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Abstract Background In healthcare systems in general, access to diabetic retinopathy (DR) screening is limited. Artificial intelligence has the potential to increase care delivery. Therefore, we trained and evaluated the diagnostic accuracy of a machine learning algorithm for automated detection of DR. Methods We included color fundus photographs from individuals from 4 databases (primary and specialized care settings), excluding uninterpretable images. The datasets consist of images from Brazilian patients, which differs from previous work. This modification allows for a more tailored application of the model to Brazilian patients, ensuring that the nuances and characteristics of this specific population are adequately captured. The sample was fractionated in training (70%) and testing (30%) samples. A convolutional neural network was trained for image classification. The reference test was the combined decision from three ophthalmologists. The sensitivity, specificity, and area under the ROC curve of the algorithm for detecting referable DR (moderate non-proliferative DR; severe non-proliferative DR; proliferative DR and/or clinically significant macular edema) were estimated. Results A total of 15,816 images (4590 patients) were included. The overall prevalence of any degree of DR was 26.5%. Compared with human evaluators (manual method of diagnosing DR performed by an ophthalmologist), the deep learning algorithm achieved an area under the ROC curve of 0.98 (95% CI 0.97–0.98), with a specificity of 94.6% (95% CI 93.8–95.3) and a sensitivity of 93.5% (95% CI 92.2–94.9) at the point of greatest efficiency to detect referable DR. Conclusions A large database showed that this deep learning algorithm was accurate in detecting referable DR. This finding aids to universal healthcare systems like Brazil, optimizing screening processes and can serve as a tool for improving DR screening, making it more agile and expanding care access.

Purpose: To evaluate the performance of artificial intelligence (AI) systems embedded in a mobile, handheld retinal camera, with a single retinal image protocol, in detecting both diabetic retinopathy (DR) and more-than-mild diabetic retinopathy (mtmDR). Design: Multicenter cross-sectional diagnostic study, conducted at 3 diabetes care and eye care facilities. Participants: A total of 327 individuals with diabetes mellitus (type 1 or type 2) underwent a retinal imaging protocol enabling expert reading and automated analysis. Methods: Participants underwent fundus photographs using a portable retinal camera (Phelcom Eyer). The captured images were automatically analyzed by deep learning algorithms retinal alteration score (RAS) and diabetic retinopathy alteration score (DRAS), consisting of convolutional neural networks trained on EyePACS data sets and fine-tuned using data sets of portable device fundus images. The ground truth was the classification of DR corresponding to adjudicated expert reading, performed by 3 certified ophthalmologists. Main Outcome Measures: Primary outcome measures included the sensitivity and specificity of the AI system in detecting DR and/or mtmDR using a single-field, macula-centered fundus photograph for each eye, compared with a rigorous clinical reference standard comprising the reading center grading of 2-field imaging protocol using the International Classification of Diabetic Retinopathy severity scale. Results: Of 327 analyzed patients (mean age, 57.0 ± 16.8 years; mean diabetes duration, 16.3 ± 9.7 years), 307 completed the study protocol. Sensitivity and specificity of the AI system were high in detecting any DR with DRAS (sensitivity, 90.48% [95% confidence interval (CI), 84.99%–94.46%]; specificity, 90.65% [95% CI, 84.54%–94.93%]) and mtmDR with the combination of RAS and DRAS (sensitivity, 90.23% [95% CI, 83.87%–94.69%]; specificity, 85.06% [95% CI, 78.88%–90.00%]). The area under the receiver operating characteristic curve was 0.95 for any DR and 0.89 for mtmDR. Conclusions: This study showed a high accuracy for the detection of DR in different levels of severity with a single retinal photo per eye in an all-in-one solution, composed of a portable retinal camera powered by AI. Such a strategy holds great potential for increasing coverage rates of screening programs, contributing to prevention of avoidable blindness. Financial Disclosure(s): F.K.M. is a medical consultant for Phelcom Technologies. J.A.S. is Chief Executive Officer and proprietary of Phelcom Technologies. D.L. is Chief Technology Officer and proprietary of Phelcom Technologies. P.V.P. is an employee at Phelcom Technologies.

