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Background: The Glittre-ADL test is a comprehensive test to evaluate functional capacity in patients with chronic obstructive pulmonary disease (COPD)., Aim: The primary aim was to validate the Glittre-ADL test with and without the backpack performed in three laps as an alternative to five laps in people with COPD., Methods: Forty-eight participants with mild to severe COPD (mean ± SD age: 71 ± 7 years; FEV 1 : 46 ± 17 %predicted) were recruited and performed two 6-min walk tests (visit 1); two Glittre-ADL tests with backpack (visit 2), and the Glittre-ADL test with and without the backpack, in random order (visit 3)., Results: The Glittre-ADL tests were performed in five laps and symptoms, heart rate and oxygen saturation were recorded for three and five laps. The Glittre-ADL test performed in three laps provoked the same oxygen desaturation [mean ± SD oxygen saturation (SpO 2 ): 90 ± 6 vs 90 ± 6, p = 0.249] and rate of perceived exertion (RPE) [RPE legs: 2.91 ± 2.23 vs 3.08 ± 2.56, p = 0.380; RPE arms: 1.91 ± 1.77 vs 2.16 ± 1.92, p = 0.306] to the Glittre-ADL test performed in five laps for both Glittre with the backpack and without the backpack SpO 2 [mean ± SD: 90 ± 6 vs 90 ± 7, p = 0.249], and RPE [legs: 3.02 ± 2.28 vs 3.25 ± 2.37, p = 0.380; arms: 2.13 ± 1.91 vs 2.03 ± 1.84, p = 0.306]. The heart rate and dyspnoea were significantly lower for both Glittre-ADL tests performed in three laps., Conclusion: The 3-lap Glittre-ADL test may be a more practical alternative to the 5-lap test, while still remaining a good test of functional capacity for activities of daily living., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2025 Elsevier Ltd. All rights reserved.)

Background: Hazard and risk assessment of nanomaterials (NMs) face challenges due to, among others, the numerous existing nanoforms, discordant data and conflicting results found in the literature, and specific challenges in the application of strategies such as grouping and read-across, emphasizing the need for New Approach Methodologies (NAMs) to support Next Generation Risk Assessment (NGRA). Here these challenges are addressed in a study that couples physico-chemical characterization with in vitro investigations and in silico similarity analyses for nine nanoforms, having different chemical composition, sizes, aggregation states and shapes. For cytotoxicity assessment, three methods (Alamar Blue, Colony Forming Efficiency, and Electric Cell-Substrate Impedance Sensing) are applied in a cross-validation approach to support NAMs implementation into NGRA., Results: The results highlight the role of physico-chemical properties in eliciting biological responses. Uptake studies reveal distinct cellular morphological changes. The cytotoxicity assessment shows varying responses among NMs, consistent among the three methods used, while only one nanoform gave a positive response in the genotoxicity assessment performed by comet assay., Conclusions: The study highlights the potential of in silico models to effectively identify biologically active nanoforms based on their physico-chemical properties, reinforcing previous knowledge on the relevance of certain properties, such as aspect ratio. The potential of implementing in vitro methods into NGRA is underlined, cross-validating three cytotoxicity assessment methods, and showcasing their strength in terms of sensitivity and suitability for the testing of NMs., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Maximal treadmill cardiopulmonary exercise testing is the gold standard for assessing functional capacity in patients with idiopathic pulmonary fibrosis (IPF)., Purpose: Primarily to investigate the concurrent validity between three field tests and cardiopulmonary exercise testing in these patients., Methods: Patients performed the cardiopulmonary exercise testing, a six-minute walk test, an incremental shuttle walk test, and, the Glittre-ADL test. For cardiopulmonary exercise testing, the ten seconds with the higher average of the peak oxygen uptake obtained within the last 30 seconds were considered; for six-minute walk test and incremental shuttle walk test, the longer distance; and for the Glittre-ADL test, the shorter time spent. Concurrent validity was assessed using different regression models based on the best adjustment of the data., Results: Twenty-two patients with IPF were assessed, aged: 68 ± 8.1 years, 13 male. Patients presented a peak oxygen uptake of 16.5 ± 3.6 mL.kg -1. min 1 , achieving a distance of 512.6 ± 102.8 meters in the six-minute walk test and 415.7 ± 125.1 meters in incremental shuttle walk test. The walking distance in the six-minute walk test and the incremental shuttle walk test explained, respectively, 64% and 56% peak oxygen uptake variance observed in the cardiopulmonary exercise testing (R 2  = 0.64, p  < .001; R 2  = 0.56, p  < .001). The time spent in the Glittre-ADL test was 233.4 ± 88.7 seconds and explained 47% of the peak oxygen uptake variance observed in cardiopulmonary exercise testing (R 2  = 0.47, p  = .001)., Conclusion: The six-minute walk test, incremental shuttle walk test, and Glittre-ADL test were considered valid tests to explain the peak oxygen uptake variance obtained by the cardiopulmonary exercise testing in patients with IPF.

Background: Epidemiological data offer conflicting views of the natural course of binge-eating disorder (BED), with large retrospective studies suggesting a protracted course and small prospective studies suggesting a briefer duration. We thus examined changes in BED diagnostic status in a prospective, community-based study that was larger and more representative with respect to sex, age of onset, and body mass index (BMI) than prior multi-year prospective studies., Methods: Probands and relatives with current DSM-IV BED ( n = 156) from a family study of BED ('baseline') were selected for follow-up at 2.5 and 5 years. Probands were required to have BMI > 25 (women) or >27 (men). Diagnostic interviews and questionnaires were administered at all timepoints., Results: Of participants with follow-up data ( n = 137), 78.1% were female, and 11.7% and 88.3% reported identifying as Black and White, respectively. At baseline, their mean age was 47.2 years, and mean BMI was 36.1. At 2.5 (and 5) years, 61.3% (45.7%), 23.4% (32.6%), and 15.3% (21.7%) of assessed participants exhibited full, sub-threshold, and no BED, respectively. No participants displayed anorexia or bulimia nervosa at follow-up timepoints. Median time to remission (i.e. no BED) exceeded 60 months, and median time to relapse (i.e. sub-threshold or full BED) after remission was 30 months. Two classes of machine learning methods did not consistently outperform random guessing at predicting time to remission from baseline demographic and clinical variables., Conclusions: Among community-based adults with higher BMI, BED improves with time, but full remission often takes many years, and relapse is common.

Background: Although inspiratory muscle training reduces dyspnea in patients with chronic respiratory diseases, it was not yet evaluated in a sample composed exclusively of patients with interstitial lung diseases., Objective: To discuss the perception of patients with interstitial lung diseases about inspiratory muscle training intervention., Methods: This is a qualitative study. Data were collected using semi-structured interviews, transcribed, and analyzed by thematic analysis., Results: Fourteen patients (64 ± 7 years) with interstitial lung disease were interviewed. Average participation in the inspiratory muscle training program was 90% (range, 66-100%). Three themes were elaborated: 1) dyspnea and other symptoms in daily life ( e.g. "I could not carry out a bag; I was very uncomfortable") ; 2) less symptom and greater performance ( e.g. "I wash and change my clothes, house cleaning, do everything without feeling anything" ); and 3) IMT: a time dedicated to my health ( e.g. "For me it was great because I saw my evolution every day" )., Conclusion: Patients noticed improvements in symptoms and performance related to daily activities. Despite initial difficulties, patients continued training as planned.

