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ainda se encontram casos de silicose por esta atividade ocupacional no Brasil&#46; Entretanto&#44; muitos ex-trabalhadores de estaleiros na cidade de S&#227;o Gon&#231;alo&#44; Estado do Rio de Janeiro&#44; ainda vivem as consequ&#234;ncias da doen&#231;a<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a>&#46; A exposi&#231;&#227;o ao jateamento parece ser mais perigosa do que muitas outras fontes conhecidas de poeira de s&#237;lica por causa da exposi&#231;&#227;o intensa que ocorre durante longas horas de trabalho&#44; em condi&#231;&#245;es de higiene prec&#225;rias e sem o uso de qualquer equipamento respirat&#243;rio de prote&#231;&#227;o<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;7</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">No Brasil&#44; a silicose tamb&#233;m &#233; observada entre os escultores de pedra<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#46; Na regi&#227;o da Baixada Fluminense do Estado do Rio de Janeiro&#44; v&#225;rios trabalhadores produzem pequenas pe&#231;as de pedra&#44; muitas vezes para exporta&#231;&#227;o&#46; Todos estes trabalhadores pertencem &#224; economia informal e trabalham em oficinas pequenas e rudimentares<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">O uso do teste de exerc&#237;cio cardiopulmonar &#40;TECP&#41; na pr&#225;tica cl&#237;nica tem-se tornado primariamente uma ferramenta para entender os mecanismos de toler&#226;ncia ao exerc&#237;cio e fadiga&#46; Em pacientes com silicose&#44; a dispneia de esfor&#231;o &#233; frequentemente relatada mesmo quando as medidas cardiopulmonares obtidas em repouso &#40;incluindo as provas de fun&#231;&#227;o pulmonar &#91;PFP&#93; e a gasometria arterial&#41; est&#227;o dentro dos limites de normalidade&#46; Assim&#44; o TECP pode constituir uma forma mais sens&#237;vel de avaliar o comprometimento pulmonar do que a avalia&#231;&#227;o funcional em repouso<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Considerando as diferentes atividades que causam silicose&#44; o objetivo do presente estudo foi comparar os achados de imagem&#44; fun&#231;&#227;o pulmonar e TECP entre os jateadores de areia de estaleiro e os escultores de pedra com silicose&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">M&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Pacientes</span><p id="par0030" class="elsevierStylePara elsevierViewall">Foi realizado um estudo transversal para avaliar 52 pacientes n&#227;o fumantes com silicose&#46; A patologia foi definida pela presen&#231;a de uma radiografia de t&#243;rax com uma classifica&#231;&#227;o &#8805; 1&#47;0 segundo a Organiza&#231;&#227;o Internacional do Trabalho &#40;OIT&#41; num trabalhador com hist&#243;ria de exposi&#231;&#227;o &#224; poeira de s&#237;lica<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46; Foram exclu&#237;dos os fumantes e os ex-fumantes&#44; assim como os indiv&#237;duos que apresentavam achados radiol&#243;gicos sugestivos de tuberculose pulmonar&#46; Os pacientes cujos achados laboratoriais indicavam doen&#231;a card&#237;aca ou neuromuscular e aqueles que n&#227;o conseguiram realizar o TECP tamb&#233;m foram exclu&#237;dos&#46; Com base nestes crit&#233;rios&#44; 11 pacientes foram exclu&#237;dos por&#58; hist&#243;ria de tabagismo &#40;5&#41;&#59; achados de imagem compat&#237;veis com tuberculose pulmonar &#40;4&#41;&#59; doen&#231;a card&#237;aca &#40;1&#41;&#59; doen&#231;a neuromuscular &#40;1&#41;&#46; Antes de iniciar o estudo&#44; os pacientes foram informados sobre o objetivo do mesmo e assinaram o termo de consentimento informado&#46; O protocolo do estudo foi aprovado pelo Comit&#233; de &#201;tica em Pesquisa da Universidade do Estado do Rio de Janeiro &#40;N&#250;mero 1117-CEP&#47;HUPE&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">No total&#44; 41 pacientes com diagn&#243;stico de silicose foram inclu&#237;dos no estudo&#46; Destes&#44; 25 eram jateadores de areia e 16 eram escultores de pedra&#46; Todos os jateadores eram ex-trabalhadores de estaleiros&#46; Esses trabalhadores haviam usado o jateamento como um m&#233;todo abrasivo para remover ferrugem e res&#237;duos de revestimento contidos em casco de navio&#46; Os pacientes n&#227;o tinham previamente trabalhado em outras atividades que pudessem causar silicose&#46; Al&#233;m disso&#44; nenhum indiv&#237;duo relatou envolvimento em passatempo associado ao risco de silicose&#46; N&#227;o foram realizadas avalia&#231;&#245;es dos n&#237;veis de exposi&#231;&#227;o &#224; poeira de s&#237;lica nos locais de trabalho&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Medidas</span><p id="par0040" class="elsevierStylePara elsevierViewall">A gravidade da dispneia foi estimada usando a escala de 5 pontos da <span