Com o objetivo de avaliar possíveis diferenças nos valores obtidos na realização da cirtometria tóraco-abdominal em ortostatismo comparado com os resultados aferidos em decúbito dorsal, foram avaliados 30 participantes com média de idade de 27,8±4,4 anos, por meio dos seguintes parâmetros: antropometria, prova de função pulmonar e mobilidade tóraco-abdominal pela cirtometria. O teste de Shapiro-Wilk foi utilizado para verificar a normalidade dos dados e o teste t pareado para a comparação entre as mensurações obtidas pela cirtometria tóraco-abdominal em decúbito dorsal e em ortostatismo. Não houve diferenças significativas na mobilidade axilar e xifoidea entre as medidas em decúbito dorsal e ortostatismo. A mobilidade abdominal mensurada em ortostatismo (2,54±1,39 cm) foi significativamente menor (34,35%) em comparação à mobilidade obtida em decúbito dorsal (3,71±1,78 cm; p<0,001). A cirtometria torácica pode ser realizada em ortostatismo como uma alternativa para a avaliação de pacientes que referem ortopnéia. A cirtometria abdominal também pode ser realizada nessa postura, com a ressalva de ser esperada uma redução em torno de um terço da mobilidade abdominal obtida em decúbito dorsal.

Objective:To compare diaphragmatic mobility, lung function, and respiratory muscle strength between COPD patients with and without thoracic hyperkyphosis; to determine the relationship of thoracic kyphosis angle with diaphragmatic mobility, lung function, and respiratory muscle strength in COPD patients; and to compare diaphragmatic mobility and thoracic kyphosis between male and female patients with COPD. Methods:Participants underwent anthropometry, spirometry, thoracic kyphosis measurement, and evaluation of diaphragmatic mobility. Results:A total of 34 patients with COPD participated in the study. Diaphragmatic mobility was significantly lower in the group of COPD patients with thoracic hyperkyphosis than in that of those without it (p = 0.002). There were no statistically significant differences between the two groups of COPD patients regarding lung function or respiratory muscle strength variables. There was a significant negative correlation between thoracic kyphosis angle and diaphragmatic mobility (r = −0.47; p = 0.005). In the sample as a whole, there were statistically significant differences between males and females regarding body weight (p = 0.011), height (p < 0.001), and thoracic kyphosis angle (p = 0.036); however, there were no significant differences in diaphragmatic mobility between males and females (p = 0.210). Conclusions:Diaphragmatic mobility is lower in COPD patients with thoracic hyperkyphosis than in those without it. There is a negative correlation between thoracic kyphosis angle and diaphragmatic mobility. In comparison with male patients with COPD, female patients with COPD have a significantly increased thoracic kyphosis angle.

The purpose of this study was to evaluate the effects of N-acetylcysteine (NAC) supplementation on cellular damage and oxidative stress indicators in volleyball athletes. Twenty male volleyball athletes at national level performed a physical training session and were divided into 2 groups, which for 7 days took the placebo substance or NAC. After 7 days the athletes repeated the same training session. In both sessions, blood samples were collected 30 min before and immediately after the training session to measure cellular damage and oxidative stress markers. The main results show that, although higher concentrations of glutathione peroxidase and superoxide dismutase were observed in post-session 1 than those in postsession 2, the other markers showed an increase in antioxidant action after supplementation of NAC, once the effect of experimental conditions (P=0.030) were observed in: time effect (P<0.001) and interaction (P=0.019) for total glutathione; time effect (P<0.001) and interaction (P<0.001) for reduced glutathione; and time effect (P<0.001) for ferric-reducing antioxidant potential. The oxidant action indicated by the protein carbonyl was higher in the placebo group than in the NAC group (P=0.028), but a time effect (P<0.001) for the thiobarbituric acid reactive substances showed lower values in presession 1 than in presession 2. For the cellular damage markers, antagonistic results between markers were found. Based in the results, the supplementation of NAC during a short period was effective in reducing oxidant action and increasing antioxidant action. However, conclusive alterations in the responses of the cellular damage markers were not obtained.