Background: COVID19 is an emerging infectious disease that has spread all over the world and became a pandemic. Cameroon is the 7th most affected country in Africa, with most of the cases in metropoles. The main objective was to assess the knowledge, perceptions and practices of the Cameroonian populations about COVID19 infection. Methods: A cross-sectional study was conducted from May 15th to July 15th, 2020; targeting all Cameroonians over 15 years old living in Cameroon. A standard Google Forms® questionnaire was submitted via social media (WhatsApp and Facebook particularly). The sampling was consecutive and not exhaustive. The data were processed on Excel 2016 and analyzed through EPI info 3.5. The questionnaire included knowledge, perceptions and practices about the disease’s existence, its functional signs, prevention and control. Knowledge, perceptions and practices were considered good for a response score ≥ 75% and poor for a score ≤ 25%. Intermediate scores were considered average and insufficient. Univariate and multivariate analyzes were performed to identify the factors associated with a significance level (p 0.05). Results: Of the 996 (507 males) participants, the median age was 26 ± 8 years. Health workers represented 20.8% of participants. A large proportion of the population (78.6%) had good knowledge, while more than half (56.5%) had good perceptions, but only (23.1%) had good practices. Having reached higher education (p = 0.007), and being a health worker (p = 0.0008) were associated with a good level of knowledge. High school education (p = 0.040) and being a health worker (p = 0.049) were associated mwith positive perceptions. Being employed (p = 0.003) and having secondary education level (p = 0.033) were associated with good practices. Conclusion: Knowledge and perceptions were good among the study population, but the practice level is still insufficient to effectively fight the COVID19 pandemic. Educational level, being employed or being healthcare workers were associated with good knowledge, perceptions and practices.

Abstract Background Diabetic macular edema (DME) is a major cause of visual impairment and its treatment is a public health challenge. Even though anti-angiogenic drugs are the gold-standard treatment, they are not ideal and subthreshold laser (SL) remains a viable and promising therapy in selected cases. The aim of this study was to evaluate its efficacy in a real-life setting. Methods Retrospective case series of 56 eyes of 36 patients with center-involving DME treated with SL monotherapy. Treatment was performed in a single session with the EasyRet® photocoagulator with the following parameters: 5% duty cycle, 200-ms pulse duration, 160-µm spot size and 50% power of the barely visible threshold. A high-density pattern was then applied to the whole edematous area, using multispot mode. Best corrected visual acuity (BCVA) and optical coherence tomography (OCT) data were obtained at baseline and around 3 months after treatment. Results Fifty-six eyes of 36 patients were included (39% women, mean age 64.8 years old); mean time between treatment day and follow-up visit was 14 ± 6 weeks. BCVA (Snellen converted to logMAR) was 0.59 ± 0.32 and 0.43 ± 0.25 at baseline and follow-up, respectively (p = 0.002). Thirty-two percent had prior panretinal photocoagulation (p = 0.011). Mean laser power was 555 ± 150 mW and number of spots was 1,109 ± 580. Intraretinal and subretinal fluid (SRF) was seen in 96 and 41% of eyes at baseline and improved in 35 and 74% of those after treatment, respectively. Quantitative analysis of central macular thickness (CMT) change was performed in a subset of 23 eyes, 43% of which exhibited > 10% CMT reduction post-treatment. Conclusions Subthreshold laser therapy is known to have RPE function as its main target, modulating the activation of heat-shock proteins and normalizing cytokine expression. In the present study, the DME cases associated with SRF had the best anatomical response, while intraretinal edema responded poorly to laser monotherapy. BCVA and macular thickness exhibited a mild response, suggesting the need for combined treatment in most patients. Given the effect on SRF reabsorption, subthreshold laser therapy could be a viable treatment option in selected cases.