Background: Burns are classified according to their mechanism of injury, depth, affected body area, affected region or part of the body, and extent of the lesions. Topical insulin modulates the healing process. However, studies evaluating the effects of topical insulin treatment on burns in human patients are lacking., Purpose: The purpose of this study was to investigate the effects of topical insulin on healing time of second-degree burns., Methods: In this nonrandomized clinical trial, patients with second-degree burns were allocated to a control group (CG) or an intervention group (IG) in which wounds were treated with 1% silver sulfadiazine and topical insulin, respectively., Results: Healing time was significantly shorter in the IG relative to the CG (9.1 ± 1.9 days and 12.7 ± 3.3 days, respectively; P < .05). The estimated burn area was similar in both groups (CG 1.44 ± 1.0%; IG 1.42 ± 0.53%)., Conclusion: In this study, topical insulin reduced healing time in second-degree burns. Further investigation is warranted to support wider use in clinical practice.

Introduction: Peripheral arterial disease (PAD) is increasingly prevalent, and supervised physical exercise programmes are recommended as the first-line treatment. However, these programmes are underused. Alternative delivery models may be able to expand treatment coverage. The objective of this study was to compare a home-based exercise programme (HBEP) and a centre-based exercise (CBE) in terms of their effects on functional capacity, peripheral muscle oxygenation and quality of life in individuals with PAD., Methods and Analysis: This single-blind, parallel randomised clinical trial will consist of two groups: HBEP and CBE. A qualitative analysis will be carried out to investigate acceptability and satisfaction. The primary outcome will be functional capacity, assessed by the incremental shuttle walk test. Secondary outcomes will include functional capacity, assessed by a treadmill walking test; peripheral muscle oxygenation and quality of life; and self-reported functional impairment, risk factors, morbidity, level of physical activity, adherence, acceptability and satisfaction. The intervention protocols will consist of 12 weeks of intermittent walking until claudication symptoms, three times a week. Participants randomly assigned to the CBE group will participate in supervised face-to-face sessions. The HBEP group will perform exercises at home with remote supervision, monitored by a pedometer and heart rate monitor, and subjective perception of effort during each session will be recorded by participants in a training diary; follow-up will be conducted by telephone calls. Statistical analyses will follow the intention-to-treat principle. Participants allocated to the HBEP group will be interviewed about their experience of remote treatment using a qualitative approach., Ethics and Dissemination: Ethics approval was obtained from the Ethics Committee of the Universidade Federal de Minas Gerais. The results will be disseminated in a peer-reviewed journal and presented at international congresses. This research has the potential to improve the care of people with PAD because if home-based rehabilitation demonstrates effectiveness, it could be considered an alternative or support resource to the usual centre-based treatment models, expanding access, coverage and participation in vascular physiotherapy TRIAL REGISTRATION: https://ensaiosclinicos.gov.br/rg/RBR-97vy9n7 on 14 April 2022., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: We hypothesized that the use of mechanical insufflation-exsufflation can reduce the incidence of acute respiratory failure within the 48-hour post-extubation period in intensive care unit-acquired weakness patients., Methods: This was a prospective randomized controlled open-label trial. Patients diagnosed with intensive care unit-acquired weakness were consecutively enrolled based on a Medical Research Council score ≤ 48/60. The patients randomly received two daily sessions; in the control group, conventional chest physiotherapy was performed, while in the intervention group, chest physiotherapy was associated with mechanical insufflation-exsufflation. The incidence of acute respiratory failure within 48 hours of extubation was evaluated. Similarly, the reintubation rate, intensive care unit length of stay, mortality at 28 days, and survival probability at 90 days were assessed. The study was stopped after futility results in the interim analysis., Results: We included 122 consecutive patients (n = 61 per group). There was no significant difference in the incidence of acute respiratory failure between treatments (11.5% control group versus 16.4%, intervention group; p = 0.60), the need for reintubation (3.6% versus 10.7%; p = 0.27), mean length of stay (3 versus 4 days; p = 0.33), mortality at Day 28 (9.8% versus 15.0%; p = 0.42), or survival probability at Day 90 (21.3% versus 28.3%; p = 0.41)., Conclusion: Mechanical insufflation-exsufflation combined with chest physiotherapy seems to have no impact in preventing postextubation acute respiratory failure in intensive care unit-acquired weakness patients. Similarly, mortality and survival probability were similar in both groups. Nevertheless, given the early termination of the trial, further clinical investigation is strongly recommended., Clinical Trials Register: NCT01931228.

Aim: The primary objective of this study was to investigate the effects of two modalities of noninvasive ventilation, continuous positive airway pressure-CPAP and non-synchronized nasal intermittent positive pressure ventilation-nsNIPPV, on breathing pattern of very low birth weight preterm infants immediately after extubation., Methods: It was conducted a quasi-experimental study at a public university hospital. Infants with gestacional age ≤32 weeks and birth weight ≤1,500 g were randomized into the sequences, prior extubation: CPAP - nsNIPPV (1) or nsNIPPV - CPAP (2). Each preterm infant was studied for a period of 60 min in each ventilatory mode. Respiratory inductive plethysmography was used to assess breathing pattern. Inferential analysis was performed by repeated measures ANOVA or Friedman test., Results: Eleven preterm infants were studied and a total of 7,564 respiratory cycles were analyzed. No significant differences were observed in any of the comparisons made for any of the breathing pattern variables ( p  > .05)., Conclusions: There was no significant difference on breathing pattern between CPAP and nsNIPPV of preterm infants after extubation.

The objective of this study is to compare the demographic characteristics and symptoms in pregnant and postpartum women who died from Severe Acute Respiratory Syndrome (SARS) caused by COVID-19 or by nonspecific cause in different states of Brazil. This is a retrospective cohort study and the analysis was conducted on SARS death records between 02/16/2020 and 04/17/2021, obtained from the Information System for the Epidemiological Surveillance of Influenza (Sistema de Informação da Vigilância Epidemiológica da Gripe, SIVEP-Gripe). Pregnant and postpartum women, aged between 10 and 55 years, who died from SARS, were included and classified into two groups: SARS due to confirmed COVID-19 or SARS due to nonspecific cause. The cases were analyzed according to the women's demographic and epidemiological characteristics, clinical symptoms, risk factors and disease evolution. As results, 19,333 pregnant and postpartum women were identified. From these, 1,279 died (1,026 deaths from COVID-19 and 253 deaths from SARS with nonspecific cause). The groups showed significant differences in age, education, race, and occurrence of obesity and chronic lung disease. The group of women who died from confirmed COVID-19 presented a significantly higher frequency of symptoms of fever, cough, fatigue, loss of taste, and loss of smell, as well as a higher rate of admission to the intensive care unit (ICU). Data analysis draws attention to the high number of cases of SARS without a causal diagnosis, the low access to ICU and orotracheal intubation (OTI), which might be explained by the demographic and regional inequalities in the access to healthcare., Competing Interests: The authors have declared that no competing interests exist.

Background: For people with chronic obstructive pulmonary disease (COPD) the ability to perform functional activities for a prolonged duration is important for completion of daily tasks. While the Glittre-ADL test measures time taken to complete a series of functional activities, there is no test of endurance capacity for common daily activities., Research Question: Is the Glittre Endurance test a valid and responsive test to measure endurance capacity for functional daily tasks in people with COPD?, Methods: This was a cross-sectional study. Fifty-seven participants with COPD (mean ± SD age:69 ± 7 years; FEV 1 :48 ± 18%predicted) were recruited. All participants performed the Glittre-ADL test without a backpack (Glittre-ADL-noBP). Nine participants (Group A) performed a Glittre Endurance test at 90% of the speed to complete one lap of the Glittre-ADL-noBP. 48 participants (Group B) performed two Glittre Endurance tests at 100% of Glittre-ADL-noBP speed. The time to voluntary cessation or not keeping up with target pace was the test outcome., Results: Mean ± SD of the Glittre Endurance test was 12.11 ± 6.43 min and 6.90 ± 4.40 min for the test at 90% and 100% speeds, respectively. When the 100% Glittre Endurance test 2 was compared to test 1, there was a 14% increase in test time, indicating a learning effect (p = 0.005). Following pulmonary rehabilitation (n = 20) the Glittre Endurance test increased by 3.12 min (29%), and the Glittre-ADL-noBP reduced by 0.33 min (10%)., Conclusion: The Glittre Endurance test performed at 100% of the Glittre-ADL-noBP speed provided an appropriate endurance test time, and was more sensitive to change following pulmonary rehabilitation than the Glittre-ADL-noBP., Competing Interests: Declaration of competing interest None., (Copyright © 2022. Published by Elsevier Ltd.)

