Correlates of Sexual Behavior Across Fatherhood Status: Finding From the National Longitudinal Study of Adolescent to Adult Health (Add Health), 2016-2018.

Amid national trends in postponed parenthood and more diverse family structures, the fatherhood identity may be important to men's sexual behaviors. This study examined factors associated with reports of consistent contraceptive use and multiple sexual partners across fatherhood status. Using public data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), Wave V (2016-2018), two sexual behaviors were examined among 1,163 men aged 32 to 42 years. Outcomes were two binary indicators: consistent contraceptive use with partner and having multiple (≥2) sexual partners in the past year. Fatherhood status was categorized as nonfather, resident father, and nonresident father. Demographic (e.g., race/ethnicity, education, income, and relationship type) and health-related (e.g., drinking, perceived stress, depressive symptoms, and insurance status) factors were considered. Logistic regression analysis produced odds ratios and 95% confidence intervals and were stratified by fatherhood categories. In the sample, 72% of men were resident fathers, 10% were nonresident fathers, and 18% were nonfathers; 28% reported consistent contraceptive use and 16% reported multiple sexual partners. For nonfathers, relationship type and race were associated with reporting multiple sexual partners. For resident fathers, relationship type was the crucial factor associated with consistent contraceptive use and reporting multiple sexual partners. In nonresident fathers, relationship type, education, and income were important factors to consistent contraceptive use and reporting multiple sexual partners. Key findings suggest that relationship type, income, and education are crucial factors to men's sexual behavior. Heterogeneous effects were observed across fatherhood status. This study adds to limited research on fatherhood and sexual behavior among men transitioning from young adulthood to middle age.

Indications and Coverage of Metabolic and Bariatric Surgery: A Worldwide IFSO Survey Comparing Different National Guidelines.

INTRODUCTION: Knowing how metabolic and bariatric surgery (MBS) is indicated in different countries is essential information for the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). AIM: To analyze the indications for MBS recommended by each of the national societies that comprise the IFSO and how MBS is financed in their countries. METHODS: All IFSO societies were asked to fill out a survey asking whether they have, and which are their national guidelines, and if MBS is covered by their public health service. RESULTS: Sixty-three out of the 72 IFSO national societies answered the form (87.5%). Among them, 74.6% have some kind of guidelines regarding indications for MBS. Twenty-two percent are still based on the US National Institute of Health (NIH) 1991 recommendations, 43.5% possess guidelines midway the 1991s and ASMBS/IFSO 2022 ones, and 34% have already adopted the latest ASMBS/IFSO 2022 guidelines. MBS was financially covered in 65% of the countries. CONCLUSIONS: Most of the IFSO member societies have MBS guidelines. While more than a third of them have already shifted to the most updated ASMBS/IFSO 2022 ones, another significant number of countries are still following the NIH 1991 guidelines or even do not have any at all. Besides, there is a significant number of countries in which surgical treatment is not yet financially covered. More effort is needed to standardize indications worldwide and to influence insurers and health policymakers to increase the coverage of MBS.

Profiling Expression Strategies for a Type III Polyketide Synthase in a Lysate-Based, Cell-free System.

Some of the most metabolically diverse species of bacteria (e.g., Actinobacteria) have higher GC content in their DNA, differ substantially in codon usage, and have distinct protein folding environments compared to tractable expression hosts like Escherichia coli. Consequentially, expressing biosynthetic gene clusters (BGCs) from these bacteria in E. coli frequently results in a myriad of unpredictable issues with protein expression and folding, delaying the biochemical characterization of new natural products. Current strategies to achieve soluble, active expression of these enzymes in tractable hosts, such as BGC refactoring, can be a lengthy trial-and-error process. Cell-free expression (CFE) has emerged as 1) a valuable expression platform for enzymes that are challenging to synthesize in vivo, and as 2) a testbed for rapid prototyping that can improve cellular expression. Here, we use a type III polyketide synthase from Streptomyces griseus, RppA, which catalyzes the formation of the red pigment flaviolin, as a reporter to investigate BGC refactoring techniques. We synergistically tune promoter and codon usage to improve flaviolin production from cell-free expressed RppA. We then assess the utility of cell-free systems for prototyping these refactoring tactics prior to their implementation in cells. Overall, codon harmonization improves natural product synthesis more than traditional codon optimization across cell-free and cellular environments. Refactoring promoters and/or coding sequences via CFE can be a valuable strategy to rapidly screen for catalytically functional production of enzymes from BCGs. By showing the coordinators between CFE versus in vivo expression, this work advances CFE as a tool for natural product research.

