ABSTRACT The dynamic balance of the lower limbs has shown great importance in accomplishing activities of daily living, especially for walking and maintenance in the orthostatic position. In this context, individuals with knee osteoarthritis have changes in their physical capacity, mainly due to joint changes and muscular wear. The instrument called OctoBalance® is one of the most used to evaluate this balance, which analyses four different executions of movement in the limbs. However, individuals with knee osteoarthritis cannot perform this evaluation due to the need for single limb support during movements. This study aimed to verify whether it is reproducible to perform the dynamic balance evaluation of lower limbs with a reduction of 10% of body weight through a suspension system. A cross-sectional study was carried out with 2 collections with a 48-hour interval between them, using the Lower Body Test performed with OctoBalance®. The dynamic balance test followed the protocol of 3 repetitions observing the learning factor and then 3 repetitions where the values were collected, with the suggested adaptation for all 4 diagonals in both limbs. The interclass correlation index (ICI), coefficient of variation (CV), estimative standard error (EEE) and minimum detectable difference (MDD) were calculated as indicators of reproducibility. Also, Bland-Altman Graphs were used for visual verification of the agreement between the means. Results: The reliability tests showed a very high interclass correlation through the ICI and low variation values for all the movements evaluated through the CV. The EEE and MDD calculations showed positive responses for greater reliability, and the Bland-Altman graphs showed an agreement between the means. Reproducibility was positive for the Lower Body Test with the Octobalance® platform for the evaluation of lower limb dynamic balance in women with knee osteoarthritis.

RESUMO OBJETIVO Desenvolver e avaliar a usabilidade de um sistema de monitoramento das internações em pronto-socorro. MÉTODOS Trata-se de uma pesquisa aplicada, com desenvolvimento de um produto de software e avaliação de sua usabilidade por enfermeiros especialistas. O desenvolvimento seguiu quatro etapas: revisão sistemática, estruturação do arcabouço do sistema, construção dos formulários do sistema e avaliação das informações geradas. Na avaliação, os especialistas simularam a utilização do sistema com a inserção de dados de um prontuário fictício, e a usabilidade foi medida pelo System Usability Scale (SUS). A pontuação e os escores foram calculados de forma individual e global. O sistema foi avaliado nos padrões: pior imaginável, pobre, mediano, bom, excelente e melhor imaginável. RESULTADOS O Sistema de Informação e Monitoramento das Internações em Pronto-Socorro (SIMIPS) realiza o monitoramento do perfil epidemiológico das internações no pronto-socorro, gestão de tempo, deterioração clínica, incidência de eventos adversos e gestão de recursos humanos. A usabilidade do SIMIPS, avaliada por 17 especialistas, atingiu o Score SUS 86,5 (melhor imaginável), e algumas sugestões de modificações foram acatadas. CONCLUSÕES O SIMIPS foi avaliado como uma ferramenta de fácil utilização, com real importância na gestão das urgências frente aos problemas de superlotação e congestão, enfrentados no Brasil.

ABSTRACT OBJECTIVE To develop and evaluate the usability of the admission monitoring system in an emergency room. METHODS This applied research intends to develop a software product and evaluate its usability. The development followed four stages: systematic review, structuring of the system framework, construction of system forms, and evaluation of the information generated. In the evaluation, the experts simulated the use of the system by inserting data from a fictitious medical record. We measured usability using the System Usability Scale (SUS). Scores and scores were calculated individually and globally. We propose these evaluation standards: worst case scenario, poor, average, good, excellent, and best-case scenario. RESULTS The Sistema de Informação e Monitoramento das Internações em Pronto-Socorro (SIMIPS - Information and Monitoring System for Emergency Room Admissions) monitors the epidemiological profile of admissions to the emergency room, time management, clinical deterioration, incidence of adverse events, and human resource management. The usability of SIMIPS, evaluated by 17 experts, reached the SUS Score 86.5 (best case scenario), and some suggestions for modifications were accepted. CONCLUSIONS We consider SIMIPS an easy-to-use tool, with real importance in the management of emergencies in view of overcrowding and congestion problems faced in Brazil.