The first observation of the semileptonic b-baryon decay Λ&#95;{b}^{0}→Λ&#95;{c}^{+}τ^{-}ν[over ¯]&#95;{τ}, with a significance of 6.1σ, is reported using a data sample corresponding to 3  fb^{-1} of integrated luminosity, collected by the LHCb experiment at center-of-mass energies of 7 and 8 TeV at the LHC. The τ^{-} lepton is reconstructed in the hadronic decay to three charged pions. The ratio K=B(Λ&#95;{b}^{0}→Λ&#95;{c}^{+}τ^{-}ν[over ¯]&#95;{τ})/B(Λ&#95;{b}^{0}→Λ&#95;{c}^{+}π^{-}π^{+}π^{-}) is measured to be 2.46±0.27±0.40, where the first uncertainty is statistical and the second systematic. The branching fraction B(Λ&#95;{b}^{0}→Λ&#95;{c}^{+}τ^{-}ν[over ¯]&#95;{τ})=(1.50±0.16±0.25±0.23)% is obtained, where the third uncertainty is from the external branching fraction of the normalization channel Λ&#95;{b}^{0}→Λ&#95;{c}^{+}π^{-}π^{+}π^{-}. The ratio of semileptonic branching fractions R(Λ&#95;{c}^{+})≡B(Λ&#95;{b}^{0}→Λ&#95;{c}^{+}τ^{-}ν[over ¯]&#95;{τ})/B(Λ&#95;{b}^{0}→Λ&#95;{c}^{+}μ^{-}ν[over ¯]&#95;{μ}) is derived to be 0.242±0.026±0.040±0.059, where the external branching fraction uncertainty from the channel Λ&#95;{b}^{0}→Λ&#95;{c}^{+}μ^{-}ν[over ¯]&#95;{μ} contributes to the last term. This result is in agreement with the standard model prediction.

Events containing a Z boson and a charm jet are studied for the first time in the forward region of proton-proton collisions. The data sample used corresponds to an integrated luminosity of 6  fb^{-1} collected at a center-of-mass energy of 13 TeV with the LHCb detector. In events with a Z boson and a jet, the fraction of charm jets is determined in intervals of Z-boson rapidity in the range 2.0

Although the standard treatment for periodontal disease is based on scaling and root planing (SRP), the use of antimicrobial photodynamic therapy (aPDT) has been studied as a complement to obtain better clinical results. The purpose of this study was to evaluate the effect of aPDT as adjuncts to SRP, compared with SRP alone, on clinical parameters of chronic periodontal patients. Only randomized controlled trials with at least 3-month follow-ups, of SRP alone and in association with aPDT, were included. The MEDLINE (PubMed), Google Scholar, and LILACS databases were searched for articles published up to July 2020. Random-effects meta-analyses were conducted for clinical attachment level (CAL) and probing pocket depth (PPD) change after treatment. Of 141 potentially relevant papers, 22 were included. The association between SRP and aPDT promoted a significant CAL gain and PPD reduction. Periodontal treatment was partially improved by aPDT, and a favorable effect of indocyanine green-mediated aPDT was observed, and high concentrations of phenothiazine chloride presented clinical improvement as well., (© 2021. The Author(s), under exclusive licence to Springer-Verlag London Ltd. part of Springer Nature.)

A measurement of mixing and CP violation in neutral charm mesons is performed using data reconstructed in proton-proton collisions collected by the LHCb experiment from 2016 to 2018, corresponding to an integrated luminosity of 5.4  fb^{-1}. A total of 30.6 million D^{0}→K&#95;{S}^{0}π^{+}π^{-} decays are analyzed using a method optimized for the measurement of the mass difference between neutral charm-meson eigenstates. Allowing for CP violation in mixing and in the interference between mixing and decay, the mass and decay-width differences are measured to be x&#95;{CP}=[3.97±0.46(stat)±0.29(syst)]×10^{-3} and y&#95;{CP}=[4.59±1.20(stat)±0.85(syst)]×10^{-3}, respectively. The CP-violating parameters are measured as Δx=[-0.27±0.18(stat)±0.01(syst)]×10^{-3} and Δy=[0.20±0.36(stat)±0.13(syst)]×10^{-3}. This is the first observation of a nonzero mass difference in the D^{0} meson system, with a significance exceeding seven standard deviations. The data are consistent with CP symmetry and improve existing constraints on the associated parameters.

Objective: To investigate upper limb (UL) energy demand during unilateral arm crank submaximal exercise testing in individuals with stroke compared with healthy controls and the relationship between UL energy demand and UL activity in individuals with stroke., Design: Cross-sectional, observational study., Setting: Research laboratory., Participants: Individuals with chronic stroke (n=14) and controls (n=12), matched for age, sex, and body mass index (N=26)., Interventions: Not applicable., Main Outcome Measures: UL energy demand was measured as peak oxygen consumption (V̇o 2 )/peak load during unilateral arm crank submaximal exercise testing. UL activity was measured using the Box and Block Test (BBT) and Grooved Pegboard Test (GPT)., Results: The energy demand of the paretic side compared with the nonparetic side of the stroke group was 0.43 mL/kg/min/W (95% confidence interval, 0.03-0.83, P=.005) greater than the dominant compared with the nondominant side of the control group. The median difference between sides in peak V̇o 2 /peak load was 52% for the group with stroke compared with 11% for the control group. Positive correlations between the median percentage difference between the paretic and the nonparetic side of peak V̇o 2 /peak load and BBT were 0.72 (P=.004) and of V̇o 2 /peak load and GPT was 0.77 (P=.002)., Conclusions: The higher energy demand of the paretic UL during unilateral arm crank submaximal exercise testing than the nonparetic and both UL of the controls together with the strong relationship between energy demand and UL activity suggest that the energy demand of the paretic UL has the potential to affect real-life UL activity after stroke., (Copyright © 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Incentive spirometers (ISs) are clinical devices used in respiratory physical therapy to increase alveolar ventilation and functional residual capacity., Objectives: To investigate factors that influence physical therapists from Minas Gerais in selecting a type of IS and the scientific background behind the use of ISs by physical therapists who work with patients with respiratory dysfunctions., Methods: Physical therapists from 13 hospital and non-hospital institutions (public/private) completed a self-administered questionnaire based on the current evidence on ISs., Results: Indications and contraindications of ISs are not fully understood by most of the 168 physical therapists who completed the questionnaire. Volume-oriented IS was preferred over flow-oriented IS. However, only half of the physical therapists have a scientific background to justify the choice of one IS type rather than the other., Conclusions: Most physical therapists from Minas Gerais do not fully understand the indications and contraindications for ISs. Despite physical therapists stating their preference for volume-oriented IS, this choice is not necessarily based on current scientific evidence. The development of strategies to bring physical therapists closer to evidence-based practice is necessary to ensure best patient care., Competing Interests: Conflicts of interest None to declare., (Copyright © 2021 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To evaluate the efficacy of an inspiratory muscle training protocol on inspiratory muscle function, functional capacity, and quality of life in patients with asthma., Design: A single-blind, randomized controlled clinical trial., Setting: Community-based., Subjects: Patients with asthma, aged between 20 and 70 years old, non-smokers., Interventions: Participants were randomized into two groups: inspiratory muscle training group performed inspiratory muscle training 5 days a week for 8 weeks, consisting of six sets of 30 breaths per day with a training load ⩾50% of maximal inspiratory pressure, plus an educational program; the control group only received the educational program., Main Measurements: Maximal inspiratory pressure, inspiratory muscle endurance, and the distance performed on the incremental shuttle walking test were assessed pre-intervention, post-intervention and at follow-up (3 months after the end of the intervention). The asthma quality of life questionnaire was applied pre and post-intervention., Results: Data from 39 participants were analyzed. Maximal inspiratory pressure in percentage of predicted and endurance test duration were significantly higher post-intervention in the inspiratory muscle training group (∆ post-pre: 50.8% vs 7.3% of predicted - P  < 0.001 and ∆ post-pre: 207.9 seconds vs 2.7 seconds - P  < 0.001, respectively). There was no significant difference in the incremental shuttle walking distance between groups (∆ post-pre: 30.9 m vs -8.1 m, P  = 0.165). Quality of life was perceived as significantly better, without a difference between groups ( P  > 0.05)., Conclusions: About 8 weeks of inspiratory muscle training in patients with controlled asthma significantly increased inspiratory muscle strength and endurance.

