Analysis of cardiovascular system responses to forced vital capacity in COPD

CONTEXTUALIZAÇÃO: O teste de capacidade vital forçada (CVF) é rotineiramente realizado na avaliação da função pulmonar de pacientes com doença pulmonar obstrutiva crônica (DPOC). Entretanto, permanece pouco compreendida a influência do teste de CVF sobre o sistema cardiovascular de pacientes com DPOC. OBJETIVOS: Analisar o comportamento da frequência cardíaca (FC), pressão arterial (PA) e variabilidade da frequência cardíaca (VFC) no teste de CVF na DPOC. MÉTODOS: Dezenove homens com DPOC (72 ± 7 anos, no estágio de gravidade GOLD I=3, II=5, III=7 e IV=4 pacientes) realizaram a manobra de CVF e tiveram sua FC monitorada durante todo o exame, e a VFC analisada nos domínios do tempo (rMSSD) e da frequência (BF, AF e BF/AF) durante o repouso, antes e após a melhor manobra de CVF. A PA foi analisada no repouso, imediatamente ao final da manobra de CVF e 10 minutos após o término de todos os testes. RESULTADOS: Ao início da manobra de CVF, a FC reduziu (p<0,001) e, em seguida, aumentou progressivamente até o final do teste (p<0,001). Após término da manobra, a FC continuou a aumentar até atingir um pico (p<0,001) e depois caiu rapidamente a valores inferiores aos de repouso (p<0,001) e retornou ao seu valor basal. A PA e os índices da VFC não sofreram alterações nos períodos analisados. CONCLUSÃO: O teste de CVF influencia o comportamento da FC, sem alterar o seu controle autonômico, bem como a PA em pacientes com DPOC nos períodos analisados.

Estimation of Maximal Work Rate Based on the 6-Minute Walk Test and Fat-Free Mass in Chronic Obstructive Pulmonary Disease

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Accuracy of six minute walk test, stair test and spirometry using maximal oxygen uptake as gold standard

OBJETIVO: Determinar a acurácia das variáveis: tempo de escada (tTE), potência de escada (PTE), teste de caminhada (TC6) e volume expiratório forçado (VEF1) utilizando o consumo máximo de oxigênio (VO2máx) como padrão-ouro. MÉTODOS: Os testes foram realizados em 51 pacientes. O VEF1 foi obtido através da espirometria. O TC6 foi realizado em corredor plano de 120m. O TE foi realizado em escada de 6 lances obtendo-se tTE e PTE. O VO2máx foi obtido por ergoespirometria, utilizando o protocolo de Balke. Foram calculados a correlação linear de Pearson (r) e os valores de p, entre VO2máx e variáveis. Para o cálculo da acurácia, foram obtidos os pontos de corte, através da curva característica operacional (ROC). A estatística Kappa (k) foi utilizada para cálculo da concordância. RESULTADOS: Obteve-se as acurácias: tTE - 86%, TC6 - 80%, PTE - 71%, VEF1(L) - 67%, VEF1% - 63%. Para o tTE e TC6 combinados em paralelo, obteve-se sensibilidade de 93,5% e em série, especificidade de 96,4%. CONCLUSÃO: O tTE foi a variável que apresentou a melhor acurácia. Quando combinados o tTE e TC6 podem ter especificidade e sensibilidade próxima de 100%. Estes testes deveriam ser mais usados rotineiramente, especialmente quando a ergoespirometria para a medida de VO2máx não é disponível.

The Incremental Shuttle Walk Test in Older Brazilian Adults

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Comparison between actual and predicted postoperative stair-climbing test, walk test and spirometric values in patients undergoing lung resection

OBJETIVO: Verificar se os testes: Volume Expiratório Forçado no 1º segundo (VEF1), Teste de Caminhada de 6 minutos (TC6) e Teste de Escada (TE) se alteram proporcionalmente ao pulmão funcionante ressecado. MÉTODOS: Foram incluídos pacientes candidatos a toracotomia para ressecção pulmonar. No pré-operatório (pré) e no mínimo três meses após a cirurgia (pós), realizaram espirometria, TC6 e TE. O TE foi realizado em escada com 12,16m de altura. O tempo para subir todos os degraus o mais rápido possível foi chamado tempo de escada (tTE). Os cálculos dos valores dos testes preditos para o pós-operatório (ppo) foram realizados conforme o número de segmentos funcionantes perdidos. Os valores pré, ppo e pós foram comparados entre si para cada teste. Estatística: foi utilizada a análise de variância para medidas repetidas (ANOVA), com significância de 5%. RESULTADOS: Foram estudados 40 pacientes. A ressecção pulmonar variou desde o ganho de dois segmentos funcionantes até a perda de 9. Os valores pré, ppo e pós foram respectivamente: VEF1 -pré = 2,6±0,8L, ppo = 2,3±0,8L, pós = 2,3±0,8L (VEF1pré > VEF1ppo = VEF1pós), TC6-pré = 604±63m, ppo = 529±103m, pós = 599±74m (TC6pré = TC6pós > TC6ppo), tTE-pré = 32,9±7,6s, ppo = 37,8±12,1s, pós = 33,7±8,5s (tTEpré = tTEpós < tTEppo). CONCLUSÃO: Nas ressecções pulmonares, este grupo de pacientes perdeu função pulmonar medida através da espirometria, mas não perdeu a capacidade de exercício, medida através dos testes de escada e caminhada.