BackgroundFluoroscopy is considered the most accurate method to evaluate the diaphragm, yet most existing methods for measuring diaphragmatic mobility using fluoroscopy are complex. To assess the validity and reliability of a new evaluation method of diaphragmatic motion using fluoroscopy by digital radiography of healthy adults.MethodsTwenty-six adults were evaluated, according to the parameters: anthropometry and pulmonary function test. The evaluation of diaphragm mobility by means of fluoroscopy by digital radiography method was randomly conducted by two raters (A and B). The Pearson correlation coefficient and the intraclass correlation coefficient (ICC) were used to assess the concurrent validity. The inter-rater and intra-rater reliability of the measurement of diaphragmatic motion was determined using ICC and a confidence interval of 95%.ResultsThere was a relationship in the assessment of the concurrent validity. There was good inter-rater reliability for right hemidiaphragm mobility and moderate reliability for left hemidiaphragm in the first assessment. In the second assessment, there was good reliability for the mobility of both hemidiaphragms. There was good intra-rater reliability in the mobility of both hemidiaphragms for raters A and B.ConclusionThe evaluation of diaphragmatic motion using fluoroscopy by digital radiography proved to be a valid and reliable method of healthy adults.

Introduction: In chronic obstructive pulmonary disease (COPD), airflow resistance impairs respiratory mechanics that may compromise postural alignment. There is a lack of studies that have investigated compromised postures and their possible associations with pulmonary function. Objectives: To compare the postural alignment of COPD patients with apparently healthy individuals; To correlate pulmonary function with postural alignment in the COPD group. Methods: 20 COPD patients and 20 apparently healthy individuals performed: anthropometry, spirometry and postural evaluation. The following postural changes were assessed: lateral head tilt (LHT), shoulder asymmetry (SA1), anterior pelvic asymmetry (APA), lateral trunk tilt (LTT), scapular asymmetry (SA2), posterior pelvic asymmetry (PPA), head protrusion (HP), shoulder protrusion (SP), anterior pelvic tilt (APT) and thoracic kyphosis (TK). Results: There was a statistically significant difference between COPD patients and apparently healthy individuals in the following variables: PPT (p= 0.021), APT (p=0.014) and TK (p=0.011). There was a correlation between pulmonary variables and postural alignment in the COPD group: Forced Volume in one second (FEV1% pred) and HP (°) (r=0.488, p=0.029), FEV1 (% pred) and APT (°) (r= -0.472, p= 0.036); Forced Vital Capacity (FVC % pred) and HP (°) (r=0.568, p=0.009); FVC (% pred) and APT (°) (r=-0.461, p=0.041). Conclusion: Postural alignment of the anterior tilt of the right

RESUMO Avaliar o músculo diafragma é importante para verificar suas possíveis alterações ou disfunções. Existem várias formas de avaliar a mobilidade diafragmática, mas poucos estudos que comparam a mobilidade do hemidiafragma direito com o esquerdo. O objetivo deste estudo é avaliar se existem diferenças entre a mobilidade diafragmática das hemicúpulas direita e esquerda em indivíduos saudáveis e em indivíduos com Doença Pulmonar Obstrutiva Crônica (DOCP), bem como comparar a mobilidade diafragmática entre homens e mulheres, e entre pacientes saudáveis e com DPOC. Foram avaliados 40 indivíduos saudáveis e 40 indivíduos com diagnóstico clínico de DPOC. Utilizaram-se os parâmetros antropométricos, cardiopulmonares e avaliação da mobilidade diafragmática pelo método radiográfico. Os dados foram analisados estatisticamente e tratados com análise descritiva (média e desvio-padrão) e análise inferencial. Para comparar a mobilidade das hemicúpulas diafragmáticas direita e esquerda, utilizou-se o teste t pareado. O nível de significância adotado para o tratamento estatístico foi de 5% (p<0,05). Não houve diferença da mobilidade diafragmática tanto do lado direito quanto do lado esquerdo nos indivíduos saudáveis (p=0,45) e nos indivíduos com DPOC (p=0,77), assim como não houve diferenças quando os grupos foram separados por sexo. Foi encontrada uma diferença importante comparando tanto a mobilidade diafragmática do lado direito quanto do lado esquerdo entre indivíduos saudáveis e DPOC (p<0,001). Concluiu-se que a mobilidade diafragmática das hemicúpulas direita e esquerda em indivíduos saudáveis e em indivíduos com DPOC é a mesma. Não há diferença da mobilidade entre homens e mulheres. A mobilidade diafragmática é reduzida em paciente com DPOC.

