Vilanterol trifenatate for the treatment of COPD

Introduction: Currently the treatment of chronic obstructive pulmonary disease (COPD) has limited effectiveness and there is a need to develop new drugs. International guidelines recommend the use of long-acting bronchodilators (β2 agonists and anti-cholinergics/muscarinics), inhaled steroids and associations between these drugs in the maintenance treatment of moderate-to-severe COPD. Area covered: Vilanterol trifenate is a new once-daily highly selective β2-agonist available in USA and Europe in association with umeclidinium bromide (a long-acting anti-muscarnic agent) and fluticasone furoate (an inhaled corticosteroid) for the once-daily maintenance treatment of COPD. Vilanterol combined in fixed-dose treatments has been tested in numerous clinical trials involving thousands of patients. Expert commentary: These new once-daily formulations have the potential to improve compliance to long-term inhaled therapy. This paper will review the clinical and experimental data regarding vilanterol use in the regular treatment of COPD as well as provide a critical discussion of possible future treatment settings

A necessidade das virtudes ?ticas e diano?ticas para a obten??o da eudaimon?a em Arist?teles

This final paper objects to present the necessity of the ethical and dianoetic virtues for the obtaining of the Eudaimonia in Aristotle?s philosophy. The book of Nicomachean Ethics of the referred author was used and this work was divided in three chapters. On the first one, the analysis consists in the investigation about the well-being, the supreme good and the human functions. In that way, obtaining a provisional definition of Eudaimonia. For this chapter, the book I of Estagirita was used. On the second chapter, the investigation is about the ethical virtues, the voluntary and involuntary acts, utilizing the books II and III of the same work, with the objective of investigating the nature of the virtues. Finally, on the third chapter, the book VI and book X was used and the analysis is referent to the dianoetic virtues, their relation to the ethical virtues and both of this relations to the Eudaimonia; and also the relation of the Eudaimonia with life in society.Este trabalho de conclus?o de curso tem por objetivo apresentar a necessidade das virtudes ?ticas e diano?ticas para a obten??o da eudaimon?a em Arist?teles. Para tanto, utilizou-se a obra ?tica a Nic?maco do referido autor e o trabalho dividiu-se em tr?s cap?tulos. No primeiro cap?tulo a an?lise consiste na investiga??o sobre o bem, o sumo bem, e a fun??o humana. Desse modo, obt?m-se uma defini??o provis?ria de eudaimon?a, uma no??o geral do conceito aristot?lico. Para esse cap?tulo foi utilizado o Livro I da obra do fil?sofo estagirita. No cap?tulo dois, a investiga??o ? referente ?s virtudes ?ticas, os atos volunt?rios, os atos involunt?rios, a escolha e a delibera??o. Utilizou-se os Livros II e III da mesma obra com o objetivo de investigar a natureza das virtudes ?ticas, a busca pela mediania e o afastamento dos v?cios, tanto por excesso quanto por defici?ncia. E no cap?tulo tr?s, utilizou-se o Livro VI e o Livro X da obra citada; a an?lise ? referente ?s virtudes diano?ticas, sua rela??o com as virtudes ?ticas e a rela??o de ambas com a eudaimon?a; e tamb?m a obten??o da eudaimon?a completa na vida em sociedade

Platelet activation and cardiovascular co-morbidities in patients with chronic obstructive pulmonary disease.

Objective: Platelet activation in COPD patients is associated with an increased risk of cardiovascular events. Aim of the study: to assess the mean platelet volume (MPV), as an index of platelet activation, in patients with COPD both when stable or during exacerbation. Research design and methods: 478 patients with COPD (75 with exacerbation) and 72 age-matched healthy controls were enrolled. Medical history, co-morbidities, medications, pulmonary function tests, MPV and blood cell count, erythrocyte sedimentation rate (ERS) and C reactive protein (CRP) were recorded. Results: MPV was higher in COPD patients than in controls (8.7 \ub1 1.1 fL and 8.4 \ub1 0.8 fL respectively, p = 0.025) and increased across the severity of the diseases as assessed by the GOLD post bronchodilator FEV1 categorized I to IV (p>0.05). MPV was higher in COPD patients during acute exacerbation as compared with stable condition (8.7 \ub1 1.0 fL and 8.9 \ub1 1.0 fL, p = 0.021). MPV 65 10.5 fL correlated with the presence of at least one co-existing cardiovascular disease (p = 0.008) . No correlation was observed between MPV and CRP or ERS in patients or in controls. An inverse significant correlation was found between platelets count and MPV in COPD patients. Conclusions: Elevated MPV is associated with lower platelet count and with cardiovascular co-morbidity in COPD patients. MPV value is higher in more severe COPD and during acute exacerbation. Present findings warrant future studies to confirm a possible clinically relevant role for platelet activation and cardiovascular risk in the population of COPD

Predictive markers of bronchial hyperreactivity in a large cohort of young adults With cough variant asthma

