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Bronchiectasis patients may present a reduced functional capacity due to an increase in the ventilatory demand during exercise.To evaluate the effects of controlled voluntary hyperinflation and increased respiratory rate on the mechanics of the respiratory system, simulating what happens during exercise, in bronchiectasis and healthy subjects.Bronchiectasis (n=30) and healthy (n=16) subjects were evaluated by impulse oscillometry (IOS) during a baseline condition, and in controlled conditions with baseline (b) tidal volume (V) and hyperinflation (H), with respiratory rates at 30(R30) and 40(R40) bpm, in a random order. The mixed effects and a significance level at 0.05 were used for comparisons.Resistance at 5Hz (R5), and at minus 20Hz (R5-R20), in kPa/L/s, were higher in subjects with bronchiectasis in all experimental conditions (p0.05). For the bronchiectasis group, R5 and R5-20 increased with R increase at V (VRb versus VR30 and VR40; VR30 versus VR40; R5, R20 and R5-20 increased with R increase at H (HRb versus HR40; HR30 versus HR40). For the same R, there was a decrease with H compared to V (HRb versus VR30 and VR40; and HR30 versus VR30 and VR40). For the healthy group, only R20 showed differences (HR30 versus HR40; HR40 versus VR40).The tachypnea increases the resistance and reactance of the respiratory system in bronchiectasis patients, and the voluntary hyperinflation caused attenuates this increase. These results can guide the development of strategies to reduce the limitation of physical activity in patients with bronchiectasis.

Introdução: Bronquiectasias são caracterizadas pela dilatação anormal, permanente e irreversível dos brônquios. A tosse com produção exacerbada de secreção é o principal sintoma. Os pacientes podem se beneficiar de técnicas de fisioterapia específicas para remoção de secreções, bem como de exercícios, no entanto, poucos estudos descrevem os mecanismos envolvidos nos efeitos benéficos associados a esta intervenção. Objetivo: Avaliar os efeitos do exercício sobre o transporte de secreções, inflamação e resistência do sistema respiratório, sistema nervoso autônomo e suas repercussões sobre a qualidade de vida em pacientes com bronquiectasias. Métodos: Trata-se de um RCT em que voluntários com bronquiectasias (BCQ: n=12) e saudáveis (SAU: n=9) participaram de um Programa de reabilitação Pulmonar (PRP). Foram realizadas avaliação da função pulmonar; tempo de transporte da sacarina (TTS); fração exalada de óxido nítrico (FENO); teste cardiopulmonar (CPET); teste de caminhada de seis minutos (TC6); teste das pressões respiratórias máximas; variabilidade da frequência cardíaca (VFC) e qualidade de vida (QV). Resultados: A comparação inicial entre os grupos BCQ e SAU mostrou diferença entre todas as variáveis analisadas na espirometria; no IOS entre as variáveis R5-R20, FRES e AX, p

Background Non-cystic fibrosis bronchiectasis (NCFB) is a heterogeneous disease, which assessment and severity can’t be defined by one particular instrument but using a multidimensional score. Thus, in additional to traditional methods, alternative tools have been developed to assist these patients’ evaluation. Objective To correlate functional and morphological indexes with severity and dyspnea in NCFB patients, focusing on the correlation between the impulse oscillometry system (IOS) and the quantitative analysis of computed tomography (CT). Methods Clinically stable NCFB patients, between 18 and 80 years old were submitted to clinical, functional and morphological evaluations assessed by Bronchiectasis Severity Index (BSI) and Medical Research Council (MRC) scale; spirometry and IOS; and subjective and quantitative Chest CT scans analysis, respectively. Results This study included 38 patients. The best correlations obtained between functional and morphological airway indexes were: resistance at 5 Hz—R5 and the normalized thickness of bronchial walls—Pi10 (r = 0.57), and the mean forced expiratory flow (FEF25-75%) and CT score (r = -0.39). BSI as well as MRC showed higher correlations with the quantitative automated analysis of CT (BSI and Pi10: r = 0.41; MRC and Pi10: r = 0.35) than with subjective CT score (BSI and CT score: r = 0.41; MRC and CT score: r = 0.15); and moderate and weak correlations were obtained on both functional airway indexes (BSI and peripheral airways resistance - R5-R20: r = 0.53; BSI and forced expiratory volume at the first second—FEV1: R = -0,64; MRC and R5-R20: r = 0.42; and MRC and VEF1: r = -0.45). Conclusion In NCFB patients, compartmentalized methods for assessing the respiratory system (IOS and the automated quantitative CT analysis) have a good correlation with severity and dyspnea.