This study aimed to develop a prototype of the GISSA Mother-Baby ChatBot Application (GCBMB), a conversational agent to promote child health and evaluate the experience of use and satisfaction with this technological solution. This is a two-stage cross-sectional research with a mixed methodology. The first stage develops the settings of dialogue and the GCBMB prototype. The second stage evaluates the experience of using the ChatBot through a structured questionnaire where statements are used to assess the respondent's level of agreement using the Likert Scale and analyzes the application's use path through its database. The sample consisted of 142 puerperae, with a mean age of 25.4 years, where 38.1% were primiparous. The level of agreement of women with simplicity, good quality of information, clarity of content, usefulness, and satisfaction with the application was above 90%. Women between 26 and 30 years of age had a higher mean number of hits (5.21), settings accessed (9.26), and usage time (272 seconds) comparing younger and older women. The use of ChatBots on smartphones is encouraging to promote the health of children in Brazil. However, more investments are required to improve technological solutions and research with robust methodologies to evaluate their effectiveness.

We present an angular analysis of the B^{+}→K^{*+}(→K&#95;{S}^{0}π^{+})μ^{+}μ^{-} decay using 9  fb^{-1} of pp collision data collected with the LHCb experiment. For the first time, the full set of CP-averaged angular observables is measured in intervals of the dimuon invariant mass squared. Local deviations from standard model predictions are observed, similar to those in previous LHCb analyses of the isospin-partner B^{0}→K^{*0}μ^{+}μ^{-} decay. The global tension is dependent on which effective couplings are considered and on the choice of theory nuisance parameters.

The Glittre-ADL test assesses the functional capacity for activities of daily living of people with chronic obstructive pulmonary disease (COPD). In the test, a weighted backpack is worn (2.5 kg for women and 5.0 kg for men). The differential in weight between men and women is not common in other tests of exercise capacity and may limit the comparison of the test between sexes. The primary aim of this study was to validate the Glittre-ADL test performed without the backpack in people with COPD. Forty participants with mild to severe COPD (mean ± SD age: 70 ± 6 years; FEV 1 : 48 ± 20%predicted) were recruited and performed two six-minute walk tests (visit 1); two Glittre-ADL tests with backpack (visit 2), and the Glittre-ADL test with and without the backpack, in random order (visit 3). The Glittre-ADL test time was shorter without the backpack than with the backpack [mean difference -0.37 min (95%CI -0.59 to -0.15)] and heart rate (HR) and oxygen saturation (SpO 2 ) were equivalents between tests [-1.31 beats/minute (-3.92 to 1.30) and -0.95% (-2.27 to 0.37), respectively]. The Glittre-ADL test without the backpack elicited similar HR and SpO2 responses as the test with the backpack, indicating equivalence of physiological demand. Thus, the Glittre-ADL test without the backpack was a valid, responsive, and appropriate test to assess functional capacity for activities of daily living.

Objective: We evaluated the effects of posture, sex, and age on breathing pattern and chest wall motion during quiet breathing in healthy participants., Methods: Eighty-three participants aged 42.72 (SD=21.74) years presenting normal pulmonary function were evaluated by optoelectronic plethysmography in the seated, inclined (with 45° of trunk inclination), and supine positions. This method allowed to assess the chest wall in a three dimensional way considering the chest wall as three compartments: pulmonary rib cage, abdominal rib cage and abdomen., Results: Posture influenced all variables of breathing pattern and chest wall motion, except respiratory rate and duty cycle. Chest wall tidal volume and minute ventilation were reduced (p<0.05) in both sexes from seated to inclined and from seated to supine positions, mainly in males. Moreover, moving from seated to supine position significantly increased the percentage contribution of the abdomen to the tidal volume in both sexes (p<0.0001). Regarding sex, women showed higher contribution of thoracic compartment compared to men (p=0.008). Aging provided reductions on rib cage contributions to tidal volume that were compensated by increases of abdomen contributions (p<0.0001). In addition, increases in end-inspiratory and end-expiratory volumes over the years were observed., Conclusion: The degree of contribution of chest wall compartments is dependent on posture, sex, and age. Therefore, verticalization increases expansion of pulmonary rib cage as well as horizontalization increases abdominal displacement. Women presented higher thoracic contribution to tidal volume than men. Aging reduces rib cage contributions to tidal volume that were compensated by increases of abdomen contributions., (Copyright © 2019. Publicado por Elsevier Editora Ltda.)

Purpose: To validate the Comprehensive and Brief International Classification of Functioning, Disability and Health Core Sets for obstructive pulmonary diseases from the perspective of adults with asthma. Methods: This was a qualitative, cross-sectional study. Individual interviews with questions related to the disease and its impact on the patient's life were performed. The meaning condensation procedure was used for analysis. Results: Thirty-five participants (26 females, 41 ± 13 years old) were interviewed. A total of 405 concepts were identified, and 348 were associated to the components Body Functions ( n  = 168), Body Structures ( n  = 22), Activities and Participation ( n  = 33), Environmental Factors ( n  = 125). These concepts were linked to 61 categories: second level ( n  = 25), third level ( n  = 33), fourth level ( n  = 3), which confirmed 41% and 77% of those included in the Comprehensive and Brief Core Sets, respectively. Twenty-four additional categories were identified, and 57 concepts could not be linked to the classification. Conclusions: The International Classification of Functioning, Disability and Health Core Sets for obstructive pulmonary diseases were supported by the perspective of adults with asthma. The Brief version seemed the best reference for rehabilitation, reflecting the typical disabilities and impairments of these patients. Unconfirmed and added categories have been reported, and their analysis may assist future document updates.Implications for rehabilitationThe use of the International Classification of Functioning, Disability and Health Core Sets for Obstructive Pulmonary Diseases is relevant to guide patient assessment, treatment and monitoring.The concepts related to the Body functions and Environmental factors were the most relevant according to the perspective of adults with asthma.The Comprehensive and Brief International Classification of Functioning, Disability and Health Core Sets for Obstructive Pulmonary Diseases were supported by adults with asthma.

