Alterações cardiorrespiratórias em indivíduos hemiparéticos crônicos pós-acidente vascular cerebral / Cardiorespiratory changes in chronic post-stroke hemiparetic patients

Objetivo: Analisar a função cardiorrespiratória em pacientes he- miparéticos crônicos pós-acidente vascular cerebral. Métodos: Estudo retrospectivo, por meio da análise de dados de prontuários de pacientes submetidos ao teste de caminhada de 6 minutos e manovacuometria em uma clínica de fisioterapia de um centro universitário. Foram analisados os dados de sete prontuários. Re- sultados: A média de metros percorridos pelos participantes no teste de caminhada de 6 minutos foi de 199,5. Os valores percentuais da manovacuometria foram de -41,34 na pressão inspiratória máxima e de 57,85 na pressão expiratória máxima. Conclusão: Os dados desta pesquisa sugerem que indivíduos hemiparéticos crônicos apresentam fadiga respiratória e muscular, diminuição da capacidade funcional durante a marcha e fraqueza dos músculos respiratórios.

Objective: To analyze the cardiorespiratory function in chronic post-stroke hemiparetic patients. Methods: This is a retrospective study, through data analysis of medical records from patients who underwent the 6-minute walk test and manovacuometry, in a physical therapy clinic of a university center. Results: The mean number of meters walked by participants in the 6-minut walk test was 199.5 meters. The percentage values of manovacuometry were -41,34 in the maximun inspiratory pressure and 57.85 in the maximun expiratory pressure. Conclusion: The data from this survey suggest that chronic hemiparetic individuals have respiratory and muscle fatigue, decreased functional capacity during gait, and respiratory muscle weakness.

Noninvasive evaluation of respiratory muscles in pre-clinical model of Duchenne Muscular Dystrophy / Avaliação não invasiva dos músculos respiratórios no modelo pré-clinico da Distrofia Muscular de Duchenne

Since respiratory insufficiency is the main cause of death in patients affected by Duchenne Muscular Dystrophy (DMD), the present study aims at establishing a new non-invasive method to evaluate the clinical parameters of respiratory conditions of experimental models affected by DMD. With this purpose in mind, we evaluated the cardiorespiratory clinical conditions, the changes in the intercostal muscles, the diaphragmatic mobility, and the respiratory cycles in Golden Retriever Muscular Dystrophy (GRMD) employing ultrasonography (US). A control group consisting of dogs of the same race, but not affected by muscular dystrophy, were used in this study. The results showed that inspiration, expiration and plateau movements (diaphragm mobility) were lower in the affected group. Plateau phase in the affected group was practically non-existent and showed that the diaphragm remained in constant motion. Respiratory rate reached 15.5 per minute for affected group and 26.93 per minute for the control group. Expiration and inspiration movements of intercostal muscles reached 8.99mm and 8.79mm, respectively, for control group and 7.42mm and 7.40mm, respectively, for affected group. Methodology used in the present analysis proved to be viable for the follow-up and evaluation of the respiratory model in GRMD and may be adapted to other muscular dystrophy experimental models.

Uma vez que, a insuficiência respiratória é a principal causa de morte em pacientes afetados pela Distrofia Muscular de Duchenne (DMD), o presente estudo avaliou as condições clínicas cardiorrespiratórias, o movimento dos músculos intercostais, a mobilidade diafragmática, os ciclos respiratórios e a expansão da cavidade torácica em cães Golden Retriever com Distrofia Muscular (GRMD) por ultrassonografia (US) a fim de estabelecer um novo método não invasivo para avaliar os parâmetros de avaliação clínica de doenças respiratórias de modelos experimentais afetados por DMD. Um grupo controle constituído por cães da mesma raça e espécie, mas não afetados pela distrofia muscular também foram utilizados neste estudo. Os resultados mostraram que os movimentos de inspiração, expiração e platô (mobilidade do diafragma) foram menores no grupo afetado. A fase de platô no grupo afetado foi praticamente inexistente e mostrou que o diafragma destes animais permaneceu em constante movimento. A frequência respiratória atingiu 15,5 por minuto para o grupo afetado e 26,93 para o controle. Movimento de expiração e inspiração dos músculos intercostais atingiu 8,99 milímetros e 8,79 milímetros, respectivamente para o grupo controle e 7,42 milímetros e 7,40 milímetros, respectivamente para o grupo afetado. A metodologia utilizada nesta análise foi viável para o acompanhamento e avaliação do modelo respiratória em modelo GRMD e pode ser adaptado para outros modelos experimentais de distrofia muscular.

