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.

Energy system contributions in indoor rock climbing

The present study cross-sectionally investigated the influence of training status, route difficulty and upper body aerobic and anaerobic performance of climbers on the energetics of indoor rock climbing. Six elite climbers (EC) and seven recreational climbers ( RC) were submitted to the following laboratory tests: ( a) anthropometry, (b) upper body aerobic power, and ( c) upper body Wingate test. on another occasion, EC subjects climbed an easy, a moderate, and a difficult route, whereas RC subjects climbed only the easy route. The fractions of the aerobic (WAER), anaerobic alactic (W-PCR) and anaerobic lactic (W-[La(])-) systems were calculated based on oxygen uptake, the fast component of excess post-exercise oxygen uptake, and changes in net blood lactate, respectively. on the easy route, the metabolic cost was significantly lower in EC [ 40.3 ( 6.5) kJ] than in RC [60.1 ( 8.8) kJ] ( P < 0.05). The respective contributions of the WAER, WPCR, and W-[La(])- systems in EC were: easy route = 41.5 (8.1), 41.1 (11.4) and 17.4% (5.4), moderate route = 45.8 (8.4), 34.6 (7.1) and 21.9% (6.3), and difficult route = 41.9 (7.4), 35.8 (6.7) and 22.3% (7.2). The contributions of the WAER, WPCR, and W-[La(])- systems in RC subjects climbing an easy route were 39.7 (5.0), 34.0 (5.8), and 26.3% (3.8), respectively. These results indicate that the main energy systems required during indoor rock climbing are the aerobic and anaerobic alactic systems. In addition, climbing economy seems to be more important for the performance of these athletes than improved energy metabolism.

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.

Stem anatomy and development of successive cambia in Hebanthe eriantha (Poir.) Pedersen: A neotropical climbing species of the Amaranthaceae

Hebanthe eriantha (Poir.) Pedersen, a climbing species of the Amaranthaceae increases in stem thickness by forming successive cambia. The family is dominated by herbaceous species and is constantly under discussion due to its disputed nature of the meristem. In the young stem small alternate segments of vascular cambium cease to divide and new arc of cambium initiates outside to it. The newly formed arcs connect with pre-existing alternate segments of cambium to complete the ring. On the contrary, in thick stems, instead of small segments, complete ring of cambium is replaced by new one. These new alternate segments/cambia originate from the parenchyma cells located outside to the phloem produced by previous cambium. Cambium is storied and exclusively composed of fusiform initials while ray cells remain absent at least in the early part of the secondary growth. However, large heterocellular rays are observed in 15-mm diameter stems but their frequency is much lower. In some of the rays, ray cells become meristematic and differentiate into radially arranged xylem and phloem elements. In fully grown plants, stems are composed of several successive rings of secondary xylem alternating with secondary phloem. Secondary xylem is diffuse-porous and composed of vessels, fibres, axial parenchyma while exceptionally large rays are observed only in the outermost regions of thick stems. Vessel diameter increases progressively from the centre towards the periphery of stems. Although the origin of successive cambia and composition of secondary xylem of H. eriantha remains similar to other herbaceous members of Amaranthaceae, the occurrence of relatively wider and thick-walled vessels and large rays in fully grown plants is characteristic to climbing habit. © 2013 Springer-Verlag Wien.

Comparison of different analysis techniques for the determination of muscle onset in individuals with patellofemoral pain syndrome

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Efeitos do estímulo verbal sobre o desempenho no teste de escada e ajustes cardiorrespiratórios em sujeitos saudáveis

Esta pesquisa teve o objetivo de avaliar os efeitos do estímulo verbal (EV) no tempo do teste de escada (TEsc) e nas variáveis cardiorrespiratórias de adultos saudáveis. Trinta e um adultos saudáveis realizaram dois TEsc (com EV e sem EV). Antes e depois de cada teste, foram avaliados os sinais vitais e a Escala de Borg. Os tempos nos TEsc foram comparados por meio do Teste t de Student para amostras pareadas e as diferenças, de acordo com a ordem de realização dos testes utilizando o Teste de Mann-Whitney. Os sinais vitais e a Escala de Borg foram comparados por meio do Teste de Friedman ou ANOVA com post hoc do Teste de Tukey. As variações foram comparadas utilizando o Teste t Student para amostras independentes ou Teste de Mann-Whitney (p<0,05). O tempo no TEsc sem EV foi de 23,48±8,28 segundos, significativamente maior que o teste com EV, que foi de 21,60±7,18 segundos (p<0,05). Todas as variáveis aumentaram após os testes, e a Escala de Borg foi a única que teve maior variação no TEsc com EV, variando 2,5±1,4 no teste sem estímulo e 3,0±1,8 pontos no com estímulo (p<0,05). O estímulo verbal melhora o desempenho no TEsc e leva à maior sensação de esforço.

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.

