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Objective. To investigate the effects of a supervised exercise training program on health parameters, physical capacity, and health-related quality of life in patients with mild and chronic juvenile dermatomyositis (DM). Methods. This was a prospective longitudinal study following 10 children with mild and chronic juvenile DM (disease duration >1 year). The exercise program consisted of twice-a-week aerobic and resistance training. At baseline and after the 12-week intervention, we assessed muscle strength and function, aerobic conditioning, body composition, juvenile DM scores, and health-related quality of life. Results. Child self-report and parent proxy-report Pediatric Quality of Life Inventory scores were improved after the intervention (؊40.3%; P ‫؍‬ 0.001 and ؊48.2%; P ‫؍‬ 0.049, respectively). Importantly, after exercise, the Disease Activity Score was reduced (؊26.9%; P ‫؍‬ 0.026) and the Childhood Muscle Assessment Scale was improved (؉2.5%; P ‫؍‬ 0.009), whereas the Manual Muscle Test presented a trend toward statistical significance (؉2.2%; P ‫؍‬ 0.081). The peak oxygen consumption and time-to-exhaustion were increased by 13.3% (P ‫؍‬ 0.001) and 18.2% (P ‫؍‬ 0.003), respectively, whereas resting heart rate was decreased by 14.7% (P ‫؍‬ 0.006), indicating important cardiovascular adaptations to the exercise program. Upper and lower extremity muscle strength and muscle function were also significantly improved after the exercise training (P < 0.05). Both the whole-body and the lumbar spine bone mineral apparent density were significantly increased after training (1.44%; P ‫؍‬ 0.044 and 2.85%; P ‫؍‬ 0.008, respectively). Conclusion. We showed for the first time that a 12-week supervised exercise program is safe and can improve muscle strength and function, aerobic conditioning, bone mass, disease activity, and health-related quality of life in patients with active and nonactive mild and chronic juvenile DM with near normal physical function and quality of life.

Objective. To evaluate the influence of exposure to inhaled environmental factors during pregnancy on the diagnosis of juvenile dermatomyositis (DM).Methods. We performed a case-control study comprising 20 juvenile DM patients and 56 healthy controls matched by age and sex who were residents in the metropolitan region of a large city. A questionnaire assessed demographic data and environmental inhalation exposure during pregnancy (occupational exposure to demolition, chalk, construction and/or quarry dust, paints, varnish, gasoline vapor, and/or battery fluids; stationary sources of inhaled pollution near the mother's home; and maternal tobacco exposure). Daily concentrations of inhaled particulate matter, SO 2 , NO 2 , O 3 , and carbon monoxide (CO) were evaluated throughout the gestational period. Results. Maternal occupational exposure to school chalk dust/gasoline vapor in the juvenile DM group was significantly higher compared with controls (50% versus 4.6%; P ‫؍‬ 0.001). Smoking mothers and secondhand smoke exposure at home during pregnancy were significantly higher in the juvenile DM group versus controls (smoking mothers: 20% versus 1.7%; P ‫؍‬ 0.01, and secondhand smoke: 35% versus 19%; P ‫؍‬ 0.07). In univariate logistic regression models, maternal smoking, occupational exposure to inhaled agents, and the highest tertile of tropospheric CO (3.2-5.4 parts per million) in the third trimester were significantly associated with juvenile DM (P < 0.05). In the multivariate analysis, smoking mother (odds ratio [

BackgroundPatients with juvenile dermatomyositis (JDM) often present strong exercise intolerance and muscle weakness. However, the role of exercise training in this disease has not been investigated.Purposethis longitudinal case study reports on the effects of exercise training on a 7-year-old patient with JDM and on her unaffected monozygotic twin sister, who served as a control.MethodsBoth the patient who was diagnosed with JDM as well as her healthy twin underwent a 16-week exercise training program comprising aerobic and strengthening exercises. We assessed one repetition-maximum (1-RM) leg-press and bench-press strength, balance, mobility and muscle function, blood markers of inflammation and muscle enzymes, aerobic conditioning, and disease activity scores. As a result, the healthy child had an overall greater absolute strength, muscle function and aerobic conditioning compared to her JDM twin pair at baseline and after the trial. However, the twins presented comparable relative improvements in 1-RM bench press, 1-RM leg press, VO2peak, and time-to-exhaustion. The healthy child had greater relative increments in low-back strength and handgrip, whereas the child with JDM presented a higher relative increase in ventilatory anaerobic threshold parameters and functional tests. Quality of life, inflammation, muscle damage and disease activity scores remained unchanged.Results and Conclusionthis was the first report to describe the training response of a patient with non-active JDM following an exercise training regimen. The child with JDM exhibited improved strength, muscle function and aerobic conditioning without presenting an exacerbation of the disease.

Original article ABSTRACTObjective: Traumatic spinal Cord injuries are common in patients with high-energy trauma, and have significant morbidity and mortality rates, as well as high psychological and social costs, causing a major impact on public health. To date, the treatment of such lesions remains controversial, with various studies in the literature comparing the results of non-surgical treatment with immediate, early or late surgical decompression. The objective of the present study is to compare the results of immediate and early (within 1 hour) spinal Cord decompression. Methods: In the belief that the surgical treatment obtains the best result, this experimental study has a case-control design, with histopathological and functional analysis of the results of surgical treatment of 25 Wistar mice submitted to posterior laminectomy immediately, or after one hour of spinal Cord compression. Results: in terms of functional and neurological deficit, the responses were better in the mice treated with immediate surgical decompression than in those treated one hour after the lesion (p=0.036). Conclusion: The earlier the decompression of spinal Cord injuries is performed, the better the end results in terms of the function and presence of neurological deficit.

