RATIONALE:The lung diffusing capacity for carbon monoxide (DLco), a metric of gas transfer, provides physiological information distinct from spirometry. While DLco independently predicts mortality in COPD, its integration into the GOLD spirometric staging (% FEV1) to improve risk assessment, remains unexplored. OBJECTIVES:To determine if DLco enhances the predictive power of GOLD spirometric classification for all-cause and respiratory mortality. METHODS:We followed 469 patients (mean age 64 years, 58% FEV1) with complete lung function tests in the Spanish multicenter CHAIN study for up to 10 years, with mortality as the main outcome. Patients were dichotomized based on DLco impairment (<50% cutoff). A Cox proportional hazard model evaluated the added value of DLco to GOLD FEV1 spirometric staging for all-cause and respiratory mortality. Validation of the results was conducted in the Kingston COPD Canadian cohort (N=300 patients). RESULTS:Over time, 184 (39.2%) patients died, 84 (17.9%) from respiratory causes. Adjusted analyses showed DLco<50% independently predicted all-cause [HR=1.83 (95%CI 1.32-2.54, p<0.001)] and respiratory [HR=2.27 (95%CI 1.43-3.60, p<0.001)] mortality. Incorporating DLco<50% increased mortality risk compared to FEV1 alone, particularly in GOLD stages 3 and 4, where survival time decreased by 1.23 years (p=0.002) and 1.25 years (p=0.004) for all-cause and respiratory deaths, respectively. These findings were validated in the Canadian cohort. CONCLUSIONS:Adding DLco to FEV1 enhances the prognostic accuracy of the GOLD spirometric severity classification, especially for patients in GOLD stages 3-4 at higher risk of adverse outcomes. CLINICALTRIALS:gov Identifier: NCT01122758.

Objective: To assess whether a slackline intervention program improves postural control in children/adolescents with spastic cerebral palsy (CP). Design: Randomized controlled trial. Setting: Patients’ association. Participants: Twenty-seven children/adolescents with spastic CP (9–16 years) were randomly assigned to a slackline intervention (n = 14, 13 ± 3 years) or control group (n = 13, 12 ± 2 years). Intervention: Three slackline sessions per week (30 min/session) for 6 weeks. Main outcome measures: The primary outcome was static posturography (center of pressure—CoP—parameters). The secondary outcomes were surface myoelectrical activity of the lower-limb muscles during the posturography test and jump performance (countermovement jump test and Abalakov test). Overall (RPE, >6–20 scale) rating of perceived exertion was recorded at the end of each intervention session. Results: The intervention was perceived as “very light” (RPE = 7.6 ± 0.6). The intervention yielded significant benefits on static posturography (a significant group by time interaction on Xspeed, p = 0.006) and jump performance (a significant group by time interaction on Abalakov test, p = 0.015). Conclusions: Slackline training improved static postural control and motor skills and was perceived as non-fatiguing in children/adolescents with spastic CP.

BACKGROUND:There is uncertainty regarding efficacy of telehealth-based approaches in COPD patients for sustaining benefits achieved with intensive pulmonary rehabilitation (PR). RESEARCH QUESTION:To determine whether a maintenance pulmonary telerehabilitation (TelePR) programme, after intensive initial PR, is superior to usual care in sustaining over time benefits achieved by intensive PR. STUDY DESIGN AND METHODS:A multicentre open-label pragmatic parallel-group randomized clinical trial was conducted. Two groups were created at completion of an 8-week intensive outpatient hospital PR programme. Intervention group (IG) patients were given appropriate training equipment and instructed to perform three weekly training sessions and send performance data through an app to a web-based platform. Patients in the control group (CG) were advised to exercise regularly (usual care). RESULTS:Ninety-four patients (46 IG, 48 CG) were randomized. The analysis of covariance showed non-significant improvements in 6-min walk distance [19.9m (95% CI -4.1/+43.8)] and Chronic Respiratory Disease Questionnaire - Emotion score [0.4 points (0-0.8)] in the IG. Secondary linear mixed models showed improvements in the IG in Short Form-36 mental component summary [9.7, (4.0-15.4)] and Chronic Respiratory Disease Questionnaire - Emotion [0.5, (0.2-0.9)] scores, but there was no association between compliance and outcomes. Acute exacerbations were associated with a marginally significant decrease in 6-minute walk distance of 15.8m (-32.3/0.8) in linear models. CONCLUSIONS:The TelePR maintenance strategy was both feasible and safe but failed to show superiority over usual care, despite improvements in some HRQoL domains. Acute exacerbations may have an important negative influence on long-term physical function. CLINICALTRIALS. GOV IDENTIFIER:NCT03247933.

