Brazilian portuguese validation of the patient-reported outcome measure for urethral stricture surgery (USS-PROM) questionnaire

ABSTRACT Introduction: Urethral stricture is a common, albeit complex, condition that predominantly affects men. The aim of this study was to translate, culturally adapt, and validate the Patient-Reported Outcome Measure questionnaire for patients undergoing urethroplasty (USS-PROM) into Brazilian Portuguese using validated psychometric criteria. Materials and Methods: The process involved translating and culturally adapting the original USS-PROM into Brazilian Portuguese (USS-PROMbr), synthesizing, back-translating, cross-culturally adapting, and analyzing the pre-final version with experts from our committee. This pre-version was administered to 10 patients who had undergone urethroplasty by the Reconstructive Urology team at the Hospital de Clínicas de Porto Alegre for face validation, linguistic, and semantic adjustments, resulting in the final USS-PROMbr version. Subsequently, well-established psychometric criteria, including content validity, internal consistency, and test-retest reproducibility, were assessed after administering the questionnaire to a total of 56 patients, with 50 of them responding to the test and retest. Results: Evaluation of the pre-final version identified 15 questions as clear, and only one question was considered somewhat unclear necessitating modifications based on patient suggestions and subsequent reassessment by the research team. Psychometric criteria demonstrated good content validity, with a content validity index exceeding 0.80 for all questions; good internal consistency, Cronbach's alpha of 0.77, ranging from 0.70 to 0.78 with the exclusion of any item, and item-total correlations ranging from 0.33 to 0.67. The test-retest intraclass correlation coefficient was 0.74 for the lower urinary tract symptoms construct (Q1-Q6). Conclusion: The USS-PROMbr demonstrated acceptable cross-cultural adaptation and psychometric properties, making it a valid and useful tool for evaluating patients undergoing urethroplasty.

Brazilian portuguese validation of the patient-reported outcome measure for urethral stricture surgery (USS-PROM) questionnaire.

INTRODUCTION: Urethral stricture is a common, albeit complex, condition that predominantly affects men. The aim of this study was to translate, culturally adapt, and validate the Patient-Reported Outcome Measure questionnaire for patients undergoing urethroplasty (USS-PROM) into Brazilian Portuguese using validated psychometric criteria. MATERIALS AND METHODS: The process involved translating and culturally adapting the original USS-PROM into Brazilian Portuguese (USS-PROMbr), synthesizing, back-translating, cross-culturally adapting, and analyzing the pre-final version with experts from our committee. This pre-version was administered to 10 patients who had undergone urethroplasty by the Reconstructive Urology team at the Hospital de Clínicas de Porto Alegre for face validation, linguistic, and semantic adjustments, resulting in the final USS-PROMbr version. Subsequently, well-established psychometric criteria, including content validity, internal consistency, and test-retest reproducibility, were assessed after administering the questionnaire to a total of 56 patients, with 50 of them responding to the test and retest. RESULTS: Evaluation of the pre-final version identified 15 questions as clear, and only one question was considered somewhat unclear necessitating modifications based on patient suggestions and subsequent reassessment by the research team. Psychometric criteria demonstrated good content validity, with a content validity index exceeding 0.80 for all questions; good internal consistency, Cronbach's alpha of 0.77, ranging from 0.70 to 0.78 with the exclusion of any item, and item-total correlations ranging from 0.33 to 0.67. The test-retest intraclass correlation coefficient was 0.74 for the lower urinary tract symptoms construct (Q1-Q6). CONCLUSION: The USS-PROMbr demonstrated acceptable cross-cultural adaptation and psychometric properties, making it a valid and useful tool for evaluating patients undergoing urethroplasty.

What is the best method to assess the abdominal wall? Restoring strength does not mean functional recovery.