ABSTRACT Agricultural spray adjuvants (ASA) are widely used in pesticide applications to enhance the performance of pesticides. The aim of this research was to investigate the effects of ASA on static surface tension (SST) and foliar spray retention on coffee leaves. The SST of ASA at different concentrations was determined by the drop weight method. Spray retention on adaxial and abaxial coffee leaf surfaces was performed using a micro-sprayer at solution concentrations of 0, 0.01, 0.1, 0.5, and 1.0% v v−1. The ASA assessed were: polyether-polymethylsiloxane-copolymer (PPC); Nonylphenol ethoxylate; nonyl polyethylene glycol ether; mineral oil; nonylphenoxy polyethoxy ethanol; carboxyl copolymer of styrene and butadiene; primary aliphatic oxyalkylated alcohol plus carboxyl copolymer of styrene and butadiene; and soyal phospholipids and propionic acid. All ASA reduced the SST of the aqueous solutions. PPC provided the best performance in decreasing SST, reaching values below 20 mN m−1 at a concentration of 0.05% v v−1. Spray retention on leaves was influenced by adjuvant type as well as concentration. A very strong positive correlation between SST and spray retention on coffee leaves was observed. Decreasing the SST of the solution provided a reduction of spray retention when spraying was performed until run-off point.

We present new records for Fleischmann’s Glassfrog, Hyalinobatrachium fleischmanni (Boettger, 1893), which extend the distribution of this species into central and southwestern Ecuador and thus represent the southernmost known localities. These new reports are based on specimens collected at Cerro de Hayas, province of Guayas, and Macul, province of Los Ríos. These new localities extend the known geographic range of H. fleischmanni by approximately 250 km south of previous known occurrences.

ABSTRACT The effect of blade angle on droplet size spectrum of five rotary cage atomizers and one rotary disc atomizer used in Brazil was evaluated in a high speed wind tunnel, with an air speed of 180 km h−1. This study included the characterization of the droplet size spectrum, via laser diffraction instrument, generated by three blades angles, of 45, 60 and 75 degrees. The spray solution was composed of Picoxystrobin+ Cyproconazole fungicide (SC), at 20 mL c.p. L−1, and at a flow rate of 6 L min−1. As the angle decreased from 75 to 45 degrees, the rotational speed of the atomizers increased and the volume median diameter (VMD) decreased. However, increasing the rotational speed also increased the percentage of droplets smaller than 100 µm (% < 100 µm). At the blade angles of 45 and 60 degrees the atomizers showed that % < 100 µm was higher than 20% and VMD was smaller than 198 µm. The disc type atomizer resulted in the lower values of relative span (RS). The use of 75 degrees blade angle produced the highest values of VMD and the lowest values of % < 100 µm; these parameters were also affected by atomizer model and brand.

Background The problem of access to medical information, particularly in low-income countries, has been under discussion for many years. Although a number of developments have occurred in the last decade (e.g., the open access (OA) movement and the website Sci-Hub), everyone agrees that these difficulties still persist very widely, mainly due to the fact that paywalls still limit access to approximately 75% of scholarly documents. In this study, we compare the accessibility of recent full text articles in the field of ophthalmology in 27 established institutions located worldwide. Methods A total of 200 references from articles were retrieved using the PubMed database. Each article was individually checked for OA. Full texts of non-OA (i.e., “paywalled articles”) were examined to determine whether they were available using institutional and Hinari access in each institution studied, using “alternative ways” (i.e., PubMed Central, ResearchGate, Google Scholar, and Online Reprint Request), and using the website Sci-Hub. Results The number of full texts of “paywalled articles” available using institutional and Hinari access showed strong heterogeneity, scattered between 0% full texts to 94.8% (mean = 46.8%; SD = 31.5; median = 51.3%). We found that complementary use of “alternative ways” and Sci-Hub leads to 95.5% of full text “paywalled articles,” and also divides by 14 the average extra costs needed to obtain all full texts on publishers’ websites using pay-per-view. Conclusions The scant number of available full text “paywalled articles” in most institutions studied encourages researchers in the field of ophthalmology to use Sci-Hub to search for scientific information. The scientific community and decision-makers must unite and strengthen their efforts to find solutions to improve access to scientific literature worldwide and avoid an implosion of the scientific publishing model. This study is not an endorsement for using Sci-Hub. The authors, their institutions, and publishers accept no responsibility on behalf of readers.