class="elsevierStyleItalic">Medical Research Council</span><a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">As radiografias de t&#243;rax foram realizadas na posi&#231;&#227;o &#226;ntero-posterior utilizando um aparelho de raio-X Siemens modelo LX30 &#40;Siemens AG&#44; Erlangen&#44; Alemanha&#41;&#46; As leituras radiol&#243;gicas foram feitas de forma independente por 3 leitores &#171;B&#187;&#46; A profus&#227;o das pequenas opacidades foi classificada conforme se segue&#58; 0&#47;&#8722;&#44; 0&#47;0&#44; 0&#47;1&#44; 1&#47;0&#44; 1&#47;1&#44; 1&#47;2&#44; 2&#47;1&#44; 2&#47;2&#44; 2&#47;3&#44; 3&#47;2&#44; 3&#47;3 ou 3&#47;&#43;&#46; As grandes opacidades foram classificadas em tipos A&#44; B ou C&#44; de acordo com as normas da OIT<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46; Os resultados foram sumarizados pela mediana das leituras&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Todos os exames de tomografia computadorizada de alta resolu&#231;&#227;o &#40;TCAR&#41; foram realizados usando um <span class="elsevierStyleItalic">scanner</span> de alta resolu&#231;&#227;o &#40;GE HiSpeed Advantage&#44; General Electric Medical Systems&#44; Milwaukee&#44; WI&#44; USA&#41;&#46; Todas as imagens foram analisadas por 4 radiologistas experientes que&#44; de forma consensual&#44; relataram os resultados&#46; Neste estudo&#44; fibrose maci&#231;a progressiva &#40;FMP&#41; foi definida pela presen&#231;a de pelo menos uma opacidade ou coalesc&#234;ncia maior que 1<span class="elsevierStyleHsp" style=""></span>cm seguindo a classifica&#231;&#227;o da OIT para coalesc&#234;ncia ou grandes opacidades<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;13&#44;14</span></a>&#46;As provas de fun&#231;&#227;o pulmonar &#40;PFP&#41; foram realizadas utilizando o <span class="elsevierStyleItalic">Collins Plus Pulmonary Function Testing System</span> &#40;Warren E&#46; Collins&#44; Inc&#46;&#44; Braintree&#44; MA&#44; USA&#41;&#59; tanto os procedimentos quanto a interpreta&#231;&#227;o dos dados seguiram as normas da <span class="elsevierStyleItalic">American Thoracic Society</span><a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16</span></a>&#46; Os resultados foram expressos como percentagem dos valores preditos para a popula&#231;&#227;o brasileira<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#8211;19</span></a>&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Cada paciente realizou um teste de exerc&#237;cio limitado por sintomas usando um cicloerg&#243;metro eletronicamente controlado e conectado ao <span class="elsevierStyleItalic">Collins Plus Pulmonary Function Testing System</span> &#40;Warren E&#46; Collins&#44; Inc&#46;&#44; Braintree&#44; MA&#44; USA&#41;&#46; A reserva ventilat&#243;ria foi calculada como a diferen&#231;a entre a ventila&#231;&#227;o volunt&#225;ria m&#225;xima &#40;VVM&#41; medida em repouso e a ventila&#231;&#227;o minute &#40;VM&#41; medida no pico de exerc&#237;cio&#44; tendo sido relatada como a percentagem da VVM &#91;1 &#8211; &#40;VM&#47;VVM&#41; x 100&#93;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;21</span></a>&#46; A reserva da frequ&#234;ncias card&#237;aca &#40;RFC&#41; foi calculada como a diferen&#231;a entre as frequ&#234;ncias card&#237;acas obtidas em repouso e no pico de exerc&#237;cio &#91;&#40;220 - idade&#41; - FC no pico de exerc&#237;cio&#93;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&#46; Estes valores foram ent&#227;o comparados com os valores preditos de Neder et al&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> para a popula&#231;&#227;o adulta brasileira&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">An&#225;lise estat&#237;stica</span><p id="par0060" class="elsevierStylePara elsevierViewall">Para verificar a homogeneidade da amostra&#44; foi usado o teste de Kolmogorov-Smirnov&#46; Os resultados s&#227;o expressos como os valores de mediana e intervalos interquartis ou como frequ&#234;ncias &#40;percentagens&#41;&#46; O grupo de jateadores de areia foi comparado ao grupo de escultores de pedra usando o teste de Mann-Whitney para vari&#225;veis num&#233;ricas e o teste exato de Fisher para vari&#225;veis categ&#243;ricas&#46; A an&#225;lise dos dados foi realizada utilizando o <span class="elsevierStyleItalic">software</span> SAS 6&#46;11 &#40;SAS Institute&#44; Inc&#46;&#44; Cary&#44; NC&#44; USA&#41;&#46; As diferen&#231;as foram consideradas significativas quando P &#60; 0&#44;05&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><p id="par0065" class="elsevierStylePara elsevierViewall">A mediana da idade dos 41 pacientes foi de 48 anos &#40;varia&#231;&#227;o&#58; 23-74 anos&#41;&#59; todos os pacientes eram homens&#44; com exce&#231;&#227;o de 2 artes&#227;s&#46; A mediana da dura&#231;&#227;o da exposi&#231;&#227;o &#224; poeira