The common trait in the obstructive sleep apnoea syndrome (OSAS) is a certain degree of upper airway instability. The interrupter technique (RINT), measures the resistance in the upper airways (UA), it could be used to identify patients with a mayor impaired anatomy. The aim of this study is to investigate if a correlation between UA resistance and OSAS can be determined Method: A cross-sectional case-control study was carried out. All subjects who underwent through a polysomnography were included. Two groups were made: OSAS (AHI >10/h), and a control group (AHI ≤ 10/h). A RINT test was performed, being awake, in both seated and supine position. Two linear regressions were obtained between pressure/flow measurements in both positions. Impaired anatomy was ascertained by measuring the angle between the linear regressions. The wider angle the greater the impairement Results: 91 patients and 31 control subjects were recruited [table 1]. The mean value for the pressure/flow angle in OSAS was 7.5º(4), and 4º(2) in the control group (p<0.001). A significant association between pressure/flow angle and AHI was found(p=0.03). Setting the threshold at 10°, the specificity was 96% and predictive positive value 95% Conclusions: –RINT is a simple and wakefulness test, that has shown a high specificity and predictive positive value in the diagnosis of OSAS –These results may help to prioritize patients on waiting list and optimize resources

Aim: to determine if a maintenance Telerehabilitation program (TeleRR) is feasible and able to achieve a better compliance and sustained clinical improvement after an intensive respiratory rehabilitation program (RR). Study Design: open, randomized, multicenter, parallel group trial designed to demostrate superiority respect to an usual care in the maintenance of benefits after a (RR) of 8 weeks. Material and Methods: COPD patients with a BODE index of 3-7 from 13 Hospitals were included and underwent during 12 months. After (RR) patients were randomized to receive a TeleRRprogram (TeleRR group, GTRR) or usual care (CG). BODE, 6 minutes walking test (6MWT), health related quality of life (HRQOL) SF36 and CRQ were measured at baseline (RR) and after 12 months. Results: 94 patients were included and 85 completed the program. There were no differences in 6MWT or HRQOL between the two groups. In 6MWT we observed a decrease in the Control group (-29 meters) and (-11 metres) in GTRR group from baseline. Adjusted mean ( GTRR 446,4 vs CG 422 meters;IC 95% (23.8, -0.24/47.8 meters) p < 0.052). There were not significant differences in HRQL among groups or throughout the study. 58% of patients in GTRR complied > 66% of adherence. We observed differences in 6MWT during the study according to the degree of adherence in the GTRR (non compliant: -0.58 meters; compliant: - 12,01 meters; and control group:- 31meters). There were no adverse events attributable to the program. Conclusions: The TeleRehab program is feasible but has not demonstrated superiority with respect to the control group. It was a usable program with not adverse events and good adherence. Supported by FIS 14/00575 Grant

Introduction: The obstructive sleep apnea syndrome (OSA) may cause local oxidative stress (OxS). The use of exhaled breath condensate (EBC) allows the study of specific biomarkers in the airway lining fluid. Previous studies in OSA patients showed the presence of OxS biomarkers as 8-isoprostane (8-i) in EBC. However the relationship between OSA and local OxS has not been enough established. Aim: to quantify the OxS and monitor the response to treatment in OSA patients by using 8-i in EBC. Methods: An observational prospective study was carried out. We consecutively included OSA patients diagnosed by polysomnography (Grael® Compumedics, AU): EEG, ECG, EMG, SpO2, thoracic and abdomen bands, oronasal flow and snoring were recorded. Individuals with apnea-hypopnea index (AHI) <5/hour were included as controls. Smokers or patients with any other respiratory disease were excluded. The EBC samples were obtained with an EcoScreen® (Jaeger, DE) and were stored at -70° C in polypropylene tubes. Results: Thirty patients and 10 controls were included. Table 1 shows a comparison of the groups. The concentrations of 8-i in the cases were 6.4 vs 5.3 (pre- and post-CPAP, p=0.03) vs 6.2 in the controls (p=NS). A positive correlation between snoring index (SI) and 8-i was found (r=0.57, p=0.04). Conclusions: 1) There was a significant decrease in 8-i in EBC after CPAP treatment in OSA patients. 2) The level of 8-i showed no relationship with OSA severity but was positively correlated to the SI. Supported by ASTURPAR grant

