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Clinical Science
Desaturation – distance ratio: a new concept for a functional assessment of interstitial lung diseases
Suzana Pinheiro Pimenta, Renata Barbosa da Rocha, Bruno Guedes Baldi, Alexandre de Melo Kawassaki, Ronaldo Adib Kairalla, Carlos Roberto Ribeiro Carvalho
Corresponding author
crrcarvalho@hcnet.usp.br

Tel.: 55 11 3069-7577
Pulmonary Division, Heart Institute (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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          "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">Desaturation - Distance Ratio &#40;DDR&#41;&#58; calculated using the ratio between DAO<span class="elsevierStyleInf">2</span> &#91;gray area - obtained by subtraction between each recorded SpO<span class="elsevierStyleInf">2</span> at every 2 seconds from 100&#37; &#40;maximal SpO<span class="elsevierStyleInf">2</span> &#41;&#93; and the distance walked&#46;<span class="elsevierStyleBold">1</span><span class="elsevierStyleBold">-</span> Desaturation - Distance Ratio &#40;DDR&#41;&#58; calculated using the ratio between DAO<span class="elsevierStyleInf">2</span> &#91;gray area - obtained by subtraction between each recorded SpO<span class="elsevierStyleInf">2</span> at every 2 seconds from 100&#37; &#40;maximal SpO<span class="elsevierStyleInf">2</span> &#41;&#93; and the distance walked&#46;</p> <p id="spara20" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; DAO<span class="elsevierStyleInf">2</span>&#58; desaturation area&#59; SpO<span class="elsevierStyleInf">2</span>&#58; peripheral oxygen saturation</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="cesec10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle70">INTRODUCTION</span><p id="para10" class="elsevierStylePara elsevierViewall">The functional capacity evaluation has become increasingly important in understanding and managing patients with chronic lung diseases&#46;<a class="elsevierStyleCrossRefs" href="#bib1">1-3</a> The cardiopulmonary exercise test &#40;CPET&#41; using a cycle ergometer or treadmill protocols have been used in patients with restrictive and obstructive lung diseases&#44; and they provide a good correlation between survival and functional capacity among individuals in these groups&#46;<a class="elsevierStyleCrossRefs" href="#bib1">1&#44;2&#44;4-6</a></p><p id="para20" class="elsevierStylePara elsevierViewall">In patients with interstitial lung diseases &#40;ILD&#41;&#44; especially those with diffuse fibrotic lung diseases&#44; these protocols typically show a fall in peripheral oxygen saturation &#40;SpO<span class="elsevierStyleInf">2</span>&#41; during exercise&#46;<a class="elsevierStyleCrossRefs" href="#bib7">7&#44;8</a> However&#44; some patients may be unfamiliar with this type of assessment&#44; it may not be possible to extrapolate their daily life activities from its results&#44; it may have limited reproducibility in patients with idiopathic pulmonary fibrosis &#40;IPF&#41;&#44; and it requires specific equipment with a high cost&#46;<a class="elsevierStyleCrossRefs" href="#bib1">1&#44;5&#44;9</a> Recently&#44; researchers observed that some patients in rehabilitation programs did not have oxygen desaturation during CPET but had such an event during walking tests&#46;<a class="elsevierStyleCrossRef" href="#bib6">6</a></p><p id="para30" class="elsevierStylePara elsevierViewall">The six-minute walk test &#40;6MWT&#41; is a simple&#44; efficient&#44; and low-cost tool used to evaluate the performance of individuals during submaximal exercise&#44; and it can be safely applied in patients with heart and&#47;or advanced lung disease&#46;<a class="elsevierStyleCrossRefs" href="#bib1">1&#44;10-12</a></p><p id="para40" class="elsevierStylePara elsevierViewall">Despite the controversy regarding the use of walked distance or oxygen desaturation for better correlation with pulmonary function or survival data&#44; recent studies have demonstrated the efficacy of using the 6MWT to evaluate the effectiveness of therapy in patients with interstitial lung diseases&#44; pulmonary rehabilitation follow-up&#44; marking criteria for transplantation and indication for supplementary oxygen&#44; concluding that it offers a good correlation with the functional capacity and survival of these patients&#46;<a class="elsevierStyleCrossRefs" href="#bib1">1-4&#44;9&#44;10&#44;13</a></p><p id="para50" class="elsevierStylePara elsevierViewall">Desaturation during 6MWT is associated with higher mortality and has a good correlation with variables of pulmonary function&#44; such as forced vital capacity &#40;FVC&#41;&#44; diffusion of carbon monoxide &#40;DLco&#41;&#44; total lung capacity &#40;TLC&#41;&#44; and SpO<span class="elsevierStyleInf">2</span> at rest in patients with interstitial lung diseases&#46;<a class="elsevierStyleCrossRefs" href="#bib4">4&#44;5&#44;13</a> Nevertheless&#44; some researchers have concluded that the distance covered in 6MWT has a stronger correlation with severity and survival of patients with IPF than SpO<span class="elsevierStyleInf">2</span> alone&#46;<a class="elsevierStyleCrossRefs" href="#bib10">10&#44;14</a> Eaton and colleagues showed that the covered distance in 6MWT is highly reproducible and has a better prognostic value than SpO<span class="elsevierStyleInf">2</span> due to its large variability and because of the fact that it may not be a reliable parameter in fibrotic idiopathic interstitial pneumonia&#46;<a class="elsevierStyleCrossRef" href="#bib9">9</a></p><p id="para60" class="elsevierStylePara elsevierViewall">Lettieri and colleagues proposed an index that includes both parameters&#58; walked distance and degree of desaturation during 6MWT&#46;<a class="elsevierStyleCrossRef" href="#bib1">1</a> Using the product of the lowest SpO<span class="elsevierStyleInf">2</span> identified by the distance in meters &#40;distance - saturation product &#8211; DSP&#41;&#44; they developed a composite index with higher sensitivity and specificity to determine 12-month survival in IPF patients compared to pulmonary function data or isolated variables of 6MWT&#46; Despite the fact that this index includes these two parameters&#44; it is limited to a specific minimum value of SpO<span class="elsevierStyleInf">2</span> during the 6MWT&#44; which does not reflect the entire oxygen saturation during the test&#44; so it may underestimate the functional condition of the patient&#46;<a class="elsevierStyleCrossRef" href="#bib1">1</a></p><p id="para70" class="elsevierStylePara elsevierViewall">The purpose of this study was to create a new composite index based on the 6MWT&#44; using oximetry &#40;continuous peripheral oxygen saturation registered every 2 seconds during the test&#41; and the distance walked&#44; in order to develop a more reliable tool for functional assessment of patients with interstitial lung diseases&#46;</p></span><span id="cesec20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle80">MATERIALS AND METHODS</span><span id="cesec30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle90">Study design</span><p id="para80" class="elsevierStylePara elsevierViewall">We developed a transversal study and invited patients to participate during their regular visits in our Interstitial Pulmonary Outpatient Division&#46; If the patient filled in all inclusion criteria noted below &#40;evaluated through medical records review and physical examination during the visit&#41; he or she was invited to sign the free informed consent form approved by the hospital ethics committee&#46;</p><p id="para90" class="elsevierStylePara elsevierViewall">All patients included in the study needed to be able to maintain peripheral resting saturation in room air &#40;SpO<span class="elsevierStyleInf">2</span>&#41; &#8805; 88&#37; and present no clinical signs of exacerbation&#46;</p></span><span id="cesec40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle100">Subjects</span><p id="para100" class="elsevierStylePara elsevierViewall">Fifty-one patients were assessed during their visits to the Interstitial Pulmonary Outpatient Division of the University of Sao Paulo Medical School&#46; Twenty-five of them had been diagnosed as having idiopathic pulmonary fibrosis &#40;IPF&#41;&#44; 6 patients had chronic hypersensitivity pneumonitis &#40;CHP&#41;&#44; 5 patients had centrilobular fibrosis secondary to gastroesophageal reflux disease &#40;GERD&#41;&#44; and 15 patients received the diagnosis of lymphangioleiomyomatosis &#40;LAM&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib15">15&#44;16</a></p><p id="para110" class="elsevierStylePara elsevierViewall">Two of the IPF patients were not able to sustain room air SpO<span class="elsevierStyleInf">2</span> &#8805; 88&#37; at rest&#46; Therefore&#44; 49 patients &#40;23 IPF patients&#41; were recruited to be a part of this study&#46;</p><p id="para120" class="elsevierStylePara