BACKGROUND: Restoring the contractile function to the abdominal wall is a major goal in hernia repair. However, the core understanding is required when choosing the method for outcome assessment. AIM: To assess the role of the anterolateral abdominal muscles on abdominal wall function in patients undergoing hernia repair by analysis of correlation between the surface electromyography activation signal of these muscles and torque produced during validated strength tests. METHODS: Activation of the rectus abdominis, external oblique, and internal oblique/transverse abdominis muscles was evaluated by surface electromyography during two validated tests: Step: 1-A, isometric contraction in dorsal decubitus; 1-B, isometric contraction in lateral decubitus; 2-A, isokinetic Biodex testing; and 2-B, isometric Biodex testing. RESULTS: Twenty healthy volunteers were evaluated. The linear correlation coefficient between root mean square/peak data obtained from surface electromyography signal analysis for each muscle and the peak torque variable was always <0.2 and statistically non-significant (p<0.05). The agonist/antagonist ratio showed a positive, significant, weak-to-moderate correlation in the external oblique (Peak, p=0.027; root mean square, 0.564). Surface electromyography results correlated positively among different abdominal contraction protocols, as well as with a daily physical activity questionnaire. CONCLUSIONS: There was no correlation between surface electromyography examination of the anterolateral abdominal wall muscles and torque measured by a validated instrument, except in a variable that does not directly represent torque generation.

What is the best method to assess the abdominal wall? Restoring strength does not mean functional recovery / Qual é o melhor método para avaliação da parede abdominal? Restabelecer força não significa recuperação funcional

ABSTRACT Background: Restoring the contractile function to the abdominal wall is a major goal in hernia repair. However, the core understanding is required when choosing the method for outcome assessment. Aim: To assess the role of the anterolateral abdominal muscles on abdominal wall function in patients undergoing hernia repair by analysis of correlation between the surface electromyography activation signal of these muscles and torque produced during validated strength tests. Methods: Activation of the rectus abdominis, external oblique, and internal oblique/transverse abdominis muscles was evaluated by surface electromyography during two validated tests: Step: 1-A, isometric contraction in dorsal decubitus; 1-B, isometric contraction in lateral decubitus; 2-A, isokinetic Biodex testing; and 2-B, isometric Biodex testing. Results: Twenty healthy volunteers were evaluated. The linear correlation coefficient between root mean square/peak data obtained from surface electromyography signal analysis for each muscle and the peak torque variable was always <0.2 and statistically non-significant (p<0.05). The agonist/antagonist ratio showed a positive, significant, weak-to-moderate correlation in the external oblique (Peak, p=0.027; root mean square, 0.564). Surface electromyography results correlated positively among different abdominal contraction protocols, as well as with a daily physical activity questionnaire. Conclusions: There was no correlation between surface electromyography examination of the anterolateral abdominal wall muscles and torque measured by a validated instrument, except in a variable that does not directly represent torque generation.

RESUMO Racional: A devolução da funcionalidade contrátil da parede abdominal é uma das metas no reparo das hérnias abdominais. Contudo, o entendimento do core deve necessariamente fazer parte na escolha do método de avaliação desse desfecho. Objetivo: Avaliar o papel dos músculos da parede anterolateral na função da parede abdominal com base na correlação entre o sinal de ativação muscular obtido na eletromiografia de superfície e torque produzido durante testes de força validados. Métodos: A ativação dos músculos reto abdominal, oblíquo externo, e oblíquo interno e transverso foi avaliada por eletromiografia de superfície durante dois testes validados. Etapa: 1-A, contração isométrica em decúbito dorsal; 1-B, contração isométrica em decúbito lateral; 2-A, teste isocinético no Biodex; e 2-B, teste isométrico no Biodex. Resultados: Foram avaliados 20 voluntários saudáveis. O coeficiente de correlação linear entre os dados de valor quadrático médio/Pico obtidos análise do sinal da eletromiografia de superfície para cada músculo e o Pico de torque foram sempre <0,2 e estatisticamente insignificantes (p<0.05). A relação agonista/antagonista demonstrou correlação positiva, significativa e de fraca a moderada no músculo externo oblíquo (Pico, p=0,027; valor quadrático médio, 0,564). Os resultados eletromiografia de superfície estiveram positivamente correlacionados nos diferentes protocolos de contração abdominal e também com um questionário de atividade física diária. Conclusões: Não houve correlação entre o exame de eletromiografia de superfície e o torque mensurado por um instrumento validado, exceto em uma variável que não representa diretamente a geração de torque.

