Introdução: Alterações pulmonares estruturais e funcionais podem ocorrer na dermatomiosite juvenil (DMJ). O objetivo foi avaliar a função pulmonar de pacientes com DMJ e analisar correlações entre os valores encontrados e os escores: tomográfico, de atividade e dano cumulativo da doença e qualidade de vida. Métodos: Estudo prospectivo, transversal, com 20 pacientes com DMJ entre 6 e 18 anos. Realizados testes de espirometria, pletismografia, difusão de monóxido de carbono (DLCO), teste de caminhada de 6 minutos (TCam6min) e tomografia de tórax (TC). Avaliados também: escores de atividade da doença (DAS), força muscular (CMAS e MMT), dano cumulativo (MDI) e qualidade de vida (PedsQL). Resultados: Vinte pacientes foram incluídos (média de 11,6 anos). Houve obstrução leve ou moderada em 35% dos pacientes, redução da difusão em 20%. Anormalidades espirométricas e/ou da difusão em 45% dos pacientes. Na pletismografia: CPT reduzida em 25% dos pacientes, condutância em 50% e relação VR/CPT em 35%. Treze pacientes realizaram TC sendo 8 alteradas com padrão intersticial(n=6) e misto(n=2). As correlações significativas (p < 0,05) foram: VEF1/CV versus DAS, PedsQL, CMAS e TC; condutância versus DAS, MDI e PedsQl; TCam6Min versus CMAS; DLCO versus MDI e CMAS; TC versus MDI, FEF 25%-75%, condutância, CMAS, PedsQL e DAS. Conclusão: A pletismografia, DLCO e o TCam6min são testes complementares na detecção de distúrbios funcionais em pacientes com DMJ. A existência de correlações significativas entre os parâmetros funcionais, estruturais e de dano cumulativo demonstram que as anormalidades da função pulmonar podem ter relação com o controle, gravidade e atividade da doença e influenciar na qualidade de vida desses pacientes. O distúrbio funcional obstrutivo, por doença inflamatória das vias aéreas, pode ser uma alteração precoce da doença pulmonar na DMJ / Background: Structural and functional pulmonary changes may occur in juvenile dermatomyositis (JDM). The objective of this study was to assess the pulmonary function of patients with JDM and the correlations between pulmonary function and scores for chest tomography, disease activity, cumulative damage, and quality of life. Methods: This prospective, cross-sectional study evaluated 20 patients with JDM aged between 6 and 18 years. Spirometry, plethysmography, diffusing capacity of the lungs for carbon monoxide (DLCO), 6-minute walk test (6MWT), and chest tomography (CT) examinations were performed. Disease Activity (DAS), muscle strength (CMAS and MMT), cumulative damage (MDI), and quality of life (PedsQL) scores were also evaluated. Results: Twenty patients were included in the study (mean age of 11.6 years). Mild or moderate pulmonary obstruction was observed in 35% of patients, and decreased pulmonary diffusion was observed in 20% of patients. Spirometric and/or diffusion abnormalities occurred in 45% of patients. With regard to the plethysmography results: total lung capacity (TLC) decreased in 25% of patients, conductance decreased in 50% of patients, and the residual volume (RV)/TLC ratio decreased in 35% of patients. Thirteen patients underwent CT; of these, 8 cases involved interstitial changes (n=6) and mixed disorders (n=2). The significant correlations (p < 0.05) were: forced expiratory volume in one second (FEV1)/vital capacity (VC) versus DAS, PedsQL, CMAS, and CT; conductance versus DAS, MDI, and PedsQL; 6MWT versus CMAS; DLCO versus MDI and CMAS; CT versus MDI, forced expiratory flow between 25% and 75% of vital capacity (FEF25-75%), conductance, CMAS, PedsQL, and DAS. Conclusion: Plethysmography, DLCO, and 6MWT can be used as complementary tests for the detection of functional disorders in patients with JDM. The significant correlations between functional, structural, and cumulative damage parameters indicate that pulmonary function abnormalities may be associated with disease control, severity, and activity and can influence the quality of life of these patients. Obstructive functional disorder due to inflammatory disease of the airways may constitute an early change in lung disease in JDM

Introdução: A diferenciação entre saúde e doença do sistema respiratório torna-se mais difícil devido à tendência de envelhecimento populacional e da necessidade de identificação das alterações próprias da senescência. Os testes de função pulmonar constituem ferramentas clínicas importantes para avaliação respiratória e sua interpretação está baseada em equações de referência derivadas de amostra de indivíduos saudáveis, que podem não expressar adequadamente o comportamento nesta faixa etária específica, dada a reduzida representatividade de indivíduos idosos nos estudos que postularam tais equações. Objetivo: Verificar a acurácia das equações de referência disponíveis para testes de função pulmonar e cardiopulmonar de esforço em relação aos valores obtidos em amostra de indivíduos idosos hígidos e o impacto clínico na interpretação funcional baseada nestas equações. Metodologia: Estudo prospectivo observacional transversal, com voluntários saudáveis, com idade igual ou superior a 65 anos, não tabagistas, urbanos. Em uma única visita, foram coletados dados demográficos, antropométricos e clínicos, seguidos da realização de provas de função pulmonar em repouso (espirometria, medidas de volumes pulmonares e difusão) e do teste cardiopulmonar de exercício máximo (TCPE). Os resultados obtidos foram comparados com os valores esperados de acordo com equações de referência rotineiramente utilizadas para a