The Impact of Obesity on Pulmonary Function in Adult Women

INTRODUCTION: Obesity can cause deleterious effects on respiratory function and impair health and quality of life. OBJECTIVE: To evaluate the effects of obesity on the pulmonary function of adult women. METHODS: An obese group, constituted of 20 women between 20 and 35 years old with a BMI of 35 - 49.99 kg/m² who were non-smokers and sedentary and had no lung disease were recruited. The non-obese group consisted of 20 women between 20 and 35 years old who were sedentary and non-smokers and had no lung disease and a body mass index between 18.5 and 24.99 kg/m². Spirometry was performed in all subjects. The statistical analysis consisted of parametric or non-parametric tests, depending on the distribution of each variable, considering p < 0.05 to be statistically significant. RESULTS: The obese group presented a mean age of 25.85 ± 3.89 years and a mean BMI of 41.1 ± 3.46 kg/m², and the non-obese group presented a mean age of 23.9 ± 2.97 years and a mean body mass index of 21.91 ± 1.81 kg/m². There were no significant differences between the obese group and the non-obese group as to the age, vital capacity, tidal volume, forced vital capacity, and forced expiratory volume in one second. However, the obese group presented a greater inspiratory reserve volume (2.44 ± 0.47 L vs. 1.87 ± 0.42 L), a lower expiratory reserve volume (0.52 ± 0.32 L vs. 1.15 ± 0.32 L), and a maximal voluntary ventilation (108.5 ± 13.3 L/min vs. 122.6 ± 19.8 L/min) than the non-obese group, respectively. CONCLUSION: The alterations evidenced in the components of the vital capacity (inspiratory reserve volume and expiratory reserve volume) suggest damage to the chest mechanics caused by obesity. These factors probably contributed to a reduction of the maximal voluntary ventilation

Bilevel positive airway pressure in two moments after bariatric surgery

Objective: To investigate the use of Bilevel Positive Airway Pressure (BiPAP) in morbidly obese individuals in two moments following bariatric surgery (Roux-en-Y gastric bypass): post-anesthetic recovery (PAR) and first postoperative day (1PO). DESIGN: Randomized and blinded clinical trial. Methods: We studied 40 morbidly obese individuals aged between 25 and 55 years who underwent pulmonary function test and chest X-ray preoperatively, and on the day of discharge (2nd day after surgery). They were randomly allocated into two groups: PAR-G (BiPAP in PAR for one hour), and 1PO-G (BIPAP for one hour on the 1PO). Results: In the PAR-G and 1PO-G, respectively there were significant reductions in slow vital capacity (SVC) (p=0.0007 vs. p<0.0001), inspiratory reserve volume (IRV) (p=0.0016 vs. p=0.0026), and forced vital capacity (FVC) (p=0.0013 vs. p<0.0001) and expiratory reserve volume (ERV) was maintained only for the PAR-G (p=0.4446 vs. p=0.0191). Comparing the groups, the SVC (p=0.0027) and FVC (p=0.0028) showed a significant difference between the treatments, while the PAR-G showed smaller declines in these capacities. The prevalence of atelectasis was 10% for the PAR-G and 30% for the 1PO-G (p=0.0027). Conclusion: Thus, the use of BiPAP in PAR can promote restoration of ERV and contribute to the reduction of atelectasis.65911611167FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESP2013/w-

Influence of age, anthropometric characteristics and body fat distribution in women's thoracic mobility

