Heart failure worsens leg muscle strength and endurance in coexistence patients with COPD and heart failure reduced ejection fraction.

Purpose: Exercise intolerance and dyspnoea are clinical symptoms in both heart failure (HF) reduced ejection fraction (HFrEF) and chronic obstructive pulmonary disease (COPD), which are suggested to be associated with musculoskeletal dysfunction. We tested the hypothesis that HFrEF + COPD patients would present lower muscle strength and greater fatigue compared to compared to the COPD group. Methods: We included 25 patients with HFrEF + COPD (100% male, age 67.8 ± 6.9) and 25 patients with COPD alone (100% male, age 66.1 ± 9.1). In both groups, COPD severity was determined as moderate-to-severe according to the GOLD classification (FEV1/FVC < 0.7 and predicted post-bronchodilator FEV1 between 30%-80%). Knee flexor-extensor muscle performance (torque, work, power and fatigue) were measured by isokinetic dynamometry in age and sex-matched patients with HFrEF + COPD and COPD alone; Functional capacity was assessed by the cardiopulmonary exercise test, the 6-min walk test (6MWT) and the four-minute step test. Results: The COPD group exhibited reduced lung function compared to the HFrEF + COPD group, as evidenced by lower FEV1/FVC (58.0 ± 4.0 vs. 65.5 ± 13.9; p < 0.0001, respectively) and FEV1 (51.3 ± 17.0 vs. 62.5 ± 17.4; p = 0.026, respectively) values. Regarding musculoskeletal function, the HFrEF + COPD group showed a knee flexor muscles impairment, however this fact was not observed in the knee extensors muscles. Power peak of the knee flexor corrected by muscle mass was significantly correlated with the 6MWT (r = 0.40; p < 0.05), number of steps (r = 0.30; p < 0.05) and work ratepeak (r = 0.40; p < 0.05) in the HFrEF + COPD and COPD groups. Conclusion: The presence of HFrEF in patients with COPD worsens muscular weakness when compared to isolated COPD.

Sequential use of nutritional additives in diets for finishing Nellore steers in confinement.

The objective was to evaluate the effect of using prebiotics (Saccharomyces cerevisiae boulardii) or Monensin in the confinement initial phase and replacing monensin with probiotics (Bacillus toyonensis) in the final phase. Forty-eight Nellore steers were used, with an initial mean body weight of 356.2 ± 17.98 kg, distributed in a completely randomized design. Two animals per pen were confined in 80 m2 pens. The experiment was divided into two stages. The first phase lasted from day 1 to the 30th day, during which the animals were divided into two groups of 24 animals each. The treatments were the nutritional additives added to the diet: monensin or prebiotics (Saccharomyces cerevisiae boulardii). In the second phase, each group was subdivided into 12 animals by treatment, which received monensin or probiotics (Bacillus toyonensis). Dry matter intake (DMI), animal performance, and economic evaluation of the use of additives were evaluated. There was no additive effect on DMI, average daily gain, and total weight gain of the animals in the first experimental stage (0-30th day). Likewise, in the second stage (31st-100th day), there was no treatment effect for the variables of intake and performance. There was no effect of the use of different nutritional additives on carcass characteristics. The use of prebiotics sequentially to probiotics promoted gross and net yield that was superior to that of the animals that consumed monensin. Yeasts and bacteria respectively in the first and second phases of confinement can replace monensin in confinement diets.

Cerebral microvascular blood flow and CO2 reactivity in pulmonary arterial hypertension.

Hypocapnia and endothelial dysfunction might impair microvascular cerebral blood flow (CBFmicr) and cerebrovascular reactivity to CO2 (CVRCO2). Pulmonary arterial hypertension (PAH) is characteristically associated with chronic alveolar hyperventilation and microvascular endothelial dysfunction. We therefore determined CBFmicr (pre-frontal blood flow index (BFI) by the indocyanine green-near infrared spectroscopy methodology) during hypocapnia and hypercapnia in 25 PAH patients and 10 gender- and age-matched controls. Cerebral BFI was lower in patients than controls at similar transcutaneous PCO2 (PtcCO2) levels in both testing conditions. In fact, while BFI increased from hypocapnia to hypercapnia in all controls, it failed to increase in 17/25 (68%) patients. Thus, BFI increased to a lesser extent from hypo to hypercapnia ("Δ") in patients, i.e., they showed lower Δ BFI/Δ PtcCO2 ratios than controls. In conclusion, CBFmicr and CVRCO2 are lessened in clinically stable, mildly-impaired patients with PAH. These abnormalities might be associated with relevant clinical outcomes (hyperventilation and dyspnea, cognition, cerebrovascular disease) being potentially amenable to pharmacological treatment.