Fructose-1,6-Bisphosphate Prevents Bleomycin-Induced Pulmonary Fibrosis in Mice and Inhibits the Proliferation of Lung Fibroblasts.

Pulmonary fibrosis is a specific form of interstitial pneumonia. In addition to the idiopathic cause, it may be caused by drugs such as bleomycin (BLM)-used in the treatment of tumors. Fructose-1,6-bisphosphate (FBP) is a high-energy endogenous glycolytic compound that has antifibrotic, anti-inflammatory, and immunomodulatory effects. The aim of this study was to investigate the effects of FBP on both BLM-induced pulmonary fibrosis in mice and in a human embryonic lung fibroblast (MRC-5) culture system. C57BL/6 mice were divided into four groups: control, FBP, BLM, and BLM plus FBP. A single dose of bleomycin (7.5 U/kg) was administered intratracheally, and survival, body weight, Ashcroft score, and histological analysis were evaluated. Pulmonary function and bronchoalveolar lavage fluid (BALF) were also evaluated after a single dose of bleomycin (1.2 U/kg-intratracheally). Treatment with FBP (500 mg/kg) was given on day 0 intraperitoneally. Fibroblasts (MRC-5 cells) were used to access the effect of FBP in vitro. In vivo, FBP increased the survival rate and reduced body weight loss (BLM vs. BLM plus FBP-p < 0.05). FBP also prevented BLM-induced loss of pulmonary function and decreased BALF inflammatory cells, level of fibrosis, and superficial collagen density (p < 0.05). In vitro, FBP (0.62 and 1.25 mM) had inhibitory activity on MRC-5 cells and was able to induce senescence in fibroblasts. These results showed that FBP has the potential of reducing the toxic effects of BLM and may provide supportive therapy for conventional methods used for the treatment of cancer.

Biochemical and inflammatory aspects in patients with severe sepsis and septic shock: The predictive role of IL-18 in mortality.

BACKGROUND: Sepsis is a major health care problem, with a significant mortality rate in intensive care units. We evaluated biochemical and inflammatory markers in patients with severe sepsis and septic shock and its association of with mortality rates. METHODS: Critically ill patients with diagnoses of sepsis - severe sepsis group (n=23) and septic shock group (n=25), and a control group (n=17) were recruited within 24h of entry into the ICU. Serum levels of inflammatory mediators were measured (IL-1ß, IL-6, IL-8, IL-10, TNF-α, IL-18 and nitric oxide). We have also collected clinical parameters and laboratorial tests to estimate severity and organ dysfunction (APACHE II, SOFA, lactate). These results were compared between survivors and no survivors. RESULTS: IL-18 was directly related to mortality independently of other inflammatory mediators, especially IL-1ß, although the inflammatory pathway is closely linked to inflammasome activation and both have simultaneous release in the infectious process. Mortality was directly proportional to IL-18 plasma levels, which did not occur with other inflammatory mediators. CONCLUSIONS: IL-18 is an important predictor of mortality in humans with both severe sepsis and septic shock, independent of IL-1ß.

Inspiratory muscle training with threshold or incentive spirometry: Which is the most effective?

Inspiratory muscular training (IMT) increases the respiratory muscle strength, however, there is no data demonstrating its superiority over the incentive spirometry (IS) in doing so. Values of muscle strength after IMT (Threshold IMT(®)) and by the IS (Voldyne(®)) in healthy females was compared. Subjects (n=40) were randomly divided into control group (CG, n=14), IS group (ISG, n=13) and threshold group (TG, n=13). PImax was measured before (pre-IMT), at 15 and 30 days of IMT. There was an increase in PImax of the TG at 15 days (p<0.001) and 30 days of IMT (p<0.001). The same occurred with the ISG, which increased the PImax at 15 days (p<0.001) and 30 days of training (p<0.001). After 30 days of IMT, the TG presented a PImax which was significantly higher than ISG and the CG (p=0.045 and p<0.001, respectively). It can be concluded that IMT by threshold was more effective in increasing muscle strength than the Voldyne.