ABSTRACT This paper aimed at investigating the knowledge level of people working on pesticide spraying activities concerning spray adjuvant properties, as well as collecting information on disposal locations for residues from internal spray tank cleaning, and finally the understanding of pesticide spray drift occurrence in the state of Mato Grosso, Brazil. The information was gathered through a questionnaire answered by participants of a rural extension program in application technology located in nineteen grain and fiber producing regions of Mato Grosso state. Among the mentioned adjuvants, 49.0% belonged to the mineral oil class and 17.9% of participants did not know the functions performed by such products. In addition, 58.5% of the participants discarded residues into the field. Among the participants who answered the question about spray drift occurrence causes, 54.1% indicated problems relating to inadequate weather conditions. In conclusion, there is a lack of knowledge on adjuvant functions, besides of inappropriate residue disposal in the state of Mato Grosso. Spray drift was referred as a problem; however, most of participants were not able to discuss the causes of these losses.

Se analizan las variables fundamentales que conforman la estructura de distribución de las participaciones en ingresos federales que reciben las entidades federativas en el marco del Sistema nacional de coordinación fiscal mexicano. Se muestran las implicaciones que ha traído utilizar esta información en la distribución interestatal y se brindan elementos técnicos para la discusión sobre el fortalecimiento a la coordinación fiscal en México.

Desde un punto de vista político, la actual Ley de Coordinación Fiscal es sorprendente pues redistribuyó las participaciones federales sin ocasionar una rebelión entre las entidades federativas. Pero, como muestra este trabajo, la ley es aún más sorprendente desde un punto de vista económico, pues no fomenta la actividad económica ni estimula el esfuerzo recaudatorio, como dictaba el espíritu original de la iniciativa.

Each year, there is an increase in pesticide consumption and in its importance of use in the large-scale agricultural production, being fundamental the knowledge of application technology to the activity success. The objective of the present study was to evaluate the influence of working pressure on the drift generated by different spray nozzles, assessed in wind tunnel. The treatments were composed of two spray nozzles AXI 110015 and AXI 11002 with pressure levels of 276 and 414 kPa. The spray solution was composed by water and NaCl at 10%. The applications were conducted at wind speed of 2.0 m s-1, being the drift collected at 5.0; 10.0 and 15.0 m away from the spray boom and at heights of 0.2; 0.4; 0.6; 0.8 e 1.0 m from the tunnel floor. To both spray nozzles, the greatest drift was collected at the smallest distance to the spray-boom and at the lowest height. The AXI 11002 nozzle gave a smaller drift relative to the AXI 110015 nozzle for the two tested pressures and for all the collection points. Regardless of the nozzle, a rise in the working pressure increases the spray drift percentage at all distances in the wind tunnel.

FUNDAMENTO: Em pacientes com diabetes tipo 2, a presença de retinopatia está associada a doença cardiovascular aumentada, independentemente dos fatores de risco conhecidos para a doença vascular. OBJETIVO: Investigar a associação da retinopatia diabética (RD) e seus graus com a presença de aterosclerose coronariana subclínica em pacientes com diabetes tipo 1. MÉTODOS: Um estudo transversal foi conduzido com 150 pacientes com diabetes tipo 1, assintomáticos para doença arterial coronariana. Foram submetidos à avaliação clínica para verificar complicações microvasculares e avaliação para a presença de calcificação arterial coronariana (CAC). RESULTADOS: Formas graves de RD (RD grave não proliferativa - RDNP - e RD proliferativa - RDP) foram associadas à CAC (RC: 3,98; IC de 95%; 1,13-13,9, p = 0,03), de maneira independente dos fatores de risco conhecidos para a doença cardiovascular (idade, A1C, hipertensão, dislipidemia e sexo masculino). CONCLUSÃO: Os pacientes com formas graves de RD estão em risco de presença de doença arterial coronariana, de maneira independente dos tradicionais fatores de risco cardiovascular.