Rewiring cell-free metabolic flux in E. coli lysates using a block-push-pull approach.

Cell-free systems can expedite the design and implementation of biomanufacturing processes by bypassing troublesome requirements associated with the use of live cells. In particular, the lack of survival objectives and the open nature of cell-free reactions afford engineering approaches that allow purposeful direction of metabolic flux. The use of lysate-based systems to produce desired small molecules can result in competitive titers and productivities when compared to their cell-based counterparts. However, pathway crosstalk within endogenous lysate metabolism can compromise conversion yields by diverting carbon flow away from desired products. Here, the 'block-push-pull' concept of conventional cell-based metabolic engineering was adapted to develop a cell-free approach that efficiently directs carbon flow in lysates from glucose and toward endogenous ethanol synthesis. The approach is readily adaptable, is relatively rapid and allows for the manipulation of central metabolism in cell extracts. In implementing this approach, a block strategy is first optimized, enabling selective enzyme removal from the lysate to the point of eliminating by-product-forming activity while channeling flux through the target pathway. This is complemented with cell-free metabolic engineering methods that manipulate the lysate proteome and reaction environment to push through bottlenecks and pull flux toward ethanol. The approach incorporating these block, push and pull strategies maximized the glucose-to-ethanol conversion in an Escherichia coli lysate that initially had low ethanologenic potential. A 10-fold improvement in the percent yield is demonstrated. To our knowledge, this is the first report of successfully rewiring lysate carbon flux without source strain optimization and completely transforming the consumed input substrate to a desired output product in a lysate-based, cell-free system.

Associations Between Cancer Risk Perceptions, Self-Efficacy, and Health Behaviors by BMI Category and Race and Ethnicity.

BACKGROUND: Cancer risk perceptions and high health-related self-efficacy may impact health behaviors and reduce risk of developing obesity-related cancers. The purpose of this study was to examine whether there are differences in associations among cancer risk perceptions, health-related self-efficacy, and health behaviors between people with healthy weight (PwHW) and people with overweight or obesity (PwO/O), and whether these associations vary by race and ethnicity. METHOD: Data from the Health Information National Trends Survey (HINTS) 5 Cycles 2 and 3 were used. Data from 6944 adults were analyzed using multivariate logistic regression to assess associations among study variables. RESULTS: PwO/O who believed there are too many cancer prevention recommendations had lower log odds of meeting guidelines for strength training (ß - 0.28; CI - 0.53 to - 0.04; p < 0.05) compared to PwHW. PwO/O who believed that obesity influences cancer risk were associated with low sedentary behavior (ß 0.29; CI 0.05-0.54; p < 0.05) compared to PwHW. NHB PwO/O who held fatalistic beliefs and reported high self-efficacy ordered less food (e.g., fewer food items, foods with less calories, or smaller food sizes) compared to NHB Pw/HW (p < 0.05). CONCLUSION: Health behavior differences in PwHW and PwO/O may be associated with differences in cancer risk beliefs and health-related self-efficacy. Findings support the need for further research considering BMI and race and ethnicity in obesity-related cancer prevention and control.

A Review of Miscarriage and Healthcare Communication in the United States.

