and FAP) and medial/lateral (VML and FML) directions. The statistical analysis of data was performed using independent t-test, Variance Analysis, and Chi Square test (α=5%)., Results: Presence of TMD was observed in 63.3% of the individuals (Group 2), with different degrees of severity (mild: 42.7%, moderate: 14.7%, severe: 6%). Significantly higher TMD was observed for women (73.8%) compared with men (40.4%) (p=0.0002). No significant difference was found in between the groups for all balance parameters, e.g., presence and severity of TMD, presence of pain to palpation of TMJ and of masticatory and cervical muscles., Conclusion: The presence and severity of TMD, in addition to the presence of pain to palpation of TMJ and masticatory and cervical muscles did not alter the variables related to postural balance in this population.

Background: Studies have shown that individuals with COPD have impaired body balance, probably caused by the disease's multisystemic manifestations plus age-related decline in balance, potentially increasing the risk of falling and its consequences. However, little is known about the profile of individuals with COPD who present balance impairments, especially related to sex and disease severity stages. The aim of this work was to compare static and functional balance between subjects with COPD and healthy controls and to check possible differences according to sex and degrees of disease severity., Methods: Forty-seven subjects with COPD and 25 healthy controls were included in this study. Their static balance was assessed in one-legged stance using a force platform and functional balance with the Timed Up and Go test. Additionally, participants performed spirometry, the 6-min walk test and isometric quadriceps maximal voluntary contraction assessment. Disease severity was classified according to the Global Initiative for Obstructive Lung Disease stages and BODE (body mass index, air-flow obstruction, dyspnea, and exercise capacity) scores., Results: In comparison with healthy controls, subjects with COPD had worse static (center of pressure displacement area: 9.3 ± 1.9 cm 2 vs 11.6 ± 4.0 cm 2 , respectively, P = .01) and functional balance (Timed Up and Go test: 8.5 ± 1.3 s vs 10.3 ± 1.8 s, respectively, P < .001). In the COPD group, men performed better in the Timed Up and Go test than women (9.8 ± 1.2 s vs 10.9 ± 2.2 s, respectively, P = .03), whereas women presented a better static balance in comparison with men for all parameters related to center of pressure (P < .005 for all). Disease severity did not affect any balance results., Conclusions: Individuals with COPD had worse static and functional balance in comparison with healthy controls. Sex can mediate these results, depending on the type of balance evaluation (force platform or functional test). Balance performance was similar among the groups classified according to disease severity., (Copyright © 2016 by Daedalus Enterprises.)

[Purpose] This study aimed to assess the exercise capacity and muscle strength in elderly people using drugs for angiotensin-II blockage. [Subjects and Methods] Four hundred and seven older adults were recruited for this study. Data about comorbidities and medication use were recorded and the individuals were divided into three groups: control group- elderly people with normal exercise capacity (n=235); angiotensin-converting enzyme inhibitor group - individuals using angiotensin-converting enzyme inhibitors (n=140); and angiotensin-II receptor blocker group- patients using angiotensin-II receptor blockers (n= 32). Exercise capacity was evaluated by a 6-minute walking test and muscle strength was measured using a handgrip dynamometer. [Results] Patients from the angiotensin-converting enzyme inhibitor group (mean: 99 ± 12%) and the angiotensin-II receptor blocker group (mean: 101 ± 14%) showed higher predicted values in the 6-minute walking test than the control group patients (mean: 96 ± 10%). Patients from the angiotensin-converting enzyme inhibitor group (mean: 105 ± 19%) and the angiotensin-II receptor blocker group (mean: 105.1 ± 18.73%) showed higher predicted values of muscle strength than control group patients (mean: 98.15 ± 18.77%). [Conclusion] Older adults using angiotensin-converting enzyme inhibitors or angiotensin-II receptor blockers have better functional exercise capacity and muscle strength.

