L’objectif de cette thèse est de détailler les effets respiratoires induits par les associations de l’éthanol au THC et de l’éthanol au GHB. Les études ont été menées chez l’animal non anesthésié par pléthysmographie corps entier pendant les quatre heures suivant l’administration intrapéritonéale. Dans une première étape, les effets respiratoires de la prise isolée d’éthanol et de GHB ont été étudiés. Ces deux substances modifient le mode respiratoire : l’éthanol provoquant une tachypnée dès 3 g.kg-1, le GHB une respiration apneustique dès 600 mg.kg-1, sans insuffisance respiratoire (PaO2 normale). Les modifications des gaz du sang observées : acidémie pour l’éthanol et alcalose pour le GHB sont d’origine métabolique. A ces doses, ces deux substances perturbent aussi la conscience des animaux et la thermorégulation : l’éthanol induit une hypothermie et le GHB une évolution triphasique de la température : hypothermie/hyperthermie/ hypothermie. Les dosages sanguins et les études cinétiques menés lors de ces études confirment la vraisemblance de notre modèle et sa pertinence clinique et médicolégale. L’étude des associations à l’éthanol montre que les effets respiratoires du THC et du GHB sont conservés, seule leur association à la dose de 3 g.kg-1 d’éthanol a provoqué une baisse de la ventilation minute avec réduction du débit inspiratoire mais selon des mécanismes différents : baisse du volume courant pour l’association THC-éthanol et augmentation de la durée des apnées expiratoires pour celle du GHB à l’éthanol. Pour cette dernière, l’interaction cinétique observée après administration intrapéritonéale n’explique pas l’intensité du phénomène, une potentialisation est probable. / The objective of this thesis was to study the time-course of the respiratory effects of THC/ethanol and GHB/ethanol associations. Respiration was studied using whole body plethysmography in non-anesthetized rats during the four hours following intraperitoneal injection. In a first step, both GHB and ethanol affected the respiratory pattern. Ethanol caused bradypnea at doses greater than 3 g.kg-1 and GHB induced apneusis above 600 mg.kg-1. Arterial blood gases modifications were metabolic: acidemia with ethanol and alkalosis with GHB. At those doses, both substances altered consciousness and body temperature of animals. Ethanol induced hypothermia and GHB a temperature triphasic change: hypothermia/ hyperthermia/hypothermia. Blood determinations and kinetic studies reinforced the likelihood, and clinical and forensic relevancies of our animal model. Association studies showed that the respiratory effects of THC and GHB were unchanged in presence of ethanol. Association with 3 g.kg-1 ethanol dose only provoked a reduction in minute volume and in mean inspiratory flow, but mechanisms were different. Ethanol and THC induced a decrease in tidal volume; ethanol and GHB an increase in expiratory apnea duration. The observed kinetic interaction between ethanol and GHB did not explain phenomenon intensity; a potentialization could occur.

