Brazilian Journal of Pulmonology

ISSN (on-line): 1806-3756 | ISSN (printed): 1806-3713

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Lung alterations in a rat model of diabetes mellitus: effects of antioxidant therapy

Alterações pulmonares em um modelo de diabetes mellitus em ratos: o efeito da terapia antioxidante

Luiz Alberto Forgiarini Junior, Nélson Alexandre Kretzmann, Juliana Tieppo, Jaqueline Nascimento Picada, Alexandre Simões Dias, Norma Anair Possa Marroni

J Bras Pneumol.2010;36(5):579-587

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate structural alterations of the lung in rats with diabetes mellitus (DM), by quantifying oxidative stress and DNA damage, as well as to determine the effects that exogenous superoxide dismutase (SOD) has on such alterations. Methods: A controlled experimental study involving 40 male Wistar rats, divided into four groups (10 animals each): control; SOD-only (without DM but treated with SOD); IDM-only (with streptozotocin-induced DM but untreated); and IDM+SOD (with streptozotocin-induced DM, treated with SOD). The animals were evaluated over a 60-day period, day 0 being defined as the day on which the streptozotocin-injected animals presented glycemia > 250 mg/dL. The SOD was administered for the last 7 days of that period. At the end of the study period, samples of lung tissue were collected for histopathological analysis, evaluation of tissue oxidative stress, and assessment of DNA damage. Results: There were no significant differences among the groups regarding DNA damage. In the IDM-only group, there was a significant increase in the extracellular matrix and significantly greater hyperplasia of the capillary endothelium than in the SOD-only and control groups. In addition, there were significant changes in type II pneumocytes and macrophages, suggesting an inflammatory process, in the IDM-only group. However, in the IDM+SOD group, there was a reduction in the extracellular matrix, as well as normalization of the capillary endothelium and of the type II pneumocytes. Conclusions: Exogenous SOD can reverse changes in the lungs of animals with induced DM.

 


Keywords: Diabetes mellitus, experimental; Oxidative stress; Lung; DNA damage.

 


Aminoguanidine reduces oxidative stress and structural lung changes in experimental diabetes mellitus

Aminoguanidina reduz o estresse oxidativo e as alterações estruturais pulmonares em diabetes mellitus experimental

Fabio Cangeri Di Naso, Luiz Alberto Forgiarini Junior, Luiz Felipe Forgiarini, Marilene Porawski, Alexandre Simões Dias, Norma Anair Possa Marroni

J Bras Pneumol.2010;36(4):-

Abstract PDF PT PDF EN Portuguese Text

We evaluated the effect of aminoguanidine on pulmonary oxidative stress and lung structure in an experimental model of diabetes mellitus. Thiobarbituric acid reactive substances (TBARS), histology and arterial blood gases were evaluated in animals with diabetes mellitus (DM group), animals with diabetes mellitus treated with aminoguanidine (DM+AG group), and controls. The TBARS levels were significantly higher in the DM group than in the control and DM+AG groups (2.90 ± 1.12 vs. 1.62 ± 0.28 and 1.68 ± 0.04 nmol/mg protein, respectively), as was PaCO2 when compared with that of the control group (49.2 ± 1.65 vs. 38.12 ± 4.85 mmHg), and PaO2 was significantly higher in the control group (104.5 ± 6.3 vs. 16.30 ± 69.48 and 97.05±14.02 mmHg, respectively). In this experimental model of diabetes mellitus, aminoguanidine reduced oxidative stress, structural tissue alterations, and gas exchange.

 


Keywords: Oxidative stress; Diabetes mellitus, experimental; Lung.

 


Physical therapy in the immediate postoperative period after abdominal surgery

Atendimento fisioterapêutico no pós-operatório imediato de pacientes submetidos à cirurgia abdominal

Luiz Alberto Forgiarini Junior, Alexandra Torres de Carvalho, Tatiane de Souza Ferreira, Mariane Borba Monteiro, Adriane Dal Bosco, Marisa Pereira Gonçalves, Alexandre Simões Dias

J Bras Pneumol.2009;35(5):455-459

Abstract PDF PT PDF EN Portuguese Text

A series of pulmonary complications can occur after abdominal surgery. Therefore, it is necessary to introduce appropriate treatment early in order to minimize postoperative complications. The objective of the present study was to evaluate patients submitted to abdominal surgery in terms of the effect of physical therapy in the immediate postoperative period. This was a randomized clinical trial, in which one group of patients was submitted to physical therapy in the postoperative recovery room and, subsequently, in the infirmary, whereas another group was submitted to physical therapy in the infirmary exclusively. We conclude that physical therapy performed in the immediate postoperative period minimizes losses in lung function and respiratory muscle strength, as well as shortening recovery room stays.