elsevierViewall">The diagnosis criteria for IPF was based on American Thoracic Society &#47; European Respiratory Society &#40;ATS&#47;ERS&#41; guidelines&#46; The CHP diagnosis was established in individuals exposed to a known offending antigen who exhibited a relationship between symptoms and exposure&#44; and there were compatible pulmonary tomographic findings&#44; and&#47;or the diagnosis was proven by a biopsy that excluded other causes&#46;<a class="elsevierStyleCrossRefs" href="#bib17">17-19</a></p><p id="para130" class="elsevierStylePara elsevierViewall">The definition of GERD-related centrilobular fibrosis is the combination of GERD-related symptoms &#40;heartburn&#44; regurgitation&#44; and dysphagia&#41;&#44; compatible tomographic features&#44; clinical improvement after specific anti-reflux therapy&#44; and&#47;or proven by a biopsy that excluded other causes&#46; Patients who had biopsy presented a pattern compatible to centrilobular fibrosis &#40;CLF&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib15">15&#44;20&#44;21</a></p><p id="para140" class="elsevierStylePara elsevierViewall">Lymphangioleiomyomatosis diagnosis was established by the presence of pulmonary cystic lesions&#44; combined or not with angiomyolipomas and with typical features found in a lung biopsy&#44; such as smooth muscle cell positive anti-actin antibody and positive antibody human melanoma black &#40;HMB45&#41; in an immunohistochemistry study&#46;<a class="elsevierStyleCrossRef" href="#bib22">22</a></p><p id="para150" class="elsevierStylePara elsevierViewall">A control group was made up of 11 healthy volunteers with no history of tobacco use&#46;</p></span><span id="cesec50" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle110">Measurements</span><p id="para160" class="elsevierStylePara elsevierViewall">Demographic data were recorded before the pulmonary function tests were performed&#46;</p><p id="para170" class="elsevierStylePara elsevierViewall">The six-minute walk test &#40;6MWT&#41; was carried out by a trained technician&#44; according to ATS guidelines&#44; and it was symptom-limited&#46; Analyzed parameters were the walked distance &#40;in meters&#41;&#44; SpO<span class="elsevierStyleInf">2</span> minimum maintained at least 10 seconds&#44; and difference between basal saturation &#40;at rest&#41; and the minimal one achieved in the test &#40;SpO<span class="elsevierStyleInf">2</span> basal &#8211; SpO<span class="elsevierStyleInf">2</span> min&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib12">12&#44;23</a></p><p id="para180" class="elsevierStylePara elsevierViewall">We created a new index named the desaturation - distance ratio &#40;DDR&#41; based on a physiologic and a holistic interpretation of 6MWT&#44; considering that desaturation and walked distance are equally important variables for pulmonary functional assessment&#46;</p><p id="para190" class="elsevierStylePara elsevierViewall">During the 6MWT that lasted 360 seconds&#44; the patient used the pulse oxymeter holter Nonin WristOx&#174; 3100 &#40;Plymouth&#44; MN&#44; USA&#41; to record SpO<span class="elsevierStyleInf">2</span> and heart frequency every 2 seconds&#46; Data obtained during the 6MWT were entered into a computer program&#44; nVISION&#174; software &#40;Plymouth&#44; MN&#44; USA&#41; and then exported to an EXCEL worksheet&#46; Then&#44; each recorded SpO<span class="elsevierStyleInf">2</span> was subtracted from 100&#37; &#40;maximal SpO<span class="elsevierStyleInf">2</span>&#41; and plotted on a graph that showed the desaturation area &#40;DAO<span class="elsevierStyleInf">2</span>&#41; &#40;gray area&#44; <a class="elsevierStyleCrossRef" href="#fig1-cln_65p841">Figure 1</a>&#41;&#46; Following that&#44; the DDR index was obtained using the ratio between the desaturation area and the distance walked &#40;see an example in Figure 1&#41;&#46; Patients who presented the worst performance during 6MWT&#44; with a low distance walked and extensive periods of desaturation&#44; presented a high DDR index value&#46;</p><elsevierMultimedia ident="fig1-cln_65p841"></elsevierMultimedia><p id="para200" class="elsevierStylePara elsevierViewall">A complete pulmonary function test &#40;PFT&#41; was performed at the Laboratory of Pulmonary Physiology&#44; Hospital das Clinicas&#44; within a period no longer than three days after 6MWT&#44; using a whole-body plethysmograph of the Elite Series Medgraphics &#174; &#40;Saint Paul&#44; MN&#44; USA&#41;&#46; The values measured were forced vital capacity &#40;FVC&#41;&#44; forced expiratory volume in one second &#40;FEV<span class="elsevierStyleInf">1</span>&#41;&#44; FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio&#44; inspiratory capacity &#40;IC&#41;&#44; total lung capacity &#40;TLC&#41;&#44; residual volume &#40;RV&#41;&#44; and carbon monoxide diffusion capacity &#40;DLco&#41;&#46; PFT was held to levels that met the recommendations of the reference values used for spirometry established by Pereira and colleagues&#46; For lung volumes and DLco&#44; the reference values were those recommended by Neder and associates&#46;<a class="elsevierStyleCrossRefs" href="#bib24">24&#44;25&#44;26</a></p><p id="para210" class="elsevierStylePara elsevierViewall">The assessment of dyspnea was performed using the Borg score&#44; obtained by using a visual analogue scale&#44; which evaluates the intensity of dyspnea by quantifying the effort during the exercise&#44; using a range that varies from 0 to 10 points&#44; where 0 is the absence of symptoms and 10 the worst feeling of dyspnea or fatigue&#46;<a class="elsevierStyleCrossRef" href="#bib20">20</a></p></span><span id="cesec60" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle120">Statistical analysis</span><p id="para220" class="elsevierStylePara elsevierViewall">Parametric variables were compared using Student&#39;s <span class="elsevierStyleItalic">t</span> test&#44; and the Pearson coefficient was used to establish correlations&#46; The Mann-Whitney and Spearman coefficients were used for non-parametric variables&#46; All data were two-tailed&#44; and p values of less than 0&#46;05 were assumed to represent statistical significance&#46; We used the software package SPSS 15&#46;0 &#40;SPSS&#44; Inc&#46;&#44; Chicago&#44; IL&#44; USA&#41; to perform statistical analysis&#46;</p></span></span><span id="cesec70" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle130">RESULTS</span><p id="para230" class="elsevierStylePara elsevierViewall">Forty-nine ILD patients and 11 control subjects completed the protocol&#46; The mean &#40;SD&#41; age was 60 &#40;12&#41; years in the first group and 65 &#40;9&#41; years in the second one&#46; Nineteen ILD patients &#40;39&#37;&#41; were ex-smokers&#46; PFT analysis revealed restrictive pattern in ILD patients&#44; with a moderate reduction in DLco &#40;46&#37; of predicted&#41;&#46; Control patients presented normal pulmonary functional parameters &#40;<a class="elsevierStyleCrossRef" href="#t1-cln_65p841">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="t1-cln_65p841"></elsevierMultimedia><p id="para240" class="elsevierStylePara elsevierViewall">Data obtained from 6MWT showed significant statistical differences between ILD patients and controls&#44; with emphasis on the mean walked distance &#40;430 and 602 meters&#44; respectively&#41; and the median difference between SpO<span class="elsevierStyleInf">2</span> basal and SpO<span class="elsevierStyleInf">2</span> minimal &#40;sustained for at least 10 s&#41; during the test&#44; resulting in a 10-point drop in the first group and only 3 points in the control group&#46; The median DDR was higher among ILD patients &#40;10&#41; than in controls &#40;2&#46;5&#41;&#44; due to the high desaturation and reduced walk distance observed in those individuals &#40;p&#60;0&#46;05&#41; &#40;<a class="elsevierStyleCrossRef" href="#t2-cln_65p841">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="t2-cln_65p841"></elsevierMultimedia><p id="para250" class="elsevierStylePara elsevierViewall">Correlation analysis revealed significant and strong correlation between DDR and predicted DLco &#40;<a class="elsevierStyleCrossRef" href="#fig2-cln_65p841">Figure 2</a>&#41;&#46; The correlations between walked distance&#44; SpO<span class="elsevierStyleInf">2</span> min&#44; and the difference &#40;SpO<span class="elsevierStyleInf">2</span> basal &#8211; SpO<span class="elsevierStyleInf">2</span> min&#41; demonstrated a lower correspondence with DLco &#40;<a class="elsevierStyleCrossRef" href="#t3-cln_65p841">Table 3</a>&#41;&#46; There was no correlation between DDR or other 6MWT variables with lung volumes &#40;TLC and RV&#41; &#40;data not shown&#41;&#46;</p><elsevierMultimedia ident="fig2-cln_65p841"></elsevierMultimedia><elsevierMultimedia ident="t3-cln_65p841"></elsevierMultimedia></span><span id="cesec80" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle140">DISCUSSION</span><p