Armadilhas na interpretação de testes de função pulmonar nas doenças neuromusculares

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Integrando medidas de troca gasosa pulmonar para responder a perguntas clinicamente relevantes

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Gasometria arterial no diagnóstico diferencial de hipoxemia

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Obesidade : como os testes de função pulmonar podem nos trair

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Neuromuscular electrical stimulation improves exercise tolerance in chronic obstructive pulmonary disease patients with better preserved fat-free mass

BACKGROUND: High-frequency neuromuscular electrical stimulation increases exercise tolerance in patients with advanced chronic obstructive pulmonary disease (COPD patients). However, it is conceivable that its benefits are more prominent in patients with better-preserved peripheral muscle function and structure. OBJECTIVE: To investigate the effects of high-frequency neuromuscular electrical stimulation in COPD patients with better-preserved peripheral muscle function. Design: Prospective and cross-over study. METHODS: Thirty COPD patients were randomly assigned to either home-based, high-frequency neuromuscular electrical stimulation or sham stimulation for six weeks. The training intensity was adjusted according to each subject's tolerance. Fat-free mass, isometric strength, six-minute walking distance and time to exercise intolerance (Tlim) were assessed. RESULTS: Thirteen (46.4%) patients responded to high-frequency neuromuscular electrical stimulation; that is, they had a post/pre &#916; Tlim >10% after stimulation (unimproved after sham stimulation). Responders had a higher baseline fat-free mass and six-minute walking distance than their seventeen (53.6%) non-responding counterparts. Responders trained at higher stimulation intensities; their mean amplitude of stimulation during training was significantly related to their fat-free mass (r = 0.65; p<0.01). Logistic regression revealed that fat-free mass was the single independent predictor of Tlim improvement (odds ratio [95% CI] = 1.15 [1.04-1.26]; p<0.05). CONCLUSIONS: We conclude that high-frequency neuromuscular electrical stimulation improved the exercise capacity of COPD patients with better-preserved fat-free mass because they tolerated higher training stimulus levels. These data suggest that early training with high-frequency neuromuscular electrical stimulation before tissue wasting begins might enhance exercise tolerance in patients with less advanced COPD

Screening Of Miners And Millers At Decreasing Levels Of Asbestos Exposure: Comparison Of Chest Radiography And Thin-section Computed Tomography.

Chest radiography (CXR) is inferior to Thin-section computed tomography in the detection of asbestos related interstitial and pleural abnormalities. It remains unclear, however, whether these limitations are large enough to impair CXR´s ability in detecting the expected reduction in the frequency of these asbestos-related abnormalities (ARA) as exposure decreases. Clinical evaluation, CXR, Thin-section CT and spirometry were obtained in 1418 miners and millers who were exposed to progressively lower airborne concentrations of asbestos. They were separated into four groups according to the type, period and measurements of exposure and/or procedures for controlling exposure: Group I (1940-1966/tremolite and chrysotile, without measurements of exposure and procedures for controlling exposure); Group II (1967-1976/chrysotile only, without measurements of exposure and procedures for controlling exposure); Group III (1977-1980/chrysotile only, initiated measurements of exposure and procedures for controlling exposure) and Group IV (after 1981/chrysotile only, implemented measurements of exposure and a comprehensive procedures for controlling exposure). In all groups, CXR suggested more frequently interstitial abnormalities and less frequently pleural plaques than observed on Thin-section CT (p<0.050). The odds for asbestosis in groups of decreasing exposure diminished to greater extent at Thin-section CT than on CXR. Lung function was reduced in subjects who had pleural plaques evident only on Thin-section CT (p<0.050). In a longitudinal evaluation of 301 subjects without interstitial and pleural abnormalities on CXR and Thin-section CT in a previous evaluation, only Thin-section CT indicated that these ARA reduced as exposure decreased. CXR compared to Thin-section CT was associated with false-positives for interstitial abnormalities and false-negatives for pleural plaques, regardless of the intensity of asbestos exposure. Also, CXR led to a substantial misinformation of the effects of the progressively lower asbestos concentrations in the occurrence of asbestos-related diseases in miners and millers.10e011858

Metodología para usar la esteganografía como medio de acreditar la validez de la documentación publicada electrónicamente

Actualmente, diversos organismos proveen gran cantidad de documentación mediante medios computarizados. Se presenta información académica y/o administrativa, se presentan formularios, noticias, resoluciones del ámbito público, etc., y en muchos casos esos formularios son utilizados para generar posteriores trámites administrativos. Sin embargo, es poco común que esa información, o documentos, sean validados para comprobar su autenticidad, integridad, etc. Las revisiones son no automatizadas y el elemento se presupone correcto solamente por las características que el receptor puede reconocer, ello implica riesgo. La información puede resultar corrupta, los documentos alterados y podría conducirse a disputas de índole administrativo/legal. Es necesario que cualquier documento/información difundido por medios masivos, tenga la posibilidad de ser verificado en su originalidad e integridad. Con este objetivo, buscamos establecer una metodología, usando herramientas esteganográficas, que brinden una respuesta a esta necesidad. Los desafíos son importantes y originales. Las herramientas existentes son ineficientes cuando el documento emitido se transfiere en diferentes soportes (impresión, fotocopia, etc.). Buscamos una metodología integral, ya que la sola herramienta no es suficiente para abarcar las múltiples situaciones posibles. Desarrollaremos el sistema de soporte informático necesario, y aunque se aplicarán técnicas esteganográficas, se pretende que sean solamente el soporte técnico de la metodología: nuestro principal objetivo.Eje: Arquitectura, Redes y Sistemas OperativosRed de Universidades con Carreras en Informática (RedUNCI

Metodología para usar la esteganografía como medio de acreditar la validez de la documentación publicada electrónicamente

Actualmente, diversos organismos proveen gran cantidad de documentación mediante medios computarizados. Se presenta información académica y/o administrativa, se presentan formularios, noticias, resoluciones del ámbito público, etc., y en muchos casos esos formularios son utilizados para generar posteriores trámites administrativos. Sin embargo, es poco común que esa información, o documentos, sean validados para comprobar su autenticidad, integridad, etc. Las revisiones son no automatizadas y el elemento se presupone correcto solamente por las características que el receptor puede reconocer, ello implica riesgo. La información puede resultar corrupta, los documentos alterados y podría conducirse a disputas de índole administrativo/legal. Es necesario que cualquier documento/información difundido por medios masivos, tenga la posibilidad de ser verificado en su originalidad e integridad. Con este objetivo, buscamos establecer una metodología, usando herramientas esteganográficas, que brinden una respuesta a esta necesidad. Los desafíos son importantes y originales. Las herramientas existentes son ineficientes cuando el documento emitido se transfiere en diferentes soportes (impresión, fotocopia, etc.). Buscamos una metodología integral, ya que la sola herramienta no es suficiente para abarcar las múltiples situaciones posibles. Desarrollaremos el sistema de soporte informático necesario, y aunque se aplicarán técnicas esteganográficas, se pretende que sean solamente el soporte técnico de la metodología: nuestro principal objetivo.Eje: Arquitectura, Redes y Sistemas OperativosRed de Universidades con Carreras en Informática (RedUNCI