ABSTRACT
End-of-life care (EOLC) is palliative support provided in the last 6 months to 1 year of a patient's life. Although there are established criteria for its indication, few studies describe the clinical and functional characteristics of individuals with interstitial lung diseases (ILD) in EOLC. ILD individuals underwent various assessments, including lung function, exercise capacity (6 min walk test), physical activity in daily life (PADL), peripheral muscle strength, maximal respiratory pressures, body composition, quality of life (SGRQ-I), symptoms of anxiety and depression, dyspnea (MRC scale), and sleep quality. Fifty-eight individuals were included and divided into two groups according to the indication for commencing EOLC (ILD with an indication of EOLC (ILD-EOLC) or ILD without an indication of EOLC (ILD-nEOLC). There were differences between the groups, respectively, for steps/day (2328 [1134-3130] vs. 5188 [3863-6514] n/day, p = 0.001), time spent/day carrying out moderate-to-vigorous physical activities (1 [0.4-1] vs. 10 [3-19] min/day, p = 0.0003), time spent/day in standing (3.8 [3.2-4.5] vs. 4.8 [4.1-6.7] h/day, p = 0.005), and lying positions (5.7 [5.3-6.9] vs. 4.2 [3.6-5.1] h/day, p = 0.0004), the sit-to-stand test (20 ± 4 vs. 26 ± 7 reps, p = 0.01), 4 m gait speed (0.92 ± 0.21 vs. 1.05 ± 0.15 m/s, p = 0.02), quadriceps muscle strength (237 [211-303] vs. 319 [261-446] N, p = 0.005), SGRQ-I (71 ± 15 vs. 50 ± 20 pts, p = 0.0009), and MRC (4 [3-5] vs. 2 [2-3] pts, p = 0.001). ILD individuals with criteria for commencing EOLC exhibit reduced PADL, functional performance, peripheral muscle strength, quality of life, and increased dyspnea.
ABSTRACT
BACKGROUND: There is limited information regarding impairment in functional performance tests and their measurement properties in ILD. The present study aimed to verify the impairment and measurement properties of functional performance tests in ILD. METHODS: ILD and healthy individuals underwent assessments of pulmonary function, peripheral muscle strength (handgrip force and maximum isometric contraction of quadriceps femoris - MIVCq) and exercise capacity (6-min walk test - 6MWT). Functional performance was assessed by timed-up-and-go with usual (TUGu) and fast (TUGf) gait speeds, 4-m gait speed (4MGS), sit-to-stand in 30 s (30sec-STS), 1 min (1min-STS) and with 5 repetition (5rep-STS) and Short Physical Performance Battery (SPPB). Functional performance was compared between groups, validity (correlation with 6MWT and MIVCq) and reliability of tests were checked in subjects with ILD (intra- and inter-rater agreement analysis). RESULTS: Seventy-six participants (40 ILD [25 women, 61 ± 11 years, FVC 75 ± 17 %pred] and 36 healthy [22 women, 61 ± 9 years, FVC 97 ± 11 %pred]) were included. Functional performance in ILD was worse than in healthy individuals in all tests, except for the 30sec-STS (p = 0.13). Pre-specified validity criteria were reached for TUGu, TUGf, 4MGS and 5rep-STS (-0.69 < r < 0.55; p < 0.05 for all). Except for 4MGS and SPPB, all tests showed good to excellent inter-rater (0.85 < ICC<0.93; p < 0.05 for all) and all tests showed good to excellent intra-rater (0.83 < ICC< 0.94; p < 0.05 for all) reliability. CONCLUSIONS: Subjects with ILD present worse functional performance than healthy individuals. According to reliability and validity results, TUGu, TUGf and 5rep-STS seem to be the most appropriate tests to evaluate functional performance in ILD.
