Insights on catheter-related bloodstream infections: a prospective observational study on the catheter colonization and multidrug resistance.

BACKGROUND: Central venous catheter-related bloodstream infection (CRBSI) is a huge public health concern with considerable impact on mortality and health costs. AIM: A three-year observational study enrolling three tertiary hospitals located in Lisbon, Portugal, was designed to identify the major aetiological agents of CRBSI, their ability to colonize central venous catheters and their antimicrobial resistance profiles. METHODS: Aetiological agents of CRBSI were identified by Vitek 2. Whole-genome sequencing was used to confirm CRBSI by the most prevalent aetiological agents and characterize their resistome. Central venous catheter colonization (namely by biofilm assembly) was monitored by scanning electron microscopy. FINDINGS: Staphylococci were the most prevalent causative agent (36/58, 62.0%), with S. aureus and coagulase-negative S. epidermidis accounting for 24.1% and 36.2% of CRBSIs, respectively. Fifty-nine of 72 staphylococci isolates were meticillin resistant. Comparative genomic analysis of central venous catheters/haemoculture pairs of isolates revealed genomic matches for 35 of 36 pairs and a good correlation between antibiotic susceptibility phenotype and the presence of antimicrobial resistance genetic determinants. Biofilms were present on 48.6% of the central venous catheters; nevertheless, no statistically significant association was established between biofilm assembly and CRBSI, and the presence/absence of ica operon and agr groups did not correlate with biofilm phenotypes, highlighting the need for further studies to elucidate biofilms' role on this healthcare-associated infection. CONCLUSION: Whole-genome sequencing was shown to be a valuable tool to confirm CRBSI. Although more than 42.3% of the central venous catheters were colonized by staphylococci, no statistically significant association was found between CRBSI and biofilms.

Surgical risk evaluation of lung cancer in COPD patients - A cohort observational study.

Coexistence between pulmonary cancer and chronic obstructive pulmonary disease (COPD) is frequent and is anticipated to be lead to high worldwide mortality in the next decades. The most powerful therapeutic approach for non-small cell lung carcinoma is lung surgical resection. However, in COPD patients, this approach bears a higher mortality and morbidity risk, thus requiring an accurate pre-operatory evaluation of the surgical risk comprising a clinical and functional assessment at rest, as well as a cardiopulmonary exercise test. In this observational study, factors associated with cardiopulmonary complications within 30 days after tumor resection surgery were investigated in a cohort of patients with COPD and lung cancer assigned to perform a cardiopulmonary exercise test. This study included 50 patients (46 men, 92.0%) with a mean age of 64.7 years old (standard deviation 7.9), forced expiratory volume in the first second (FEV1) of 61.8% (SD 19.0%) and carbon monoxide diffusing capacity (DLCO) of 46.0% (SD 14.8%). Complications were observed in eighteen patients (36.0%) including 2 deaths (4.0%). Peak oxygen uptake (VO2peak) expressed in percentage of the predicted value was the only parameter showing a statistically significant difference between the groups with and without complications (p=0.027). The best value of VO2peak to discriminate complications occurrence was 61.0%. This study highlights the relevance of the cardiopulmonary exercise test in the risk assessment of pulmonary resection surgery in patients with COPD. The VO2peak (percentage of predicted value) is shown to be associated with complications within 30 days after surgery.

Necrotizing pulmonary aspergillosis: regarding two clinical cases.

The authors present two case reports of necrotizing pulmonary aspergillosis. This disease is part of a spectrum of clinical conditions caused by the inhalation of Aspergillus spores. The necrotizing pulmonary aspergillosis (NPA) corresponds to an indolent, destructive process of the lung due to invasion by Aspergillus species, usually A. fumigatus. The diagnosis is confirmed by a histological demonstration of tissue invasion by Aspergillus species and its growth on culture. Due to the difficulty in confirming the diagnosis, the following diagnosis criteria were established and when combined are highly indicative of NPA: characteristic clinical and radiological findings, elevation of inflammatory markers and either serological results positive for Aspergillus or the isolation of Aspergillus from respiratory samples. Active tuberculosis, non tuberculosis mycobacteriosis, cavitary histoplasmosis and coccidioidomycosis should be excluded. It is necessary to raise the level of suspicion and perform the adequate diagnostic tests in order to start therapy and avoiding disease progression.

