Effects of non-invasive ventilation and posture on chest wall volumes and motion in patients with amyotrophic lateral sclerosis: a case series

ABSTRACT Background The effects of non-invasive ventilation (NIV) on the breathing pattern and thoracoabdominal motion of patients with amyotrophic lateral sclerosis (ALS) are unknown. Objectives 1) To analyze the influence of NIV on chest wall volumes and motion assessed by optoelectronic plethysmography in ALS patients and 2) to compare these parameters in the supine and sitting positions to those of healthy individuals (without NIV). Method Nine ALS patients were evaluated in the supine position using NIV. In addition, the ALS patients and nine healthy individuals were evaluated in both sitting and supine positions. Statistical analysis was performed using the paired Student t-test or Wilcoxon test and the Student t-test for independent samples or Mann-Whitney U test. Results Chest wall volume increased significantly with NIV, mean volume=0.43 (SD=0.16)L versus 0.57 (SD=0.19)L (p=0.04). No significant changes were observed for the pulmonary rib cage, abdominal rib cage, or abdominal contribution. The index of the shortening velocity of the diaphragmatic muscle, mean=0.15 (SD=0.05)L/s versus 0.21 (SD=0.05)L/s (p<0.01), and abdominal muscles, mean=0.09 (SD=0.02)L/s versus 0.14 (SD=0.06)L/s (p<0.01), increased during NIV. Comparisons between the supine and sitting positions showed similar changes in chest wall motion in both groups. However, the ALS patients presented a significantly lower contribution of the abdomen in the supine position compared with the controls, mean=56 (SD=13) versus 69 (SD=10) (p=0.02). Conclusions NIV improved chest wall volumes without changing the contribution of the chest wall compartment in ALS patients. In the supine position, ALS patients had a lower contribution of the abdomen, which may indicate early diaphragmatic dysfunction.

Morfologia das glândulas salivares de glironia venusta Thomas, 1912 (didelphimorphia) / Morphology of salivary glands of the glironia venusta Thomas, 1912 (didelphimorphia)

O objetivo deste trabalho foi descrever a morfologia das glândulas salivares de Glironia venusta. Foi utilizado um exemplar coletado no resgate de fauna da Usina Hidroeletrica Teles Pires. Este foi fixado com solução de formaldeído a 10%. Para a análise macroscópica, as glândulas foram dissecadas e fotografadas in situ e para a microscopia foram retirados fragmentos das glândulas. Estes foram desidratados em concentrações crescentes de álcool, diafanizados em xilol, inclusos em parafina e corados com HE. G. venusta apresentou as glândulas mandibulares, parótidas, sublinguais, labiais e zigomáticas. As mandibulares se mostraram como estruturas alongadas, constituídas por lobos não septados e localizadas na porção anterior da região cervical. De formato triangular, a parótida estava localizada na depressão do masseter, ventral à cartilagem auricular. As sublinguais encontravam-se ventrais ao ramo da mandíbula, caudais ao digástrico. Foi observado na porção dorsoposterior à comissura labial, dorsal ao músculo orbicular da boca, as glândulas labiais, que apresentaram formato de "U". Já as glândulas zigomáticas acompanhavam a forma da porção anterior do arco zigomático, na margem infraorbital. As glândulas mandibulares e sublinguais apresentaram ácinos do tipo mucosos, com alguns ácinos serosos. A parótida era constituída por ácinos puramente serosos. Na glândula labial foi observado ácinos do tipo mistos ou seromucosos. Para a glândula zigomática não foi possível a realização da análise microscópica devido problemas de procedimento histológico. As características das glândulas salivares observadas em G. venusta se assemelham a de outros mamíferos onívoros, entretanto, apresentaram pequenas diferenças no que se refere à sua localização e forma.

The aim of this study was to describe the morphology of the salivary glands of Glironia venusta. A sample of G. venusta was collected in fauna rescue of hidroelectric usine of Teles Pires was used. This exemplar was fixed with formaldehyde solution 10%. For macroscopic analysis, the glands were dissected and photographed in situ and for the microscopy fragments of the glands were removed, that were dehydrated in increasing alcohol concentrations, diaphanizated in xylene, included in paraffin and stained with hematoxylin and eosin. G. venusta presented the mandibular, parotid, sublingual, labial and zygomatic glands. The mandible is shown as elongated structures, composed of non-septated lobes and located in the anterior cervical region. With a triangular format, the parotid was located in the depression of the masseter, ventral an auricular cartilage. The sublingual were located ventral to the mandible, caudal to the digastric muscle. In the posterior dorsal portion, until the labial commissure, dorsal to the orbicularis muscle of mouth was observed the labial glands, which showed a "U" shape. The zygomatic glands was accompanied the shape of the anterior portion of the zygomatic arch at the infraorbital margin. The mandibulars and sublinguals glands showed acini of mucous type, with some serous acini. The parotid one was made up purely by serous acini. In the labial gland was observed acini of mixed types mixed or seromucosous. Related the zygomatic gland was not possible to perform the microscopic analysis because of histological proceeding problems. Characteristics of the salivary glands observed in G. venusta resemble other omnivores mammals, but showed small differences as regards their location and shape.