La pléthysmographie pénienne est actuellement considérée comme la méthode objective la plus rigoureuse pour déterminer la présence d’intérêts sexuels déviants. Malgré leur importance dans l’évaluation, plusieurs questionnements demeurent quant au contenu des stimuli sexuels devant être utilisés. Cette thèse présente deux articles empiriques qui visent à évaluer la faisabilité du développement de stimuli idiosyncrasiques sur la base des caractéristiques morphologiques et la pertinence de leur ajout à une banque de stimuli standardisés dans le cadre de l’évaluation des intérêts sexuels. Une première étude, effectuée auprès d’hommes n’ayant pas de problématique sexuelle, vise à décrire le processus de création de personnages générés par ordinateurs (PGO) idiosyncrasiques et à évaluer leur capacité à générer des profils d'excitation sexuelle correspondant aux intérêts sexuels des participants. Une deuxième étude se penche sur la comparaison d’hommes ayant ou non adopter des comportements sexuels à l’égard de mineurs quant à leur capacité à identifier les caractéristiques qu’ils considèrent sexuellement attirantes et à les transposer sur des PGO dits idiosyncrasiques. Elle vise aussi à comparer les profils de réponses érectiles ainsi que la capacité de discrimination de stimuli auditifs, de personnage standardisés et de la combinaison de personnages standardisés et idiosyncrasiques Globalement, les résultats présentés illustrent l’importance du développement de méthodologies permettant d’identifier les caractéristiques idiosyncrasiques associées à l’attirance sexuelle. Ils présentent par ailleurs des résultats mitigés quant au développement et à l’utilisation de personnages idiosyncrasiques sur la base des caractéristiques morphologiques pour les participants des deux groupes. Ce projet exploratoire présente les avantages prometteurs reliés à la malléabilité des personnages générés par ordinateur pour développer une meilleure compréhension et une évaluation plus précise des intérêts sexuels. / Penile plethysmography is currently considered the most rigorous objective method for determining the presence of deviant sexual interests. Despite its importance in evaluating these interests, several questions remain about the content of the sexual stimuli that should be used or that are being used. This thesis presents two empirical articles examining the feasibility of developing idiosyncratic stimuli on the basis of morphological characteristics, and the relevance of their addition to a standardized stimulus bank being used to evaluate sexual interests. A first study, conducted with men who did not have a sexual problem, aims to describe the process of creating idiosyncratic computer generated characters (CGCs) that correspond to the specific sexual interests of participants, and to evaluate their ability to generate profiles of sexual arousal. A second study aims at comparing males with sexual behavior towards minors to those without on their ability to identify characteristics that they consider sexually attractive and transpose them on so-called idiosyncratic CGCs. It also attempts to compare the profiles of erectile responses, as well as their ability to discriminate between auditory stimuli, standardized characters, and the combination of standardized and idiosyncratic characters. Overall, the results presented illustrate the importance of developing methodologies that enable the identification of idiosyncratic characteristics associated with sexual attraction. They display moderate results, for participants in both groups, as to the development and use of idiosyncratic characters on the basis of morphological characteristics. This exploratory project presents promising advantages for the malleability of computer generated characters in developing a better understanding and a more accurate assessment of sexual interests.

Os pacientes com doença pulmonar obstrutiva crônica (DPOC), devido à obstrução brônquica e redução da retração elástica pulmonar apresentam o aumento do recrutamento da musculatura respiratória, predispondo à incoordenação toracoabdominal, aumentando o trabalho respiratório, provocando fadiga e dispnéia. O alongamento dos músculos respiratórios (AMR) poderia diminuir a atividade muscular, melhorar a sua capacidade contrátil e a mobilidade da caixa torácica otimizando a ventilação pulmonar, entretanto, estes efeitos nos músculos respiratórios permanecem desconhecidos. Objetivo: Avaliar os efeitos da adição do AMR associados à reabilitação pulmonar na mecânica ventilatória, na capacidade funcional e na atividade muscular em pacientes com DPOC. Método: Estudo randomizado e controlado incluiu 30 pacientes com DPOC que foram distribuídos aleatoriamente para os grupos: tratado (GT, n = 15) e controle (GC, n = 15). Todos os