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Background Immersive virtual reality (iVR)-based digital therapeutics are gaining clinical attention in the field of pain management. Based on known analogies between pain and dyspnoea, we investigated the effects of visual respiratory feedback on persistent dyspnoea in patients recovering from coronavirus disease 2019 (COVID-19) pneumonia. Methods We performed a controlled, randomised, single-blind, crossover proof-of-concept study (feasibility and initial clinical efficacy) to evaluate an iVR-based intervention to alleviate dyspnoea in patients recovering from COVID-19 pneumonia. Included patients reported persistent dyspnoea (≥5 on a 10-point scale) and preserved cognitive function (Montreal Cognitive Assessment score >24). Assignment was random and concealed. Patients received synchronous (intervention) or asynchronous (control) feedback of their breathing, embodied via a gender-matched virtual body. The virtual body flashed in a waxing and waning visual effect that could be synchronous or asynchronous to the patient's respiratory movements. Outcomes were assessed using questionnaires and breathing recordings. Results Study enrolment was open between November 2020 and April 2021. 26 patients were enrolled (27% women; median age 55 years, interquartile range (IQR) 18 years). Data were available for 24 of 26 patients. The median rating on a 7-point Likert scale of breathing comfort improved from 1 (IQR 2) at baseline to 2 (IQR 1) for synchronous feedback, but remained unchanged at 1 (IQR 1.5) for asynchronous feedback (p

IntroductionThe type of donation may affect how susceptible a donor kidney is to injury from pre-existing alloimmunity. Many centers are, therefore, reluctant to perform donor specific antibody (DSA) positive transplantations in the setting of donation after circulatory death (DCD). There are, however, no large studies comparing the impact of pre-transplant DSA stratified on donation type in a cohort with a complete virtual cross-match and long-term follow-up of transplant outcome.MethodsWe investigated the effect of pre-transplant DSA on the risk of rejection, graft loss, and the rate of eGFR decline in 1282 donation after brain death (DBD) transplants and compared it to 130 (DCD) and 803 living donor (LD) transplants.ResultsThere was a significant worse outcome associated with pre-transplant DSA in all of the studied donation types. DSA directed against Class II HLA antigens as well as a high cumulative mean fluorescent intensity (MFI) of the detected DSA showed the strongest association with worse transplant outcome. We could not detect a significant additive negative effect of DSA in DCD transplantations in our cohort. Conversely, DSA positive DCD transplants appeared to have a slightly better outcome, possibly in part due to the lower mean fluorescent intensity (MFI) of the pre-transplant DSA. Indeed when DCD transplants were compared to DBD transplants with similar MFI (

Background and Objectives: Community-acquired respiratory virus (CARV) infections pose a serious risk for lung transplant recipients (LTR) as they are prone to severe complications. When the COVID-19 pandemic hit Switzerland in 2020, the government implemented hygiene measures for the general population. We investigated the impact of these measures on the transmission of CARV in lung transplant recipients in Switzerland. Materials and Methods: In this multicenter, retrospective study of lung transplant recipients, we investigated two time periods: the year before the COVID-19 pandemic (1 March 2019–29 February 2020) and the first year of the pandemic (1 March 2020–28 February 2021). Data were mainly collected from the Swiss Transplant Cohort Study (STCS) database. Descriptive statistics were used to analyze the results. Results: Data from 221 Swiss lung transplant cohort patients were evaluated. In the year before the COVID-19 pandemic, 157 infections were diagnosed compared to 71 infections in the first year of the pandemic (decline of 54%, p < 0.001). Influenza virus infections alone showed a remarkable decrease from 17 infections before COVID-19 to 2 infections after the beginning of the pandemic. No significant difference was found in testing behavior; 803 vs. 925 tests were obtained by two of the three centers during the respective periods. Conclusions: We observed a significant decline in CARV infections in the Swiss lung transplant cohort during the first year of the COVID-19 pandemic. These results suggest a relevant impact of hygiene measures when implemented in the population due to the COVID-19 pandemic on the incidence of CARV infections.