WITHDRAWN: Inspiratory muscle training with threshold or incentive spirometry: Which is the most effective?

This article has been withdrawn for editorial reasons because the journal will be published only in English. In order to avoid duplicated records, this article can be found at http://dx.doi.org/10.1016/j.rppnen.2014.05.005. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

The influence of active and passive smoking on the cardiorespiratory fitness of adults.

BACKGROUND: The aim of this study was to analyze the influence of active and passive smoking on cardiorespiratory responses in asymptomatic adults during a sub-maximal-exertion incremental test. METHODS: The participants (n = 43) were divided into three different groups: active smokers (n = 14; aged 36.5 ± 8 years), passive smokers (n = 14; aged 34.6 ± 11.9 years) and non-smokers (n = 15; aged 30 ± 8.1 years). They all answered the Test for Nicotine Dependence and underwent anthropometric evaluation, spirometry and ergospirometry according to the Bruce Treadmill Protocol. RESULTS: VO2max differed statistically between active and non-smokers groups (p < 0.001) and between non-smokers and passive group (p=0.022). However, there was no difference between the passive and active smokers groups (p=0.053). Negative and significant correlations occurred between VO2max and age (r = - 0.401, p = 0.044), percentage of body fat (r = - 0.429, p = 0.011), and waist circumference (WC) (r = - 0.382, p = 0.025). CONCLUSION: VO2max was significantly higher in non-smokers compared to active smokers and passive smokers. However, the VO2max of passive smokers did not differ from active smokers.

Capacidade funcional submáxima e força muscular respiratória entre idosas praticantes de hidroginástica e dança: um estudo comparativo / Submaximal functional capacity and respiratory muscle strength among elderly practitioners of hydrogymnastics and dance: a comparative study

O exercício físico é uma estratégia eficaz para prevenir e retardar as perdas funcionais do envelhecimento, mas há poucos estudos indicando qual a melhor modalidade para incrementar o status funcional do idoso. OBJETIVO: Comparar a força muscular respiratória (FMR) e a capacidade funcional submáxima de idosas praticantes de hidroginástica e dança. MATERIAL e MÉTODOS: Estudo transversal com idosas do sexo feminino (n=46), praticantes de hidroginástica (Grupo Hidroginástica - GH; n=23) e dança (Grupo Dança - GD; n=23). Para medida da prática de atividade física, foi utilizado o International Physical Activit Questionnarie (IPAQ-versão curta); a FMR foi avaliada por meio da pressão inspiratória máxima (PImax) e da pressão expiratória máxima (PEmax), e a medida da capacidade funcional submáxima, realizada pelo Teste da Caminhada dos Seis Minutos (TC6m). RESULTADOS: O GD apresentou maior PImax (84 ± 12,49 cmH2O) quando comparado ao GH (63,35 ± 10,47 cmH2O) (p< 0,0001), e a PEmax não variou significativamente entre os grupos (p= 0,08). Quanto à distância percorrida no TC6m, o GD (616,53 ± 60,81 m) obteve melhor desempenho que o GH (446,65 ± 48,67 m) (p< 0,0001). Quanto ao nível de atividade física, o GD apresentou 19 idosas (82,61%) muito ativas e quatro (17,39%) ativas, e o GH apresentou oito idosas (30,76%) muito ativas e 15 (69,23%) ativas. CONCLUSÃO: As idosas praticantes de dança evidenciaram maior força muscular inspiratória e capacidade funcional submáxima, possivelmente devido ao maior nível de atividade física e também pelo fato de a dança ser uma modalidade essencialmente aeróbia.