Osteoarthritis (OA) is the most prevalent disease of the musculoskeletal system and it has an important genetic component. Despite several reports have shown the involvement of pro-inflammatory cytokine such as interleukin-1β and TNF-α, the role of interleukin-6 (IL-6) in osteoarthritis is still unclear. Thus, this study aimed to analyze the relationship between the single nucleotide polymorphism in the portion -572 of the promoter region of the IL6 gene (SNP -572G/C) with hip and knee OA in the elderly. In this case-control study, 257 physically independent elderly were recruited (case group: 92 individuals with osteoarthritis and control group: 165 individuals with no osteoarthritis). Blood samples were collected from patients for the DNA fragments extraction and amplification by real-time polymerase chain reaction (PCR) by TaqMan system for subsequent genotyping of IL6 gene. The degree of joint damage was assessed by radiographic classification based on the criteria of Kellgren and Lawrence. The functional status was evaluated by Lequesne and WOMAC questionnaires. It was observed that individuals carrying the C allele have lower susceptibility to osteoarthritis (OR=0.51, 95% CI: 0.32-0.80, p=0.004) and less radiological impairment for both hip (Fisher-Freeman-Halton test=4.2 and p=0.04) and knee joints (Fisher-Freeman-Halton test=4.7 and p=0.03). Regarding functional status, individuals carrying the C allele has a lower degree of functional impairment assessed by WOMAC (Mann-Whitney test, p=0.04), although no difference was observed in the Lequesne questionnaire (p>0.05). Additionally, it was observed a marked reduction in IL-6 serum levels in individuals with GC and CC genotypes when compared to individuals harboring GG genotype. In conclusion, the polymorphism -572G/C IL6 is a protective factor for the presence and severity of hip and knee osteoarthritis in the elderly. Further prospective studies with large sample size and methods (e.g. effect of this polymorphism on gene expression, haplotype analysis for IL-6 promoter polymorphism) are needed to validate this study findings., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Introduction Dizziness can be characterized as a balance disorder that causes discomfort, leading to several functional limitations. Currently, vestibular rehabilitation has been highlighted as a possible treatment. Objective Analyze the effects of completing a vestibular rehabilitation treatment protocol on quality of life and postural balance in patients with vestibular complaints, as well as to compare these effects between the patients taking or not taking antivertigo drugs. Methods A nonrandomized controlled trial was performed with 20 patients previously diagnosed with vestibular diseases. Information regarding vertigo symptoms, quality of life as assessed through the Dizziness Handicap Inventory, visual analog scale of dizziness, and stabilometry using force platform was collected. Patients were treated for 12 weeks by a custom protocol. The sample was divided into two groups according to the use (medicated group, n = 9) or not (control group, n = 11) of antivertigo drugs. Results There was improvement in quality of life (p < 0.001) and intensity of dizziness (p = 0.003) with the intervention. An improvement of postural balance was observed through functional tests. However, no statistically significant difference was noted in stabilometry. When both groups were compared, no statistically significant differences between the variations of the variables analyzed were found in the re-evaluation session. Conclusion Quality of life and postural balance are improved with intervention. However, this improvement is not associated with pharmacologic treatment.

Objective: To evaluate if the Incremental Shuttle Walking Test (ISWT) requires maximal effort in healthy subjects of different ages., Design: Cross-sectional., Setting: University-based research laboratory., Participants: 331 healthy subjects separated into six groups according to age: G1, 18 to 28 years; G2, 29 to 39 years; G3, 40 to 50 years; G4, 51 to 61 years; G5, 62 to 72 years and; G6, 73 to 83 years., Main Outcome Measures: Two ISWTs were performed and participants were permitted to run and to exceed 12 levels during the test, if necessary. Heart rate (HR) and symptoms of dyspnoea and fatigue were recorded before and after the test, and the percentage of age-predicted maximal HR (HRmax) was calculated. Maximal effort was defined as HRmax >90% of age-predicted HRmax., Results: Almost 31% of the subjects exceeded 12 levels in the ISWT. At the end of the test, all groups presented a median [interquartile range] HR greater than 90% of HRmax (G1: 100 [95 to 104]; G2: 100 [96 to 105]; G3: 103 [97 to 108]; G4: 99 [91 to 106]; G5: 96 [87 to 106] and G6: 96 [91 to 109]% HRmax). Regarding symptoms, all groups showed higher values after the test (P<0.05). A multiple logistic regression analysis identified female gender, older age and a lower HR before the test as determinants of not achieving 90% of HRmax at the end of the test., Conclusions: The ISWT requires maximal effort in healthy individuals, but for that it is necessary to extend the test beyond twelve levels. Female gender, older age and lower heart rate before the test are the determinants of not reaching maximal effort., (Copyright © 2014 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.)