Immunocompromised patients (ICPs) have a higher risk of developing severe forms of COVID-19 and experience a higher burden of complications and mortality than the general population. However, recent studies have suggested that the antibody response to SARS-CoV-2 mRNA vaccines could be highly variable among different ICPs. Using a collaborative, monocentric, prospective cohort study, we assessed anti-SARS-CoV-2 spike protein antibody titers following two and three doses of mRNA vaccines in four groups of ICPs (cancer [n = 232]: hematopoietic stem cell transplant [HSCT; n = 126] patients; people living with HIV [PLWH; n = 131]; and lung transplant [LT; n = 39] recipients) treated at Geneva University Hospitals; and healthy individuals (n = 49). After primo-vaccination, the highest anti-S antibody geometric mean titer (IU/mL) was observed in healthy individuals (2417 IU/mL [95% CI: 2327–2500]), the PLWH group (2024 IU/mL [95% CI:1854–2209]) and patients with cancer (840 IU/mL [95% CI: 625–1129]), whereas patients in the HSCT and LT groups had weaker antibody responses (198 IU/mL [95% CI: 108–361] and 7.3 IU/mL [95% CI: 2.5–22]). The booster dose conferred a high antibody response after 1 month in both PLWH (2500 IU/mL) and cancer patients (2386 IU/mL [95% CI: 2182–2500]), a moderate response in HSCT patients (521 IU/mL [95% CI: 306–885]) and a poor response in LT recipients (84 IU/mL [95% CI: 18–389]). Contemporary treatment with immunosuppressive drugs used in transplantation or chemotherapy was associated with a poor response to vaccination. Our findings confirmed the heterogeneity of the humoral response after mRNA vaccines among different ICPs and the need for personalized recommendations for each of these different groups.

Background and purposes: Motion management is crucial for optimal stereotactic body radiotherapy (SBRT) of moving targets. We aimed to describe our clinical experience with real-time tracking of lung-specific electromagnetic transponders (EMTs) for SBRT of early stage non-small cell lung cancer in free-breathing (FB) or deep inspiration breath-hold (DIBH). Material and methods: Seven patients were implanted with EMTs. Simulation for SBRT was performed in FB and in DIBH. We prescribed 60 Gy in 3, 5 or 8 fractions to the tumor and delivered SBRT with volumetric modulated arcs and a 6 MV flattening filter free photon beam. Patients’ setup at the linac was performed using EMT positions and cone-beam CT (CBCT) verification. Four patients were treated in DIBH because of a dosimetric benefit. We analysed patient alignment and treatment delivery parameters using DIBH or FB and EMT real-time tracking. Results: There were no complications from the EMT implantation. Visual inspection of CBCT before and/or after SBRT revealed good alignment of structures and EMTs. The median setup time was 9.8 min (range: 4.6–34.1 min) and the median session time was 14.7 min (range: 7.3–36.5 min). EMT positions in lungs remained stable during overall treatment and allowed real-time tracking both in FB and in DIBH SBRT. The treatment beam was gated when EMT centroid position exceeded tolerance thresholds ensuring correct delivery of radiation to the tumor. Conclusion: Using EMTs for real-time tracking of tumor motion during lung SBRT proved to be safe, accurate and easy to integrate clinically for treatments in FB or DIBH. Keywords: Lung SBRT, Real-time tracking, Electromagnetic transponder, Intra-fraction motion, Deep inspiration breath-hold

Background: Noninvasive ventilation (NIV) is accepted as standard of care for chronic hypercapnic respiratory failure (CHRF) and is being increasingly implemented in older subjects. However, little is known regarding the use of NIV on a long-term basis in the very old. The outcomes of this study were: 1/to report the proportion of patients ≥ 75 years old (elderly) among a large group of long-term NIV users and its trend since 2000; 2/to compare this population to a younger population (

Intravenous treprostinil administration by an implantable pump is an attractive option for pulmonary arterial hypertension (PAH) treatment and is the subject of recent publications. Short-term studies are promising, but there is still a lack of long-term prospective data. We analyzed the treprostinil flow rate administered by the Lenus Pro® implantable pump in 2 patients suffering from PAH during follow-up times of respectively 4.2 and 3 years. The flow rate delivered by the pumps in these 2 patients exceeded the manufacturer admitted margin of error within 2 years and continued to increase to reach, respectively, 158 and 120% of the expected flow rate at the end of the follow up. In one case, the implantable pump had to be removed for this reason. The ex-vivo flow rate of the withdrawn pump determined in the laboratory reached 173% of the predicted value. This correlated with the in-vivo measurement, which suggests a continuous flow increase even after pump removal and without treprostinil use. Spontaneous flow increase from such an implantable pump is a potentially major pitfall, which needs to be identified and actively managed by the responsible clinicians.