interpretação (teste-T pareado e avaliação de concordância pelo diagrama de Bland-Altman) e a frequência de casos fora das faixas previstas foi determinada. Novas equações de referência foram geradas por regressão linear múltipla. Resultados: Foram incluídos 95 indivíduos (55 mulheres), com idade (anos) 75 ± 6 (feminino) e 74±6 (masculino). Caracterizou-se diferença significativa entre as médias dos parâmetros de função pulmonar em repouso observados e previstos por pelo menos 2 das 3 equações testadas para CVF, VEF1, CPT, VR e difusão para ambos os sexos. O mesmo ocorreu para os parâmetros funcionais ao exercício (carga e VO2 no pico do esforço) para 3 de 4 equações testadas. Não houve homogeneidade de um autor específico em predizer com melhor acurácia os valores observados na amostra testada para todos os parâmetros funcionais em ambos os sexos. A frequência de classificação de parâmetros fora das faixas de referência foi elevada para todas as equações avaliadas. Novas equações de referência foram apresentadas a partir dos dados obtidos. Conclusões: A utilização das equações de referência existentes apresentou aplicabilidade limitada à amostra de idosos saudáveis estudada, gerando elevados índices de valores sub e superestimados, potencialmente comprometendo a sensibilidade e especificidade dos testes. Foram derivadas equações idade-específicas para uma amostra de idosos suadáveis brasileiros, visando contemplar as mudanças fisiológicas nesta faixa etária / Introduction: Differentiating between health and disease of the respiratory system becomes more challenging due to the tendency of population aging and the need to identify themselves senescence changes. Pulmonary function tests are important tools for respiratory evaluation. Its interpretation is based on reference equations derived from healthy people studies that possibly not accordingly express the behavior at this particular age group, due to the low representativity of elderly individuals in the studies that postulated such equations. Objective: To verify the accuracy of reference equations available for pulmonary function and cardiopulmonary exercise tests in comparison to values obtained in a sample of healthy elderly subjects and assess the clinical impact on functional interpretation based on these equations. Methodology: Cross-sectional observational prospective study in healthy volunteers, aged over 65 years, non-smokers, urban living. Demographic, anthropometric and clinical data, were collected and pulmonary function tests at rest (spirometry, lung volumes measures and diffusing capacity pulmonary), and the maximal cardiopulmonary exercise test (CPET) were performed. Results were compared to the expected values according to reference equations routinely used for interpretation (paired t-test and evaluation agreement by Bland-Altman plot) and the frequency of cases outside the reference ranges were determined. New reference equations elderly-specific were generated using multiple linear regression. Results: 95 subjects (55 women), age (years) 75 ± 6 (female) and 74 ± 6 (male) were included. Significant difference between the mean lung function parameters observed versus predicted by at least 2 of 3 tested equations for FVC, FEV1, TLC, RV for both sexes were identified. The same occured for exercise measurements (load and VO2 at peak exercise) for 3 of 4 tested equations. There was no homogeneity of a particular author to predict more accurately values observed in the sample tested for all functional parameters in both sexes. There was high rates of out of reference range classification for all evaluated equations. New elderly-specific reference equations were presented from the data obtained. Conclusions: The use of existing reference equations had limited applicability to the sample of healthy elderly studied, generating high rates of under and overestimated values, potentially compromising the sensitivity and specificity of the tests. Age-specific equations were derived from a sample of Brazilian healthy elderly, aiming to represent the physiological changes in this age group

Le chat est la seule espèce animale qui développe spontanément une entité clinique similaire à bien des égards à lasthme allergique humain. Communément appelée « asthme félin » par homologie à la maladie humaine, cette entité pathologique est le résultat dune inflammation persistante des voies respiratoires, associée à des phases aiguës de bronchospasme, une hyperréactivité bronchique à des stimuli divers et dans les stades avancés à des remaniements tissulaires de la paroi bronchique (e.g., érosions épithéliales, hypertrophie de la musculature lisse, hyperplasie glandulaire). Des modèles dasthme félin, obtenus par sensibilisation expérimentale à un allergène, reproduisent la majorité des caractéristiques cliniques, fonctionnelles et lésionnelles de la maladie naturelle et sont au premier plan de la découverte de nouvelles stratégies thérapeutiques (i.e., cyclosporine A, corticostéroïdes oraux et inhalés, immunothérapie spécifique). De la pathogénie de lasthme, ressort toute limportance de dominer lobstruction récurrente des voies respiratoires. Même si les bronchodilatateurs inhalés sont recommandés dans la prise en charge des crises dasthme chez le chat, leur efficacité clinique reste incertaine et peu étayée. Ainsi, les principes actifs, les posologies et les protocoles thérapeutiques actuellement préconisés sont dans une large mesure empiriques et/ou extrapolés de la médecine humaine, et nécessitent