BACKGROUND: Bronchiectasis is characterized by abnormal and permanent dilatation of the bronchi, caused mainly by the progression of inflammatory processes and loss of the ability to remove mucus. Techniques to clear the airways are essential for the treatment of these patients. In this study, we aimed to evaluate the acute effects of oscillatory PEP and thoracic compression on both the clearance of secretions and impedance of airways in subjects with bronchiectasis. METHODS: This was a randomized crossover single-blinded study that involved both subjects with bronchiectasis and healthy subjects evaluated by using an impulse oscillometry system, which assessed resistance at 5 Hz and resistance 20 Hz, reactance at 5 Hz, reactance area, and resonant frequency, before, after, and 30 min after oscillatory PEP, chest compression, or control sessions. Dry and total weights, adhesiveness, purulence of the expectorated secretions, the dyspnea scale score, the acceptability and tolerance scale score, pulse oximetry, and difficulty in expectoration were also assessed. RESULTS: The dry and total weights of secretions were higher after the use of the oscillatory PEP technique than those in a control session (P = .005 and P = .039, respectively). In the bronchiectasis group, there was a decrease after oscillatory PEP in total airway resistance (P = .04), peripheral resistance (P = .005), and reactance area (P = .001). After compression, there was a decrease in peripheral resistance Hz (P = .001) and reactance area (P = .001). In the healthy group, there was an increase in resistance at 5 Hz (P = .02) after oscillatory PEP. There were no differences in acceptability and tolerance, dyspnea, and oxygen saturation. CONCLUSIONS: The oscillatory PEP technique was effective for the removal of secretions and in decreasing total and peripheral respiratory system resistance; thoracic compression had comparable positive effects on the peripheral resistance. Both techniques were safe and well tolerated by the subjects with bronchiectasis. ClinicalTrials.gov registration NCT02509637.)

Impulse oscillometry (IOS) allows evaluation of the compartmentalized resistance and reactance of the respiratory system, distinguishing central and peripheral obstruction. The IOS measurements are getting attention in the diagnosis and differentiation of chronic respiratory diseases. However, no data are available in the literature to differentiate between COPD and BE using IOS parameters. We aimed to evaluate the feasibility of IOS in the diagnosis of bronchiectasis non-cystic fibrosis (BE) in comparison to COPD. Whole breath, inspiration, expiration, and inspiratory-expiratory difference (Δ) were evaluated based on the IOS parameters: total resistance (R5), central airway resistance (R20), peripheral airway resistance (R5-R20), reactance (X5), reactance area (AX), and resonance frequency (Fres). Fifty-nine subjects (21 Healthy, 19 BE, and 19 COPD) participated in this study. It was observed a significant difference in the comparison of healthy and pulmonary disease groups (BE and COPD) for total breathing (R5-R20, X5, AX, and Fres), inspiratory phase (R5 and R5-R5), and expiratory phase (R5-R20 and X5). The comparison between BE and COPD groups showed significant difference in the expiratory phase for resistance at 5 and 20 Hz and, ΔR5 and ΔR20. The IOS evidenced an increase of R5, R20 and R5-R20 in patients with BE and COPD when compared to healthy subjects. Expiratory measures of IOS revealed increased airway resistance in COPD compared to BE patients who had similar FEV1 measured by spirometry, however, further studies are needed to confirm these differences.

BACKGROUND: Impulse oscillometry is a method of airway assessment and diagnosis that provides data on lung mechanics. In the literature, studies have used different types of mouthpieces or did not describe the model used for the tests. We sought to compare the 3 most commonly described mouthpieces in terms of test results, comfort, and subject preference. METHODS: Thirty-nine healthy volunteers were evaluated with spirometry and impulse oscillometry, assessing the resistance at 5 Hz and 20 Hz (R5 and R20, respectively), reactance at 5 Hz (X5), reactance area, and resonant frequency. A filter heat exchanger with a circular mouthpiece (B1), a filter heat exchanger with an oval mouthpiece (B2), and a filter heat exchanger with a circular mouthpiece coupled with a free-flow piece (B3) were compared using an acceptability and tolerance scale, and subjects noted their preference. RESULTS: Statistical analysis showed differences between all the mouthpieces and the predicted values for R5, R20, and X5. The mouthpiece comparison showed differences in R5 between a filter heat exchanger with an oval mouthpiece (B2) and a circular mouthpiece coupled with a free-flow piece (B3) (P = .007); resonant frequency between a filter heat exchanger with a circular mouthpiece (B1) and a filter heat exchanger with an oval mouthpiece (B2) (P = .004) and between a filter heat exchanger with a circular mouthpiece (B1) and a circular mouthpiece coupled with a free-flow piece (B3) (P = .003); and reactance area between a filter heat exchanger with a circular mouthpiece (B1) and a circular mouthpiece coupled with a free-flow piece (B3) (P = .01). In the subjective evaluation, acceptability and tolerance differences were found in the ease of carrying out the evaluation, and no difference was found with regard to the degree of discomfort. Ten subjects preferred a filter heat exchanger with a circular mouthpiece (B1), 15 preferred a filter heat exchanger with an oval mouthpiece (B2), and 14 preferred a circular mouthpiece coupled with a free-flow piece (B3). CONCLUSIONS: A circular mouthpiece coupled with a free-flow piece (B3) appeared to be the most suitable mouthpiece for the impulse oscillometry tests. It assured smaller impedance values for the respiratory system, and subjects expressed the most confidence in using this mouthpiece.