id="para260" class="elsevierStylePara elsevierViewall">Many researchers have employed functional evaluations using submaximal testing of patients with respiratory diseases&#44; such as chronic obstructive pulmonary disease &#40;COPD&#41;&#44; pulmonary hypertension &#40;PH&#41;&#44; and interstitial lung disease &#40;ILD&#41;&#46; In particular&#44; the 6MWT has been widely used&#46;</p><p id="para270" class="elsevierStylePara elsevierViewall">Interstitial lung diseases&#44; especially idiopathic pulmonary fibrosis &#40;IPF&#41;&#44; are associated with high mortality and a progressive decrease in exercise capacity&#46;<a class="elsevierStyleCrossRef" href="#bib17">17</a> There is growing interest in diagnostic and prognostic methods in this population in order to improve understanding and management and provide better quality of life for these patients&#46;</p><p id="para280" class="elsevierStylePara elsevierViewall">Protocols using a treadmill or cycle ergometer have been employed to assess the functional capacity of the population with ILD&#44; but these tests may be unfamiliar to patients and require sophisticated and expensive equipment&#46;<a class="elsevierStyleCrossRefs" href="#bib1">1&#44;5&#44;9</a> The 6MWT is a simple tool with a low cost&#44; and it is easily applied in functional evaluation of patients with ILD&#44; but there is a disagreement in the literature about which is the best 6MWT parameter &#40;walked distance or decrease in SpO<span class="elsevierStyleInf">2</span>&#41; to assess functional capacity&#44; severity&#44; or mortality in this population&#46;<a class="elsevierStyleCrossRefs" href="#bib2">2&#44;4&#44;9&#44;10&#44;13</a></p><p id="para290" class="elsevierStylePara elsevierViewall">In this study&#44; we created a composite index - DDR index - that includes the two main variables obtained in 6MWT&#44; the distance walked and the decrease in SpO<span class="elsevierStyleInf">2</span> evaluated at regular intervals during the 360-second test&#46; We hypothesized that the incorporation of these two main variables in a unique index may help researchers evaluate one of the main features of ILD&#44; a disturbance in gas exchange that worsens during exercise&#46;<a class="elsevierStyleCrossRefs" href="#bib26">26&#44;27</a> In this population&#44; exercise leads to an increase in the alveolar-arterial O<span class="elsevierStyleInf">2</span> gradient concomitant with a decrease in peripheral partial oxygen pressure &#40;PaO<span class="elsevierStyleInf">2</span>&#41; and peripheral oxygen saturation &#40;SpO<span class="elsevierStyleInf">2</span>&#41;&#44; secondary to multiple changes&#44; especially in ventilation &#47; perfusion mismatch and a diffusion limitation in the alveolar capillary membrane&#46;<a class="elsevierStyleCrossRefs" href="#bib26">26&#44;27</a></p><p id="para300" class="elsevierStylePara elsevierViewall">According to Eaton and colleagues&#44; walked distance showed less variability and better correlation with DLco and VO<span class="elsevierStyleInf">2</span> max than SpO<span class="elsevierStyleInf">2</span>&#46; <a class="elsevierStyleCrossRef" href="#bib9">9</a> However&#44; in a study done by Lama et al&#44; patients who presented a decrease in SpO<span class="elsevierStyleInf">2</span> during a 6MWT&#44; equal or below 88&#37;&#44; exhibited significantly lower values of FVC and DLco&#44; and the decrease in saturation &#40;SpO<span class="elsevierStyleInf">2</span> basal &#8211; lowest saturation&#41; was a significant predictor of mortality&#44; showing that for each percentage decrease in saturation&#44; mortality increased 23&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib4">4</a></p><p id="para310" class="elsevierStylePara elsevierViewall">The divergence in these results may be due to the fact that distance is highly dependent on patient efforts&#46; Limited efforts may lead to a smaller distance&#44; preventing the development of hypoxia&#46; However&#44; hypoxia can promote dyspnea and reduce the distance covered&#46; A combination of these two parameters may minimize the impact of this effort factor&#46;</p><p id="para320" class="elsevierStylePara elsevierViewall">We demonstrated that DDR had a strong and significant correlation with DLco but a weaker correlation with FVC and FEV<span class="elsevierStyleInf">1</span> &#40;<a class="elsevierStyleCrossRef" href="#t3-cln_65p841">Table 3</a>&#41;&#46; Full oxymetry&#44; measured every 2 seconds&#44; may more accurately reflect the diffusion capacity of the alveolar &#8211; capillary membrane&#44; which is reduced in patients with ILD due to impaired gas exchange &#40;reflected by DLco&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib1">1&#44;4&#44;10&#44;13</a></p><p id="para330" class="elsevierStylePara elsevierViewall">The strong correlation of DDR with DLco but not with FVC or with other lung volumes may be explained by the following factors&#46; In the initial phases of ILD&#44; decline in DLco may precede abnormalities in lung volume&#46;<a class="elsevierStyleCrossRef" href="#bib17">17</a> Many patients in our sample were ex-smokers with superimposed COPD&#44; and&#44; in this context&#44; combined pulmonary fibrosis and emphysema can lead to preserved or mildly reduced lung volumes despite the significant decrease in DL<span class="elsevierStyleInf">CO</span>&#46;<a class="elsevierStyleCrossRefs" href="#bib28">28&#44;29</a> In patients with LAM&#44; there is also airway flow obstruction caused by compression of the airways by smooth cell proliferation or loss of lung elastic coil&#44; leading to an increase in lung volumes&#46;<a class="elsevierStyleCrossRef" href="#bib30">30</a></p><p id="para340" class="elsevierStylePara elsevierViewall">We concluded that the combination of the desaturation area and distance walked in a six-minute walk test &#40;DDR index&#41; is a promising concept and a more reliable physiologic tool to assess pulmonary diseases characterized by involvement of the alveolar-capillary membrane&#44; such as ILD&#44; and other pulmonary disorders like pulmonary emphysema&#46; Further studies are necessary to determine the role of DDR in predicting mortality&#44; disease progression&#44; and response to treatment in this subset of patients&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
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        0 => array:2 [
          "identificador" => "xpalclavsec1582498"
          "titulo" => "KEYWORDS"
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        1 => array:2 [
          "identificador" => "cesec10"
          "titulo" => "INTRODUCTION"
        ]
        2 => array:3 [
          "identificador" => "cesec20"
          "titulo" => "MATERIALS AND METHODS"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "cesec30"
              "titulo" => "Study design"
            ]
            1 => array:2 [
              "identificador" => "cesec40"
              "titulo" => "Subjects"
            ]
            2 => array:2 [
              "identificador" => "cesec50"
              "titulo" => "Measurements"
            ]
            3 => array:2 [
              "identificador" => "cesec60"
              "titulo" => "Statistical analysis"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "cesec70"
          "titulo" => "RESULTS"
        ]
        4 => array:2 [
          "identificador" => "cesec80"
          "titulo" => "DISCUSSION"
        ]
        5 => array:2 [
          "identificador" => "xack639358"
          "titulo" => "ACKNOWLEDGMENT"
        ]
        6 => array:1 [
          "titulo" => "REFERENCES"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2010-05-29"
    "fechaAceptado" => "2010-06-04"
    "PalabrasClave" => array:1 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "KEYWORDS"
          "identificador" => "xpalclavsec1582498"
          "palabras" => array:3 [
            0 => "The six-minute walk test"
            1 => "Pulmonary function tests"
            2 => "Interstitial lung diseases"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:1 [
      "en" => array:2 [