dêtre validés dans des conditions expérimentales contrôlées. Nos travaux sinscrivent donc dans cette optique et visent à définir une approche thérapeutique tant préventive que symptomatique des crises de bronchospasme chez le chat, ainsi quune utilisation rationnelle des bronchodilatateurs à longue durée daction pour un contrôle optimal de linflammation asthmatique. Lors dune première étude, nous avons investigué lactivité in vitro, vis-à-vis du muscle lisse bronchique félin, de différentes agents bronchodilatateurs parmi lesquels des agonistes β2-adrénergiques (isoprotérénol, salbutamol [SAL], fénotérol, formotérol, salmétérol [SLM]), un anticholinergique (ipratropium bromide [IB]) et une méthylxanthine (théophylline). Tous ont produit une relaxation dose-dépendante de la musculature lisse bronchique, avec des spécificités propres en termes de puissance, defficacité ou dactivité intrinsèque. Sur une base comparative, le formotérol est le ß2-mimétique le plus puissant, et lisoprotérénol le plus efficace avec le fénotérol. Le fénotérol et le formotérol sont des agonistes complets des récepteurs ß2-adrénergiques, le SAL et le SLM des agonistes partiels. Tenant compte des résultats des essais in vitro et de la disponibilité de formulations administrables par aérosols dans lespèce féline, les effets bronchoprotecteurs (intensité, durée daction) de six médications inhalées ont été caractérisés chez le chat sain, en préambule à leur utilisation dans des conditions pathologiques. Un modèle de bronchoconstriction induite par le carbachol a été retenu dans le cadre de cette deuxième étude. Il ressort de cette étude que le SLM en aérosol-doseur (25µg) présente un effet bronchoprotecteur soutenu persistant 24 heures mais est aussi la médication la moins efficace. Le SAL et lIB (nébulisation ou aérosol-doseur) sont des bronchodilatateurs à courte durée daction (48 heures) dont lutilisation combinée en aérosol-doseur (SAL IB : 100µg/20µg) met en exergue une synergie daction. Les conditions naturelles étant souvent incompatibles avec une approche anticipative de la crise dasthme, les traitements instaurés sont davantage à visée curative que prophylactique. Dans une troisième étude, nous avons exploré les effets bronchorelaxants du SAL (100µg) et de lIB (20µg), administrés seuls ou en traitement combiné, sur une bronchoconstriction induite par un aéroallergène (Ascaris suum) chez des chats rendus expérimentalement asthmatiques. La technique dinhalation par aérosol-doseur a été privilégiée vu les effets synergiques de la combinaison « SAL IB » et lintérêt de cette voie dadministration dans la gestion à domicile des crises dasthme. Aux doses testées, les bronchodilatateurs inhalés nont exercé aucun effet notable, naffectant en rien la résolution du bronchospasme induit. Chez lhomme, les crises et les épisodes dexacerbation de lasthme sont fréquents dans le cours évolutif de la maladie. Aucune étude chez le chat asthmatique en crise aiguë (induite ou spontanée) natteste de lefficacité des corticostéroïdes inhalés ni ne mentionne dans ce contexte lintérêt scientifique dune association aux ß2-mimétiques à longue durée daction. Nous avons donc comparé les effets de la prednisolone orale (1mg/kg q12h) à ceux dune dose élevée de fluticasone inhalée, seule (500µg q12h aérosol-doseur) ou en traitement combiné avec du SLM (500µg/50µg q12h aérosol-doseur), sur la fonction et linflammation pulmonaires dans un modèle félin dasthme aigu. Cette quatrième étude a montré quune courte cure orale de prednisolone diminue significativement linflammation bronchique à éosinophiles. De fortes doses de fluticasone inhalée se sont avérées bénéfiques dans le contrôle de lhyperréactivité bronchique non spécifique, sans toutefois exercer des effets marqués sur linflammation bronchique sous-jacente. Combiner cette corticothérapie inhalée au SLM a permis dobtenir des effets anti-éosinophiliques accrus et comparables à ceux de la prednisolone orale. Aucune des médications testées na modifié significativement la réponse clinique et fonctionnelle consécutive à linhalation de lallergène. Létude précédente permet de supposer que le SLM potentialise lactivité anti-inflammatoire des corticostéroïdes inhalés et/ou est doté de propriétés anti-inflammatoires intrinsèques. Dans une cinquième étude, nous avons donc investigué les effets du SLM en monothérapie (50µg q12h aérosol-doseur) sur la fonction et linflammation pulmonaires. Il ressort de cette étude, conduite sur un modèle félin dasthme aigu, que le SLM en monothérapie nexerce pas deffet protecteur sur la survenue dun bronchospasme allergique et est dépourvu de tout effet anti-inflammatoire propre. Les résultats obtenus, dans les conditions expérimentales de nos essais, conduisent aux conclusions suivantes : 1) les bronchodilatateurs inhalés (SAL, IB, SLM) sont dune efficacité thérapeutique limitée dans la prévention et le traitement symptomatique du bronchospasme allergique chez le chat sensibilisé à Ascaris suum 2) en revanche, recourir au SLM comme thérapie adjuvante aux corticostéroïdes inhalés ouvre de nouvelles perspectives thérapeutiques dans le contrôle de linflammation et de lhyperréactivité bronchiques chez le chat asthmatique./The cat is the only animal species that spontaneously develops a clinical entity closely similar to human allergic asthma and commonly referred to as feline asthma. Feline asthma is a chronic inflammatory disease of the lower airways characterised by intermittent respiratory distress due to bronchoconstriction, non-specific