Implication of Sarcopenia and Sarcopenic Obesity on Lung Function in Healthy Elderly: Using Korean National Health and Nutrition Examination Survey

Previous studies have demonstrated a positive association between obesity and decreased lung function. However, the effect of muscle and fat has not been fully assessed, especially in a healthy elderly population. In this study, we evaluated the impact of low muscle mass (LMM) and LMM with obesity on pulmonary impairment in healthy elderly subjects. Our study used data from the Korea National Health and Nutrition Examination Survey from 2008 to 2011. Men and women aged 65 yr or older were included. Muscle mass was measured by dual-energy X-ray absorptiometry. LMM was defined as two standard deviations below the sex-specific mean for young healthy adults. Obesity was defined as body mass index > or = 25 kg/m2. The prevalence of LMM in individuals aged over 65 was 11.9%. LMM and pulmonary function (forced vital capacity and forced expiratory volume in 1 second) were independently associated after adjusting for age, sex, body mass index, smoking status, alcohol consumption, and frequency of exercise. LMM with obesity was also related to a decrease in pulmonary function. This study revealed that LMM is an independent risk factor of decreased pulmonary function in healthy Korean men and women over 65 yr of age.

Miopatía inflamatoria con compromiso inicial de músculos respiratorios y artritis reumatoidea

Las miopatías inflamatorias constituyen un grupo heterogéneo de enfermedades musculares adquiridas de presentación subaguda, crónica y a veces aguda. Las entidades clínicas más frecuentes son la dermatomiositis, la polimiositis, la miositis necrotizante autoinmune y la miositis por cuerpos de inclusión. Suelen presentarse con debilidad muscular con predominio proximal y simétrica, pero rara vez comprometen los músculos respiratorios. Presentamos el caso de una mujer de 39 años con miopatía inflamatoria inespecífica que presentó insuficiencia respiratoria secundaria a hipoventilación alveolar por debilidad muscular y requirió asistencia respiratoria mecánica. Respondió favorablemente y de forma rápida tras el tratamiento instaurado con inmunosupresores (corticoides y metotrexato) e inmunoglobulina humana endovenosa. Se utilizó ventilación no invasiva como alternativa a la intubación orotraqueal con adecuada tolerancia.

Inflammatory myopathies comprise a heterogeneous group of subacute, chronic and sometimes acute acquired muscle diseases. The most common inflammatory myopathies seen in practice can be separated into four distinct subsets: polymyositis, dermatomyositis, necrotizing autoimmune myositis and inclusion body myositis. These disorders present as proximal and symmetric muscle weakness but rarely respiratory muscles may also be affected. We report the case of a 39 year-old female with inflammatory myopathy with acute respiratory failure due to alveolar hypoventilation secondary to respiratory muscle dysfunction that required mechanical ventilation. The treatment with steroids, methotrexate and intravenous immune globulin was successful as well as the implementation of non-invasive ventilation as an alternative to endotracheal intubation.

Liga com memória de forma: estudo preliminar do grampo de judet de nitinol e sua possível aplicação em tórax instável / Shape memory alloy: a preliminary study of nitinol judet staples for future application in flail chest

Este artigo sucintamente descreve a evolução da liga metálica “inteligente”, com memória de forma na área de Saúde. A confecção de grampos de Judet em nitinol ocorreu no Laboratório de Transformação Mecânica da UFRGS (LdTM) e a simples verificação das qualidades superelásticas e de memória de forma foram contempladas no LdTM e no HCPA pela equipe envolvida no projeto. A título de ilustração, demonstramos com um caso clínico a aplicabilidade do grampo de Judet no cenário de instabilidade da parede torácica, a qual, além de prejudicar a mecânica respiratória, apresenta uma alta taxa de mortalidade. Os resultados preliminares evidenciaram a transformação provocada pelo calor, ocasionando o fechamento das garras dos grampos de Judet, que se manteve firme e sem alteração da consistência com o tempo, permitindo antever sua aplicabilidade num modelo experimental. Grampos de Judet em Nitinol são apresentados teoricamente como vantajosos em relação aos já existentes em aço inoxidável 316L, especialmente pela facilidade de manuseio e possível simplificação do procedimento cirúrgico. Detalhes no acabamento permitem a biocompatibilidade e o engenheiro projetista de materiais deve compatibilizar as ligas de níquel e titânio (NiTi) utilizadas nos grampos. O nitinol possui amplo emprego no cenário médico-odontológico e há normas técnicas bem definidas. A epidemiologia do trauma e a gravidade das lesões associadas à instabilidade da parede torácica evidenciam a oportunidade de estudos nessa direção. Concluímos sobre a necessidade de prosseguir para uma avaliação experimental, agregando a mensuração de parâmetros viscosos e viscoelásticos da mecânica respiratória, especialmente em seu componente de parede torácica (cw).