Background: Use of adaptive servo-ventilation (ASV) has been questioned in patients with central sleep apnea (CSA) and chronic heart failure (CHF). This study aims to detail the present use of ASV in clinical practice.Methods: Descriptive, cross-sectional, multicentric study of patients undergoing long term (≥3 months) ASV in the Cantons of Geneva or Vaud (1,288,378 inhabitants) followed by public or private hospitals, private practitioners and/or home care providers.Results: Patients included (458) were mostly male (392; 85.6%), overweight [BMI (median, IQR): 29 kg/m2 (26; 33)], comorbid, with a median age of 71 years (59–77); 84% had been treated by CPAP before starting ASV. Indications for ASV were: emergent sleep apnea (ESA; 337; 73.6%), central sleep apnea (CSA; 108; 23.6%), obstructive sleep apnea (7; 1.5%), and overlap syndrome (6; 1.3%). Origin of CSA was cardiac (n = 30), neurological (n = 26), idiopathic (n = 28), or drug-related (n = 22). Among CSA cases, 60 (56%) patients had an echocardiography within the preceding 12 months; median left ventricular ejection fraction (LVEF) was 62.5% (54–65); 11 (18%) had a LVEF ≤45%. Average daily use of ASV was [mean (SD)] 368 (140) min; 13% used their device

Background.Pulmonary alveolar proteinosis (PAP) is a pulmonary disease characterized by disruption of surfactant homeostasis resulting in its accumulation in the alveoli. PAP is classically classified into three categories (Table 1): 1/primary (or autoimmune) with antibodies targeting the GM-CSF pathway, 2/secondary to another disease, typically a hematologic malignancy, and 3/genetic.Case-report.A 30 year-old woman received an allogenic hematopoietic stem cell transplantation (HSCT) after treatment for acute myeloid leukemia (AML). Within the first 6 months post HSCT, she developed an ocular, oral, digestive and hepatic graft-versus-host disease associated with a mixed ventilatory defect with a very severe obstructive syndrome and a severe CO diffusion impairment. High resolution computed tomography showed a classical “crazy paving” pattern. Aspect and differential cell count of BAL were normal. All microbiological samples remained culture negative. Histo-pathological analysis of transbronchial biopsies was unremarkable. Because of the severity of the respiratory insufficiency, open-lung biopsy (OBL) could not be performed. Despite multiple immunosuppressive therapies, lung function deteriorated rapidly; the patient also developed an excavated fungal lesion unresponsive to treatment. She underwent a bilateral lung transplant 48 months after HSCT. Histo-pathological analysis of explanted lungs showed obliterative bronchiolitis (OB), diffuse PAP and invasive cavitary pulmonary aspergillosis.Conclusions.This case illustrates the simultaneous occurrence of OB, PAP and a fungal infection in a 30-year old female patient who underwent HSCT for acute myeloid leukemia (AML). To our knowledge this is the only documented case of PAP associated with OB treated by lung transplantation.

Abstract Complications following lung transplantation may impede allograft function and threaten patient survival. The five main complications after lung transplantation are primary graft dysfunction, post-surgical complications, alloimmune responses, infections, and malignancy. Primary graft dysfunction, a transient ischemic/reperfusion injury, appears as a pulmonary edema in almost every patient during the first three days post-surgery. Post-surgical dysfunction could be depicted on computed tomography (CT), such as bronchial anastomosis dehiscence, bronchial stenosis and bronchomalacia, pulmonary artery stenosis, and size mismatch. Alloimmune responses represent acute rejection or chronic lung allograft dysfunction (CLAD). CLAD has three different forms (bronchiolitis obliterans syndrome, restrictive allograft syndrome, acute fibrinoid organizing pneumonia) that could be differentiated on CT. Infections are different depending on their time of occurrence. The first post-operative month is mostly associated with bacterial and fungal pathogens. From the second to sixth months, viral pneumonias and fungal and parasitic opportunistic infections are more frequent. Different patterns according to the type of infection exist on CT. Malignancy should be depicted and corresponded principally to post-transplantation lymphoproliferative disease (PTLD). In this review, we describe specific CT signs of these five main lung transplantation complications and their time of occurrence to improve diagnosis, follow-up, medical management, and to correlate these findings with pathology results. Key Points • The five main complications are primary graft dysfunction, surgical, alloimmune, infectious, and malignancy complications. • CT identifies anomalies in the setting of unspecific symptoms of lung transplantation complications. • Knowledge of the specific CT signs can allow a prompt diagnosis. • CT signs maximize the yield of bronchoscopy, transbronchial biopsy, and bronchoalveolar lavage. • Radiopathological correlation helps to understand CT signs after lung transplantation complications.