La acumulación de la grasa torácica puede contribuir a la reducción de la movilidad torácica (MT) con disminución del volumen pulmonar. También las alteraciones de la MT pueden ocurrir en el envejecimiento, debido a la progresiva calcificación de las articulaciones implicadas en los movimientos respiratorios y a la reducción de los espacios intervertebrales. Este estudio tuvo el objetivo de verificar la influencia de la edad, de las características antropométricas y de la distribución de grasa corporal en conductas de la MT de mujeres, así como verificar cuál de las variables es la más relevante para la MT. Se trata de un estudio transversal, del cual participaron 100 mujeres con edades entre 25 y 75 años y con índice de masa corporal (IMC) entre 18,5 y 55kg/m2. Se midieron las circunferencias del cuello (CC), de la cintura, de las caderas y la relación entre cintura/cadera. Se evaluó la MT a través de la cirtometría torácica en los niveles axilar y xifoides y, tras realizarse las tres mediciones, se determinó la MT por la diferencia entre el valor más grande obtenido en la inspiración y el menor valor en la espiración. Se emplearon los test de correlación y de regresión lineal múltiple. Mediante las correlaciones significativas, los resultados demostraron que la MT disminuye debido al aumento de edad y a la obesidad. La CC tuvo mayor influencia (16,60%) bajo la MT en el nivel axilar y el IMC en el nivel xifoides (18,16%). Se concluyó que la MT redujo con el envejecimiento y la obesidad, y que la acumulación de grasa en el cuello y el aumento del IMC son los factores que más influyen en el comprometimiento de la MT de mujeres.The accumulation of fat in the chest can contribute to reduced thoracic mobility (TM) with a decrease of lung volumes. TM changes can also occur in aging, due to progressive calcification of joints involved in respiratory movements and reduced intervertebral spaces. The objective of this study was to verify the influence of age, anthropometric characteristics and distribution of body fat on the behavior of women's TM and to check which of these variables is more relevant to the TM. This is a cross-sectional study with 100 women, from 25 to 75 years and body mass index (BMI) between 18.5 and 55kg/m2. Circumferences of neck (NC), waist, hips and waist/hip ratio were measured. TM was assessed by thoracic cirtometry, in axillary and xiphoid levels and, after three measures, the TM was determined by the difference between the highest value obtained in the inspiration and the lowest value at expiration. We used correlation tests and multiple linear regression. Results show, through significant correlations, that with increasing age and obesity, TM decreases. The NC had the greatest influence (16.60%) on TM in axillary level and on BMI in xiphoid level (18.16%). It is concluded that TM is reduced with aging and obesity and that the deposition of fat in the neck and the increase of BMI are the most important factors in the commitment of women's TM.O acúmulo de gordura no tórax pode contribuir para a redução da mobilidade torácica (MT) com declínio de volumes pulmonares. Alterações da MT também podem ocorrer no envelhecimento, devido à progressiva calcificação das articulações envolvidas nos movimentos respiratórios e redução dos espaços intervertebrais. O objetivo deste estudo foi verificar a influência da idade, das características antropométricas e da distribuição de gordura corporal no comportamento da MT de mulheres e verificar qual dessas variáveis é mais relevante para a MT. Trata-se de um estudo transversal, com 100 mulheres com idades entre 25 e 75 anos e índice de massa corporal (IMC) entre 18,5 e 55kg/m2. Foram mensuradas as circunferências do pescoço (CP), da cintura, do quadril e a relação cintura/quadril. A MT foi avaliada pela cirtometria torácica nos níveis axilar e xifoidiano e, após a realização de três medidas, a MT foi determinada pela diferença entre o maior valor obtido na inspiração e o menor valor obtido na expiração. Foram utilizados testes de correlação e de regressão linear múltipla. Os resultados mostram, por meio de correlações significativas, que com o aumento da idade e devido à obesidade ocorre diminuição da MT. A CP exerceu maior influência (16,60%) sobre a MT no nível axilar e o IMC no nível xifoidiano (18,16%). Conclui-se que a MT está reduzida com o envelhecimento e obesidade e que a deposição de gordura no pescoço e o aumento do IMC são os fatores mais importantes no comprometimento da MT de mulheres

Applying continuous positive airways pressure in patients after bariatric surgery

