ABSTRACT
RESUMO Objetivo avaliar os diferentes componentes da resistência do sistema respiratório e a força muscular respiratória, bem como investigar a ocorrência de limitação de fluxo expiratório (LFE) de pacientes obesos mórbidos (OM) na posição sentada. Métodos a amostra foi composta de OM (IMC ≥ 40 kg/m2) e de indivíduos não obesos (NO) com IMC entre 18 e 30 kg/m2. O protocolo foi composto de: avaliação antropométrica e da função respiratória (espirometria, pressões inspiratória (PIM) e expiratória máximas (PEM) e oscilometria de impulso). Na comparação entre os grupos, foi utilizado o teste T para amostras não pareadas. As correlações foram avaliadas pelo teste de Pearson, e o nível de significância foi de 5%. Resultados Foram avaliados 50 OM (idade 40,0 ± 10,4 anos, 1,64 ± 0,09 m, 138,8 ± 33,6 kg e 50,7 ± 8,9 kg/m2), além de 30 NO (idade 37,6 ± 11,5 anos, 1,67 ± 0,09 m, 65,2 ± 10,3 kg e 23,2 ± 22 kg/m2). Os OM apresentaram maiores valores de resistência total, central, de vias aéreas, tecidual e periférica quando comparados aos NO. Nenhum paciente apresentou LFE. A circunferência abdominal se associou com variáveis espirométricas PIM e PEM. A relação cintura-quadril se correlacionou com variáveis de mecânica respiratória, além das espirométricas PIM e PEM. Conclusões pacientes com obesidade mórbida e sem padrão espirométrico obstrutivo apresentam aumento nas resistências total, de vias aéreas, periférica e tecidual do sistema respiratório quando comparados a não obesos. Esses indivíduos, entretanto, não apresentam limitação de fluxo expiratório e redução da força muscular respiratória.
ABSTRACT Objective To evaluate the different components of the resistance of the respiratory system, respiratory muscle strength and to investigate the occurrence of expiratory flow limitation (EFL) in patients with morbid obesity (MO) when seated. Methods The sample was composed of MO (BMI≥40 kg/m2) and non-obese individuals (NO) with a BMI between 18 and 30 kg/m2. The protocol consisted of the anthropometric assessment and the following measures of respiratory function: spirometry, maximal inspiratory and expiratory pressures (MIP and MEP, respectively) and impulse oscillometry. The group comparison was performed using T-test for unpaired samples. The correlations were evaluated by the Pearson test with a significance level of 5%. Results Fifty MO (age 40±10.4 years, 1.64±0.09 m, 138.8±33.6 kg and 50.7±8.9 kg/m2), and 30 NO (age 37.6±11.5 years, 1.67±0.09 m, 65.2±10.3 kg and 23.2±22 kg/m2) were evaluated. The MO showed higher values of total, peripheral, airways, tissue and central resistance when compared to the NO. No patient showed EFL. The waist circumference was associated with spirometric variables, MIP, and MEP. The waist-to-hip ratio was correlated to respiratory mechanics and spirometric variables, MIP, and MEP. Conclusion Morbidly obese patients with no obstructive spirometric pattern show increased total, airway, peripheral, and tissue respiratory system resistance when compared to nonobese. These individuals, however, do not present with expiratory flow limitation and reduced respiratory muscles strength.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Obesity, Morbid/physiopathology , Respiratory Muscles/physiopathology , Respiratory Mechanics/physiology , Muscle Strength/physiology , Reference Values , Respiratory Function Tests , Case-Control Studies , Anthropometry , Cross-Sectional Studies , Statistics, Nonparametric , Exhalation/physiologyABSTRACT