Cough variant asthma (CVA), a common asthma phenotype characterized by nonproductive cough and bronchial hyperreactivity (BHR), is usually detected by bronchial provocation tests (BPTs) which are time-consuming, expensive, and unsafe. The primary study objective was to provide proof of concept for the use of fractional exhaled nitric oxide (FENO), eosinophil count percentage in induced sputum (sEOS%), forced expiratory flow between 25 and 75% of forced vital capacity (FEF25–75%) % predicted value, and FEF25–75% z-scores as surrogate markers predicting BHR in young adults with suspected CVA; the secondary objective was to compare the diagnostic performance of the various techniques. Three hundred and ten subjects (median age 24 years) were included in a cross-sectional study. Subjects were characterized as BHR positive (POS) (n 147) or BHR negative (NEG) (n 163) according to methacholine BPT. Classification accuracies were expressed as areas under the receiver operator characteristic curves (AUC). Compared with BHR NEG, FEF25–75% % predicted value and FEF25–75% z-scores were lower in the BHR POS group (p < 0.001), whereas FENO (p < 0.001) and sEOS% were higher (p < 0.001). AUC values for detecting BHR were as follows: FENO, 0.98 (SD 0.02); sEOS%, 0.98 (SD 0.02); FEF25–75% % pred, 0.93 (SD 0.05); FEF25–75% z scores, 0.92 (SD 0.05). Optimal cutoff values (OCV) for BHR prediction were as follows: FENO, 32.7 ppb (sensitivity 0.93, specificity 0.96), sEOS %, 3.80% (sensitivity 0.94, specificity 0.94), FEF25–75% % predicted value, 80.0% (sensitivity 0.90, specificity 0.87), and FEF25–75% z-score, −0.87 (sensitivity 0.89, specificity 0.87). Non-invasive/semi-invasive airway inflammatory or small airway functional measures might be used as surrogate markers predicting BHR in young adults with suspected CV

Femoral overgrowth following surgical treatment of long-established dysplasia of the hip

OBJECTIVE: To measure femoral overgrowth using radiographic scanning in patients with long-established Developmental Dysplasia of the Hip treated with femoral shaft shortening, open reduction and acetabuloplasty. METHODS: We studied 30 children (33 hips) submitted to surgical treatment including femoral shaft shortening, open reduction according to Scaglietti & Calandriello's procedure and Salter acetabuloplasty without preliminary traction. There were 29 females and 1 male, with mean age = 4 years and 5 months at the time of operation. According to Zionts & MacEwen's classification, 23 hips were classified as type III (69.6%), 5 (15.2%) as type I and 5 (15.2%) as type II. The average femoral shortening was 45.12 mm (range: 30.00 mm to 80.00 mm). The mean follow-up time was 10 years and 2 months (range: 2 years and 3 months to 18 years) and we noticed a mean femoral discrepancy of 13.48mm (range: 0.00 mm to 60.00 mm) using plain scanning images. RESULTS: All patients evolved to femoral overgrowth; in 18 cases (54.6%), the leg length discrepancy found was 30mm. Conclusion: We noticed a significantly decreased discrepancy of femurs after surgical treatment when compared to the measurements obtained during outpatient follow-up.OBJETIVO: Medir radiograficamente através de escanometria o hipercrescimento femoral em pacientes portadores de Displasia do Desenvolvimento do Quadril inveterada tratados cirurgicamente com encurtamento femoral, redução cruenta e acetabuloplastia. MÉTODOS: Avaliamos 30 crianças (33 quadris) submetidas à redução cruenta pela técnica de Scaglietti e Calandriello, ostectomia para encurtamento femoral e acetabuloplastia de Salter. Haviam 29 do sexo feminino e 1 do sexo masculino, com idade média de 4 anos e 5 meses na ocasião da cirurgia. De acordo com a classificação de Zionts e MacEwen, 23 (69,6%) quadris foram classificados como tipo III, 5 (15,2%) como tipo I e 5 (15,2%) como tipo II. O encurtamento femoral médio foi 45,12mm (variando de 30,00mm a 80,00mm). O tempo de seguimento médio foi de 10 anos e 2 meses. A discrepância femoral média mensurada nos escanogramas foi 13,48mm (variando de 0,00mm a 60,00mm) após acompanhamento mínimo de 2 anos e 3 meses. RESULTADOS: Todos os pacientes evoluíram com hipercrescimento sendo que em 18 (54,6%) casos a anisomelia observada foi 30mm. CONCLUSÃO: Observamos diminuição significante na diferença entre os comprimentos femorais após tratamento cirúrgico comparando com as medidas obtidas durante o seguimento ambulatorial.Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Departamento de Ortopedia e TraumatologiaUNIFESP, EPM, Depto. de Ortopedia e TraumatologiaSciEL

Exhaled nitric oxide in patients with PiZZ Phenotype-related α 1-anti-trypsin deficiency

