Reduced exercise capacity can predispose solid organ transplant (SOT) recipients to higher risk of diabetes, cardiovascular complications, and mortality and impact their quality of life. This systematic review and meta-analysis investigated the effects of exercise training (versus no training) in adult SOT recipients. We conducted an electronic search of randomized controlled trials reporting on exercise interventions in SOT recipients. Primary outcomes were exercise capacity, quadriceps muscle strength, and health-related quality of life (HRQoL). Twenty-nine articles met the inclusion criteria. In 24 studies, there were either high risk of bias or some concerns about the potential risk of bias. There was an increase in exercise capacity (VO 2 peak) (SMD: 0.40; 95%CI 0.22-0.57; P = 0.0) and quadriceps muscle strength (SMD: 0.38; 95%CI 0.16-0.60; P = 0.001) in the exercise vs control groups. There were also improvements in several domains of the SF-36. Diastolic blood pressure improved in the exercise group compared to controls (SMD: À0.22; 95%CI À0.41-0.03; P = 0.02). Despite the considerable variation in exercise training characteristics and high risk of bias in the included studies, exercise training improved maximal exercise capacity, quadriceps muscle strength, HRQoL, and diastolic blood pressure and should be an essential part of the post-transplant care.

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Objective: To compare the incidence and intensity of acute adverse effects and the variation in the temperature of facial skin by thermography after the use of noninvasive ventilation (NIV). Methods: We included 20 healthy volunteers receiving NIV via oronasal mask for 1 h. The volunteers were randomly divided into two groups according to the ventilatory mode: bilevel positive airway pressure (BiPAP) or continuous positive airway pressure (CPAP). Facial thermography was performed in order to determine the temperature of the face where it was in contact with the mask and of the nasal dorsum at various time points. After removal of the mask, the volunteers completed a questionnaire about adverse effects of NIV. Results: The incidence and intensity of acute adverse effects were higher in the individuals receiving BiPAP than in those receiving CPAP (16.1% vs. 5.6%). Thermographic analysis showed a significant cooling of the facial skin in the two regions of interest immediately after removal of the mask. The more intense acute adverse effects occurred predominantly among the participants in whom the decrease in the mean temperature of the nasal dorsum was lower (14.4% vs. 7.2%). The thermographic visual analysis of the zones of cooling and heating on the face identified areas of hypoperfusion or reactive hyperemia. Conclusions: The use of BiPAP mode was associated with a higher incidence and intensity of NIV-related acute adverse effects. There was an association between acute adverse effects and less cooling of the nasal dorsum immediately after removal of the mask. Cutaneous thermography can be an additional tool to detect adverse effects that the use of NIV has on facial skin.

Introdução. As lesões do plexo braquial têm graves repercussões sobre a funcionalidade, vida familiar e qualidade de vida. Objetivo. Analisar a função pulmonar em indivíduos com lesão do plexo braquial. Méto­do. Estudo transversal desenvolvido com 15 voluntários com lesão no plexo braquial em uma clínica escola de Fisioterapia na cidade de For­taleza-CE. A função pulmonar foi avaliada através da ventilometria, manovacuometria e espirometria. Resultados. Dos 15 voluntários com lesão no plexo braquial, 73,26% (n=11) tinham lesão completa e 26,74% (n=4) lesão incompleta. Na avaliação da função pulmonar encontramos uma frequência respiratória média de 15,73rpm (10- 24), volume corrente médio de 0,72L (0,29-1,2) e volume minuto médio de 10,68L/min (5,60-17,55). Na manovacometria, a amostra em estudo apresentou uma PiMáx de -121,66±8,58 cmH20 e PeMáx de 86±6,78 cmH2O, valores expiratórios menores do que o predi­to (p<0,001). Em relação aos valores espirométricos, os voluntários apresentaram uma característica de distúrbio ventilatório restritivo. Conclusão. Os indivíduos com lesão do plexo braquial apresentaram déficit na função pulmonar, com característica de padrão restritivo além de apresentarem fraqueza muscular expiratória.

Sarcopenia is an important predictor of clinical outcomes in lung transplant candidates. Dual-energy Xray absorptiometry (DXA) is the gold standard to determine appendicular lean mass, a primary marker of sarcopenia which is not always feasible due to requirement of DXA equipment, cost, technical expertise, and risk of radiation exposure. Muscle ultrasound can be used to quantify muscle size and quality and may be a simpler, alternative tool for detecting sarcopenia. The objectives of this study were (i) to develop a regression-based model to predict appendicular lean mass index (ALMI) from DXA using ultrasonography and (ii) determine the most parsimonious model from ultrasound to predict ALMI.Methods: We conducted a cross-sectional study of adult lung transplant candidates from a single centre. Subjects underwent B-mode ultrasound of the dominant leg to assess muscle layer thickness of quadriceps (sum of rectus femoris (RF), vastus intermedius and lateralis), and gastrocnemius, RF cross-sectional area (CSA), tibialis anterior (TA) CSA and echogenicity (ECHO) of RF and TA. Ultrasound measures of muscle size were normalized to limb length. ALMI (kg/m 2 ) was assessed with DXA, and used to define sarcopenia using cut‐points of ≤7.26 kg/m 2 for men and ≤5.45 kg/m 2 for women. Hierarchical, stepwise multilinear regression analysis was used to predict ALMI from ultrasound measures and demographic variables (age, sex, diagnosis). Three multilinear regression analysis were developed based on the feasibility of the ultrasound imaging protocol (i.e. number of muscles, subject position and image acquisition time). Level of significance was set at p ≤ 0.05.Results: 61 lung transplant candidates were included (52% female, median (IQR) age= 63 [55][56][57][58][59][60][61][62][63][64][65][66][67]] kg/m 2 , diagnosis: 48% ILD, 34% COPD, 18% other diseases). 53% of females and 52% of males had sarcopenia based on ALMI criteria. Age, diagnosis and TA ECHO were not correlated with ALMI. All the regression models were strongly associated with ALMI: five muscle model [quadriceps thickness (sum of RF, vastus intermedius and lateralis thickness) + gastrocnemius thickness + TA CSA + sex; R 2 = 0.764, p < 0.001]; four-muscle model (quadriceps thickness + TA CSA + sex; R 2 = 0.748, p < 0.001) and two-muscle model (RF CSA + TA CSA + sex; R 2 = 0.723, p = 0.001). Conclusions: Lower limb muscle ultrasound can be used to predict ALMI in lung transplant candidates using as few as two muscles. This method may be applicable in clinical/research settings to evaluate sarcopenia.