Introduction: The objective of this study was to adapt the Brazilian version, and verify the validity, reliability and internal consistency of the Oliveira questionnaire on low back pain in young people. Material and Methods: The questionnaire was translated from European Portuguese into Brazilian Portuguese by means of translation and re-translation. The validity of the contents was determined by experts who analyzed the clarity and pertinence of the questions. Fifteen young people aged 15 to 18 took part in the pre-test step (qualitative analysis), 40 in the test-retest (reliability) and 679 in the evaluation of internal consistency. The intra-class correlation coefficient and Spearman’s correlation coefficient were used in the reliability analysis (test-retest), and Cronbach’s alpha to determine the internal consistency (stability). Results: In the translation phase the questionnaire was modified and considered suitable, observing similarity and equivalence of the two versions. After being corrected by the experts in the validation of the contents, the instrument was considered suitable and valid, and in the pre-test, the young people suggested some modifications to make the questionnaire more succinct. With respect to reliability, the values for the intra-class correlation coefficient were between 0.512 – acceptable and 1 – excellent and Spearman’s correlation coefficient varied between 0.525 and 1, classifying the instrument as reproducible. The internal consistency was considered acceptable with a 0.757 Cronbach’s alpha. Discussion: The Oliveira questionnaire was choosen since it has been used in several Portuguese studies; moreover, it addresses the need to raise data regarding low back pain and associated risk factors. Conclusions: The Brazilian version of the Oliveira questionnaire on low back pain in young people showed valid and reliable cultural adaptation, with good reliability and stability.

Abstract Introduction: The postural deviations associated with the changes in the habits of young people have increased over the last decades. Investigating the subject by way of a self-perception questionnaire allows one to understand the level of awareness the individual has concerning his/her postural habits. Objective: Designing a self-perception evaluation questionnaire about the postural habits of young people and to validate, pre-test, verify the reliability and the internal consistency of this instrument. Methods: The validity of the content was determined by 10 judges. The study involved young people (15 - 18 years old) from Florianopolis/Brazil. The questionnaire was pre-tested, applied to 15 youthful who provided qualitative information about it. The reproducibility was analyzed by way of a test-retest with 40 students, in a one-week gap, and was analyzed by interclass correlation coefficient. The internal consistency was analyzed by Cronbach’s alpha with 679 students. A 5% significance level was adopted. Results: Concerning to the validation of content, the questionnaire presented a total coefficient of 0.28 and 72% concordance was observed amongst the reviewers. The interclass correlation coefficient (test-retest) indicated acceptable reproducibility values (R = 0.66, 0.74 and 0.59; p < 0.001), with a decrease in the object-carrying dimension (R = 0.32; p = 0.04). The questionnaire was considered suitable, quick and easy to fill in. The internal consistency presented a value of 0.80. Conclusion: The questionnaire on body awareness of postural habits in young people is a valid instrument with good repeatability and reliability, its use can be recommended with teenagers showing the same profile as those used in this study.

Background: Predicting outcome after index admission in the ICU for COPD-related acute hypercapnic respiratory failure (AHRF) is difficult. Simple tools to stratify this risk and to promote interventions to mitigate it are needed.Aim: To prospectively evaluate the ability of severe dyspnea (NYHAIII-IV) to predict hospital readmission or death in COPD patients surviving AHRF in the ICU.Methods: 50 consecutive COPD patients were recruited from a larger cohort of patients (n = 78) surviving AHRF in the ICU. All predictive variables were collected within 15 days after resolution of respiratory failure before hospital discharge. COPD was diagnosed by spirometry. Heart failure was diagnosed with clinical rules and echocardiography. NYHA was measured upon hospital discharge. Hospital readmission and death were recorded at regular intervals for 3 months.Results: 21/50 (42%) COPD patients died or were readmitted to the hospital during the observation period: 12 out of the 20 NYHA III-IV patients (60%) and 8 out of the 28 NYHA I-II patients (29%). NYHA III-IV was associated with risk of readmission or death (univariate HR: 2.73, IC95: 1.11–6.69, p = 0.028). After controlling for age, FEV1, heart failure and BMI, NYHA III-IV remained associated with readmission or death (multivariate HR: 2.71, IC95: 1.06–6.93, p = 0.038).Conclusions: Our findings suggest that severe dyspnea measured upon hospital discharge in COPD patients surviving AHRF can stratify patient's risk of 3-month readmission or death.