Determination of anaerobic threshold in rats using the lactate minimum test

The break point of the curve of blood lactate vs exercise load has been called anaerobic threshold (AT) and is considered to be an important indicator of endurance exercise capacity in human subjects. There are few studies of AT determination in animals. We describe a protocol for AT determination by the lactate minimum test in rats during swimming exercise. The test is based on the premise that during an incremental exercise test, and after a bout of maximal exercise, blood lactate decreases to a minimum and then increases again. This minimum value indicates the intensity of the AT. Adult male (90 days) Wistar rats adapted to swimming for 2 weeks were used. The initial state of lactic acidosis was obtained by making the animals jump into the water and swim while carrying a load equivalent to 50% of body weight for 6 min (30-s exercise interrupted by a 30-s rest). After a 9-min rest, blood was collected and the incremental swimming test was started. The test consisted of swimming while supporting loads of 4.5, 5.0, 5.5, 6.0 and 7.0% of body weight. Each exercise load lasted 5 min and was followed by a 30-s rest during which blood samples were taken. The blood lactate minimum was determined from a zero-gradient tangent to a spline function fitting the blood lactate vs workload curve. AT was estimated to be 4.95 ± 0.10% of body weight while interpolated blood lactate was 7.17 ± 0.16 mmol/l. These results suggest the application of AT determination in animal studies concerning metabolism during exercise.

Effects of prenatal exposure to deltamethrin on forced swimming behavior, motor activity, and striatal dopamine levels in male and female rats

The effects of prenatal exposure of rat pups to 0.08 mg/kg deltamethrin (DTM) on physical, reflex and behavioral developmental parameters, on forced swimming and open-field behaviors, and on striatal monoamine levels at 60 days of age were observed. Maternal and offspring body weight, physical and reflex development were unaffected by the exposure to the pesticide. At 21 days of age, open-field locomotion frequency and immobility duration of male and female offspring were not different between control and exposed animals. However, male rearing frequency was increased in experimental animals. A decreased immobility latency to float and in general activity after the swimming test in male offspring was observed at adult age; no interference was detected in the float duration during the swimming test. In addition, these animals presented higher striatal 3,4-dihydroxyphenylacetic acid (DOPAC) levels without modification in dopamine (DA) levels and an increased DOPAC/DA ratio. These data indicate a higher activity of the dopaminergic system in these animals. Noradrenaline (NA) levels were increased, while MHPG levels were not detectable in the system studied. Serotonin (5-HT) and 5-hydroxyindolacetic acid (5-HIAA) levels, as well as the homovanillic acid (HVA)/DA ratio, were not modified by the exposure to the pesticide. No changes were observed in swimming and open-field behaviors nor were there any changes in striatal monoamines or their metabolites in the female experimental group. In relation to the pesticide formula, the present data showing that prenatal exposure to DTM alters latency to float and the activity of striatal dopaminergic system might reflect a persistent effect of the pesticide on animal motor activity, mainly in males. on the other hand, the decrease in general activity observed in experimental male rats suggests higher levels of emotionality induced by previous exposure to the swimming behavior test in relation to control animals. Data gathered in the present study may be important for the assessment of the safety of pyrethroid insecticides. (C) 2001 Elsevier B.V. All rights reserved.

