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1.
Braz J Med Biol Res ; 54(7): e10865, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34008758

RESUMO

This study verified the effects of respiratory muscle training (RMT) on hemodynamics, heart rate (HR) variability, and muscle morphology in rats with streptozotocin-induced diabetes mellitus (DM). Thirty-six male Wistar rats were randomized into 4 groups and 34 completed the study: i) sham-sedentary (Sham-ST; n=9); ii) sham-RMT (Sham-RMT; n=9); iii) DM-sedentary (DM-ST; n=8); and iv) DM-RMT (DM-RMT; n=8). Hemodynamics were assessed by central cannulation, and R-R intervals were measured by electrocardiogram. In addition, the effects of RMT on the cross-sectional area of the diaphragm, anterior tibial, and soleus muscles were analyzed. The induction of DM by streptozotocin resulted in weight loss, hyperglycemia, reduced blood pressure, and attenuated left ventricular contraction and relaxation (P<0.05). We also observed a decrease in root mean square of successive differences between adjacent RR intervals (RMSSD) index and in the cross-sectional area of the muscles assessed, specifically the diaphragm, soleus, and anterior tibial muscles in diabetic rats (P<0.05). Interestingly, RMT led to an increase in RMSSD in rats with DM (P<0.05). The induction of DM produced profound deleterious changes in the diaphragmatic and peripheral muscles, as well as impairments in cardiovascular hemodynamics and autonomic control. Nevertheless, RMT may beneficially attenuate autonomic changes and improve parasympathetic modulation.


Assuntos
Diabetes Mellitus Experimental , Animais , Exercícios Respiratórios , Frequência Cardíaca , Hemodinâmica , Masculino , Ratos , Ratos Wistar , Músculos Respiratórios
2.
Artigo em Inglês | MEDLINE | ID: mdl-33809595

RESUMO

Bronchiectasis is characterised by airflow obstruction and hyperinflation resulting in respiratory muscle weakness, and decreased exercise capacity. Inspiratory muscle training (IMT) is potentially an alternative treatment strategy to enhance respiratory muscle strength and endurance. Therefore, the aim was to investigate the effects of IMT on those with bronchiectasis. Eighteen participants (10 bronchiectasis) took part in an eight-week, three times a week IMT programme at 80% sustained maximal inspiratory pressure (SMIP). Lung function, respiratory muscle strength and endurance, exercise capacity, physical activity and self-determination theory measures were taken. Participants also took part in a semi-structured interview to assess their perceptions and experience of an IMT intervention. After eight weeks of IMT, bronchiectasis and healthy participants exhibited significant increases in MIP (27% vs. 32%, respectively), SMIP (16% vs. 17%, respectively) and inspiratory duration (36% vs. 30%, respectively). Healthy participants exhibited further improvements in peak expiratory flow and maximal oxygen consumption. Bronchiectasis participants reported high levels of perceived competence and motivation, reporting higher adherence and improved physical ability. Eight weeks of IMT increased inspiratory muscle strength and endurance in those with bronchiectasis. IMT also had a positive effect on perceived competency and autonomy, with bronchiectasis participants reporting improved physical ability and motivation, and high adherence.


Assuntos
Exercícios Respiratórios , Bronquiectasia , Adulto , Bronquiectasia/terapia , Teste de Esforço , Humanos , Força Muscular , Músculos Respiratórios
3.
Artigo em Inglês | MEDLINE | ID: mdl-33809922

RESUMO

This study aims to investigate and compare the effects of conventional breathing exercises and an inspiratory muscle training intervention on clinical symptoms in asthma patients. Sixty asthma patients (40-65 years old) were randomly assigned to either the conventional breathing exercises (BTE) or inspiratory muscle training (IMT) group for a 12-week intervention period. Outcome measurements were performed before and after the intervention, including the spirometry data, maximal inspiratory and expiratory pressures (PImax and PEmax), asthma control test, asthma control questionnaire, six-minute walk test, and three-day physical activity log, were recorded. PImax expressed as % of predicted value controlled for age and gender in healthy subjects (% predicted) increased by 16.92% (82.45% to 99.38%, p < 0.05) in the BTE group and by 29.84% (71.19% to 101.03%, p < 0.05) in the IMT group. Except for forced vital capacity, which was reduced in the BTE group, all other measured variables improved in both groups, and no statistically significant between-group differences were found. IMT appears to be more effective than breathing exercise intervention in promoting improvements in respiratory muscle strength. IMT may act as an alternative to conventional breathing exercises for middle-aged and elderly asthma patients.