bronchial hyperresponsiveness and airway remodeling at latter stages (e.g., epithelial erosions, smooth muscle hypertrophy, glandular hyperplasia). Based on experimental sensitisation to allergens, models of feline asthma mimic many clinical, functional and lesional features of the naturally developing condition. Moreover, development and implementation of feline asthma models have greatly facilitated the search for novel therapies (i.e., cyclosporin A, oral and inhaled corticosteroids, specific immunotherapy). In considering the pathogenesis of asthma, it is of major importance to control recurrent airway obstruction. Although inhaled bronchodilators are recommended for the management of acute asthmatic exacerbations in cats, their clinical efficacy remains uncertain and poorly documented. Most currently recommended drugs, dosages and therapeutic schemes are largely empirical and extrapolated from human medicine, and need to be further validated under controlled experimental conditions. Hence, our work was aimed at determining the potential of inhaled bronchodilators for preventive and curative treatment of acute bronchospasms in asthmatic cats as well as at exploring the benefit of using long-acting bronchodilators to optimally control the airway inflammation. In the first study, we investigated in vitro effects on isolated feline bronchi of different bronchodilating agents including β2-adrenergic agonists (isoproterenol, salbutamol [SAL], fenoterol, formoterol, salmeterol [SLM]), an anticholinergic (ipratropium bromide [IB]) and a methylxanthin derivative (theophylline). All compounds caused a dose-related relaxation of bronchial smooth muscle, each exhibiting specificities in terms of potency, efficacy and intrinsic activity. On a comparative basis, isoproterenol and fenoterol are the most efficacious β2-mimetics while formoterol is the most potent one. Fenoterol and formoterol act as full agonists of β2-adrenoceptors, SAL and SLM as partial agonists. Taking into account results from in vitro testing procedures and availability of aerosol formulations suitable for lung delivery in cats, we compared the antispasmodic effects (magnitude, duration of action) of six inhaled medications against carbachol-induced bronchoconstriction in healthy cats. This second study showed that SLM by metered-dose inhaler (25µg) has a sustained activity for as long as 24 hours but is also the least efficacious medication. SAL and IB (nebulisation or metered-dose inhaler) are short-acting bronchodilators (4-8 hours) whose combination delivered with a metered-dose inhaler (SAL IB: 100µg/20µg) exhibits a synergistic antispasmodic effect. In the natural disease, asthmatic crisis are difficult to predict in terms of occurrence. Therefore, therapeutic interventions are more curative than preventive. In a third study, we explored the bronchodilating effects of SAL (100µg) and IB (20µg), delivered either alone or as a combined therapy, on allergen-induced bronchospasms in Ascaris suum-sensitised cats. The inhalation technique using a metered-dose inhaler was retained given the synergistic effects of the combination SAL IB with this method and its therapeutic interest for at-home management of asthmatic crisis. At the tested doses, these bronchodilators failed to reverse allergen-induced bronchospasms in cats with experimental asthma. In human beings, crisis and exacerbations of asthma are frequent events in the natural course of the disease. Efficacy of inhaled corticosteroids in cats with acute asthmatic exacerbations (induced or spontaneous) has not yet been determined, nor the potential benefit of adding long-acting β2-agonists in this context. Thus, the fourth study was aimed at comparing the effects of oral prednisolone (1mg/kg q12h) with those of inhaled fluticasone at high doses, alone (500µg q12h metered-dose inhaler) or combined with salmeterol (500µg/50µg q12h metered-dose inhaler), on lung function and airway inflammation in a feline model of acute asthma. This study showed that a short course of oral prednisolone significantly reduced allergen-induced bronchial eosinophilic inflammation. High doses of inhaled fluticasone proved to be efficient for decreasing non specific airway hyperresponsiveness but failed to markedly reduce the underlying airway inflammation. Adding salmeterol to inhaled fluticasone led to anti-eosinophilic effects of the same magnitude as those found for oral prednisolone. None of these treatments improved clinical and functional responses to allergen exposure. According to the previous study, it may be that SLM has an anti-inflammatory effect on its own and/or functions as a steroid-potentiating agent. In a fifth study, we investigated the effects of salmeterol as monotherapy (50 µg q12h metered-dose inhaler) on lung function and airway inflammation in our feline model of acute asthma. This inhaled medication did not prevent occurrence of allergic bronchospasm in Ascaris suum-sensitised and challenged cats, nor did it possess intrinsic anti-inflammatory activity. Under our experimental conditions, the main results achieved led to the following conclusions: 1) the inhaled bronchodilators (SAL, IB, SLM) are of limited efficacy for the prevention and symptomatic treatment of allergic bronchospasm in cats sensitised to Ascaris suum; 2) in contrast, using salmeterol as adjuvant therapy to inhaled corticosteroids opens up new perspectives for the treatment of bronchial inflammation and hyperresponsiveness in asthmatic cats.

