Made available in DSpace on 2014-06-11T19:22:13Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-02-25Bitstream added on 2014-06-13T19:48:22Z : No. of bitstreams: 1 servio_tc_me_botfm.pdf: 1055866 bytes, checksum: d86e7a487aac3e078c759f6ceaf80ca8 (MD5) / Universidade Estadual Paulista (UNESP) / A Doença de refluxo gastroesofágico é uma afecção muito comum. Atualmente, o tratamento cirúrgico videolaparoscópico tem sido amplamente empregado. Porém, apesar de ser uma técnica minimamente invasiva, pode acarretar uma série de alterações pulmonares importantes. Analisar as alterações funcionais respiratórias em indivíduos submetidos à válvula anti-refluxo videolaparoscópica. Foram avaliados, pela equipe do Hospital Estadual Bauru, no período de março de 2009 até maio de 2010, todos os pacientes com indicação cirúrgica. No período pré-operatório todos foram submetidos à anamnese, espirometria, medida do índice diafragmático, ventilometria, manovacuometria, pico de fluxo expiratório, teste de caminhada de 6 minutos e teste de escada. Todos os testes foram repetidos no primeiro, segundo, quinto e trigésimo pós-operatórios. Somente o teste de escada não foi repetido no primeiro pós-operatório. Foi avaliada em cada pós-operatório a escala analógica de dor, e a escala de Borg foi aplicada após os testes dinâmicos. Foram avaliados 32 pacientes, sendo 59% mulheres. A média da idade e do IMC foi de, respectivamente, 44,4±10,9 anos e 28,4±4,8 kg/m2. A amostra foi formada por 75% de não tabagistas, 6% de tabagistas e 19% de ex-tabagistas. Não houve qualquer caso de complicação pós-operatória. O VEF1, CVF, VVM e o PFE apresentaram queda significativa no PO1 e PO2, voltado aos valores pré no PO5. A PImáx e PEmáx apresentaram queda significativa no PO1, mantendo-se no PO2 ainda baixas, mas sem significância estatística com o pré, sendo que no PO5 seus valores já eram superiores aos do PO1 e semelhantes ao pré. O VE teve incremento estatisticamente significativo no PO2, ficando nos outros momentos em valores intermediários entre os valores PRÉ e PO2, enquanto a f teve acréscimo estatisticamente significante no PO1e nos outros momentos... / Gastroesophageal reflux disease is a very common condition. Currently, the laparoscopic surgical treatment has been widely used. However, despite being a minimally invasive technique, it may lead to a series of major pulmonary changes. Evaluate changes in respiratory function in patients who underwent laparoscopic anti-reflux valve. All patients with surgical indications were evaluated by the team of Bauru State Hospital, from March 2009 until May 2010. In the preoperative period all patients underwent history taking, spirometry, measurement of diaphragmatic index, respirometry, manometer, expiratory peak flow, 6-minute walking test and stairclimbing. All the tests were repeated in the first, second, fifth and thirtieth postoperative days. Only the stair climbing test was not repeated in the first postoperative day. It was assessed at each postoperative day the pain analog scale and the Borg scale was applied after the dynamic tests. We evaluated 32 patients, 59% women. The mean age and BMI was respectively 44.4 ± 10.9 years and 28.4 ± 4.8 kg/m2. The sample comprised 75% of nonsmokers, 6% of smokers and 19% of former smokers. There was no case of postoperative complication. FEV1, FVC, MVV and EPF showed significant decrease in PO2 and PO1, and it returned to baseline levels in PO5. The MIP and MEP showed a significant drop in the PO1, PO2 remaining at still low, but without statistical significance with the PRE, while in PO5 their values were already higher than PO1, and similar to the PRE. The MV had statistically significant increase in PO2, presenting at other times intermediate values between PRE and PO2, whereas the f had statistically significant increase in PO1 and presenting at other moments intermediate values to PRE and PO2. The TV and ID did not differ significantly at any time. The distance in 6MWT showed a significant drop in the PO1, and PO2. In PO5 there was no statistical... (Complete abstract click electronic access below)