Assuntos
Asma , Músculos Respiratórios , Adulto , Idoso , Asma/terapia , Exercícios Respiratórios , Humanos , Pessoa de Meia-Idade , Força Muscular , Terapia Respiratória
4.
Int J Mol Sci ; 22(7)2021 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-33807278

RESUMO

Pompe disease is an autosomal recessive disorder caused by a deficiency in the enzyme acid alpha-glucosidase. The late-onset form of Pompe disease (LOPD) is characterized by a slowly progressing proximal muscle weakness, often involving respiratory muscles. In LOPD, the levels of GAA enzyme activity and the severity of the clinical pictures may be highly variable among individuals, even in those who harbour the same combination of GAA mutations. The result is an unpredictable genotype-phenotype correlation. The purpose of this study was to identify the genetic factors responsible for the progression, severity and drug response in LOPD. We report here on a detailed clinical, morphological and genetic study, including a whole exome sequencing (WES) analysis of 11 adult LOPD siblings belonging to two Italian families carrying compound heterozygous GAA mutations. We disclosed a heterogeneous pattern of myopathic impairment, associated, among others, with cardiac defects, intracranial vessels abnormality, osteoporosis, vitamin D deficiency, obesity and adverse response to enzyme replacement therapy (ERT). We identified deleterious variants in the genes involved in autophagy, immunity and bone metabolism, which contributed to the severity of the clinical symptoms observed in the LOPD patients. This study emphasizes the multisystem nature of LOPD and highlights the polygenic nature of the complex phenotype disclosed in these patients.


Assuntos
Autofagia/genética , Doença de Depósito de Glicogênio Tipo II/genética , alfa-Glucosidases/genética , Adulto , Idoso , Autofagia/fisiologia , Terapia de Reposição de Enzimas/métodos , Família , Feminino , Variação Genética/genética , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/metabolismo , Mutação , Linhagem , Músculos Respiratórios , Irmãos , alfa-Glucosidases/metabolismo
5.
Medicine (Baltimore) ; 100(13): e25339, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33787632

RESUMO

BACKGROUND: To the best of our knowledge, no studies have evaluated the effects of inspiratory muscle training (IMT) on recovered COVID-19 patients after weaning from mechanical ventilation. Therefore, this study assessed the efficacy of IMT on recovered COVID-19 patients following mechanical ventilation. METHODS: Forty-two recovered COVID-19 patients (33 men and 9 women) weaned from mechanical ventilation with a mean age of 48.05 ±â€Š8.85 years were enrolled in this pilot control clinical study. Twenty-one patients were equipped to 2-week IMT (IMT group) and 21 matched peers were recruited as a control (control group). Forced vital capacity (FVC%), forced expiratory volume in 1 second (FEV1%), dyspnea severity index (DSI), quality of life (QOL), and six-minute walk test (6-MWT) were assessed initially before starting the study intervention and immediately after intervention. RESULTS: Significant interaction effects were observed in the IMT when compared to control group, FVC% (F = 5.31, P = .041, ηP2 = 0.13), FEV1% (F = 4.91, P = .043, ηP2 = 0.12), DSI (F = 4.56, P = .032, ηP2 = 0.15), QOL (F = 6.14, P = .021, ηP2 = 0.17), and 6-MWT (F = 9.34, P = .028, ηP2 = 0.16). Within-group analysis showed a significant improvement in the IMT group (FVC%, P = .047, FEV1%, P = .039, DSI, P = .001, QOL, P < .001, and 6-MWT, P < .001), whereas the control group displayed nonsignificant changes (P > .05). CONCLUSIONS: A 2-week IMT improves pulmonary functions, dyspnea, functional performance, and QOL in recovered intensive care unit (ICU) COVID-19 patients after consecutive weaning from mechanical ventilation. IMT program should be encouraged in the COVID-19 management protocol, specifically with ICU patients.