Bronchiolitis obliterans syndrome (BOS), the main manifestation of chronic lung allograft dysfunction, leads to poor long-term survival after lung transplantation. Identifying predictors of BOS is essential to prevent the progression of dysfunction before irreversible damage occurs. By using a large set of 107 samples from lung recipients, we performed microarray gene expression profiling of whole blood to identify early biomarkers of BOS, including samples from 49 patients with stable function for at least 3 years, 32 samples collected at least 6 months before BOS diagnosis (prediction group), and 26 samples at or after BOS diagnosis (diagnosis group). An independent set from 25 lung recipients was used for validation by quantitative PCR (13 stables, 11 in the prediction group, and 8 in the diagnosis group). We identified 50 transcripts differentially expressed between stable and BOS recipients. Three genes, namely POU class 2 associating factor 1 (POU2AF1), T-cell leukemia/lymphoma protein 1A (TCL1A), and B cell lymphocyte kinase, were validated as predictive biomarkers of BOS more than 6 months before diagnosis, with areas under the curve of 0.83, 0.77, and 0.78 respectively. These genes allow stratification based on BOS risk (log-rank test p

RATIONALE:Acute hypercapnic respiratory failure (AHRF) treated with non-invasive ventilation in the ICU is frequently caused by chronic obstructive pulmonary disease (COPD) exacerbations and obesity-hypoventilation syndrome, the latter being most often associated with obstructive sleep apnea. Overlap syndrome (a combination of COPD and obstructive sleep apnea) may represent a major burden in this population, and specific diagnostic pathways are needed to improve its detection early after ICU discharge. OBJECTIVES:To evaluate whether pulmonary function tests can identify a high probability of obstructive sleep apnea in AHRF survivors and outperform common screening questionnaires to identify the disorder. METHODS:Fifty-three patients surviving AHRF (31 males; median age 67 years (interquartile range: 62-74) participated in the study. Anthropometric data were recorded and body plethysmography was performed 15 days after ICU discharge. A sleep study was performed 3 months after ICU discharge. RESULTS:The apnea-hypopnea index was negatively associated with static hyperinflation as measured by the residual volume to total lung capacity ratio in the % of predicted (coefficient = -0.64; standard error 0.17; 95% CI -0.97 to -0.31; p

Bronchial thermoplasty is a young yet promising treatment for severe asthma whose benefit for long-term asthma control outweighs the short-term risk of deterioration and hospitalisation in the days following the treatment. It is an innovative treatment whose clinical efficacy and safety are beginning to be better understood. Since this is a device-based therapy, the overall evaluation of risk–benefit is unlike that of pharmaceutical products; safety aspects, regulatory requirements, study design and effect size assessment may be unfamiliar. The mechanisms of action and optimal patient selection need to be addressed in further rigorous clinical and scientific studies. Bronchial thermoplasty fits in perfectly with the movement to expand personalised medicine in the field of chronic airway disorders. This is a device-based complimentary asthma treatment that must be supported and developed in order to meet the unmet needs of modern severe asthma management. The mechanisms of action and the type of patients that benefit from bronchial thermoplasty are the most important challenges for bronchial thermoplasty in the future.

BackgroundChronic lung allograft dysfunction and its main phenotypes, bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome (RAS), are major causes of mortality after lung transplantation (LT). RAS and early-onset BOS, developing within 3 years after LT, are associated with particularly inferior clinical outcomes. Prediction models for early-onset BOS and RAS have not been previously described.MethodsLT recipients of the French and Swiss transplant cohorts were eligible for inclusion in the SysCLAD cohort if they were alive with at least 2 years of follow-up but less than 3 years, or if they died or were retransplanted at any time less than 3 years. These patients were assessed for early-onset BOS, RAS, or stable allograft function by an adjudication committee. Baseline characteristics, data on surgery, immunosuppression, and year-1 follow-up were collected. Prediction models for BOS and RAS were developed using multivariate logistic regression and multivariate multinomial analysis.ResultsAmong patients fulfilling the eligibility criteria, we identified 149 stable, 51 BOS, and 30 RAS subjects. The best prediction model for early-onset BOS and RAS included the underlying diagnosis, induction treatment, immunosuppression, and year-1 class II donor-specific antibodies (DSAs). Within this model, class II DSAs were associated with BOS and RAS, whereas pre-LT diagnoses of interstitial lung disease and chronic obstructive pulmonary disease were associated with RAS.ConclusionAlthough these findings need further validation, results indicate that specific baseline and year-1 parameters may serve as predictors of BOS or RAS by 3 years post-LT. Their identification may allow intervention or guide risk stratification, aiming for an individualized patient management approach.