Heart Failure Impairs Muscle Blood Flow and Endurance Exercise Tolerance in COPD.

Heart failure, a prevalent and disabling co-morbidity of COPD, may impair cardiac output and muscle blood flow thereby contributing to exercise intolerance. To investigate the role of impaired central and peripheral hemodynamics in limiting exercise tolerance in COPD-heart failure overlap, cycle ergometer exercise tests at 20% and 80% peak work rate were performed by overlap (FEV1 = 56.9 ± 15.9% predicted, ejection fraction = 32.5 ± 6.9%; N = 16), FEV1-matched COPD (N = 16), ejection fraction-matched heart failure patients (N = 15) and controls (N = 12). Differences (Δ) in cardiac output (impedance cardiography) and vastus lateralis blood flow (indocyanine green) and deoxygenation (near-infrared spectroscopy) between work rates were expressed relative to concurrent changes in muscle metabolic demands (ΔO2 uptake). Overlap patients had approximately 30% lower endurance exercise tolerance than COPD and heart failure (p < 0.05). ΔBlood flow was closely proportional to Δcardiac output in all groups (r = 0.89-0.98; p < 0.01). Overlap showed the largest impairments in Δcardiac output/ΔO2 uptake and Δblood flow/ΔO2 uptake (p < 0.05). Systemic arterial oxygenation, however, was preserved in overlap compared to COPD. Blunted limb perfusion was related to greater muscle deoxygenation and lactate concentration in overlap (r = 0.78 and r = 0.73, respectively; p < 0.05). ΔBlood flow/ΔO2 uptake was related to time to exercise intolerance only in overlap and heart failure (p < 0.01). In conclusion, COPD and heart failure add to decrease exercising cardiac output and skeletal muscle perfusion to a greater extent than that expected by heart failure alone. Treatment strategies that increase muscle O2 delivery and/or decrease O2 demand may be particularly helpful to improve exercise tolerance in COPD patients presenting heart failure as co-morbidity.

Effects of heart failure on cerebral blood flow in COPD: Rest and exercise.

Cerebral blood flow (CBF) and oxygenation (COx) are generally well-preserved in COPD. It is unknown whether prevalent cardiovascular co-morbidities, such as heart failure, may impair CBF and COx responses to exertion. Eighteen males with moderate-to-severe COPD (8 with and 10 without overlapping heart failure) underwent a progressive exercise test with pre-frontal CBF and COx measurements (indocyanine green and near-infrared spectroscopy). Mean arterial pressure and cardiac output were lower from rest to exercise in overlap. Only COPD patients demonstrated an increase in arterialized PCO2 towards the end of progressive exercise. CBF index was consistently higher and increased further by ∼40% during exercise in COPD whereas a ∼10% reduction was observed in overlap. COx was lower in overlap despite preserved arterial oxygenation. In conclusion, heart failure introduces pronounced negative effects on CBF and COx in COPD which may be associated with clinically relevant outcomes, including dyspnea, exercise intolerance, cerebrovascular disease and cognitive impairment.

Effects of heart failure on cerebral blood flow in COPD: Rest and exercise

Cerebral blood flow (CBF) and oxygenation (COx) are generally well-preservedin COPD. It is unknown whether prevalent cardiovascular co-morbidities, suchas heart failure, may impair CBF and COx responses to exertion. Eighteen maleswith moderate-to-severe COPD (8 with and 10 without overlapping heart failure)underwent a progressive exercise test with pre-frontal CBF and COxmeasurements (indocyanine green and near-infrared spectroscopy). Meanarterial pressure and cardiac output were lower from rest to exercise in overlap. Only COPD patients demonstrated an increase in arterialized PCO2 towards theend of progressive exercise. CBF index was consistently higher and increasedfurther by ~40% during exercise in COPD whereas a ~10% reduction wasobserved in overlap. COx was lower in overlap despite preserved arterialoxygenation. In conclusion, heart failure introduces pronounced negative effectson CBF and COx in COPD which may be associated with clinically relevantoutcomes, including dyspnea, exercise intolerance, cerebrovascular disease and cognition...

