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    "textoCompleto" => "<p class="elsevierStylePara">Dear Editor&#44;</p><p class="elsevierStylePara">Idiopathic scoliosis is a 3-dimensional deformity of the spine&#44; with direct effects on the thoracic cage&#44; characterized by the lateral displacement &#40;greater than 10&#176;&#41; and rotation of vertebral bodies during periods of rapid somatic growth&#46;<a href="&#35;bib8" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a> Adolescent idiopathic scoliosis &#40;AIS&#41; is found between the age of 10 and skeletal maturity<a href="&#35;bib9" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a> and its prevalence is estimated at 2&#8211;4&#37; in children between 10 and 16 years of age&#46;<a href="&#35;bib9" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib10" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a> This condition encompasses several complications including back pain&#44; poor body image&#44; and impaired pulmonary function&#46;<a href="&#35;bib10" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a> In fact&#44; previous studies have shown a decreased pulmonary function in adolescents with idiopathic scoliosis&#44;<a href="&#35;bib11" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a> and an inverse correlation between scoliosis Cobb angles and pulmonary function&#46;<a href="&#35;bib11" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a> Adolescents with severe scoliosis&#44; with Cobb angles above 45&#8211;50&#176;&#44; are routinely managed with spinal fusion surgery&#46;<a href="&#35;bib10" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a> In addition to the mechanical restriction to ventilation&#44; changes in spine and thoracic cage position may alter the length of respiratory muscles influencing the ability to generate tension&#46; Therefore&#44; the aim of this study was to evaluate pulmonary function and respiratory muscle strength in subjects with AIS&#46;</p><p class="elsevierStylePara">From November 2012 to May 2013&#44; 12 females with AIS &#40;15&#46;1&#160;&#177;&#160;1&#46;6 years of age&#41; and 12 age-matched controls &#40;15&#46;2&#160;&#177;&#160;1&#46;4 years of age&#41; were enrolled in this study&#46; The AIS group was recruited in the Paediatrics Department of Centro Hospitalar Porto-Hospital Santo Ant&#243;nio&#44; Portugal&#44; whereas the control group was recruited in the Porto metropolitan area&#46; Eligible participants were those idiopathic scoliosis preoperative patients aged 10 or over&#44; with thoracic Cobb angles of &#8805;40&#176;&#46; Exclusion criteria for this study included bronchial asthma and other pulmonary&#44; cardiovascular or skeletal muscle problems&#44; and previous spinal surgery&#46; The study procedures were in accordance with the ethical standards on human experimentation&#46; Written informed consent was obtained from parents&#47;guardians&#46; The Ethics Committee of the Centro Hospitalar Porto-Hospital Santo Ant&#243;nio approved the study&#46; Lung function and respiratory muscle strength were measured before surgery&#46; Forced expiratory volume in one second &#40;FEV<span class="elsevierStyleInf">1</span>&#41;&#44; forced vital capacity &#40;FVC&#41;&#44; peak expiratory flow &#40;PEF&#41; and the fraction of FVC expired in one second &#40;FEV<span class="elsevierStyleInf">1</span>&#44; FVC&#37;&#41; were assessed using a computerized spirometer &#40;Spirolab III&#44; MIR Medical International Research&#44; Roma&#44; Italy&#41;&#44; according to standard methods&#46;<a href="&#35;bib12" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a> Maximal inspiratory pressure &#40;MIP&#41; and maximal expiratory pressure &#40;MEP&#41; muscle strength was measured with a digital mouth pressure meter &#40;Micro Respiratory Muscle Analyze&#44; CareFusion&#44; Basingstoke&#44; UK&#41;&#46;<a href="&#35;bib13" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a> Data were analyzed using SPSS 17&#46;0&#46; The normality of data distribution was tested with the Shapiro&#8211;Wilk test&#59; the data were not normally distributed&#46; Groups were compared by Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> tests&#46; Associations between pulmonary function and respiratory muscle strength were tested with Spearman&#39;s rho test&#46; The level of significance was set as <span class="elsevierStyleItalic">P</span>&#160;&#8804;&#160;0&#46;05&#46;</p><p