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RESUMO: A avaliarção da Qualidade de Vida (QV) do doente respiratório crónico, tem suscitado um interesse cresceote nos últimos anos. O conceito de QV é complexo, sendo, segundo o grupo de trabalho da OMS sobre este tema: â⦠influenciado pelo estado de saúde fisico, psicológico, o grau de independência, a inserrção social e as relarções com os constituintes essenciais do meio ambienteâ. Neste trabalho, os autores abordam a importância e o lugar da avaliação da QV no estudo do doente com asma brônquica e analisam OS diferéntes métodos de avaliação disponíveis.Tal como as outras doenças respiratórias crónicas, a asma tem repercussões na qualidade de vida dos doentes. Como resposta, o.doente asmà tico pode desenvolver mecanismos de adaptação complexos, ex: diminuir o seu nível de actividade funcional (fenómeno de ânormalidade ajustadaâ) em que ao fim de certo tempo, a incapacidade para a realização de certas actividades fisicas é assumido pelo doente como ânormalâ. A avaliação da qualidade de vida deve, nestes casos, ser capaz de evidenciar a real limitação da actividade do doente.Os factores exteriores (ex: elirna), também exercem uma influência determinante sobre o doente asmátìco. Em resposta a estes, o doente pode limitar a sua actividadc (ex: evitar ambientcs enfumarados ou evitar o exercicio ao ar livre nos dias frios) ou pode alterar o meio ambientc (ex: medidas de evicção dos ácaros).A asma brônquica afecta três domínios da vida do indivíduo: Físico, Psíquico e Social. Como resultado, a avaliarção da QV do doente asmático é um estudo pluridimensional e deve ser encarada como complementar dos restantes indicadores habitualmente empregues no estudo da asma (estudo funcional respiratório, análiscs, âscoresâ clinicos, etc.). Além disso, acrescenta um dado novo: fornecer a perspectiva do doente sobre a sua qualidade de vida e não a perspectiva do médico ou técnico, permitindo, em estudos clínicos que comparam duas alternativas terapêuticas, substituir as eventuais diferenças âestatisticamente significativasâ por diferenças âclinicamente significativasâ para os doentes.Os instrumentos utilizados devem ser válidos - exprimindo com exactidão a força de ligação entre o impacto da asma sobre o indivíduo e o conceito que o pretende exprimir e fiáveis ou reprodutiveis - permitindo repetir a avaliarção com um mínimo de variabilidade nos seus resultados.Os autores descrevem as características dos questionà rios genéricos, ex: NHP - Notthingham Health Profile (Hunt), SF36 -Short Form 36 (Ware) e dos questionários específicos de doença respiratória, ex: para a asma e doença pulmonar obstrutiva crónica: SGRQ â Questionário Respiratório do Hospital St George (Jones), para a asma: AQLQ- Questionário da QV na asma (Juniper), LWAQ - Viver com a sua asma (Hyland), entre outros e concluem que, para melhor apreendcr a situação clinica dos doentes, será necessário empregar frequentemente diferentes questionários. seleccionando com este objcctivo o questionário SF36 eo questionário AQLQ. COMENTÃRIOS: O estudo do impacto das doenças e suas terapêuticas sobre a saúde e o bern estar do doente, tern sido objecto de grande interesse nos ultimos anos. Apesar de serem vários os conceitos de qualidade de vida, o que ressalta de mais importante é o conceito de percepção de saúde pelo próprio indivíduo (subjectividade), em função de variáveis fisicas, funcionais e psicológicas (1).A escolha dos questionários de QV a adoptar deverá recair sobre a sua validação, de acordo com a patologia a estudar e a sua sensibilidade, reproductibilidade e fiabilidade (2).A avaliação da qualidade de vida no doente respiratório tem muitas aplicações, sendo exemplos, a comparação da eficácia entre duas altemativas terapêuticas, ex: comparação entre o efeito do salmeterol e do salbutamol na QV do doente asmatico (3); a avaliação de factores predictivos do sucesso operatório nacirurgia de redução de volwne pulmonar (4); a relação entre a força muscular periférica e a QV em doentes com lirnitação crónica do débito aéreo (5).No nosso país, em reunião da Comissão de Trabalho de Reabilitação Respiratória da Sociedade Portuguesa de Pneumologia, foi decidido adoptar-se o Questionário Respiratório do Hospital de St George nas situações de Asma e Bronquite Crónica e o Notthingham Health Profile, como complemento deste, noutras patologias respiratórias.Estes questionários foram já traduzidos para a lingua portuguesa(l) e encontram-se em fase de validação para aplicação no nosso pais. Palavras-chave: Asma, Qualidade de Vida