pacientes foram submetidos a 24 sessões de treinamento aeróbico duas vezes por semana. Além disso, o GT recebeu AMR e o GC recebeu o alongamento dos membros superiores e inferiores, antes dos exercícios aeróbicos. Foram avaliados: teste da capacidade funcional (teste de caminhada de 6 minutos, TC6), mecânica toracoabdominal (pletismografia optoeletrônica, POE) e atividade muscular respiratória (eletromiografia de superfície, EMG) durante o exercício. Os dados representam a variação (delta)=pós- - pré-avaliação, foi utilizado o teste t para comparar os grupos e o nível de significância foi fixado em 5%. Resultados: O GT apresentou o aumento da capacidade funcional (25,14m +) com a redução da sensação de dispneia após o TC6 (p < 0,01), quando comparado ao GC. Provavelmente está relacionado com a melhora do volume da caixa torácica (p < 0,01), capacidade ventilatória (p < 0,01) com o aumento do volume e da contribuição do compartimento abdominal (p < 0,01). Observamos também no GT a redução da atividade muscular (p < 0,01) com maior eficiência ventilatória (p < 0,006). Conclusão: Nossos resultados sugerem que a adição do AMR no treinamento aeróbio aumenta a capacidade funcional com diminuição da dispneia, melhora a eficácia da contração muscular e da capacidade ventilatória devido à maior participação do compartimento abdominal em pacientes com DPOC / Chronic obstructive pulmonary disease (COPD) patients due to bronchial obstruction and reduced lung elastic recoil present increased in the recruitment of respiratory muscles, predisposing an thoracoabdominal incoordination, major breathing work, causing fatigue and dyspnea. The respiratory muscles stretching (RMS) could decrease the muscle activity and improve their contractile capacity, chest wall mobility and optimize the pulmonary ventilation, however, this effect remains unknown. Objective: To evaluate the effects of adding the RMS associated with pulmonary rehabilitation in ventilatory mechanics, functional capacity and muscle activity in patients with COPD. Method: Randomized and controlled trial, enrolled 30 COPD patients who were randomly allocated into treatment (TG, n = 15) and control (CG, n = 15) groups. All patients underwent 24 sessions of aerobic training twice a week. In Addition, TG received RMS and CG received upper and lower limb stretching before aerobic exercises. Were evaluated: functional capacity (6-minute walking distance test, 6MWDT), thoracoabdominal mechanics (optoelectronic plethysmography, OEP) and respiratory muscle activity (surface electromyography, EMG) during exercise. The data represents the change (delta) = post- - pre-evaluation, a t-test was used to compare the groups, and the significance level was set at 5%. Results: TG showed improvement in the functional capacity (25,14m +) with decrease of the dyspnea sensation after the 6MWDT (p < 0.01), compared with CG. Probably is related with increased of chest wall volume (p < 0.01), ventilatory capacity (p < 0.01), volume and the contribution of the abdominal compartment (p < 0.01). We also observed in the TG, a reduction of respiratory muscle activity (p < 0,01) and the ratio between volume displaced (p < 0,006). Conclusion: Our results suggest that the addition of RMS to aerobic training increases the functional capacity with dyspnea reduction, improvement of efficacy of respiratory muscle contraction and ventilatory capacity due to higher participation of the abdominal compartment in patients with COPD

Title: Comparison of individual methods of basal metabolism determination Objectives: The aim of the work is to compare the individual methods of basal metabolism. These values were measured by indirect calorimetry, plethysmography, bioelectric impedance and predictive equations. Methods: The research was attended by 31 people, including eight men and twenty-three women. All participants of my research were aged 21-30 years. None of the participants was a professional athlete, they were all healthy and none of the women were pregnant or had menstruation. The indirect calorimetry, bioelectronics impedance device Tanita MC - 980 and BOD POD were used to collect the data. Basal metabolic rates were calculated from the prediction equations by Harris & Benedict, Fleisch's equation and Schofield's equation using measured anthropometric values. Results: The results of the methods that have been used for this group of people vary, but the difference is not significant. If we choose as a reference method indirect calorimetry, we can't replace it by any other method. The results for other methods are not significantly different, so we can replace one method with another, except indirect calorimetry. From calculations, we also found out that fat free mass greatly influences the results of basal metabolic rate...