        "resumen" => "<span id="ceabs10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle10">INTRODUCTION&#58;</span><p id="spara100" class="elsevierStyleSimplePara elsevierViewall">The functional evaluation has become increasingly important in the understanding and management of patients with interstitial lung diseases&#46; The cardiopulmonary exercise test and the six-minute walk test &#40;6MWT&#41;&#44; through their isolated variables&#44; have been used to do this evaluation&#44; with some limitations&#46;</p></span> <span id="ceabs20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle20">OBJECTIVES&#58;</span><p id="spara110" class="elsevierStyleSimplePara elsevierViewall">We proposed a new composite index &#40;desaturation distance ratio using continuous peripheral oxygen saturation &#40;SpO<span class="elsevierStyleInf">2</span>&#41; and the distance walked as a more reliable tool for doing a functional evaluation of these patients&#46;</p></span> <span id="ceabs30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle30">METHODS&#58;</span><p id="spara120" class="elsevierStyleSimplePara elsevierViewall">6MWT was performed by interstitial lung diseases patients and controls&#46; Analyzed parameters were walked distance and desaturation area &#40;DAO<span class="elsevierStyleInf">2</span>&#41;&#44; obtained by taking the difference between maximal SpO<span class="elsevierStyleInf">2</span> possible &#40;100&#37;&#41; and patient&#39;s SpO<span class="elsevierStyleInf">2</span> every 2 seconds&#46; desaturation distance ratio was calculated using the ratio between DAO<span class="elsevierStyleInf">2</span> and distance walked&#46;</p></span> <span id="ceabs40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle40">RESULTS&#58;</span><p id="spara130" class="elsevierStyleSimplePara elsevierViewall">Forty-nine interstitial lung diseases patients and 11 control subjects completed the protocol&#46; The mean &#40;SD&#41; age was 60 &#40;12&#41; years and 65 &#40;9&#41; years&#44; respectively &#40;p&#58;NS&#41;&#46; Data obtained from 6MWT showed a significant statistical difference between interstitial lung diseases patients and controls&#58; mean walked distance &#40;430 and 602 meters&#44; respectively&#41;&#59; SpO<span class="elsevierStyleInf">2</span> minimal maintained at least 10 seconds - SpO<span class="elsevierStyleInf">2</span> min &#40;85&#37; and 94&#37;&#44; respectively&#41;&#44; and median desaturation distance ratio &#40;10 and 2&#46;5&#44; respectively&#41;&#46; A correlation analysis&#44; considering interstitial lung diseases patients&#44; revealed the best correlation between desaturation distance ratio and DLco &#40;r &#61; - 0&#46;72&#59; p&#60;0&#46;001&#41;&#44; being the correlation between SpO<span class="elsevierStyleInf">2</span> min and DLco of 0&#46;61 &#40;p&#60;0&#46;001&#41; and among walked distance and DLco of 0&#46;58 &#40;p&#60;0&#46;05&#41;&#46;</p></span> <span id="ceabs50" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle50">CONCLUSION&#58;</span><p id="spara140" class="elsevierStyleSimplePara elsevierViewall">Desaturation distance ratio is a promising concept and a more reliable physiologic tool to assess pulmonary diseases characterized by involvement of the alveolar-capillary membrane&#44; such as interstitial lung diseases&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "ceabs10"
            "titulo" => "INTRODUCTION&#58;"
          ]
          1 => array:2 [
            "identificador" => "ceabs20"
            "titulo" => "OBJECTIVES&#58;"
          ]
          2 => array:2 [
            "identificador" => "ceabs30"
            "titulo" => "METHODS&#58;"
          ]
          3 => array:2 [
            "identificador" => "ceabs40"
            "titulo" => "RESULTS&#58;"
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          4 => array:2 [
            "identificador" => "ceabs50"
            "titulo" => "CONCLUSION&#58;"
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        "identificador" => "fig1-cln_65p841"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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        "descripcion" => array:1 [
          "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">Desaturation - Distance Ratio &#40;DDR&#41;&#58; calculated using the ratio between DAO<span class="elsevierStyleInf">2</span> &#91;gray area - obtained by subtraction between each recorded SpO<span class="elsevierStyleInf">2</span> at every 2 seconds from 100&#37; &#40;maximal SpO<span class="elsevierStyleInf">2</span> &#41;&#93; and the distance walked&#46;<span class="elsevierStyleBold">1</span><span class="elsevierStyleBold">-</span> Desaturation - Distance Ratio &#40;DDR&#41;&#58; calculated using the ratio between DAO<span class="elsevierStyleInf">2</span> &#91;gray area - obtained by subtraction between each recorded SpO<span class="elsevierStyleInf">2</span> at every 2 seconds from 100&#37; &#40;maximal SpO<span class="elsevierStyleInf">2</span> &#41;&#93; and the distance walked&#46;</p> <p id="spara20" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; DAO<span class="elsevierStyleInf">2</span>&#58; desaturation area&#59; SpO<span class="elsevierStyleInf">2</span>&#58; peripheral oxygen saturation</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig2-cln_65p841"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
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        "figura" => array:1 [
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        "descripcion" => array:1 [
          "en" => "<p id="spara30" class="elsevierStyleSimplePara elsevierViewall">Correlation between DLco&#37; and DDR in ILD patients&#46;<span class="elsevierStyleBold">2</span><span class="elsevierStyleBold">-</span> Correlation between DLco&#37; and DDR in ILD patients&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "t1-cln_65p841"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spara50" class="elsevierStyleSimplePara elsevierViewall">ILD &#8211; interstitial lung disease&#59; IPF &#8211; interstitial pulmonary fibrosis&#59; LAM &#8211; lymphangioleiomyomatosis&#59; CHP &#8211; chronic hypersensitivity pneumonitis&#59; CLF &#8211; centrilobular fibrosis&#59; SD - Standard deviation&#59; FVC &#37; - predicted forced vital capacity&#59; FEV1 &#37; - predicted forced expiratory volume in the first second&#59; TLC &#37; - predicted total lung capacity&#59; DLco &#37; - predicted diffusion capacity for carbon monoxide</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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="bottom" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="bottom" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="5" align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">ILD</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="bottom" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">CONTROLS &#40;N &#61; 11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">TOTAL &#40;N &#61; 49&#41;<a class="elsevierStyleCrossRef" href="#tfn2-cln_65p841"><span class="elsevierStyleSup">&#9830;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">IPF &#40;N &#61; 23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">LAM &#40;N &#61; 15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">CHP &#40;N &#61; 6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">CLF &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="bottom">Age years &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">65 &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">60 &#40;12&#41;<a class="elsevierStyleCrossRef" href="#tfn3-cln_65p841"><span class="elsevierStyleSup">&#8727;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">68 &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">47 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">63 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">58 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="bottom">Sex &#40;M &#47; F&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">9 &#47; 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">24 &#47; 25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">17&#47;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">0&#47;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">2&#47;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">4&#47;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="bottom">Ex- smokers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">0 &#47; 11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">19 &#47; 49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">15&#47;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">3&#47;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">4&#47;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">1&#47;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="bottom">FVC &#37; &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">103 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">76 &#40;16&#41;<span class="elsevierStyleSup">&#8224;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">72 &#40;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">89 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">70 &#40;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">74 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="bottom">FEV1 &#37; &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">106 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">75 &#40;18&#41;<span class="elsevierStyleSup">&#8224;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">79 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">71 &#40;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">76 &#40;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">81 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="bottom">TLC &#37; &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">98 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">80 &#40;19&#41;<span class="elsevierStyleSup">&#8224;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">74 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">98 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">72 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">73 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="bottom">DLco &#37; &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">103 &#40;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">46 &#40;16&#41;<span class="elsevierStyleSup">&#8224;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">39 &#40;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">55 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">46 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">56 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          ]
