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

Bezlotoxumab for Prevention of Recurrent Clostridium difficile Infection

BACKGROUND Clostridium difficile is the most common cause of infectious diarrhea in hospitalized patients. Recurrences are common after antibiotic therapy. Actoxumab and bezlotoxumab are human monoclonal antibodies against C. difficile toxins A and B, respectively. METHODS We conducted two double-blind, randomized, placebo-controlled, phase 3 trials, MODIFY I and MODIFY II, involving 2655 adults receiving oral standard-of-care antibiotics for primary or recurrent C. difficile infection. Participants received an infusion of bezlotoxumab (10 mg per kilogram of body weight), actoxumab plus bezlotoxumab (10 mg per kilogram each), or placebo; actoxumab alone (10 mg per kilogram) was given in MODIFY I but discontinued after a planned interim analysis. The primary end point was recurrent infection (new episode after initial clinical cure) within 12 weeks after infusion in the modified intention-to-treat population. RESULTS In both trials, the rate of recurrent C. difficile infection was significantly lower with bezlotoxumab alone than with placebo (MODIFY I: 17% [67 of 386] vs. 28% [109 of 395]; adjusted difference, −10.1 percentage points; 95% confidence interval [CI], −15.9 to −4.3; P<0.001; MODIFY II: 16% [62 of 395] vs. 26% [97 of 378]; adjusted difference, −9.9 percentage points; 95% CI, −15.5 to −4.3; P<0.001) and was significantly lower with actoxumab plus bezlotoxumab than with placebo (MODIFY I: 16% [61 of 383] vs. 28% [109 of 395]; adjusted difference, −11.6 percentage points; 95% CI, −17.4 to −5.9; P<0.001; MODIFY II: 15% [58 of 390] vs. 26% [97 of 378]; adjusted difference, −10.7 percentage points; 95% CI, −16.4 to −5.1; P<0.001). In prespecified subgroup analyses (combined data set), rates of recurrent infection were lower in both groups that received bezlotoxumab than in the placebo group in subpopulations at high risk for recurrent infection or for an adverse outcome. The rates of initial clinical cure were 80% with bezlotoxumab alone, 73% with actoxumab plus bezlotoxumab, and 80% with placebo; the rates of sustained cure (initial clinical cure without recurrent infection in 12 weeks) were 64%, 58%, and 54%, respectively. The rates of adverse events were similar among these groups; the most common events were diarrhea and nausea. CONCLUSIONS Among participants receiving antibiotic treatment for primary or recurrent C. difficile infection, bezlotoxumab was associated with a substantially lower rate of recurrent infection than placebo and had a safety profile similar to that of placebo. The addition of actoxumab did not improve efficacy. (Funded by Merck; MODIFY I and MODIFY II ClinicalTrials.gov numbers, NCT01241552 and NCT01513239.

Chemical composition and fatty acids profile in milk and mozzarella cheese of water buffalo fed different lipid sources

The chemical composition of milk and fatty acids profile in milk fat of water buffaloes fed different lipid sources were evaluated. Nine lactating multiparous water buffaloes, averaging 6.5kg of milk daily, were used. The statistical design was 3x3 triple Latin Square, three periods of 21 days and nine repetitions. The treatments were diet without additional fat, diet with soybean grain, and diet with soybean oil. Corn silage content in the diets ranged from 70 to 75%. The inclusion of soybean oil increased fat content in milk and mozzarella. Saturated fatty acid (SFA) concentrations in milk ranged from 62.8 to 69.8%. SFA content was similar in milk for the diets without additional fat and with soybean grain. However, in the diet with soybean oil, SFA decreased about 10%. Lipid sources reduced SFA and increased unsaturated fatty acids (UFA). The main fatty acids found in mozzarella fat, in decreasing array, were: palmitic, oleic, lauric, and estearic. Diet with soybean oil presented higher capacity of increasing conjugated linoleic acid (CLA) and vaccenic acid concentrations in milk and mozzarella.Avaliaram-se a composição química e o perfil de ácidos na gordura do leite de búfalas alimentadas com fontes de lipídeos. Foram utilizadas nove búfalas em lactação, multíparas e com produção média diária de leite de 6,5kg. O delineamento experimental foi quadrado latino 3x3, triplo, composto por três tratamentos, três períodos de 21 dias e nove repetições. Os tratamentos foram dietas sem lipídeo adicional, com grão de soja e com óleo de soja. A proporção de silagem de milho variou entre 70 e 75%. A inclusão de óleo de soja elevou os teores de gordura no leite e no queijo tipo muçarela. As concentrações de ácidos graxos saturados (AGS) variaram de 62,8 a 69,8%. Não houve diferenças nos teores de AGS entre os tratamentos sem lipídeo adicional e com grão de soja. O tratamento com óleo de soja resultou em queda de 10% no teor de AGS. As fontes lipídicas reduziram as concentrações de AGS e aumentaram as concentrações de ácidos graxos insaturados. Ácidos graxos encontrados na muçarela, em ordem decrescente, foram: palmítico, oleico, láurico e esteárico. O óleo de soja apresentou maior capacidade de elevar as concentrações do ácido linoleico conjugado (CLA) e do ácido vaccênico no leite e no queijo muçarela

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