O objetivo deste trabalho foi avaliar o efeito da aplicação da pressão positiva contínua nas vias aéreas (CPAP), na frequência respiratória (FR), no volume corrente (VC) e no volume minuto (VM), em pacientes em pós-operatório de cirurgia bariátrica. Foram estudadas dez pacientes com média de idade 29,8±8 anos, classificadas como obesas mórbidas [índice de massa corpórea (IMC) de 47,5±7,2 kg/m²] que receberam CPAP de 8 a 10 cmH2O, por 30 minutos, uma vez ao dia, durante dois dias consecutivos, no pós-operatório de cirurgia bariátrica. Antes e após a aplicação da CPAP, foram aferidos a FR e o VM por meio do ventilômetro e, de forma indireta, foi calculado o VC. Para verificar a normalidade dos dados foi aplicado o teste de Shapiro-Wilk, e, após, as medidas foram comparadas com o uso do Teste t de Student e de Man-Whitney. As análises foram processadas com o uso do SPSS 7,5 considerando o nível de 5% de significância. Houve um aumento significativo para as seguintes variáveis estudadas no primeiro e no segundo dia de aplicação: FR=20±6 resp/min versus 26±7 resp/min (p=0,009) e FR=22±7 resp/min versus 26±8 resp/min (p=0,007); VM=9,57±2,75 L versus 12,39±4,18 L (p=0,041) e VM=9,71±2,52 L versus 11,18±2,96 L (p=0,037). Os valores do VC=360±157,59 mL versus 440±69,18 mL (p=0,21) e 401±90,46 mL versus 416±78,04 mL (p=0,18) não apresentaram diferença significativa na comparação pré- e pós-aplicação, nos dois dias de terapia. Assim, foi possível concluir que a CPAP pode ser aplicada como recurso auxiliar da fisioterapia respiratória no tratamento de pacientes em período pós-operatório de cirurgia bariátrica, para a manutenção do VC, porém atenção deve ser tomada durante a aplicação, pois pode haver aumento da FR.The objective was to evaluate the effect of continuous positive airway pressure (CPAP) in the respiratory rate (RR), tidal volume (TV) and minute volume (MV) in patients after bariatric surgery. Ten patients with mean age 29.8±8 years, classified as morbidly obese (BMI 47.5±7.2 kg/m²) who received CPAP from 8 to 10 cmH2O, for 30 minutes, once a day for two consecutive days, in the post-bariatric surgery were studied. Before and after applying CPAP were measured RR and the MV through the ventilometer, and indirectly the TV were calculated . The Shapito-Wilk was applied to check the normality of data, and then the measures were compared using the Student's t-test and Mann-Whitney test. Analyses were processed using the SPSS 7.5 considering the 5% level of significance. There was a significant increase for the following variables in the first and second days of application: RR=20±6 breathing/min versus 26±7 breathing/min (p=0.009), and RR=22±7 breathing/min versus 26±8 breathing/min (p=0,007); MV=9.57±2.75 L versus 12.39±4.18 L (p=0.041), and MV=9.71±2.52 L versus 11,18±2.96 L (p=0.037). The values of TV=360±157,59 mL versus 440±69,18 mL (p=0,21), and 401±90,46 mL versus 416±78,04 mL (p=0,18) did not differ significantly when comparing pre- and post-application in two days therapy. Thus, it was concluded that CPAP can be applied as an auxiliary respiratory therapy in the treatment of patients in post-bariatric surgery for the maintenance of TV, but care should be taken during application, there may be increased RR

Fisioterapia respiratória associada à pressão positiva nas vias aéreas na evolução pós-operatória da cirurgia bariátrica