          "notaPie" => array:2 [
            0 => array:3 [
              "identificador" => "tfn2-cln_65p841"
              "etiqueta" => "&#9830;"
              "nota" => "<p class="elsevierStyleNotepara" id="cenpara10">t test between controls and all 49 ILD patients</p>"
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            1 => array:3 [
              "identificador" => "tfn3-cln_65p841"
              "etiqueta" => "&#8727;"
              "nota" => "<p class="elsevierStyleNotepara" id="cenpara20">p value not significant <span class="elsevierStyleSup">&#8224;</span>p &#60; 0&#44;05</p>"
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          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara40" class="elsevierStyleSimplePara elsevierViewall">Demographic and functional parameters in ILD patients and controls&#46;</p>"
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        "identificador" => "t2-cln_65p841"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spara70" class="elsevierStyleSimplePara elsevierViewall">SD - Standard deviation&#59; IQ &#8211; interquartile&#59; Distance in meters&#59; DDR - desaturation distance ratio&#59; SpO<span class="elsevierStyleInf">2</span> basal &#37; - peripheral oxygen saturation at rest&#59; SpO<span class="elsevierStyleInf">2</span> min &#37; - minimal sustained SpO2 during &#8805; 10 seconds</p>"
          "tablatextoimagen" => array:1 [
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                0 => """
                  <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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="bottom" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="bottom" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="5" align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">ILD</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="bottom" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">CONTROLS &#40;N &#61; 11&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">TOTAL &#40;N &#61; 49&#41;<a class="elsevierStyleCrossRef" href="#tfn5-cln_65p841">&#9830;</a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">IPF &#40;N &#61; 23&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">LAM &#40;N &#61; 15&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">CHP &#40;N &#61; 6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="bottom" scope="col" style="border-bottom: 2px solid black">CLF &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="bottom">Distance &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">602 m &#40;95&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">430 m &#40;122&#41;<span class="elsevierStyleSup">&#8224;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">373 m &#40;114&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">480m &#40;116&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">484 m &#40;117&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">474 m &#40;87&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="bottom">SpO<span class="elsevierStyleInf">2</span> basal &#37; &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">96&#46;5 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">95 &#40;2&#41;<a class="elsevierStyleCrossRef" href="#tfn6-cln_65p841">&#8727;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">94 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">95 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">95 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">96 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="bottom">SpO<span class="elsevierStyleInf">2</span> min &#37; &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">94 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">85 &#40;8&#41;<span class="elsevierStyleSup">&#8224;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">82 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">87 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">86 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">86 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="bottom">SpO<span class="elsevierStyleInf">2</span> basal - min &#40;IQ&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">3 &#40;2 &#8211; 4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">10 &#40;6 - 13&#41;<span class="elsevierStyleSup">&#8224;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">10 &#40;9 - 15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">5 &#40;2 - 11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">9 &#40;6 - 11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">10 &#40;6 - 12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="bottom">DDR &#40;IQ&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">2&#46;5 &#40;2 &#8211; 4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">10 &#40;6 - 17&#41;<span class="elsevierStyleSup">&#8224;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">11 &#40;9 - 23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">6 &#40;4 - 12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">8 &#40;6 - 10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="bottom">8 &#40;6 - 8&#41;&nbsp;\t\t\t\t\t\t\n
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          "notaPie" => array:2 [
            0 => array:3 [
              "identificador" => "tfn5-cln_65p841"
              "etiqueta" => "&#9830;"
              "nota" => "<p class="elsevierStyleNotepara" id="cenpara30">Comparison between controls and all 49 ILD patients</p>"
            ]
            1 => array:3 [
              "identificador" => "tfn6-cln_65p841"
              "etiqueta" => "&#8727;"
              "nota" => "<p class="elsevierStyleNotepara" id="cenpara40">p value not significant <span class="elsevierStyleSup">&#8224;</span>p &#60; 0&#44;05</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara60" class="elsevierStyleSimplePara elsevierViewall">Six-minute walk test parameters in ILD patients and controls&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "t3-cln_65p841"
        "etiqueta" => "Table 3"
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        "mostrarFloat" => true
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        "tabla" => array:3 [
          "leyenda" => "<p id="spara90" class="elsevierStyleSimplePara elsevierViewall">Distance in meters&#59; DD Ratio - desaturation distance ratio&#59; SpO2 min &#37; - minimal sustained peripheral oxygen saturation during &#8805; 10 seconds&#59; SpO2 basal &#37; - peripheral oxygen saturation at rest</p>"
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                              CJ Lettieri \n
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                              SD Nathan \n
                              \t\t\t\t\t\t\t\t
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                              RF Browning \n
                              \t\t\t\t\t\t\t\t
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                              SD Barnett \n
                              \t\t\t\t\t\t\t\t
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                              S Ahmad \n
                              \t\t\t\t\t\t\t\t
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                              AF Shorr \n
                              \t\t\t\t\t\t\t\t
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                              R Carter \n
                              \t\t\t\t\t\t\t\t
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                              DB Holiday \n
                              \t\t\t\t\t\t\t\t
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                              C Nwasuruba \n
                              \t\t\t\t\t\t\t\t
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                            3 => """