de s&#237;lica e a mediana do per&#237;odo de lat&#234;ncia foi de 96 meses &#40;varia&#231;&#227;o&#58; 9-244 meses&#41; e 132 meses &#40;varia&#231;&#227;o&#58; 12-257 meses&#41;&#44; respetivamente&#46; A mediana do per&#237;odo de acompanhamento foi de 72 meses &#40;varia&#231;&#227;o&#58; 12-122&#41;&#46; A maioria dos pacientes relata ter trabalhado sem m&#225;scara de prote&#231;&#227;o da respira&#231;&#227;o&#46; Nenhum jateador de areia ainda estava a trabalhar na atividade de exposi&#231;&#227;o &#224; poeira de s&#237;lica na &#233;poca do estudo&#46; Entretanto&#44; metade dos artes&#227;os ainda exercia a atividade de exposi&#231;&#227;o &#224; poeira de s&#237;lica na &#233;poca do estudo&#46; As caracter&#237;sticas da amostra separada de acordo com a ocupa&#231;&#227;o &#40;jateadores de areia <span class="elsevierStyleItalic">vs&#46;</span> escultores de pedra&#41; s&#227;o apresentadas na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Entre os jateadores de areia&#44; 21 &#40;84&#37;&#41; tinham dist&#250;rbio ventilat&#243;rio&#44; tendo sido identificado dist&#250;rbio restritivo em 8 &#40;32&#37;&#41;&#44; obstrutivo em 6 &#40;24&#37;&#41; e misto em 7 &#40;28&#37;&#41;&#46; Entre os escultores de pedra&#44; 11 &#40;68&#44;7&#37;&#41; tinham dist&#250;rbio ventilat&#243;rio&#44; sendo restritivo em 3 &#40;18&#44;8&#37;&#41;&#44; obstrutivo em 5 &#40;31&#44;2&#37;&#41; e misto em 3 &#40;18&#44;8&#37;&#41;&#46; A capacidade de difus&#227;o do mon&#243;xido de carbono &#40;DL<span class="elsevierStyleInf">CO</span>&#41; estava abaixo do limite inferior da normalidade em 22 &#40;88&#37;&#41; jateadores de areia e em 7 &#40;43&#44;7&#37;&#41; escultores de pedra&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Das 41 radiografias de t&#243;rax&#44; a concord&#226;ncia inter-observador para a profus&#227;o das pequenas opacidades e para o tipo de grandes opacidades mostrou coeficientes kappa de 0&#44;38 &#40;P &#60; 0&#44;001&#41; e 0&#44;72 &#40;P &#60; 0&#44;001&#41;&#44; respetivamente&#46; A distribui&#231;&#227;o dos jateadores de areia e dos escultores de pedra nas categorias radiol&#243;gicas da OIT e os achados da TCAR &#233; apresentada na <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Os resultados do TECP para os 2 grupos de pacientes &#40;jateadores de areia <span class="elsevierStyleItalic">vs&#46;</span> escultores de pedra&#41; s&#227;o sumarizados na <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a> e <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#46; Enquanto 92&#37; dos jateadores de areia n&#227;o conseguiu atingir pelo menos 80&#37; do consumo de oxig&#233;nio &#40;VO<span class="elsevierStyleInf">2</span>&#41; predito para o pico de exerc&#237;cio&#44; este facto foi observado em somente 43&#44;7&#37; dos escultores de pedra&#46; Uma reserva ventilat&#243;ria menor que 25&#37; foi observada em 40&#44;5&#37; dos jateadores de areia e em nenhum escultor de pedra&#46; Al&#233;m disso&#44; 48&#37; dos jateadores de areia tinha valores de P&#40;A-a&#41;O<span class="elsevierStyleInf">2</span> maior que 35<span class="elsevierStyleHsp" style=""></span>mmHg&#44; o que n&#227;o foi notado para qualquer escultor de pedra&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discuss&#227;o</span><p id="par0085" class="elsevierStylePara elsevierViewall">Este estudo mostra que o jateamento de areia causa um pior desfecho cl&#237;nico&#44; embora os jateadores de areia apresentem uma menor dura&#231;&#227;o da exposi&#231;&#227;o e tamb&#233;m um menor per&#237;odo de lat&#234;ncia quando comparados aos escultores de pedra&#46; As diferen&#231;as nos resultados podem ser observadas nos achados de imagem&#44; fun&#231;&#227;o pulmonar e TECP&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Num estudo com 49 pacientes com silicose&#44; Moreira et al&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> demonstraram que a TCAR &#233; mais sens&#237;vel do que a radiografia de t&#243;rax na dete&#231;&#227;o das anormalidades intrator&#225;cicas<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a>&#46; A superioridade da TCAR em rela&#231;&#227;o &#224; radiografia de t&#243;rax para dete&#231;&#227;o das grandes opacidades e do enfisema j&#225; &#233; bem estabelecida na literatura<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;24&#8211;26</span></a>&#46; Conforme relatado por outros autores<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#44;27&#8211;29</span></a>&#44; n&#243;s demonstramos que a TCAR identifica mais FMP quando comparada com a radiografia de t&#243;rax&#46; Em alguns pacientes com silicose&#44; &#233; poss&#237;vel que uma conflu&#234;ncia de n&#243;dulos na TCAR seja visualizada apenas como pequenos n&#243;dulos pulmonares difusos na radiografia de