Miscarriage is a pervasive and socioemotionally complex pregnancy complication. Evidence suggests that poor clinical management can worsen these experiences. Yet, assessments of healthcare communication during a miscarriage are limited and a systematic review of the literature is needed. This review identified and synthesized original research on miscarriage and healthcare communication in the United States from the past 20 years to identify existing knowledge gaps for future miscarriage research. The following databases were searched: PubMed, PsychINFO, and ERIC Database. Data were charted according to Arksey and O'Malley's Scoping Review Framework. Eleven articles were included in the review and three primary themes emerged: (a) patients overwhelmingly prefer patient-centered care; (b) miscarriage is often overmedicalized, which leads to poor communication; and (c) informed decision-making related to one's miscarriage can improve patient experiences. Several gaps were also identified, including studies seeking physician perspectives on miscarriage communication, evaluation of standard care guidelines, and studies evaluating diverse patients' perspectives. This review highlights the need for patient-centered care that utilizes compassionate and accessible language and promotes informed decision-making. Future research should use quantitative methodologies and longitudinal designs to build upon these findings and improve patient experiences of miscarriage.

Investigating and Optimizing the Lysate-Based Expression of Nonribosomal Peptide Synthetases Using a Reporter System.

Lysate-based cell-free expression (CFE) systems are accessible platforms for expressing proteins that are difficult to synthesize in vivo, such as nonribosomal peptide synthetases (NRPSs). NRPSs are large (>100 kDa), modular enzyme complexes that synthesize bioactive peptide natural products. This synthetic process is analogous to transcription/translation (TX/TL) in lysates, resulting in potential resource competition between NRPS expression and NRPS activity in cell-free environments. Moreover, CFE conditions depend on the size and structure of the protein. Here, a reporter system for rapidly investigating and optimizing reaction environments for NRPS CFE is described. This strategy is demonstrated in E. coli lysate reactions using blue pigment synthetase A (BpsA), a model NRPS, carrying a C-terminal tetracysteine (TC) tag which forms a fluorescent complex with the biarsenical dye, FlAsH. A colorimetric assay was adapted for lysate reactions to detect the blue pigment product, indigoidine, of cell-free expressed BpsA-TC, confirming that the tagged enzyme is catalytically active. An optimized protocol for end point TC/FlAsH complex measurements in reactions enables quick comparisons of full-length BpsA-TC expressed under different reaction conditions, defining unique requirements for NRPS expression that are related to the protein's catalytic activity and size. Importantly, these protein-dependent CFE conditions enable higher indigoidine titer and improve the expression of other monomodular NRPSs. Notably, these conditions differ from those used for the expression of superfolder GFP (sfGFP), a common reporter for optimizing lysate-based CFE systems, indicating the necessity for tailored reporters to optimize expression for specific enzyme classes. The reporter system is anticipated to advance lysate-based CFE systems for complex enzyme synthesis, enabling natural product discovery.

Examining the trajectory of parent emotion talk in mothers of toddlers: A predominantly Latine sample.

Supportive parent emotion socialization has been associated with greater child emotion understanding and expression and lower levels of externalizing behavior problems, with limited understanding on parent emotion socialization in toddlerhood. The current study examined the developmental trajectory of emotion socialization via emotion talk in mothers of toddlers from a predominantly Latine sample. Participants were 101 mother-toddler dyads assessed over three time points from ages 12-25 months. Overall, maternal emotion talk remained relatively stable over time, although there was a significant decrease between the first and second assessments before returning to initial rates at the third assessment. Maternal emotion talk did not predict child externalizing behavior over time. Interestingly, however, greater toddler externalizing behavior problems was associated with an increase in maternal emotion talk over time. These findings suggest maternal emotion talk is relatively stable for parents of children who are low on externalizing behaviors and may fluctuate (i.e., slowly increase) for mothers of children who are high in externalizing behaviors. Understanding these mechanisms further could help inform how we implement and personalize parenting interventions.