Assuntos
Exercícios Respiratórios/métodos , COVID-19/fisiopatologia , Músculos Respiratórios/fisiopatologia , Desmame do Respirador/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Qualidade de Vida , SARS-CoV-2
6.
Anesthesiology ; 134(5): 748-759, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33711154

RESUMO

BACKGROUND: The lateral abdominal wall muscles are recruited with active expiration, as may occur with high breathing effort, inspiratory muscle weakness, or pulmonary hyperinflation. The effects of critical illness and mechanical ventilation on these muscles are unknown. This study aimed to assess the reproducibility of expiratory muscle (i.e., lateral abdominal wall muscles and rectus abdominis muscle) ultrasound and the impact of tidal volume on expiratory muscle thickness, to evaluate changes in expiratory muscle thickness during mechanical ventilation, and to compare this to changes in diaphragm thickness. METHODS: Two raters assessed the interrater and intrarater reproducibility of expiratory muscle ultrasound (n = 30) and the effect of delivered tidal volume on expiratory muscle thickness (n = 10). Changes in the thickness of the expiratory muscles and the diaphragm were assessed in 77 patients with at least two serial ultrasound measurements in the first week of mechanical ventilation. RESULTS: The reproducibility of the measurements was excellent (interrater intraclass correlation coefficient: 0.994 [95% CI, 0.987 to 0.997]; intrarater intraclass correlation coefficient: 0.992 [95% CI, 0.957 to 0.998]). Expiratory muscle thickness decreased by 3.0 ± 1.7% (mean ± SD) with tidal volumes of 481 ± 64 ml (P < 0.001). The thickness of the expiratory muscles remained stable in 51 of 77 (66%), decreased in 17 of 77 (22%), and increased in 9 of 77 (12%) patients. Reduced thickness resulted from loss of muscular tissue, whereas increased thickness mainly resulted from increased interparietal fasciae thickness. Changes in thickness of the expiratory muscles were not associated with changes in the thickness of the diaphragm (R2 = 0.013; P = 0.332). CONCLUSIONS: Thickness measurement of the expiratory muscles by ultrasound has excellent reproducibility. Changes in the thickness of the expiratory muscles occurred in 34% of patients and were unrelated to changes in diaphragm thickness. Increased expiratory muscle thickness resulted from increased thickness of the fasciae.


Assuntos
Músculos Abdominais/anatomia & histologia , Respiração Artificial , Músculos Respiratórios/anatomia & histologia , Ultrassonografia/métodos , Expiração , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Variações Dependentes do Observador , Estudos Prospectivos , Reto do Abdome/anatomia & histologia , Reprodutibilidade dos Testes
7.
NeuroRehabilitation ; 48(2): 243-245, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33664161

RESUMO

BACKGROUND: Progressive muscle weakness is a feature of neuromuscular diseases (NMDs), a heterogeneous group of conditions with variable onset, presentation and prognosis that affect both children and adults. Respiratory muscle weakness compromises respiratory function and may lead to respiratory failure. OBJECTIVE: To assess the effects of respiratory muscle training (RMT) in adults and children with NMD. METHODS: A Cochrane Review by Silva et al. was summarized with comments. RESULTS: Eleven studies involving 250 randomized participants with NMD were included. While the studies showed that RMT may lead to improvements in lung function and respiratory muscle strength in people with ALS and DMD, this was not a consistent finding. The evidence from all the included trials was of low or very low certainty. CONCLUSIONS: There may be some improvement in lung capacity and respiratory muscle strength following RMT in some NMD. There appears to be no clinically meaningful effect of RMT on physical functioning and quality of life in ALS. The low certainty of the evidence means that the results need to be interpreted with caution.