Cerebral microvascular blood flow and CO2 reactivity in pulmonary arterial hypertension

Hypocapnia and endothelial dysfunction might impair microvascular cerebral blood flow (CBFmicr) and cerebrovascular reactivity to CO2 (CVRCO2). Pulmonary arterial hypertension (PAH) is characteristical lyassociated with chronic alveolar hyperventilation and microvascular endothelial dysfunction. We therefore determined CBFmicr (pre-frontal blood flow index (BFI) by the indocyanine green-near infrared spectroscopy methodology) during hypocapnia and hypercapnia in 25 PAH patients and 10 gender- andage-matched controls. Cerebral BFI was lower in patients than controls at similar transcutaneous PCO2(PtcCO2) levels in both testing conditions. In fact, while BFI increased from hypocapnia to hypercapnia inall controls, itfailed to increase in 17/25 (68%) patients. Thus, BFI increased to a lesser extentfrom hypo tohypercapnia (“”) in patients, i.e., they showed lower BFI/ PtcCO2 ratios than controls. In conclusion,CBFmicr and CVRCO2 are lessened in clinically stable, mildly-impaired patients with PAH. These abnormalities might be associated with relevant clinical outcomes (hyperventilation and dyspnea, cognition,cerebrovascular disease) being potentially amenable to pharmacological treatment...

Heart Failure Impairs Muscle Blood Flow and Endurance Exercise Tolerance in COPD

Heart failure, a prevalent and disabling co-morbidity of COPD, may impair cardiac output and muscle blood flow there by contributing to exercise intolerance. To investigate the role of impaired central and peripheral hemodynamics in limiting exercise tolerance in COPD-heart failure overlap, cycle ergometer exercise tests at20% and 80% peak work rate were performed by overlap (FEV1 = 56.9 ± 15.9% predicted, ejection fraction =32.5 ± 6.9%; N = 16), FEV1-matched COPD (N = 16), ejection fraction-matched heart failure patients (N =15) and controls (N = 12). Differences () in cardiac output (impedance cardiography) and vastus lateralis blood flow (indocyanine green) and deoxygenation (near-infrared spectroscopy) between work rates were expressed relative to concurrent changes in muscle metabolic demands (O2 uptake). Overlap patientshad approximately 30% lower endurance exercise tolerance than COPD and heart failure (p < 0.05). Blood flow was closely proportional to cardiac output in all groups (r = 0.89–0.98; p < 0.01). Overlap showedthe largest impairments in cardiac output/O2 uptake and blood flow/O2 uptake (p < 0.05). Systemicarterial oxygenation, however, was preserved in overlap compared to COPD. Blunted limb perfusion wasrelated to greater muscle deoxygenation and lactate concentration in overlap (r = 0.78 and r = 0.73, respectively;p < 0.05). Blood flow/O2 uptake was related to time to exercise intolerance only in overlap andheart failure (p < 0.01). In conclusion, COPD and heart failure add to decrease exercising cardiac output andskeletal muscle perfusion to a greater extent than that expected by heart failure alone. Treatment strategiesthat increase muscle O2 delivery and/or decrease O2 demand may be particularly helpful to improveexercise tolerance in COPD patients presenting heart failure as co-morbidity...

Craniofacial surgery for esthesioneuroblastoma: report of an international collaborative study.

Introduction Impact of treatment and prognostic indicators of outcome are relatively ill-defined in esthesioneuroblastomas (ENB) because of the rarity of these tumors. This study was undertaken to assess the impact of craniofacial resection (CFR) on outcome of ENB. Patients and Methods Data on 151 patients who underwent CFR for ENB were collected from 17 institutions that participated in an international collaborative study. Patient, tumor, treatment, and outcome data were collected by questionnaires and variables were analyzed for prognostic impact on overall, disease-specific and recurrence-free survival. The majority of tumors were staged Kadish stage C (116 or 77%). Overall, 90 patients (60%) had received treatment before CFR, radiation therapy in 51 (34%), and chemotherapy in 23 (15%). The margins of surgical resection were reported positive in 23 (15%) patients. Adjuvant postoperative radiation therapy was used in 51 (34%) and chemotherapy in 9 (6%) patients. Results Treatment-related complications were reported in 49 (32%) patients. With a median follow-up of 56 months, the 5-year overall, disease-specific, and recurrence-free survival rates were 78, 83, and 64%, respectively. Intracranial extension of the disease and positive surgical margins were independent predictors of worse overall, disease-specific, and recurrence-free survival on multivariate analysis. Conclusion This collaborative study of patients treated at various institutions across the world demonstrates the efficacy of CFR for ENB. Intracranial extension of disease and complete surgical excision were independent prognostic predictors of outcome.

Influência do perfil clínico e sociodemográfico na qualidade de vida de cardiopatas submetidos à reabilitação cardíaca / Influence of socio-demographic and clinical profiles in quality of life of cardiac patients undergoing cardiac rehabilitation

Introdução: Programas de reabilitação cardiovascular são fundamentais para garantir uma melhor qualidade de vida (QV) em pacientes cardiopatas. Objetivos: Avaliar a QV de pacientes submetidos à reabilitação cardíaca (RC) e investigar se aspectos sociodemográficos, tipo de diagnóstico e tempo de tratamento são variáveis que influenciam a QV desses pacientes. Métodos: Realizou-se um estudo transversal com 82 pacientes, 64,52 ± 9,04 anos, que responderam dois questionários, para avaliação da QV (questionário SF-36) e para classificação do nível socioeconômico, e tiveram seu nível sociodemográfico determinado. Resultados: Maiores valores dos escores do questionário SF-36 que avaliam aspectos emocionais foram observados em todas as associações realizadas. Os aspectos do perfil da amostra abordados neste estudo não repercutiram de forma representativa na QV. Conclusão: Pacientes cardiopatas submetidos à RC apresentaram maiores valores em escores de qualidade de vida que avaliam aspectos emocionais. Os fatores estudados não influenciaram a QV desses participantes.

Introduction: Cardiovascular rehabilitation programs are fundamental to ensure a better quality of life (QL) in cardiac patients. Objective: Evaluate the QL of patients undergoing cardiac rehabilitation (CR) and investigate if demographic aspects, diagnosis and treatment time are variables that influence on these patients QL. Methods: It was conducted a cross-sectional study with 82 patients, 64,52 ± 9,04 years old, who answered two questionnaires, for QL assessment (questionnaire SF-36) and for socioeconomic level classification, and their socio-demographie profile determined. Results: Higher values of scores of SF-36 questionnaire that assess emotional aspects were observed in all associations held. The sample profile aspects addressed in this study did not represent echo in QL. Conclusion: Cardiac patients submitted to RC showed greater benefits on emotional aspects and factors studied did not influence on these patients QL.

Outcome of craniofacial surgery in children and adolescents with malignant tumors involving the skull base: an international collaborative study.

BACKGROUND: The aim of the study was to characterize the distribution of anterior skull base (ASB) cancers in the pediatric population and to identify predictors of outcome. METHODS: This was an international study of 1307 patients undergoing craniofacial surgery for malignant tumors; 6.4% (n = 84) among these were

Impacto da terapia nutricional enteral ambulatorial em pacientes oncológicos / Impact of enteral nutrition therapy in ambulatory cancer patients / Impacto de la terapia nutricional enteral ambulatoria en pacientes con cáncer

O objetivo do presente estudo foi verificar o efeito da Terapia Nutricional Enteral (TNE) no estado nutricional (EN) de pacientes oncológicos. Realizou-se estudo do tipo transversal, de natureza quantitativa retrospectiva. A população estudada constituiu-se de 95 pacientes maiores de 18 anos, em uso de TNE, atendidos ambulatorialmente no período de 01/2005 a 05/2005. Foram coletados dados de estatura, peso e percentual de perda de peso (% PP), no início e após certo tempo de TNE. O EN foi verificado através da análise concomitante do IMC e do %PP. Os programas Microsoft Excel e Statistical Package for the Social Science for Windows foram utilizados para a tabulação e análise dos dados. Obteve-se dados de 95 pacientes (H:83, M:12) com média de idade de 57,28 mais ou menos 10,61 anos com neoplasias malignas de cabeça e pescoço (58,94%), esôfago (29,47), outros (11,56%). Estavam em tratamento oncológico 73,68% destes, sendo: apenas quimioterapia (11,57%), apenas radioterapia (11,57%), quimioterapía e radioterapia (26,31%), paliativo (9,47%) e 26,31% dos pacientes não tinham tratamento identificado. Receberam dieta com proteína de origem vegetal 60% dos pacientes, animal 21% e mista 18,94%. Encontrou-se % PP significativa em 10,5% dos casos avaliados e em 47,36% verificou-se manutenção ou aumento de peso. o presente estudo reafirmou a importância do uso de TNE na manutenção do EN, demonstrando sua importância como adjuvante no tratamento oncológico.