Surgical risk tests related to cardiopulmonary postoperative complications: comparison between upper abdominal and thoracic surgery

PURPOSE: To investigate if tests used in the preoperative period of upper abdominal or thoracic surgeries are able to differentiate the patients that presented cardiopulmonary postoperative complications. METHODS: Seventy eight patients, 30 submitted to upper abdominal surgery and 48 to thoracic surgery were evaluated. Spirometry, respirometry, manovacuometry, six-minute walk test and stair-climbing test were performed. Complications from immediate postoperative to discharge from hospital were registered. RESULTS: The postoperative complications rate was 17% in upper abdominal surgery and 10% in thoracic surgery. In the univariate regression, the only variable that kept the correlation with postoperative complications in the upper abdominal surgery was maximal expiratory pressure. In thoracic surgery, the maximal voluntary ventilation, six-minute walk test and time in stair-climbing test presented correlation with postoperative complications. After multiple regression only stair-climbing test continued as an important risk predictor in thoracic surgery. CONCLUSION: The respiratory pressure could differentiate patients with complications in upper abdominal surgery, whereas in thoracic surgery, only spirometric values and exercise tests could differentiate them.

Study on functional cardiorespiratory changes after laparoscopic Nissen fundoplication

PURPOSE: To analyze the behavior of cardiopulmonary function in postoperative of laparoscopic Nissen fundoplication.METHODS: Thirty-two patients, 13 males (41%) and 19 females (59%), were evaluated. Their age ranged from 25 to 67 years, with a mean of 44.4 +/- 10.9. Pulmonary volumes, respiratory pressures and exercise tests were performed in the preoperative period (PRE) and in the first (PO1), second (PO2), fifth (PO5) and thirtieth (PO30) postoperative periods.RESULTS: Thirty-two patients were evaluated, of whom 59% were females. Mean age was 44.4 +/- 10.9 years. Lung volumes had significant decrease at PO1 and PO2 and were similar to PRE values at PO5. Respiratory pressures were altered only at PO1. The distance covered in the 6-minute walk test had significant reduction until PO2, and climbing time in the stair-climbing test significantly increased at PO2.CONCLUSION: Patients submitted to LNF surgery have decreased cardiorespiratory function in the early postoperative period; however, they soon return to preoperative conditions.

Florística de trepadeiras numa floresta estacional semidecídua, Rio Claro - Araras, Estado de São Paulo, Brasil

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Fear and adventure tourism in Brazil

The search for new non-routine emotions and sensations has become a decisive factor in taking part in adventure tourism. As Barros and Dines (2000) have pointed out, Brazil's natural resources are abundant and have been widely used to promote the nation's tourism. Empirical literature describes fear as one of the main emotions in adventure activities, and for this reason a questionnaire was designed to examine the presence of fear before and after three adventure activities (parachuting, white-water rafting, and rock-climbing). This study not only aimed to consolidate fear as a fundamental emotion in performing such activities but also to stimulate interest for further studies in this area. (C) 2009 Elsevier Ltd. All rights reserved.

Phylogeny, Ecology, and Heart Position in Snakes

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

Influences of the load centre of gravity on heavy vehicle acceleration

The aim of this paper is to analyse the influence of the load centre of gravity on heavy vehicle acceleration. This analysis is done through a method in which a vehicle centre of gravity map is used. A model for the driving force is presented for bus, truck and tractor-semi trailer combinations. The proposed model takes into consideration the resistance forces (drag, rolling resistance, translation and rotation acceleration, climbing resistance) and the 4 X 2 traction system. The positions of the vehicle centre of gravity as a function of the position of the load centre of gravity are determined. The vehicle acceleration is calculated based on the position of the load centre of gravity. This study analyses the acceleration of one of the Mercedes-Benz do Brasil tractor-semitrailer vehicle. A comparison of the acceleration for different maximum adhesion coefficients and ramps are presented, showing new results. An example showing the variations of the load centre of gravity position with the acceleration time and distance is provided. The load centre of gravity position is important for vehicle safety and the efficiency and economy in the transportation of the load.

Aspectos fisiológicos do mountain biking competitivo

A prática do ciclismo off-road (mountain biking - MTB), cresceu muito nas últimas duas décadas, sendo incluído como esporte olímpico, nos Jogos de Atlanta em 1996, na modalidade Cross Country. Na última década, houve um aumento no número de publicações científicas que verificaram a demanda fisiológica durante competições, assim como o estudo de possíveis preditores da performance nesta modalidade. O objetivo deste estudo de revisão foi descrever alguns aspectos fisiológicos específicos do MTB Cross Country (MTB CC) competitivo (intensidade de provas, perfil fisiológico de atletas de elite, uso de suspensões e determinantes da performance em subidas). Observa-se na literatura analisada que as provas de MTB CC parecem impor uma sobrecarga fisiológica maior, quando analisada através da frequência cardíaca, do que provas de ciclismo de estrada com duração semelhante. Entretanto, quando analisada pela potência de pedalada, observa-se claramente a característica intermitente da modalidade, com variações de potência durante a prova entre zero e 500W, e potência média relativamente baixa em comparação aos valores de FC encontrados. Outro fator importante levantado neste estudo são as alterações fisiológicas decorrentes do uso de suspensões nas bicicletas de MTB CC. O uso deste equipamento reduz o estresse muscular provocado pelo terreno acidentado, embora pareça não afetar o gasto energético total, tanto em percurso plano como em subidas. Entretanto, é fato que o desempenho em circuitos acidentados é melhorado com o uso das suspensões. Com base nos estudos abordados nessa revisão, conclui-se que o MTB CC enquanto modalidade competitiva apresenta uma grande variação de intensidade (avaliada através da potência), sendo esta atribuída principalmente ao tipo de terreno (irregular e com muitas aclives e declives acentuados) em que as provas de MTB CC acontecem.