Assuntos
Exercícios Respiratórios/métodos , Força Muscular/fisiologia , Doenças Neuromusculares/terapia , Músculos Respiratórios/fisiologia , Adulto , Criança , Feminino , Humanos , Masculino , Debilidade Muscular/fisiopatologia , Debilidade Muscular/terapia , Doenças Neuromusculares/fisiopatologia , Qualidade de Vida , Testes de Função Respiratória/métodos
8.
J Nutr Health Aging ; 25(4): 507-515, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33786569

RESUMO

The condition of muscle fiber atrophy and weakness that occurs in respiratory muscles along with systemic skeletal muscle with age is known as respiratory sarcopenia. The Japanese Working Group of Respiratory Sarcopenia of the Japanese Association of Rehabilitation Nutrition narratively reviews these areas, and proposes the concept and diagnostic criteria. We have defined respiratory sarcopenia as "whole-body sarcopenia and low respiratory muscle mass followed by low respiratory muscle strength and/or low respiratory function." Respiratory sarcopenia can be caused by various factors such as aging, decreased activity, undernutrition, disease, cachexia, and iatrogenic causes. We have also created an algorithm for diagnosing respiratory sarcopenia. Respiratory function decreases with age in healthy older people, along with low respiratory muscle mass and strength. We have created a new term, "Presbypnea," meaning a decline in respiratory function with aging. Minor functional respiratory disability due to aging, such as that indicated by a modified Medical Research Council level 1 (troubled by shortness of breath when hurrying or walking straight up hill), is an indicator of presbypnea. We also define sarcopenic respiratory disability as "a disability with deteriorated respiratory function that results from respiratory sarcopenia." Sarcopenic respiratory disability is diagnosed if respiratory sarcopenia is present with functional disability. Cases of respiratory sarcopenia without functional disability are diagnosed as "at risk of sarcopenic respiratory disability." Functional disability is defined as a modified Medical Research Council grade of 2 or more. Rehabilitation nutrition, treatment that combines rehabilitation and nutritional management, may be adequate to prevent and treat respiratory sarcopenia and sarcopenic respiratory disability.


Assuntos
Músculos Respiratórios/fisiopatologia , Sarcopenia , Envelhecimento/fisiologia , Feminino , Fragilidade , Humanos , Masculino , Força Muscular/fisiologia , Sarcopenia/complicações , Sarcopenia/diagnóstico , Sarcopenia/patologia , Sarcopenia/terapia
9.
Medicine (Baltimore) ; 100(9): e24930, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33655957

RESUMO

BACKGROUND: Rehabilitation training is beneficial for patients with chronic obstructive pulmonary disease (COPD). This study was aimed at evaluating the efficacy of muscle training on dyspnea. METHODS: We used 5 common databases for conducting a meta-analysis included PubMed, the Cochrane Library, Science Direct, Web of Science and Clinical Trials.gov, and eligible randomized controlled trials (RCTs) were included. The main results of include studies were dyspnea of patients who had a clinical diagnosis of COPD measured using Borg score and Medical Research Council (MRC) or modified Medical Research Council (mMRC) scale as the criteria before and after intervention. The intervention measures included respiratory or expiratory muscles or upper limb (UL) or lower limb (LL) training. The mean differences (MD) with the 95% confidence interval (CI) were considered for summary statistics. We also assessed risk of bias using the Cochrane collaboration's tool, and the value of I2 was applied to evaluate the heterogeneity of the trials. RESULTS: Fourteen RCTs with 18 interventions (n = 860 participants) were included. Muscle training significantly improved dyspnea during exercise and in the daily life of patients with COPD (MD, 95% CI: -0.58, -0.84 to -0.32, P  < .0001 and -0.44, -0.65 to -0.24, P  < .0001, respectively). In the subgroup analyses, the trials that used respiratory muscle and UL trainings significantly improved dyspnea during exercise (MD, 95% CI: -0.72, -1.13 to -0.31, P = .0005 and -0.53, -0.91 to -0.15, P = .007, respectively). The studies also showed that the participants in the rehabilitation group, who received respiratory muscle and UL trainings, had a significant improvement of dyspnea in daily life (MD, 95% CI: -0.38, -0.67 to -0.09, P = .01 and -0.51, -0.80 to -0.22, P = .0007, respectively). CONCLUSION: There were some limitations that most of the subjects in this study were patients with moderate to severe COPD and were male, and the training period and duration were different. The analyses revealed that respiratory muscle and UL trainings can improve dyspnea in patients with COPD during exercise and in daily life.