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal

Aptikus minimalius PAL simptomus, yra labai svarbūs diagnostiniai, greitai atliekami neinvaziniai tyrimo metodai (kulkšnies-žasto indeksas, nykščio indeksas, ėjimo testas, segmentinių slėgio gradientų matavimas ir kt.). Ambulatorinėje grandyje retai matuojamas kulkšnies-žasto indeksas riboja galimybę nustatyti PAL kiek galima anksčiau, numatyti galimas gyvybiškai svarbių organų kraujagyslines komplikacijas, laiku siųsti pacientą konsultuoti angiochirurgui. Mažai tyrinėtu alternatyvaus neinvazinio impedanso pletizmografijos tyrimu galima nustatyti ne tik periferinių arterijų ligos simptomus, bet vienu metu įvertinti eilę kitų parametrų. Darbo tikslas buvo nustatyti neinvazinio impedanso pletizmografijos metodo efektyvumą kojų arterinei kraujotakai įvertinti ir šį metodą palyginti su kitais neinvaziniais bei invaziniais diagnostikos metodais. Tyrimo metu nustatyta statistiškai reikšminga kulkšnies-žasto indekso bei impedanso pletizmografijos parametrų sąsaja pacientams, sergantiems lėtiniu prieširdžių virpėjimu, lyginant su pacientais neturinčiais šio ritmo sutrikimo, nustatyta impedanso pletizmografijos - bangos viršūnės laiko parametro sąsaja su angiografiškai aptikta kraujagyslės okliuzijos vieta. Pagrindinio impedanso pletizmografijos parametro (bangos viršūnės laiko) specifiškumas yra 96 proc., jautrumas – 73 proc. atsižvelgiant į KŽI pokyčius, o lyginant su angiografija – jautrumas 100 proc., specifiškumas – 50 proc. Taigi, neinvazinis impedanso pletizmografijos... [toliau žr. visą tekstą] / In cases of observing even the slightest PAD symptoms, rapid non-invasive diagnostic test methods become extremely important (the ankle-brachial index, thumb index, walking test, measurement of segmental pressure gradients, etc.). in an outpatient setting , the ankle-brachial index (ABI) is rarely measured, thus limiting the opportu¬nities for the earliest possible detection of PAD, prediction of vascular com¬plications of vital organs, and timely referral of the patient for a con¬sultation with an angiosurgeon. An alternative non-invasive test method of impedance plethysmo¬graphy, which has been little investigated so far, allows both detection of symptoms of peripheral arterial disease and concurrent assessment of a number of other parameters. The aim of the study is to assess the efficiency of a non-invasive method of impedance plethysmography in diagnosing arterial circulation disorders in the legs, and to compare this method with other non-invasive and invasive diagnostic methods of peripheral arterial disease. A significant correlation between the Ankle-Brachial Index and the im¬pedance plethysmography parameters was established in subjects with permanent atrial fibrillation, but not in subjects without this rhythm disorder. During the study, an obvious correlation between the Crest Time in¬ter¬val measured by the impedance plethysmography method and the vas¬¬cular occlusion site shown on angiography was established. Specificity of the impedance plethysmography... [to full text]

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Il est avéré que les signaux de pléthysmographie par inductance comportent des composantes cardiaques et respiratoires pouvant présenter un intérêt pour un suivi physiologique. Cette technique est largement utilisée chez l’homme et chez les mammifères de taille moyenne, mais n’a jamais été mise en œuvre chez les petits rongeurs de laboratoire comme le rat. Cette thèse vise à apporter la preuve analytique et expérimentale (TRL3) d’une application cardiaque de la pléthysmographie cardiorespiratoire par inductance (PCRI) fondée sur le concept amont de « bague aortique virtuelle » (BAOV). La BAOV permet de mettre en œuvre une mesure externe des débits aortiques « instantanés » à l’aide de la PCRI en lieu et place d’un instrument positionné autour du vaisseau lui-même.La thèse a débuté par une phase de spécification et de conception guidée par l’interdépendance entre la physiologie et les contraintes instrumentales. Les performances métrologiques à atteindre sont dictées par un saut d’échelle entre l’homme et le rat. Le développement d’une chaine de mesure optimisée a permis de repousser les limites des systèmes existants en rendant possible la mesure de variations de volumes de quelques microlitres. En parallèle, l’identification de critères de validation, de méthodes de référence et la mise au point de protocoles expérimentaux ont conduit à la définition d’une stratégie de validation de l’instrument de mesure développé et du concept de BAOV.À l’issue de ces trois années, un système de PCRI à ultra-haute résolution a été mis au point. Après calibration, l’exactitude sur les mesures de variations de section est de 5 % sur un banc de test micrométrique. L’interchangeabilité de la mesure des variations de volume du thorax sur la gamme physiologique a été évaluée par rapport à une mesure pneumotachographique sur 9 animaux anesthésiés. Les limites d’agrément obtenues sont inférieures à 20 %. L’induction d’un challenge hémodynamique sur 11 animaux anesthésiés dont le débit aortique est mesuré en parallèle avec la PCRI et une bague de débit ultrasonique placée au niveau sous-diaphragmatique démontre l’équivalence entre les deux systèmes. Par ailleurs, la grande similitude entre les signaux de débits des deux méthodes valide le concept de bague aortique virtuelle proposé / It is recognized that inductive plethysmographic signals contain cardiac and respiratory components, which can be of interest for physiological monitoring. This technology is widely used in humans and medium mammals, but it has never been implemented in small laboratory rodents. This PhD aims to provide the analytic and experimental proof (TRL3) of a cardiac application of the cardio-respiratory inductive plethysmography (CRIP), based on the upstream concept of an “virtual aortic probe” (VAP). The VAP allows to realize an extern measure of “instantaneous” aortic flows thanks to CRIP instead of an instrument located directly around the vessel.The PhD starts with a phase of specification and conception driven by the interdependency between physiology and instrumental constraints. The expected metrological performances are established by a scale jumping between man and rat. The development of an optimized acquisition line has enabled to stretch the limits of existing systems; it allows to measure volume variations of a few microliters. At the same time, validation criteria and reference methods have been identified and experimental protocols have been specified in order to define the validation strategy of the developed instrument and VAP concept.At the end of these 3 years, an ultra-high resolution CRIP system has been developed. After calibration, the accuracy on the section variation measurements is 5% on a micrometric test-bench. The interchangeability of the thorax volume variation measure on a physiological range has been evaluated by comparison with a pneumotachographic measure on 9 anesthetized animals and the limits of agreement are lower than 20%. A hemodynamic challenge has been induced on 11 anesthetized animals, and the aortic flow has been simultaneously measured by CRIP and with an ultrasonic flow probe at under diaphragm level. This demonstrates the equivalence between both systems. And the high similarity between flow signals from both methods validates the proposed concept of virtual aortic probe