To assess the tidal volume (VT), minute volume (MV) and respiratory rate (RR) of morbidly obese women in postoperative bariatric surgery (BS), after the conventional respiratory physiotherapy (CRP) with or without preoperatively continuous positive airway pressure (CPAP). Thirty-six women, aged 40.1±8.41 years, that would be submitted to BS by laparotomy were studied. All of them underwent preoperative outpatient conventional respiratory physiotherapy (CRP) (diaphragmatic breathing exercises, deep breathing, fractionated breathing and breathing associated to movements of the upper limbs, a series of 10 repetitions of each exercise) by 30 days. Once admitted, 18 were subjected to 20 minutes of CPAP, an hour before induction of anesthesia and composed group CRP+CPAP. The other 18 did not receive CPAP and composed group CRP. VT, MV, and RR were performed through the ventilometer, at admission and 24 hours after surgery. It was found that measures of TV, VM and RR were not statistically significant when comparing pre and postoperative in both groups and as well as when the two groups were compared between them in both pre and postoperative. The results suggest that both the application and the implementation of FRC and FRC+CPAP in the preoperative period contribute to the maintenance of respiratory variables in the postoperative period. The use of CPAP before induction of anesthesia, did not provide additional benefits in the post-bariatric surgery with regard to the volumes.Analisar volume corrente (VC), volume minuto (VM) e frequência respiratória (FR) de obesas mórbidas no pós-operatório de cirurgia bariátrica (CB), após a fisioterapia respiratória convencional (FRC) associada ou não à pressão positiva contínua nas vias aéreas (CPAP) no pré-operatório. Foram estudadas 36 mulheres, com idade de 40,1±8,41 anos, que seriam submetidas à CB por laparotomia e que realizaram FRC (exercícios respiratórios diafragmáticos, de inspirações profundas, fracionadas e associados a movimentos de membros superiores, 1 série de 10 repetições de cada exercício) por 30 dias antes da cirurgia. Após internação, 18 delas foram submetidas a 20 minutos de CPAP, 1 hora antes da indução anestésica e compuseram o grupo FRC+CPAP. As outras 18 não receberam o CPAP e compuseram o grupo FRC. Foram avaliados VM, VC e FR por meio do ventilômetro, no momento da internação e 24 horas após a realização da cirurgia. Constatou-se que as medidas de VC, VM e FR não apresentaram significância estatística quando comparados os resultados do pré e pós-operatório em ambos os grupos, bem como quando comparados os dois grupos entre si tanto no pré como no pós-operatório. Os resultados sugerem que a tanto a aplicação da FRC como a aplicação da FRC+CPAP no período pré-operatório contribui para a manutenção das variáveis respiratórias no pós-operatório. A aplicação do CPAP antes da indução anestésica não promoveu benefícios adicionais no pós-operatório de CB no que se refere aos volumes pulmonares

Efeitos do método Pilates sobre a função pulmonar, a mobilidade toracoabdominal e a força muscular respiratória: ensaio clínico não randomizado, placebo-controlado