t&#243;rax&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">De forma interessante&#44; o presente estudo identificou FMP em 25 jateadores de areia &#40;92&#37;&#41; e em somente 7 escultores de pedra &#40;43&#44;7&#37;&#41;&#46; Similarmente&#44; Antao et al&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> encontraram FMP em 39&#44;1&#37; dos escultores de pedra&#46; Ao contr&#225;rio dos nossos resultados&#44; Alper et al&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> observaram FMP em metade dos casos de silicose diagnosticados em jateadores da ind&#250;stria de brim&#46; Embora ambos os estudos mostrem per&#237;odos de lat&#234;ncia semelhantes &#40;mediana de 84 vs&#46; media de 82 meses&#41;&#44; as dura&#231;&#245;es do tempo de exposi&#231;&#227;o&#44; as idades dos trabalhadores e os crit&#233;rios para o diagn&#243;stico de FMP na TCAR foram diferentes&#59; estes fatores tornam dif&#237;cil fazer uma conclus&#227;o sobre as diferentes frequ&#234;ncias de FMP entre os 2 estudos&#46; Apesar destas considera&#231;&#245;es&#44; a identifica&#231;&#227;o de FMP &#233; importante porque constitui a substitui&#231;&#227;o de tecido pulmonar normalmente aerado por massa de tecido fibroso sem fun&#231;&#227;o&#59; al&#233;m disso&#44; a FMP &#233; geralmente associada a fun&#231;&#227;o pulmonar deficiente&#44; incapacidade funcional e morte prematura<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a>&#46; Um risco relativo significativamente alto de FMP est&#225; associado com maiores n&#237;veis de exposi&#231;&#227;o &#224; poeira de s&#237;lica<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a>&#44; podendo esta ser no nosso estudo uma poss&#237;vel explica&#231;&#227;o para a maior frequ&#234;ncia de FMP observada nos jateadores de areia&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">No presente estudo&#44; n&#227;o houve diferen&#231;as significantes nos resultados dos PFP quando os jateadores de areia foram comparados com os escultores de pedra&#46; Entretanto&#44; enquanto que os valores de DL<span class="elsevierStyleInf">CO</span> foram apenas ligeiramente alterados nos artes&#227;os&#44; foram observadas altera&#231;&#245;es acentuadas nos jateadores de areia &#40;P &#61; 0&#44;02&#41;&#46; De forma interessante&#44; a DL<span class="elsevierStyleInf">CO</span> tem sido descrita por apresentar forte correla&#231;&#227;o com as anormalidades nas trocas gasosas&#44; e tamb&#233;m por ser o melhor &#237;ndice preditivo e sens&#237;vel para uma queda na PaO<span class="elsevierStyleInf">2</span><a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">O TECP permite a determina&#231;&#227;o objetiva da capacidade funcional e a avalia&#231;&#227;o dos mecanismos subjacentes que limitam o exerc&#237;cio<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&#46; No presente estudo&#44; quando comparados os jateadores de areia com os escultores de pedra&#44; as vari&#225;veis de resposta do TECP exibiram maiores diferen&#231;as significantes em rela&#231;&#227;o &#224;s medidas avaliadas em repouso&#46; Isto n&#227;o &#233; necessariamente surpreendente porque a capacidade de exerc&#237;cio &#233; o resultado da resposta de m&#250;ltiplos fatores&#44; incluindo a troca gasosa alv&#233;olo-capilar&#44; o teor de oxig&#233;nio no sangue e a capta&#231;&#227;o de oxig&#233;nio pelos tecidos<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">A medida da VO<span class="elsevierStyleInf">2</span> de pico permanece o melhor &#237;ndice dispon&#237;vel para a avalia&#231;&#227;o da capacidade de exerc&#237;cio<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&#46; No estudo atual&#44; enquanto que quase todos os jateadores de areia n&#227;o conseguiram atingir pelo menos 80&#37; da VO<span class="elsevierStyleInf">2</span> de pico &#40;&#37; predito&#41;&#44; este facto ocorreu em menos da metade dos escultores de pedra&#46; Violante et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#44; que avaliaram 45 pacientes com silicose causada por ocupa&#231;&#245;es distintas incluindo fundi&#231;&#227;o&#44; minera&#231;&#227;o e moagem de carv&#227;o e metal e jateamento de areia&#44; observaram valores de VO<span class="elsevierStyleInf">2</span> de pico &#40;&#37; predito&#41; abaixo de 80&#37; em 35 pacientes&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">No presente estudo&#44; os jateadores de areia tiveram uma menor reserva ventilat&#243;ria comparada com a observada nos escultores de pedra &#40;P &#60; 0&#44;0001&#41;&#46; Da mesma forma&#44; Wang et al&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> encontraram valores baixos de reserva ventilat&#243;ria em pacientes com silicose que tinham sido empregados na fabrica&#231;&#227;o de tijolos &#224; prova de fogo na China&#46; Segundo esses autores&#44; o