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2016-08-11T15:02:24Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) DISSERTAÇÃO - MARCELY KELLYANE FLORENÇO BARROS.pdf: 1908000 bytes, checksum: 3adc6a18797e1222ccc8153fe1466b76 (MD5) / Made available in DSpace on 2016-08-11T15:02:24Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) DISSERTAÇÃO - MARCELY KELLYANE FLORENÇO BARROS.pdf: 1908000 bytes, checksum: 3adc6a18797e1222ccc8153fe1466b76 (MD5) Previous issue date: 2015-08-19 / A respiração freno labial (RFL) é muitas vezes utilizada espontaneamente para alívio da dispnéia em pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC). A realização da técnica favorece a saída do ar dos pulmões com menor resistência, uma vez que induz pressões respiratórias na boca que previnem o colapso precoce das vias aéreas. A RFL tem sido associada à redução da hiperinsuflação dinâmica (HD), redução da frequência respiratória (f), melhora do volume corrente (VC) e saturação periférica de oxigênio (SpO2). Por apresentar esses benefícios a utilização da técnica tem sido recomendada nos programas de reabilitação pulmonar durante o repouso, exercício e recuperação pós-exercício. Os efeitos na tolerância ao exercício têm sido estudados apenas com testes que utilizem caminhada, sem averiguar efeitos na fadiga de membros superiores (MMSS). Também não são encontrados estudosque apontemos benefícios da utilização da RFL na posição supina com inclinação 45º e seu impacto nos volumes pulmonares e mobilidade diafragmática. Sendo assim, esta dissertação teve como objetivos: 1) realizar uma revisão sistemática com metanálise averiguando os efeitos da RFL sobre a tolerância ao exercício e dispnéia nos pacientes com DPOC; 2) realizar um ensaio clínico para avaliar o efeito da RFL na posição supina a 45º sobre os volumes pulmonares e a mobilidade diafragmática e averiguar a tolerância ao exercício com o teste Glittre-AVD em pacientes com DPOC. A revisão sistemática mostrou que a grande maioria dos estudos concorda que os pacientes mais gravemente obstruídos e que não realizam a técnica da RFL espontaneamente são os que mais se beneficiam. Entretanto na metanálise esse resultado não foi expressivo, não se podendo concluir melhora nos desfechos estudados. O ensaio clínico controlado randomizado do tipo crossover realizado com 14 pacientes DPOC apontou aumento dos volumes com a utilização da RFL em todos os compartimentos torácicos (parede torácica, caixa torácica pulmonar, caixa torácica abdominal e abdômen), tempo total do ciclo respiratório (Ttot) (p<0,0001), tempo inspiratório (Ti) (p=0.002) e tempo expiratório (Te) (p< 0.0001) com diminuição da frequência respiratória (f) (p< 0.0001) e razão Ti/Ttot (p=0,008). Não foram observadas diferenças nos Volumes Expiratórios Finais (VEF) de todos os compartimentos, entretanto foi achado um aumento nos Volumes Inspiratórios Finais (VIF) (p<0.0001). Não houve mudanças na mobilidade diafragmática. No teste Glittre-AVD verificou-se redução significativa da f com a utilização da RFL (p= 0,001). Em relação ao índice de dispnéia e fadiga, foi verificada diminuição na percepção de fadiga de membros superiores (Borg MMSS) (p=0,04). / The pursed lips breathing (PLB) is often spontaneously use for relief of dyspnea in patients with Chronic Obstructive Pulmonary Disease (COPD). The performance of the technique favors the outflow of air from the lungs with a lower resistance, since it induces respiratory pressures in the mouth to prevent premature collapse of airways. The PLB has been linked to reduced dynamic hyperinflation (DH), reduced respiratory rate (rr) improvement of tidal volume (TV) and peripheral oxygen saturation (SpO2). By presenting these benefits using the technique has been recommended in pulmonary rehabilitation programs during rest, exercise and post-exercise recovery. The effects on exercise tolerance have been studied only to tests that use walk without ascertain effects on fatigue from upper limb. Nor are found estudosque's aim benefits of using RFL in the supine position with 45 ° inclination and its impact on lung volumes and diaphragmatic excursion. Thus, this work aimed to: 1) conduct a systematic review with meta-analysis ascertaining the effects of PLB on exercise tolerance and dyspnea in patients with COPD; 2) conduct a clinical trial to evaluate the effect of PLB in the supine position 45 on lung volumes and diaphragmatic mobility and assess exercise tolerance with Glittre-AVD test in patients with COPD. A systematic review showed that the vast majority of studies agree that the most severely obstructed patients and they do not realize the PLB technical spontaneously are the ones who benefit most. However meta-analysis in this result was not significant and can not be complete improvement in outcomes studied. The clinical trial with 14 patients COPD pointed increasing the volume with the use of PLB in all thoracic compartments (chest wall, pulmonary rib cage, abdominal rib cage and abdomen), total respiratory cycle (Ttot) (p <0, 0001), inspiratory time (Ti) (p = 0.002) and expiratory time (Te) (p <0.0001) with decreased respiratory rate (rr) (p <0.0001) and reason Ti / Ttot (p = 0.008). No differences were observed in expiratory volumes final (VEF) from all compartments, however was found an increase in inspiratory volumes final (VIF) (p <0.0001). There were no changes in diaphragmatic excursion. In Glittre-AVD test there was a significant reduction of f using the PLB (p = 0.001). Compared with the index of dyspnea and fatigue was observed decrease in the perception of fatigue from upper limb (p = 0.04).