IntroduktionSpirometri är en vanlig undersökningsmetod för att bedöma en persons lungfunktion och lungkapacitet, där total lungkapacitet (TLC) är av stort värde. Kroppspletysmografi och kvävgasutsköljning är två metoder som mäter statiska lungvolymer, däribland TLC. Syftet med studien var att jämföra kroppspletysmografi med kvävgasutsköljning och se om det förelåg någon signifikant skillnad på mätresultaten mellan metoderna. Material och metod Studien bestod av 32 försökspersoner, varav 22 kvinnor och 10 män där samtliga undersökningar utfördes på Fysiologkliniken på Västmanlands sjukhus Västerås under februari och mars 2021. Variablerna TLC, funktionell residualkapacitet/intrathorakal gasvolym (FRC/ITGV) och vitalkapacitet (VC) uppmättes och beräknades. Resultatet jämfördes mot Hedenströms referensmaterial. Ett parat t-test med signifikansnivå p&lt;0,05 användes för att se om det förelåg signifikant skillnad.  Resultat och slutsats Vid jämförelse av kroppspletysmografi och kvävgasutsköljning föreligger signifikant skillnad mellan samtliga variabler (p&lt;0,001). Där kvävgasutsköljning uppmäter lägre volymer än kroppspletysmografi. / Introduction Spirometry is a commonly used examination method for validating pulmonary function and lung capacities, where total lung capacity (TLC) is of great value. Body plethysmography and multiple breath nitrogen washout are two methods that measure statical lung volumes, including TLC. The purpose of the study was to compare body plethysmography and multiple breath nitrogen washout to examine if there was a significant difference between the two methods. Material and method The study consisted of 32 test subjects, 22 women and 10 men, all examinations were performed at the Physiological Clinic at Västmansland´s Hospital Västerås between February and Mars 2021. The variables TLC, functional residual capacity/intrathoracic gas volume (FRC/ITGV) and vital capacity (VC) were measured and calculated. The result was compared against Hedenströms reference material. A paired t-test with significance level p&lt;0,05 was used to evaluate if there was a significant difference.  Result and conclusion When comparing body plethysmography and multiple breath nitrogen washout, there is a significant difference between all variables (p&lt;0,001). Where multiple breath nitrogen washout measures lower volumes than body plethysmography.

Heart rate can say a lot about a person's health. While most conventional methods for heart rate measurement require contact with the subject, these are not always applicable. In this thesis, a non-invasive method for pulse detection is implemented and analyzed. Different signals from the color of the forehead—including the green channel, the hue channel and different ICA and PCA components—are inspected, and their resulted heart rates are weighted together according to the significance of their FFT peaks. The system is tested on videos with different difficulties regarding the amount of movement and setting of the scene. The results show that the approach of weighting measurements from different signals together has great potential. The system in this thesis, however, does not perform very well on videos with a lot of movement because of motion noise. Though, with better, less noisy signals, good results can be expected. / En människas puls säger en hel del om dennes hälsa. För att mäta pulsenanvänds vanligtvis metoder som vidrör människan, vilket iblandär en nackdel. I det här examensarbetet tas en metod för pulsmätningpå avstånd fram, som endast använder klipp från en vanlig videokamera. Färgen i pannan mäts och utifrån den genereras flera signalersom analyseras, vilket resulterar i olika mätvärden för pulsen. Genomatt värdera dessa mätvärden med avseende på hur tydliga signalernaär, beräknas ett viktat medelvärde som ett slutgiltigt estimat på medelpulsen. Metoden testas på videoklipp med varierande svårighetsgrad,beroende på hur mycket rörelser som förekommer och på vilketavstånd från kameran försökspersonen står. Resultaten visar att metodenhar mycket god potential och att man kan man förvänta sig finaresultat med bättre, mindre brusiga signaler.