                              J Stocks \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              C Grothues \n
                              \t\t\t\t\t\t\t\t
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                              B Tiep \n
                              \t\t\t\t\t\t\t\t
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                              JM Marin \n
                              \t\t\t\t\t\t\t\t
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                              SJ Carrizo \n
                              \t\t\t\t\t\t\t\t
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                              M Gascon \n
                              \t\t\t\t\t\t\t\t
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                              A Sanchez \n
                              \t\t\t\t\t\t\t\t
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                              VN Lama \n
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                              KR Flaherty \n
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                              Q Long \n
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                            0 => """
                              A Chetta \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              M Aiello \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              A Foresi \n
                              \t\t\t\t\t\t\t\t
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                            3 => """
                              E Marangio \n
                              \t\t\t\t\t\t\t\t
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                              R D&#39;Ippolito \n
                              \t\t\t\t\t\t\t\t
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                              A Castagnaro \n
                              \t\t\t\t\t\t\t\t
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                        "tituloSerie" => "Sarcoidosis Vasc Diffuse Lung Dis"
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                        "paginaInicial" => "170"
                        "paginaFinal" => "175"
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                          0 => array:2 [
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                              M Poulain \n
                              \t\t\t\t\t\t\t\t
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                              F Durand \n
                              \t\t\t\t\t\t\t\t
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                              \t\t\t\t\t\t\t\t
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                              J Desplan \n
                              \t\t\t\t\t\t\t\t
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                              A Varray \n
                              \t\t\t\t\t\t\t\t
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                      "doi" => "10.1016/0007-0971(81)90050-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dis Chest"
                        "fecha" => "1981"
                        "volumen" => "75"
                        "paginaInicial" => "169"
                        "paginaFinal" => "180"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7272198"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
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                      "doi" => "10.1016/0007-0971(81)90050-4"
                      "WWW" => array:1 [
                        "link" => "10&#46;1016&#47;0007-0971&#40;81&#41;90050-4"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mechanisms of gas-exchange impairment in idiopathic pulmonary fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => """
                              AG Agust&#237; \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              J Roca \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              J Gea \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              PD Wagner \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              A Xaubet \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              R Rodriguez-Roisin \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm/143.2.219"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am Rev Respir Dis"
                        "fecha" => "1991"
                        "volumen" => "143"
                        "paginaInicial" => "219"
                        "paginaFinal" => "225"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1990931"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Six-minute walk&#44; maximal exercise tests&#58; Reproducibility in Fibrotic Interstitial Pneumonia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => """
                              T Eaton \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              P Young \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              D Milne \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              AU Wells \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200405-578OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2005"
                        "volumen" => "171"
                        "paginaInicial" => "1150"
                        "paginaFinal" => "1157"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15640367"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1164/rccm.200405-578OC"
                      "WWW" => array:1 [
                        "link" => "10&#46;1164&#47;rccm&#46;200405-578OC"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Walking distance on 6-MWT is a prognostic factor in idiopathic pulmonary fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              A Caminati \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              A Bianchi \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              R Cassandro \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              MR Mirenda \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              S Harari \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rmed.2008.07.022"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respir Med"
                        "fecha" => "2009"
                        "volumen" => "103"
                        "paginaInicial" => "117"
                        "paginaFinal" => "123"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18786822"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1016/j.rmed.2008.07.022"
                      "WWW" => array:1 [
                        "link" => "10&#46;1016&#47;j&#46;rmed&#46;2008&#46;07&#46;022"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The body weight-walking distance product as related to lung function&#44; anaerobic threshold and peak VO2 in COPD patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => """
                              ML Chuang \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              IF Lin \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              K Wasserman \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1053/rmed.2001.1115"
                      "Revista" => array:7 [
                        "tituloSerie" => "Respir Med"
                        "fecha" => "2001"
                        "volumen" => "95"
                        "paginaInicial" => "618"
                        "paginaFinal" => "626"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11453321"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0302283811014114"
                          "estado" => "S300"
                          "issn" => "03022838"
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1053/rmed.2001.1115"
                      "WWW" => array:1 [
                        "link" => "10&#46;1053&#47;rmed&#46;2001&#46;1115"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines for the six-minute walk test"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => """
                              American Thoracic Society statement \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.166.1.at1102"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2002"
                        "volumen" => "166"
                        "paginaInicial" => "111"
                        "paginaFinal" => "117"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12091180"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Idiopathic pulmonary Fibrosis&#58; prognostic value of changes in physiology and Six-minute-walk test"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              KR Flaherty \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              AC Andrei \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              S Murray \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              C Fraley \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              TV Colby \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              WD Travis \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200604-488OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2006"