Time in the stair-climbing test as a predictor of thoracotomy postoperative complications

Objectives: The stair-climbing test as measured in meters or number of steps has been proposed to predict the risk of postoperative complications. The study objective was to determine whether the stair-climbing time can predict the risk of postoperative complications. Methods: Patients aged more than 18 years with a recommendation of thoracotomy for lung resection were included in the study. Spirometry was performed according to the criteria by the American Thoracic Society. The stair-climbing test was performed on shaded stairs with a total of 12.16 m in height, and the stair-climbing time in seconds elapsed during the climb of the total height was measured. The accuracy test was applied to obtain stair-climbing time predictive values, and the receiver operating characteristic curve was calculated. Variables were tested for association with postoperative cardiopulmonary complications using the Student t test for independent populations, the Mann-Whitney test, and the chi-square or Fisher exact test. Logistic regression analysis was performed. Results: Ninety-eight patients were evaluated. Of these, 27 showed postoperative complications. Differences were found between the groups for age and attributes obtained from the stair-climbing test. The cutoff point for stair-climbing time obtained from the receiver operating characteristic curve was 37.5 seconds. No differences were found between the groups for forced expiratory volume in 1 second. In the logistic regression, stair-climbing time was the only variable associated with postoperative complications, suggesting that the risk of postoperative complications increases with increased stair-climbing time. Conclusions: The only variable showing association with complications, according to multivariate analysis, was stair-climbing time. © 2013 by The American Association for Thoracic Surgery.

Modified constraint-induced movement therapy and modified forced-use therapy for stroke patients are both effective to promote balance and gait improvements

Background: Previous studies show that chronic hemiparetic patients after stroke, presents inabilities to perform movements in paretic hemibody. This inability is induced by positive reinforcement of unsuccessful attempts, a concept called learned non-use. Forced use therapy (FUT) and constraint induced movement therapy (CIMT) were developed with the goal of reversing the learned non-use. These approaches have been proposed for the rehabilitation of the paretic upper limb (PUL). It is unknown what would be the possible effects of these approaches in the rehabilitation of gait and balance. Objectives: To evaluate the effect of Modified FUT (mFUT) and Modified CIMT (mCIMT) on the gait and balance during four weeks of treatment and 3 months follow-up. Methods: This study included thirty-seven hemiparetic post-stroke subjects that were randomly allocated into two groups based on the treatment protocol. The non-paretic UL was immobilized for a period of 23 hours per day, five days a week. Participants were evaluated at Baseline, 1st, 2nd, 3rd and 4th weeks, and three months after randomization. For the evaluation we used: The Stroke Impact Scale (SIS), Berg Balance Scale (BBS) and Fugl-Meyer Motor Assessment (FM). Gait was analyzed by the 10-meter walk test (T10) and Timed Up & Go test (TUG). Results: Both groups revealed a better health status (SIS), better balance, better use of lower limb (BBS and FM) and greater speed in gait (T10 and TUG), during the weeks of treatment and months of follow-up, compared to the baseline. Conclusion: The results show mFUT and mCIMT are effective in the rehabilitation of balance and gait. Trial Registration ACTRN12611000411943.

Six minute walk test Z score: Correlations with cystic fibrosis severity markers

Background: The six-minute-walk-test (6MWT) has been increasingly used in cystic fibrosis (CF) patients. However, few studies in children have correlated 6MWT with current parameters used to evaluate CF severity. Moreover, no study transformed the values of distance walked from meters into Z scores to avoid bias like age and gender, which are sources of 6MWT variability. Methods: A cross-sectional descriptive study was performed to analyze the correlations (Spearman) among forced expiratory volume in one second (FEV1), body mass index (BMI), chest radiography (CXR), chest tomography (CT), and 6MWT Z score (Z-6MWT). Clinically stable CF patients, aged 6-21 years, were included. Results: 34 patients, 14F/20M, mean age 12.1 +/- 4.0 years were studied. The mean Z-6MWT was -1.1 +/- 1.106. The following correlations versus Z-6MWT were found: FEV1 (r=0.59, r(2)=0.32, p=0.0002), BMI Z score (r=0.42, r(2)=0.17, p=0.013), CXR (r=0.34, r(2)=0.15, p=0.0472) and CT (r=-0.45, r(2)=0.23, p=0.0073). Conclusions: In conclusion there was a significant, but poor, correlation between the six minute walk test Z score and the cystic fibrosis severity markers currently in use. (C) 2011 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.