Early career medical physicist groups in Europe: An EFOMP survey.

INTRODUCTION: Training, educating, and fostering of young professionals are key requisites for the progress of any profession. The young medical physicists (MPs) of today are the medical physics professionals and leaders of tomorrow. It is, therefore, essential that they learn to work collectively and in a coordinated manner at both national and European levels at an early stage in their career. In view of this, EFOMP is planning to create a special interest group (SIG) encompassing early career MPs from across Europe. METHODS: A survey was developed by EFOMP and circulated to all National Member Organisations (NMOs) to gather information on the status of early career groups in their respective societies and on the interest to partake in such group within the Federation. RESULTS: Of the 36 NMOs that are part of EFOMP, 32 responded to the survey. Only 9 NMOs have established early career MPs groups within their NMOs, while the remaining countries are either considering setting up young MPs groups in the future (15 NMOs) or do not show such interest (8 NMOs). Of all responders, 59% expressed interest in the creation of the EFOMP SIG, 34% remained neutral towards this issue by not answering the question and for two NMOs the SIG idea had no appeal. CONCLUSION: Most NMOs showed interest in the creation of an early career MPs group within EFOMP and offered constructive feedbacks on the roles they envisage for the group. EFOMP will use and implement this information when establishing the special interest group.

Liquid Chromatography Coupled to Refractive Index or Mass Spectrometric Detection for Metabolite Profiling in Lysate-based Cell-free Systems.

Engineering cellular metabolism for targeted biosynthesis can require extensive design-build-test-learn (DBTL) cycles as the engineer works around the cell's survival requirements. Alternatively, carrying out DBTL cycles in cell-free environments can accelerate this process and alleviate concerns with host compatibility. A promising approach to cell-free metabolic engineering (CFME) leverages metabolically active crude cell extracts as platforms for biomanufacturing and for rapidly discovering and prototyping modified proteins and pathways. Realizing these capabilities and optimizing CFME performance requires methods to characterize the metabolome of lysate-based cell-free platforms. That is, analytical tools are necessary for monitoring improvements in targeted metabolite conversions and in elucidating alterations to metabolite flux when manipulating lysate metabolism. Here, metabolite analyses using high-performance liquid chromatography (HPLC) coupled with either optical or mass spectrometric detection were applied to characterize metabolite production and flux in E. coli S30 lysates. Specifically, this report describes the preparation of samples from CFME lysates for HPLC analyses using refractive index detection (RID) to quantify the generation of central metabolic intermediates and by-products in the conversion of low-cost substrates (i.e., glucose) to various high-value products. The analysis of metabolite conversion in CFME reactions fed with 13C-labeled glucose through reversed-phase liquid chromatography coupled to tandem mass spectrometry (MS/MS), a powerful tool for characterizing specific metabolite yields and lysate metabolic flux from starting materials, is also presented. Altogether, applying these analytical methods to CFME lysate metabolism enables the advancement of these systems as alternative platforms for executing faster or novel metabolic engineering tasks.

A lysate proteome engineering strategy for enhancing cell-free metabolite production.

Cell-free systems present a significant opportunity to harness the metabolic potential of diverse organisms. Removing the cellular context provides the ability to produce biological products without the need to maintain cell viability and enables metabolic engineers to explore novel chemical transformation systems. Crude extracts maintain much of a cell's capabilities. However, only limited tools are available for engineering the contents of the extracts used for cell-free systems. Thus, our ability to take full advantage of the potential of crude extracts for cell-free metabolic engineering is constrained. Here, we employ Multiplex Automated Genomic Engineering (MAGE) to tag proteins for selective depletion from crude extracts so as to specifically direct chemical production. Specific edits to central metabolism are possible without significantly impacting cell growth. Selective removal of pyruvate degrading enzymes resulted in engineered crude lysates that are capable of up to 40-fold increases in pyruvate production when compared to the non-engineered extract. The described approach melds the tools of systems and synthetic biology to showcase the effectiveness of cell-free metabolic engineering for applications like bioprototyping and bioproduction.