Background: Chronic obstructive pulmonary disease (COPD) leads to peripheral and respiratory muscle dysfunctions. Nowadays, inspiratory muscle training can be geared toward strength or endurance gains. This study aims to investigate the effects of an inspiratory muscle training (IMT) protocol using different therapeutic modalities to be implemented in pulmonary rehabilitation programs. The effects of IMT on exercise capacity were considered as the primary endpoint, and the effects of IMT on inspiratory muscle function, health-related quality of life, and daily physical activity level were considered as the secondary outcomes., Methods: This study is a blinded-investigator randomized controlled clinical trial. Sixty subjects will be randomly allocated into three groups: (1) pulmonary rehabilitation (PR) associated with inspiratory muscle training without any load (PRWIMT), (2) PR associated with inspiratory muscle training with a linear load (PRIMTLL), and (3) PR associated with inspiratory muscle training with isocapnic voluntary hyperpnea (PRIMTIVH). The protocol will be performed 5 days a week (3 days with supervision) for 10 weeks. The study will assess anthropometric data, lung function, respiratory muscle strength, and functional capacity by the Incremental Shuttle Walking Test and the Six-Minute Walk Test, lung volumes during the submaximal endurance test, peripheral muscle strength of the upper and lower limbs, dyspnea, and quality of life related to health, before and after the training protocol. Normality will be tested using the Kolmogorov-Smirnov test, and variables will be compared by two-way analysis of variance. The significance level was set at p < 0.05. Ethics approval was obtained from the Institutional Ethics Committee in Research (1.663.411). The study results will be disseminated through presentation at specific scientific conferences and publication in peer-reviewed journals., Discussion: The different IMT protocols used in our study will be able to guide respiratory therapists to understand and to include in conventional PR programs the most effective respiratory muscle training type in subjects with COPD., Trial Registration: Brazilian Clinical Trials Registry, RBR-94v6kd . Registered on 11 March 2017.

Aim: To assess thoracoabdominal asynchrony (TAA) and the presence of paradoxical motion in middle stage amyotrophic lateral sclerosis (ALS) and its relationships with chest wall tidal volume (V T,CW ), breathing pattern and cough peak flow (CPF)., Methods: Phase angle (θ) between upper (RCp) and lower ribcage (RCa) and abdomen (AB), as well as percentage of inspiratory time for the lower ribcage (IP RCa ) and abdomen (IP AB ) moving in opposite directions were quantified using optoelectronic plethysmography in 12 ALS patients during quiet breathing and coughing. Paradoxical motion of the compartments was based on threshold values of θ and IP, obtained in twelve age and sex matched healthy persons., Results: During quiet breathing, significantly higher RCa and AB θ (p < .05), IP RCa (p = 0.001) and IP AB (p < 0.05) were observed in ALS patients as compared to controls. In ALS patients, correlations between RCa and AB θ with forced vital capacity (FVC) (r=-0.773, p < 0.01), vital capacity (r=-0.663, p < 0.05) and inspiratory capacity (IC) (r=-0.754, p < 0.01), as well as between RCp and RCa θ with FVC (r=-0.608, p < 0.05) and CPF (r=-0.601, p < 0.05) were found. During coughing, correlations between RCp and AB θ with CPF (r=-0.590, p < 0.05), IC (r=-0.748, p < 0.01) and V T,CW (r=-0.608, p < 0.05), as well as between RCa and AB θ with CPF (r=-0.670, p < 0.05), IC (r=-0.713, p < 0.05) and peak expiratory flow (r=-0.727, p < 0.05) were also observed in ALS patients. ALS patients with paradoxical motion presented lower vital capacity and FVC %pred (p < 0.05) compared to those without paradoxical motion., Conclusions: Middle stage ALS patients exhibit TAA and paradoxical motion during quiet spontaneous breathing and coughing. In addition, diaphragmatic weakness (i.e. decrease in excursion of the RCa and AB compartments) was observed earlier in the lower ribcage rather than the abdominal compartment in this population., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Some inspiratory muscle training protocols for patients with heart failure report the request of diaphragmatic breathing during inspiratory loaded breathing. However, it is unclear whether this condition modifies the chest wall volumes., Objective: The primary purpose was to evaluate chest wall volumes during inspiratory loaded breathing as well as during inspiratory loaded breathing associated with diaphragmatic breathing in patients with heart failure., Methods: Sixteen men with heart failure functional class I to III, aged 50(SD=7) years were evaluated. Volumes of the pulmonary rib cage, abdominal rib cage and abdomen, as well as other breathing pattern variables, were assessed by optoelectronic plethysmography during quiet breathing, inspiratory loaded breathing, and inspiratory loaded breathing associated with diaphragmatic breathing., Results: Chest wall tidal volume significantly increased from quiet breathing 0.53(SD=0.14)L to inspiratory loaded breathing 1.33(SD=0.48)L and to inspiratory loaded breathing associated with diaphragmatic breathing 1.36(SD=0.48)L. A significant volume variation was observed on the three compartments (p<0.05 for all). During inspiratory loaded breathing associated with diaphragmatic breathing, patients showed increased abdominal volume compared to quiet breathing [0.28(SD=0.05) to 0.83(SD=0.47)L, p<0.001]; as well as from inspiratory loaded breathing [0.63(SD=0.23) to 0.83(SD=0.47)L, p=0.044]. No significant changes were observed between the two inspiratory loaded breathing conditions on the percentages of the contribution of each chest wall compartment for the tidal volume, respiratory rate, minute ventilation, and duty cycle., Conclusion: When inspiratory loaded breathing was associated with diaphragmatic breathing, a higher volume in the abdominal compartment was obtained without significant changes in other breathing pattern variables., (Copyright © 2018 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Silk fibroin (SF) and konjac glucomannan (KGM) are promising materials in the biomedical field due to their low toxicity, biocompatibility, biodegradability and low immune response. Beads of these natural polymers are interesting scaffolds for biomedical applications, but their fabrication is a challenge due to their low stability and the necessary adaptation of their chemical and mechanical properties to be successfully applied. In that sense, this study aimed to synthesize a blend of silk fibroin and konjac glucomannan (SF/KGM) in the form of porous beads obtained through dripping into liquid nitrogen, with a post-treatment using ethanol. Intermolecular hydrogen bonds promoted the integration of SF and KGM. Treated beads showed higher porous size, crystallinity, and stability than untreated beads. Characterization analyses by Fourier-transform infrared spectroscopy (FTIR), thermogravimetric (TGA), and X-ray diffraction (XDR) evidenced that ethanol treatment allows a conformational transition from silk I to silk II in SF and an increase in the KGM deacetylation. Those chemical changes significantly enhanced the mechanical resistance of SF/KGM beads in comparison to pure SF and KGM beads. Moreover, samples showed cytocompatibility with HaCaT and BALB/c 3T3 cells.

Nadolol is a blocking agent with activity in β-adrenergic receptors. The objective of this research was to develop and validate an HPLC and circular dichroism method for the quantification of four nadolol stereoisomers in capsules. The HPLC method was validated using a Chiralcel OD column (250 × 4,6 mm, 10 μm). The mobile phase consisted of hexane-ethanol-diethylamine-acetic acid (86 + 14 + 0.3 + 0.3, v/v/v/v), with a flow rate of 0.7 mL/min and temperature of 25 ± 1°C and UV detection carried out at 220 nm. Solutions were prepared in ethanol containing 200 μg/mL nadolol. The method proved to be precise, selective, accurate, and robust and was successfully applied for the determination of the two homologs of four nadolol stereoisomers in capsules.