Objetivo. Investigar os efeitos e a segurança de um programa de exercícios físicos supervisionados em parâmetros da doença, capacidade física e qualidade de vida relacionada à saúde em pacientes com dermatomiosite juvenil (DMJ). Métodos. Estudo longitudinal e prospectivo com 10 pacientes com DMJ crônica e com atividade leve. O programa de exercícios consistiu de treinos aeróbios e de resistência duas vezes por semana. Nos momentos inicial e 12 semanas após a intervenção foram avaliadas força e função musculares, condicionamento aeróbio, composição corpórea, escores da DMJ e qualidade de vida relacionada à saúde. Resultados. Pediatric Quality of Life Inventory do paciente e dos pais melhoraram após a intervenção (8,3%; p=0,0008 e 8,7%; p=0,027, respectivamente). Disease Activity Score reduziu (-30,6%; p=0,021) e Childhood Muscle Assessment Scale melhorou (2,5%; p=0,009), enquanto Manual Muscle Testing apresentou uma tendência à significância estatística (2,2%; p=0,081). O pico de consumo de oxigênio e o tempo para exaustão aumentou em 13,3% (p=0,001) e 18,2% (p=0,003), respectivamente, enquanto a frequência cardíaca de repouso diminuiu em 14,7% (p=0,006), indicando importantes adaptações cardiovasculares ao exercício. A força muscular dos membros superiores e inferiores e a função muscular também melhoraram significantemente após o programa (p<0,05). A densidade mineral aparente do corpo total e da coluna lombar aumentaram significantemente após os treinos (1,44%; p=0,044 e 2,85%; p=0,008, respectivamente). Conclusão. Pela primeira vez na literatura foi mostrado que um programa de exercícios físicos supervisionados por 12 semanas é seguro e capaz de melhorar força e função musculares, condicionamento aeróbio, massa óssea, atividade da doença, e qualidade de vida relacionada à saúde em pacientes com DMJ crônica e leve, em atividade ou em remissão. Descritores: Dermatomiosite; exercício; criança; adolescente; estudos prospectivos; estudos longitudinais; qualidade de vida; treinamento de resistência.

Background Juvenile dermatomyositis (JDM) belongs to a heterogeneous group of diseases known as idiopathic inflammatory myopathies that share common symptoms, such as a proximal muscle weakness and a nonsuppurative inflammation of the skeletal muscle. The prognosis of JDM in terms of physical function is often positive. However, many patients continue to present chronic illness and suffer sequelae of the disease. In this regard, it has been speculated that exercise training could promote functional benefits to these patients, ultimately leading to improvements in their quality of life. Objectives To investigate the effects a supervised exercise training program on health-related quality of life, health parameters, physical capacity, bone mass and body composition in a cohort of juvenile dermatomyositis patients. Methods This was a prospective longitudinal study. The sample consisted of 10 children with JDM. The exercise program consisted of a twice-a-week supervised aerobic and resistance training. At baseline and after the 12-week intervention, we assessed health-related quality of life, JDM scores (DAS, CMAS, MMT) aerobic conditioning, muscle strength and function, bone mineral apparent density and body composition. Results Both the child self-report and the parent proxy-report PedsQL scores improved after the intervention (-40.3%, p=0.001 and -48.2%, p=0.049 respectively). Importantly, DAS score reduced after the exercise (-26.9%, p=0.026), CMAS score improved after exercise (+2.5%, p=0.009) and MMT presented a trend towards statistical significance (+2.2%, p=0.081). The V02peak and time-to-exhaustion increased by 13.3% (p=0.001) and 18.2% (p=0.003), respectively, whereas resting heart-rate decreased by 14.7% (p=0.006), indicating important cardiovascular adaptations to the exercise program. Upper- and lower-limb muscle strength and muscle function also improved significantly after the exercise training (p<0.05). Both the whole body and the lumbar spine bone mineral apparent density increased significantly after training (1.44%, p=0.044 and 2.85%, p=0.008, respectively). Conclusions We showed for the first time that a 12-week supervised exercise program is safe and can improve health-related quality of life, disease activity, aerobic conditioning, muscle strength and function, and bone mass in patients with active and non-active chronic JDM. References de Salles Painelli V, Gualano B, Artioli GG, de Sa Pinto AL, Bonfa E, Lancha Junior AH, et al. The possible role of physical exercise on the treatment of idiopathic inflammatory myopathies. Autoimmun Rev 2009;8:355-9. Feldman BM, Rider LG, Reed AM, Pachman LM. Juvenile dermatomyositis and other idiopathic inflammatory myopathies of childhood. Lancet 2008;371:2201-12. Harris-Love MO. Physical activity and disablement in the idiopathic inflammatory myopathies. Curr Opin Rheumatol 2003;15:679-90 Disclosure of Interest None Declared