Branched-Chain Volatiles in Fruit: A Molecular Perspective.

Branched-chain volatiles (BCVs) constitute an important family of fruit volatile metabolites essential to the characteristic flavor and aroma profiles of many edible fruits. Yet in contrast to other groups of volatile organic compounds important to fruit flavor such as terpenoids, phenylpropanoids, and oxylipins, the molecular biology underlying BCV biosynthesis remains poorly understood. This lack of knowledge is a barrier to efforts aimed at obtaining a more comprehensive understanding of fruit flavor and aroma and the biology underlying these complex phenomena. In this review, we discuss the current state of knowledge regarding fruit BCV biosynthesis from the perspective of molecular biology. We survey the diversity of BCV compounds identified in edible fruits as well as explore various hypotheses concerning their biosynthesis. Insights from branched-chain precursor compound metabolism obtained from non-plant organisms and how they may apply to fruit BCV production are also considered, along with potential avenues for future research that might clarify unresolved questions regarding BCV metabolism in fruits.

Anti-proliferative effects of a blueberry extract on a panel of tumor cell lines of different origin.

BACKGROUND: Blueberries are among the fruits with the highest antioxidant activity and have been recognized by their health promoting properties. AIM: In vitro study of the anti-proliferative effects of a blueberry extract on a panel of cancer cells from different origin. MATERIALS AND METHODS: A blueberry extract was produced using ethanol as extracting solvent. The anti-proliferative activity of the extract was evaluated against seven tumor cell lines. The properties of blueberry extract to decrease cell adhesion and migration were also investigated. RESULTS: Blueberry extract showed a dose-dependent inhibitory effect on cell proliferation for all cell lines. Non-cytotoxic concentrations of the extract decreased cell adhesion in five of seven cell lines studied and inhibited the migration of MDA-MB-231 and PC-3 tumor cells. CONCLUSION: This work provides additional evidence regarding the ability of blueberry extract to inhibit the growth and decrease cell adhesion and migration of different cancer cell lines in vitro.

A Review of the Fruit Volatiles Found in Blueberry and Other Vaccinium Species.

Variations in volatile organic compound (VOC) type and content can result in noticeable differences in fruit aroma. The genus Vaccinium encompasses over 500 distinct species of berry-producing plants, several of which are important to commercial horticulture. Understanding which VOCs are produced by different members of this genus could greatly aid efforts to improve the aroma of multiple Vaccinium crops by breeding for desirable fruit volatiles. This review summarizes the published research available on this topic, examining prior work done to characterize the volatile profiles of blueberries, cranberries, bilberries, lingonberries, whortleberries, and other Vaccinium berries. In addition, analytical methodologies used to obtain Vaccinium berry volatile profiles are discussed. Possible future directions for Vaccinium berry volatile research are also examined.

Improving Nausea and Vomiting Post-Elipse Balloon: a Novel Single-Dose Regimen of 300 mg Netupitant/0.5 mg Palonosetron Hydrochloride.