FUNDAMENTO: A presença de neuropatia autonômica cardíaca (NAC) em pacientes com diabete melito (DM) está associada a aumento da mortalidade e a complicações crônicas microvasculares do diabete. OBJETIVO: Investigar uma possível associação entre achados sugestivos de NAC durante a realização do teste ergométrico (TE) e nefropatia e retinopatia em pacientes com DM tipo 1. MÉTODOS: Realizamos um estudo transversal com 84 pacientes com DM tipo 1. Todos os pacientes foram submetidos à avaliação clínica e laboratorial e realizaram TE, sendo que aqueles que apresentaram achados sugestivos de isquemia miocárdica foram excluídos da análise dos dados (n = 3). A avaliação de complicações microvasculares (retinopatia e nefropatia) foi realizada na amostra. RESULTADOS: Os pacientes com nefropatia e aqueles com retinopatia atingiram uma frequência cardíaca (FC) durante o pico de exercício (FC máxima) menor e apresentaram aumento menor da FC em relação ao repouso (ΔFC pico) quando comparados com aqueles sem estas complicações. Esses pacientes também apresentaram menor redução da FC no segundo e 4º minutos após o final do teste (ΔFC recuperação dois e 4 minutos). Após realização de análise multivariada com controle para os possíveis fatores de confusão, os ΔFC recuperação em dois e 4 minutos, FC máxima e o ΔFC pico permaneceram significativamente associados à retinopatia; e os ΔFC recuperação no segundo e 4º minutos permaneceram associados à presença de nefropatia. CONCLUSÃO: O TE pode ser considerado um instrumento adicional para a detecção precoce de NAC e para identificar pacientes em maior risco para complicações microvasculares do diabete.

OBJETIVO: Determinar a prevalência e os fatores associados ao consumo abusivo de álcool. MÉTODOS: Estudo transversal de base populacional incluindo 2.177 indivíduos adultos (20 a 69 anos) residentes na zona urbana da cidade de Pelotas, RS. Amostragem em múltiplos estágios. Consumo de álcool abusivo foi definido como mais de 30 g/dia. A análise ajustada foi realizada por regressão logística não condicional. RESULTADOS: A prevalência de consumo abusivo de álcool foi de 14,3%, sendo 29,2% para os homens e 3,7% para as mulheres. Os seguintes grupos apresentaram maior consumo abusivo de álcool após análise ajustada: homens, idosos, indivíduos com pele preta ou parda, de nível social mais baixo, fumantes pesados e que apresentam alguma doença crônica. Somente entre os homens, os que apresentavam distúrbios psiquiátricos menores mostraram maior índice de consumo abusivo e entre as mulheres a relação foi inversa com idade. Constatou-se também que entre os hipertensos, aqueles classificados como consumidores excessivos apresentavam pior controle da doença. CONCLUSÕES: O consumo abusivo de álcool é elevado e acarreta inúmeras conseqüências negativas para a saúde e qualidade de vida dos indivíduos. Os resultados indicam uma alta prevalência de consumo abusivo de álcool e identificam alguns subgrupos da população mais suscetíveis ao alcoolismo.