Assuntos
Dispneia/reabilitação , Tolerância ao Exercício/fisiologia , Expiração/fisiologia , Modalidades de Fisioterapia , Doença Pulmonar Obstrutiva Crônica/reabilitação , Ensaios Clínicos Controlados Aleatórios como Assunto , Músculos Respiratórios/fisiopatologia , Dispneia/etiologia , Dispneia/fisiopatologia , Humanos , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Qualidade de Vida
10.
Anesthesiology ; 134(5): 680-682, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33760018
12.
Int J Cardiol ; 330: 50-58, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33571562

RESUMO

BACKGROUND: The effect of exercise training and its mechanisms on the functional capacity improvement in Fontan patients (FP) are virtually unknown. This trial evaluated four-month aerobic exercise training and inspiratory muscle training on functional capacity, pulmonary function, and autonomic control in patients after Fontan operation. METHODS: A randomized controlled clinical trial with 42 FP aged 12 to 30 years and, at least, five years of Fontan completion. Twenty-seven were referred to a four-months supervised and personalized aerobic exercise training (AET) or an inspiratory muscle training (IMT). A group of non-exercise (NET) was used as control. The effects of the exercise training in peak VO2; pulmonary volumes and capacities, maximal inspiratory pressure (MIP); muscle sympathetic nerve activity (MSNA); forearm blood flow (FBF); handgrip strength and cross-sectional area of the thigh were analyzed. RESULTS: The AET decreased MSNA (p = 0.042), increased FBF (p = 0.012) and handgrip strength (p = 0.017). No significant changes in autonomic control were found in IMT and NET groups. Both AET and IMT increased peak VO2, but the increase was higher in the AET group compared to IMT (23% vs. 9%). No difference was found in the NET group. IMT group showed a 58% increase in MIP (p = 0.008) in forced vital capacity (p = 0.011) and forced expiratory volume in the first second (p = 0.011). No difference in pulmonary function was found in the AET group. CONCLUSIONS: Both aerobic exercise and inspiratory muscle training improved functional capacity. The AET group developed autonomic control, and handgrip strength, and the IMT increased inspiratory muscle strength and spirometry. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02283255.


Assuntos
Técnica de Fontan , Adolescente , Adulto , Exercícios Respiratórios , Criança , Exercício Físico , Tolerância ao Exercício , Força da Mão , Humanos , Força Muscular , Músculos Respiratórios , Adulto Jovem
13.
J Sports Med Phys Fitness ; 61(5): 617-624, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33586923

RESUMO

BACKGROUND: Although the effects of sub-maximal continuous aerobic training (SCT) and high-intensity interval training (HIIT) are well studied in performance athletes and in several patient groups, there is not much evidence about the effects of these exercises in sedentary healthy young population. The aim of the study was to compare the effects of these two different types of aerobic exercises on respiratory parameters, aerobic capacity and perceived stress in healthy university students. METHODS: Thirty-six healthy, young subjects with a mean age of 20.83±0.97 years were included in the study (N.=19 in HIIT and N.=17 in SCT). Pulmonary function tests (PFTs) and respiratory muscle strength (RMS) assessments were done using a desktop spirometer. Aerobic capacity was estimated with the Bruce treadmill exercise test. The Perceived Stress Scale (PSS) was used for the assessment of stress perception. All participants exercised 3 times per week for 4 weeks (a total of 12 sessions). RESULTS: After 12 sessions, the peak expiratory flow parameter (a PFT value) of both groups showed significant increases, but there was no difference between the groups. The RMS of the subjects increased significantly in both the groups (P<0.05), but there was no significant difference between the groups. Both groups showed significant increases in terms of aerobic capacity (P>0.05), and the improvement was significantly higher in the HIIT group. Perceived stress values showed a significant increase in the SCT group. CONCLUSIONS: Based on the results of this study, the two exercise types were found to have similar effects on RMS. Also, when compared with SCT, HIIT was found to have more effect on aerobic capacity.