Although many studies have investigated the benthic environment of temperate marine waters, little is known about the acoustic behaviour of the organisms in these habitats, particularly crustaceans. This study focused on the acoustic behaviour of large crustaceans in NE Atlantic coastal regions. A total of 11 crustacean species were recorded in tank-based experiments to identify sound-producing species and the behaviours associated with their sounds as well as to quantitatively characterise and compare the sounds. A total of 34 sounds were associated with behaviours such as moving, feeding, mandible rubbing, swimming, species-specific behaviour and other unidentified behaviours. The sounds included single pulse and pulse train signals that were distributed across a peak frequency spectrum of 3 to 45 kHz with received levels between 93 and 142 dB re 1 µPa (peak to peak). The results demonstrated that Brachyura had the most diverse sound types. Using a combination of several acoustic features, 24% of the recorded sounds appeared to have a high potential to be differentiated in field recordings: the feeding sound of Cancer pagurus, Carcinus maenas, Necora puber and Pachygrapsus marmoratus; the species-specific sound of C. pagurus and Galathea squamifera; and the pulse train sound associated with unidentified behaviours of Lophozozymus incisus and N. puber. These findings extend the existing crustacean acoustic library in marine ecosystems and contribute to our understanding of in situ acoustic recordings in temperate regions.

Researchers often use metabolic measurements in the field over narrow time periods to estimate an organism’s metabolism over large time scales. Here, we measured in situ respiration, calcification and excretion rates of the tropical gastropod Tectus niloticus L. through benthic chamber experiments. Our samples spanned a 21 h time frame and were taken during both the warm and cool seasons. We assessed diel and seasonal variability in metabolic rates, as well as the effect of individual size and the contribution of shell epi- and endobionts. Our results show that metabolic rates vary through time at both diel and seasonal scales, as measured fluxes for respiration and calcification were significantly higher at night during the warm season. This nocturnal pattern was not significant in the cool season. Size effects were significant with higher respiration and calcification rates for small individuals regardless of the season, although the difference tended to be more pronounced in the warm season. We also found that shell epi- and endobionts made an important contribution to respiration, as 40 and up to 100% of total measured fluxes for night and day, respectively, could be attributed to the shell community. More importantly, the direction of the measured flux was occasionally opposite that of the individual trochus, highlighting that the contribution of shell epi- and endobionts must be accounted for in order to achieve an accurate understanding of individual metabolism. Lastly, depending on the time of day and season when measurements are taken, ignoring diel or seasonal variations in metabolic rates could result in important under- or overestimation of the contributions of gastropods to carbon and calcium carbonate fluxes in coastal ecosystems.

The effects of ocean acidification alone or in combination with warming on coral metabolism have been extensively investigated, whereas none of these studies consider that most coral reefs near shore are already impacted by other natural anthropogenic inputs such as metal pollution. It is likely that projected ocean acidification levels will aggravate coral reef health. We first investigated how ocean acidification interacts with one near shore locally abundant metal on the physiology of two major reef-building corals: Stylophora pistillata and Acropora muricata. Two pH levels (pHT 8.02; pCO2 366 μatm and pHT 7.75; pCO2 1140 μatm) and two cobalt concentrations (natural, 0.03 μg L-1 and polluted, 0.2 μg L-1) were tested during five weeks in aquaria. We found that, for both species, cobalt input decreased significantly their growth rates by 28% while it stimulated their photosystem II, with higher values of rETRmax (relative Electron Transport Rate). Elevated pCO2 levels acted differently on the coral rETRmax values and did not affect their growth rates. No consistent interaction was found between pCO2 levels and cobalt concentrations. We also measured in situ the effect of higher cobalt concentrations (1.06 ± 0.16 μg L-1) on A. muricata using benthic chamber experiments. At this elevated concentration, cobalt decreased simultaneously coral growth and photosynthetic rates, indicating that the toxic threshold for this pollutant has been reached for both host cells and zooxanthellae. Our results from both aquaria and in situ experiments, suggest that these coral species are not particularly sensitive to high pCO2 conditions but they are to ecologically relevant cobalt concentrations. Our study reveals that some reefs may be yet subjected to deleterious pollution levels, and even if no interaction between pCO2 levels and cobalt concentration has been found, it is likely that coral metabolism will be weakened if they are subjected to additional threats such as temperature increase, other heavy metals, and eutrophication.