Introdução: O Programa Bolsa Família é a principal estratégia brasileira para amenizar a pobreza e vulnerabilidade social, com diferentes impactos na vida dos beneficiários. O aumento da renda, em função do benefício, poderia trazer resultados positivos na alimentação, uma vez que possibilitam uma maior diversidade da dieta. Porém, poderia trazer resultados negativos como a ingestão excessiva de energia e consequente aumento da adiposidade. As avaliações dos impactos do programa em termos de obesidade e massa gorda de crianças são inexistentes. Objetivo: Avaliar o impacto do Programa Bolsa Família no estado nutricional (IMC/idade) e na composição corporal aos 6 anos de idade entre as crianças da Coorte de Nascimentos de Pelotas (RS), 2004. Métodos: Os dados foram provenientes da integração dos bancos da Coorte de Nascimentos de Pelotas de 2004 e do Cadastro Único do Governo Federal. Foi realizada análise descritiva da cobertura e focalização do programa, com informações do nascimento e dos 6 anos de idade (n=4231). Considerou-se focalização o percentual de elegíveis entre o total de beneficiários e cobertura o percentual de famílias elegíveis que são beneficiárias do programa. Nos modelos de impacto (n=3446), as exposições principais foram o recebimento do benefício: beneficiário em 2010, no período de 2004-2010; o valor médio mensal recebido e o tempo de recebimento. Foram gerados modelos de regressão linear para os desfechos score-Z do índice de massa corporal por idade (IMC/I), percentual e índice de massa gorda (IMG), e percentual e índice de massa livre de gordura (IMLG); e de Poisson, com ajuste robusto, para o desfecho obesidade (score-Z IMC/I 2), todos estratificados por sexo. As informações antropométricas e de composição corporal (BOD POD) foram obtidas do acompanhamento aos 6-7 anos de idade. Potenciais fatores de confusão foram identificados por modelo hierárquico e por um diagrama causal (DAG). Para analisar os impactos foram usadas como medidas de efeito a diferença de médias na regressão linear múltipla (IMC/I, por cento MG, IMG, por cento MLG e IMLG, variáveis contínuas) e a razão de prevalência (obesidade, variável binária). Para permanecer no modelo, considerou-se valor p0,20. A análise dos dados foi realizada por meio do software STATA. Resultados: Entre 2004-2010, a proporção de famílias beneficiárias na coorte aumentou (11 por cento para 34 por cento ) enquanto, de acordo com a renda familiar, a proporção de famílias elegíveis diminui (29 por cento para 16 por cento ). No mesmo período, a cobertura do programa aumentou tanto pela renda familiar quanto pelo IEN. Já a focalização caiu de 78 por cento para 32 por cento de acordo com a renda familiar e, de acordo com o IEN, manteve-se em 37 por cento . A média (não ajustada) de IMC e de MG dos não beneficiários foi superior a dos não beneficiários tanto em meninos quanto em meninas. Meninos do 3º tercil de valor per capita recebido e meninas com menos de 7 meses de benefício em 2010 tiveram IMC maior do que, respectivamente, aqueles dos demais tercis e daquelas com mais de 7 meses de benefício em 2010; esse padrão foi semelhante para obesidade. Meninas não beneficiárias tiveram MG maior do que as beneficiárias e superior também aos meninos, independente de ser beneficiário ou não. Em relação à MLG observou-se um comportamento contrário, no qual meninas beneficiárias tiveram maior MLG, quando comparadas com meninas não beneficiárias e, meninos quando comparados com meninas. Nos modelos de regressão ajustados, não houve diferença significativa entre beneficiários e não beneficiários em nenhum desfecho. Conclusões: De acordo com os resultados, as famílias que receberam maiores valores per capita parecem incluir crianças com maior média de IMC. O programa, nessa análise, parece não ter impacto sobre a composição corporal das crianças, nem em termos de massa gorda, tampouco em termos de massa livre de gordura. / Introduction: the Bolsa Família Program (BFP) is the main Brazilian strategy to alleviate poverty and social vulnerability, with different impacts on the lives of beneficiaries. The increase of income, depending on the benefit, could bring positive results in food consumption, since enable greater dietary diversity. However, it could bring negative results as excessive intake of energy and consequent increased adiposity. The evaluations of the impacts of the program in terms of obesity and fat mass of children are nonexistent. Objective: to evaluate the impact of BFP in nutritional status (BMI/A) and body composition to 6 years of age among children of the Cohort of Births of Pelotas (RS), 2004. Methods: data were obtained from the integration of the banks of the cohort of births of 2004 pellets and Single Record of the Federal Government. Descriptive analysis was performed of the coverage and focus of the program, with information of birth and 6 years of age (n=4231). Effect models (n=3446), the main exhibition were the approaches of the receipt of the benefit: beneficiary in 2010, in the 2004-2010 period; average monthly value and time of receipt. Linear regression models were generated for the Z-score outcomes of the body mass index for age illness (BMI/A), percentage and fat mass index (FMI), and percentage and fat-free mass index (FFMI); and Poisson, with robust adjustment for obesity outcome (score-Z BMI/A 2), all stratified by sex. The information and measurements of body composition (BOD POD) were obtained from monitoring to 6-7 years of age. Potential confounding factors were identified by hierarchical model and a causal diagram (DAG). The measures used were the average difference in multiple linear regressions (BMI/A, FM, FMI, FFM, FFMI, continuous variables) and the ratio of prevalence (obesity, binary variable). To stay at the model considered value p 0.20. Data analysis was performed using STATA software. Results: Between 2004-2010, the proportion of recipient families has increased (11 per cent to 34 per cent ); by family income eligible families number decreases (29 per cent to 16 per cent ). The coverage of the program increased both by family income as by IEN. The focus fell from 78 per cent to 32 per cent (household income) and remained at 37 per cent (IEN). The average (not adjusted) of BMI and FM of non-beneficiaries was higher in boys and girls. Boys of 3 tercil per capita value received and girls under the age of 7 months of 2010 had BMI greater benefit; this pattern was similar for obesity. Non-beneficiary girls had FM larger than the beneficiary and also higher than the boys, regardless of whether or not the beneficiary. Regarding the FFM observed a contrary behavior, in which beneficiaries girls had higher FFM, compared to non-beneficiary girls and boys compared to girls. In adjusted regression models, there was no significant difference between beneficiaries and non-beneficiaries in any outcome. Conclusions: there is evidence that the families who received largest per capita values include children with a higher average BMI. Although children beneficiaries have indexes under fat mass, the generated models showed that the program also has no effect on the fatfree mass.