Polygenic obesity in Solid Organ Transplant (SOT) populations is considered a risk factor for the development of metabolic abnormalities and graft survival. Few studies to date have studied the genetics of weight gain in SOT recipients. We aimed to determine whether weighted genetic risk scores (w-GRS) integrating genetic polymorphisms from GWAS studies (SNP group#1 and SNP group#2) and from Candidate Gene studies (SNP group#3) influence BMI in SOT populations and if they predict ≥10% weight gain (WG) one year after transplantation. To do so, two samples (nA = 995, nB = 156) were obtained from naturalistic studies and three w-GRS were constructed and tested for association with BMI over time. Prediction of 10% WG at one year after transplantation was assessed with models containing genetic and clinical factors.w-GRS were associated with BMI in sample A and B combined (BMI increased by 0.14 and 0.11 units per additional risk allele in SNP group#1 and #2, respectively, p-values

Cardiac output (CO) is a major diagnostic and prognostic factor in pre-capillary pulmonary hypertension (PH). Reference methods for CO determination, like thermodilution (TD), require invasive procedures and allow only steady-state measurements. The Modelflow (MF) method is an appealing technique for this purpose as it allows non-invasive and beat-by-beat determination of CO.We aimed to compare CO values obtained simultaneously from non-invasive pulse wave analysis by MF (COMF) and by TD (COTD) to determine its precision and accuracy in pre-capillary PH. The study was performed on 50 patients with pulmonary arterial hypertension (PAH) or chronic thrombo-embolic PH (CTEPH). CO was determined at rest in all patients (n = 50) and during nitric oxide vasoreactivity test, fluid challenge or exercise (n = 48).Baseline COMF and COTD were 6.18 ± 1.95 and 5.46 ± 1.95 L·min-1, respectively. Accuracy and precision were 0.72 and 1.04 L·min-1, respectively. Limits of agreement (LoA) ranged from -1.32 to 2.76 L·min-1. Percentage error (PE) was ±35.7%. Overall sensitivity and specificity of COMF for directional change were 95.2% and 82.4%, (n = 48) and 93.3% and 100% for directional changes during exercise (n = 16), respectively. After application of a correction factor (1.17 ± 0.25), neither proportional nor fixed bias was found for subsequent CO determination (n = 48). Accuracy was -0.03 L·min-1 and precision 0.61 L·min-1. LoA ranged from -1.23 to 1.17 L·min-1 and PE was ±19.8%.After correction against a reference method, MF is precise and accurate enough to determine absolute values and beat-by-beat relative changes of CO in pre-capillary PH.

The present work identifies cases of depression tendency in physically active senior citizens. In our proposal, the data were collected by interviewing senior members of the Seniority Related Studies Group (GETI/CEFID-UDESC) using a depression scale method that was adapted from Stoppe e Louzã (1999). To establish the data base 122 candidates with an average age of 68.8 years were included. Most of them (91%) did not show any tendency to depression. On the other hand, the remaining examinees (9%) presented a lack of hope for their own future, leading to an evident condition of depression tendency. Considering the complexity of the factors that are related to depression conditions, physical activities do lead to body, social and mental benefits, reducing the possibility of a depressive state in senior citizens. RESUMO O presente trabalho verificou a tendência ao estado depressivo em idosos praticantes de atividade física. Para tanto, foi realizada uma entrevista com idosos do Grupo de Estudos da Terceira Idade (GETI/CEFIDUDESC). O instrumento utilizado foi a escala de depressão adaptada de Stoppe e Louzã (1999). A análise dos resultados foi feita por meio de estatística descritiva mediante cálculo de freqüência simples e percentual. A amostra foi composta de 122 idosos, com a idade média de 68,8 anos (DP= 5,5). A maioria dos idosos (91%) não apresentou tendência ao estado depressivo. Os que apresentaram tendência (9%) referem não ter esperança em relação ao futuro, ter pouca energia e estar pouco animado na maior parte do tempo; apesar disto continuam estimulados a participar do programa de atividade física. Considerando a complexidade dos fatores que predispõem os estados depressivos, entende-se que a atividade física proporciona benefícios físicos, sociais e mentais, podendo reduzir a depressão no idoso.