O presente estudo teve como objetivo investigar a tendência temporal no hábito de fumar entre os estudantes de Medicina da Universidade Federal de Pelotas, através de entrevistas com todos os alunos matriculados nos cinco primeiros anos do curso, em 1986 e 1991. Os percentuais de perdas foram de 4% e 2%, respectivamente. Houve uma diminuição na prevalência de fumantes de 21,6%, em 1986, para 14,6%, em 1991. Os percentuais de ex-fumantes foram de 7,3% e 10,9%, respectivamente. Não foi encontrada uma relação entre sexo e hábito de fumar assim como não houve associação entre o tabagismo de pais e filhos. Em 1991, o percentual de fumantes foi maior nas duas últimas séries do curso; a sintomatologia respiratória mostrou-se associada significativamente com o hábito de fumar. Concluindo, o presente estudo mostra que o tabagismo está se tornando menos comum entre os estudantes de Medicina da Faculdade de Medicina de Pelotas.A cross-sectional survey of smoking habits was carried out among students at the School of Medicine in Pelotas, State of Rio Grande do Sul, Brazil, in 1986 and 1991. The overall participation rate for the originally selected sample was 96% and 98% respectively. In 1986, regular smokers comprised 21.6% of the students and 14.6% in 1991; former smokers were 7.3% and 10.9%, respectively. There was no association between sex, parental smoking, and smoking habits of the students. Students in their last two years of medical training showed an increased prevalence in smoking habits (1991). Respiratory symptoms were associated with smoking habits. It was concluded that the prevalence of smoking is decreasing among students of the School of Medicine in Pelotas.

É conhecido que o paciente com diabetes é mais susceptível a infecções. Entretanto, apesar de freqüentes, determinados tipos de infecções cutâneas nem sempre são familiares ao médico que presta o atendimento a este paciente. O objetivo deste artigo foi revisar as infecções mais comuns nos pacientes com diabetes, através de uma abordagem simplificada do quadro clinico, diagnóstico e primeiro atendimento.

O presente estudo teve como objetivo investigar a tendência temporal no hábito de fumar entre os estudantes de Medicina da Universidade Federal de Pelotas, através de entrevistas com todos os alunos matriculados nos cinco primeiros anos do curso, em 1986 e 1991. Os percentuais de perdas foram de 4% e 2%, respectivamente. Houve uma diminuição na prevalência de fumantes de 21,6%, em 1986, para 14,6%, em 1991. Os percentuais de ex-fumantes foram de 7,3% e 10,9%, respectivamente. Não foi encontrada uma relação entre sexo e hábito de fumar assim como não houve associação entre o tabagismo de pais e filhos. Em 1991, o percentual de fumantes foi maior nas duas últimas séries do curso; a sintomatologia respiratória mostrou-se associada significativamente com o hábito de fumar. Concluindo, o presente estudo mostra que o tabagismo está se tornando menos comum entre os estudantes de Medicina da Faculdade de Medicina de Pelotas.

OBJETIVO: Determinar a prevalência e os fatores associados ao consumo abusivo de álcool. MÉTODOS: Estudo transversal de base populacional incluindo 2.177 indivíduos adultos (20 a 69 anos) residentes na zona urbana da cidade de Pelotas, RS. Amostragem em múltiplos estágios. Consumo de álcool abusivo foi definido como mais de 30 g/dia. A análise ajustada foi realizada por regressão logística não condicional. RESULTADOS: A prevalência de consumo abusivo de álcool foi de 14,3%, sendo 29,2% para os homens e 3,7% para as mulheres. Os seguintes grupos apresentaram maior consumo abusivo de álcool após análise ajustada: homens, idosos, indivíduos com pele preta ou parda, de nível social mais baixo, fumantes pesados e que apresentam alguma doença crônica. Somente entre os homens, os que apresentavam distúrbios psiquiátricos menores mostraram maior índice de consumo abusivo e entre as mulheres a relação foi inversa com idade. Constatou-se também que entre os hipertensos, aqueles classificados como consumidores excessivos apresentavam pior controle da doença. CONCLUSÕES: O consumo abusivo de álcool é elevado e acarreta inúmeras conseqüências negativas para a saúde e qualidade de vida dos indivíduos. Os resultados indicam uma alta prevalência de consumo abusivo de álcool e identificam alguns subgrupos da população mais suscetíveis ao alcoolismo.