Bilateral pedaling asymmetry during a simulated 40-km cycling time-trial.

AIM: This study investigated the pedaling asymmetry during a 40-km cycling time-trial (TT). METHODS: Six sub-elite competitive male cyclists pedaled a SRM Training Systems cycle ergometer throughout a simulated 40-km TT. A SRM scientific crank dynamometer was used to measure the bilateral crank torque (N.m) and pedaling cadence (rpm). All data were analyzed into 4 stages with equal length obtained according to total time. Comparisons between each stage of the 40-km TT were made by an analysis of variance (ANOVA). Dominant (DO) and non-dominant (ND) crank peak torque asymmetry was determined by the equation: asymmetry index (AI%)=[(DO-ND)/DO] 100. Pearson correlation analysis was performed to verify the relationship between exercise intensity, mean and crank peak torque. RESULTS: The crank peak torque was significantly (P<0.05) greater in the 4th stage compared with other stages. During the stages 2 and 3, was observed the AI% of 13.51% and 17.28%, respectively. Exercise intensity (%VO(2max)) was greater for stage 4 (P<0.05) and was highly correlated with mean and crank peak torque (r=0.97 and r=0.92, respectively) for each stage. CONCLUSIONS: The DO limb was always responsible for the larger crank peak torque. It was concluded that pedaling asymmetry is present during a simulated 40-km TT and an increase on crank torque output and exercise intensity elicits a reduction in pedaling asymmetry.

Mercado consumidor de carne suína e derivados em Belo Horizonte / Pork consumer market in Belo Horizonte, Brazil

Avaliou-se o comportamento do mercado consumidor de carne suína e seus derivados em Belo Horizonte. Foram entrevistados 401 consumidores, homens e mulheres, maiores de 19 anos de idade, mantendo-se a proporcionalidade observada no censo populacional. Além de sexo e faixa etária, escolaridade, ocupação e renda familiar foram levantadas para compor os fatores condicionantes da pesquisa. A carne suína in natura é consumida até três vezes por semana pela maioria da população (61,6 por cento), em função de seu sabor e versatilidade. A compra costuma ser feita num mesmo estabelecimento comercial, sendo preferidos os cortes feitos na hora. O consumo de derivados da carne suína é maior que o da carne in natura em razão da grande variedade de produtos. Os consumidores acreditam que a carne suína in natura e derivados sejam perigosos à saúde pelo excesso de gordura ou de colesterol (38,4 por cento) e por transmitir doenças (27,8 por cento). Sexo, idade e renda familiar têm influência no consumo, mas não escolaridade e ocupação. As marcas dos produtos derivados aumentam a confiabilidade e indicam a origem, para a maioria dos consumidores. A população, embora mais atenta aos conceitos de alimentação saudável e segura, não conhece o significado e a função da rastreabilidade e certificação de origem dos produtos. Para aumentar o consumo e justificar a criação de programa de certificação da carne suína e derivados em Minas Gerais, é necessário campanha dirigida de marketing para eliminar os preconceitos em relação a estes produtos.

Effect of exercise and nasal splinting on static and dynamic measures of nasal airflow.

The main aim of this study was to assess the separate and combined effects of exercise and nasal splinting on static and dynamic measures of nasal airflow. In a randomized crossover design, 12 healthy participants (6 men, 6 women) performed static and dynamic spirometric nasal airflow assessment tests, with or without nasal splinting (Breathe-Right), before and after a maximal oxygen uptake (VO2max) treadmill test. At least 7 days later, the VO2max, and nasal airflow tests were repeated. The results showed that the measured variables were not significantly different with and without nasal splinting. We conclude that the absence of significantly enhanced nasal patency observed for nasal splinting and after exercise suggest that these factors have a minimal impact on nasal airflow volume and rate.

Nasal splinting effects on breathing patterns and cardiorespiratory responses.