Introdução: Pacientes com câncer de laringe costumam apresentar histórico de tabagismo. Nos pacientes submetidos à tratamento cirúrgico, as complicações pulmonares podem levar à morte no período pós-operatório. Um método com dispositivo extratraqueal padronizado, simples e de baixo custo para a avaliação pulmonar dos pacientes laringectomizados seria muito útil. Objetivo: Validar a metodologia para a avaliação pulmonar em pacientes submetidos à laringectomia total por meio da aplicação de um dispositivo extratraqueal adesivo. Métodos: Participaram deste estudo transversal 50 pacientes submetidos à laringectomia total há pelo menos seis meses como modalidade de tratamento para o câncer de laringe em acompanhamento no Serviço de Cirurgia de Cabeça e Pescoço do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Por meio da anamnese e do prontuário dos pacientes foram obtidos dados demográficos, tabagismo, a presença de doenças respiratórias nos últimos 30 dias, dados acerca do tumor e sobre o tratamento realizado. Os testes de função pulmonar foram utilizados para caracterizar a presença de limitação funcional respiratória e o padrão funcional do paciente laringectomizado. Na intenção de avaliar a reprodutibilidade dos exames realizados, foram utilizados parâmetros com respectivos critérios de aceitação dos exames. Os critérios de reprodutibilidade são indicadores de exatidão. Foi feita a comparação desses parâmetros com 50 exames realizados em pacientes não laringectomizados, no mesmo período com o mesmo equipamento, pareados para idade e gênero. Resultados: Em todos os casos de nosso estudo, uma vedação aérea foi mantida durante todo o procedimento com o uso do dispositivo extratraqueal adesivo. Após a realização dos testes de função pulmonar, encontramos que 44% dos pacientes apresentavam um padrão respiratório normal e 56% alterado. Comparando a frequência e porcentagem dos exames rejeitados entre os laringectomizados e o grupo controle, dos nove parâmetros avaliados, cinco foram exatamente iguais, três apresentaram frequência de rejeição maior no grupo controle e somente um mostrou uma maior frequência de exames rejeitados no grupo dos pacientes submetidos à laringectomia total. O total de exames rejeitados foi maior no grupo controle (72%) do que no grupo dos laringectomizados (46%). Conclusões: A maioria dos pacientes submetidos à laringectomia total apresenta função pulmonar alterada, de caráter obstrutivo, na maioria das vezes, devido ao histórico de tabagismo. A metodologia para a avaliação da função pulmonar por meio do uso do dispositivo extra-traqueal proposto é confiável, precisa e reprodutível / Introduction: Laryngeal cancer patients usually have a smoking history. In patients submitted to laryngectomy, pulmonary complications may lead to death in the post-operative phase. A simple and low-cost method with a standardized extra-tracheal device for the pulmonary assessment of laryngectomized patients would be very useful. Objective: Validate the methodology for pulmonary assessment in patients submitted to total laryngectomy through the application of an adhesive extra-tracheal device. Methods: This transversal study included 50 patients who had been submitted to total laryngectomy at least six months prior to this investigation, as choice of treatment for laryngeal cancer while followed by the Head and Neck Service from Hospital das Clínicas, São Paulo University. Through anamnesis and patients medical records the following information was collected: demographic data, smoking habits, the presence of respiratory diseases in the last 30 days, as well as information about the tumor and the performed treatment. Pulmonary tests were used to characterize the presence of respiratory functional limitation as well as laryngectomized patient\'s functional standards. Aiming at evaluating the reproducibility of the performed tests, parameters were used with the respective criteria for the acceptance of the tests. The reproducibility criteria are indicators of accuracy. A comparison of these parameters was made with 50 tests performed in non-laryngectomized patients, in the same period with the same equipment, paired up according to age and gender. Results: In all cases of our study, an air-tight seal was maintained through the entire procedure with the use of the adhesive extra-tracheal device. After the performance of pulmonary function tests, 44% of patients presented a normal respiratory standard whereas 56% had an altered one. When comparing the frequency and percentage of the rejected tests between laryngectomized and control group, out of nine assessed parameters, five were exactly the same, three presented a greater rejection frequency in the control group and only one showed a greater frequency of rejected tests in the group of patients submitted to total laryngectomy. The total of rejected tests was greater in the control group (72%) when compared to the laryngectomized one (46%). Conclusions: Most patients submitted to total laryngectomy present altered pulmonary function, of the obstructive type most of the times, due to a smoking history. The methodology for the assessment of the pulmonary function by using the extra-tracheal proposed device is reliable, accurate and reproducible