Exercise is an effective strategy to prevent and slow the functional losses of aging, but there are few studies indicating the best method to improve functional status of the elderly. OBJETIVE: To compare respiratory muscle strength (RMS) and submaximal functional capacity of older practitioners of hydrogymnastics and dance. MATERIAL AND METHODS: A cross-sectional study with elderly women (n=46), practitioners of hydrogymnastics (Hydrogymnastics Group - HG; n=23) and dance (Dance Group - DG; n=23). For the measurement of physical activity, it was used tthe International Physical Activity Questionnaire (IPAQ - short version); the RMS was assessed by measurement of the maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP); and the measure of submaximal functional capacity was assessed by the six-minute walk test (6MWT). RESULTS: The DG showed that higher MIP (84 ± 12.49 cmH2O) compared to the HG (63.35 ± 10.47 cmH2O) (p< 0.0001) and the MEP did not differ significantly between the groups (p= 0.08). The distance covered in the 6MWT DG (616.53 ± 60.81 m) was better performed than HG (446.65 ± 48.67 m) (p <0.0001). For the physical activity level, the DG showed that 19 elderly women (82.61%) were very active and four (17.39%) active, and the HG showed that eight elderly women (30.67%) were very active and 15 (69.23%) active. CONCLUSION: The elderly women practitioners of dance showed higher respiratory muscle strength and submaximal functional capacity, possibly due to the higher level of physical activity and also because dance is primarily an aerobic modality.

Influência do tabagismo ativo e passivo sobre a capacidade cardiorrespiratória / Influence of active and passive smoking on cardiorespiratory fitness

Os danos advindos do tabagismo ativo estão bem estabelecidos,destacando-se o prejuízo na aptidão cardiorrespiratória, acentuadaredução do condicionamento aeróbico e alteração da função cardiovascular.Além disso, o tabaco tem alto conteúdo de monóxidode carbono, o que resulta em prejuízo na hematose e na oferta deoxigênio (O2) à musculatura periférica e respiratória. Entretanto,quanto ao tabagismo passivo, pouco se sabe a respeito dos seus efeitossobre a aptidão funcional avaliada através do teste de exercíciocardiopulmonar. Assim, a presente revisão sumariza informações arespeito da influência do tabagismo ativo e passivo sobre a capacidadecardiorrespiratória, sendo realizada busca de artigos científicos nosprincipais bancos de dados utilizados na área de saúde, como Pubmed,Bireme e Scielo, bem como em livros didáticos da bibliotecada Universidade de Santa Cruz do Sul (UNISC). Considerando aspublicações analisadas, torna-se indubitável os efeitos danosos dofumo ativo e passivo sobre a função respiratória e cardiovascular. Talestudo faz-se importante, pois alerta para os malefícios do tabagismoativo e passivo, podendo contribuir para o planejamento de ações desaúde, direcionando iniciativas de políticas públicas para a prevençãoe cessação do tabagismo.

The risks of active smoking are well established and accepted,most notably the damage to cardio-respiratory fitness, with significantreduction of aerobic capacity and changes in the cardiovascularfunction. Moreover, tobacco contains high levels of carbon monoxide,which results in damages to hematosis and in the supply ofoxygen (O2) to peripheral and respiratory muscles. Nevertheless,little is known about the effects of passive smoking on functionalfitness assessed through cardiopulmonary exercise testing. Hence,this review aimed to analyze relevant information about the influenceof active and passive smoking on cardiorespiratory fitness. Thereview used the main databases related to the health area, such asPubmed, Bireme and Scielo, as well as textbooks from the Universityof Santa Cruz do Sul (UNISC) library. Considering the analyzedreports, there is no doubt about the harmful effects of active andpassive smoking on respiratory and cardiovascular function. Thisstudy is relevant as it points out the risk of active and passive tobaccosmoking, which can contribute to plan health actions, stimulatingthe implementation of public policies to smoking prevention andcessation.

Effects of expiratory positive airway pressure on the electromyographic activity of accessory inspiratory muscles in COPD patients.