aumento da demanda ventilat&#243;ria foi provavelmente devido ao aumento da ventila&#231;&#227;o de espa&#231;o morto secund&#225;rio ao desequil&#237;brio ventila&#231;&#227;o-perfus&#227;o&#59; al&#233;m disso&#44; a diminui&#231;&#227;o da satura&#231;&#227;o de oxig&#233;nio no sangue estimula os recetores perif&#233;ricos da respira&#231;&#227;o a impulsionarem o aumento da ventila&#231;&#227;o&#46; A nossa hip&#243;tese &#233; que a maior frequ&#234;ncia de FMP observada na silicose induzida por jateamento de areia pode explicar essas altera&#231;&#245;es funcionais&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Algumas limita&#231;&#245;es deste estudo devem ser abordadas&#46; Primeiro&#44; os grupos de pacientes por n&#243;s avaliados podem n&#227;o ser representativos de toda a popula&#231;&#227;o de jateadores de areia e de escultores de pedra das regi&#245;es envolvidas&#46; Segundo&#44; n&#243;s n&#227;o temos as informa&#231;&#245;es sobre o tipo exato de s&#237;lica e as concentra&#231;&#245;es de s&#237;lica &#224;s quais os pacientes foram expostos&#46; Finalmente&#44; o esfor&#231;o subm&#225;ximo de alguns pacientes poderia explicar a reduzida mediana da VO<span class="elsevierStyleInf">2</span> de pico observada neste estudo&#46; Entretanto&#44; todos os pacientes foram ativamente incentivados&#44; durante o exerc&#237;cio&#44; a atingirem o m&#225;ximo&#44; e mostraram altos n&#237;veis sangu&#237;neos de lactato e elevadas taxas de troca gasosa ao final do exerc&#237;cio<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Em conclus&#227;o&#44; os dados indicam que os achados de imagem&#44; fun&#231;&#227;o pulmonar e TECP s&#227;o fortemente influenciados pelo tipo de exposi&#231;&#227;o &#224; poeira de s&#237;lica em pacientes com silicose&#46; Al&#233;m disso&#44; quando os jateadores de areia foram comparados com os escultores de pedra&#44; as anormalidades no TECP foram mais acentuadas quando comparadas com as altera&#231;&#245;es observadas nas medidas obtidas em repouso&#46; Pelo nosso conhecimento&#44; este &#233; o primeiro estudo a comparar 2 grupos diferentes de trabalhadores expostos &#224; poeira de s&#237;lica atrav&#233;s da an&#225;lise do TECP&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflito de interesses</span><p id="par0130" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflito de interesses&#46;</p></span></span>"
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          "titulo" => "Resultados"
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          "titulo" => "Bibliografia"
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    "fechaRecibido" => "2012-02-09"
    "fechaAceptado" => "2012-04-13"
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            0 => "Exerc&#237;cio"
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            2 => "Testes de fun&#231;&#227;o respirat&#243;ria"
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            1 => "Occupational exposure"
            2 => "Respiratory function tests"
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    "resumen" => array:2 [
      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<span><span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Compara&#231;&#227;o dos achados de imagem&#44; fun&#231;&#227;o pulmonar e teste de exerc&#237;cio cardiopulmonar &#40;TECP&#41; entre jateadores de areia de estaleiro e escultores de pedra com silicose no Brasil&#46;</p></span> <span><span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dos 41 pacientes&#44; 25 eram jateadores de areia e 16 eram escultores de pedra&#44; com medianas da idade de 52 e 46&#44;4 anos&#44; respetivamente&#46; Todos os pacientes se submeteram aos testes de fun&#231;&#227;o pulmonar e ao TECP&#46; As radiografias de t&#243;rax foram classificadas de acordo com as recomenda&#231;&#245;es da Organiza&#231;&#227;o Internacional do Trabalho&#46; Os seguintes par&#226;metros foram avaliados na tomografia computadorizada de alta resolu&#231;&#227;o &#40;TCAR&#41;&#58; n&#243;dulos&#44; fibrose maci&#231;a progressiva &#40;FMP&#41;&#44; enfisema e aumento dos linfonodos intrator&#225;cicos&#46;</p></span> <span><span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Grandes opacidades na radiografia de t&#243;rax foram observadas em 76&#37; dos jateadores e em somente 18&#44;7&#37; dos escultores&#46; Por utilizar a TCAR&#44; FMP foi identificada em 92&#37; dos jateadores e em somente 43&#44;7&#37; dos escultores&#46; Embora os resultados da capacidade de difus&#227;o do mon&#243;xido de carbono tenham sido significativamente diferentes entre os 2 grupos&#44; essas diferen&#231;as foram mais acentuadas nos resultados do TECP&#46; Enquanto 92&#37; dos jateadores n&#227;o conseguiu atingir pelo menos 80&#37; de seu