Foram avaliadas as características quantitativas das carcaças de novilhos 5/8 Nelore-3/8 Charolês terminados em confinamento até estes atingirem o peso médio de abate (P) de 425, 467 e 510 kg. Os novilhos apresentaram ao início do confinamento idade média de 660 dias, peso de 361 kg e estado corporal de 2,9 pontos. A dieta oferecida, com relação volumoso:concentrado de 60:40 na base matéria seca (MS), continha 10,25% de proteína bruta e 72,18% de nutrientes digestíveis totais. O volumoso foi silagem de milho contendo 46,5% de grãos na MS. O rendimento de carcaça fria ( ou = 37,618+0,011Pi+0,028P) aumentou linearmente com o P. No entanto, quando o rendimento de carcaça foi expresso em relação ao peso de corpo vazio (PCV) este não foi influenciado pelo P. A espessura de gordura subcutânea na carcaça fria ( ou = -15,499-0,001Pi+0,047P), expressa por 100 kg de carcaça fria ( ou = -1,724-0,006Pi+0,013P) e PCV ( ou = -1,124-0,003Pi+0,008P) aumentou com o avanço do P. A área do músculo Longissimus dorsi aumentou linearmente com o P ( ou = -33,471 + 0,120Pi + 0,121P), no entanto, quando expresso por 100 kg de carcaça fria decresceu ( ou = 45,173-0,023Pi-0,028P) e quando expresso por 100 kg de corpo vazio não foi influenciada pelo peso de abate. A porcentagem do corte serrote decresceu ( ou = 63,007-0,001Pi-0,026P), enquanto a do costilhar elevou-se ( ou = -3,053+0,005Pi+0,030P) com o aumento do P. A espessura de coxão ( ou = 6,223+0,014Pi+0,0310P), comprimento de carcaça ( ou = 58,564+0,0916Pi+0,075P), perna (Y=28,326+0,061Pi+0,050P) e perímetro de braço ( ou = 9,173+0,053Pi+0,017P) foram influenciados positivamente pelo aumento do peso de abate dos animais. A conformação da carcaça não foi alterada pelo peso de abate.The carcass quantitative characteristics of 5/8 Nellore-3/8 Charolais steers feedlot finished to reach slaughter weight (SW) of 425, 467 and 510 kg, were studied. At the beginning of the feedlot the average age, weight and body condition were, respectively, 660 days, 361 kg and 2.9 points. The diet offered, with 60:40 roughage:concentrate relation, dry matter basis (DM), contained 10.25% crude protein and 72.18% of total digestible nutrients. The roughage was corn silage with 46.5% of grain in the DM. Cold carcass dressing percentage showed linear relation with SW ( or = 37.618 + .011Pi (initial weight) + .028SW). However, when dressing percentage was expressed in relation to empty body weight (EB), it was not influenced by SW. Subcutaneous fat thickness expressed per cold carcass ( or = -15.499 - .001Pi + .047SW), per 100 kg of cold carcass weight ( or = -1.724 - .006Pi + .013SW) and per 100 kg of EB ( or = -1.124 - .003Pi + .008SW) increased as SW increased. Longissimus dorsi area increased linearly with SW ( or = -33.472 + .120Pi + .120SW), however, when expressed per 100 kg of cold carcass weight it declined ( or = 45.173 - .023Pi - .028SW), and when expressed per 100 kg of EB, it did not show relationship with SW. The percentage of sawcut declined ( or = 63.007 - .001Pi - .026SW) while the side cut increased ( or = -3.054 + .005Pi + .030SW), as SW increased. Slaughter weight influenced positively cushion thickness ( or = 6.223 + .014Pi + .031SW), leg length ( or = 28.326 + .061Pi + .05SW) and arm perimeter ( or = 9.173+ .053Pi + .017SW). Carcass conformation was not alterated by SW.

