Introduction: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) lead to a decline not only in the patient’s lung function but also in other important health domains, such as functional status. Functional status includes functional capacity and functional performance. Functional capacity refers to one’s maximal potential to realize a functional activity in a standardized environment. Functional performance refers to the activities people actually do during their daily life. Pulmonary rehabilitation (PR) is fundamental for COPD management, however, its effectiveness in improving the functional status (capacity and performance) during and after AECOPD is less known. Objectives: To systematize the effects of PR in the functional status (capacity and performance) during or immediately after an AECOPD. Methods: This systematic review was registered (no. CRD42022298593). Systematic searches for randomised controlled trials (RCTs) comparing PR (with, at least, exercise training and education and/or psychosocial support) with usual care in people during and/or after AECOPD were conducted in PubMed/MEDLINE, Scopus, and Web of Science Core Collection. Two independent reviewers assessed the titles, abstracts and full text of studies, extracted data and assessed the risk of bias with the Risk of Bias 2 tool. Mean and standardized differences (MD/SMD) were calculated to synthesize results. A statistical random effects model was applied in the meta-analysis. Results: Eight studies were included. The total number of participants was 533, with an age range of 58-74 years and an FEV1%predicted of 35-56%pred. PR was conducted in inpatient (n = 3), outpatient (n = 4) and inpatient/outpatient (n = 1) settings with varying durations and frequencies. Functional capacity was assessed with six measures, the six-minute walk test (6MWT) (n = 3), incremental shuttle walk test (ISWT) (n = 2), the 2-minute walk test (2MWT) (n = 1), 5-repetition sit-to-stand test (5 STS) (n = 1), 30-second sit-to-stand test (30sec STS) (n = 1), and timed up and go (TUG) (n = 1). Functional performance was assessed with four measures, the functional independence measure (FIM) (n = 1), london chest activity of daily living (LCADL) (n = 1), activity of daily living dyspnoea (ADL-D) (n = 1) and stepwatch activity monitor (steps/day) (n = 1). Significant improvements were observed in functional capacity, measured with the 6MWT (n = 159, MD 91.5, 95%CI [23.5; 159.5], p = 0.008) after outpatient and in TUG (n = 32, MD -2.2, 95%CI [-3.9; -0.5], p = 0.009) after inpatient PR in the EG compared to CG. Functional performance, measured with the ADL-D and the LCADL (n = 160, SMD 1.0, 95%CI [0.8; 1.2], p < 0.0001), as well as with the FIM (n = 44, MD 7.5, 95%CI [2.1; 12.8], p = 0.006), improved significantly after inpatient PR in comparison to usual care. No other significant between-group differences were observed for functional capacity or performance. Conclusions: Pulmonary rehabilitation improves functional status during or immediately after an AECOPD. Nevertheless, few studies with small samples and high heterogeneity of outcome measures and interventions exist, which hinders conclusions. Functional performance is less assessed than functional capacity. Inclusion of both is fundamental to tailor PR in AECOPD and ensure benefits translate not just to what people can, but also do in their daily life.

Introduction. Peritubular capillary complement 4d staining is one of the criteria for the diagnosis of antibody-mediated rejection, and research into this is essential to kidney allograft evaluation. The immunofluorescence technique applied to frozen sections is the present gold-standard method for complement 4d staining and is used routinely in our laboratory. The immunohistochemistry technique applied to paraffin-embedded tissue may be used when no frozen tissue is available. Material and Methods. The aim of this study is to evaluate the sensitivity and specificity of immunohistochemistry compared with immunofluorescence. We describe the advantages and disadvantages of the immunohistochemistry vs. the immunofluorescence technique. For this purpose complement 4d staining was performed retrospectively by the two methods in indication biopsies (n=143) and graded using the Banff 07 classification. Results. There was total classification agreement between methods in 87.4% (125/143) of cases. However, immunohistochemistry staining caused more difficulties in interpretation, due to nonspecific staining in tubular cells and surrounding interstitium. All cases negative by immunofluorescence were also negative by immunohistochemistry. The biopsies were classified as positive in 44.7% (64/143) of cases performed by immunofluorescence vs. 36.4% (52/143) performed by immunohistochemistry. Fewer biopsies were classified as positive diffuse in the immunohistochemistry group(25.1% vs. 31.4%) and more as positive focal (13.2% vs. 11.1%). More cases were classified as negative by immunohistochemistry (63.6% vs. 55.2%). Study by ROC curve showed immunohistochemistry has a specificity of 100% and a sensitivity of 81.2% in relation to immunofluorescence (AUC: 0.906; 95% confidence interval: 0.846-0.949; p=0.0001). Conclusions. The immunohistochemistry method presents an excellent specificity but lower sensitivity to C4d detection in allograft dysfunction. The evaluation is more difficult, requiring a more experienced observer than the immunofluorescence method. Based on these results, we conclude that the immunohistochemistry technique can safely be used when immunofluorescence is not available.

Helicobacter pylori (H. pylori) infection triggers a sequence of gastric alterations starting with an inflammation of the gastric mucosa that, in some cases, evolves to gastric cancer. Efficient vaccination has not been achieved, thus it is essential to find alternative therapies, particularly in the nutritional field. The current study evaluated whether curcumin could attenuate inflammation of the gastric mucosa due to H. pylori infection. Twenty-eight C57BL/6 mice, were inoculated with the H. pylori SS1 strain; ten non-infected mice were used as controls. H. pylori infection in live mice was followed-up using a modified 13C-Urea Breath Test (13C-UBT) and quantitative real-time polymerase chain reaction (PCR). Histologically confirmed, gastritis was observed in 42% of infected non-treated mice at both 6 and 18 weeks post-infection. These mice showed an up-regulation of the expression of inflammatory cytokines and chemokines, as well as of toll-like receptors (TLRs) and MyD88, at both time points. Treatment with curcumin decreased the expression of all these mediators. No inflammation was observed by histology in this group. Curcumin treatment exerted a significant anti-inflammatory effect in H. pylori-infected mucosa, pointing to the promising role of a nutritional approach in the prevention of H. pylori induced deleterious inflammation while the eradication or prevention of colonization by effective vaccine is not available.