Can static hyperinflation predict exercise capacity in COPD?

Introduction: The diagnosis and severity assessment of COPD relies on spirometry, and in particular the FEV1. However, it has been proposed that hyperinflation and air-trapping are better predictors of exercise capacity and mortality than the FEV1. Research: QUESTION: Does static hyperinflation predict exercise capacity? Methods: We conducted an observational prospective study. Patients with COPD referred to the lung function laboratory were consecutively recruited. Patients with hyperinflation (the experimental group) were compared to patients without hyperinflation (the control group). The sample sizes were determined assuming an effect size of 0.5 and a power of 0.80. Results: We recruited 124 participants, of whom 87% were male, the mean age was 66.1 ± 8.8 years. 67% were symptomatic (GOLD B or D). Airflow limitation was moderate to severe in the majority of patients (median FEV1 47%, IQR 38-65%) and 43% of patients had static hyperinflation. The median 6MWD was 479 meters (404-510) and peak workload in CPET was 64 watts (46-88) with peak VO2 1.12 L/min, 0.89-1.31 L/min. Patients with lower FEV1, DLCO and IC/TLC and higher RV/TLC had reduced exercise capacity in both 6MWT and CPET, measured as lower distance, greater desaturation and ∆Borg dyspnoea, and reduced workload, peak VO2 and peak VE and higher desaturation and ventilatory limitation (VE/MVV). An IC/TLC < 0.33 predicted reduced exercise performance (peak O2 <60%). Dyspnoea assessed by mMRC and QoL measured by CAT and CCQ were also worse in the hyperinflation in COPD patients. Conclusion: In COPD patients, IC/TLC and RV/TLC are valuable predictors of exercise performance in both 6MWT and CPET and PRO.This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors

Reference equations for the 6-minute walk distance in healthy Portuguese subjects 18-70 years old

Introduction Six-minute walk test (6MWT) is used for evaluating functional exercise capacity. To the best of our knowledge, there are no reference equations to predict six-minute walk distance (6MWD) for the Portuguese population. The aims of the present study were to measure anthropometric data and 6MWD in a sample of healthy Portuguese population, to establish reference equations to predict 6MWD and to compare our equations with those obtained by previously published studies. Methods We conducted an observational prospective study. We consecutively recruited 158 healthy 18–70 years old subjects from Porto district, who performed two 6MWTs using a standardized protocol. The best 6MWD was used for further analysis. Results The mean 6MWD was 627.8 m (SD = 73.3 m). The variables that were significantly associated with the 6MWD were age, sex, BMI and ΔHR (Heart Rateat the end of the test − HRat rest). We found three explanatory models for 6MWD, the best with an explanatory power of 38%: 6MWD = 721.7 − 1.6 × Age − 4.0 × BMI + 0.9 × ΔHR + 58.4 × Sex. We verified that 6MWD decreased 1.6 m per year of age, and 4.0 m per unit of BMI and increased 0.892 m per beat per minute. Moreover, on average, males walk 58.4 m more than females (p < 0.001). Applying equations from other studies to our population resulted in an overestimation or underestimation of the 6MWD. Conclusion The present study was the first to describe the 6MWD in healthy Portuguese people aged 18–70 years old and to propose predictive equations. These can contribute to improving the evaluation of Caucasian Mediterranean patients with diseases that affect their functional capacity

Milk production and composition of cows fed diets with different contents of concentrate and lipids

Avaliaram-se a produ??o e a composi??o do leite de vacas da ra?a Holandesa alimentadas com diferentes propor??es de forragem e teores de lip?deos na dieta. Foram utilizadas oito vacas com 58?9 dias em lacta??o, com produ??o m?dia de 28?4kg/dia de leite, distribu?das em delineamento quadrado latino 4 x 4 duplo, em arranjo fatorial 2 x 2. Os tratamentos foram dietas com alta forragem e baixo n?vel de lip?deos, alta forragem e alto n?vel de lip?deos, baixa forragem e baixo n?vel de lip?deos e baixa forragem e alto n?vel de lip?deos. As produ??es de leite e leite corrigido para 3,5% de gordura n?o diferiu entre os tratamentos (P>0,05). A redu??o na propor??o de forragem reduziu a produ??o e a concentra??o de gordura no leite (P0.05). The reduction on forage ratio in the diet decreased milk fat percentage and production (P<0.05). The increase in lipid levels in the diets reduced total milk solids as well as milk urea nitrogen concentrations (P<0.05)

Infection control, genetic assessment of drug resistance and drug susceptibility testing in the current management of multidrug/extensively-resistant tuberculosis (M/XDR-TB) in Europe: A tuberculosis network European Trialsgroup (TBNET) study