Background: Lung clearance index (LCI), obtained by multiple breath washout testing (MBW), is a sensitive measure of lung disease in infants. It has been identified as a particularly suitable endpoint for clinical trials in cystic fibrosis (CF), but has potential applications in many other conditions. However, MBW in infants presents a number of technical challenges. Conventional MBW is based on simultaneous measurement of flow and gas. These two signals are then aligned and combined to derive expired gas volumes and measures of ventilation inhomogeneity: this process becomes increasingly vulnerable to errors in gas signal alignment at rapid respiratory rates. At present, no existing system for infant MBW meets all the criteria set out in international guidelines, and there is no simple method of assessing lung function outside research laboratories in this population. This thesis describes an alternative method of performing MBW in infants. In this method, expired gas is collected and analysed to derive functional residual capacity (FRC) and LCI. There is no need to simultaneously measure flow, and therefore no need for the complicated step of integrating flow and gas signals. Dead space is also significantly reduced by removing the flowmeter. Methods: In the first phase of testing, an existing lung model was modified to generate realistic infant breathing parameters with high accuracy. The prototype system was modified to improve accuracy and subsequently tested at FRC of 100-250mls with respiratory rates of 20-60min-1. In the second phase, testing proceeded to an in vivo pilot study of the novel method in children with cystic fibrosis and healthy controls. Practical applicability of the system was determined by the number of successful duplicate tests, and within-subject repeatability. Comparison was made with LCI measurements obtained using a respiratory mass spectrometer, currently considered the gold standard for infant LCI. Results: In a total of 103 tests performed in the lung model, overall mean error (standard deviation) of FRC measurement was -1.0(3.3)%, with 90% of tests falling within +/-5%. 13 patients were excluded from the clinical study due to being unsedated or inadequately sedated and therefore failing to tolerate the test. A total of 25 patients (7 children with CF, 18 healthy control children) were deemed to be adequately sedated at the start of the test, of these 20 patients (7 with CF) successfully underwent duplicate testing (80% success rate). Mean FRC for healthy controls was 19.5ml/kg, and mean LCI 6.45. For children with CF, mean FRC was 21.8ml/kg and mean LCI 6.98. Mean within-subject coefficient of variation for FRC was 7.18% and for LCI 5.94%. Of 4 infants assessed with both the novel method and the respiratory mass spectrometer, there was good correlation in FRC measurement (mean difference -8.1%). Comparison of LCI with the mass spectrometer was affected by technical difficulties with the test; in those patients who underwent technically adequate tests with both methods, mean difference in LCI between the two methods was 1.65%. Discussion: FRC measurement using the novel method has superior accuracy in vitro than previously described systems. Data from the pilot study suggest that this is a feasible and reproducible method of performing LCI in infants and young children, as long as they are adequately sedated. Results in both children with CF and controls fall within the expected range, and well within accuracy limits set by international guidelines. However, the system and testing protocol could be further improved to reduce the number of technically inadequate tests having to be excluded. This could provide a more accessible alternative to previously described systems for infant MBW.

Thesis--Wisconsin. / Vita. Includes bibliographical references.

