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BACKGROUND: A high workload has been associated with musculoskeletal pain in public school teachers. However, the hypothesis of the present study was that physical activity (PA) practice is able to attenuate this association. OBJECTIVE: To analyze the associations between high workload with musculoskeletal pain according to PA levels in public school teachers. METHODS: Teachers (n = 239) from 13 public schools were evaluated. Workload was assessed using a Likert scale in which teachers reported their perception of their work routine as: very low, low, regular, high, and very high. Musculoskeletal pain and PA were assessed using questionnaires. Multivariate logistic regression models were used to investigate the association of high workload with PA levels and musculoskeletal pain in different body regions, compared to participants with normal workload, adjusted by sex, age, and socioeconomic status. RESULTS: A high workload was associated with higher chances of reporting pain in the wrists and hands (OR = 3.55; 95% CI = 1.27-9.89), knee (OR = 3.09; 95CI%  = 1.09-8.82), and feet and ankles (OR = 3.16; 95% CI = 1.03-9.76) in less active teachers. However, these associations were not observed in teachers considered more active. CONCLUSION: PA practice is able to act as a good protector against musculoskeletal pain in teachers, even in individuals with a high workload.

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BACKGROUND: Minimally invasive pancreatoduodenectomy (PD) is one of the most complex procedures in oncologic surgery. We present a video of robotic portomesenteric reconstruction with bovine pericardial graft during PD. METHODS: A 52-year-old woman was referred with a mass in the head of the pancreas. The tumor was in contact with the portomesenteric axis. The multidisciplinary team decided to perform an upfront resection. The surgery was performed as a pylorus-preserving pancreaticoduodenectomy with lymphadenectomy. The superior mesenteric artery first approach was used to expose the head of the pancreas, so that the entire surgical specimen was attached only through the tumor invasion of the portomesenteric axis. After resection of the invaded portomesenteric axis, its large extension precluded primary reconstruction, so a bovine pericardial graft was used for venous reconstruction. After completion of the venous anastomosis, reconstruction of the digestive tract was performed as usual. RESULTS: Surgical time was 430 min; clamp time was 55 min; and portomesenteric reconstruction took 41 min. Estimated blood loss was 320 mL without transfusion. Pathology confirmed T3N1 ductal adenocarcinoma with free margins. No pancreatic or biliary fistula was observed, and she was discharged on postoperative day 8. A postoperative examination confirmed the patency of the graft. The patient is doing well 6 months after surgery and has no signs of the disease. CONCLUSIONS: A bovine pericardial graft is useful for reconstruction and readily available, eliminating the need to harvest an autologous vein or use synthetic grafts. This procedure can be safely performed with the robotic platform.

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CONTEXTUALIZAÇÃO: O uso da eletromiografia de superfície (EMG-S) tem sido considerado como instrumento de avaliação quantitativa na síndrome da dor patelofemoral (SDPF). Tratamentos conservadores objetivam melhorar o alinhamento patelar, e a estimulação elétrica do músculo vasto medial oblíquo (VMO) tem sido considerada por ser seletiva e não causar irritação articular. OBJETIVO: Verificar o efeito de um programa de fortalecimento muscular com estimulação elétrica do VMO na SDPF por meio da capacidade de avaliação da EMG-S. MÉTODOS: Participaram deste estudo 10 mulheres jovens (idade: 23,1±4,9 anos; massa corporal: 66,8±14,0 kg; estatura: 1,63±6,9 cm; IMC: 25,1±5,6 kg/m²) com SDPF unilateral, as quais realizaram o teste funcional de subir degrau para captação da atividade eletromiográfica dos músculos VMO e vasto lateral (VL), antes e após um programa de estimulação elétrica do VMO. A eletroestimulação foi realizada três vezes por semana, durante seis semanas. Foram consideradas, para análise entre VMO e VL, as variáveis razão do tempo do início até o pico de ativação, razão da integral do sinal (teste t para amostras dependentes) e diferença de início de ativação (teste de Wilcoxon), com nível de significância de p<0,05. RESULTADOS: Os resultados mostraram que ocorreu alteração somente no comportamento eletromiográfico relativo à razão da integral do sinal, mostrando que, após o treinamento muscular, ocorreram mudanças na capacidade de geração da força. CONCLUSÃO: O uso da eletroestimulação deve ser considerado no sentido de complementar a abordagem terapêutica conservadora em portadores da SDFP e a análise da razão da integral do sinal de EMG-S, como instrumento de avaliação. Artigo registrado no Australian New Zealand Clinical Trials Registry (ANZCTR) sob o número ACTRN 12609000079246.