RESUMO OBJETIVO Desenvolver e avaliar a usabilidade de um sistema de monitoramento das internações em pronto-socorro. MÉTODOS Trata-se de uma pesquisa aplicada, com desenvolvimento de um produto de software e avaliação de sua usabilidade por enfermeiros especialistas. O desenvolvimento seguiu quatro etapas: revisão sistemática, estruturação do arcabouço do sistema, construção dos formulários do sistema e avaliação das informações geradas. Na avaliação, os especialistas simularam a utilização do sistema com a inserção de dados de um prontuário fictício, e a usabilidade foi medida pelo System Usability Scale (SUS). A pontuação e os escores foram calculados de forma individual e global. O sistema foi avaliado nos padrões: pior imaginável, pobre, mediano, bom, excelente e melhor imaginável. RESULTADOS O Sistema de Informação e Monitoramento das Internações em Pronto-Socorro (SIMIPS) realiza o monitoramento do perfil epidemiológico das internações no pronto-socorro, gestão de tempo, deterioração clínica, incidência de eventos adversos e gestão de recursos humanos. A usabilidade do SIMIPS, avaliada por 17 especialistas, atingiu o Score SUS 86,5 (melhor imaginável), e algumas sugestões de modificações foram acatadas. CONCLUSÕES O SIMIPS foi avaliado como uma ferramenta de fácil utilização, com real importância na gestão das urgências frente aos problemas de superlotação e congestão, enfrentados no Brasil.

ABSTRACT OBJECTIVE To develop and evaluate the usability of the admission monitoring system in an emergency room. METHODS This applied research intends to develop a software product and evaluate its usability. The development followed four stages: systematic review, structuring of the system framework, construction of system forms, and evaluation of the information generated. In the evaluation, the experts simulated the use of the system by inserting data from a fictitious medical record. We measured usability using the System Usability Scale (SUS). Scores and scores were calculated individually and globally. We propose these evaluation standards: worst case scenario, poor, average, good, excellent, and best-case scenario. RESULTS The Sistema de Informação e Monitoramento das Internações em Pronto-Socorro (SIMIPS - Information and Monitoring System for Emergency Room Admissions) monitors the epidemiological profile of admissions to the emergency room, time management, clinical deterioration, incidence of adverse events, and human resource management. The usability of SIMIPS, evaluated by 17 experts, reached the SUS Score 86.5 (best case scenario), and some suggestions for modifications were accepted. CONCLUSIONS We consider SIMIPS an easy-to-use tool, with real importance in the management of emergencies in view of overcrowding and congestion problems faced in Brazil.

Abstract Aim: To investigate the hypothesis that the resistance exercise (RE) may be safer if the blood pressure (BP) is properly controlled through antihypertensive pharmacological treatment in hypertensive middle-aged women. Methods: The final sample was comprised of 19 hypertensive women, with an average age of 58±5 years and a body mass index of 29±5 Kg/m2. They were divided into three groups: controlled (n=6), uncompensated (n=8), and untreated (n=5). The subjects from all groups were submitted to a test of maximal strength on extensor chair and held a session of RE (knee extension, 3x12 to 60% 1RM) and the cardiovascular response (BP and heart rate) was monitored continuously by photoplethysmography during exercise and until five minutes after exercise (recovery). Results: Systolic BP (SBP) and diastolic BP (DBP) responses were lower in the controlled group compared to the other groups (p<0.05). The heart rate was not different between groups, while the double product was lower in the controlled group compared to the untreated group (p<0.05). The SBP and DBP peaks were lower in the controlled group compared to the other groups (p<0.05). Conclusion: The BP increases significantly during RE when the hypertension is not controlled. Pharmacological control was shown to be effective in preventing the increase of BP during the performance of the RE.

Resumo Fundamento: O D-limoneno (DL) é um monoterpeno e o principal componente do óleo essencial de frutas cítricas. Ele apresenta atividades anti-hiperglicêmicas e vasodilatadoras. Objetivos: Este estudo avaliou os efeitos cardiovasculares e antiarrítmicos potenciais do DL em ratos. Métodos: Os parâmetros hemodinâmicos e eletrocardiográficos (ECG) foram mensurados em ratos Wistar machos que, sob anestesia, tiveram a aorta abdominal e a veia cava inferior canuladas e receberam eletrodos implantados subcutaneamente. Na abordagem in vitro, o coração foi removido e perfundido utilizando a técnica de Langendorff. O nível de significância adotado foi de 5% (p < 0,05). Resultados: DL, nas doses de 10, 20 e 40 mg/kg (i.v), produziu bradicardia intensa e persistente associada à hipotensão. A bradicardia com QTc prolongado foi observada no registro in vivo do ECG. No modelo in vivo de arritmia induzida por Bay K8644, DL (10 mg / kg) houve diminuição do escore da arritmia de 15,33 ± 3,52 para 4,0 ± 2,64 u.a (p < 0,05, n = 4). Em corações perfundidos isolados, o DL (10-3 M) promoveu reduções significativas na frequência cardíaca (de 228,6 ± 8,5 ms para 196,0 ± 9,3 bpm; p < 0,05) e na pressão desenvolvida do ventrículo esquerdo (de 25,2 ± 3,4 para 5,9 ± 1,8 mmHg; n = 5, p < 0,05). Conclusões: O DL produz bradicardia e atividade antiarrítmica no coração de ratos.