Three longitudinal pulmonary function data sets were analyzed by several statistical methods for the purposes of: 1) determining to what degree the conclusions of an analysis for a given data set are method dependent; 2) assessing the properties of each method across the different data sets; 3) studying the correlates of FEV₁ decline including physical, behavioral, and respiratory factors, as well as city of residence and type of work. 4) assessing the appropriateness of modelling the standard linear relationship of FEV₁ with time and providing alternative approaches; 5) describing longitudinal change in various lung function variables, apart from FEV₁. The three data sets were comprised of (1) yearly data on 141 veterans with mild chronic bronchitis, taken at three Canadian centres, for a maximum of 23 years of follow-up; their mean age at the start of the study was 49 years (s.d.=9) and only 10.6% were nonsmokers during the follow-up; (2) retrospective data on 384 coal workers categorized into four groups according to vital status (dead or alive) and smoking behavior, with irregular follow-up intervals ranging from 2 to 12 measurements per individual over a period of 9 to 30 years; (3) a relatively balanced data set on 269 grain workers and a control group of 58 civic workers, which consisted of 3 to 4 measurements taken over an average follow-up of 9 years. Their mean age at first measurement was 37 years (s.d.=10) and 53.2% of the subjects did not smoke. A review of the pulmonary and statistical literature was carried out to identify methods of analysis which had been applied to calculate annual change in FEV₁. Five methods chosen for the data analyses were variants of ordinary least squares approaches. The other four methods were based on the use of transformations, weighted least squares, or covariance structure models using generalized least squares approaches. For the coal workers, the groups that were alive at the time of ascertainment had significantly smaller average FEV₁ declines than the deceased groups. Post-retirement decline in FEV₁ was shown by one statistical method to significantly increase for coal workers who smoked, while a significant decrease was observed for nonsmokers. Veterans from Winnipeg consistently showed the lowest decline estimates in comparison to Halifax and Toronto; recorded air pollution measurements were found to be the lowest for Winnipeg, while no significant differences in smoking behavior were found between the veterans of each city. The data set of grain workers proved most ameniable to all the different analytical techniques, which were consistent in showing no significant differences in FEV₁ decline between the grain and civic workers groups and the lowest magnitude of FEV₁ decline. It was shown that quadratic and allometric analyses provided additional information to the linear description of FEV₁ decline, particularly for the study of pulmonary decline among older or exposed populations over an extended period of time. Whether the various initial lung function variables were each predictive of later decline was dependent on whether absolute or percentage decline was evaluated. The pattern of change in these lung function measures over time showed group differences suggestive of different physiological responses. Although estimates of FEV₁ decline were similar between the various methods, the magnitude and relative order of the different groups and the statistical significance of the observed inter-group comparisons were method-dependent No single method was optimal for analysis of all three data sets. The reliance on only one model, and one type of lung function measurement to describe the data, as is commonly found in the pulmonary literature, could lead to a false interpretation of the result Thus a comparative approach, using more than one justifiable model for analysis is recommended, especially in the usual circumstances where missing data or irregular follow-up times create imbalance in the longitudinal data set. / Graduate and Postdoctoral Studies / Graduate

No description available.

No description available.

No description available.

No description available.

Master of Science / Department of Kinesiology / Craig A. Harms / High-intensity interval training (HIT) has been utilized as a time-efficient strategy to induce numerous physiological adaptations and improve performance usually associated with “traditional” endurance training (ET). It is not known however, if HIT might lead to improvements in pulmonary function. Therefore we hypothesized that HIT would increase respiratory muscle strength and expiratory flow rates. Fifteen healthy subjects were randomly assigned to an ET group (n = 7) and a HIT group (n = 8). All subjects performed an incremental test to exhaustion (VO2 max) on a cycle ergometer prior to and after training. Standard pulmonary function tests, maximum inspiratory pressure (PImax), maximum expiratory pressure (PEmax), and maximal flow volume loops, were performed pre training and after each week of training. HIT subjects performed a four week training program on a cycle ergometer at 90% of their VO2 max final workload while the ET subjects performed exercise at 60-70% of their VO2 max final workload. All subjects trained three days/ week. The HIT group performed five one-minute bouts with three minute recovery periods and the ET group cycled for 45 minutes continuously at a constant workload. A five-mile time trial was performed prior to training, after two weeks of training, and after four weeks of training. Both groups showed similar (p<0.05) increases in VO2 max (~8-10%) and improvements in time trials following training (HIT 6.5 ± 1.3%, ET 4.4 ± 1.8%) with no difference (p>0.05) between groups. Both groups increased (p<0.05) PImax post training (ET ~25%, HIT ~43%) with values significantly higher for HIT than ET. There was no change (p>0.05) in expiratory flow rates with training in either group. These data suggest that whole body exercise training is effective in increasing inspiratory muscle strength with HIT leading to greater improvements than ET. Also, HIT offers a time-efficient alternative to ET in improving aerobic capacity and performance.

No description available.