pico de consumo de oxig&#233;nio &#40;VO<span class="elsevierStyleInf">2</span>&#41; predito&#44; isto foi observado em somente 43&#44;7&#37; dos escultores&#46; Foi observada uma reserva ventilat&#243;ria de menos de 25&#37; em 40&#44;5&#37; dos jateadores e em nenhum dos escultores&#46;</p></span> <span><span class="elsevierStyleSectionTitle">Conclus&#227;o</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Na silicose&#44; os achados de imagem&#44; fun&#231;&#227;o pulmonar e TECP s&#227;o fortemente influenciados pelo tipo de exposi&#231;&#227;o &#224; poeira de s&#237;lica&#46; Adicionalmente&#44; as anormalidades do TECP s&#227;o mais acentuadas quando comparadas com aquelas medidas tomadas em repouso&#46;</p></span>"
      ]
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        "titulo" => "Abstract"
        "resumen" => "<span><span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To compare imaging findings&#44; lung function variables and cardiopulmonary exercise testing &#40;CPET&#41; results between Brazilian sandblasters of shipyard and stone carvers with silicosis&#46;</p></span> <span><span class="elsevierStyleSectionTitle">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Of the 41 patients&#44; 25 subjects were sandblasters and 16 were stone carvers&#44; with median ages of 52 and 46&#46;4 years&#44; respectively&#46; All of the patients underwent pulmonary function tests and CPET&#46; Chest radiographs were classified according to the International Labour Organization recommendations&#46; The following parameters were examined through the use of high-resolution computerized tomography &#40;HRCT&#41;&#58; nodules&#44; progressive massive fibrosis &#40;PMF&#41;&#44; emphysema&#44; and intrathoracic lymph node enlargement&#46;</p></span> <span><span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Large opacities on chest radiography were observed in 76&#37; of sandblasters and only 18&#46;7&#37; of stone carvers&#46; Using HRCT&#44; PMF was identified in 92&#37; of sandblasters and only 43&#46;7&#37; of stone carvers&#46; Although carbon monoxide diffusing capacity results were significantly different between the sandblasters and stone carvers&#44; these differences were more pronounced in the CPET results&#46; While 92&#37; of sandblasters failed to reach at least 80&#37; of their predicted peak oxygen uptake &#40;VO<span class="elsevierStyleInf">2</span>&#41;&#44; this was observed for only 43&#46;7&#37; of stone carvers&#46; A breathing reserve of less than 25&#37; was observed in 40&#46;5&#37; of sandblasters but not in any of the stone carvers&#46;</p></span> <span><span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">In silicosis&#44; imaging findings&#44; lung function and CPET results are strongly influenced by the type of exposure to silica dust&#46; Additionally&#44; CPET abnormalities are more pronounced compared to measurements taken at rest&#46;</p></span>"
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          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Diagramas de caixa &#40;mediana&#44; 1&#46;&#176; e 3&#46;&#176; quartis&#44; m&#237;nimo e m&#225;ximo&#41; do consumo de oxig&#233;nio no pico de exerc&#237;cio &#40;VO<span class="elsevierStyleInf">2</span> de pico&#41; de acordo com o tipo de trabalhadores expostos &#224; poeira de s&#237;lica&#46; Foi encontrada uma diferen&#231;a significante &#40;P &#60; 0&#44;0001&#41; entre os jateadores de areia e os escultores de pedra&#46;</p>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">CPT&#58; capacidade pulmonar total&#59; CVF&#58; capacidade vital for&#231;ada&#59; DLco&#58; capacidade de difus&#227;o do mon&#243;xido de carbono&#59; VEMS&#58; volume expirat&#243;rio m&#225;ximo no primeiro segundo&#59; VR&#58; volume residual&#46;</p>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Vari&#225;veis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Jateadores de areia &#40;n &#61; 25&#41; Mediana &#40;intervalos interquartis&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Escultores de pedra &#40;n &#61; 16&#41; Mediana &#40;intervalos interquartis&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">P-valor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Caracter&#237;sticas demogr&#225;ficas</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Idade &#40;anos&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52 &#40;31-58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&#44;4 &#40;38-51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dura&#231;&#227;o da exposi&#231;&#227;o &#40;meses&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42 &#40;9-80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">193 &#40;132-244&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Per&#237;odo de lat&#234;ncia &#40;meses&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84 &#40;12-144&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">206 &#40;141-257&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="char" valign="top"><span class="elsevierStyleItalic">Gravidade da dispneia</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Presen&#231;a de dispneia<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23 &#40;92&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;62&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dispneia grau 0 ou 1<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;87&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dispneia grau 2 ou 3<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;12&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="char" valign="top">Par&#226;metros de fun&#231;&#227;o pulmonar</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CVF &#40;&#37; predito&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89 &#40;81&#44;5&#8211;97&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>VEMS &#40;&#37; predito&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72 &#40;58&#8211;78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79 &#40;72&#8211;86&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>VEMS&#47;CVF &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84 &#40;79&#8211;93&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">87&#44;5 &#40;81&#8211;93&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CPT &#40;&#37; predito&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77 &#40;65&#8211;89&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83 &#40;72&#44;5&#8211;87&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>VR &#40;&#37; predito&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85 &#40;69&#8211;97&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89 &#40;76&#44;5&#8211;108&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>VR&#47;CPT &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">113 &#40;101&#8211;128&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">111 &#40;96&#8211;131&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>DL<span class="elsevierStyleInf">CO</span> &#40;&#37; predito&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63 &#40;57&#8211;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81 &#40;70&#8211;83&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "pt" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Compara&#231;&#227;o entre jateadores de areia e escultores de pedra de acordo com os dados demogr&#225;ficos&#44; a gravidade da dispneia e os par&#226;metros de fun&#231;&#227;o pulmonar</p>"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">FMP&#58; fibrose maci&#231;a progressiva&#59; TCAR&#58; tomografia computadorizada de alta resolu&#231;&#227;o&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Achado na radiografia e na TCAR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Jateadores de areia &#40;n &#61; 25&#41; N&#250;mero de pacientes &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Escultores de pedra &#40;n &#61; 16&#41; N&#250;mero de pacientes &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Pequenas opacidades na radiografia</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1&#47;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1&#47;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;12&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1&#47;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;12&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2&#47;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;6&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2&#47;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;18&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2&#47;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;6&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>3&#47;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;12&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>3&#47;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;6&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>3&#47;&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Grandes opacidades na radiografia</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Tipo A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;6&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Tipo B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;12&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Tipo C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Achados na TCAR</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Micron&#243;dulos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>FMP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23 &#40;92&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;43&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Enfisema cicatricial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Aumento dos linfonodos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19 &#40;76&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "pt" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Achados na radiografia de t&#243;rax e na tomografia computadorizada de t&#243;rax de alta resolu&#231;&#227;o em jateadores de areia e escultores de pedra</p>"