Understanding the relationship between growth and temperature will aid in the evaluation of thermal stress and threats to ectotherms in the context of anticipated climate changes. Most Pecten maximus scallops living at high latitudes in the northern hemisphere have a larger maximum body size than individuals further south, a common pattern among many ectotherms. We investigated differences in daily shell growth among scallop populations along the Northeast Atlantic coast from Spain to Norway. This study design allowed us to address precisely whether the asymptotic size observed along a latitudinal gradient, mainly defined by a temperature gradient, results from differences in annual or daily growth rates, or a difference in the length of the growing season. We found that low annual growth rates in northern populations are not due to low daily growth values, but to the smaller number of days available each year to achieve growth compared to the south. We documented a decrease in the annual number of growth days with age regardless of latitude. However, despite initially lower annual growth performances in terms of growing season length and growth rate, differences in asymptotic size as a function of latitude resulted from persistent annual growth performances in the north and sharp declines in the south. Our measurements of daily growth rates throughout life in a long-lived ectothermic species provide new insight into spatio-temporal variations in growth dynamics and growing season length that cannot be accounted for by classical growth models that only address asymptotic size and annual growth rate.

Fluxes of dissolved inorganic carbon and oxygen at the water-sediment interface were measured at eight coral reef stations (Indian Ocean) in summer and winter. The dark fluxes provided the community respiratory quotient (CRQ = dissolved inorganic carbon release / oxygen uptake) and the diurnal fluxes corrected from the dark fluxes gave the community photosynthetic quotient (CPQ = oxygen gross release / dissolved inorganic carbon gross uptake). The CRQ and the winter CPQ were not significantly different from 1. Summer CPQ (0.79; SD 0.02) was significantly lower than 1 due to the combined effect of the daily evolution of the community respiration and the discrepancy between the daily evolution in community oxygen respiration and community carbon respiration. These results highlight the importance of measuring simultaneously the benthic community production and respiration for long term integrated data sets, instead of the traditional daily or seasonal budget calculations from limited measures of community respiration.

Previous studies of contracting muscle with low loading and partial vascular occlusion demonstrated hypertrophy and strength adaptations similar to and exceeding those observed with traditional moderate to high resistance (Shinohara M, Kouzaki M, Yoshihisa T, and Fukunaga T. Eur J Physiol 77: 189-191, 1998; Takarada Y, Takazawa H, Sato Y, Takebayashi S, Tanaka Y, and Ishii N. J Appl Physiol 88: 2097-2106, 2000; Takarada Y, Sato Y, and Ishii N. Eur J Physiol 86: 308-314, 2002). The purpose of the study was to determine the anabolic and catabolic hormone responses to light resistance exercise combined with partial vascular occlusion. Three experimental conditions of light resistance with partial occlusion (LRO), moderate resistance with no occlusion (MR), and partial occlusion without exercise (OO) were performed by eight healthy subjects [mean 21 yr (SD 1.8)]. Three sets of single-arm biceps curls and single-leg calf presses were completed to failure with 1-min interset rest periods. Workloads of 30 and 70% one repetition maximum for each exercise were lifted for the LRO and MR trials, respectively. Blood samples were taken preexercise, postexercise, and 15 min postexercise for each experimental condition. Lactate increased significantly in the LRO and MR trials and was not significantly different from each other at any time point. Growth hormone (GH) increased significantly by fourfold from pre- to postexercise in the LRO session but did not change significantly during this time period in the MR and OO trials (8.3 +/- 2.3 vs. 2.1 +/- 1.2 and 2.6 +/- 0.94 microg/l; respectively, P < 0.05). There were no changes in resting total testosterone [T; mean 15.7 +/- 1.6 (SE) nmol/l], free testosterone (FT; 54.1 +/- 4.5 pmol/l), or cortisol (267.6 +/- 22 nmol/l) across all trials and times. In conclusion, with similar lactate responses, light exercise combined with partial vascular occlusion elicits a greater GH response than moderate exercise without occlusion but does not affect T, FT, or cortisol.

Shell disease in the abalone Haliotis tuberculata L. is characterized by a conchiolin deposit on the inner surface of the shell. The gross clinical signs appear similar to the Brown Ring Disease (BRD) of clams. BRD has been extensively described in clams and is known to be responsible for severe mortalities and the collapse of the clam aquaculture industry in western France. In the clam, it was found to be caused by the infection of the mantle by Vibrio tapetis. Brown protein deposits have been observed in various abalone species around the world; some of these have been associated with a fungal infection in New Zealand, but the ones described here are similar to bacterial infections observed in clams. Larger animals appeared to be more affected by the disease, and a positive correlation of the number of successive infections found in the shells with the level of infestation of the shell by borers suggests that boring polychaetes and sponges may be vectors of the disease, or that the parasite infestation may increase the susceptibility of the animal to this infection. There is no evidence, however, that this infection causes mortality in abalone.

