CONDE, RYAN CARLO P.

BS- BIOLOGY III

March 20, 2016

Ms. Kathleen Ordoez

RESPIRATORY JOURNAL
The 6-min walk distance in healthy subjects: reference standards from
seven countries
C. Casanova*,#, B.R. Celli", P. Barria+, A. Casas1, C. Cote e, J.P. de Torres**, J. Jardim##, M.V.
Lopez"", J.M. Marin++, M. Montes de Oca11, V. Pinto-Plataee and A. Aguirre-Jaime# on
behalf of the Six Minute Walk Distance Project (ALAT)***

ABSTRACT: The 6-min walk distance (6MWD) predicted values have been derived
from small cohorts mostly from single countries. The aim of the present study was
to investigate differences between countries and identify new reference values to
improve 6MWD interpretation. We studied 444 subjects (238 males) from seven
countries (10 centres) ranging 4080 yrs of age. We measured 6MWD, height,
weight, spirometry, heart rate (HR), maximum HR (HRmax) during the 6-min walk
test/the predicted maximum HR (HRmax % pred), Borg dyspnoea score and oxygen
saturation. The meanSD 6MWD was 57190 m (range 380782 m). Males walked 30
m more than females (p,0.001). A multiple regression model for the 6MWD included
age, sex, height, weight and HRmax % pred (adjusted r250.38; p,0.001), but there
was variability across centres (adjusted r250.090.73) and its routine use is not
recommended. Age had a great impact in 6MWD independent of the centres,
declining significantly in the older population (p,0.001). Age-specific reference
standards of 6MWD were constructed for male and female adults. In healthy
subjects, there were geographic variations in 6MWD and caution must be taken
when using existing predictive equations. The present study provides new 6MWD
standard curves that could be useful in the care of adult patients with chronic
diseases.

Pseudomonas aeruginosa quorum sensing molecules correlate with clinical

status in cystic fibrosis
Helen L. Barr1, Nigel Halliday2, Miguel Cmara2, David A. Barrett3, Paul Williams2, Douglas
L. Forrester1, Rebecca Simms1, Alan R. Smyth4, David Honeybourne5, Joanna L.
Whitehouse5, Edward F. Nash5, Jane Dewar6, Andrew Clayton6, Alan J. Knox1 and Andrew W.
Fogarty7

ABSTRACT Pseudomonas aeruginosa produces quorum sensing signal molecules

that are potential biomarkers for infection. A prospective study of 60 cystic fibrosis
patients with chronic P. aeruginosa, who required intravenous antibiotics for
pulmonary exacerbations, was undertaken. Clinical measurements and biological
samples were obtained at the start and end of the treatment period. Additional data
were available for 29 of these patients when they were clinically stable. Crosssectionally, quorum sensing signal molecules were detectable in the sputum,
plasma and urine of 86%, 75% and 83% patients, respectively. They were positively
correlated between the three biofluids. Positive correlations were observed for most
quorum sensing signal molecules in sputum, plasma and urine, with quantitative
measures of pulmonary P. aeruginosa load at the start of a pulmonary exacerbation.

CONDE, RYAN CARLO P.

BS- BIOLOGY III

March 20, 2016

Ms. Kathleen Ordoez

RESPIRATORY JOURNAL

Plasma concentrations of 2-nonyl-4-hydroxy-quinoline (NHQ) were significantly

higher at the start of a pulmonary exacerbation compared to clinical stability
(p<0.01). Following the administration of systemic antibiotics, plasma 2-heptyl-4hydroxyquinoline (p=0.02) and NHQ concentrations (p<0.01) decreased
significantly. In conclusion, quorum sensing signal molecules are detectable in cystic
fibrosis patients with pulmonary P. aeruginosa infection and are positively correlated
with quantitative measures of P. aeruginosa. NHQ correlates with clinical status and
has potential as a novel biomarker for P. aeruginosa infection.

Prone position in acute respiratory distress syndrome

P. Pelosi*, L. Brazzi#, L. Gattinoni#

ABSTRACT: In the last few years prone positioning has been used increasingly in
the treatment of patients with acute respiratory distress syndrome (ARDS) and this
manoeuvre is now considered a simple and safe method to improve oxygenation.
However, the physiological mechanisms causing respiratory function improvement
as well as the real clinical benefit are not yet fully understood. The aim of this
review is to discuss the physiological and clinical effects of prone positioning in
patients with ARDS. The main physiological aims of prone positioning are: 1) to
improve oxygenation; 2) to improve respiratory mechanics; 3) to homogenise the
pleural pressure gradient, the alveolar inflation and the ventilation distribution; 4) to
increase lung volume and reduce the amount of atelectatic regions; 5) to facilitate
the drainage of secretions; and 6) to reduce ventilator-associated lung injury.
According to the available data, the authors conclude that: 1) oxygenation improves
iny7080% of patients with early acute respiratory distress syndrome; 2) the
beneficial effects of oxygenation reduce after 1 week of mechanical ventilation; 3)
the aetiology of acute respiratory distress syndrome may markedly affect the
response to prone positioning; 4) extreme care is necessary when the manoeuvre is
performed; 5) pressure sores are frequent and related to the number of pronations;
6) the supports used to prone and during positioning are different and
nonstandardised among centres; and 7) intensive care unit and hospital stay and
mortality still remain high despite prone positioning. Eur Respir J 2002; 20: 1017
1028.

Impact of inspiratory muscle training in patients with COPD: what is the

evidence?
R. Gosselink*,#, J. De Vos*,#, S.P. van den Heuvel", J. Segers*,#, M. Decramer*,# and G.
Kwakkel+

ABSTRACT: A meta-analysis including 32 randomised controlled trials on the

effects of inspiratory muscle training (IMT) in chronic obstructive pulmonary disease

CONDE, RYAN CARLO P.

BS- BIOLOGY III

March 20, 2016

Ms. Kathleen Ordoez

RESPIRATORY JOURNAL

(COPD) patients was performed. Overall and subgroup analyses with respect to
training modality (strength or endurance training, added to general exercise
training) and patient characteristics were performed. Significant improvements were
found in maximal inspiratory muscle strength (PI,max; +13 cmH2O), endurance
time (+261 s), 6- or 12-min walking distance (+32 and +85 m respectively) and
quality of life (+3.8 units). Dyspnoea was significantly reduced (Borg score -0.9
point; Transitional Dyspnoea Index +2.8 units). Endurance exercise capacity tended
to improve, while no effects on maximal exercise capacity were found. Respiratory
muscle endurance training revealed no significant effect on PI,max, functional
exercise capacity and dyspnoea. IMT added to a general exercise programme
improved PI,max significantly, while functional exercise capacity tended to increase
in patients with inspiratory muscle weakness (PI,max ,60 cmH2O). IMT improves
inspiratory muscle strength and endurance, functional exercise capacity, dyspnoea
and quality of life. Inspiratory muscle endurance training was shown to be less
effective than respiratory muscle strength training. In patients with inspiratory
muscle weakness, the addition of IMT to a general exercise training program
improved PI,max and tended to improve exercise performance.