Experimental and Numerical Analysis of Gas Forced Convection through Microtubes and Micro Heat Exchangers

The last decade has witnessed very fast development in microfabrication technologies. The increasing industrial applications of microfluidic systems call for more intensive and systematic knowledge on this newly emerging field. Especially for gaseous flow and heat transfer at microscale, the applicability of conventional theories developed at macro scale is not yet completely validated; this is mainly due to scarce experimental data available in literature for gas flows. The objective of this thesis is to investigate these unclear elements by analyzing forced convection for gaseous flows through microtubes and micro heat exchangers. Experimental tests have been performed with microtubes having various inner diameters, namely 750 m, 510 m and 170 m, over a wide range of Reynolds number covering the laminar region, the transitional zone and also the onset region of the turbulent regime. The results show that conventional theory is able to predict the flow friction factor when flow compressibility does not appear and the effect of fluid temperature-dependent properties is insignificant. A double-layered microchannel heat exchanger has been designed in order to study experimentally the efficiency of a gas-to-gas micro heat exchanger. This microdevice contains 133 parallel microchannels machined into polished PEEK plates for both the hot side and the cold side. The microchannels are 200 µm high, 200 µm wide and 39.8 mm long. The design of the micro device has been made in order to be able to test different materials as partition foil with flexible thickness. Experimental tests have been carried out for five different partition foils, with various mass flow rates and flow configurations. The experimental results indicate that the thermal performance of the countercurrent and cross flow micro heat exchanger can be strongly influenced by axial conduction in the partition foil separating the hot gas flow and cold gas flow.

Forced fluid removal in critically ill patients with acute kidney injury

The aim was to test the feasibility of protocol-driven fluid removal with continuous renal replacement therapy (CRRT) in patients in whom standard fluid balance prescription did not result in substantial negative fluid balances.

Evaluation of angle-dependent absorption: Computer simulation and listening test for an objective and subjective evaluation