Abstract Background: D-limonene (DL) is a monoterpene and is the major component in the essential oil of citrus fruit. It presents antihyperglycemic and vasodilatation activities. Objectives: This study evaluated the cardiovascular effects and potential antiarrhythmic of DL in rats. Methods: Hemodynamic and electrocardiographic (ECG) parameters were measured in male Wistar rats, which under anesthesia had been cannulated in the abdominal aorta and lower vena cava and had electrodes subcutaneously implanted. In the in vitro approach, the heart was removed and perfused using the Langendorff technique. The significance level adopted was 5% (p < 0.05). Results: DL, in doses of 10, 20, and 40 mg/kg (i.v), produced intense and persistent bradycardia associated with hypotension. Bradycardia with prolonged QTc was observed in the ECG in vivo recording. In the in vivo model of arrhythmia induced by Bay K8644, DL (10 mg/kg) decreased the arrhythmia score from 15.33 ± 3.52 to 4.0 ± 2.64 u.a (p < 0.05, n = 4). In isolated perfused hearts, DL (10-3 M) promoted significant reductions in heart rate (from 228.6 ± 8.5 ms to 196.0 ± 9.3 bpm; p < 0.05) and left ventricular development pressure (from 25.2 ± 3.4 to 5.9 ± 1.8 mmHg; n = 5, p < 0.05). Conclusions: DL produces bradycardia and antiarrhythmic activity in rat heart.

Abstract Background: Neuromuscular electrical stimulation seems to be a promising option to intensify the rehabilitation and improve the exercise capacity of patients in the immediate postoperative period of cardiac surgery. Objective: This study aimed to evaluate the hemodynamic (heart rate, systolic blood pressure, diastolic blood pressure, and mean blood pressure) and respiratory (respiratory rate and oxygen saturation) responses to neuromuscular electrical stimulation in the immediate postoperative period in patients submitted to cardiac surgery and to verify its feasibility and safety. Methods: This is a pilot randomized controlled trial, wherein critical patients in the immediate postoperative period of cardiac surgery were randomly assigned to a control group, using sham neuromuscular electrical stimulation, or an experimental group, submitted to neuromuscular electrical stimulation sessions (FES), for 60 min, with a 50-Hz frequency, 200-µs pulse duration, time on: 3 s, and time off: 9 s. Data distribution was evaluated by the Shapiro-Wilk test. The analysis of variance was used and a p-value < 0.05 was considered significant. Results: Thirty patients were included in the study. The neuromuscular electrical stimulation was applied within the first 23.13 ± 5.24 h after cardiac surgery, and no changes were found regarding the hemodynamic and respiratory variables between the patients who underwent neuromuscular electrical stimulation, and those in the control group. Conclusions: In the present study, neuromuscular electrical stimulation did not promote changes in hemodynamic and respiratory responses of patients in the immediate postoperative period of cardiac surgery.

OBJECTIVE: During cardiac surgery, several factors contribute to the development of postoperative pulmonary complications. Non-invasive ventilation is a promising therapeutic tool for improving the functionality of this type of patient. The aim of this study is to evaluate the functional capacity and length of stay of patients in a nosocomial intensive care unit who underwent prophylactic non-invasive ventilation after heart valve replacement. METHOD: The study was a controlled clinical trial, comprising 50 individuals of both sexes who were allocated by randomization into two groups with 25 patients in each group: the control group and experimental group. After surgery, the patients were transferred to the intensive care unit and then participated in standard physical therapy, which was provided to the experimental group after 3 applications of non-invasive ventilation within the first 26 hours after extubation. For non-invasive ventilation, the positive pressure was 10 cm H2O, with a duration of 1 hour. The evaluation was performed on the 7th postoperative day/discharge and included a 6-minute walk test. The intensive care unit and hospitalization times were monitored in both groups. Brazilian Registry of Clinical Trials (REBeC): RBR number 8bxdd3. RESULTS: Analysis of the 6-minute walk test showed that the control group walked an average distance of 264.34±76 meters and the experimental group walked an average distance of 334.07±71 meters (p=0.002). The intensive care unit and hospitalization times did not differ between the groups. CONCLUSION: Non-invasive ventilation as a therapeutic resource was effective toward improving functionality; however, non-invasive ventilation did not influence the intensive care unit or hospitalization times of the studied cardiac patients.