PURPOSE:Asthmatics are adversely affected by the presence of air pollutants, the concentrations of which can nowadays be measured. However, the utility of this information in clinical practice has not been defined in a group of asthmatics in stable condition. Our objective was to determine what impact the level of air pollutants had on the control of their asthma and the degree of airway inflammation.METHODS:We performed a cross-sectional study of adult asthmatics in stable condition. From the regional environmental authority, we obtained the concentrations of ambient nitric oxide (NO2), ozone (O3), suspended particulate matter up to 10 micrometers in diameter (PM10) and sulphur dioxide (SO2) at fixed geographical points. Disease control was assessed using asthma control test (ACT) scores, and airway inflammation using fraction of exhaled nitric oxide (FeNO) values. Correlation and linear regression studies were performed using ACT scores as the dependent variable.RESULTS:The study included 99 asthmatics, aged 39 years (SD 8), 55% women. Mean ACT value was 17.2 (SD 6.5), and FeNO 33.7 (SD 16). Of the pollutants studied, only NO2 was correlated with ACT scores (CC = 0.45, p < 0.001). We found no relationship between pollutants and airway inflammation. Multivariate analysis showed that ACT score was predicted by ambient air NO2 concentration and, to a lesser extent, mean FeNO.CONCLUSIONS:Information on the concentration of ambient NO2 in our environment can help the clinician to interpret the evolution of asthmatic patients.

Objective: Study the impact that might have the environmental contaminants in the clinical control of asthmatic patients in stable condition. PATIENTS AND METHODS: (April-August 2012) We recruited from the pulmonary function laboratory, asthmatic patients who came to perform lung function tests for its control. We included patients without exacerbations or need for therapeutic changes in the past four weeks, and that had in the vicinity of their usual housing a measurement point of pollutants (MPP). We analyzed the age, gender, body mass index, smoking, usual treatment, presence of pollutants at home and sensitization to aeroallergens.We localized the patients geographically by their postal code and selected the nearest MPP. The measured pollutants were: particles larger than 10 microns in diameter, ozone and nitrogen dioxide. RESULTS: 77 cases. Mean age: 33 (19), 46 women (60 %). The mean values of the data analyzed were: FEV1 88% (SD 14), ACT 15.36 (SD 7.47), FeNO 30 ppb (SD 25.7), BMI 26.43 (SD 5.94), 9 patients (12.3%) were active smokers, 63 patients (84%) were receiving treatment with inhaled steroids and 19 patients (25.3%) used anti-leukotrienes. Presence of pollutants were found in 60% of the houses. The correlation study showed significant association between the values of the ACT with the NO2 measured the day of the interview and with the mean values of NO2 of the previous month, and the value of FeNO with the O3 measured the day of the test. There was no association between the rest of the pollutants and the values of ACT, FeNO or lung function. CONCLUSION:The NO2 seems to be the pollutant most related to the control of the asthma patient not exacerbated.

AIM The aim of the study was to measure the physiological demands of a group of high-level female judokas through laboratory tests and field tests (Tatami) and to retest the validity of the Santos test on a different population. METHODS Eight high-level female judokas participated in the study. Heart rate (HR), maximal oxygen consumption (VO2 max), blood lactate, anaerobic threshold, and ratings of perceived exertion (RPE) were measured using laboratory and field tests that shared common characteristics. RESULTS The mean (±SD) values obtained in the laboratory tests were HRmax 198.3 (4.1) beats.min-1, VO2 max: 40.9 (7.7) mL.kg-1.min-1, lactate max 9.1 (1.4) mmol.L-1, HR at the anaerobic threshold 171.5 (4.8) beats.min-1, lactate threshold 3.8 (0.4) mmol.L-1, and RPE: 17 (1.1). The mean (±SD) values obtained in the field test were HRmax 199.0 (5.0) beats.min-1, VO2 max: 44.8 (7.3) mL.kg-1.min-1, lactate max: 11.8 (1.5) mmol.l-1, HR at the anaerobic threshold 170.5 (3.2) beats.min-1, lactate threshold: 3.8 (0.1) mmol.L-1, and RPE: 18 (1.4) points. There were no significant differences between the data obtained on both tests in any of the parameters, except for the lactate maximum and VO2 max. CONCLUSION The Santos test is a helpful instrument for judo training in female athletes. Coaches could use it to design specific training protocols that could help to improve their performance in competition.