RESUMO Na doença pulmonar obstrutiva crônica (DPOC), os pacientes podem apresentar redução da mobilidade diafragmática e uma série de compensações na coluna torácica, nas cinturas escapular e pélvica. No entanto, não está clara a relação da mobilidade diafragmática com alterações posturais na coluna vertebral e na pelve desses indivíduos. Objetivou-se verificar se existe relação entre a mobilidade diafragmática com as curvaturas da coluna vertebral de pacientes com DPOC e em indivíduos aparentemente saudáveis. Foram avaliados 22 pacientes com DPOC e 22 indivíduos aparentemente saudáveis. As avaliações foram: antropometria, espirometria, mobilidade diafragmática e avaliação postural. Foram analisadas quatro alterações posturais: lordose cervical, cifose torácica, lordose lombar, posição pélvica. Não houve diferença estatisticamente significativa entre os grupos, em relação às variáveis idade, massa corporal, estatura e IMC, confirmando que os grupos foram pareados. Não houve diferença estatisticamente significante em nenhuma das variáveis referentes às curvaturas da coluna vertebral e à posição da pelve entre os grupos estudados. No grupo DPOC houve correlação da mobilidade diafragmática com a cifose torácica (r=-0,543; p=0,009). Já em relação ao grupo de indivíduos aparentemente saudáveis, não houve correlação da mobilidade quanto os indivíduos aparentemente saudáveis apresentaram os mesmos ângulos de curvatura da coluna vertebral e a mesma posição da pelve. Contudo, os pacientes com DPOC apresentaram relação entre a mobilidade diafragmática e o ângulo da curvatura torácica.

Cardiomyopathy / Pulmonary embolism: risk-adjusted management 345(126±27 vs. 104±24 ml, before RT vs. after RT; P<0.01) significantly decreased at 12-month after RT, in which a decrease in LVMI was more evident in the REF group than that in the PEF group (-27±5 and -8±7% respectively, P<0.05). In the REF group, mean LVEF gradually increased and was normalized at 12-month after RT (from 46±3 to 71±4%, P<0.0001), albeit not obvious in the PEF group. Of note, the change in LVEF after RT negatively correlated well with basal EF (r = -0.84, P<0.0001, Figure). RT recipients had improvement of anemia (mean hemoglobin level; from 10.7±1.3 to 12.0±1.6 g/dl, P<0.01) and hypertension (mean systolic blood pressure; from 148±16 to 126±9.7 mmHg, P<0.01). Moreover, washout rate of MIBG was significantly decreased in the RT group when compared to baseline data (from 19.6±3 to 10.2±0.9%, P<0.01). Background:We have previously shown that potentially fatal pulmonary embolism (PE) is increased sevenfold during the first trimester (T1) of an IVF pregnancy. We hypothesized that this could be caused by the estrogen surge during the ovarian stimulation phase (OS). IVF pregnancies after frozen embryo transfer (FET) are not preceded by this surge in estrogen level. Purpose: We compared the incidence of PE and venous thromboembolism (VTE) in IVF pregnancies immediately after OS and after FET to that in natural pregnancies (NP) to investigate whether the estrogen surge might explain the increased incidence of PE. Methods: A population-based observational cohort study comprising all women who delivered their first child during 1992-2012 (n=902 891). Exposures: IVF pregnancies immediately after OS respectively after FET and natural pregnancies. Multivariable adjusted time-varying hazard ratios in trimester 1-3 and postpartum were analyzed. Follow-up period was from start of pregnancy until +42 days post-partum (PP). Results: We found an increased incidence of PE during the first trimester (T1) in the OS group as compared to NP; HR 8.69 p<0.001). There were no cases of PE in the FET group during T1. There were very few PE events during T2-T3 after both OS and FET. The VTE incidence in the OS group was increased as compared to NP during T1; HR 8.96 (CI 6.33-12.67; p<0.000). The incidence of VTE in the FET group was not significantly increased during T1. No increased VTE incidence as compared to NP was identified during T2-3 in the OS and FET groups. Conclusion: OS seems to be the inducting event preceding both PE as well as VTE during IVF. Thus, it seems plausible that the estrogen surge during OS might provoke thrombogenicity. An increased use of FET in IVF might decrease the risk of potentially fatal pulmonary embolism. Acknowledgement/Funding: The Stockholm County Council (ALF project) and the Swedish Heart and Lung Foundation P1611 | BEDSIDE Prognostic value of thrombus burden, thrombus distribution and RV/LV ratio assessed by multi-detector computed tomography in pulmonary embolism Background: The 2014 ESC guideline recommends risk st...