Background: Impulse oscillometry (IOS) allows the early identification changes in lung function when compared to spirometry, and it is possible to obtain parameters of whole-breathe, inspiratory and expiratory phases. Obesity may cause changes in lung volumes and increase in resistance, but the limitation of expiratory flow, which can be identified by the difference in inspiratory-expiratory resistance (ΔRrs), is not described. Aims: To evaluate the ΔRrs of women with grade III obesity and compare it with the values obtained from eutrophic women, both with normal spirometry. Methods: Inspiratory and expiratory resistance parameters were assessed by IOS. Then, it were calculated the inspiratory-expiratory difference to total (ΔR5), central (ΔR20) and peripheral (ΔR5-ΔR20) resistance of the respiratory system. Results: In total, 70 women were included (40 with IMC≥40kg/m2 and 30 with IMC Conclusions: When compared to eutrophic women, grade III obesity women, without spirometry changes and no history of pulmonary diseases, present a limitation to the expiratory flow that can be attributed to the small airways.

Background: To analyze the health-related quality of life (HRQoL) in bronchiectasis, the Quality of Life in Bronchiectasis (QoLB) questionnaire was proposed. HRQoL may be reduced, however, it is not known about the association with the disease severity, evaluated by multidimensional indices, due to the heterogeneity of bronchiectasis. Aims: To evaluate anxiety, depression, and HRQoL in patients with bronchiectasis, using QoLB, and correlate with disease severity. Methods: Twenty-six individuals with non-cystic fibrosis bronchiectasis of both sexes, 56 ± 16 years, were classified by the Bronchiectasis Severity Index (BSI) and answered the Mini-Mental State Examination (MMSE), Hospital Anxiety and Depression Scale (HADS) and QoLB. Results: None of the subjects presented cognitive loss when assessed by MMSE (25.84 ± 2.70) so, they were considered to be able to respond to QoLB. The anxiety and depression rates were 5.6 ± 4.22 and 5.24 ± 3.19, respectively. There was no significant correlations (p> 0.05) between BSI and HADS and between BSI and QoLB domains (physical functioning, role functioning, vitality, emotional functioning, social functioning, treatment burden, health perceptions, and respiratory symptoms). Conclusions: Although both instruments are specific for bronchiectasis, the results suggest that the severity of the disease-related neither with the perception of anxiety and depression, nor with the quality of life assessed by QoLB.

Background: Bronchiectasis (BC) diagnosis is based on clinical findings, high-resolution computed tomography (HRCT), and by pulmonary function tests (PFT) as a complementary evaluation. When compared to spirometry, which is the most common used PFT, Impulse Oscilometry System (IOS) detects early changes in respiratory system both in central and peripheral airways. Objective: To correlate PFT, evaluated by spirometry and by IOS, with the area of the lumen obtained in HRCT in BC subjects. Methods: Thirty eight clinically stable non-cystic fibrosis BC subjects were evaluated by HRCT (area of the lumen measurements in the 3rd and 4th bronchial generations (AL3 and AL4)), spirometry (FVC% and FEV1%), and IOS (R5 and R20: airway resistance at 5 and 20 Hz). Results: AL3 showed significant correlation (p Conclusion: The area of the lumen analysed by the HRCT shows a higher correlation with IOS than with spirometry parameters.