                        "volumen" => "174"
                        "paginaInicial" => "803"
                        "paginaFinal" => "809"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16825656"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1164/rccm.200604-488OC"
                      "WWW" => array:1 [
                        "link" => "10&#46;1164&#47;rccm&#46;200604-488OC"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Six-minute-walk distance predicts waiting list survival in Idiopathic Pulmonary Fibrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => """
                              DJ Lederer \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              SM Arcasoy \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              JS Wilt \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              F D&#39;Ovidio \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              JR Sonett \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              SM Kawut \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200604-520OC"
                      "Revista" => array:7 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2006"
                        "volumen" => "174"
                        "paginaInicial" => "659"
                        "paginaFinal" => "664"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16778159"
                            "web" => "Medline"
                          ]
                        ]
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                          "pii" => "S0302283813002236"
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                          "issn" => "03022838"
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                    1 => array:2 [
                      "doi" => "10.1164/rccm.200604-520OC"
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                        "link" => "10&#46;1164&#47;rccm&#46;200604-520OC"
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            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Centrilobular fibrosis&#58; a novel histological pattern of idiopathic interstitial pneumonia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => """
                              ME Carvalho \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              RA Kairalla \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              VL Capelozzi \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              D Deheinzelin \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              PH do Nascimento Saldiva \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              CR de Carvalho \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1078/0344-0338-00305"
                      "Revista" => array:7 [
                        "tituloSerie" => "Pathol Res Pract"
                        "fecha" => "2002"
                        "volumen" => "198"
                        "paginaInicial" => "577"
                        "paginaFinal" => "583"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12440779"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0302283810000837"
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                          "issn" => "03022838"
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                    1 => array:2 [
                      "doi" => "10.1078/0344-0338-00305"
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                        "link" => "10&#46;1078&#47;0344-0338-00305"
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                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Linfangioleiomiomatose pulmonar"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => """
                              P Medeiros-Junior \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              CRR Carvalho \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Bras Pneumol"
                        "fecha" => "2004"
                        "volumen" => "30"
                        "paginaInicial" => "66"
                        "paginaFinal" => "67"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Idiopathic Pulmonary Fibrosis&#58; diagnosis and treatment&#46; International consensus statement&#46; American Thoracic Society &#40;ATS&#41; and European Respiratory Society &#40;ERS&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => """
                              American Thoracic Society \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.161.2.ats3-00"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2000"
                        "volumen" => "161"
                        "paginaInicial" => "646"
                        "paginaFinal" => "664"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10673212"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hypersensitivity pneumonitis&#58; current concepts"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => """
                              SJ Bourke \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              JC Dalphin \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              G Boyd \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              C McSharry \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              CI Baldwin \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              JE Calvert \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J Suppl"
                        "fecha" => "2001"
                        "volumen" => "32"
                        "paginaInicial" => "81s"
                        "paginaFinal" => "92s"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11816827"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical diagnosis of hypersensitivity pneumonitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:7 [
                            0 => """
                              Y Lacasse \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              M Selman \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              U Costabel \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              JC Dalphin \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              M Ando \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              F Morell \n
                              \t\t\t\t\t\t\t\t
                              """
                            6 => """
                              HP Study Group \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200301-137OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2003"
                        "volumen" => "168"
                        "paginaInicial" => "952"
                        "paginaFinal" => "958"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12842854"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1164/rccm.200301-137OC"
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                        "link" => "10&#46;1164&#47;rccm&#46;200301-137OC"
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                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pulmonary manifestations of gastroesophageal reflux disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => """
                              GS Gaude \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.4103/1817-1737.53347"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Med"
                        "fecha" => "2009"
                        "volumen" => "4"
                        "paginaInicial" => "115"
                        "paginaFinal" => "123"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19641641"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.4103/1817-1737.53347"
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                        "link" => "10&#46;4103&#47;1817-1737&#46;53347"
                      ]
                    ]
                  ]
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              ]
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              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Extraesophageal manifestations of gastroesophageal reflux disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              RR Gurski \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              AR da Rosa \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              E do Valle \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              MA de Borba \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              AA Valiati \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/s1806-37132006000200011"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bras Pneumol"