The aim of this study was to compare the effects of nasal splinting during different modes of breathing on breathing patterns and cardiorespiratory responses. Ten healthy subjects (4 males, 6 females) performed five maximal treadmill tests while breathing through the nose, nose + dilator, mouth, nose + mouth, and nose + mouth + dilator. Repeated-measures analysis of variance and Tukey HSD revealed no significant differences between trials for maximal oxygen consumption, minute ventilation at an oxygen consumption of 30 ml.kg-1.min-1, carbon dioxide production, respiratory exchange ratio, tidal volume, dead space to tidal volume ratio, or completed treadmill stages to exhaustion. No significant difference was found in subjective dyspnoea ratings between stages of nose versus nose + dilator breathing. Minute ventilation, ventilatory equivalent for oxygen, and breath frequency for nose and nose + dilator versus mouth, nose + mouth, and nose + mouth + dilator were significantly lower. Ventilatory equivalent for carbon dioxide was significantly lower for nose versus mouth, and nose + dilator versus nose + mouth + dilator breathing. End-tidal carbon dioxide was significantly higher in nose versus mouth, nose + mouth, and nose + mouth + dilator breathing, and in nose + dilator versus mouth breathing. Nose breathing revealed a significantly lower heart rate versus nose + dilator, mouth, nose + mouth, and nose + mouth + dilator breathing. These results suggest that nasal splinting during exercise has minimal effects when nasal breathing and no effects when oronasal breathing.

Cardiorespiratory responses to exercises of equal relative intensity distributed between the upper and lower body.

The principles underlying the cardiorespiratory responses to upper body versus lower body exercise remain unclear. We explored the hypothesis that workloads of the same percentage of maximum strength for a particular part of the body might elicit similar cardiovascular responses. Twelve trained female university rowers (mean +/- s: age, 22.8 +/- 1.3 years; body mass, 66.9 +/- 1.8 kg; height, 169 +/- 6 cm; body fat, 18 +/- 2%; HRpeak, 190 +/- 3 beats min(-1); VO2 peak, 50.7 +/- 2.6 ml kg(-1) min(-1)) performed four 12 min exercise trials on a rowing ergometer. Arm rowing, leg extension and arm rowing + leg extension workloads were set at 20% of the mean of their respective three-repetition maximum (3-RM). The combination of arm rowing and leg extension was also performed in a reciprocal workload fashion; that is, the arm workload was 20% of the mean 3-RM for leg extension, and the leg extension workload was 20% of the mean 3-RM for arm rowing. Analysis of variance and Tukey HSD showed that, although the power output for leg extension was 144% higher than for arm rowing, the mean VO2, VE and heart rate values were not significantly different between exercise modes. Oxygen uptake for reciprocal arm rowing + leg extension, with the arms performing 71% of the total power output, was not significantly different from non-reciprocal arm rowing + leg extension; however, the VE and heart rate values were higher. Our results suggest that, during submaximal exercise, cardiorespiratory responses to upper body exercise do not differ significantly from those to lower body exercise, so long as the upper and lower body workloads are set at an equal relative strength level.

Metabolic and ventilatory response to cross-country skiing classical and double arm poling exercise.

Nordic skiers place great emphasis on upper body endurance. Therefore, the purpose of this study was to compare oxygen uptake (VO2), minute ventilation (VE), tidal volume (VT), breath frequency (fB), heart rate (HR), and ventilatory anaerobic threshold (Tvan) responses to upper body classical poling (CP) and double poling (DP). Sixteen male master class cross-country ski racers performed DP and CP at similar incremental power outputs at 45 strokes/min on a modified Biokinetic swim bench variable-resistance arm ergometer. Leg VO2peak was measured during a Monark bicycle ergometer graded exercise test. Mean CP VO2peak was 34.8 +/- 9.0 ml kg-1 min-1 compared to 40.3 +/- 10.5 ml.kg-1 for DP (p < 0.05). CP and DP VO2peak was 70 +/- 3.4% and 81 +/- 3.8% respectively of the bicycle test VO2peak. DP VO2peak, and HR peak were significantly (p < 0.05) higher than for CP. CP Tvan appeared at 30.1 +/- 6.9 ml.kg-1.min-1 or 86 +/- 3.2% of CP VO2peak and DP Tvan occurred at 36.6 +/- 9.0 ml.kg-1.min-1 or 92 +/- 3.6% of DP VO2peak (p < 0.01). HR at Tvan was significantly higher for DP than for CP (< 0.05). Values for VT, fB, and VE measured at Tvan for both arm exercise modes were not significantly (p > 0.05) different. At submaximal exercise values for VO2, and HR were significantly different between the arm exercise modes. It is concluded that the mechanisms responsible for these observations may be increased active upper body muscle mass involvement for DP and that Tvan adaptations occur specifically to the exercise mode and recruited muscle groups.

Ventilatory response pattern of Nordic skiers during simulated poling.

Cross-country ski poling is a distinctive exercise imposed by biomechanical motion which may influence the breathing pattern. To examine the ventilatory patterns of competitive cross-country skiers, the pulmonary function of nine male master level skiers was studied during simulated bilateral synchronous and asynchronous arm poling and upright leg cycling. Physiological and ventilatory responses during arm and leg exercise were compared on a Biokinetic arm ergometer and Monark bicycle. At similar levels of oxygen consumption, minute ventilation (VE) was lower for leg cycling than for the arm exercise modes. Heart rate was significantly higher (P < 0.05) during bilateral synchronous poling than for either bilateral asynchronous poling or leg cycling. Leg cycling elicited a higher tidal volume (VT) than either of the arm poling modes (1.8 vs 1.7 and 1.6 l). Breathing frequency (fR) was significantly higher (P < 0.05) for both arm exercise modes when compared to leg cycling (41 and 42 vs 27 breaths min-1). Frequency of strokes per breath (fS/fR) was significantly higher (P < 0.01) while cycling compared to synchronous arm work. The mean ratio of fS/fR per minute was 1.1:1 and 1.7:1 for arm exercise and leg cycling, respectively. Bilateral synchronous arm poling invoked a similar VE, lower VT and higher fR than bilateral asynchronous poling or leg cycling. These results demonstrate that ventilatory responses to arm poling are different from those to upright cycle exercise. There was a greater reliance during poling upon fR to maintain VE.

Energy expenditure, aerodynamics and medical problems in cycling. An update.

The cyclist's ability to maintain an extremely high rate of energy expenditure for long durations at a high economy of effort is dependent upon such factors as the individual's anaerobic threshold, muscle fibre type, muscle myoglobin concentration, muscle capillary density and certain anthropometric dimensions. Although laboratory tests have had some success predicting cycling potential, their validity has yet to be established for trained cyclists. Even in analysing the forces producing propulsive torque, cycling effectiveness cannot be based solely on the orientation of applied forces. Innovations of shoe and pedal design continue to have a positive influence on the biomechanics of pedalling. Although muscle involvement during a complete pedal revolution may be similar, economical pedalling rate appears to differ significantly between the novice and racing cyclist. This difference emanates, perhaps, from long term adaptation. Air resistance is by far the greatest retarding force affecting cycling. The aerodynamics of the rider and the bicycle and its components are major contributors to cycling economy. Correct body posture and spacing between riders can significantly enhance speed and efficiency. Acute and chronic responses to cycling and training are complex. To protect the safety and health of the cyclist there must be close monitoring and cooperation between the cyclist, coach, exercise scientist and physician.

Effect of exercise on blood lipid constituents and aerobic capacity of fire fighters.