Objectives: The aim of this systematic review of randomised controlled trials (RCTs), and quasi-experimental and retrospective studies is to investigate the effects of pulmonary rehabilitation (PR) in patients with advanced chronic disease on the waiting list for lung transplantation., Setting: PR performed for inpatient or outpatient lung transplant candidates., Intervention: PR programme including aerobic exercise training and/or resistance exercise training., Primary and Secondary Outcomes: Quality of life and exercise capacity (primary outcomes). Survival rate after transplant surgery; pulmonary function; respiratory muscle strength; psychological aspects; upper and lower extremity muscle strength and adverse effects (secondary outcomes). Two review authors independently selected the studies, assessed study quality and extracted data. Studies in any language were included., Results: This was a systematic review and studies were searched on the Cochrane Library, MEDLINE, EMBASE, CINAHL and PEDro. Experimental and retrospective studies evaluating the effects of PR in candidates for lung transplantation (>18 years old) with any lung diseases were included. 2 RCTs, and two quasi-experimental and two retrospectives studies, involving 1305 participants were included in the review. 5 studies included an enhancement reported in quality of life using the Short Form 36 questionnaire and showed improvements in some domains. All studies included exercise capacity evaluated through 6 min walk test and in five of them, there were improvements in this outcome after PR. Owing to the different characteristics of the studies, it was not possible to perform a meta-analysis., Conclusions: Studies included in this review showed that PR is an effective treatment option for patients on the waiting list for lung transplantation and can improve quality of life and exercise capacity in those patients. Although individual studies reported positive effects of PR, this review shows that there is a need for more studies of a high methodological quality addressing PR effects in lung transplant candidates., Trial Registration Number: PROSPERO CDR42015025110., Competing Interests: Competing interests: None declared., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Antimicrobial photodynamic therapy (aPDT) was introduced as a promising adjuvant therapy on the periodontal treatment. The aim of this study was to evaluate the effect of aPDT on inflammatory mediator levels in residual periodontal pockets of patients with severe chronic periodontitis under periodontal maintenance, during 12 months follow-up. A randomized controlled trial study was conducted in 28 patients with severe chronic periodontitis. After non-surgical periodontal treatment, patients with at least four teeth with residual pocket probing depth (PPD) ≥4 mm were randomly assigned to either aPDT or control group. The aPDT (low power laser: 660 nm, 40 mW, 90 J/cm 2 , methylene blue 0.01 %) was performed at baseline and 3, 6, and 9 months. Clinical parameters were collected before and 3 and 12 months after the intervention, and gingival crevicular fluid was collected in the same times, including 1 week after the intervention. Immunological evaluation was carried out using the Luminex assay which quantified the expression of ten cytokines: interleukin (IL)-1α, IL-1β, IL-8, IL-1ra, fibroblast growth factor (FGF), vascular endothelial growth factor (VEGF), interferon (IFN)-γ, tumor necrosis factor (TNF)-α, IL-4, and IL-10. All clinical variables showed significant improvement for both groups, but there was no statistical difference between groups with no clinical benefits. IL-1α, IL-1β, IL-8, and VEGF showed significant differences (p < 0.05) between groups, whereas IL-1ra mediators, IFN-γ, and IL-10 demonstrated a statistical difference (p < 0.01) over time in the same group. At any time, FGF, IL-4, and TNF-α showed no statistical difference between groups (p > 0.05). aPDT therapy can improve the benefits on inflammation control during the periodontal maintenance.

Objective: To generate prediction equations for spirometry in 4- to 6-year-old children., Methods: Forced vital capacity, forced expiratory volume in 0.5s, forced expiratory volume in one second, peak expiratory flow, and forced expiratory flow at 25-75% of the forced vital capacity were assessed in 195 healthy children residing in the town of Sete Lagoas, state of Minas Gerais, Southeastern Brazil. The least mean squares method was used to derive the prediction equations. The level of significance was established as p<0.05., Results: Overall, 85% of the children succeeded in performing the spirometric maneuvers. In the prediction equation, height was the single predictor of the spirometric variables as follows: forced vital capacity=exponential [(-2.255)+(0.022×height)], forced expiratory volume in 0.5s=exponential [(-2.288)+(0.019×height)], forced expiratory volume in one second=exponential [(-2.767)+(0.026×height)], peak expiratory flow=exponential [(-2.908)+(0.019×height)], and forced expiratory flow at 25-75% of the forced vital capacity=exponential [(-1.404)+(0.016×height)]. Neither age nor weight influenced the regression equations. No significant differences in the predicted values for boys and girls were observed., Conclusion: The predicted values obtained in the present study are comparable to those reported for preschoolers from both Brazil and other countries., (Copyright © 2016 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)

Cervical cancer is the fourth most common cancer among women, and ∼70-80% of these cancers are associated with two human papillomavirus types: HPV16 and HPV18. Several studies have reported that intra-type diversity is associated with the progression of infection to invasive cancer. Herein, we report the genetic diversity of HPV16 and HPV18 in a cohort of 594 Brazilian women with invasive cervical cancer and describe the prevalence of lineages and intra-type diversity prior to the implementation of the public immunization program in Brazil. HPV detection and genotyping were performed using PCR, PGMY/GP primers, and DNA extracted from fresh tumors. The HPV16 (378 women) and HPV18 (80 women) lineages were identified by PCR and sequencing of the LCR and E6 fragments, followed by SNV comparison and phylogenetic analysis. In our cohort, was found a higher frequency of the lineage A (in 217 women), followed by lineage D (in 97 women) and lineages B and C (in 10 women each) for HPV16; and a higher frequency of lineage A (in 56 women) followed by lineage B (in 15 women) in HPV18. The genetic diversity of HPV16 indicated a recent expansion of specific variants or a selective advantage that is associated with invasive cancer; this pattern was not observed for HPV18., (© 2016 Wiley Periodicals, Inc.)

Background: The relationship between diabetes mellitus (DM) and periodontal disease is bidirectional. DM is a predisposing and modifying factor of periodontitis, which, in turn, worsens glycemic control and increases proteins found in the acute phase of inflammation, such as C-reactive protein. The gold standard for the treatment of periodontal disease is oral hygiene orientation, scaling and planing. Moreover, systemic antibiotic therapy may be employed in some cases. In an effort to minimize the prescription of antibiotics, photodynamic therapy (PDT) has been studied as an antimicrobial technique and has demonstrated promising results. The aim of the proposed study is to determine whether PDT as a complement to periodontal therapy (PT) is helpful in the metabolic control of individuals with type 2 diabetes and the reduction of acute-phase inflammatory markers., Methods/design: The patients will be randomized using a proper software program into two groups: 1) PT + placebo PDT or 2) PT + active PDT. All patients will first be examined by a specialist, followed by PT performed by two other healthcare professionals. At the end of each session, PDT (active or placebo) will be administered by a fourth healthcare professional. The following will be the PDT parameters: diode laser (660 nm); power output = 110 mW; exposure time = 90 s per point (9 J/point); and energy density = 22 J/cm(2). The photosensitizer will be methylene blue (50 μg/mL). The patients will be re-evaluated 15, 30, 90 and 180 days after treatment. Serological examinations with complete blood count, fasting glucose, glycated hemoglobin and salivary examinations to screen for tumor necrosis factor alpha, interleukin 1, interleukin 6, ostelocalcin, and osteoprotegerin/RANKL will be performed at each evaluation. The data will be statistically evaluated using the most appropriate tests., Discussion: The results of this study will determine the efficacy of photodynamic therapy as an adjuvant to periodontal treatment in diabetic patients., Trial Registration: The protocol for this trial was registered with Clinical Trials registration number NCT01964833 on 14 October 2013.