class="elsevierStylePara">In terms of the results&#44; the Cobb angle ranged from 42&#176; to 62&#176;&#46; The AIS group presented significantly lower FEV<span class="elsevierStyleInf">1</span>&#44; FVC and PEF than the age-matched control group &#40;<a href="&#35;t0005" class="elsevierStyleCrossRefs">Table 1</a>&#41;&#46; With respect to the respiratory muscle strength&#44; both MIP and MEP were significantly higher in the control group&#59; indeed&#44; the median values of MIP and MEP in the control group were two times higher than those in the control group &#40;<a href="&#35;t0005" class="elsevierStyleCrossRefs">Table 1</a>&#41;&#46; In the AIS group&#44; no correlation was found between pulmonary function variables and MIP and MEP&#46;</p><p class="elsevierStylePara">Table 1&#46; Spirometric and respiratory muscle strength values &#91;median &#40;interquartile range&#41;&#93;&#46;</p><a name="t0005" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td>&#160;</td><td>AIS group</td><td>Control group</td><td><span class="elsevierStyleItalic">P</span> value</td></tr><tr align="left"><td>FVC &#40;L&#41;</td><td>2&#46;69 &#40;1&#46;18&#41;</td><td>3&#46;54 &#40;0&#46;73&#41;</td><td>0&#46;005</td></tr><tr align="left"><td>FEV<span class="elsevierStyleInf">1</span> &#40;L&#41;</td><td>2&#46;30 &#40;1&#46;00&#41;</td><td>3&#46;42 &#40;0&#46;68&#41;</td><td>0&#46;001</td></tr><tr align="left"><td>PEF &#40;L&#47;min&#41;</td><td>307&#46;2 &#40;147&#46;60&#41;</td><td>387&#46;6 &#40;202&#46;2&#41;</td><td>0&#46;039</td></tr><tr align="left"><td>FEV<span class="elsevierStyleInf">1</span>&#44; FVC&#37;</td><td>91&#46;50 &#40;13&#46;00&#41;</td><td>95&#46;70 &#40;9&#46;00&#41;</td><td>0&#46;178</td></tr><tr align="left"><td>MIP &#40;cm&#160;H<span class="elsevierStyleInf">2</span>O&#41;</td><td>23&#46;50 &#40;11&#46;00&#41;</td><td>63&#46;50 &#40;21&#46;00&#41;</td><td>&#60;0&#46;001</td></tr><tr align="left"><td>MEP &#40;cm&#160;H<span class="elsevierStyleInf">2</span>O&#41;</td><td>29&#46;50 &#40;23&#46;00&#41;</td><td>54&#46;00 &#40;17&#46;00&#41;</td><td>0&#46;008</td></tr></table><p class="elsevierStylePara">FEV<span class="elsevierStyleInf">1</span>&#44; forced expiratory volume in one second&#59; FVC&#44; forced vital capacity&#59; FEV<span class="elsevierStyleInf">1</span>&#44; FVC&#37;&#44; the fraction of FVC expired in one second&#59; PEF&#44; peak expiratory flow&#59; MEP&#44; maximal expiratory pressure&#59; MIP&#44; maximal inspiratory pressure&#46;<br></br></p><p class="elsevierStylePara">Our results are similar to others which have shown a restrictive lung defect and impaired respiratory muscle strength<a href="&#35;bib14" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">7</span></a> in subjects with AIS&#46; It is worth noting that the decrease in MIP is a major finding in the preoperative evaluation of the patient&#44; since MIP and MEP of less than 30&#160;cm H<span class="elsevierStyleInf">2</span>O augment the risk of postoperative respiratory failure&#46;<a href="&#35;bib8" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a> The inability to generate normal MIP and MEP could be a result of the chest wall deformity&#44; which causes the respiratory muscles to work at a mechanical disadvantage&#46;<a href="&#35;bib8" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a> This study has some limitations&#44; one of which is its small sample size&#46; In conclusion&#44; subjects with AIS referred to surgery showed worse pulmonary function and respiratory muscle strength than age-matched controls&#46; From a practical standpoint&#44; if our MIP and MEP results are corroborated by future studies&#44; subjects with AIS could benefit from preoperative respiratory muscle strength training programmes aimed at decreasing the risk of postoperative complications&#46;</p><a name="sec0025" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p class="elsevierStylePara">The authors have no conflicts of interest to declare&#46;</p><p class="elsevierStylePara">Corresponding author&#46; adl&#64;estsp&#46;ipp&#46;pt</p>"
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Preoperative pulmonary function and respiratory muscle strength in Portuguese adolescents with idiopathic scoliosis
F.. Floresa, J.. Cavaleiroa, A.A.. Lopesa,
,b
, F.. Ribeiroc, A.. Oliveirad
a Department of Physiotherapy and CEMAH, School of Allied Health Sciences of Porto (ESTSP), Polytechnic Institute of Porto, Porto, Portugal