Aim Europe has the highest documented caseload and greatest increase in multidrug and extensively drug-resistant tuberculosis (M/XDR-TB) of all World Health Organization (WHO) regions. This survey examines how recommendations for M/XDR-TB management are being implemented. Methods TBNET is a pan-European clinical research collaboration for tuberculosis. An email survey of TBNET members collected data in relation to infection control, access to molecular tests and basic microbiology with drug sensitivity testing. Results 68/105 responses gave valid information and were from countries within the WHO European Region. Inpatient beds matched demand, but single rooms with negative pressure were only available in low incidence countries; ultraviolet decontamination was used in 5 sites, all with &gt;10 patients with M/XDR-TB per year. Molecular tests for mutations associated with rifampicin resistance were widely available (88%), even in lower income and especially in high incidence countries. Molecular tests for other first line and second line drugs were less accessible (76 and 52% respectively). A third of physicians considered that drug susceptibility results were delayed by &gt; 2 months. Conclusion Infection control for inpatients with M/XDR-TB remains a problem in high incidence countries. Rifampicin resistance is readily detected, but tests to plan regimens tailored to the drug susceptibilities of the strain of Mycobacterium tuberculosis are significantly delayed, allowing for further drug resistance to develop

DNA damage in circulating leukocytes measured with the comet assay may predict the risk of death

The comet assay or single cell gel electrophoresis, is the most common method used to measure strand breaks and a variety of other DNA lesions in human populations. To estimate the risk of overall mortality, mortality by cause, and cancer incidence associated to DNA damage, a cohort of 2,403 healthy individuals (25,978 person-years) screened in 16 laboratories using the comet assay between 1996 and 2016 was followed-up. Kaplan-Meier analysis indicated a worse overall survival in the medium and high tertile of DNA damage (p < 0.001). The effect of DNA damage on survival was modelled according to Cox proportional hazard regression model. The adjusted hazard ratio (HR) was 1.42 (1.06-1.90) for overall mortality, and 1.94 (1.04-3.59) for diseases of the circulatory system in subjects with the highest tertile of DNA damage. The findings of this study provide epidemiological evidence encouraging the implementation of the comet assay in preventive strategies for non-communicable diseases

Burden of non-communicable disease studies in Europe: a systematic review of data sources and methodological choices

Background: Assessment of disability-adjusted life years (DALYs) resulting from non-communicable diseases (NCDs) requires specific calculation methods and input data. The aims of this study were to (i) identify existing NCD burden of disease (BoD) activities in Europe; (ii) collate information on data sources for mortality and morbidity; and (iii) provide an overview of NCD-specific methods for calculating NCD DALYs. Methods: NCD BoD studies were systematically searched in international electronic literature databases and in grey literature. We included all BoD studies that used the DALY metric to quantify the health impact of one or more NCDs in countries belonging to the European Region. Results: A total of 163 BoD studies were retained: 96 (59%) were single-country or sub-national studies and 67 (41%) considered more than one country. Of the single-country studies, 29 (30%) consisted of secondary analyses using existing Global Burden of Disease (GBD) results. Mortality data were mainly derived (49%) from vital statistics. Morbidity data were frequently (40%) drawn from routine administrative and survey datasets, including disease registries and hospital discharge databases. The majority (60%) of national BoD studies reported mortality corrections. Multimorbidity adjustments were performed in 18% of national BoD studies. Conclusion: The number of national NCD BoD assessments across Europe increased over time, driven by an increase in BoD studies that consisted of secondary data analysis of GBD study findings. Ambiguity in reporting the use of NCD-specific BoD methods underlines the need for reporting guidelines of BoD studies to enhance the transparency of NCD BoD estimates across Europe

Methodological considerations in injury burden of disease studies across Europe: a systematic literature review

Background Calculating the disease burden due to injury is complex, as it requires many methodological choices. Until now, an overview of the methodological design choices that have been made in burden of disease (BoD) studies in injury populations is not available. The aim of this systematic literature review was to identify existing injury BoD studies undertaken across Europe and to comprehensively review the methodological design choices and assumption parameters that have been made to calculate years of life lost (YLL) and years lived with disability (YLD) in these studies. Methods We searched EMBASE, MEDLINE, Cochrane Central, Google Scholar, and Web of Science, and the grey literature supplemented by handsearching, for BoD studies. We included injury BoD studies that quantified the BoD expressed in YLL, YLD, and disability-adjusted life years (DALY) in countries within the European Region between early-1990 and mid-2021. Results We retrieved 2,914 results of which 48 performed an injury-specific BoD assessment. Single-country independent and Global Burden of Disease (GBD)-linked injury BoD studies were performed in 11 European countries. Approximately 79% of injury BoD studies reported the BoD by external cause-of-injury. Most independent studies used the incidence-based approach to calculate YLDs. About half of the injury disease burden studies applied disability weights (DWs) developed by the GBD study. Almost all independent injury studies have determined YLL using national life tables. Conclusions Considerable methodological variation across independent injury BoD assessments was observed; differences were mainly apparent in the design choices and assumption parameters towards injury YLD calculations, implementation of DWs, and the choice of life table for YLL calculations. Development and use of guidelines for performing and reporting of injury BoD studies is crucial to enhance transparency and comparability of injury BoD estimates across Europe and beyond