Objective to investigate the differences n expressions of P-glycoprotein (P-gp), breast cancer drug resistance protein (BCRP) and pulmonary resistance protsnn (LRP) between psimary breast careinoma and metastatic lymph nodes. Methods The expressions of P-gp, BCRP and LRP in breast cancer tissues, including 126 primary carcinoma and 66 metastasis lymph nodes, were determined immunohistochemically on formalin-fixed, paraffin-embedded tumor sections. Results (1)The positive expression rates of P-gp, BCRP and LRP were 41. 27% (52/126), 38. 89% (49/126), and 65. 87% (83/126) in primary breast carcinoma, and were 59. 09% (39/66), 63. 64%(42/66),and 60. 61% (40/66) n metastatic lymph nodes, respctively. The posiiive rates of P-gp and BCRP in the metastatic lymph nodes were significantly higher than those in primary cancer iissue(P0. 05). (2) There was a poor consistency in P-gp and BCRP expressoon between the psimary and metastatic sites(P0. 05). (3) The co-expresion rate of two resistance proteins in primary breast carcinoma was 35. 71%(45/126), of three resistance proteins was 15. 08%(19/ 126), and of two or three resistance proteins was 50. 79% (64/126), being significantly higher than that of a single protein 33. 33% (42/126,P<0. 05). The co-expression rate of two resistance proteins in metastasis lymph nodes was 53. 03% (35/66), which was significantly higher than that of a single protein 27. 27% (18/66, P < 0. 05). The co-expression rate of three resistance proteins was 16. 67%(11/66), two or three resistance proteins was 69. 70%(46/66), which was significantly higher than that of a single protein (P<0. 01). Both the co-expresion levels of two resistance proteins and two or three resistance proteins in metastatic lymph nodes were significantly higher than those in primary cancer (P<0. 05). (4)Kaplan-Meier analyses revealed that patients with P-gp, BCRP and LRP expressed in the metastatic lymph nodes had a lower 5-year survival rate compared with patients whose primary breast cancer being positive for them. Conclusion The expression of P-gp and BCRP is different between the primary and metastatic breast cancer sites, and there is no signAcant difference in LRP expression. Coordination of multi-protein expression is a major feature of resistance. Metastasis lymph nodes may have a stronger resistance.
ABSTRACT
JUSTIFICATIVA E OBJETIVOS: Em ventilação mecânica invasiva e não-invasiva, o conhecimento da fisiologia da mecânica respiratória, é imprescindível para tomada de decisões e no manuseio eficiente dos ventiladores modernos. A monitorização dos parâmetros da mecânica pulmonar é recomendada nos trabalhos de revisão e de pesquisas clínicas. O objetivo deste estudo foi rever os conceitos de mecânica pulmonar e os métodos utilizados para obtenção de medidas à beira do leito, enfatizando três parâmetros: resistência, complacência e PEEP intrínseca. MÉTODO: Foi realizada revisão bibliográfica através dos bancos de dados LILACS, MedLine e PubMed, no período de 1996 a 2006. RESULTADOS: Esta revisão abordou os parâmetros de resistência, complacência pulmonar e PEEP intrínseca como fundamentais na compreensão da insuficiência respiratória aguda e suporte ventilatório mecânico, principalmente na doença pulmonar obstrutiva crônica (DPOC) e na síndrome da angústia respiratória aguda (SARA). CONCLUSÕES: A monitorização da mecânica pulmonar em pacientes sob ventilação mecânica em unidade de terapia intensiva (UTI) pode fornecer dados relevantes e deve ser implementada de forma sistemática e racional.
BACKGROUND AND OBJECTIVES: In mechanical ventilation, invasive and noninvasive, the knowledge of respiratory mechanic physiology is indispensable to take decisions and into the efficient management of modern ventilators. Monitoring of pulmonary mechanic parameters is been recommended from all the review works and clinical research. The objective of this study was review concepts of pulmonary mechanic and the methods used to obtain measures in the bed side, preparing a rational sequence to obtain this data. METHODS: It was obtained bibliographic review through data bank LILACS, MedLine and PubMed, from the last ten years. RESULTS: This review approaches parameters of resistance, pulmonary compliance and intrinsic PEEP as primordial into comprehension of acute respiratory failure and mechanic ventilatory support, mainly in acute respiratory distress syndrome (ARDS) and in chronic obstructive pulmonary disease (COPD). CONCLUSIONS: Monitoring pulmonary mechanics in patients under mechanical ventilation in intensive care units gives relevant informations and should be implemented in a rational and systematic way.