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          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">FR m&#225;x&#58; frequ&#234;ncia respirat&#243;ria m&#225;xima no pico de exerc&#237;cio&#59; P&#40;A-a&#41;O<span class="elsevierStyleInf">2</span>&#58; diferen&#231;a alv&#233;olo-arterial de oxig&#233;nio no pico de exerc&#237;cio&#59; Pulso de O<span class="elsevierStyleInf">2</span> m&#225;x&#58; pulso de oxig&#233;nio m&#225;ximo &#40;VO<span class="elsevierStyleInf">2</span>&#47;frequ&#234;ncia card&#237;aca&#41; no pico de exerc&#237;cio&#59; RFC&#58; reserva da frequ&#234;ncia card&#237;aca&#59; TTR m&#225;x&#58; taxa de troca respirat&#243;ria m&#225;xima &#40;VCO<span class="elsevierStyleInf">2</span>&#47;VO<span class="elsevierStyleInf">2</span>&#41; no pico de exerc&#237;cio&#59; VO<span class="elsevierStyleInf">2</span> de pico&#58; consumo de oxig&#233;nio no pico de exerc&#237;cio&#59; VO<span class="elsevierStyleInf">2</span>&#952;L&#58; VO<span class="elsevierStyleInf">2</span> de pico no limiar anaer&#243;bio estimado&#59; &#916; SpO<span class="elsevierStyleInf">2</span>&#58; diferen&#231;a entre a satura&#231;&#227;o de oxig&#233;nio em repouso e no pico de exerc&#237;cio&#59; &#916; lactato s&#233;rico&#58; diferen&#231;a entre o lactato s&#233;rico em repouso e no pico de exerc&#237;cio&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Vari&#225;veis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Jateadores de areia &#40;n &#61; 25&#41; Mediana &#40;intervalos interquartis&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Escultores de pedra &#40;n &#61; 16&#41; Mediana &#40;intervalos interquartis&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">P-valor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">VO<span class="elsevierStyleInf">2</span> de pico &#40;&#37; predito&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35 &#40;32&#8211;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65 &#40;69&#8211;69&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60; 0&#44;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">VO<span class="elsevierStyleInf">2</span>&#952;L &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45 &#40;31&#8211;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44 &#40;39&#44;5&#8211;54&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">TTR max&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;24 &#40;1&#44;11&#8211;1&#44;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;21 &#40;1&#44;11&#8211;1&#44;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Pulso de O<span class="elsevierStyleInf">2</span> max &#40;&#37; predito&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&#44;6 &#40;46&#44;3&#8211;83&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66&#44;7 &#40;59&#46;3&#8211;76&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">RFC &#40;batimentos&#47;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47 &#40;37&#8211;54&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43 &#40;24&#44;5&#8211;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">FR max &#40;respira&#231;&#245;es&#47;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50 &#40;40&#8211;63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&#44;5 &#40;31&#8211;40&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;0003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Reserva ventilat&#243;ria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#44;7 &#40;11&#44;8&#8211;41&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&#44;1 &#40;56&#44;2&#8211;77&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60; 0&#44;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">P&#40;A-a&#41;O<span class="elsevierStyleInf">2</span> &#40;mm Hg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&#44;5 &#40;22&#44;2&#8211;40&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#44;9 &#40;16&#44;1&#8211;21&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;0005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">&#916; SpO<span class="elsevierStyleInf">2</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;2&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
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