The Pilates method can be an effective tool for the physical therapist during rehabilitation, because it has varied benefits and few contraindications. Although widely practiced by the population, the literature is scarce about the benefits related to the respiratory system. The purpose of this study was to evaluate the influence of the Pilates method on lung function, thoracoabdominal mobility, respiratory muscle strength and anthropometric characteristics in healthy women. This is a non-randomized placebo-controlled clinical trial with 21 volunteers, who were allocated for convenience in two groups: Pilates with 11 female volunteers, aged 33.18±8.08 years, subjected to the Pilates method twice a week for three months; and Control with 10 female volunteers, aged 31.70±7.39 years that remained three months without regular physical exercises. All of them were submitted to the anthropometric evaluation, physical activity Baecke questionnaire, spirometry lung function, thoracoabdominal mobility by cirtometry and respiratory muscle strength by measures of the maximum respiratory pressure obtained by means of a manovacuometer. All volunteers were evaluated prior to insertion in the groups and revaluated after three months. In the Pilates group, there was significant increase in recreational physical activity, total of the physical activity questionnaire, mobility in the three levels (axillary, xiphoid and abdominal) of the respiratory, inspiratory and expiratory muscle strength, and significant reduction in waist circumference (WC) (p;0.05). As to the lung function, significant differences were not detected (p>;0.05) in the groups and between them. It is concluded that, after the practice of the Pilates method, there was improvement in leisure physical activity, thoracoabdominal mobility, respiratory muscle strength and waist circumference reduction, however, in comparison with the control group, the Pilates method did not show relevant changes in pulmonary function, thoracoabdominal mobility, respiratory muscle strength and anthropometric characteristics in healthy women that did not perform physical activities.El método Pilates puede ser una herramienta eficaz para el fisioterapeuta en la rehabilitación, pues presenta algunos beneficios y pocas contraindicaciones. Aunque ampliamente practicado por la población, la literatura es escasa acerca de los beneficios relacionados al sistema respiratorio. El objetivo de este estudio fue evaluar la influencia del método Pilates sobre la función pulmonar, movilidad toracoabdominal, fuerza muscular respiratoria y características antropométricas en mujeres saludables. Se trata de un ensayo clínico no randomizado, placebo-controlado con 21 voluntarias, que fueron divididas por conveniencia en dos grupos: Pilates con 11 voluntarias, con edades de 33,18±8,08 años, sometidas al método Pilates dos veces a la semana durante tres meses y Control con 10 voluntarias, con edades de 31,70±7,39 que permanecieron tres meses sin ejercicios físicos regulares. Todas fueron sometidas a la evaluación antropométrica, cuestionario de actividad física de Baecke, función pulmonar por espirometría, movilidad toracoabdominal por cirtometría y fuerza muscular respiratoria por las medidas de las presiones respiratorias máximas obtenidas por medio de un manovacuómetro. Todas las voluntarias fueron evaluadas antes de la inserción en los grupos y revaluadas después de tres meses. En el grupo Pilates hubo aumento significativo de la actividad física recreativa y en el cuestionario total de actividad física hubo aumento de la movilidad en los tres niveles (axilar, del xifoides y abdominal) de la fuerza muscular respiratoria, tanto inspiratoria como espiratoria, así como la reducción significativa de la circunferencia de la cintura (CC) (pO método Pilates pode ser uma ferramenta eficaz para o fisioterapeuta na reabilitação, pois apresenta benefícios variados e poucas contraindicações. Embora largamente praticado pela população, a literatura é escassa quanto aos seus benefícios relacionados ao sistema respiratório. O objetivo deste estudo foi avaliar a influência do método Pilates sobre a função pulmonar, mobilidade toracoabdominal, força muscular respiratória e características antropométricas em mulheres saudáveis. Trata-se de um ensaio clínico não randomizado, placebo-controlado com 21 voluntárias, que foram alocadas por conveniência em dois grupos: Pilates com 11 voluntárias, com idade de 33,18±8,08 anos, submetidas ao método Pilates duas vezes por semana durante três meses e Controle com 10 voluntárias, com idade de 31,70±7,39 anos que permaneceram três meses sem a realização de exercícios físicos regulares. Todas foram submetidas à avaliação antropométrica, questionário de atividade física de Baecke, função pulmonar por espirometria, mobilidade toracoabdominal por cirtometria e força muscular respiratória pelas medidas das pressões respiratórias máximas obtidas por meio de um manovacuômetro. Todas as voluntárias foram avaliadas antes da inserção nos grupos e reavaliadas após três meses. No Grupo Pilates houve aumento significativo da atividade física de lazer e no total do questionário de atividade física, aumento da mobilidade nos três níveis (axilar, xifoidiano e abdominal), da força muscular respiratória, tanto inspiratória como expiratória, bem como redução significativa da circunferência da cintura (CC) (p;0,05). Para a função pulmonar, não foram constatadas diferenças significativas (p>;0,05) entre os grupos e tampouco entre seus integrantes. Conclui-se que, após a prática do método Pilates, houve melhora na atividade física de lazer, mobilidade toracoabdominal, força muscular respiratória e redução da circunferência da cintura. No entanto, em comparação ao Grupo Controle, o método Pilates não promoveu alterações relevantes na função pulmonar, mobilidade toracoabdominal, força muscular respiratória e características antropométricas de mulheres saudáveis que não realizaram programa de exercício físico