OBJECTIVE: To evaluate the electromyographic activity (EA) of sternocleidomastoid (SCM) and scalene muscles during and after the use of expiratory positive airway pressure (EPAP) in patients with COPD. METHODS: This was a clinical single-blind trial involving 13 healthy subjects as controls and 12 patients with stable COPD. At baseline, we determined EA during spontaneous respiration, lung function parameters, and respiratory muscle strength. Subsequently, EPAP at 15 cmH2O was applied by means of a face mask for 25 min, during which the EA of the SCM and scalene muscles was recorded every 5 min. A final record was obtained 10 min after the mask removal. RESULTS: We found that the behavior of the EA of SCM and scalene muscles was comparable between the controls and the COPD patients (p = 0.716 and p = 0.789, respectively). However, during the use of EPAP, both muscles showed a trend toward an increase in the EA. In addition, there was a significant decrease in the EA of the SCM between the baseline and final measurements (p = 0.034). CONCLUSIONS: The use of EPAP promoted a significant reduction in the EA of the SCM in the controls and in the patients with stable COPD. However, this did not occur regarding the EA of the scalene muscle.

Efeitos da pressão positiva expiratória nas vias aéreas sobre a atividade eletromiográfica da musculatura acessória da inspiração em portadores de DPOC / Effects of expiratory positive airway pressure on the electromyographic activity of accessory inspiratory muscles in COPD patients

OBJETIVO: Avaliar a atividade eletromiográfica (AE) dos músculos esternocleidomastoideo (ECM) e escaleno durante e após a aplicação de expiratory positive airway pressure (EPAP, pressão positiva expiratória nas vias aéreas) em portadores de DPOC. MÉTODOS: Ensaio clínico simples cego com 13 indivíduos hígidos como controles e 12 pacientes com DPOC estável. No momento basal, foram determinados a AE em respiração espontânea, parâmetros da função pulmonar e a força muscular respiratória. Posteriormente, foi aplicada EPAP de 15 cmH2O com uma máscara facial durante 25 min, com o registro do sinal eletromiográfico dos músculos ECM e escaleno a cada 5 min. Um último registro foi obtido 10 min após a retirada da máscara. RESULTADOS: Observamos que o comportamento da AE dos músculos ECM e escaleno foi semelhante nos controles e pacientes com DPOC (p = 0,716 e p = 0,789, respectivamente). Porém, ao longo da aplicação de EPAP, ambos os músculos mostraram uma tendência ao aumento da AE. Além disso, houve uma redução significativa da AE do ECM entre o momento final e basal (p = 0,034). CONCLUSÕES: A aplicação de EPAP promoveu uma redução significativa da AE do músculo ECM tanto nos controles quanto nos portadores de DPOC estável. Porém, isso não ocorreu em relação à AE do músculo escaleno.

OBJECTIVE: To evaluate the electromyographic activity (EA) of sternocleidomastoid (SCM) and scalene muscles during and after the use of expiratory positive airway pressure (EPAP) in patients with COPD. METHODS: This was a clinical single-blind trial involving 13 healthy subjects as controls and 12 patients with stable COPD. At baseline, we determined EA during spontaneous respiration, lung function parameters, and respiratory muscle strength. Subsequently, EPAP at 15 cmH2O was applied by means of a face mask for 25 min, during which the EA of the SCM and scalene muscles was recorded every 5 min. A final record was obtained 10 min after the mask removal. RESULTS: We found that the behavior of the EA of SCM and scalene muscles was comparable between the controls and the COPD patients (p = 0.716 and p = 0.789, respectively). However, during the use of EPAP, both muscles showed a trend toward an increase in the EA. In addition, there was a significant decrease in the EA of the SCM between the baseline and final measurements (p = 0.034). CONCLUSIONS: The use of EPAP promoted a significant reduction in the EA of the SCM in the controls and in the patients with stable COPD. However, this did not occur regarding the EA of the scalene muscle.