Introduction: Changes on the structures involved in breathing, promoted by the change of posture, can influence the function of the respiratory system. Variations in the volumes related to decubitus have already been evaluated in eutrophic and obese subjects, but not the behavior of impedance of the lung in relation to the changes of decubitus using the Impulse Oscillometry System (IOS). Objective: To evaluate the effect of different positions on the respiratory resistance in normal weight and obese subjects, using the IOS. Methods: After recruitment and allocation of the participants in the group of obese (OG) or eutrophic participants (EG), according to body mass index (BMI), in a random order, the positions were evaluated by IOS – seated (Se), supine (Su), left lateral (LL), or right lateral decubitus (RL). The following parameters was obtained: total resistance (R5), central resistance (R20) and peripheral resistance (R5-R20). Results: 61 volunteers, 34 in OG (age: 35.4 years, BMI: 48.6 kg/cm2) and 27 in EG (age: 27.8 years, BMI: 21.7 kg/cm2). In the comparison between groups, OG showed higher resistance values for all positions and all IOS parameters (p Conclusion: OG presented higher resistance values than EG with minor changes related to the change of posture.

Background: Obesity is a health public problem with comorbidities that can impair the respiratory function. Impulse oscillometry (IOS) has been revealed to be sensitive to detect both central and peripheral airways changes. Objective: To evaluate the respiratory system resistance by IOS and the relation with the six-minute walk test (6MWT) in obese women. Methods: We used IOS as a measure of central and peripheral airways, 6MWT as a submaximal functional capacity measure and the modified Medical Research Council scale (mMRC). Results: We evaluated 37 women with mean age of 36.3±7.9 years and BMI of 47.1±6.3kg/m2. The spirometry results were in the normal range. The IOS detected alterations in the resistance of central and peripheral airways in comparison of predicted values (kPa/L/s) (R5: 0.35±0.01 and 0.55±0.14, R20: 0.29±0.01 and 0.40±0.07, R5-20: 0.06±0.00 and 0.15±0.09, X5: -0.03±0.02 and -0.23±0.09, respectively) (p Conclusions: Obese women with normal spirometry and no dyspnea complaints have central and peripheral airways obstruction when evaluated by IOS. The correlations between R5-20 and X5 with 6MWD suggest that increased resistance of the peripheral airways is related to worsening 6MWD.

A qualidade de vida dentro do ambiente organizacional não tem refletido de forma positiva para as pessoas com deficiência, pois além de suas características comuns, portam outras que as limitam a executar tarefas que são simples para as demais. Nesse sentido, o estudo tem como objetivo geral analisar a qualidade de vida no trabalho das pessoas com deficiência em instituição de ensino privado. A pesquisa tem caráter qualitativo, descritiva e comparativa. Os dados foram coletados por meio de entrevista semiestruturada, participaram da pesquisa três instituições públicas de ensino e uma instituição privada de ensino. Os principais achados foram que nas instituições públicas de ensino não haviam pessoas com deficiência, não podendo assim analisar a qualidade de vida dos mesmos nessas instituições. Já na instituição privadas existem pessoas com deficiência, ter esse tipo de colaborador é de iniciativa da organização e não somente pelo fato de existirem leis que as obrigam ter uma percentagem desse tipo de colaborador. Esse tipo de colaborador é tratado como os demais colaboradores, desde a etapa de recrutamento e seleção até a avaliação de desempenho. Porém, os mesmos sofrem preconceitos de alunos e colaboradores da própria instituições de ensino. Para que isso diminuía, são propostas ações internas de conscientização. The quality of life within the organizational environment has not reflected positively on people with disabilities, because in addition to their common characteristics, they carry others that limit them to perform tasks that are simple for others. In this sense, the study aims to analyze the quality of life at work of people with disabilities in private school. The research has qualitative, descriptive and comparative character. Data were collected through semi-structured interviews. Three public educational institutions and one private educational institution participated in the research. The main findings were that in public educational institutions there were no people with disabilities, so they could not analyze their quality of life in these institutions. In the private institution there are people with disabilities, having this type of employee is the initiative of the organization and not only because there are laws that require them to have a percentage of this type of employee. This type of employee is treated like other employees, from the recruitment and selection stage to the performance evaluation. However, they suffer prejudice from students and employees of the educational institutions themselves. To reduce this, internal awareness actions are proposed.

