Effects of exercise training in water and on land in patients with COPD: a randomised clinical trial.

OBJECTIVES: To compare the effects of two similar 6-month protocols of high-intensity exercise training, in water and on land, in patients with chronic obstructive pulmonary disease (COPD). DESIGN: Randomised controlled trial. SETTING: University-based outpatient clinic. PARTICIPANTS: Thirty-six patients with predominantly moderate-to-severe COPD completed the study. INTERVENTION: Patients were evaluated at baseline, at 3 months and at the end of the programme (i.e. 6 months). For both groups, the 6-month protocol consisted of high-intensity endurance and strength exercises with gradual increase in time and/or workload, totalling 60 sessions. MAIN OUTCOMES: Objective monitoring of physical activity in daily life (PADL, primary outcome), lung function, peripheral and respiratory muscle strength, body composition, maximal and submaximal exercise capacity, functional status, quality of life, and symptoms of anxiety and depression. RESULTS: After 6 months of training, a significant improvement in PADL was seen for both groups [mean difference (95% confidence interval): land group 993 (358 to 1628) steps/day; water group 1669 (404 to 2934) steps/day]. Significant improvements were also seen in inspiratory, expiratory and peripheral muscle strength; maximal and submaximal exercise capacity; quality of life and functional status for both groups. There were no significant improvements in lung function, body composition, and symptoms of anxiety and depression for either group. No difference was found in the magnitude of improvement between the two types of training for any outcome. CONCLUSION: High-intensity exercise training in water generates similar effects compared with training on land in patients with moderate-to-severe COPD, rendering it an equally beneficial therapeutic option for this population. CLINICAL TRIAL REGISTRATION NUMBER: NCT01691131.

Isotopic variation in five species of stream fishes under the influence of different land uses.

The aim of this study was to test if changes in land use alter the isotopic signature of fish species, promoting changes in the trophic position and food resource partitioning between these consumers. Three different systems were investigated: pasture streams (n = 3), streams in sugar cane plantations (n = 3) and reference streams (n = 3). Fish species Aspidoras fuscoguttatus, Astyanax altiparanae, Characidium zebra, Hisonotus piracanjuba and Knodus moenkhausii were selected, and their nitrogen and carbon isotopic compositions were estimated to assess changes in the trophic level and partitioning of food items consumed. The composition of δ(13) C (‰) only differed among the land use categories for A. altiparanae, H. piracanjuba and K. moenkhausii. Resource partitioning was different for all species, with changes in the sources or proportions they consumed in each land use category, but only A. altiparanae introduced new food sources in large quantity in altered land uses. It is important to note, however, that the results from the resource partitioning analysis are limited due to large overlapping of isotopic signatures between the analysed food resources. All fish species exhibited variation in δ(15) N (‰), with the highest values found in streams under sugar cane or pasture influence. Despite the variation in nitrogen isotopic values, only C. zebra and H. piracanjuba displayed changes in trophic level. Therefore, it is believed that the increase in the δ(15) N (‰) value of the individuals collected in streams under the influence of sugar cane or pasture was due to the greater influence of livestock dung and chemical and organic fertilizers. The results also highlight the importance of studying consumer species along with all forms of resources available at each location separately, because the signatures of these resources also vary within different land uses.

Smith-Magenis syndrome: clinical evaluation in seven Brazilian patients.

Smith-Magenis syndrome (SMS) is a complex congenital anomaly characterized by craniofacial anomalies, neurological and behavioral disorders. SMS is caused by a deletion in region 17p11.2, which includes the RAI1 gene (90% of cases), or by point mutation in the RAI1 gene (10% of cases). Laboratory diagnosis is through cytogenetic analysis by GTG banding and molecular cytogenetic analysis by FISH. We carried out an active search for patients in Associations of Parents and Friends of Exceptional Children (APAE) of São Paulo and genetic centers in Brazil. Forty-eight patients were screened for mental retardation, craniofacial abnormalities and stereotyped behavior with a diagnosis of SMS. In seven of them, chromosome banding at high resolution demonstrated chromosome 17p11.2 deletions, confirmed by FISH. We also made a meta-analysis of 165 cases reported between 1982 and 2010 to compare with the clinical data of our sample. We demonstrated differences between the frequencies of clinical signs among the cases reported and seven Brazilian cases of this study, such as dental anomalies, strabismus, ear infections, deep hoarse voice, hearing loss, and cardiac defects. Although the gold standard for diagnosis of SMS is FISH, we found that the GTG banding technique developed to evaluate chromosome 17 can be used for the SMS diagnosis in areas where the FISH technique is not available.

Mutational screening of ACVR1 gene in Brazilian fibrodysplasia ossificans progressiva patients.

Fibrodysplasia ossificans progressiva (FOP) is a severe genetic disorder reported worldwide. A specific heterozygous mutation (c.617G> A; p.R206H) in the activin A type I receptor gene (ACVR1) is regarded as the genetic cause of FOP in all classically affected individuals worldwide. However, a few patients with FOP variants harbor distinct mutations in ACVR1. We screened a group of FOP Brazilian population for mutations in ACVR1. Of 16 patients with a classic FOP phenotype (10 males and 6 females, age range of 3-42 years), all had the classic mutation (p.R206H). One 21-year-old woman with a variant FOP phenotype had the previously reported c.983G> A mutation (p.G328E). Our study contributes to the understanding of the predominant FOP phenotype and genotype and suggests that variant FOP phenotypes are associated with specific mutations in ACVR1 gene.

Autosomal dominant atretic cephalocele with phenotype variability: report of a Brazilian family with six affected in four generations.

Atretic cephalocele is a clinicopathological entity, which is different from the common form of cephalocele. Its etiopathogenesis has not been completely explained and there are only two previous reports of familial recurrence. We report a Brazilian family with autosomal dominant inheritance with variable expressivity.

Noonan syndrome associated with unilateral iris coloboma and congenital chylothorax in an infant.

Chylothorax and colobomas are uncommon features reported in Noonan syndrome. We describe an infant with Noonan phenotype, congenital chylothorax and a unilateral iris coloboma. The presence of these both abnormalities in the same patient has not previously been reported.