Il est proposé que la pléthysmographie pénienne puisse faire l’objet d’améliorations par la combinaison de la pléthysmographie pénienne et de la vidéo-oculographie lors de la présentation de stimuli générés par ordinateur (SGO). L’application de cette combinaison n’a fait l’objet d’aucune étude auprès d’agresseurs sexuels d’enfants. Cette thèse comporte trois articles empiriques qui visent respectivement à soutenir le développement d’un instrument d’évaluation basé sur l’utilisation combinée des réponses oculaires et érectiles lors de la présentation de SGO afin d’évaluer les intérêts sexuels d'agresseurs sexuels d’enfants. Pour ce faire, des hommes ayant eu (n = 26) ou non (n = 36) des comportements sexuels envers des enfants sont recrutés afin de constituer des groupes de comparaison. Le premier article représente une exploration préliminaire des données issues de caractéristiques sociodémographiques, sexuelles et criminologiques ainsi que des réponses oculaires et péniennes lors de présentations de SGO et de bandes sonores conventionnelles. Il permet d’orienter les décisions entourant la poursuite de la recherche. Le second article porte sur la comparaison des profils des réponses péniennes issues de présentations de SGO et de bandes sonores conventionnelles ainsi que sur leur capacité respective à classifier les individus selon la présence d’antécédents de comportements sexuels sur des enfants. Il permet d’établir la validité discriminante de l’utilisation de SGO et d’établir des normes d’utilisation clinique. Le troisième article vise à circonscrire une dynamique oculaire associée à l’intérêt sexuel envers l’âge d’un objet et à soutenir la contribution de la combinaison des réponses oculaires et péniennes lors de la présentation de SGO. En somme, les résultats issus de cette thèse soutiennent l’utilisation clinique de la pléthysmographie pénienne lors de la présentation de SGO. Ils permettent d’identifier la présence d’une signature oculaire spécifique aux agresseurs sexuels lors de la présentation de SGO. Ils démontrent la contribution de la combinaison des réponses oculaires et péniennes par rapport à une mesure reposant uniquement sur les réponses péniennes. Ces résultats ouvrent la voie à l’utilisation clinique de la vidéo-oculographie et de SGO et offrent non seulement des possibilités intéressantes dans le domaine de la délinquance sexuelle, mais également de la sexualité en général. / We propose that penile plethysmography could be improved by its combination with eye-tracking devices during the presentation of computer-generated stimuli (CGS). To date, the application of this combination has not been studied among child molesters. This dissertation includes three empirical articles supporting the development of an assessment instrument based on the joint measurement of ocular and penile responses during the presentation of CGS in order to evaluate the sexual interests of child molesters. To this end, men who had (n = 26) or had not (n = 36) engaged in sexual behaviors towards children were recruited. The first article consists of a preliminary exploration of the sociodemographic, sexual, and criminological characteristics of child molesters and nonoffenders as well as their respective ocular and penile responses to CGS and conventional auditory stimuli. This investigation provided a framework for the subsequent phases of the study. The second article compares the profiles of penile responses to CGS and conventional auditory stimuli and each presentation modality’s ability to classify individuals in terms of their history of sexual behaviors towards children. The third article identifies gaze patterns associated with sexual interest towards a given age group and provides support for the joint measurement of penile and ocular responses during the presentation of CGS. To summarize, the results of these studies support the clinical application of penile plethysmography in conjunction with the presentation of CGS. These results enable the identification of the eye movement signature of sexual offenders in response to CGS. Additionally, the data demonstrate the added benefits of measuring both penile and ocular responses relative to measuring penile responses in isolation. These findings provide insights for the clinical use of eye tracking and CGS and suggest interesting possibilities for the study of deviant sexuality, as well as sexuality in general.