OBJECTIVES: To determine the prevalence of Her-2/Neu-cerbb-2 in the gastric mucosa of patients with gastric adenocarcinoma in a brazilian patient group. METHODS: The immunohistochemical expression of Her-2/Neu was studied in 37 formalin-fixed paraffin-embedded tissue sections. RESULTS: The immunohistochemical reaction produced by the anti-HER-2/Neu antibody was positive in two cases (5.4%). CONCLUSION: The low prevalence of Her-2/Neu observed in these southern brazilian cases is probably due to the great number of poorly differentiated cancers in this serie.

Carbon dots are synthesized alone and in the presence of commercial magnetite nanoparticles using a simple hydrothermal reaction. The spectroscopic and structural characteristics of CDot and CDot–magnetite materials are presented and their behaviors under combustion conditions are studied. A careful examination of their combustion behaviors reveals interesting results for the CDot–magnetite material: it undergoes early catalytic combustion at ~200 °C and a strong endothermic process that quenches combustion. By investigating the physical mixtures of pre-formed CDots and magnetite and the starting material ascorbic acid and magnetite, it is determined that the strong endothermic behavior requires intimate interactions between the carbon source and the magnetite, highlighting the importance of the nano-interface of the CDots being synthesized onto the magnetite substrate. The results are discussed in the context of the fuels used for low-temper combustion, materials with stored endothermic potential, and the use of combustion-quenching materials for fire control. [ABSTRACT FROM AUTHOR]

Purpose: Several studies have demonstrated that physiological variables predict cycling endurance performance. However, it is still unclear whether the predictors will change over different performance durations. The aim of this study was to assess the correlations between physiological variables and cycling time trials with different durations. Methods: Twenty trained male cyclists (maximal oxygen uptake [VO[subscript 2 max] = 60.5 ± 5.6 mL/kg/min) performed 4 separate experimental trials during a 2-week period. Cyclists initially completed an incremental exercise test until volitional exhaustion followed by 3 maximal cycling time trials on separate days. Each time trial consisted of 3 different durations: 5 min, 20 min, and 60 min performed in a randomized order. Results: The main results showed that the physiological measures strongly correlated with long cycling performances rather than short and medium time trials. The time-trial mean power output was moderately high to highly correlated with peak power output and VO[subscript 2max] (r = 0.61-0.87, r =0.72-.089, respectively), and was moderately to highly correlated with the lactate threshold Dmax method and second ventilatory threshold (r = 0.52--0.75, r = 0.55-0.82, respectively). Conclusions: Therefore, trained cyclists should develop maximal aerobic power irrespective of the duration of time trial, as well as enhancements in metabolic thresholds for long-duration time trials.

Abstract Evaluate the results of a series of 28 cases of high obstetric paralysis treated with the Sever-L'Episcopo technique modified by Hoffer, between 2003 and 2016. Children (mean age, four years and seven months) with adduction contracture and internal rotation of the shoulder without secondary bone deformities (Mallet class II) underwent lengthening of the pectoralis major muscle and tenotomy of the subscapularis muscle associated with transfer of the latissimus dorsi and teres major muscle to the infraspinatus muscle, moving to the function of external rotators and elevators. The mean follow-up was three years and 10 months. At the end of the study, 24 patients achieved excellent functional assessment scores, mainly of the abduction and external rotation, passing from Mallet class II to class IV. Four patients still demonstrated some degree of global movement limitation, passing from class II to class III. Regardless of the final functional gain, all patients were able to perform tasks that were previously difficult. The data from this study suggest that Hoffer's surgery is an effective method in the treatment of the sequelae of high obstetric paralysis without secondary bone deformities.