                        "fecha" => "2006"
                        "volumen" => "32"
                        "paginaInicial" => "150"
                        "paginaFinal" => "160"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17273585"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lymphangioleiomyomatosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => """
                              SR Johnson \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.06.00113303"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2006"
                        "volumen" => "27"
                        "paginaInicial" => "1056"
                        "paginaFinal" => "1065"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16707400"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Oxigen desaturation on the six-minute walk test and mortality in untreated primary pulmonary hypertension"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => """
                              G Paciocco \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              FJ Martinez \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              E Bossone \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              E Pielsticker \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              B Gillespie \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              M Rubenfire \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.01.17406470"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2001"
                        "volumen" => "17"
                        "paginaInicial" => "647"
                        "paginaFinal" => "652"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11401059"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1183/09031936.01.17406470"
                      "WWW" => array:1 [
                        "link" => "10&#46;1183&#47;09031936&#46;01&#46;17406470"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib24"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "New reference values for forced spirometry in white adults in Brazil"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => """
                              CA Pereira \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              T Sato \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              SC Rodrigues \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/s1806-37132007000400008"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bras Pneumol"
                        "fecha" => "2007"
                        "volumen" => "33"
                        "paginaInicial" => "397"
                        "paginaFinal" => "406"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17982531"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reference values for lung function tests&#46; I&#46; Static volumes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => """
                              JA Neder \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              S Andreoni \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              A Castelo-Filho \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              LE Nery \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/s0100-879x1999000600006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Braz J Med Biol Res"
                        "fecha" => "1999"
                        "volumen" => "32"
                        "paginaInicial" => "703"
                        "paginaFinal" => "717"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10412549"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reference values for lung function tests&#46; III&#46; Carbon monoxide diffusing capacity &#40;transfor factor&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => """
                              JA Neder \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              S Andreoni \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              C Peres \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              LE Nery \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/s0100-879x1999000600008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Braz J Med Biol Res"
                        "fecha" => "1999"
                        "volumen" => "32"
                        "paginaInicial" => "729"
                        "paginaFinal" => "737"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10412551"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Psychophysical bases of perceived exertion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => """
                              GAV Borg \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Sci Sports Exercise"
                        "fecha" => "1982"
                        "volumen" => "14"
                        "paginaInicial" => "377"
                        "paginaFinal" => "381"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Combined pulmonary fibrosis and emphysema&#58; a distinct underrecognised entity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              V Cottin \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              H Nunes \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              PY Brillet \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              P Delaval \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              G Devouassoux \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              I Tillie-Leblond \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.05.00021005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2005"
                        "volumen" => "26"
                        "paginaInicial" => "586"
                        "paginaFinal" => "593"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16204587"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1183/09031936.05.00021005"
                      "WWW" => array:1 [
                        "link" => "10&#46;1183&#47;09031936&#46;05&#46;00021005"
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                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "HRCT and histopathological evaluation of fibrosis and tissue destruction in IPF associated with pulmonary emphysema"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              P Rogliani \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              M Mura \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              P Mattia \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              A Ferlosio \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              G Farinelli \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              S Mariotta \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rmed.2008.07.010"
                      "Revista" => array:7 [
                        "tituloSerie" => "Respir Med"
                        "fecha" => "2008"
                        "volumen" => "102"
                        "paginaInicial" => "1753"
                        "paginaFinal" => "1761"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18723334"
                            "web" => "Medline"
                          ]
                        ]
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                          "pii" => "S0022347619316014"
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                          "issn" => "00223476"
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                    1 => array:2 [
                      "doi" => "10.1016/j.rmed.2008.07.010"
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              "identificador" => "bib30"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comprehensive evaluation of 35 patients with lymphangioleiomyomatosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              SC Chu \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              K Horiba \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              J Usuki \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              NA Avila \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              CC Chen \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              WD Travis \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.115.4.1041"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1999"
                        "volumen" => "115"
                        "paginaInicial" => "1041"
                        "paginaFinal" => "1052"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10208206"
                            "web" => "Medline"
                          ]
                        ]
                      ]
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                      "doi" => "10.1378/chest.115.4.1041"
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos