Beyond pulmonary rehabilitation: can the PICk UP programme fill the gap? A randomised trial in COPD.

INTRODUCTION AND OBJECTIVES: Pulmonary rehabilitation (PR) is a fundamental intervention to manage COPD, however, maintaining its benefits is challenging. Engaging in physical activity might help to prolong PR benefits. This study assessed the efficacy and effectiveness of a personalised community-based physical activity programme to sustain physical activity and other health-related PR benefits, in people with COPD. MATERIALS AND METHODS: This was a multicentre, assessor blinded, randomised controlled trial. Following 12-weeks of PR, people with COPD were assigned to a six-months personalised community-based physical activity programme (experimental group), or to standard care (control group). Physical activity was assessed via: time spent in moderate to vigorous physical activities per day (primary outcome measure), steps/day and the brief physical activity assessment tool. Secondary outcomes included sedentary behaviour, functional status, peripheral muscle strength, balance, symptoms, emotional state, health-related quality of life, exacerbations and healthcare utilization. Assessments were performed immediately post-PR and after three- and six-months. Efficacy and effectiveness were evaluated using intention-to-treat and per-protocol analysis with linear mixed models. RESULTS: Sixty-one participants (experimental group: n = 32; control group: n = 29), with balanced baseline characteristics between groups (69.6 ± 8.5 years old, 84 % male, FEV1 57.1 ± 16.7 %predicted) were included. Changes in all physical activity outcomes and in one-minute sit-to-stand were significantly different (P < 0.05) between groups at the six-month follow-up. In the remaining outcomes there were no differences between groups. CONCLUSIONS: The community-based physical activity programme resulted in better physical activity levels and sit-to-stand performance, six-months after completing PR, in COPD. No additional benefits were observed for other secondary outcomes.

Enhancing the assessment of cardiorespiratory fitness using field tests.

OBJECTIVE: To establish normative values and reference equations of the 6-minute walk test (6MWT), incremental shuttle walk test (ISWT) and unsupported upper limb exercise test (UULEX) for Portuguese adults. DESIGN: Cross-sectional study. Descriptive statistics and differences between age decades and genders were explored using univariate general linear models to compute reference values. Reference equations were established with a forward stepwise multiple regression. SETTING: General community. PARTICIPANTS: In total, 645 adult volunteers without disabilities [43% male, mean age 55.1 (standard deviation 23.6) years] were recruited from the university campus and surrounding community. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Data on age, gender, height, weight, body mass index and smoking status were collected using a structured questionnaire. Physical activity was evaluated using the Brief Physical Activity Assessment Tool. Participants performed two repetitions of the 6MWT, ISWT and UULEX, and the best repetition was used for analysis. RESULTS: Overall, performance was better in males than in females, and decreased with age. Participants' performance was significantly reduced after the sixth decade of life compared with the other decades (P<0.001). Reference equations were: 6MWT=226.93-(5.00×age)+(360.41×height), R2=71%; ISWT=393.81-(17.98×age)+(185.64×gender)+(775.88×height), R2=83%; and UULEX=16.71-(0.14×age)+(2.66×gender), R2=57%. CONCLUSION: Leg or arm exercise field tests are affected significantly by age and gender. These results will aid health professionals to interpret the results of field tests obtained from healthy or diseased adult populations.

Thalamic Directional Deep Brain Stimulation for tremor: Spend less, get more.

BACKGROUND: Directional Deep Brain Stimulation (D-DBS) allows axially asymmetric electrical field shaping, away from structures causing side-effects. However, concerns regarding the impact on device lifespan and complexity of the monopolar survey have contributed to sparing use of these features. OBJECTIVE: To investigate whether chronically implanted D-DBS systems can improve the therapeutic window, without a negative impact on device lifespan, in thalamic deep brain stimulation (DBS). METHODS: We evaluated stable outcomes of initial programming sessions (4-6 weeks post-implantation) retrospectively in 8 patients with drug-resistant disabling tremor syndromes. We assessed the impact of directional stimulation on the Therapeutic Window (TW), Therapeutic Current Strength (TCS), tremor scores, disability scores and total electrical energy delivered. Finally, we performed Volume of Tissue Activation (VTA) modelling, based on a range of parameters. RESULTS: We report significant gains in TW (91%) and reductions in TCS (31%) with stimulation in the best direction compared to best omnidirectional stimulation alternative. Tremor and ADL scores improvements remained unchanged at six months. There was no increase in averaged IPG power consumption (there is a 6% reduction over the omnidirectional-only alternative). Illustrative VTA modelling shows that D-DBS achieves 85% of the total activation volume at just 69% of the stimulation amplitude of non-directional configuration. CONCLUSIONS: D-DBS can improve the therapeutic window over non-directional DBS, leading to significant reduction in disability that may be sustained without additional reprogramming visits. When averaged across the cohort, power output and predicted device lifespan was not impacted by the use of directional stimulation in this study.

Dermato-polimiosite tumoral. / Tumoral dermatopolymyositis

Os autores compararam 14 pacientes portadores de dermato-polimiosite primaria (DP) com pacientes portadores de reumatismo tumoral nao invasivo (RTNI) e neoplasias malignas. As idades medias no DP, DS, RNTI e neoplasias malignas foram de 25,3 mais ou menos 19,0, 47,8 mais ou menos 10,8, 51,7 mais ou menos 14,1 e 58,2 mais ou menos 13,3 anos respectivamente.Houve preponderancia do sexo masculino no grupo RTNI e feminino do DS tumoral (DST). A terapeutica para a DST mostrou-se mais eficaz com o uso de quimioterapia, radioterapia do que com o uso de anti-inflamatorios. Os dados obtidos sugerem que as dermato-polimiosite tumorais possam surgir numa faixa etaria intermediaria entre a DP e tumores malignos. A incidencia de neoplasias em dermato-polimiosite foi de 28,5%, enquanto a incidencia de DST para uma populacao de portadores de RNTI e neoplasias foi respectivamente de 22,2% e 1,1%. Especula-se tambem a respeito de um possivel mecanismo imunopatologico da DST pelo qual o nucleo tumoral poderia ter a capacidade de desviar do tumor uma populacao de celulas capazes de reagir a antigenos tumorais de uma maneira tal que a reacao se daria a nivel do sistema muscular

Estudo da tolerancia da imunoterapia anti-cancer no homem com infusao endovenosa de 5 mg de BCG da cepa Rio de Janeiro. / Tolerance of anti-cancer immunotherapy in the man with 5 mg of BCG of Rio de Janeiro strain

Os autores praticaram a imunoterapia anti-cancer empregado infusao endovenosa de 5 mg de BCG da cepa Rio de Janeiro. Concluiram ser este um metodo aceitavel, considerando sua boa tolerancia. Os efeitos colaterais foram moderados e as complicacoes reversiveis.