The aim of this study was to investigate the effect of Enteral Nutrition Therapy (NET) on nutrition (EN) of cancer patients. We performed a cross-sectional study, quantitative retrospective. The study population consisted of 95 patients over 18 years, while using TNE patient clinic in the period from 01/2005 to 05/2005. Data were collected on height, weight and percentage weight loss (% PP), at baseline and after certain time of TNE. NS was determined by analyzing concurrent BMI and % PP. the Microsoft Excel and Statistical Package for Social Science for Windows were used to tabulate and analyze data. We obtained data from 95 patients (M: 83 M: 12) with a mean age of 57.28 plus or minus 10.61 years with malignant head and neck (58.94%), esophagus (29.47 ), other (11.56%). Were at 73.68% of cancer treatment, as follows: chemotherapy alone (11.57%), only radiotherapy (11.57%), quimioteraía and radiotherapy (26.31%), palliative (9.47%) and 26 31% of patients had no treatment identified. Received diets with vegetable protein 60% of patients, 21% animal and 18.94% mixed. Found % PP significantly in 10.5% of cases assessed at 47.36% and there was maintenance or weight gain. The present study reaffirmed the importance of using TNE maintenance of EN, demonstrating its importance as ajuvante in cancer treatment.

El objetivo de este estudio fue investigar el efecto de la Terapia de Nutrición Enteral (NET) en materia de nutrición (EN) de los pacientes de cáncer. Se realizó estudio transversal, retrospectivo cuantitativo. La población del estudio consistió en 95 pacientes mayores de 18 año, durante el uso de la clínica del paciente TNE en el período comprendido entre el 01/2005 al 05/2005. Se recogieron datos sobre altura, peso y porcentaje de pérdida de peso (% PP), al inicio del estudio y después de cierto tiempo de NET. NS se determinó mediante el análisis simultáneo de IMC y % PP. Microsoft Excel y Paquete Estadístico para Ciencias Sociales para Windows se utiliza para tabular y analizar datos. Se recogieron datos de 95 pacientes (M: 83 M: 12) con una edad media de 57,28 más o menos 10,61 años con la cabeza y el cuello malignos (58,94%), esófago (29.47%), otros (11,56%). Fueron a 73,68% del tratamiento del cáncer, según se indica: la quimioterapia sola (11,57%), sólo la radioterapia (11,57%), quimioteraía y radioterapia (26,31%), paliativa (9,47%) y 26 31% de los pacientes sin tratamiento identificados. Recibido dietas con proteínas vegetales 60% de los pacientes, el 21% animal y 18,94% mixtos. Se encontraron % PP significativa en el 10,5% de los casos evaluados en 47,36% y no hubo mantenimiento o aumento de peso. El presente estudio reafirma la importancia de utilizar el mantenimiento de la norma EN TNE, lo que demuestra su importancia como ajuvante en el tratamiento del cáncer.

Complications of craniofacial resection for malignant tumors of the skull base: report of an International Collaborative Study.

BACKGROUND: Advances in imaging, surgical technique, and perioperative care have made craniofacial resection (CFR) an effective and safe option for treating malignant tumors involving the skull base. The procedure does, however, have complications. Because of the relative rarity of these tumors, most existing data on postoperative complications come from individual reports of relatively small series of patients. This international collaborative report examines a large cohort of patients accumulated from multiple institutions with the aim of identifying patient-related and tumor-related predictors of postoperative morbidity and mortality and set a benchmark for future studies. METHODS: One thousand one hundred ninety-three patients from 17 institutions were analyzed for postoperative mortality and complications. Postoperative complications were classified into systemic, wound, central nervous system (CNS), and orbit. Statistical analyses were carried out in relation to patient characteristics, extent of disease, prior radiation treatment, and type of reconstruction to determine factors that predicted mortality or complications. RESULTS: Postoperative mortality occurred in 56 patients (4.7%). The presence of medical comorbidity was the only independent predictor of mortality. Postoperative complications occurred in 433 patients (36.3%). Wound complications occurred in 237 (19.8%), CNS-related complications in 193 (16.2%), orbital complications in 20 (1.7%), and systemic complications in 57 (4.8%) patients. Medical comorbidity, prior radiation therapy, and the extent of intracranial tumour involvement were independent predictors of postoperative complications. CONCLUSIONS: CFR is a safe surgical treatment for malignant tumors of the skull base, with an overall mortality of 4.7% and complication rate of 36.3%. The impact of medical comorbidity and intracranial tumor extent should be carefully considered when planning therapy for patients whose tumors are amenable to CFR.