 


Keywords: Physical therapy (specialty); Postoperative period; Surgery/abdomen.

 


Assessment of ICU readmission risk with the Stability and Workload Index for Transfer score

Avaliação de riscos de readmissão em UTI através do escore Stability and Workload Index for Transfer

Daiane Ferreira Oakes, Ingrid Nemitz Krás Borges, Luiz Alberto Forgiarini Junior, Marcelo de Mello Rieder

J Bras Pneumol.2014;40(1):69-72

Abstract PDF PT PDF EN Portuguese Text

We compared bacteremic pneumococcal pneumonia (BPP) and pneumococcal empyema (PE), in terms of clinical, radiological, and laboratory findings, in under-fives. A cross-sectional nested cohort study, involving under-fives (102 with PE and 128 with BPP), was conducted at 12 centers in Argentina, Brazil, and the Dominican Republic. Among those with PE, mean age was higher; disease duration was longer; and tachypnea, dyspnea, and high leukocyte counts were more common. Among those with BPP, fever and lethargy were more common. It seems that children with PE can be distinguished from those with BPP on the basis of clinical and laboratory findings. Because both conditions are associated with high rates of morbidity and mortality, prompt diagnosis is crucial.

 


Keywords: Empyema, pleural; Pneumonia, pneumococcal; Pneumococcal infections.

 


Chest compression with a higher level of pressure support ventilation: effects on secretion removal, hemodynamics, and respiratory mechanics in patients on mechanical ventilation

Compressão torácica com incremento da pressão em ventilação com pressão de suporte: efeitos na remoção de secreções, hemodinâmica e mecânica pulmonar em pacientes em ventilação mecânica

Wagner da Silva Naue, Luiz Alberto Forgiarini Junior, Alexandre Simões Dias, Silvia Regina Rios Vieira

J Bras Pneumol.2014;40(1):55-60

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the efficacy of chest compression accompanied by a 10-cmH2O increase in baseline inspiratory pressure on pressure support ventilation, in comparison with that of aspiration alone, in removing secretions, normalizing hemodynamics, and improving respiratory mechanics in patients on mechanical ventilation. Methods: This was a randomized crossover clinical trial involving patients on mechanical ventilation for more than 48 h in the ICU of the Porto Alegre Hospital de Clínicas, in the city of Porto Alegre, Brazil. Patients were randomized to receive aspiration alone (control group) or compression accompanied by a 10-cmH2O increase in baseline inspiratory pressure on pressure support ventilation (intervention group). We measured hemodynamic parameters, respiratory mechanics parameters, and the amount of secretions collected. Results: We included 34 patients. The mean age was 64.2  14.6 years. In comparison with the control group, the intervention group showed a higher median amount of secretions collected (1.9 g vs. 2.3 g; p = 0.004), a greater increase in mean expiratory tidal volume (16  69 mL vs. 56  69 mL; p = 0.018), and a greater increase in mean dynamic compliance (0.1  4.9 cmH2O vs. 2.8  4.5 cmH2O; p = 0.005). Conclusions: In this sample, chest compression accompanied by an increase in pressure support significantly increased the amount of secretions removed, the expiratory tidal volume, and dynamic compliance. (ClinicalTrials.gov Identifier:NCT01155648 [http://www.clinicaltrials.gov/])

 


Keywords: Physical therapy modalities; Respiration, Artificial; Intensive care units; Respiratory therapy.

 


Oxidative damage induced by cigarette smoke exposure in mice: impact on lung tissue and dia-phragm muscle

Dano oxidativo induzido por exposição a fumaça de cigarro em camundongos: impacto sobre o pulmão e o músculo diafragma

Samanta Portão de Carlos, Alexandre Simões Dias, Luiz Alberto Forgiarini Júnior, Patrícia Damiani Patricio, Thaise Graciano, Renata Tiscoski Nesi, Samuel Valença, Adriana Meira Guntzel Chiappa, Gerson Cipriano Jr, Claudio Teodoro de Souza, Gaspar Rogério da Silva Chiappa