The aim of this article is to briefly describe the incorporation of nitinol (NiTi) – an intelligent nickel-titanium alloy presenting shape memory – for use in medical applications. Nitinol Judet staples were developed at the Mechanical Processing Laboratory (LdTM) at Universidade Federal do Rio Grande do Sul. Simple confirmation assays of superelasticity and shape memory were performed at the LdTM and Hospital de Clínicas de Porto Alegre by the project team. A clinical case was used to demonstrate the applicability of nitinol Judet staples in the treatment of flail chest, a condition characterized by respiratory mechanics associated with fairly high mortality. The initial observation revealed a transformation resulting from heat exposure causing the closure of staple prongs. With time, the consistency of the Judet staples remained unchanged, indicating the feasibility of an experimental model employing these staples. The advantages of NiTi-made Judet staples in relation to 316L stainless steel staples are outlined, with emphasis on the ease of use and possible simplification of the surgical procedure. Finishing details ensure biocompatibility, with a focus on specific adaptations in the NiTi alloy employed to manufacture the staples; nevertheless, nitinol is widely employed in medicine and dentistry, with well-defined standards. The epidemiology of trauma and the severity of lesions associated with flail chest provide an opportunity for the proposed studies. The experimental assessment of nitinol Judet staples must now address viscosity and viscoelastic parameters of respiratory mechanics, especially concerning the chest wall.

How Respiratory Muscle Strength Correlates with Cough Capacity in Patients with Respiratory Muscle Weakness

PURPOSE: The purpose of this study is to investigate how respiratory muscle strength correlates to cough capacity in patients with respiratory muscle weakness. MATERIALS AND METHODS: Forty-five patients with amyotrophic lateral sclerosis (ALS), 43 with cervical spinal cord injury (SCI), and 42 with Duchenne muscular dystrophy (DMD) were recruited. Pulmonary function tests including forced vital capacity (FVC) and respiratory muscle strength (maximal expiratory pressure, MEP; maximal inspiratory pressure, MIP) were performed. The correlation between respiratory muscle strength and cough capacity was analyzed. RESULTS: In the SCI group, FVC in a supine position (2,597 +/- 648 mL) was significantly higher than FVC in a sitting position (2,304 +/- 564 mL, p < 0.01). Conversely, in the ALS group, FVC sitting (1,370 +/- 604 mL) was significantly higher than in supine (1,168 +/- 599 mL, p < 0.01). In the DMD group, there was no statistically significant difference between FVC while sitting (1,342 +/- 506 mL) and FVC while supine (1,304 +/- 500 mL). In addition, the MEP and MIP of all three groups showed a significant correlation with peak cough flow (PCF) (p < 0.01, Pearson's correlation analysis). In the SCI group, MIP was more closely correlated with PCF, while in the ALS and DMD groups, MEP was more closely correlated with PCF (p < 0.01, multiple regression analysis). CONCLUSION: To generate cough flow, inspiratory muscle strength is significantly more important for SCI patients, while expiratory muscle function is significantly more important for ALS and DMD patients.

Respiratory muscle function and spirometry in patients with systemic lupus erythematosus

Systemic lupus erythematosus [SLE] can affect all organ systems including the respiratory tract and skeletal muscles. Some of the respiratory findings can be attributed to respiratory muscle involvement. The purpose of this study was to clarify the characteristics of pulmonary function tests [PFT], especially maximum inspiratory pressure [MIP] and maximum expiratory pressure [MEP] in females with systemic lupus erythematosus [SLE]. During a 12-mounth period, forced vital capacity [FVC], FEV1, FEF25-75, MIP, and MEP were measured prospectively in 76 consecutive female patients, suffering active SLE. The measured values were compared to an age-matched group of healthy women. FVC was lower in the patients than in controls [2.81versus 3.64] P=0.000. Maximal inspiratory pressure [PImax] was lower in the female patients than in 78 controls [3.42 versus 7.36]P=0.000. Maximal expiratory pressure [PEmax] was lower in the female patients than in controls [4.14versus 9.68 kPa] P=0.000, There were no correlations between PImax or PEmax and parameters of disease activity. Mouth occlusion pressure within the first 0.1 s of inspiration was higher in SLE patients than in controls [2.43 versus 1.38]; however, the difference was not statistically significant [P=0.16]. This study provides evidence of inspiratory and expiratory muscle weakness in SLE and may cause FVC reduction as well. The pathophysiologic mechanisms and the prognostic significance should be further investigated

Respiratory Muscle Strength and Cough Capacity in Patients with Duchenne Muscular Dystrophy

The function of inspiratory muscles is crucial for effective cough as well as expiratory muscles in patients with Duchenne muscular dystrophy (DMD). However, there is no report on the correlation between cough and inspiratory muscle strength. To investigate the relationships of voluntary cough capacity, assisted cough techniques, and inspiratory muscle strength as well as expiratory muscle strength in patients with DMD (n=32). The vital capacity (VC), maximum insufflation capacity (MIC), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP) were measured. Unassisted peak cough flow (UPCF) and three different techniques of assisted PCF were evaluated. The mean value of MICs (1918 +/- 586 mL) was higher than that of VCs (1474 +/- 632 mL) (p < 0.001). All three assisted cough methods showed significantly higher value than unassisted method (212 +/- 52 L/min) (F = 66.13, p < 0.001). Combined assisted cough technique (both manual and volume assisted PCF; 286 +/- 41 L/min) significantly exceeded manual assisted PCF (MPCF; 246 +/- 49 L/ min) and volume assisted PCF (VPCF; 252 +/- 45 L/min) (F = 66.13, p < 0.001). MIP (34 +/- 13 cmH2O) correlated significantly with both UPCF and all three assisted PCFs as well as MEP (27 +/- 10 cmH2O) (p < 0.001). Both MEP and MIP, which are the markers of respiratory muscle weakness, should be taken into account in the study of cough effectiveness.

Respiratory muscle dysfunction in schistosomal cor pulmonale: physiological histopathological and immunohistochemical studies

The study was conducted on 18 patients with schistosomal cor pulmonale with mean pulmonary artery pressure of 52.6 +/- 21.2 mm Hg, pulmonary vascular resistance of 8.1 +/- 4.7 unit and cardiac index of 3.03 +/- 0.37 L/min/m2. This work aimed to evaluate respiratory and diaphragmatic muscle strength and its impact on breathing pattern alteration. Histopathological and immunohistochemical studies were also performed on ten patients with evident reduced respiratory muscle strength to assess the structural changes and to identify the possible etiological mechanism for respiratory muscle dysfunction. Schistosomal cor pulmonale patients demonstrated reduction in respiratory muscle strength with mean values of 68.6 +/- 9.1% pred and 70.1 +/- 10.2% pred for maximal inspiratory and expiratory pressures respectively. On the other hand, transdiaphragmatic pressure during both normal and maximal effort showed mean values within the normal range [34.7 +/- 6.2 and 181.2 +/- 43.7cm H2O respectively]. Yet; diaphragmatic endurance index in the term of tension time index was found to be [0.09 +/- 0.05] reflecting reduction in diaphragmatic endurance. Breathing pattern demonstrated significant [P<0.01] increment in minute ventilation [VE: 13.5 +/- 1.6 L/min] respiratory frequency [F: 25.2 +/- 2.7] and mean inspiratory flow [V[t] /T[i]; 570.5 +/- 95.8]; whereas; inspiratory duty cycle was significantly [P<0.01] reduced [T[i]T[tot]: 0.4 +/- 0.03] in comparison to control. PE[max] and PI[max] showed significant [P<0.05] negative correlation with V[T] /T[i] [r=-0.69,r =-0.88] and significant [P<0.05] positive correlation with T[i]T[tot] [r = 0.78 and r = 6.85] suggesting that respiratory muscle dysfunction does contribute to breathing pattern alterations. Histopathological study revealed myopathic changes in the form of increased variation in fiber diameter, degenerative changes with increased eosinophilic staining in 6 cases, fiber splitting and fragmentation in 7 cases and endomysial fatty changes in 5 patients Immunohistochemical study using anti-IgG and IgM antibodies revealed positive cytoplasmic staining for IgG in all cases and for IgM in 6 cases while none of the control showed positive stiaining. These previously unreported data document that patients with schistosomal cor pulmonale suffer from respiratory muscle affection at both physiological and histopathological levels. Immunohistochemical findings suggest immunopathogenetic mechanism for their deranged function. Greater attention should be paid for respiratory muscle while evaluating the respiratory functional state of patients with schistosomal cor pulmonale