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The impact of exercise on the levels of endothelial progenitor cells (EPCs), a marker of endothelial repair and angiogenesis, and circulating endothelial cells (CECs), an indicator of endothelial damage, in heart failure patients is largely unknown. This study aims to evaluate the effects of a single exercise bout on the circulating levels of EPCs and CECs in heart failure patients. Thirteen patients with heart failure underwent a symptom-limited maximal cardiopulmonary exercise test to assess exercise capacity. Before and after exercise testing, blood samples were collected to quantify EPCs and CECs by flow cytometry. The circulating levels of both cells were also compared to the resting levels of 13 volunteers (age-matched group). The maximal exercise bout increased the levels of EPCs by 0.5% [95% Confidence Interval, 0.07 to 0.93%], from 4.2 × 10-3 ± 1.5 × 10-3% to 4.7 × 10-3 ± 1.8 × 10-3% (p = 0.02). No changes were observed in the levels of CECs. At baseline, HF patients presented reduced levels of EPCs compared to the age-matched group (p = 0.03), but the exercise bout enhanced circulating EPCs to a level comparable to the age-matched group (4.7 × 10-3 ± 1.8 × 10-3% vs. 5.4 × 10-3 ± 1.7 × 10-3%, respectively, p = 0.14). An acute bout of exercise improves the potential of endothelial repair and angiogenesis capacity by increasing the circulating levels of EPCs in patients with heart failure.

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BACKGROUND: The congenital muscular torticollis is characterized by a persistent lateral flexion of the head to the affected side and cervical rotation to the opposite side due to unilateral shortening of the sternocleidomastoid muscle. The majority of the cases resolve with conservative management, with parents/caregivers education and physical therapy.The aim of this study was to assess demographic and clinical characteristics, treatment options, and outcome, amongst infants referred to pediatric rehabilitation consultation due to congenital muscular torticollis. METHODS: Retrospective cohort study of infants diagnosed with congenital muscular torticollis between January 2012 and December 2014. Obstetric and perinatal data, clinical presentation, comorbidities, treatment, and outcome were abstracted from clinical records. RESULTS: One hundred six infants were included. There was no sex predominance and mean age at first pediatric rehabilitation consultation was 11.6 (10.4) weeks. Most women were primiparous (76.4%), dystocic labor predominated (73.6%), and pelvic fetal presentation occurred in 20.8%. At examination, 49.1% of the infants had abnormalities, beyond the tilt cervical, mainly range of motion restrictions and palpable nodule in sternocleidomastoid muscle. Among the 87 children who performed the cervical ultrasound, 29 (27.4%) had anomalies. Associated clinical conditions such as hip dysplasia were identified. The majority (71.7%) were submitted to conservative treatment, 30.2% in the Pediatric Rehabilitation Department. Most infants (97.2%) showed a complete resolution of the torticollis. CONCLUSIONS: Congenital muscular torticollis is the most common cause of torticollis in the infants. Early diagnosis, parent/caregivers education, and conservative treatment are crucial to achieving good results.

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INTRODUCTION AND OBJECTIVES: To describe the progression of aerobic exercise intensity in patients on a cardiac rehabilitation (CR) program. METHODS: We conducted a retrospective analysis of a random sample of patients referred for CR after acute coronary syndrome between 2008 and 2016. The weekly peak exercise intensity achieved during aerobic exercise was estimated by treadmill speed and grade at peak effort and the corresponding perception of effort was assessed using the Borg scale. Initial exercise intensity was prescribed as 60-80% of reserve heart rate plus resting heart rate, and was modified according to perceived exertion. Peak heart rate/intensity and perceived exertion index were used as variables to characterize the response to the intensity achieved. Variables were compared at different time points: T1 (1st week), T2 (4th week) and T3 (8th week). RESULTS: Of the total of 868, 238 patients were randomly selected. At peak heart rate during the session, exercise intensity (in metabolic equivalents) was: T1: 7.2±2.0, T2: 9.0±2.2, and T3: 9.4±2.2 (p<0.01). The peak heart rate/intensity index was T1: 16.8±5.4, T2: 13.4±3.6 and T3: 13.1±3.8 (p<0.01) and the perceived exertion index was T1: 1.8±0.6; T2: 1.4±0.5; T3: 1.4±0.5 (p<0.01). CONCLUSIONS: Increasing exercise intensity during CR, associated with lower perception of effort and lower heart rate necessary to achieve such intensity, leads to significant improvement in functional capacity.

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HIGHLIGHTS: Chronic anal fissure is a common condition associated with intense pain.Local botulinum toxin injection is a valid option in its management.Pain intensity scores significantly improved after BoNT injection.Side effects were rare and mild.Our results support the inclusion of BoNT in the management algorithm of chronic anal fissure. INTRODUCTION: Chronic anal fissure is a common condition associated with intense pain. Local botulinum toxin injection is a valid option in its management. The purpose of this study was to evaluate the efficacy of botulinum toxin on pain relief in chronic anal fissure patients. METHODS: We conducted a retrospective cohort study, involving 81 consecutive patients referred to a chronic pain management unit due to a chronic anal fissure for treatment with botulinum toxin, during a 4 year period. Data were collected from hospital records regarding pre-treatment and post-treatment pain (numeric rating scale), side effects, need for botulinum toxin reinjection and need for surgical treatment. We used standard statistical methods for inter (t-test and qui2) and intra-group (paired sample t-test) comparisons, according to variables distribution. RESULTS: Pain intensity rest score significantly improved after BoNT injection [variation: -4.2 ± 2.9 (p < 0.001)], as did pain post-defecation score [variation: -5.1 ± 3.0 (p < 0.001)]. 8.6% needed botulinum toxin reinjection and 23.5% were submitted to surgery. Side effects were reported in 8.6%. DISCUSSION: The efficacy of botulinum toxin use on pain reduction along with its non-permanent and minor side effects support its role in the resolution of chronic anal fissure. However, treatment failure in the long term is still significant. CONCLUSION: Botulinum toxin is effective on pain relief in patients with chronic anal fissure, which supports its inclusion in the management algorithm of this condition.

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Knee joint lesions can be solitary or occur concomitantly with other lower limb abnormalities. Ring-shaped lateral meniscus (RSM) and hypoplasic anterior cruciate ligament (ACL) are two rare malformations. The therapeutic management of such abnormalities is not consensual, and highly depends on clinical symptomatology. We report a case of a 25-year-old girl with progressive knee pain whose MRI demonstrated a continuous segment of lateral meniscus situated along the medial aspect of the lateral compartment, continuous with the otherwise normal-appearing lateral meniscus, compatible with an RSM. This anatomic variant can be mistaken by a displaced meniscal fragment, like a bucket-handle tear, a central tear of a discoid meniscus, or incomplete discoid meniscus, as previously reported. Her MRI examination also showed a thinned ACL with anomalous lateral course. This abnormality may be mistaken for an ACL rupture and/or a meniscofemoral ligament with agenesis of ACL. Multiple images in different planes as well as following the course of meniscal and ligaments are critical clues to avoid misdiagnosis. As a result, the diagnosis of an RSM along with hypoplasic ACL with abnormal attachment was assumed based on MRI and confirmed during arthroscopy. The patient was treated conservatively with clinical outcome improvement.

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