Previous studies have suggested the utility of D-Dimer ELISA assays in eliminating a diagnosis of pulmonary embolism (PE). Our objectives were to evaluate the performance of a new, rapid, quantitative, and automated Liatest D-Dimer Assay in patients with suspected PE. Three hundred eighty-six consecutive patients referred to our institution between March 1992 and December 1996 for clinically suspected PE, with recent clinical signs not exceeding 1 wk, were included in this study. Diagnosis of PE was based on clinical evaluation, radionuclide lung imaging, lower limb examination, and, when required, pulmonary angiography. D-Dimer performances, for both Liatest D-Dimer and standard D-Dimer ELISA (Asserachrom DDi), assays, were assessed at the end of the study. Among the 386 patients tested, 146 (37.8%) were classified as PE-positive. Liatest D-Dimer assay had a 100% sensitivity (95% confidence interval, 97 to 100%) and a negative predictive value of 100% (95% confidence interval, 94 to 100%). A normal result, below the cutoff of 500 ng/ml, occurred in 83 of the 386 (21%) patients. There was a strong agreement between Liatest D-Dimer and Asserachrom DDi analyses. These findings suggest that this rapid, quantitative, and automated D-Dimer assay provides a useful diagnostic tool for the clinician with regard to exclusion of PE.

The Asthma Quality of Life Questionnaire (AQLQ) is a well-validated instrument. Our objectives were to explore the cross-sectional validity of the French version, using usual outcomes of asthma, as well as assessment of knowledge of asthma, self-management and compliance. A self-administered version of the AQLQ was given to 124 consecutive patients recruited from two out-patient clinics and an emergency room in order to reflect a wide range of asthma severity. The other outcomes of asthma measured were the FEV1, patient-perceived asthma severity using a visual analogue scale, compliance, knowledge of asthma condition and self-management autonomy. Correlations were predicted before analysis ( r > 0.5, strong correlation, ++ r = 0.35-0.5, moderate correlation and + r = 0.20-0.35, fair correlation). The AQLQ scores correlated moderately to strongly with asthma severity and fairly with the pulmonary function results. Of the behavioural outcomes assessed, only knowledge of asthma correlated fairly with the AQLQ scores, as expected. This study of the French version of the AQLQ, while showing similar cross-sectional correlations with functional assessment and asthma severity to those observed with the original English version, suggested in addition a positive association between quality of life and knowledge of asthma.

Purpose: The purpose of the study was to assess the possible benefit of the combination vinorelbine (NVB)-cisplatin (DDP) in comparison with NVB alone in advanced non-small cell lung cancer (NSCLC), not treated previously. It also involved confirmation of the efficacy of vinorelbine as monotherapy., Patients and Methods: In this phase III trial, 231 eligible patients were stratified by centre and randomized to receive either NVB alone, 30 mg/m2/week or the combination of NVB 30 mg/m2/week and DDP 80 mg/m2/3 weeks. Patients were to be treated for a minimum of 6 weeks, with the first response assessment performed 9 weeks after the beginning of treatment., Results: The two groups differed in terms of objective response rates (16% and 43%, respectively, p = 0.0001) and median time to progression (10 weeks and 20 weeks, p = 0.0001). However, the difference was not significant for median survival time (32 weeks, 33 weeks, p = 0.48). The addition of DDP resulted in an increase in toxicity, in particular renal, hematologic, neurologic and emetic. This toxicity led to treatment discontinuation in 8% and 21% of patients, respectively. Respectively 3% and 13% of patients stopped treatment early during objective response (toxicity or refusal)., Conclusions: The NVB-DDP combination increased objective response rates and time to progression in comparison with NVB alone, but did not influence the survival of patients. The activity of NVB in the treatment of advanced NSCLC was confirmed.

Between April, 1981, and December, 1982, 32 patients with squamous cell bronchial carcinoma were treated with a chemotherapy regimen followed by operation. The preoperative chemotherapeutic agents used were cisplatin, bleomycin, and mitomycin C. A thoracotomy was performed 3 to 4 weeks after the last day of the last treatment. Of the 29 undergoing resection, three (10.3%) had no tumor cells in the resected specimen and four (12.5%) had only a few neoplastic microcenters in tissue necrosis or fibrosis. We suggest that the use of this new chemotherapy combination with surgical resection provides excellent palliation, increases resectability, and has a potential for increasing the cure rate in squamous cell carcinoma of the lung.

Antiperinuclear factor (APF) might be a specific serum rheumatoid factor directed towards keratohyaline granules. It was found to be present in 40 of 79 (50.6%) patients with primary and in 21 of 36 (58.3%) patients with metastatic lung cancer, compared with 12 of 95 (12.6%) sex- and age-matched normal controls. Additionally, APF frequency and titer correlated well with tumor dissemination, even though no relationship could be shown with histopathological type.