b Department of Orthophysiatry, Centro Hospitalar do Porto, Porto, Portugal
c School of Health Sciences, University of Aveiro and CINTESIS.UA, Aveiro, Portugal
d Director of the Department of Orthophysiatry, Centro Hospitalar do Porto and Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), University of Porto, Porto, Portugal
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    "textoCompleto" => "<p class="elsevierStylePara">Dear Editor&#44;</p><p class="elsevierStylePara">Idiopathic scoliosis is a 3-dimensional deformity of the spine&#44; with direct effects on the thoracic cage&#44; characterized by the lateral displacement &#40;greater than 10&#176;&#41; and rotation of vertebral bodies during periods of rapid somatic growth&#46;<a href="&#35;bib8" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a> Adolescent idiopathic scoliosis &#40;AIS&#41; is found between the age of 10 and skeletal maturity<a href="&#35;bib9" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a> and its prevalence is estimated at 2&#8211;4&#37; in children between 10 and 16 years of age&#46;<a href="&#35;bib9" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib10" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a> This condition encompasses several complications including back pain&#44; poor body image&#44; and impaired pulmonary function&#46;<a href="&#35;bib10" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a> In fact&#44; previous studies have shown a decreased pulmonary function in adolescents with idiopathic scoliosis&#44;<a href="&#35;bib11" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a> and an inverse correlation between scoliosis Cobb angles and pulmonary function&#46;<a href="&#35;bib11" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a> Adolescents with severe scoliosis&#44; with Cobb angles above 45&#8211;50&#176;&#44; are routinely managed with spinal fusion surgery&#46;<a href="&#35;bib10" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a> In addition to the mechanical restriction to ventilation&#44; changes in spine and thoracic cage position may alter the length of respiratory muscles influencing the ability to generate tension&#46; Therefore&#44; the aim of this study was to evaluate pulmonary function and respiratory muscle strength in subjects with AIS&#46;</p><p class="elsevierStylePara">From November 2012 to May 2013&#44; 12 females with AIS &#40;15&#46;1&#160;&#177;&#160;1&#46;6 years of age&#41; and 12 age-matched controls &#40;15&#46;2&#160;&#177;&#160;1&#46;4 years of age&#41; were enrolled in this study&#46; The AIS group was recruited in the Paediatrics Department of Centro Hospitalar Porto-Hospital Santo Ant&#243;nio&#44; Portugal&#44; whereas the control group was recruited in the Porto metropolitan area&#46; Eligible participants were those idiopathic scoliosis preoperative patients aged 10 or over&#44; with thoracic Cobb angles of &#8805;40&#176;&#46; Exclusion criteria for this study included bronchial asthma and other pulmonary&#44; cardiovascular or skeletal muscle problems&#44; and previous spinal surgery&#46; The study procedures were in accordance with the ethical standards on human experimentation&#46; Written informed consent was obtained from parents&#47;guardians&#46; The Ethics Committee of the Centro Hospitalar Porto-Hospital Santo Ant&#243;nio approved the study&#46; Lung function and respiratory muscle strength were measured before surgery&#46; Forced expiratory volume in one second &#40;FEV<span class="elsevierStyleInf">1</span>&#41;&#44; forced vital capacity &#40;FVC&#41;&#44; peak expiratory flow &#40;PEF&#41; and the fraction of FVC expired in one second &#40;FEV<span class="elsevierStyleInf">1</span>&#44; FVC&#37;&#41; were assessed using a computerized spirometer &#40;Spirolab III&#44; MIR Medical International Research&#44; Roma&#44; Italy&#41;&#44; according to standard methods&#46;<a href="&#35;bib12" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a> Maximal inspiratory pressure &#40;MIP&#41; and maximal expiratory pressure &#40;MEP&#41; muscle strength was measured with a digital mouth pressure meter &#40;Micro Respiratory Muscle Analyze&#44; CareFusion&#44; Basingstoke&#44; UK&#41;&#46;<a href="&#35;bib13" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a> Data were analyzed using SPSS 17&#46;0&#46; The normality of data distribution was tested with the Shapiro&#8211;Wilk test&#59; the data were not normally distributed&#46; Groups