Subject(s)
Lung Diseases, Interstitial/diagnosis , Lung Diseases, Interstitial/physiopathology , Respiratory Function Tests/methods , Aged , Female , Gait , Healthy Volunteers , Humans , Male , Middle Aged , Muscle Strength , Reproducibility of Results , Walk TestABSTRACT
Abstract Introduction: In the rehabilitation of musculoskeletal injuries, ultrasound is widely used in clinical practice. Objective: To evaluate the effects of pulsed ultrasonic therapy on the viability and modulation of genes involved in inflammation (IL-6) and neovascularization (VEGF) processes of L929 fibroblast cells. Methods: For irradiation with ultrasound the cells were subdivided into groups: G1 (without irradiation), G2 (0.3 W/cm2-20%) and G3 (0.6 W/cm2-20%), with periods of treatment at 24, 48 and 72 hours. The cell viability assay was analyzed by the MTT method and gene modulation was analyzed by RT-qPCR method. Results: After the comparative analysis between groups, only G2 and G3 (48-hour) presented statistically significant differences in relation to the control. In relation to the gene expression, the selection of the groups analyzed was delimited according to the comparative analysis of the values obtained by the MTT test. After the achievement of RT-qPCR, it could be observed that in G2 the amount of VEGF gene transcripts increased by 1.125-fold compared to endogenous controls, and increased 1.388-fold in G3. The IL-6 gene, on the other hand, had its transcripts reduced in both G2 (5.64x10-9) and G3 (1.91x10-6). Conclusion: Pulsed ultrasound in L929 fibroblasts showed a significant biostimulatory effect in the 48-hour period, with increased cell viability, and the same effect in the modulation of gene expression related the neovascularization and inflammation, mediating the acceleration of the tissue repair cascade.
Resumo Introdução: Na reabilitação de lesões musculoesqueléticas, o ultrassom é amplamente utilizado na prática clínica. Objetivo: Avaliar os efeitos da terapia ultrassônica pulsada sobre a viabilidade e modulação de genes envolvidos nos processos de inflamação (IL-6) e neovascularização (VEGF) de fibroblastos L929. Métodos: Para irradiação com ultrassom, as células foram subdivididas em grupos: G1 (sem irradiação), G2 (0,3 W/cm2-20%) e G3 (0,6 W/cm2-20%), com períodos de tratamento de 24, 48 e 72 horas. O ensaio de viabilidade celular foi analisado pelo método MTT e a modulação gênica pelo método RT-qPCR. Resultados: Após a análise comparativa entre os grupos, apenas G2 e G3 (48 horas) apresentaram diferenças estatisticamente significantes em relação ao controle. Em relação à expressão gênica, a seleção dos grupos analisados foi delimitada de acordo com a análise comparativa dos valores obtidos pelo teste MTT. Após a obtenção do RT-qPCR, pôde-se observar que no G2 a quantidade de transcritos do gene VEGF aumentou 1,125 vezes em relação aos controles endógenos e 1,388 vezes no G3. O gene IL-6, por outro lado, teve seus transcritos reduzidos tanto no G2 (5,64x10-9) quanto no G3 (1,91x10-6). Conclusão: O ultrassom pulsado em fibroblastos L929 apresentou efeito bioestimulador significativo no período de 48 horas, com aumento da viabilidade celular, e o mesmo efeito na modulação da expressão gênica relacionou neovascularização e inflamação, mediando a aceleração da cascata de reparação de tecidos.
ABSTRACT
OBJECTIVE: This study aimed to analyze cell viability and gene expression interleukin 6 and vascular endothelial growth factor after continuous ultrasound therapy of 1 and 3 MHz in L929 fibroblast cells. DESIGN: The L929 cells were cultivated in 12-well plates and divided into the following five groups: Group 1 (G1), nonirradiated; G2, 0.2 W/cm-1 MHz; G3, 0.5 W/cm-1 MHz; G4, 0.2 W/cm-3 MHz; and G5, 0.5 W/cm-3 MHz. The cells were irradiated at 24 and 48 hrs. Cell viability was evaluated using the MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) method. The gene expression analysis was assessed using real-time polymerase chain reaction. RESULTS: The G2 and G3 showed a decrease in cell viability when compared with the G1 at 48 hrs (P < 0.01). The G4 and G5 presented an increase in viability (P = 0.01 and P = 0.03, respectively) in 24 to 48 hrs. The cells irradiated at an intensity of 0.5 W/cm-3 MHz at 48 hrs showed a 0.21-fold decrease in interleukin-6 gene transcripts and a 1.67-fold increase in vascular endothelial growth factor gene transcripts. CONCLUSIONS: Continuous ultrasound therapy with a frequency of 3 MHz at an intensity of 0.5 W/cm stimulates cell proliferation, decreases interleukin-6 gene expression, and increases vascular endothelial growth factor gene expression in L929 fibroblast cells.