The main goal of this research project was to retest the validity of a specifically designed judo field test (Santos Test) in a different group of judokas. Eight (n=8) national-level male judokas underwent laboratory and field testing. The mean data (mean +/- SD) obtained in the laboratory tests was: HRmax: 200 ± 4.0 beats × min(-1), VO2 max: 52.8 ± 7.9 ± ml × kg(-1) × min(-1), lactate max: 12 ± 2.5 mmol × l(-1), HR at the anaerobic threshold: 174.2 ± 9.4 beats × min(-1), percentage of maximum heart rate at which the anaerobic threshold appears: 87 ± 3.6 %, lactate threshold: 4.0 ± 0.2 mmol × l(-1), and RPE: 17.2 ± 1.0. The mean data obtained in the field test (Santos) was: HRmax: 201.3 ± 4.1 beats × min(-1), VO2 max: 55.6 ± 5.8 ml × kg(-1) × min(-1), lactate max: 15.6 ± 2.8 mmol × l(-1), HR at the anaerobic threshold: 173.2 ± 4.3 beats × min(-1), percentage of maximum heart rate at which the anaerobic threshold appears: 86 ± 2.5 %, lactate threshold: 4.0 ± 0.2 mmol × l(-1), and RPE: 16.7 ± 1.0. There were no significant differences between the data obtained on both tests in any of the parameters, except for maximum lactate concentration. Therefore, the Santos test can be considered a valid tool specific for judo training.

The main goal of this research project was to design a specific, simple, and noninvasive field test to determine the individual aerobic-anaerobic transition zone in judokas. Our aim was to develop a field test as close as possible to real judo combat. Eight state- and national-level judokas participated in the study. To find the reliability of our test, all subjects repeated the same test under the same conditions within a 7-day period. Because the results were positive, we tested the validity of our proposal using a laboratory test that possessed the same characteristics. On both tests, the same parameters were studied. The mean data obtained in the laboratory test were as follows: maximum heart rate (HRmax): 198.2 +/- 3.9 bxmin-1, HR at the anaerobic threshold: 170.3 +/- 5.7 bxmin-1, percentage of HRmax at which the anaerobic threshold appears: 85.9 +/- 2.9%, lactate max: 14.6 +/- 1.4 mmolxL-1, lactate threshold: 4 +/- 0.3 mmolxL-1, and VO2max: 58.3 +/- 4.4 mlxkgxmin-1. The mean data obtained in the field test were as follows: HRmax: 199.7 +/- 1.8 bxmin-1, HR at the anaerobic threshold: 169.7 +/- 2.7 bxmin-1, percentage of HRmax at which the anaerobic threshold appears: 85.0 +/- 1.8%, lactate max: 17.0 +/- 2 mmolxL-1, lactate threshold: 4.0 +/- 0.3 mmolxL-1, and VO2max: 59.8 +/- 3.6 mlxkgxmin-1. There were no significant differences between the data obtained on both tests in any of the parameters evaluated, except for the lactate maximum. Therefore, we can conclude that our field test is a useful tool for judo training.

The maximal oxygen uptake (VO(2) max) is a standard tool for preoperative counseling of candidates for lung and heart transplantations, as well as an optional measurement to assess liver or renal transplant patients. Also, it provides an objective tool of the functional capacity of posttransplant patients. Exercise limitation and loss of aerobic capacity are common among patients with end-stage liver disease. The functional capacity of these subjects is decreased, as estimated by measuring the VO(2) max in a cardiopulmonary exercise test (CPET). After transplantation improvement is expected in physical capacity. We sought to describe the influence of orthotopic liver transplantation (OLT) on the physical fitness of the recipient at 3 and 12 months after transplantation. Since CPET is an objective test, it is an important tool for clinicians to evaluate patients' functional capacity before and after OLT.

Background. Health-Related Quality of Life of patients with heart transplantation is an important variable; however, it has received little attention so far, and only two Spanish validated measurement instruments are available. The aim of our study was to validate the Spanish version of the Kansas City Cardiomyopathy Questionnaire (KCCQ) in heart transplant patients.Methods. A prospective study was performed in 186 patients awaiting heart transplantation in nine transplant hospitals. Hundred transplant recipients filled Out the KCCQ, the Euroqol 5-D (EQ5D), and the Short Form-36 (SF-36) Health Survey at pretransplant, after 3 months, 6 months, and I year Of follow-up. A complete set of sociodemographic and clinical data were also collected. The validity, reliability, sensitivity to change, and effect size were studied. Two questionnaires, the SF-36 and EQ5D, were used to evaluate the validity.Results. Mean age of patients was 56.0 years, and 80.5% were men. Twenty-six percent had acute rejection. A five-dimensional factorial structure could be discerned. The questionnaire presented a Cronbach's a coefficient of more than 0.7. Correlations between the KCCQ and the other questionnaires and clinical variables were satisfactory.Conclusions. The KCCQ features adequate psychometric properties. The KCCQ offers several advantages over other questionnaires because it quantifies symptoms (frequency, severity, and stability) and it is much more sensitive to change, even when compared with the SF-36. The specific questionnaire for heart transplant patients is a useful and user-friendly instrument for measuring the Health-Related Quality of Life related to functional status, quality of life, and social limitation more accurately.