Background: In addition to symptoms, such as dyspnea and fatigue, patients with chronic obstructive pulmonary disease (COPD) also experience mood disturbances., Objective: To explore the relationships between health-related quality of life measures collected from patients with stable COPD and a commonly used measure of depression and anxiety., Methods: The present analysis was a retrospective study of patients with COPD enrolled in a pulmonary rehabilitation program. Hospital Anxiety and Depression Scale (HADS), Chronic Respiratory Disease Questionnaire (CRQ), Medical Research Council dyspnea scale and 6 min walk test data were collected. Statistical analyses were performed using Spearman's correlations, and categorical regression and categorical principal component analysis were interpreted using the biplot methodology., Results: HADS anxiety scores retrieved from 80 patients were grouped as 'no anxiety' (n=43 [54%]), 'probable anxiety' (n=21 [26%]) and 'presence of anxiety' (n=16 [20%]). HADS depression scores were similarly grouped. There was a moderate relationship between the anxiety subscale of the HADS and both the emotional function (r=-0.519; P<0.01) and mastery (r=-0.553; P<0.01) domains of the CRQ. Categorical regression showed that the CRQ-mastery domain explained 40% of the total variation in anxiety. A principal component analysis biplot showed that the highest distance between the groups was along the mastery domain, which separated patients without feelings of anxiety from those with anxiety. However, none of the CRQ domains were able to discriminate the three depression groups., Conclusions: The CRQ-mastery domain may identify symptoms of anxiety in patients with COPD; however, the relationship is not strong enough to use the CRQ-mastery domain as a surrogate measure. None of the CRQ domains were able to discriminate the three depression groups (no depression, probable and presence); therefore, specific, validated tools to identify symptoms of depression should be used.

In this work, a device based on diffusive gradients in thin films (DGT) was evaluated for the determination of Hg(II) in river water. The DGT device was assembled with a cellulose phosphate ion exchange membrane (P81 Whatman) as a binding phase and agarose gel 1.5% (m/v) as a diffusive layer. Laboratory deployments showed that the binding of Hg(2+) ([Hg(DGT)]/[Hg(solution)]) by P81 membrane was more effective (97%) than the Chelex 100 resin (80%).The effect of ionic strength, pH and potential interfering ions on Hg binding with DGT׳s was investigated. The results showed no significant effect on the binding of Hg(II) at pH range from 3.5 to 8.5 and at an ionic strength range from 0.0005 to 0.1 mol L(-1). Uptakes of 50 µg L(-1) Hg(II) by P81 membrane were not affected by Fe, Mn, Zn, Cu, Ca and Mg at the concentration range of 200-1800 µg L(-1). Finally, the DGT device using the P81 as the binding layer was applied for in situ measurements of Hg in river water. For in situ measurements, the labile Hg concentration (from <2 to 13 ng L(-1)) was lower than 10% of the dissolved fraction (from 155 to 446 ng L(-1))., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Chest wall volumes and breathing patterns of 13 male COPD patients were evaluated at rest and during inspiratory loaded breathing (ILB). The sternocleidomastoid (SMM) and abdominal muscle activity was also evaluated. The main compartment responsible for the tidal volume at rest and during ILB was the abdomen. During ILB patients exhibited, in addition to increases in the ratio of inspiratory time to total time of the respiratory cycle and minute ventilation, increases (p<0.05) in the chest wall tidal volume by an increase in abdomen tidal volume as a result of improvement of end chest wall inspiratory volume without changing on end chest wall expiratory volume. The SMM and abdominal muscle activity increased 63.84% and 1.94% during ILB. Overall, to overcome the load imposed by ILB, COPD patients improve the tidal volume by changing the inspiratory chest wall volume without modifying the predominant mobility of the abdomen at rest and without affecting the end chest wall expiratory volume., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Objective: To investigate the maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) in patients with Parkinson's disease (PD) during the on and off periods of levodopa and to compare with healthy controls., Methods: Twenty-six patients were analyzed with Hoehn and Yahr scores (2-3) and 26 age and gender matched-controls. Statistical analysis was performed with Student's t-test for paired and independent samples., Results: MIP and MEP values in patients were significantly lower than the values obtained in controls both for off and on stages -excepted for MIP in women (p=0.28). For patients with PD, the studied parameters did not differ between stages on and off, with the exception of MEP in women (p=0.00)., Conclusions: Patients with PD have respiratory pressure lower than controls, even in early stages of the disease, and dopamine replacement has little impact over these respiratory pressures. These findings suggest that respiratory changes in PD may be unrelated to dopaminergic dysfunction.

A polyacrylamide hydrogel containing the Chelex-100 resin has traditionally been used as the binding agent for the diffusion gradients in thin films (DGT) technique. The Chelex-100 resin, although important for the determination of various transition metals, is unsatisfactory for the determination of alkaline earth metals, particularly Ba. In this paper, a cellulose membrane, treated with phosphate (P81 membrane), was evaluated as a binding agent for DGT devices for the determination of Ba in produced formation water (PFW) samples. In addition, diffusive layers of filter paper (cellulose) were tested to diffuse Ba through the DGT devices. Experiments to evaluate the key variables of the technique (pH, deployment time, and ionic strength/salinity) were performed. The Ba sampled by these DGT devices was measured using inductively coupled plasma optical emission spectrometry. Aiming to generate information (related to bioavailability of Ba) on the reuse of PFW for irrigation, the determination of Ba in onshore and offshore samples was performed. The new approach was effective for determination of Ba in onshore samples. To determine Ba in offshore samples, it was necessary to use an alternative calibration procedure due to the high NaCl concentration in these samples., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Background: Second primary tumors and recurrences are an important problem in patients with head and neck squamous cell carcinoma. The purpose of this study was to determine the genetic changes in tumor samples to improve knowledge of tumor progression., Methods: Copy number changes of 37 genes were analyzed by multiplex ligation-dependent probe amplification (MLPA) in 36 primary tumors and their corresponding 21 second primary tumors and 15 recurrences., Results: CCND1 and EMS1 amplifications and gain of BCL2L1 were the most common genetic alterations in the primary tumor, second primary tumor, and recurrence samples. Gains of ERBB2 and PTPN1 were associated with recurrences., Conclusion: Specific genetic profiles for each group have been found. Similarities between primary tumor and second primary tumor and dissimilarity between primary tumor and recurrence suggest that clinicopathological criteria do not always accurately differentiate these entities. Genetic profiling may aid in the diagnosis and prognosis of these difficult cases., (Copyright © 2011 Wiley Periodicals, Inc.)

The aim of this study is to compare the response of interleukin-6 (IL-6) and soluble tumor necrosis factor alpha receptor 1 (s-TNFr1) to two submaximal intensities of exercise in individuals with heart failure (HF). Thirty-two HF individuals aged 45.53 ± 9.41 years, classes II and III of the New York Heart Association (NYHA) classification underwent two sessions of exercise at low and moderate intensities with blood analysis at baseline, exercise and after exercise. The differences were evaluated by Friedman test and factorial ANOVA. Alpha = 5% was considered. No difference in IL-6 was detected for low intensity. At moderate intensity, there was a significant increase after exercise. The s-TNFr1 increased in moderate-intensity exercise and went back to baseline levels after it. A session of moderate-intensity exercise is better than low-intensity exercise at promoting positive immediate inflammatory responses in individuals with HF class II and III of the NYHA.