Resumo Justificativa e objetivos: A Escala Comportamental de Dor (Behavioral Pain Scale) é uma ferramenta de avaliação da dor para pacientes não-comunicativos e sedados em unidade de tratamento intensivo (UTI). A falta de uma escala brasileira para a avaliação da dor em adultos sob ventilação mecânica justifica a relevância deste estudo que teve por objetivo validar a versão brasileira da Escala Comportamental de Dor (ECD), bem como correlacionar seus escores com os registros de parâmetros fisiológicos, nível de sedação e gravidade da doença. Métodos: Vinte e cinco pacientes adultos internados em UTI foram incluídos neste estudo. A versão brasileira da ECD (previamente traduzida e adaptada culturalmente) e os registros dos parâmetros fisiológicos foram realizados simultaneamente por dois avaliadores durante o repouso, durante a limpeza dos olhos (estímulo não doloroso) e durante a aspiração endotraqueal (estímulo doloroso). Resultados: Valores elevados do coeficiente de coeficiente de responsividade (coeficiente = 3,22) foram observados. O coeficiente alfa de Cronbach do escore total da ECD durante a limpeza dos olhos e aspiração endotraqueal foi de 0,8. O coeficiente de correlação intraclasse do escore total da ECD foi ≥ 0,8 durante a limpeza dos olhos e aspiração endotraqueal. Houve um escore significativamente mais alto na ECD durante a aplicação do estímulo doloroso em comparação com o período de descanso (p ≤ 0,0001). No entanto, não foram observadas correlações entre dor e parâmetros hemodinâmicos, nível de sedação e gravidade da doença. Conclusões: Este estudo pioneiro de validação da ECD brasileira apresenta índices satisfatórios de consistência interna, confiabilidade entre avaliadores, responsividade e validade. Portanto, a versão da ECD brasileira foi considerada um instrumento válido para ser usado em pacientes adultos sedados e ventilados mecanicamente no Brasil.

Abstract Background and objectives: The Behavioral Pain Scale is a pain assessment tool for uncommunicative and sedated Intensive Care Unit patients. The lack of a Brazilian scale for pain assessment in adults mechanically ventilated justifies the relevance of this study that aimed to validate the Brazilian version of Behavioral Pain Scale as well as to correlate its scores with the records of physiological parameters, sedation level and severity of disease. Methods: Twenty-five Intensive Care Unit adult patients were included in this study. The Brazilian Behavioral Pain Scale version (previously translated and culturally adapted) and the recording of physiological parameters were performed by two investigators simultaneously during rest, during eye cleaning (non-painful stimulus) and during endotracheal suctioning (painful stimulus). Results: High values of responsiveness coefficient (coefficient = 3.22) were observed. The Cronbach's alpha of total Behavioral Pain Scale score at eye cleaning and endotracheal suctioning was 0.8. The intraclass correlation coefficient of total Behavioral Pain Scale score was ≥ 0.8 at eye cleaning and endotracheal suctioning. There was a significant highest Behavioral Pain Scale score during application of painful procedure when compared with rest period (p ≤ 0.0001). However, no correlations were observed between pain and hemodynamic parameters, sedation level, and severity of disease. Conclusions: This pioneer validation study of Brazilian Behavioral Pain Scale exhibits satisfactory index of internal consistency, interrater reliability, responsiveness and validity. Therefore, the Brazilian Behavioral Pain Scale version was considered a valid instrument for being used in adult sedated and mechanically ventilated patients in Brazil.

Resumo Fundamentos: O exercício resistido (ER) tem sido recomendado para pacientes com doenças cardiovasculares. Recentemente, alguns estudos demonstraram que a intensidade de uma sessão de ER exerce um efeito sobre a disfunção endotelial. No entanto, não há dados sobre os efeitos de diferentes volumes de ER sobre a função endotelial. Objetivo: O objetivo deste estudo foi avaliar os efeitos de diferentes volumes de ER, realizados em uma única sessão, sobre a vasodilatação dependente do endotélio e síntese de óxido nítrico (NO) em artéria mesentérica de animais saudáveis. Métodos: Ratos Wistar machos foram divididos em três grupos: Controle (Ct); baixo volume (BV, 5 séries x 10 repetições) e alto volume de ER (AV, 15 séries x 10 repetições). Foi estabelecida a intensidade de 70% do teste de repetição máxima. Após o protocolo de exercício, anéis de artéria mesentérica foram utilizados na avaliação da reatividade vascular, e outras artérias mesentéricas foram preparadas para a detecção da produção de NO por fluorescência com para do DAF-FM. A resposta à insulina pela síntese de NO foi avaliada estimulando-se os anéis vasculares com insulina (10nM). Resultados: A resposta máxima do relaxamento induzido por insulina foi aumentada somente no grupo AV em comparação ao grupo Ct. Além disso, a inibição da síntese do NO (L-NAME), aboliu completamente o relaxamento vascular induzido por insulina em ratos exercitados. A produção de NO mostrou um aumento dependente do volume no endotélio e no músculo liso. No endotélio, apenas os grupos Ct e BV mostraram aumento significativo na síntese de NO quando comparado aos seus respectivos grupos sob condição basal. No entanto, no músculo liso, a fluorescência foi aumentada em todos os grupos quando comparados aos seus respectivos grupos sob a condição basal. Conclusões: Nossos resultados sugerem que uma única sessão de ER foi capaz de promover adaptações no endotélio vascular. Além disso, nós observamos que este efeito é volume-dependente e o volume de 15 séries x10 repetições induziu o maior aumento na síntese de NO.