[Purpose] This study aimed to evaluate the anti-inflammatory and analgesic effects of intraoral application of low-level laser therapy (660 nm) to control pain, swelling and interincisal opening following the extraction of mandibular third molars. [Subjects and Methods] Ten patients underwent removal of lower third molars using the same surgical protocol and pharmacological approach. In the postoperative period, all patients received four consecutive daily sessions of low-level laser therapy, beginning 24 hours after the surgery. Intraoral applications using the diode laser with 660 nm wavelength in the continuous scan mode were performed covering the entire surgical area, which was divided into four quadrants, each of 1 cm(2) area at a distance of 1 cm. The energy applied at each point was 5 J/cm(2) during 8 seconds. [Results] The swelling and interincisal opening returned to normal 24 hours after the first low-level laser therapy application (Friedman test). Moreover, the pain intensity was reduced on the third postoperative day, according to the Friedman test. [Conclusion] Low-level laser therapy (660 nm), at the dosimetry used in this study, was effective in reducing postoperative pain and swelling following oral surgery.

The vulnerability of epigenetic marks of brain cells to environmental stimuli and its implication for health have been recently debated. Thus, we used the rat model of acute restraint stress (ARS) to evaluate the impact of stress on the global DNA methylation and on the expression of the Dnmt1 and Bdnf genes of hippocampus, cortex, hypothalamus and periaqueductal gray (PAG). Furthermore, we verified the potential of physical exercise to modulate epigenetic responses evoked by ARS. Sedentary male Wistar rats were submitted to ARS at the 75th postnatal day (PND), whereas animals from a physically active group were previously submitted to swimming sessions (35-74th PND) and to ARS at the 75th PND. Global DNA methylation profile was quantified using an ELISA-based method and the quantitative expression of the Dnmt1 and Bdnf genes was evaluated by real-time PCR. ARS induced a decrease in global DNA methylation in hippocampus, cortex and PAG of sedentary animals and an increased expression of Bdnf in PAG. No change in DNA methylation was associated with ARS in the exercised animals, although it was associated with abnormal expression of Dnmt1 and Bdnf in cortex, hypothalamus and PAG. Our data reveal that ARS evokes adaptive changes in global DNA methylation of rat brain that are independent of the expression of the Dnmt1 gene but might be linked to abnormal expression of the Bdnf gene in the PAG. Furthermore, our evidence indicates that physical exercise has the potential to modulate changes in DNA methylation and gene expression consequent to ARS., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Aims: This study aimed to assess the influence of pharmacotherapy on health-related quality of life of elderly with ostheoartritis., Methods: Longitudinal study involving 91 older adults from both genders (Age: 70.36±5.57 years) from EELO project with self-reported knee or hip ostheoartritis, confirmed by radiographic analysis. Data regarding pharmacotherapy was assessed by a structured questionnaire and the quality of life was analyzed by SF-36 questionnaire at the initial moment and two years thereafter. All domains from quality of life were grouped in physical and mental components for further data analysis., Results: A statistically significant decline in health-related quality of life was observed (Wilcoxon test, p<0.05). However, it was observed a slighted decline in physical components in group treated with chondroitin/glucosamine when compared to other groups, according to Kruskal-Wallis test (p=0.007). On the other hand, it was not observed any influence of pharmacological treatment on mental components of health-related quality of life (p>0.05)., Conclusions: Treatment with condroitin/glucosamin contributes to a lower decline in physical component while it had no influence on mental component of health-related quality of life in older adults with ostheoartritis., (Copyright © 2014 Elsevier Editora Ltda. All rights reserved.)