J Bras Pneumol.2014;40(4):411-420

Abstract PDF PT PDF EN Portuguese Text

Objetivo: Avaliar o dano oxidativo (oxidação lipídica, oxidação proteica, thiobarbituric acid-reactive substances [TBARS, substâncias reativas ao ácido tiobarbitúrico], e carbonilação) e inflamação (expressão de phosphorylated AMP-activated protein kinase e de phosphorylated mammalian target of rapamycin (p-AMPK e p-mTOR, respectivamente) em tecido pulmonar e músculos do diafragma em camundongos C57BL/6 machos expostos à fumaça de cigarro (FC) por 7, 15, 30, 45 ou 60 dias. Métodos: Trinta e seis camundongos machos da espécie C57BL/6 foram divididos em seis grupos (n = 6/grupo): grupo controle e 5 grupos expostos a FC por 7, 15, 30, 45 e 60 dias, respectivamente. Resultados: Comparados aos camundongos controle, os camundongos expostos à FC apresentaram menor peso corporal em 30 dias. Nos camundongos expostos à FC (comparados aos controle) as maiores diferenças (aumentos) nos níveis de TBARS foram observados no dia 7 no músculo diafragma, comparado ao dia 45 em tecido pulmonar; as maiores diferenças (aumentos) nos níveis de carbonilas foram observados no dia 7 em ambos os tipos de tecido; e os níveis de sulfidrilas foram menores, nos dois tipos de tecidos, em todos os tempos. No tecido pulmonar e no músculo diafragma, a expressão de p-AMPK exibiu um comportamento semelhante ao dos níveis de TBARS. A expressão de p-mTOR foi maior que o valor controle nos dias 7 e 15 no tecido pulmonar, assim como no dia 45 no músculo diafragma. Conclusões: Nossos dados demonstram que a exposição à FC produz dano oxidativo tanto no tecido pulmonar quanto (primariamente) no tecido muscular, tendo um efeito adicional no músculo respiratório, como é frequentemente observado em fumantes com DPOC.

 


Keywords: Oxidative stress; Mice; Respiratory system; Smoking; Inflammation.

 


Melatonin effects on pulmonary tissue in the experimental model of Hepatopulmonary Syndrome

Efeitos da melatonina sobre o tecido pulmonar no modelo experimental de Síndrome Hepatopulmonar

Adriane Dal Bosco1,a, Filipe Boeira Schedler2,b, Josieli Raskopf Colares2,c, Elisângela Gonçalves Schemitt2,3,d, Renata Minuzzo Hartmann2,3,e, Luiz Alberto Forgiarini Junior4,f, Alexandre Simões Dias2,3,g, Norma Possa Marroni2,3,h

J Bras Pneumol.2019;45(3):e20170164-e20170164

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Objective: To evaluate the pulmonary alterations of animals with Hepatopulmonary Syndrome (HPS) submitted to Biliary Duct Ligature (BDL), as well as the antioxidant effect of Melatonin (MEL). Methods: Sixteen male Wistar rats, divided into four Sham groups: BDL group, Sham + MEL group and BDL + MEL. The pulmonary and hepatic histology, lipoperoxidation and antioxidant activity of lung tissue, alveolar-arterial O2 difference and lung / body weight ratio (%) were evaluated. Results: When comparing the groups, could be observed an increase of vasodilation and pulmonary fibrosis in the BDL group and the reduction of this in relation to the BDL + MEL group. It was also observed significant changes in the activity of catalase, ApCO2, ApO2 in the LBD group when compared to the other groups. Conclusion: The use of MEL has been shown to be effective in reducing vasodilation, fibrosis levels and oxidative stress as well as gas exchange in an experimental HPS model.

 


Keywords: Bile duct; Hepatopulmonary Syndrome; Melatonin; Lung.

 


Effects of methylprednisolone on inflammatory activity and oxidative stress in the lungs of brain-dead rats

Efeitos da metilprednisolona na atividade inflamatória e estresse oxidativo nos pulmões de ratoscom morte cerebral

Eduardo Sperb Pilla, Raôni Bins Pereira, Luiz Alberto Forgiarini Junior, Luiz Felipe Forgiarini,Artur de Oliveira Paludo, Jane Maria Ulbrich Kulczynski, Paulo Francisco Guerreiro Cardoso,Cristiano Feijó Andrade