Hypertension causes cardiac hypertrophy, cardiac dysfunction and heart failure (HF). The mechanisms implicated in the transition from compensated to decompensated cardiac hypertrophy are not fully understood. This study was aimed to investigate whether alterations in the expression of intercalated disk proteins could contribute to the transition of compensated cardiac hypertrophy to dilated heart development that culminates in HF. Male rats were submitted to abdominal aortic constriction and at 90 days post surgery (dps), three groups were observed: sham-operated animals (controls), animals with hypertrophic hearts (HH) and animals with hypertrophic + dilated hearts (HD). Blood pressure was evaluated. The hearts were collected and Western blot and immunofluorescence were performed to desmoglein-2, desmocollin-2, N-cadherin, plakoglobin, Bcatenin, and connexin-43. Cardiac systolic function was evaluated using the Vevo 2100 ultrasound system. Data were considered significant when p b 0.05. Seventy percent of the animals presented with HH and 30% were HD at 90 dps. The blood pressure increased in both groups. The amount of desmoglein-2 and desmocollin-2 expression was increased in both groups and no difference was observed in either group. The expression of N-cadherin, plakoglobin and B-catenin increased in the HHgroup and decreased in the HDgroup; and connexin-43 decreased only in theHDgroup. Therewas no difference between the ejection fraction and fractional shortening at 30 and 60 dps; however, they were decreased in the HD group at 90 dps. We found that while some proteins have increased expression accompanied by the increase in the cell volume associated with preserved systolic cardiac function in theHHgroup, these same proteins had decreased expression evenwithout significant reduction in the cell volume associated with decreased systolic cardiac function in HD group. The increased expression of desmoglein-2 and desmocollin-2 in both the HH and HD groups could work as a protective compensatory mechanism, helping tomaintain the dilated heart.We can hypothesize that inappropriate intercellular mechanical and electrical coupling associated with necrosis and/or apoptosis are important factors contributing to the transition to HF.

Made available in DSpace on 2018-11-26T15:47:45Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-02-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Background: Bronchiectasis is characterized by pathological and irreversible bronchial dilatation caused by the inefficient mucus and microorganism clearance and progression of inflammatory processes. The most frequent characteristic is the increase in bronchial mucus production resulting in slower transport and damage to the mucociliary transport. Aims: To evaluate the effects of exercise on mucus transport, inflammation, and resistance of the respiratory and autonomic nervous systems and subsequent effects on quality of life in patients with bronchiectasis who are enrolled in a pulmonary rehabilitation program. Methods: Sixty subjects of both sexes between 18 and 60 years (30 volunteers with clinically stable bronchiectasis and 30 healthy volunteers) will be included. Participants with chronic obstructive pulmonary disease, decompensated cardiovascular or metabolic diseases, neuromuscular and musculoskeletal diseases, and active smokers will be excluded. Volunteers will be randomly allocated to the pulmonary rehabilitation or control groups. The primary outcomes will be nasal transport time as evaluated by nasal saccharin transport time, analysis of nasal lavage, enzyme immunoassay of exhaled expiration, and analysis of the mucus properties. The secondary outcomes will include pulmonary function tests, impulse oscillometry, heart rate variability analysis, and quality of life questionnaires. Discussion: In addition to the benefits for patients already described in the literature, the additional benefit of mucus removal may contribute to optimizing treatments and better control of the disease. Conclusion: This protocol could provide new information about the unclear mechanisms regarding exercise to aid in the removal of secretions. Univ Sao Paulo, Ribeirao Preto Med Sch, Dept Physiotherapy, Av Bandeirantes 3900, BR-14049900 Sao Paulo, Brazil Univ Sao Paulo, Ribeirao Preto Med Sch, Internal Med Dept, Sao Paulo, Brazil Sao Paulo State Univ, Dept Physiotherapy, Sao Paulo, Brazil Sao Paulo State Univ, Dept Physiotherapy, Sao Paulo, Brazil FAPESP: 2016/20077-6 : 2016/20492-3

Hypertension causes cardiac hypertrophy, one of the most important risk factors for heart failure (HF). Despite the importance of cardiac hypertrophy as a risk factor for the development of HF, not all hypertrophied hearts will ultimately fail. Alterations of cytoskeletal and sarcolemma-associated proteins are considered markers cardiac remodeling during HF. Dystrophin provides mechanical stability to the plasma membrane through its interactions with the actin cytoskeleton and, indirectly, to extracellular matrix proteins. This study was undertaken to evaluate dystrophin and calpain-1 in the transition from compensated cardiac hypertrophy to HF. Wistar rats were subjected to abdominal aorta constriction and killed at 30, 60 and 90 days post surgery (dps). Cardiac function and blood pressure were evaluated. The hearts were collected and Western blotting and immunofluorescence performed for dystrophin, calpain-1, alpha-fodrin and calpastatin. Statistical analyses were performed and considered significant when p

TEMA: consciência fonológica em alunos de ensino fundamental. OBJETIVO: analisar evolução de consciência fonológica em alunos do ensino público fundamental após programa de estimulação fonoaudiológica. MÉTODO: foram selecionados 20 alunos com piores resultados na avaliação inicial de letramento. Foram analisadas as provas de consciência fonológica no início e final do programa de estimulação. RESULTADOS: a maioria dos sujeitos demonstrou noção de atividades de consciência fonológica. CONCLUSÃO: os alunos apresentaram evolução, sugerindo eficácia do programa.