AbstractThere is no report of exhaled NO (eNO) in subjects with different phenotypes ofα1 -anti-trypsin (AAT) deficiency.Exhaled nitric oxide was evaluated by means of single-breath chemiluminescence analysis (fractional exhaled concentration at the plateau level [plFENO]) in 40 patients with AAT deficiency. Patients were divided according to the protease inhibitor (Pi) phenotype: PiMZ/MS, n=25; PiSZ n=6; PiZZ, n=9. Nineteen healthy subjects served as controls. Levels of eNO in PiZZ patients were also compared with those of subjects, without AAT deficiency (PiMM), matched for diagnosis, sex, age, smoking habit and forced expiratory volume in 1 sec (FEV1). In AAT deficiency subjects airway hyper-responsiveness to methacholine (PD20FEV1) was also assessed.plFENOwas significantly lower in the PiZZ group (4·5±1·4 ppb) than in matched PiMM subjects (8·2±3·8 ppb), in healthy controls (9·3±2·8 ppb) and in patients of other phenotypes. Dynamic lung volumes and DLCOwere significantly lower in PiZZ than in other AAT-deficient patients. Bronchial hyper-responsiveness was not different among AAT phenotypes.These results suggest that eNO may be significantly reduced in PiZZ as compared to healthy control subjects and to AAT subjects with other phenotypes, independent of the level of airway obstruction. Whether, at least potentially, eNO may be considered as an early marker of lung involvement in AAT deficiency must be confirmed with studies on larger number of subjects

Bronchoalveolar lavage, sputum and exhaled clinically relevant inflammatory markers: values in healthy adults.

11noBronchoalveolar lavage (BAL), induced sputum and exhaled breath markers (exhaled nitric oxide and exhaled breath condensate) can each provide biological insights into the pathogenesis of respiratory disorders. Some of their biomarkers are also employed in the clinical management of patients with various respiratory diseases. In the clinical context, however, defining normal values and cut-off points is crucial. The aim of the present review is to investigate to what extent the issue of defining normal values in healthy adults has been pursued for the biomarkers with clinical value. The current authors reviewed data from literature that specifically addressed the issue of normal values from healthy adults for the four methodologies. Most studies have been performed for BAL (n = 9), sputum (n = 3) and nitric oxide (n = 3). There are no published studies for breath condensate, none of whose markers yet has clinical value. In healthy adult nonsmokers the cut-off points (mean+2sd) for biomarkers with clinical value were as follows. BAL: 16.7% lymphocytes, 2.3% neutrophils and 1.9% eosinophils; sputum: 7.7 x 10(6).mL(-1) total cell count and 2.2% eosinophils; nitric oxide: 20.2 ppb. The methodologies differ concerning the quantity and characteristics of available reference data. Studies focusing on obtaining reference values from healthy individuals are still required, more evidently for the new, noninvasive methodologies.nonemixedBALBI B; PIGNATTI P; CORRADI M; BAIARDI P; BIANCHI L; BRUNETTI G; RADAELI A; MOSCATO G; MUTTI A; SPANEVELLO A; MALERBA MBalbi, B; Pignatti, P; Corradi, M; Baiardi, P; Bianchi, L; Brunetti, G; Radaeli, A; Moscato, G; Mutti, A; Spanevello, Antonio; Malerba, M

Polarization Dependence of Anomalous X-ray Scattering in Orbital Ordered Manganites

In order to determine types of the orbital ordering in manganites, we study theoretically the polarization dependence of the anomalous X-ray scattering which is caused by the anisotropy of the scattering factor. The general formulae of the scattering intensity in the experimental optical system is derived and the atomic scattering factor is calculated in the microscopic electronic model. By using the results, the X-ray scattering intensity in several types of the orbital ordering is numerically calculated as a function of azimuthal and analyzer angles.Comment: 9 pages, 7 figure

A METÁFORA DAS ORGANIZAÇÕES VISTAS COMO CULTURAS A PARTIR DA PERSPECTIVA DE MORGAN E SUA BASE TEÓRICA

A cultura no ambiente organizacional influencia diretamente o comportamento dos colaboradores. A metáfora, por conseguinte, auxilia na reflexão de muitos aspectos deste ambiente, dentre elas a estratégia, a estrutura e o tipo de liderança desta organização. Dado este contexto, o objetivo da pesquisa foi analisar a produção de artigos internacionais acerca da evolução dos estudos sobre as organizações vistas como culturas do autor Gareth Morgan e sua base teórica, encontrada na obra “Imagens da Organização”. A pesquisa utilizou como método uma revisão sistemática da literatura, com abordagem qualitativa e objetivo exploratório e descritivo, utilizando a base de dados Scopus, selecionando-se todos os anos até 2016. Como resultado da pesquisa, foram encontrados 55 artigos, antes da aplicação dos critérios de exclusão. A principal contribuição dos trabalhos selecionados foi que os estilos de liderança são fundamentais para a perpetuação da cultura organizacional e esta, por sua vez, serve de suporte para a criação de conhecimento, criatividade e inovação. Como contribuição teórica, este estudo propõe uma atualização da metáfora das organizações vistas como culturas, dentro de um contexto atual, analisando a evolução dos estudos que se referenciaram a Gareth Morgan e sua base teórica