The aim of this thesis is the subjective and objective evaluation of angledependent absorption coefficients. As the assumption of a constant absorption coefficient over the angle of incidence is not always held, a new model acknowledging an angle-dependent reflection must be considered, to get a more accurate prediction in the sound field. The study provides information about the behavior of different materials in several rooms, depending on the reflection modeling of incident sound waves. An objective evaluation was run for an implementation of angle-dependent reflection factors in the image source and ray tracing simulation models. Results obtained were analysed after comparison to diffuse-field averaged data. However, changes in acoustic characteristics of a room do not always mean a variation in the listener’s perception. Thus, additional subjective evaluation allowed a comparison between the different results obtained with the computer simulation and the response from the individuals who participated in the listening test. The listening test was designed following a three-alternative forced-choice (3AFC) paradigm. In each interaction asked to the subjects a sequence of either three pink noise bursts or three natural signals was alternated. These results were supposed to show the influence and perception of the two different ways to implement surface reflection –either with diffuse or angle-dependent absorption properties. Results show slightly audible effects when material properties were exaggerated. El objetivo de este trabajo es la evaluación objetiva y subjetiva del coeficiente de absorción en función del ángulo de incidencia de la onda de sonido. La suposición de un coeficiente de absorción constante con respecto al ángulo de incidencia no siempre se sostiene. Por ello, un nuevo modelo considerando la reflexión dependiente del ángulo se debe tener en cuenta para obtener predicciones más certeras en el campo del sonido. El estudio proporciona información sobre el comportamiento de diferentes materiales en distintos recintos, dependientes del modelo de reflexión de las ondas de sonido incidentes. Debido a las dificultades a la hora de realizar las medidas y, por lo tanto, a la falta de datos, los coeficientes de absorción dependientes del ángulo a menudo no se tienen en cuenta a la hora de realizar las simulaciones. Hoy en día, aún no hay una tendencia de aplicar el coeficiente de absorción dependiente del ángulo para mejorar los modelos de reflexión. Por otra parte, para una medición satisfactoria de la absorción dependiente del ángulo, sólo hay unos pocos métodos. Las técnicas de medición actuales llevan mucho tiempo y hay algunos materiales, condiciones y ángulos que no pueden ser reproducidos y, por lo tanto, no es posible su medición. Sin embargo, en el presente estudio, los ángulos de incidencia de las ondas de sonido son conocidos y almacenados en una de base de datos para cada uno de los materiales, de modo que los coeficientes de absorción para el ángulo dado pueden ser devueltos siempre que sean requeridos por el usuario. Para realizar el estudio se llevó a cabo una evaluación objetiva, por medio de la implementación del factor de reflexión dependiente del ángulo en los modelos de fuentes imagen y trazado de rayos. Los resultados fueron analizados después de ser comparados con el promedio de los datos obtenidos en medidas en el campo difuso. La simulación se hizo una vez se configuraron un número de materiales creados por el autor, a partir de los datos existentes en la literatura y los catálogos de fabricantes. Los modelos de Komatsu y Mechel sirvieron como referencia para los materiales porosos, configurando la resistividad al aire o el grosor, y para los paneles perforados, introduciendo el radio de los orificios y la distancia entre centros, respectivamente. Estos materiales se situaban en la pared opuesta a la que se consideraba que debía alojar a la fuente sonora. El resto de superficies se modelaban con el mismo material, variando su coeficiente de absorción y/o de dispersión. Al mismo tiempo, una serie de recintos fueron modelados para poder reproducir distintos escenarios de los que obtener los resultados. Sin embargo, los cambios en las características acústicas de un recinto no significan variaciones en la percepción por parte del oyente. Por ello, una evaluación subjetiva adicional permitió una comparación entre los diferentes resultados obtenidos mediante la simulación informática y la respuesta de los individuos que participaron en la prueba de escucha. Ésta fue diseñada bajo las pautas del modelo de test three-alternative forced-choice (3AFC), con treinta y dos preguntas diferentes. En cada iteración los sujetos fueron preguntados por una secuencia alterna entre tres señales, siendo dos de ellas iguales. Éstas podían ser tanto ráfagas de ruido rosa como señales naturales, en este test se utilizó un fragmento de una obra clásica interpretada por un piano. Antes de contestar al cuestionario, los bloques de preguntas eran ordenados al azar. Para cada ensayo, la mezcla era diferente, así los sujetos no repetían la misma prueba, evitando un sesgo por efectos de aprendizaje. Los bloques se barajaban recordando siempre el orden inicial, para después almacenar los resultados reordenados. La prueba de escucha fue realizada por veintitrés personas, toda ellas con conocimientos dentro del campo de la acústica. Antes de llevar a cabo la prueba de escucha en un entorno adecuado, una hoja con las instrucciones fue facilitada a cada persona. Los resultados muestran la influencia y percepción de las dos maneras distintas de implementar las reflexiones de una superficie –ya sea con respecto a la propiedad de difusión o de absorción dependiente del ángulo de los materiales. Los resultados objetivos, después de ejecutar las simulaciones, muestran los datos medios obtenidos para comprender el comportamiento de distintos materiales de acuerdo con el modelo de reflexión utilizado en el caso de estudio. En las tablas proporcionadas en la memoria se muestran los valores del tiempo de reverberación, la claridad y el tiempo de caída temprana. Los datos de las características del recinto obtenidos en este análisis tienen una fuerte dependencia respecto al coeficiente de absorción de los diferentes materiales que recubren las superficies del cuarto. En los resultados subjetivos, la media de percepción, a la hora de distinguir las distintas señales, por parte de los sujetos, se situó significativamente por debajo del umbral marcado por el punto de inflexión de la función psicométrica. Sin embargo, es posible concluir que la mayoría de los individuos tienden a ser capaces de detectar alguna diferencia entre los estímulos presentados en el 3AFC test. En conclusión, la hipótesis de que los valores del coeficiente de absorción dependiente del ángulo difieren es contrastada. Pero la respuesta subjetiva de los individuos muestra que únicamente hay ligeras variaciones en la percepción si el coeficiente varía en intervalos pequeños entre los valores manejados en la simulación. Además, si los parámetros de los materiales acústicos no son exagerados, los sujetos no perciben ninguna variación. Los primeros resultados obtenidos, proporcionando información respecto a la dependencia del ángulo, llevan a una nueva consideración en el campo de la acústica, y en la realización de nuevos proyectos en el futuro. Para futuras líneas de investigación, las simulaciones se deberían realizar con distintos tipos de recintos, buscando escenarios con geometrías irregulares. También, la implementación de distintos materiales para obtener resultados más certeros. Otra de las fases de los futuros proyectos puede realizarse teniendo en cuenta el coeficiente de dispersión dependiente del ángulo de incidencia de la onda de sonido. En la parte de la evaluación subjetiva, realizar una serie de pruebas de escucha con distintos individuos, incluyendo personas sin una formación relacionada con la ingeniería acústica.

Normative contrast sensitivity values for the back-lit Melbourne Edge Test and the effect of visual impairment

Background: The Melbourne Edge Test (MET) is a portable forced-choice edge detection contrast sensitivity (CS) test. The original externally illuminated paper test has been superseded by a backlit version. The aim of this study was to establish normative values for age and to assess change with visual impairment. Method: The MET was administered to 168 people with normal vision (18-93 years old) and 93 patients with visual impairment (39-97 years old). Distance visual acuity (VA) was measured with a log MAR chart. Results: In those eyes without disease, MET CS was stable until the age of 50 years (23.8 ± .7 dB) after which it decreased at a rate of ≈1.5 dB per decade. Compared with normative values, people with low vision were found to have significantly reduced CS, which could not be totally accounted for by reduced VA. Conclusions: The MET provides a quick and easy measure of CS, which highlights a reduction in visual function that may not be detectable using VA measurements. © 2004 The College of Optometrists.