Assuntos
Treinamento Intervalado de Alta Intensidade , Percepção/fisiologia , Esforço Físico/fisiologia , Testes de Função Respiratória , Comportamento Sedentário , Teste de Esforço , Feminino , Treinamento Intervalado de Alta Intensidade/psicologia , Humanos , Medidas de Volume Pulmonar , Masculino , Força Muscular , Consumo de Oxigênio , Músculos Respiratórios/fisiologia , Espirometria , Estresse Psicológico , Adulto Jovem
14.
Artigo em Inglês | MEDLINE | ID: mdl-33578776

RESUMO

Exercise intolerance may be considered a hallmark in patients who suffer from heart failure (HF) syndrome. Currently, there is enough scientific evidence regarding functional and structural deterioration of skeletal musculature in these patients. It is worth noting that muscle weakness appears first in the respiratory muscles and then in the musculature of the limbs, which may be considered one of the main causes of exercise intolerance. Functional deterioration and associated atrophy of these respiratory muscles are related to an increased muscle metaboreflex leading to sympathetic-adrenal system hyperactivity and increased pulmonary ventilation. This issue contributes to increased dyspnea and/or fatigue and decreased aerobic function. Consequently, respiratory muscle weakness produces exercise limitations in these patients. In the present review, the key role that respiratory muscle metaboloreceptors play in exercise intolerance is accurately addressed in patients who suffer from HF. In conclusion, currently available scientific evidence seems to affirm that excessive metaboreflex activity of respiratory musculature under HF is the main cause of exercise intolerance and sympathetic-adrenal system hyperactivity. Inspiratory muscle training seems to be a useful personalized medicine intervention to reduce respiratory muscle metaboreflex in order to increase patients' exercise tolerance under HF condition.


Assuntos
Insuficiência Cardíaca , Músculos Respiratórios , Dispneia , Exercício Físico , Tolerância ao Exercício , Humanos
15.
Minerva Anestesiol ; 87(4): 432-438, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33594871

RESUMO

BACKGROUND: The aim of this study was to evaluate whether measurement of diaphragm thickness (DT) by ultrasonography may be a clinically useful noninvasive method for identifying patients at risk of adverse outcomes defined as need of invasive mechanical ventilation or death. METHODS: We prospectively enrolled 77 patients with laboratory-confirmed COVID-19 infection admitted to our intermediate care unit in Pisa between March 5 and March 30, 2020, with follow-up until hospital discharge or death. Logistic regression was used identify variables potentially associated with adverse outcomes and those P<0.10 were entered into a multivariate logistic regression model. Cumulative probability for lack of adverse outcomes in patients with or without low baseline diaphragm muscle mass was calculated with the Kaplan-Meier product-limit estimator. RESULTS: The main findings of this study are that: 1) patients who developed adverse outcomes had thinner diaphragm than those who did not (2.0 vs. 2.2 mm, P=0.001); and 2) DT and lymphocyte count were independent significant predictors of adverse outcomes, with end-expiratory DT being the strongest (ß=-708; OR=0.492; P=0.018). CONCLUSIONS: Diaphragmatic ultrasound may be a valid tool to evaluate the risk of respiratory failure. Evaluating the need of mechanical ventilation treatment should be based not only on PaO2/FiO2, but on a more comprehensive assessment including DT because if the lungs become less compliant a thinner diaphragm, albeit free of intrinsic abnormality, may become exhausted, thus contributing to severe respiratory failure.


Assuntos
COVID-19/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Músculos Respiratórios/anatomia & histologia , Idoso , Idoso de 80 Anos ou mais , COVID-19/mortalidade , COVID-19/terapia , Estudos de Coortes , Diafragma/anatomia & histologia , Diafragma/patologia , Feminino , Mortalidade Hospitalar , Humanos , Itália/epidemiologia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Pneumonia Viral/mortalidade , Pneumonia Viral/terapia , Valor Preditivo dos Testes , Respiração Artificial/estatística & dados numéricos , Insuficiência Respiratória/diagnóstico por imagem , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/mortalidade , Músculos Respiratórios/diagnóstico por imagem , Resultado do Tratamento , Ultrassonografia
16.
Am J Pathol ; 191(4): 730-747, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33497702