The effect of 32 weeks of exercise training, at moderate intensity, on serum lipids, lipoproteins, aerobic power, anaerobic threshold, body composition, and coronary heart disease (CHD) risk factors was examined in 38 male fire fighters (mean +/- SD 42.7 +/- 6.4 yr). Exercise training included cycling, rowing, walking, jogging, running, and circuit weight training 3 d/wk, 30 min/session at 350 to 450 kcal/session. Fasting blood samples collected pre- and post-training were assayed for triglyceride (TG), total cholesterol (CHOL), low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDL-C), and high-density lipoprotein (HDL-C). Maximum aerobic power (VO2max) was measured during a treadmill test. Anaerobic threshold (AT) was predicted by observing the onset of a systematic increase in VE/VO2 without a concomitant increase in VE/VCO2. Body composition was determined via underwater weighing and skinfold measurements. There were no significant differences in CHOL, CHOL/HDL-C ratio, or LDL-C/HDL-C ratio. Only the AT, HDL-C, VO2max, and CHD risk levels changed significantly (P less than 0.05). Cholesterol, LDL-C, VLDL-C and triglycerides were linearly related to body fat. Maximal oxygen uptake and HDL-C were inversely related to body fat. It was concluded that moderate exercise intensity can yield a marked increase in AT, VO2max, and HDL-C while not significantly affecting the CHOL level. The findings lend support to the contention that risk reduction for CHD lies on a continuum.

Relationship of the anthropometric and physical characteristics of male junior gymnasts to performance.

To evaluate the structural characteristics concomitant to excellence in gymnastics performance, body composition, anthropometric measurements, power, strength, and flexibility were determined in Junior Olympic gymnastics competitors. Physical parameter measurements were performed on 65 male Class I and II all-around gymnasts. National team qualifiers, top 10 Class I and II, were compared to those who placed 11th to 34th in the all-around scoring at the 1987 U.S. Gymnastics Federation Junior Olympic National Championships. The mean percent body fat, 7.1 +/- 1.6%, compared favorably with European gymnasts (7.07 +/- 1.7%). Top Class II gymnasts were significantly leaner (6.1 +/- 0.8% fat) than Class I (6.9 +/- 1.5% fat) and Class II (8.8 +/- 3.2% fat). The mean strength to body ratio was 138.8 +/- 16.8% while the Top Class I exhibited the highest ratio of 148.2 +/- 21.1%. Class II recorded a significantly higher absolute jump and reach (66.8 +/- 19.3 cm) and polyometric (66.2 +/- 6.4 cm) than the other classes. Class I and Top Class II gymnasts exhibited the greatest shoulder rotation while Top Class I exhibited the greatest hip flexion. Grip strength was low for all groups. To Class I and Top Class II when compared to other classes were characterized as shorter in stature, stronger in both relative and absolute strength, possessed greater flexibility through the hip region, shoulder girdle, back, were leaner, and possessed more muscle mass.

Applied physiology of cycling.

Historically, the bicycle has evolved through the stages of a machine for efficient human transportation, a toy for children, a finely-tuned racing machine, and a tool for physical fitness development, maintenance and testing. Recently, major strides have been made in the aerodynamic design of the bicycle. These innovations have resulted in new land speed records for human powered machines. Performance in cycling is affected by a variety of factors, including aerobic and anaerobic capacity, muscular strength and endurance, and body composition. Bicycle races range from a 200m sprint to approximately 5000km. This vast range of competitive racing requires special attention to the principle of specificity of training. The physiological demands of cycling have been examined through the use of bicycle ergometers, rollers, cycling trainers, treadmill cycling, high speed photography, computer graphics, strain gauges, electromyography, wind tunnels, muscle biopsy, and body composition analysis. These techniques have been useful in providing definitive data for the development of a work/performance profile of the cyclist. Research evidence strongly suggests that when measuring the cyclist's aerobic or anaerobic capacity, a cycling protocol employing a high pedalling rpm should be used. The research bicycle should be modified to resemble a racing bicycle and the cyclist should wear cycling shoes. Prolonged cycling requires special nutritional considerations. Ingestion of carbohydrates, in solid form and carefully timed, influences performance. Caffeine appears to enhance lipid metabolism. Injuries, particularly knee problems which are prevalent among cyclists, may be avoided through the use of proper gearing and orthotics. Air pollution has been shown to impair physical performance. When pollution levels are high, training should be altered or curtailed. Effective training programmes simulate competitive conditions. Short and long interval training, blended with long distance tempo cycling, will exploit both the anaerobic and aerobic systems. Strength training, to be effective, must be performed with the specific muscle groups used in cycling, and at specific angles of involvement.