Abstract Background: Resistance exercise (RE) has been recommended for patients with cardiovascular diseases. Recently, a few studies have demonstrated that the intensity of a single bout of RE has an effect on endothelial adaptations to exercise. However, there is no data about the effects of different volumes of RE on endothelium function. Objective: The aim of the study was to evaluate the effects of different volumes of RE in a single bout on endothelium-dependent vasodilatation and nitric oxide (NO) synthesis in the mesenteric artery of healthy animals. Methods: Male Wistar rats were divided into three groups: Control (Ct); low-volume RE (LV, 5 sets x 10 repetitions) and high-volume RE (HV, 15 sets x 10 repetitions). The established intensity was 70% of the maximal repetition test. After the exercise protocol, rings of mesenteric artery were used for assessment of vascular reactivity, and other mesenteric arteries were prepared for detection of measure NO production by DAF-FM fluorescence. Insulin responsiveness on NO synthesis was evaluated by stimulating the vascular rings with insulin (10 nM). Results: The maximal relaxation response to insulin increased in the HV group only as compared with the Ct group. Moreover, the inhibition of nitric oxide synthesis (L-NAME) completely abolished the insulin-induced vasorelaxation in exercised rats. NO production showed a volume-dependent increase in the endothelial and smooth muscle layer. In endothelial layer, only Ct and LV groups showed a significant increase in NO synthesis when compared to their respective group under basal condition. On the other hand, in smooth muscle layer, NO fluorescence increased in all groups when compared to their respective group under basal condition. Conclusions: Our results suggest that a single bout of RE promotes vascular endothelium changes in a volume-dependent manner. The 15 sets x 10 repetitions exercise plan induced the greatest levels of NO synthesis.

Abstract Objective: The aim of the study is to compare the available reference values and the six-minute walk test equations in healthy children/adolescents. Our systematic review was planned and performed in accordance with the PRISMA guidelines. We included all studies that established reference values for the six-minute walk test in healthy children/adolescents. Methods: To perform this review, a research was performed in PubMed, EMBASE (via SCOPUS) and Cochrane (LILACS), Bibliographic Index Spanish in Health Sciences, Organization Collection Pan-American Health Organization, Publications of the World Health Organization and Scientific Electronic Library Online (SciELO) via Virtual Health Library until June 2015 without language restriction. Results: The initial research identified 276 abstracts. Twelve studies met the inclusion criteria and were fully reviewed and approved by both reviewers. None of the selected studies presented sample size calculation. Most of the studies recruited children and adolescents from school. Six studies reported the use of random samples. Most studies used a corridor of 30 meters. All studies followed the American Thoracic Society guidelines to perform the six-minute walk test. The walked distance ranged 159 meters among the studies. Of the 12 included studies, 7 (58%) reported descriptive data and 6 (50%) established reference equation for the walked distance in the six-minute walk test. Conclusion: The reference value for the six-minute walk test in children and adolescents ranged substantially from studies in different countries. A reference equation was not provided in all studies, but the ones available took into account well established variables in the context of exercise performance, such as height, heart rate, age and weight. Countries that did not established reference values for the six-minute walk test should be encouraged to do because it would help their clinicians and researchers have a more precise interpretation of the test.