O objetivo deste trabalho foi avaliar o desempenho produtivo de vacas de corte, das raças Charolês (C), Nelore (N), mestiças CN e NC, mantidas em pastagem nativa, suplementadas com farelo de arroz e desmamadas aos 42 ou 63 dias pós-parto, ou não suplementadas e desmamadas aos 63 dias. A idade das vacas variou de 3 a 12 anos, sendo agrupadas em quatro classes, primíparas, jovens, adultas e velhas. O ganho de peso médio diário (GMD) do parto aos 63 dias pós-parto foi maior para as vacas suplementadas. Vacas desmamadas aos 42 dias apresentaram maior diferença de peso (61,5 kg), do parto ao diagnóstico de gestação, em relação às não suplementadas (45,7 kg), não diferindo das suplementadas desmamadas aos 63 dias (57,8 kg). Do final do período de acasalamento ao diagnóstico de gestação as mestiças CN apresentaram maior GMD (860 g), em relação às C (552 g) e N (648 g), não diferindo das mestiças NC (670 g). Vacas N foram mais leves em relação aos demais grupos genéticos, em todos os períodos. Vacas primíparas e velhas perderam peso, enquanto as jovens e adultas apresentaram leve ganho de peso do parto ao desmame. Vacas suplementadas desmamadas aos 42 dias apresentaram menor intervalo de partos (IP), em relação as desmamadas aos 63 dias (367 contra 384 dias), no entanto, não diferiram quanto à percentagem de parição, respectivamente, 72,0 e 72,2%. Nas vacas desmamadas aos 63 dias, a suplementação não alterou o IP, mas resultou em aumento significativo na taxa de reprodução (72,2 contra 53,7%). Vacas adultas e velhas que desmamaram aos 42 dias apresentaram IP inferior a um ano, 356 e 353 dias, respectivamente, apresentaram maiores peso e condição corporal, por ocasião do diagnóstico de gestação, e maior taxa de parição, respectivamente, 80,0 e 76,3%, contra 41,4 e 57,5% que o observado nas primíparas e jovens.The objective of this experiment was to evaluate the performance of Charolais (C), Nellore (N), CN and NC crossbred cows, kept on native pasture, supplemented with rice bran and weaned at 42 or 63 days, or not supplemented and weaned of 63 days. Cow age ranged from 3 to 12 years and was classified into four groups, first calf, young, adult and old cows. Average daily weight gain (ADG) from calving to 63 days postpartum was higher for supplemented cows. Cows weaned at 42 days showed higher weight difference (61.5 kg) from calving to pregnancy diagnostic than the not supplemented cows (45.7 kg), and did not differ from the supplement cows weaned at 63 days (57.8 kg). From the end of the mating season to the pregnancy diagnostic the CN crossbred cows showed higher ADG (860 g) than the C (552 g) and N (648 g) and did not differ from the NC (670 g). Nellore cows were lighter than the other genetic groups at all periods evaluated. First calf and old cows lost weight, while young and adult cows showed light weight gain from calving to weaning. Supplemented cows weaned at 42 days showed lower calving interval (CI) than those weaned at 63 days (367 vs 384 days), however, did not differ in calving rate, respectively, 72.0 and 72.2%. For 63 days weaned cows, supplementation did not alter CI, but resulted in significant increase in calving rate (72.2 vs 53.7%). Adult and old cows weaned at 42 days showed shorter CI than one year, 356 and 353 days, respectively, displayed higher weight and body condition at gestation diagnostic and higher calving rate, respectively, 80.0 and 76.3 %, versus 41.4 and 57.5%, observed for first calf and young cows.

Introduction: The use of extracorporeal membrane oxygenation (ECMO) is considered a risk factor for, or even a potential con- traindication to, lung transplantation. However, only a few pediatric cases have been described thus far. Case Presentation: A 9-year-old boy with idiopathic pulmonary arterial hypertension developed cardiac arrest after the insertion of a central catheter. ECMO was used as a bridge to lung transplantation. However, after prolonged resuscitation, he developed medullary ischemia and medullary syndrome. After 6 weeks of ECMO and triple combination therapy for pulmonary hypertension, including continuous intravenous prostacyclin, he was weaned off support, and after 2 weeks, bilateral lung transplantation was performed. At 4 years post-transplant, he has minimal problems. The medullary syndrome has also alleviated. He is now back to school and can walk with aids. Conclusions: Increasing evidence supports the use of ECMO as a bridge to LT, reporting good outcomes. In the modern era of PAH therapy, it is feasible to use prolonged ECMO support as a bridge to lung transplant, with the aim of weaning off this support; however, its use requires more experience and knowledge of long-term outcomes.

Memory responses require immune competence. We assessed the influence of priming with AS03-adjuvanted pandemic vaccine (Pandemrix®) on memory responses of HIV patients, kidney recipients (SOT) and healthy controls (HC).Participants (HIV: 197, SOT: 53; HC: 156) were enrolled in a prospective study and 390/406 (96%) completed it. All had been primed in 2009/2010 with 1 (HC) or 2 (patients) doses of Pandemrix®, and were boosted with the 2010/2011 seasonal influenza vaccine. Geometric mean titres and seroprotection rates were measured 12 months after priming and 4 weeks after boosting. Primary and memory responses were directly compared in 191 participants (HCW: 69, HIV: 71, SOT: 51) followed during 2 consecutive seasons.Most participants (HC: 77.8%, HIV: 77.6%, SOT: 66%) remained seroprotected at 12 months post-priming. Persisting A/09/H1N1 titers were high in HIV (100.2) and HC (120.1), but lower in SOT (61.4) patients. Memory responses reached higher titers in HIV (507.8) than in HC (253.5) and SOT (136.9) patients. Increasing age and lack of HAART reduced persisting and memory responses, mainly influenced by residual antibody titers. Comparing 2009/2010 and 2010/2011 titers in 191 participants followed for 2 seasons indicated lower post-2010/2011 titers in HC (240.2 vs 313.9), but higher titers in HIV (435.7 vs 338.0) and SOT (136 vs 90.3) patients.Priming with 2 doses of Pandemrix® elicited persistent antibody responses and even stronger memory responses to non-adjuvanted seasonal vaccine in HIV patients than 1 dose in healthy subjects. Adjuvanted influenza vaccines may improve memory responses of immunocompromised patients.ClinicalTrials.gov NCT01022905.