BACKGROUND: Post intragastric balloon placement symptoms like nausea and vomiting have been the major cause of a high rate of early removal. Common therapy with ondansetron alone, or in combination, with prokinetic agents have been shown to have very little or no effect. Recently, an improved therapy based on aprepitant and ondansetron combination showed a significant improvement in symptoms management. Lack of aprepitant availability in several countries and patients difficulties to follow the right prescription convinced us to explore other pharmacological options. OBJECTIVE: Evaluate safety and efficacy of a netupitant and palonosetron-combined drug and to reduce and control post Elipse® placement symptoms METHODS: Between January and March 2018, 30 patients (9 male, 21 female), (mean weight 97.8 and mean BMI 34.7), underwent Elispe® placements, at 550 ml volume, in an outpatient fashion. All patients received a single pill 300 mg netupitant/0.5 mg palonosetron 6 h prior to placement. All patients received ondansetron 4 mg prescription to be taken as needed. A daily VAS score to report intensity of nausea, vomit, cramps, gastric pain, satiety for the first week post-placement was completed. RESULTS: 4/30 (13%) reported vomiting on days 1, 2, and 3; 9/30 (30%) reported nausea higher than score 4 on days 1, 2, and 3; 8/30 (26.6%) reported gastric pain higher than score 4 on days 1, 2, and 3. CONCLUSION: In our experience, the use of a single-pill netupitant/palonosetron resulted to be very easy to administer and effective in reducing vomit, nausea, and gastric pain in 87%, 70%, and 73.4% patients respectively, ameliorating the post Elipse™ placements symptoms safely.

Exposure to Aeromonas hydrophila induces inflammation and increases expression of the gene encoding for a putative dual CTLD-containing lectin in milkfish liver.

Milkfish (Chanos chanos Forsskal) is an important aquaculture product and is the sole extant species of the family Chanidae (order Gonorynchiformes). While there are already several reports regarding milkfish aquaculture, studies on milkfish immunity and gene expression are very limited. In this study, we showed that Aeromonas hydrophila induces inflammation in milkfish liver. We identified a milkfish C-type lectin-like domain containing proteins (CTLDcps) gene, designated as CcClec, which was upregulated in respond to A. hydrophila. Full-length sequencing was performed using Rapid Amplification of cDNA Ends (RACE PCR) to produce a complete Coding DNA Sequence (CDS) of the gene. The CcClec gene encoded a predicted protein of 340 amino acids containing two CTLDs that may potentially bind carbohydrates, especially sucrose and cellobiose. The CcClec mRNA transcript was expressed highest in the liver, followed by head kidney, brain, heart, gills, spleen, and midgut. CcClec transcripts were upregulated in damaged liver upon exposure to A. hydrophila. Overall, these findings demonstrated that CcClec is implicated in milkfish innate immunity, and is most highly expressed in the liver, suggesting a role of the liver in the milkfish immune system.

Evaluation of Ready, Set, BABY: A prenatal breastfeeding education and counseling approach.

BACKGROUND: Comprehensive prenatal education on infant feeding is recommended by many United States health organizations because of the need to maximize maternal preparedness for managing lactation physiology. Ready, Set, BABY (RSB) is a curriculum developed for counseling women about breastfeeding benefits and management including education on optimal maternity care practices. We hypothesized that RSB would be acceptable to mothers and that mothers' strength of breastfeeding intentions would increase, and their comfort with the idea of formula feeding would decrease after educational counseling using the materials. We also hypothesized that mothers' knowledge of optimal maternity care practices would increase after participation. METHODS: Materials were sent to a total of seven sites in the United States and Puerto Rico. Local health care practitioners completed training before counseling mothers with the curriculum. A pre- and postintervention questionnaire was administered to participants. Statistical analysis of results included paired t tests, Wilcoxon signed-rank tests, and McNemar's tests. RESULTS: Four hundred and sixteen expectant women participated. In the pre- and postintervention comparison, maternal participation in RSB significantly improved Infant Feeding Intentions Scale scores (P < 0.001) and knowledge of Baby-Friendly recommended maternity care practices (P < 0.001), while significantly decreasing comfort with the idea of formula feeding (P < 0.001). The education materials were positively rated by participants. CONCLUSIONS: The findings indicate that the approach of using RSB in prenatal counseling group classes or individual sessions improves breastfeeding intentions. Future testing is needed to determine the effectiveness of the materials for impacting breastfeeding outcomes.

Measuring effects of SNAP on obesity at the intensive margin.