La pléthymographie pénienne est considérée comme la méthode la plus objective pour évaluer les intérêts sexuels d'hommes adultes. Par contre, un nombre grandissant de chercheurs déplorent le manque de correspondance qui existe entre les stimuli présentés dans ce type d'évaluation et la réalité. Il est proposé de tenter de remédier à cette lacune en utilisant des personnages virtuels générés par ordinateur et présentant une variété de dispositions affectives lors d'évaluations pléthysmographiques. Ces stimuli n'ont jamais été utilisés dans l'évaluation des intérêts sexuels auprès d’agresseurs sexuels d'enfants. Cette thèse est composée de deux articles qui visent à soutenir le recours à ce type de stimuli lors d'évaluations pléthysmographiques. Afin d'atteindre cet objectif, des hommes ayant eu ou non des contacts sexuels avec des enfants ont été recrutés dans le but de les comparer. Une première étude empirique est bipartite. Elle vise en premier lieu à déterminer auprès d'une population étudiante si les dispositions affectives simulées par les personnages virtuels sont identifiables. Elle cherche ensuite à déterminer la capacité des personnages virtuels à générer un profil d'excitation sexuelle propre à un groupe d'individus n'ayant pas de problématique sexuelle. La seconde étude expérimentale porte sur la comparaison des profils de réponses érectiles issus de la présentation des personnages virtuels et évalue leur capacité à discriminer les individus selon qu'ils possèdent ou non des antécédents en matière de délinquance sexuelle envers les enfants. Dans l'ensemble, les résultats soutiennent l'utilisation de ces stimuli lors d'évaluations pléthysmographiques. Ils démontrent que les personnages virtuels simulent les dispositions affectives prévues et qu'ils génèrent des profils d'excitation sexuelle et des indices de déviance permettant de discriminer entre les groupes à l'étude. Ce projet de recherche présente les avantages associés à la présentation des personnages virtuels simulant différentes dispositions affectives lors de l'évaluation des intérêts sexuels chez les agresseurs d'enfants et propose des avenues intéressantes en termes d'évaluation et de traitement auprès de cette population. / Penile plethysmography is considered the most objective method to assess adult men's sexual interests. However, a growing number of researchers underline the poor correspondence between the stimuli used during this type of assessment and reality. It is proposed to try to overcome this issue by using computer generated virtual characters that present a variety of affective dispositions during plethysmographic assessments. These stimuli have never been used in the assessment of child molesters' sexual interests. This thesis is composed of two articles that aim at supporting the use of this type of stimuli during plethysmographic assessments. In order to reach this goal, men who have or not engaged in sexual contact with children were recruited so that they could be compared. A first empirical study is bipartite. On one hand, it aims to determine in a student sample whether the affective dispositions simulated by the virtual characters represent what was intended. Its second goal is to determine the ability of the charcarters to generate a sexual arousal profile representative of non-deviant men. The second experimental study focuses on comparing profiles of erectile responses recorded to the virtual characters and determining their ability to discriminate individuals according to their group membership. Overall, results support the use of these stimuli during plethysmographic assessments. They demonstrate that the virtual characters simulate intended affective dispositions as well as their ability to generate profiles of sexual arousal and deviance differentials representative of group membership. This research project presents the advantages of using virtual characters that simulate varying affective dispositions in the assessment of child molesters' sexual interests and proposes interesting avenues in terms of assessment and treatment with this population.