BACKGROUND: The use of surface electromyography (SEMG) has been considered a tool for quantitative assessment of patellofemoral pain syndrome (PFPS). Conservative treatments aim to improve patellar alignment, and electrical stimulation of the vastus medialis obliquus (VMO) muscle has been considered effective because it is selective and does not cause joint irritation. OBJECTIVE: This study aims to investigate the efficiency of a muscle strengthening program with electrical stimulation of the VMO muscle in PFPS by SEMG. METHODS: A group of ten young women (age: 23.1±4.9 years; body mass: 66.8±14.0 kg; height: 1.63±6.9 cm; BMI: 25.1±5.6 kg/m²) with unilateral PFPS participated in the study. They performed the functional test of stair stepping to capture the electromyographic (EMG) activity of the VMO and vastus lateralis (VL) muscles, before and after a program of electrical stimulation of the VMO muscle. The electrical stimulation was performed three times per week for six weeks. For analysis between the VMO and VL muscles, we considered the variables: ratio of time of onset to peak of activation, ratio of the integrals of the signals (t-test for dependent samples), and difference between onsets of activation (Wilcoxon test), with significance level of p<0.05. RESULTS: The results only showed change in behavior in the EMG signal for the ratio of the integrals of the signals, indicating that changes occurred in the force-generating capacity of the muscle after the training. CONCLUSION: The use of electrical stimulation should be considered to complement the conservative therapeutic approach in patients with PFPS, and the analysis of the ratio of the integrals of the SEMG signals should be considered as an instrument of evaluation. Article registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) under number ACTRN 12609000079246.

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Many authors have studied physical and functional changes in individuals post-stroke, but there are few studies that assess changes in the non-plegic side of hemiplegic subjects. This study aimed to compare the electromyographic activity in the forearm muscles of spastic patients and clinically healthy individuals, to determine if there is difference between the non-plegic side of hemiplegics and the dominant member of normal individuals. 22 hemiplegic subjects and 15 clinically healthy subjects were submitted to electromyography of the flexor and extensor carpi ulnaris muscles during wrist flexion and extension. The flexor muscles activation of stroke group (average 464.6 u.n) was significantly higher than the same muscles in control group (mean: 106.3 u.n.) during the wrist flexion, what shows that the non affected side does not present activation in the standard of normality found in the control group.

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Many authors have studied physical and functional changes in individuals post-stroke, but there are few studies that assess changes in the non-plegic side of hemiplegic subjects. This study aimed to compare the electromyographic activity in the forearm muscles of spastic patients and clinically healthy individuals, to determine if there is difference between the non-plegic side of hemiplegics and the dominant member of normal individuals. 22 hemiplegic subjects and 15 clinically healthy subjects were submitted to electromyography of the flexor and extensor carpi ulnaris muscles during wrist flexion and extension. The flexor muscles activation of stroke group (average 464.6 u.n) was significantly higher than the same muscles in control group (mean: 106.3 u.n.) during the wrist flexion, what shows that the non affected side does not present activation in the standart of normality found in the control group.

Muitos autores estudaram as modificações funcionais e físicas em indivíduos pós-acidente vascular cerebral; porém, poucos estudos avaliam alterações no hemicorpo não plégico de indivíduos hemiplégicos. O objetivo deste estudo foi comparar a atividade eletromiográfica nos músculos do antebraço de pacientes espásticos e indivíduos clinicamente saudáveis, para averiguar se há diferença entre o lado não plégico de indivíduos hemiplégicos e o lado dominante de indivíduos clinicamente saudáveis. 22 indivíduos hemiplégicos e 15 clinicamente saudáveis foram submetidos à eletromiografia dos músculos flexor e extensor ulnar do carpo durante a flexão e extensão do punho. A ativação dos músculos flexores dos hemiplégicos (média: 464,6 u.n), foi significantemente maior que nos indivíduos do grupo controle (média: 106,3 u.n) durante o movimento de flexão do punho, o que demonstra que o hemicorpo não acometido dos pacientes estudados não apresenta o comportamento padrão de normalidade encontrado no grupo controle.

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BACKGROUND: The use of surface electromyography (SEMG) has been considered a tool for quantitative assessment of patellofemoral pain syndrome (PFPS). Conservative treatments aim to improve patellar alignment, and electrical stimulation of the vastus medialis obliquus (VMO) muscle has been considered effective because it is selective and does not cause joint irritation. OBJECTIVE: This study aims to investigate the efficiency of a muscle strengthening program with electrical stimulation of the VMO muscle in PFPS by SEMG. METHODS: A group of ten young women (age: 23.1 ± 4.9 years; body mass: 66.8 ± 14.0 kg; height: 1.63 ± 6.9 cm; BMI: 25.1 ± 5.6 kg/m²) with unilateral PFPS participated in the study. They performed the functional test of stair stepping to capture the electromyographic (EMG) activity of the VMO and vastus lateralis (VL) muscles, before and after a program of electrical stimulation of the VMO muscle. The electrical stimulation was performed three times per week for six weeks. For analysis between the VMO and VL muscles, we considered the variables: ratio of time of onset to peak of activation, ratio of the integrals of the signals (t-test for dependent samples), and difference between onsets of activation (Wilcoxon test), with significance level of p < 0.05. RESULTS: The results only showed change in behavior in the EMG signal for the ratio of the integrals of the signals, indicating that changes occurred in the force-generating capacity of the muscle after the training. CONCLUSION: The use of electrical stimulation should be considered to complement the conservative therapeutic approach in patients with PFPS, and the analysis of the ratio of the integrals of the SEMG signals should be considered as an instrument of evaluation. Article registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) under number ACTRN 12609000079246.