Mapping genomic loci implicates genes and synaptic biology in schizophrenia

Schizophrenia has a heritability of 60-80%1, much of which is attributable to common risk alleles. Here, in a two-stage genome-wide association study of up to 76,755 individuals with schizophrenia and 243,649 control individuals, we report common variant associations at 287 distinct genomic loci. Associations were concentrated in genes that are expressed in excitatory and inhibitory neurons of the central nervous system, but not in other tissues or cell types. Using fine-mapping and functional genomic data, we identify 120 genes (106 protein-coding) that are likely to underpin associations at some of these loci, including 16 genes with credible causal non-synonymous or untranslated region variation. We also implicate fundamental processes related to neuronal function, including synaptic organization, differentiation and transmission. Fine-mapped candidates were enriched for genes associated with rare disruptive coding variants in people with schizophrenia, including the glutamate receptor subunit GRIN2A and transcription factor SP4, and were also enriched for genes implicated by such variants in neurodevelopmental disorders. We identify biological processes relevant to schizophrenia pathophysiology; show convergence of common and rare variant associations in schizophrenia and neurodevelopmental disorders; and provide a resource of prioritized genes and variants to advance mechanistic studies

Interaction Testing and Polygenic Risk Scoring to Estimate the Association of Common Genetic Variants with Treatment Resistance in Schizophrenia

Importance: About 20% to 30% of people with schizophrenia have psychotic symptoms that do not respond adequately to first-line antipsychotic treatment. This clinical presentation, chronic and highly disabling, is known as treatment-resistant schizophrenia (TRS). The causes of treatment resistance and their relationships with causes underlying schizophrenia are largely unknown. Adequately powered genetic studies of TRS are scarce because of the difficulty in collecting data from well-characterized TRS cohorts. Objective: To examine the genetic architecture of TRS through the reassessment of genetic data from schizophrenia studies and its validation in carefully ascertained clinical samples. Design, Setting, and Participants: Two case-control genome-wide association studies (GWASs) of schizophrenia were performed in which the case samples were defined as individuals with TRS (n = 10501) and individuals with non-TRS (n = 20325). The differences in effect sizes for allelic associations were then determined between both studies, the reasoning being such differences reflect treatment resistance instead of schizophrenia. Genotype data were retrieved from the CLOZUK and Psychiatric Genomics Consortium (PGC) schizophrenia studies. The output was validated using polygenic risk score (PRS) profiling of 2 independent schizophrenia cohorts with TRS and non-TRS: a prevalence sample with 817 individuals (Cardiff Cognition in Schizophrenia [CardiffCOGS]) and an incidence sample with 563 individuals (Genetics Workstream of the Schizophrenia Treatment Resistance and Therapeutic Advances [STRATA-G]). Main Outcomes and Measures: GWAS of treatment resistance in schizophrenia. The results of the GWAS were compared with complex polygenic traits through a genetic correlation approach and were used for PRS analysis on the independent validation cohorts using the same TRS definition. Results: The study included a total of 85490 participants (48635 [56.9%] male) in its GWAS stage and 1380 participants (859 [62.2%] male) in its PRS validation stage. Treatment resistance in schizophrenia emerged as a polygenic trait with detectable heritability (1% to 4%), and several traits related to intelligence and cognition were found to be genetically correlated with it (genetic correlation, 0.41-0.69). PRS analysis in the CardiffCOGS prevalence sample showed a positive association between TRS and a history of taking clozapine (r2 = 2.03%; P =.001), which was replicated in the STRATA-G incidence sample (r2 = 1.09%; P =.04). Conclusions and Relevance: In this GWAS, common genetic variants were differentially associated with TRS, and these associations may have been obscured through the amalgamation of large GWAS samples in previous studies of broadly defined schizophrenia. Findings of this study suggest the validity of meta-analytic approaches for studies on patient outcomes, including treatment resistance