RESUMO A estimulação diafragmática elétrica transcutânea (EDET) é uma técnica de mobilização da musculatura respiratória que interfere no padrão e no ritmo respiratório. Na tentativa de avaliar as alterações no balanço autonômico cardíaco à EDET em indivíduos saudáveis, foi utilizado um modelo já estabelecido de eletroestimulação diafragmática. 22 voluntários com idades entre 22 e 35 anos, sem histórico cardíaco, foram randomizados em dois grupos (controle, n=8; EDET, n=14). O protocolo de eletroestimulação foi aplicado nos indivíduos em repouso (posição supina). O grupo controle foi submetido a estimulação elétrica em nível perceptivo, enquanto no grupo EDET o estímulo gerava contração diafragmática. Os intervalos cardíacos (CI) foram registrados por cardiofrequencímetro Polar (RS800CX). A variabilidade do intervalo cardíaco foi estudada nos domínios de tempo e frequência. No grupo controle, a estimulação elétrica não alterou a duração do intervalo cardíaco e sua variabilidade (CI: 761±44 vs. 807±39ms; RMSSD: 37±9 vs. 42±13ms; LF: 69±6 vs. 67±5nu; HF: 31±6 vs. 33±5nu), em comparação às condições basais). No entanto, o grupo EDET apresentou diminuição na modulação simpática cardíaca (LF: 43 ±3 vs. 63±4nu) e aumento da modulação parassimpática cardíaca (RMSSD: 109±10 vs. 41±6ms; HF: 57±3 vs. 37±4nu) durante a eletroestimulação diafragmática. No entanto, a duração do intervalo cardíaco não foi alterada por estimulação elétrica (CI: 686±59 vs. 780±31ms). Pode-se sugerir que o uso da EDET promove mudanças acentuadas no balanço simpatovagal, resultando em maior modulação parassimpática cardíaca, possivelmente induzida pelo aumento da mobilidade diafragmática.

ABSTRACT The transcutaneous electrical diaphragmatic stimulation (TEDS) is a technique of respiratory muscle activation that affects breathing pattern and rhythm. In an attempt to evaluate changes in cardiac autonomic balance in response to TEDS in healthy individuals, we used a well-established TEDS model. Twenty-two volunteers aged between 22 and 35 years old, with no cardiac pathology history, were randomized into two groups (control, n = 8; TEDS, n = 14). The individuals were allowed to rest in supine position and were then subjected to the electrical stimulation protocol. The control group was subjected to electrical stimulation at perceptive level, whereas for the TEDS group the electric stimulus generated diaphragm contraction. Cardiac intervals (CI) were sampled by a Polar RS800CX monitor. Cardiac interval variability was studied in the time and frequency domains. In the control group, electrical stimulation did not change cardiac interval length and variability (CI: 761±44 vs. 807±39 ms; RMSSD: 37±9 vs. 42±13 ms ; LF: 69±6 vs. 67±5 nu; HF: 31±6 vs. 33±5 nu; all comparisons versus baseline). Nevertheless, as compared to baseline, TEDS group showed decreased sympathetic cardiac modulation (LF: 43±3 vs. 63±4 nu) and increased parasympathetic cardiac modulation (RMSSD: 109±10 vs. 41±6 ms; HF: 57±3 vs. 37±4 nu) during diaphragmatic stimulation. However, cardiac interval length was not changed by electrical stimulation (CI: 686±59 vs. 780±31 ms). It can be suggested that the use of TEDS stimulus leads to pronounced changes in the cardiac sympathovagal balance, with higher parasympathetic cardiac modulation, possibly induced by increased diaphragmatic excursion.

RESUMEN La estimulación eléctrica transcutánea del diafragma (EETD) es un método que moviliza la musculatura respiratoria que interfiere en el patrón y en la frecuencia respiratoria. Para evaluar las alteraciones en el balance autónomo cardiaco por la EETD en individuos sanos, se empleó un modelo prestablecido de estimulación eléctrica muscular del diagrama. Han participado 22 voluntarios con edad entre 22 y 35 años, sin enfermedades cardiacas, puestos en grupos aleatorios: Grupo control (n=8) y EETD (n=14). Se aplicó el protocolo de estimulación eléctrica en individuos en posición decúbito supino. Al grupo control se lo sometió a la estimulación eléctrica a nivel perceptual, mientras que en el EETD la estimulación le generaba contracción del diafragma. Los intervalos cardiacos (CI) se registraron a través del monitor de ritmo cardiaco polar (RS800CX). Se estudió la variabilidad del intervalo cardiaco en los dominios tiempo y frecuencia. En el grupo control, la estimulación eléctrica no presentó alteraciones en la duración del intervalo cardiaco y su variabilidad (CI: 761±44 vs. 807±39ms; RMSSD: 37±9 vs. 42±13ms; LF: 69±6 vs. 67±5nu; HF: 31±6 vs. 33±5nu; comparado con las condiciones de base). Pero si comparado las condiciones de base en el grupo EETD presentó una disminución en la modulación simpática cardiaca (LF: 43±3 vs. 63±4nu) y un aumento en la modulación parasimpática cardiaca (RMSSD: 109±10 vs. 41±6ms; HF: 57±3 vs. 37±4nu) durante la realización de este método. Sin embargo, la duración del intervalo cardiaco no presentó alteraciones por la estimulación eléctrica del diafragma (CI: 686±59 vs. 780±31ms). Se puede concluir que el empleo de la EETD promueve cambios significativos en el balance simpático, resultando en una modulación parasimpática cardiaca más grande, posiblemente inducida del aumento de la movilidad del diafragma.