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Objetivo: Este trabalho teve por objetivo caracterizar os pacientes e as atividades realizadas no Projeto Hemiplegia, que consiste em encontros de portadores de hemiplegia para realização de fisioterapia em grupo. Método: A caracterização dos pacientes foi feita por meio da análise de seus prontuários e da aplicação da Escala de Equilíbrio de Berg (EEB), e a descrição do projeto pela análise da filmagem de 18 sessões do projeto. Resultados: Dos pacientes analisados 15 pertenciam ao sexo masculino e 4 ao feminino, com idade média de59,63 ± 11,1 anos. O tempo médio de seqüela pós-AVC foi de 5,17 ± 3,92 anos. As médias alcançadas nas avaliações da EEB foram 43,00 ± 10,48 pontos na 1ª avaliação e 44,95 ± 9,69 pontos na 2ª avaliação. A análise comparativa entre as duas avaliações determinou que houve diferença estatística significativa entre elas(p<0,05). A conduta fisioterapêutica caracteriza-se pela utilização de exercícios ativos, alongamentos, exercícios de equilíbrio e coordenação e atividades lúdicas. Conclusão: O Projeto Hemiplegia demonstra que a terapia em grupo pode ser uma boa opção terapêutica capaz de impedir complicações que possam determinar uma maior deterioração da capacidade funcional e da dependência, também garante a manutenção ou melhora do equilíbrio, melhorando assim a qualidade de vida desses pacientes.

Objective: The aim of this study was to characterize the patients and the physical activities performed in theHemiplegia Project. This project consisted of a group of hemiplegic patients that get together to performgroup physical therapy. Method: The profile of the patients was made through the analysis of their medicalrecords and the use of Berg balance scale. The outline of the project was made by analyzing the recordingimages of 18 sessions of the program. Results: Of the 19 patients enrolled, 15 were male and 4 female. Meanage was 59.63 ± 11.1 years. The median known duration of sequela after a stroke (CVA) was 5.17 ± 3.92 years.The average scores reached in the BBS evaluations were 43.00 ± 10.48 points in 1st evaluation and 44.95 ± 9.69points in 2nd evaluation. A comparative analysis was performed to test differences between the two evaluations.There were no significant statistical differences between the two evaluations (p £ 0.05). The average time ofsequel after AVC was 5.17 ± 3.92 years. The physical therapy session is characterized for the use of activeexercises, stretching, equilibrium and motor coordination exercises, and playful activities. Conclusion: TheHemiplegia Project demonstrates that the group therapy can be a good therapeutical option to preventcomplications that may determine a much large deterioration of the functional capacity and the dependence.Also the group therapy assures the maintenance of the equilibrium or improves it, thus improving the qualityof life of these patients.

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Objetivo: Analisar o comportamento do sistema cardiovascular de pacientes hemiplégicos crônicos, durante exercícios físicos em grupo, e correlacionar esse comportamento com a intensidade com que são executados.Método: Foram analisados dados de 23 hemiplégicos crônicos, freqüentadores do “Projeto Hemiplegia”desenvolvido na FCT/UNESP. Para coleta dos dados as sessões deste projeto foram divididas em quatro fases: repouso, sentado, em pé e sentado1. A freqüência cardíaca foi registrada batimento a batimento durante toda a sessão por meio de um freqüencímetro Polar S810 e a pressão arterial verificada indiretamente ao final das fases da sessão. A escala de Borg e a reserva de freqüência cardíaca (RCF) foram coletadas nas fases: sentado, em pé e sentado1. A variabilidade da freqüência cardíaca (VFC) foi analisada no domínio do tempo nas quatro fases da sessão. Análise de variância para medidas repetidas seguida da aplicação do teste de Tukey foi utilizada para análise dos dados (p < 0,05). Resultados: Ocorreram diferenças significativas da freqüência cardíaca entre os valores da fase de repouso em comparação com as fases sentado e em pé e da fase sentado1 com a fase em pé. O índice de VFC apresentou diferenças entre as fases sentado e sentado1.Diferenças significativas foram observadas com a pressão arterial sistólica, quando comparada às atividades realizadas na fase em pé com as fases de repouso e sentado, enquanto que a pressão arterial diastólica não apresentou diferença significativa entre as fases. Os valores médios da escala de Borg foram nas fases sentado, em pé e sentado1: 8,0; 10,5 e 9,0, respectivamente, sendo significativos entre as fases sentado e em pé e a RCF apresentou valores significativos comparando a fase em pé com as fases sentado e sentado1.Conclusão: Os resultados permitem concluir que as atividades realizadas, apesar da baixa intensidade,produzem modificações significativas do sistema cardiovascular em hemiplégicos crônicos.

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