were compared by Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> tests&#46; Associations between pulmonary function and respiratory muscle strength were tested with Spearman&#39;s rho test&#46; The level of significance was set as <span class="elsevierStyleItalic">P</span>&#160;&#8804;&#160;0&#46;05&#46;</p><p class="elsevierStylePara">In terms of the results&#44; the Cobb angle ranged from 42&#176; to 62&#176;&#46; The AIS group presented significantly lower FEV<span class="elsevierStyleInf">1</span>&#44; FVC and PEF than the age-matched control group &#40;<a href="&#35;t0005" class="elsevierStyleCrossRefs">Table 1</a>&#41;&#46; With respect to the respiratory muscle strength&#44; both MIP and MEP were significantly higher in the control group&#59; indeed&#44; the median values of MIP and MEP in the control group were two times higher than those in the control group &#40;<a href="&#35;t0005" class="elsevierStyleCrossRefs">Table 1</a>&#41;&#46; In the AIS group&#44; no correlation was found between pulmonary function variables and MIP and MEP&#46;</p><p class="elsevierStylePara">Table 1&#46; Spirometric and respiratory muscle strength values &#91;median &#40;interquartile range&#41;&#93;&#46;</p><a name="t0005" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td>&#160;</td><td>AIS group</td><td>Control group</td><td><span class="elsevierStyleItalic">P</span> value</td></tr><tr align="left"><td>FVC &#40;L&#41;</td><td>2&#46;69 &#40;1&#46;18&#41;</td><td>3&#46;54 &#40;0&#46;73&#41;</td><td>0&#46;005</td></tr><tr align="left"><td>FEV<span class="elsevierStyleInf">1</span> &#40;L&#41;</td><td>2&#46;30 &#40;1&#46;00&#41;</td><td>3&#46;42 &#40;0&#46;68&#41;</td><td>0&#46;001</td></tr><tr align="left"><td>PEF &#40;L&#47;min&#41;</td><td>307&#46;2 &#40;147&#46;60&#41;</td><td>387&#46;6 &#40;202&#46;2&#41;</td><td>0&#46;039</td></tr><tr align="left"><td>FEV<span class="elsevierStyleInf">1</span>&#44; FVC&#37;</td><td>91&#46;50 &#40;13&#46;00&#41;</td><td>95&#46;70 &#40;9&#46;00&#41;</td><td>0&#46;178</td></tr><tr align="left"><td>MIP &#40;cm&#160;H<span class="elsevierStyleInf">2</span>O&#41;</td><td>23&#46;50 &#40;11&#46;00&#41;</td><td>63&#46;50 &#40;21&#46;00&#41;</td><td>&#60;0&#46;001</td></tr><tr align="left"><td>MEP &#40;cm&#160;H<span class="elsevierStyleInf">2</span>O&#41;</td><td>29&#46;50 &#40;23&#46;00&#41;</td><td>54&#46;00 &#40;17&#46;00&#41;</td><td>0&#46;008</td></tr></table><p class="elsevierStylePara">FEV<span class="elsevierStyleInf">1</span>&#44; forced expiratory volume in one second&#59; FVC&#44; forced vital capacity&#59; FEV<span class="elsevierStyleInf">1</span>&#44; FVC&#37;&#44; the fraction of FVC expired in one second&#59; PEF&#44; peak expiratory flow&#59; MEP&#44; maximal expiratory pressure&#59; MIP&#44; maximal inspiratory pressure&#46;<br></br></p><p class="elsevierStylePara">Our results are similar to others which have shown a restrictive lung defect and impaired respiratory muscle strength<a href="&#35;bib14" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">7</span></a> in subjects with AIS&#46; It is worth noting that the decrease in MIP is a major finding in the preoperative evaluation of the patient&#44; since MIP and MEP of less than 30&#160;cm H<span class="elsevierStyleInf">2</span>O augment the risk of postoperative respiratory failure&#46;<a href="&#35;bib8" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a> The inability to generate normal MIP and MEP could be a result of the chest wall deformity&#44; which causes the respiratory muscles to work at a mechanical disadvantage&#46;<a href="&#35;bib8" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a> This study has some limitations&#44; one of which is its small sample size&#46; In conclusion&#44; subjects with AIS referred to surgery showed worse pulmonary function and respiratory muscle strength than age-matched controls&#46; From a practical standpoint&#44; if our MIP and MEP results are corroborated by future studies&#44; subjects with AIS could benefit from preoperative respiratory muscle strength training programmes aimed at decreasing the risk of postoperative complications&#46;</p><a name="sec0025" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p class="elsevierStylePara">The authors have no conflicts of interest to declare&#46;</p><p class="elsevierStylePara">Corresponding author&#46; adl&#64;estsp&#46;ipp&#46;pt</p>"
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