RESUMO

Duchenne muscular dystrophy (DMD) is a genetic, degenerative, striated muscle disease exacerbated by chronic inflammation. Mdx mice in the genotypic DMD model poorly represent immune-mediated pathology observed in patients. Improved understanding of innate immunity in dystrophic muscles is required to develop specific anti-inflammatory treatments. Here, inflammation in mdx mice and the more fibrotic utrn+/-;mdx Het model was comprehensively investigated. Unbiased analysis showed that mdx and Het mice contain increased levels of numerous chemokines and cytokines, with further increased in Het mice. Chemokine and chemokine receptor gene expression levels were dramatically increased in 4-week-old dystrophic quadriceps muscles, and to a lesser extent in diaphragm during the early injury phase, and had a small but consistent increase at 8 and 20 weeks. An optimized direct immune cell isolation method prevented loss of up to 90% of macrophages with density-dependent centrifugation previously used for mdx flow cytometry. Het quadriceps contain higher proportions of neutrophils and infiltrating monocytes than mdx, and higher percentages of F4/80Hi, but lower percentages of F4/80Lo cells and patrolling monocytes compared with Het diaphragms. These differences may restrict regenerative potential of dystrophic diaphragms, increasing pathologic severity. Fibrotic and inflammatory gene expression levels are higher in myeloid cells isolated from Het compared with mdx quadriceps, supporting Het mice may represent an improved model for testing therapeutic manipulation of inflammation in DMD.


Assuntos
Distrofina/metabolismo , Inflamação/metabolismo , Músculo Esquelético/patologia , Distrofia Muscular Animal/patologia , Distrofia Muscular de Duchenne/patologia , Animais , Inflamação/patologia , Macrófagos/metabolismo , Camundongos Transgênicos , Monócitos/metabolismo , Músculo Esquelético/metabolismo , Distrofia Muscular Animal/metabolismo , Distrofia Muscular de Duchenne/metabolismo , Músculos Respiratórios/metabolismo , Músculos Respiratórios/patologia
17.
Support Care Cancer ; 29(7): 3903-3909, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33392768

RESUMO

PURPOSE: This study aimed to evaluate respiratory muscle strength and endurance, maximal oxygen consumption, and fatigue of colorectal cancer (CRC) survivors and compare them with healthy individuals. METHODS: Demographic and clinical characteristics were recorded. Respiratory muscle strength (maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP)) was measured using an electronic mouth pressure device, and respiratory muscle endurance was assessed using a constant workload protocol with linear workload device. Peak oxygen consumption (VO2peak) was measured using the cardiopulmonary exercise test (CPET) with modified Bruce protocol. Fatigue was assessed using the Brief Fatigue Inventory (BFI). RESULTS: The patients had similar demographic characteristics (p > 0.05). MEP (cmH2O and %predicted) were lower in the CRC group than in healthy controls (p < 0.05). MIP (cmH2O and %predicted) and test duration did not differ between the groups (p > 0.05). VO2peak (ml/min and %predicted) and VO2peak/kg (%predicted) were significantly lower in the CRC group (p < 0.05). BFI score differed significantly in the CRC and control groups (p < 0.05). CONCLUSION: Respiratory muscle strength, maximal exercise capacity, and fatigue are adversely affected in CRC survivors. Cancer treatment may cause loss of muscle strength and impair energy metabolism and oxygen transmission. These changes can result in decreased exercise capacity and respiratory muscle strength and increased fatigue. Studies examining the effects of different exercise training programs in CRC survivors are needed.


Assuntos
Neoplasias Colorretais/complicações , Fadiga/etiologia , Força Muscular/fisiologia , Consumo de Oxigênio/fisiologia , Músculos Respiratórios/fisiologia , Adolescente , Adulto , Idoso , Sobreviventes de Câncer , Estudos de Casos e Controles , Neoplasias Colorretais/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Sobrevida , Adulto Jovem
19.
Physiother Res Int ; 26(2): e1892, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33471945