J Bras Pneumol.2013;39(2):173-180

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Objective: To evaluate the effects that early and late systemic administration of methylprednisolone have on lungs in a rat model of brain death. Methods: Twenty-four male Wistar rats were anesthetized and randomly divided into four groups (n = 6 per group): sham-operated (sham); brain death only (BD); brain death plus methylprednisolone (30 mg/kg i.v.) after 5 min (MP5); and brain death plus methylprednisolone (30 mg/kg i.v.) after 60 min (MP60). In the BD, MP5, and MP60 group rats, we induced brain death by inflating a balloon catheter in the extradural space. All of the animals were observed and ventilated for 120 min. We determined hemodynamic and arterial blood gas variables; wet/dry weight ratio; histological score; levels of thiobarbituric acid reactive substances (TBARS); superoxide dismutase (SOD) activity; and catalase activity. In BAL fluid, we determined differential white cell counts, total protein, and lactate dehydrogenase levels. Myeloperoxidase activity, lipid peroxidation, and TNF-α levels were assessed in lung tissue. Results: No significant differences were found among the groups in terms of hemodynamics, arterial blood gases, wet/dry weight ratio, BAL fluid analysis, or histological score-nor in terms of SOD, myeloperoxidase, and catalase activity. The levels of TBARS were significantly higher in the MP5 and MP60 groups than in the sham and BD groups (p < 0.001). The levels of TNF-α were significantly lower in the MP5 and MP60 groups than in the BD group (p < 0.001). Conclusions:áIn this model of brain death, the early and late administration of methylprednisolone had similar effects on inflammatory activity and lipid peroxidation in lung tissue.

 


Palavras-chave: Ratos; Morte encefálica; Estresse oxidativo; Pulmão; Hidroxicorticosteroides.

 


Experimental diabetes mellitus: oxidative stress and changes in lung structure

Estresse oxidativo e alterações estruturais pulmonares no diabetes mellitus experimental

Luiz Alberto Forgiarini Junior, Nélson Alexandre Kretzmann, Marilene Porawski, Alexandre Simões Dias, Norma Anair Possa Marroni

J Bras Pneumol.2009;35(8):788-791

Abstract PDF PT PDF EN Portuguese Text

Diabetes mellitus is an endocrine/metabolic disorder characterized by hyperglycemia. Its impact on the respiratory system is characterized by functional changes and alterations in gas exchange. The objective of this study was to evaluate the increase in oxidative stress and the potential damages to the lung structure in an experimental model of streptozotocin-induced diabetes. We conducted histological, biochemical and blood gas analyses in the lungs of diabetic rats. We concluded that the effects of experimental diabetes mellitus include oxidative stress, structural changes in the lung tissue and altered gas exchange.

 


Keywords: Lung; Diabetes mellitus; Oxidative stress; Diabetes mellitus, experimental; Free radicals.

 


The rapid shallow breathing index as a predictor of successful mechanical ventilation weaning: clinical utility when calculated from ventilator data

Índice de respiração rápida e superficial como previsor de sucesso de desmame da ventilação mecânica: utilidade clínica quando mensurado a partir de dados do ventilador

Luiz Alberto Forgiarini Junior1, Antonio M. Esquinas2

J Bras Pneumol.2016;42(4):306-306

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Reflex cough PEF as a predictor of successful extubation in neurological patients

Pico de fluxo de tosse reflexa como preditor de sucesso na extubação em pacientes neurológicos

Fernanda Machado Kutchak1,2, Andressa Maciel Debesaitys2, Marcelo de Mello Rieder2,3, Carla Meneguzzi2, Amanda Soares Skueresky3, Luiz Alberto Forgiarini Junior3,4, Marino Muxfeldt Bianchin5

J Bras Pneumol.2015;41(4):358-364

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Objective: To evaluate the use of reflex cough PEF as a predictor of successful extubation in neurological patients who were candidates for weaning from mechanical ventilation. Methods: This was a cross-sectional study of 135 patients receiving mechanical ventilation for more than 24 h in the ICU of Cristo Redentor Hospital, in the city of Porto Alegre, Brazil. Reflex cough PEF, the rapid shallow breathing index, MIP, and MEP were measured, as were ventilatory, hemodynamic, and clinical parameters. Results: The mean age of the patients was 47.8 ± 17 years. The extubation failure rate was 33.3%. A reflex cough PEF of < 80 L/min showed a relative risk of 3.6 (95% CI: 2.0-6.7), and the final Glasgow Coma Scale score showed a relative risk of 0.64 (95% CI: 0.51-0.83). For every 1-point increase in a Glasgow Coma Scale score of 8, there was a 36% reduction in the risk of extubation failure. Conclusions: Reflex cough PEF and the Glasgow Coma Scale score are independent predictors of extubation failure in neurological patients admitted to the ICU.

 


Keywords: Weaning; Intensive care units; Cough.