Were evaluated individuals divided into two groups: we studied chronic heart failure (CHF) (19 patients with CHF plus cardiomegaly) and control (12 healthy volunteers) during performance of inspiratory loaded breathing (ILB). We evaluated: spirometry, functional capacity through the six-minute walk test (6MWT), and distribution of thoracoabdominal volumes via optoelectronic plethysmography (OEP), namely volume variations of pulmonary rib cage (Vrc,p), abdominal rib cage (Vrc,a), and abdomen (Vab). In each compartment, the percentage contributions of right and left sides were also calculated. During ILB, patients with heart failure were characterized by a significant reduction of the Vrc,a volume variations compared to the control group. Correlations were found between left %Vrc,a on the left side measured during ILB and left ventricular ejection fraction (r=0.468; p=0.049), and dyspnea after the 6MWT (r=-0.878; p<0.01).Then, patients with CHF and cardiomegaly are characterized by a reduced mobility in left part of the lower part of the rib cage, that contributes leading to increased perception of dyspnea during submaximal exercise., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Background: The measurement of maximal respiratory pressure (MRP) is a procedure widely used in clinical practice to evaluate respiratory muscle strength through the maximal inspiratory pressure (P(Imax)) and maximal expiratory pressure (P(Emax)). Its clinical applications include diagnostic procedures and evaluating responses to interventions. However, there is great variability in the equipment and measurement procedures. Understanding the impacts of the characteristics of different interfaces can augment the repeatability of this method and help to establish widely applicable predictive equations. The aim of this study was to evaluate the influence of 4 different interfaces on a subject's capacity to generate MRP and the impact of these interfaces on the repeatability of these measurements., Methods: Fifty healthy subjects (mean ± SD age 26.36 ± 4.89 y) with normal spirometry were evaluated. MRP was measured by a digital manometer connected to 4 interfaces using different combinations of mouthpieces and tubes. The following variables were analyzed: maximum mean pressure, peak pressure, plateau pressure, and plateau variation. Analysis of variance for repeated measures or a Friedman test was used to compare the 4 interfaces, with P < .008 after Bonferroni adjustment considered significant., Results: There was no significant difference between the 4 interfaces with respect to maximum mean pressure, peak pressure, plateau pressure, or plateau variation for P(Imax) (P ≥ .49) or P(Emax) (P ≥ .11), nor did the number of tests performed to fulfill the criteria of repeatability for P(Imax) (P = .69) or P(Emax) (P = .47) differ among the 4 interfaces., Conclusions: P(Imax) and P(Emax) values seem not to be influenced by the different interfaces studied, suggesting that patient comfort and availability of interfaces can be considered.

Background: Slow expiration with glottis opened in lateral posture (ELTGOL, l'expiration lente totale glotte ouverte en infralatéral) has been used in clinical practice to improve mucus clearance from peripheral airways. The purpose of this crossover study was to evaluate the effect of ELTGOL on mucus clearance of right and left lungs, especially of peripheral lung areas, in stable patients with chronic bronchitis., Methods: Twelve 45-75-year-old patients with chronic bronchitis were studied (10 of whom had mild to moderate COPD according to the Global Initiative for Chronic Obstructive Lung Disease guidelines). Control and ELTGOL interventions were performed on a randomized allocation of subjects. Mucus clearance was measured through 6 posterior scintigraphy images taken with the patient in the right lateral decubitus position 20 (T1), 40 (T2), 60 (T3), 80 (T4), and 120 (T5) min after baseline image (T0). In the control intervention only ventilatory scintigraphy measurements were performed. During ELTGOL the technique was performed after the baseline image (T0)., Results: Significant increases in mucus clearance from the peripheral area were found only in the right lung, and were observed at all times during ELTGOL (P < .05) except T1. Significant increases in mucus clearance were observed at all times studied in the total area of the right lung and in the left lung at T1 and T2. For the intermediate area and central areas, results were similar in both lungs., Conclusions: ELTGOL was efficient in increasing peripheral airway clearance in dependent lung of patients with chronic bronchitis, most of them with mild to moderate COPD.

This study was performed with the objective of understanding the reasons why workers of a birthing center in southern Brazil use natural birth practices considered harmful by the World Health Organization. This exploratory study was performed in July 2009 through interviews with 23 workers. The analysis revealed three themes: Actions and behaviors dependent on health workers; Routine practices as facilitators of work; and Restricting the parturients' participation in the decision-making process. Some justifications for using the practices were: perpetuation of inappropriate models, facilitation of the care provided during delivery and authoritarianism that some workers impose over parturients in the erroneous belief that workers have all the knowledge.

Aim: The aim of this 12-month prospective study was to assess the adjunctive effect of smoking cessation in non-surgical periodontal therapy of subjects with severe chronic periodontitis., Materials and Methods: Of the 201 subjects enrolled from a smoking cessation clinic, 93 were eligible and received non-surgical periodontal treatment and concurrent smoking cessation treatment. Periodontal maintenance was performed every 3 months. Full-mouth periodontal examination in six sites per tooth was performed by a calibrated examiner, blinded to smoking status, at baseline, 3, 6 and 12 months after non-surgical periodontal treatment. Furthermore, expired air carbon monoxide concentration measurements and interviews based on a structured questionnaire were performed in order to collect demographic and smoking data., Results: Of the 93 eligible subjects, 52 remained in the study after 1 year. Of these, 17 quit smoking and 35 continued smoking or oscillated. After 1 year, only quitters presented significant clinical attachment gain (p=0.04). However, there were no differences between the groups regarding clinical attachment level, probing depth, bleeding on probing and plaque index after 1 year (p>0.05)., Conclusion: Smoking cessation promoted clinical attachment gain in chronic periodontitis subjects from a smoking cessation clinic after 1 year of follow-up., (© 2011 John Wiley & Sons A/S.)

Ovarian carcinoma is one of the most aggressive gynecological diseases and generally diagnosed at advanced stages. Osteopontin (OPN) is one of the proteins overexpressed in ovarian cancer and is involved in tumorigenesis and metastasis. Alternative splicing of OPN leads to 3 isoforms, OPNa, OPNb, and OPNc. However, the expression pattern and the roles of each of these isoforms have not been previously characterized in ovarian cancer. Herein, we have evaluated the expression profiling of OPN isoforms in ovarian tumor and nontumor samples and their putative roles in ovarian cancer biology using in vitro and in vivo functional assays. OPNa and OPNb were expressed both in tumor and nontumor ovarian samples, whereas OPNc was specifically expressed in ovarian tumor samples. The isoform OPNc significantly activated OvCar-3 cell proliferation, migration, invasion, anchorage-independent growth and tumor formation in vivo. Additionally, we have also shown that some of the OPNc-dependent protumorigenic roles are mediated by PI3K/Akt signaling pathway. OPNc stimulated immortalized ovarian epithelial IOSE cell proliferation, indicating a role for this isoform in ovarian cancer tumorigenesis. Functional assays using OPNc conditioned medium and an anti-OPNc antibody have shown that most cellular effects observed herein were promoted by the secreted OPNc. According to our data, OPNc-specific expression in ovarian tumor samples and its role on favoring different aspects of ovarian cancer progression suggest that secreted OPNc contributes to the physiopathology of ovarian cancer progression and tumorigenesis. Altogether, the data open possibilities of new therapeutic approaches for ovarian cancer that selectively down regulate OPNc, altering its properties favoring ovarian tumor progression.

Objective: To compare the results of 6-month follow-ups for hospitalized patients who were divided into two groups of low- and high-intensity treatments for smoking cessation and compared to the results of standard hospital treatment., Methods: A total of 2414 patients were screened. Two hundred thirty-seven current smokers were randomly assigned to high-intensity intervention (HII; 30-min motivational interview plus seven routine telephone calls after hospital discharge) or to low-intensity intervention (LII; 15-min counseling about the benefits of quitting) and 80 comprised the usual care (UC) group. Six months after hospital discharge, all participants were contacted by phone. The main outcome measure was smoking cessation., Results: The smoking-cessation rates were 44.9%, 41.7% and 26.3% for the HII, LII and UC groups, respectively (P = .03). The multivariable analysis identified the following variables which are associated with the failure to stop smoking: the absence of a tobacco-related disease (TRD), younger age and a low motivation for cessation at the initial contact., Conclusions: There was a great difference between intervention and nonintervention. The LII had an impact similar to the HII. The variables associated with no smoking cessation demonstrate the need for more personalized interventions for smokers who present lower indexes of motivation, are younger and do not have smoking-related diseases., (Copyright © 2010 Elsevier Inc. All rights reserved.)