RESUMO Objetivo: Avaliar a dor e observar parâmetros fisiológicos em crianças sedadas e submetidas à ventilação mecânica durante um procedimento de rotina. Métodos: Estudo observacional realizado em uma unidade de terapia intensiva pediátrica. Foram avaliadas 35 crianças, com idades entre 1 mês e 12 anos, em três momentos distintos: antes, durante e 5 minutos após coleta de sangue arterial para análise gasométrica (procedimento doloroso). Utilizou-se a Escala Face, Legs, Activity, Cry and Consolability para avaliação da dor e foram registradas a frequência cardíaca, frequência respiratória, saturação periférica de oxigênio e pressão arterial (sistólica e diastólica). O nível de sedação dos participantes foi verificado utilizando-se a escala Comfort-B, aplicada antes da mensuração da dor e da avaliação dos parâmetros fisiológicos. Resultados: Durante os estímulos dolorosos, ocorreu aumento do escore da Escala Face, Legs, Activity, Cry and Consolability (p = 0,0001). Houve também aumento da frequência cardíaca (p = 0,03), da frequência respiratória (p = 0,001) e da pressão arterial diastólica (p = 0,006) em razão da dor causada pelo procedimento de rotina. Conclusões: Avaliação da dor com uso de escalas padrão, como a Escala Face, Legs, Activity, Cry and Consolability, e observação de parâmetros fisiológicos, deve ser realizada rotineiramente para melhorar o manejo da dor nas unidades de terapia intensiva pediátricas.

ABSTRACT Objective: This study assessed pain and observed physiological parameters in sedated and mechanically ventilated children during a routine procedure. Methods: This observational study was performed in a pediatric intensive care unit. Thirty-five children between 1 month and 12 years of age were assessed before, during, and five minutes after an arterial blood collection for gas analysis (painful procedure). Face, Legs, Activity, Cry and Consolability scale was used to assess pain. In addition, patients' heart rate, respiratory rate, peripheral saturation of oxygen and blood pressure (diastolic and systolic) were recorded. COMFORT-B scale was applied before the pain and physiological parameter assessments to verify sedation level of the subjects. Results: There was an increase in Face, Legs, Activity, Cry and Consolability score (p = 0.0001) during painful stimuli. There was an increase in heart rate (p = 0.03), respiratory rate (p = 0.001) and diastolic blood pressure (p = 0.006) due to pain caused by the routine procedure. Conclusions: This study suggests that assessments of pain using standard scales, such as Face, Legs, Activity, Cry and Consolability score, and other physiological parameters should be consistently executed to optimize pain management in pediatric intensive care units.

Introdução: A força muscular periférica tem sido pouco explorada na literatura atual no contexto da reabilitação cardiovascular. Objetivo: Avaliar a força muscular periférica de pacientes submetidos à cirurgia cardíaca eletiva. Métodos: Trata-se de um estudo observacional e longitudinal. A força muscular periférica foi mensurada por meio de dinamometria isométrica de MMII (extensores e flexores de joelho) em três momentos distintos: pré-operatório (M1), dia da alta da unidade de terapia intensiva (M2) e dia da alta hospitalar (M3). Os participantes receberam atendimento fisioterapêutico pré e pós-operatório durante os dias do internamento, nos períodos matutino e vespertino. Resultados: Foram avaliados 22 pacientes. Os valores de força muscular periférica de extensores de joelho pré-operatórios encontrados foram cerca de 50% menores do que os preditos para a população saudável. Ao comparar a força muscular prévia (M1), com os demais momentos de avaliação, encontrou-se em M2 queda de 29% para o movimento de extensão do joelho e 25% para o movimento de flexão de joelho e queda de 10% para o movimento de extensão do joelho e 13% para o movimento de flexão de joelho em M3 ao comparar com M1. Conclusão: Os valores de força muscular periférica prévia dos pacientes do estudo foram menores do que o predito para a população saudável com a mesma faixa etária. Após o evento cirúrgico, essa redução é ainda mais notável, sendo reestabelecida até o momento da alta hospitalar a valores próximos ao basal.