RESUMO

BACKGROUND AND PURPOSE: Many stroke trials include maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and sniff nasal inspiratory pressure (SNIP) outcome measurements. However, data on agreement and reliability of repeated MIP, MEP, and SNIP measurements in acute and subacute stroke patients are scarce. METHODS: This study employed a test-retest design. Eighteen patients (seven female) with mean (SD) age 59 (14.5) years were recruited from neurological wards. Median (range) time since first stroke was 50.5 (21-128) days. MIP, MEP, and SNIP were measured repeatedly in three testing sessions (S1-3) conducted within 24 h and following international standards. Intra-rater agreement between testing sessions was analyzed using the Bland-Altman method. Test-retest reliability was analyzed using intra-class correlation coefficient (ICC). Association between individual measurement variability, time poststroke, and level of stroke impairment was analyzed using Spearman's rho. RESULTS: Mean difference and 95% limits of agreement for MIP were -0.40 (-23.02, 22.22) cmH2 O between S1 and S2, and 2.14 (-12.79, 16.99) cmH2 O between S2 and S3; for MEP, -4.56 (-29.01, 19.90) cmH2 O between S1 and S2, and 0.29 (-24.28, 24.87) cmH2 O between S2 and S3; and for SNIP, -10.56 (-38.48, 17.37) cmH2 O between S1 and S2, and -6.06 (-27.32, 15.20) cmH2 O between S2 and S3. ICCs for MIP, MEP, and SNIP were ≥0.9 throughout. There were no strong correlations between individual measurement variability and time poststroke or level of stroke impairment. DISCUSSION: MIP, MEP, and SNIP in acute and subacute stroke patients show good test-retest reliability for group averages; however, absolute agreement can vary considerably for some individuals.


Assuntos
Músculos Respiratórios , Acidente Vascular Cerebral , Feminino , Humanos , Pressões Respiratórias Máximas , Pessoa de Meia-Idade , Força Muscular , Reprodutibilidade dos Testes , Acidente Vascular Cerebral/diagnóstico
20.
Medicina (Kaunas) ; 57(1)2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33467421

RESUMO

Background and objectives: Respiratory muscle fatigue is one of the important factors limiting sports performance due to the metaboreflex. This reflex will cause a decrease in blood flow to the extremities and accelerate exercising limb fatigue. Previous studies found that inspiratory muscle training (IMT) can effectively enhance the respiratory muscle endurance and reduce fatigue during long-duration exercise or aerobic exercise, thereby enhancing athletic performance. However, the mechanism between inspiratory muscle strength, change of limb blood flow and sports performance still requires investigation, especially in short-duration exercise, anaerobic or both aerobic and anaerobic exercise. The purpose of this study was to investigate the effects of 4-week inspiratory muscle training on respiratory muscle strength, limb blood flow change rate and sports performance in recreational 800-m college runners. Materials and Methods: Twenty healthy 800-m college runners randomized into the IMT group (11 subjects) and control group (9 subjects). IMT consisted of 30 inspiratory efforts twice daily, 5 days a week, with intensity at 50%, 60%, 70% and 80% of maximum inspiratory pressure (MIP) for 4 weeks, while a control group kept 50% of MIP for 4 weeks. An 800-m trial test, limb blood flow change rate by using Impedance Plethysmography, and MIP were as the outcome measured variables and be evaluated. All measured variables were assessed before and after 4-week IMT training. Two-way ANOVA was conducted for statistical analysis. Results: The results showed significantly interaction between groups and pre-posttest. IMT group significantly decreased limb blood flow change rate from 19.91 ± 11.65% to 9.63 ± 7.62% after received the IMT training program (p < 0.05). The MIP significantly improved from 112.95 ± 27.13 cmH2O to 131.09 ± 28.20 cm H2O in IMT group, and the 800-m trial test also shorted the running time from 162.97 ± 24.96 s to 156.75 ± 20.73 s. But the control group no significantly changed in MIP and 800-m trial test. Conclusions: Our results indicated that the 4-week IMT training (twice a day, 5 days a week) significantly improves participants' inspiratory muscle strength, 800-m running performance and decreases the limb blood flow change rate.


Assuntos
Exercícios Respiratórios , Músculos Respiratórios , Tolerância ao Exercício , Humanos , Fadiga Muscular , Força Muscular
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