INTRODUÇÃO: Artrite reumatoide (AR) é uma doença inflamatória autoimune comum, de predomínio feminino e presente em 1% da população brasileira. O acometimento do sistema respiratório é frequente e ocorre em aproximadamente 50% desta população, principalmente as doenças de vias aéreas e as doenças pulmonares intersticiais. Pacientes tabagistas têm maior chance de desenvolver AR em relação aos não tabagistas, mas o papel do tabaco na doença pulmonar da AR ainda está indefinido. Este trabalho foi dividido em 2 partes. Na primeira avaliamos as características epidemiológicas, clínicas, radiográficas e espirométricas dos pacientes com AR, e comparamos o grupo de pacientes com alterações em qualquer dos exames realizados com grupo onde os exames foram normais. Na segunda parte, fizemos uma avaliação mais aprofundada do sistema respiratório dos pacientes com alteração à espirometria e os comparamos de acordo com a exposição ao tabagismo: elevada (carga tabágica > 10 anos.maço) contra baixa ou ausente. MÉTODOS: Pacientes acompanhados no ambulatório de Artrite Reumatoide do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo foram submetidos a um estudo de corte transversal com avaliação clínica, oximetria de pulso em repouso, radiografia de tórax e espirometria. Aqueles que apresentavam espirometria alterada foram submetidos a tomografia de alta resolução do tórax (TCAR) e função pulmonar com espirometria, pletismografia, difusão de monóxido de carbono (DLCO) e teste de washout de nitrogênio por respiração única. RESULTADOS: Um total de 246 pacientes foram analisados. História de tabagismo prévio ou atual foi visto em metade da amostra. Houve baixa prevalência de nódulos reumatoides e Síndrome de Sjögren. Alterações à espirometria foram vistas em 30% dos pacientes, radiografia de tórax em 45% e oximetria de pulso em 13%. Exames normais estavam simultaneamente presentes em apenas 41% dos casos. Houve fraca correlação negativa entre carga tabágica e diferentes parâmetros da espirometria. No grupo de pacientes com elevada exposição ao tabaco, observamos uma maior frequência de enfisema à TCAR de tórax e menor DLCO, enquanto que no grupo com exposição baixa ou ausente houve maior prevalência de bronquiolite. CONCLUSÕES: Alteração combinada em radiografia de tórax, espirometria e oximetria de pulso foi mais frequentemente observada em pacientes com mais idade, história de tabagismo e uso prévio de metotrexate e biológicos. Apesar de frequentes, a maioria das alterações à radiografia de tórax e espirometria foram leves. A exposição ao tabagismo consegue explicar apenas uma pequena parte das alterações espirométricas da doença pulmonar da AR. A maioria dos pacientes com alteração à espirometria apresentou TCAR de tórax e função pulmonar sugestivas de doença pulmonar obstrutiva, principalmente bronquiolite. A presença de enfisema à TCAR é um marcador altamente específico de exposição ao tabaco / INTRODUCTION: Rheumatoid Arthritis (RA) is a frequent connective tissue disorder, occurring mainly in women, with a 1% prevalence in Brazil. Pulmonary disease, which is present in up to 50% of patients, manifests most commonly as interstitial lung disease (ILD) and airways disease. A high frequency of smoking is observed among RA patients, but its role on pulmonary involvement is unknown. This work was divided in 2 parts. At the first part, we analyzed epidemiological, clinical, radiographic and spirometric RA patients´ characteristics, and compared the group of patients with any abnormality on complementary medical tests against the group with normal tests. At the second part, patients with abnormal spirometry were submitted to a more complex respiratory evaluation, and we compared RA patients with high tobacco exposure ( > 10 pack-years) versus absent or low tobacco exposure. METHODS: RA patients undergoing regular follow-ups at the rheumatoid arthritis clinic of the Rheumatology Division, University of Sao Paulo Medical School, Brazil, were submitted to a cross-sectional clinical pulmonary evaluation, rest pulse oximetry, chest radiograph and spirometry. Those with abnormal spirometry were submitted to chest high-resolution computed tomography (HRCT) and pulmonary function tests with spirometry, plethysmography, carbon monoxide diffusion capacity (DLCO) and single breath nitrogen washout. RESULTS: A total of 246 RA patients underwent complete assessments. Half of the population reported tobacco exposure. Rheumatoid nodules and Sjögren Syndrome were uncommon. Spirometry was abnormal in 30% of the patients; CXR was abnormal in 45%, and pulse oximetry was abnormal in 13%. Normal CXR, spirometry and oximetry were observed simultaneously in only 41% of the RA patients. A weak negative correlation was found between tobacco exposure and spirometric parameters. Thorax HRCT emphysema and lower DLCO were more frequent in patients with high tobacco exposure, while patients with absent or low tobacco exposure had a higher frequency of bronchiolitis. CONCLUSIONS: A significant difference was observed in age, smoking status, and ever methotrexate or biologic treatments when comparing patients with normal and abnormal complementary medical tests. Even though radiographic and spirometric abnormalities were frequent, most of them were mild. Tobacco exposure was slightly responsible for RA patients´ spirometric abnormalities. HRCT and pulmonary function tests compatible with obstructive lung disease, mainly bronchiolitis, were the most frequent patterns among RA patients with abnormal spirometry. HRCT emphysema was a highly specific marker of tobacco exposure