Introduction: Peripheral muscle strength has been little explored in the literature in the context of cardiac rehabilitation. Objective: To evaluate the peripheral muscle strength of patients undergoing elective cardiac surgery. Methods: This was a longitudinal observational study. The peripheral muscle strength was measured using isometric dynamometry lower limb (knee extensors and flexors) at three different times: preoperatively (M1), the day of discharge (M2) and hospital discharge (M3). Participants received physiotherapy pre and postoperatively during the days of hospitalization during the morning and afternoon. Results: Twenty-two patients were evaluated. The values of peripheral muscle strength of knee extensors preoperative found were about 50% lower than those predicted for the healthy population. When comparing muscle strength prior (M1), with the remaining evaluation, found himself in a fall of 29% for the movement of knee extension and 25% for knee flexion in M2 and a decrease of 10% movement for knee extension and 13% for knee flexion in M3 when comparing with M1. Conclusion: The values of peripheral muscle strength prior of the study patients were lower than predicted for the healthy population of the same age. After the surgical event this reduction is even more remarkable, being reestablished until the time of discharge, to values close to baseline.

FUNDAMENTO: A hipertensão arterial é uma síndrome multifatorial, crônica, causada tanto por fatores congênitos ou adquiridos. OBJETIVO: Avaliar os efeitos do treinamento físico resistido (TR) sobre pressão arterial, reatividade e morfologia vascular de ratos hipertensos induzidos por L-NAME. MÉTODOS: Ratos Wistar machos (200-250 g) foram divididos em 3 grupos: normotenso sedentário (NS), hipertenso sedentário (HS) e hipertenso treinado (HT). A hipertensão foi induzida pela administração de L-NAME (40 mg/kg) na água de beber por 4 semanas. A pressão arterial foi avaliada antes e após o TR. O TR foi realizado utilizando 50% de 1RM, em 3 séries de 10 repetições, 3 vezes por semana, durante quatro semanas. A reatividade vascular foi mensurada em artéria mesentérica superior por curvas concentração resposta ao nitroprussiato de sódio (NPS) e fenilefrina (FEN). Além disso, foram realizadas análises histológicas e estereológicas. RESULTADOS: O TR inibiu o aumento das pressões arteriais média e diastólica. Foi observada uma redução significativa na resposta máxima e na potência da FEN entre os grupos HS e HT. A análise histológica evidenciou aspecto normal para as túnicas íntima, média e adventícia em todos os grupos. Não houve diferença significativa nas áreas do lúmen, da túnica média e total das artérias dos grupos HS e HT em relação ao NS. A razão parede/lúmen arterial do grupo HS apresentou diferença significativa em relação ao NS (p < 0,05), mas esta não foi diferente do HT. CONCLUSÕES: O TR foi capaz de prevenir a elevação da pressão arterial sob as condições deste estudo. Este controle parece envolver a regulação de mecanismo vasoconstritor e a manutenção do diâmetro luminal de ratos hipertensos induzidos por L-NAME.

BACKGROUND: Arterial hypertension is a multifactorial chronic condition caused by either congenital or acquired factors. OBJECTIVE: To evaluate the effects of Resistance Training (RT) on arterial pressure, and on vascular reactivity and morphology, of L-NAME-treated hypertensive rats. METHODS: Male Wistar rats (200 - 250 g) were allocated into Sedentary Normotensive (SN), Sedentary Hypertensive (SH) and Trained Hypertensive (TH) groups. Hypertension was induced by adding L-NAME (40 mg/Kg) to the drinking water for four weeks. Arterial pressure was evaluated before and after RT. RT was performed using 50% of 1RM, 3 sets of 10 repetitions, 3 times per week for four weeks. Vascular reactivity was measured in rat mesenteric artery rings by concentration-response curves to sodium nitroprusside (SNP); phenylephrine (PHE) was also used for histological and stereological analysis. RESULTS: Resistance training inhibited the increase in mean and diastolic arterial pressures. Significant reduction was observed in Rmax (maximal response) and pD2 (potency) of PHE between SH and TH groups. Arteries demonstrated normal intima, media and adventitia layers in all groups. Stereological analysis demonstrated no significant difference in luminal, tunica media, and total areas of arteries in the SH and TH groups when compared to the SN group. Wall-to-lumen ratio of SH arteries was significantly different compared to SN arteries (p<0.05) but there was no difference when compared to TH arteries. CONCLUSIONS: RT was able to prevent an increase in blood pressure under the conditions in this study. This appears to involve a vasoconstrictor regulation mechanism and maintenance of luminal diameter in L-NAME induced hypertensive rats.