 


Ischemic preconditioning by selective occlusion of the pulmonary artery in rats

Pré-condicionamento isquêmico por oclusão seletiva da artéria pulmonar em ratos

Eduardo Sperb Pilla, Giovani Schirmer Vendrame, Pablo Gerardo Sánchez, Gustavo Grun, Eduardo Fontena, Luiz Alberto Forgiarini Júnior, Norma Anair Possa Marroni, Cristiano Feijó Andrade, Paulo Francisco Guerreiro Cardoso

J Bras Pneumol.2008;34(8):583-589

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Objective: To evaluate the effect of lung ischemic preconditioning (IPC) on normothermic ischemia/reperfusion (I/R) injury in a rat model, quantifying the production of reactive oxygen species. Methods: Forty-seven male Wistar rats were randomized into four groups: control, sham, I/R and IPC. Control group animals were anesthetized and killed by decapitation, after which pneumonectomy was performed and the left lungs were stored in liquid nitrogen. Sham, IPC and I/R group rats were anesthetized, tracheostomized, ventilated, anticoagulated and submitted to left thoracotomy with dissection of the left pulmonary artery for clamping. Sham group rats underwent dissection of the left pulmonary artery, I/R group rats underwent 30 min of total hilar clamping, and IPC group rats underwent 5-min clamping of the left pulmonary artery followed by 30 min of total hilar clamping. Lungs were reperfused for 90 min and ventilated with the same parameters, with additional positive end-expiratory pressure of 1 cmH2O. Hemodynamic and blood gas values were obtained prior to thoracotomy, prior to total hilar clamping, after 30 min of reperfusion and after 90 min of reperfusion. Lipid peroxidation was determined by measuring levels of thiobarbituric acid reactive substances. Results: There were no significant differences among the groups in terms of the levels of thiobarbituric acid reactive substances. Nor were there any significant differences among the sham, I/R and IPC groups in terms of arterial oxygen tension, arterial carbon dioxide tension or hemodynamic values. Conclusions: In an in situ I/R rat model, 5-min IPC of the left pulmonary artery does not attenuate I/R injury.

 


Keywords: Ischemia; Reperfusion; Organ preservation; Reactive oxygen species.

 


Pulmonary rehabilitation in severe COPD with hyperinflation: some insights into exercise performance

Reabilitação pulmonar em DPOC grave com hiperinsuflação: algumas percepções sobre desempenho ao exercício

Luiz Alberto Forgiarini Junior1, Antonio Matias Esquinas2

J Bras Pneumol.2016;42(5):397-397

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Reflections on the article "Correlation of lung function and respiratory muscle strength with functional exercise capacity in obese individuals with obstructive sleep apnea syndrome"

Reflexões sobre o artigo

Andressa Silva Figueira1,a, Marina Esteves1,b, Luiz Alberto Forgiarini Júnior2,c

J Bras Pneumol.2019;45(2):e20180327-e20180327

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Simple motor tasks independently predict extubation failure in critically ill neurological patients

Tarefas motoras simples predizem independentemente a falha de extubação em pacientes neurológicos críticos

Fernanda Machado Kutchak1,2,3,4, Marcelo de Mello Rieder1,2,4, Josué Almeida Victorino1,4, Carla Meneguzzi4, Karla Poersch3, Luiz Alberto Forgiarini Junior5, Marino Muxfeldt Bianchin1,2,6

J Bras Pneumol.2017;43(3):183-189

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the usefulness of simple motor tasks such as hand grasping and tongue protrusion as predictors of extubation failure in critically ill neurological patients. Methods: This was a prospective cohort study conducted in the neurological ICU of a tertiary care hospital in the city of Porto Alegre, Brazil. Adult patients who had been intubated for neurological reasons and were eligible for weaning were included in the study. The ability of patients to perform simple motor tasks such as hand grasping and tongue protrusion was evaluated as a predictor of extubation failure. Data regarding duration of mechanical ventilation, length of ICU stay, length of hospital stay, mortality, and incidence of ventilator-associated pneumonia were collected. Results: A total of 132 intubated patients who had been receiving mechanical ventilation for at least 24 h and who passed a spontaneous breathing trial were included in the analysis. Logistic regression showed that patient inability to grasp the hand of the examiner (relative risk = 1.57; 95% CI: 1.01-2.44; p < 0.045) and protrude the tongue (relative risk = 6.84; 95% CI: 2.49-18.8; p < 0.001) were independent risk factors for extubation failure. Acute Physiology and Chronic Health Evaluation II scores (p = 0.02), Glasgow Coma Scale scores at extubation (p < 0.001), eye opening response (p = 0.001), MIP (p < 0.001), MEP (p = 0.006), and the rapid shallow breathing index (p = 0.03) were significantly different between the failed extubation and successful extubation groups. Conclusions: The inability to follow simple motor commands is predictive of extubation failure in critically ill neurological patients. Hand grasping and tongue protrusion on command might be quick and easy bedside tests to identify neurocritical care patients who are candidates for extubation.

 


Keywords: Ventilator weaning; Airway extubation/adverse effects; Critical care; Neurosurgery.

 


 

 


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