The effects of the Supplemental Nutrition Assistance Program (SNAP) on obesity have been the focus of much debate. However, causal interpretation of estimates from previous studies, comparing participants to non-participants, is complicated by endogeneity and possible misreporting of participation in SNAP. In this paper, we take a novel approach to examine quasi-experimental variation in SNAP benefit amount on adult obesity. Children of SNAP households qualify for free in-school meals, thus freeing some additional benefits for the household. A greater proportion of school-age children eligible for free in-school meals proxies for an exogenous increase in the amount of SNAP benefits available per adult. Using data from the National Longitudinal Survey of Youth-1979 we show that school meals represent a non-trivial part of the food budget for SNAP households. We find that increases in SNAP benefits have no effect on obesity levels for the full sample of those who report SNAP participation. To better isolate the effects of additional benefits from other potential changes we restrict our analysis to adults living in households with at least one child under 5 years of age. In this setting, we find that additional SNAP benefits reduce BMI and the probability of being obese for SNAP adults. Specifically, when one child in a household of four becomes school-aged, adult BMI is expected to decrease by 0.23 units and the probability of being obese decreases by 2.58 percentage points or by about 10%.

Paciente con EPOC grave, insuficiencia respiratoria crónica y agudización cardiorrespiratoria tratado con la asociación CDB-SWEETraining / Patient with severe COPD, chronic respiratory failure and cardiopulmonary exacerbation treated with a combination of CDB-SWEETraining

Objetivo: Evaluar el tratamiento combinado del comprehensive directed breathing con el programa de entrenamiento Square Wave Endurance Exercise Test en cicloergómetro con oxigenoterapia en el ejercicio en un paciente con EPOC grave, insuficiencia respiratoria crónica y agudización cardiorrespiratoria. Metodología: Se evalúa clínica y funcionalmente tras el alta médica a un paciente de 61 años con EPOC grave. Inicia entrenamiento tipo Square Wave Endurance Exercise Test combinado con ventilación dirigida contrastada (Comprehensive Directed Breathing) y oxigenoterapia en el ejercicio. Tras 40 sesiones de 90min se analizan parámetros físicos (frecuencia cardiaca, respiratoria y SaO2) en reposo y tras el ejercicio, funcionales (disnea de reposo y esfuerzo) y espirométricos. Resultados: Tras 8 semanas de entrenamiento se objetivan mejoras en la frecuencia cardiorrespiratoria, la SaO2, la disnea de reposo y esfuerzo, la gasometría y la espirometría (PEF 4,8L/s [+98%] y PIF 3,9L/s [+48%]), manteniéndose a los 6 meses, uno y 3 años. Conclusión: El tratamiento combinado comprehensive directed breathing -Square Wave Endurance Exercise Test con oxigenoterapia durante el ejercicio supervisado mejora la frecuencia cardiorrespiratoria, la SaO2, la disnea, la gasometría y la espirometría, manteniéndose a los 6 meses, uno y 3 años

Objective: To evaluate the effect of combined treatment with comprehensive directed breathing and Square Wave Endurance Exercise Test in cycle ergometer associated with oxygen therapy on exercise in a patient with severe COPD, chronic respiratory failure and cardiopulmonary exacerbation. Methods: Treatment with Square Wave Endurance Exercise Test, comprehensive directed breathing, and oxygen therapy during exercise was implemented in a 61-year-old patient with severe COPD. After 40 sessions of 90min, an analysis was performed on the physical parameters, including heart and respiratory rate, oxygen saturation, gasometry, and spirometry. Results: After 8 weeks of training, improvement were obtained in heart and respiratory rates, oxygen saturation, dyspnoea, gasometry, and spirometry (PEF 4.8L/s [+98%] and PIF 3.9L/s [+48%]) at 6 month and one and 3 years. Conclusion: Comprehensive directed breathing -Square Wave Endurance Exercise Test and oxygen therapy during exercise improved clinical and functional parameters at 6 months, and one and 3 years