Introdução: Alterações pulmonares podem ocorrer no lúpus eritematoso sistêmico juvenil (LESJ) e estar relacionadas com a morbidade e mortalidade. Os objetivos deste estudo foram analisar a função pulmonar de pacientes com LESJ e identificar possíveis correlações com escore da tomografia de alta resolução (TCAR) do tórax, escore de atividade da doença, dano cumulativo da doença e qualidade de vida dos pacientes. Métodos: Quarenta pacientes com LESJ, de 7,4 a 17,9 anos (mediana: 14,1 anos), foram submetidos a espirometria e pletismografia. Difusão de monóxido de carbono (DLCO), TCAR do tórax, teste da caminhada de 6 minutos (TC6M), atividade da doença, dano cumulativo da doença e qualidade de vida também foram avaliados. Resultados: Alterações subclínicas foram observadas em 19/40 (47,5%) pacientes com LESJ na espirometria/DLCO. O volume expiratório forçado no primeiro segundo (VEF1%) foi o parâmetro mais afetado (30%). A TCAR de tórax estava alterada em 22/30 (73,3%) pacientes, sendo alterações mínimas em 43%. Sinais de envolvimento de vias aéreas foram observados em 50% dos casos. Doze pacientes (30%) foram hospitalizados por complicações pulmonares decorrentes do LESJ, com alta hospitalar há pelo menos 11 meses antes do início do estudo (mediana da alta: 2,1 anos). Capacidade pulmonar total (CPT%), capacidade vital (CV%), capacidade vital forçada (CVF%) e VEF1% foram menores no grupo que foi hospitalizado quando comparado com o grupo sem hospitalização por complicações pulmonares (p < 0,05). Houve correlação entre o escore da TCAR com VEF1/VC (r=-0.63; p=0.0002), VEF1 (r=-0.54; p=0.018), FEF25-75% (r=-0.67; p < 0.0001) e resistência das vias aéreas (r=+0.49; p=0.0056). A DLCO apresentou correlação com o tempo de doença (r=+0.4; p=0.01). Conclusão: Aproximadamente metade dos pacientes com LESJ apresentaram alterações funcionais significativas independentemente da atividade da doença e do dano cumulativo. Alterações de vias aéreas foram predominantes, especialmente na TCAR. A correlação positiva entre a DLCO e duração da doença provavelmente está relacionada com a melhora decorrente do tratamento. Complicações pulmonares decorrentes do LESJ podem determinar dano funcional / Introduction: Pulmonary abnormalities can occur in childhood-onset systemic lupus erythematosus (cSLE) and can affect both morbidity and mortality. The aims of this study were to analyze the pulmonary function of cSLE patients and to identify possible correlations with the high-resolution computed chest tomography (HRCT) score, disease activity, disease cumulative damage and the participants\' quality of life. Methods: Forty cSLE patients, median age: 14.1 years (range: 7.4-17.9), underwent spirometry and plethysmography. Carbon monoxide diffusing capacity (DLCO), HRCT, 6-minute walk test (6MWT), disease activity, disease cumulative damage and quality of life were assessed. Results: Subclinical abnormalities were evident in 19/40 (47,5%) cSLE patients according to spirometry/DLCO. Forced expired volume in one second (FEV1%) was the parameter most affected (30%). The HRCT showed some abnormality in 22/30 patients (73,3%), which were minimal in 43%. Signs of airway affection were found in 50%. Twelve patients (30%) were hospitalized due to cSLE-related pulmonary complications, at least 11 month before the study began (median discharge: 2.1years earlier). Total lung capacity (TLC%), vital capacity (VC%), forced vital capacity (FVC%), and FEV1% were lower in the group with hospitalization (p < 0.05). The HRCT-score was correlated with FEV1/VC (r=-0.63; p=0.0002), FEV1 (r=-0.54; p=0.018), FEF25-75% (r=-0.67; p < 0.0001), and resistance (r =+ 0.49; p=0.0056). DLCO was correlated with disease duration (r =+ 0.4; p=0.015). Conclusions: Almost half of patients with cSLE exhibited significant functional abnormalities, regardless of the disease activity and disease cumulative damage. Airway abnormalities were predominant, especially in the HRCT. The positive correlation between DLCO and duration of disease is most likely related to improvement resulting from treatment. The cSLE-related pulmonary complications can determine functional damage