Abnormal Respiratory Function Research Articles

Melatonin alleviates palmitic acid-induced mitochondrial dysfunction by reducing oxidative stress and enhancing autophagy in bovine endometrial epithelial cells

BackgroundNegative energy balance (NEB) typically occurs in dairy cows after delivery. Cows with a high yield are more likely to experience significant NEB. This type of metabolic imbalance could cause ketosis, which is often accompanied by a decline in reproductive performance. However, the molecular mechanisms underlying NEB have yet to be fully elucidated. During excessive NEB, the body fat is extensively broken down, resulting in the abnormal accumulation of non-esterified fatty acids (NEFAs), represented by palmitic acid (PA), within the uterus. Such an abnormal accumulation has the potential to damage bovine endometrial epithelial cells (BEECs), while the molecular mechanisms underlying its involvement in the PA-induced injury of BEECs remains poorly understood. Melatonin (MT) is recognized for its regulatory role in maintaining the homeostasis of mitochondrial reactive oxygen species (mitoROS). However, little is known as to whether MT could ameliorate the damage incurred by BEECs in response to PA and the molecular mechanism involved.ResultsAnalysis showed that 0.2 mmol/L PA stress increased the level of cellular and mitochondrial oxidative stress, as indicated by increased reactive oxygen species (ROS) level. In addition, we observed mitochondrial dysfunction, including abnormal mitochondrial structure and respiratory function, along with a reduction in mitochondrial membrane potential and mitochondrial copy number, and the induction of apoptosis. Notably, we also observed the upregulation of autophagy proteins (PINK, Parkin, LC3B and Ubiquitin), however, the P62 protein was also increased. As we expected, 100 μmol/L of MT pre-treatment attenuated PA-induced mitochondrial ROS and restored mitochondrial respiratory function. Meanwhile, MT pretreatment reversed the upregulation of P62 induced by PA and activated the AMPK-mTOR-Beclin-1 pathway, contributing to an increase of autophagy and decline apoptosis.ConclusionsOur findings indicate that PA can induce mitochondrial dysfunction and enhance autophagy in BEECs. In addition, MT is proved to not only reduce mitochondrial oxidative stress but also facilitate the clearance of damaged mitochondria by upregulating autophagy pathways, thereby safeguarding the mitochondrial pool and promoting cellular viability. Our study provides a better understanding of the molecular mechanisms underlying the effect of an excess of NEB on the fertility outcomes of high yielding dairy cows.

Intrauterine hyperglycemia induces SIRT3-mediated mitochondrial dysfunction: the fetal origin pathogenesis of precocious osteoarthritis

Diabetes and other metabolic and inflammatory comorbidities are highly associated with osteoarthritis (OA). However, whether early-life hyperglycemia exposure affects susceptibility to long-term OA is still unknown. The purpose of this study was to explore the fetal origins of OA and provide insights into early-life safeguarding for individual health. This study utilized streptozotocin to induce intrauterine hyperglycemia and performed destabilization of the medial meniscus surgery on the knee joints of the offspring mice to induce accelerated OA. Cartilage degeneration-related markers, as well as the expression levels of mitochondrial respiratory chain complexes and mitophagy genes in the adult offspring mice, were investigated. In vitro, mitochondrial function and mitophagy of chondrocyte C28/I2 cells stimulated under high glucose conditions were also evaluated. The methylation levels of the sirt3 gene promoter region in the articular cartilage of intrauterine hyperglycemia-exposed offspring mice were further analyzed. In this study, we found that the intrauterine hyperglycemic environment could lead to an increase in individual susceptibility to OA in late adulthood, mainly due to persistently low levels of Sirt3 expression. Downregulation of Sirt3 causes impaired mitophagy in chondrocytes and abnormal mitochondrial respiratory function due to a failure to clear aged and damaged mitochondria in a timely manner. Overexpressing Sirt3 at the cellular level or using Sirt3 agonists like Honokiol in mouse models can partially rescue mitophagy disorders caused by the hyperglycemic environment and thus alleviate the progression of OA. Our study revealed a significantly increased susceptibility to OA in the gestational diabetes mellitus offspring, which is partly attributed to exposure to adverse factors in utero and ultimately to the onset of disease via epigenetic modulation.

Assessment of Left Lung Remodeling With Magnetic Resonance Imaging in a Murine Model Following Exposure to Douglas Fir Smoke.

Wildland firefighters (WLFFs) experience lung function decline due to occupational exposure to fire smoke. WLFFs typically do not wear respiratory personal protective equipment, and if they do, it is a simple bandana, which is not effective at filtering smoke. To pinpoint the biological underpinnings of abnormal respiratory function following 3-7 years of WLFF service, we exposed mice to Douglas fir smoke (DFS) over 8 weeks. Following exposure, we assessed changes in lung structure through Magnetic Resonance Imaging (MRI) and histological analysis, which was supported by immunohistochemistry staining. With MRI, we found that the signal decay time, T2*, from ultrashort echo time (UTE) images was significantly shorter in mice exposed to DFS compared to air controls. In addition, the variation in T2* was more heterogeneously distributed throughout the left lung in DFS-exposed mice, compared to air controls. As confirmed by histological analysis, shorter T2* was caused by larger parenchyma airspace sizes and not fibrotic remodeling. Destruction of the alveolar spaces was likely due to inflammation, as measured by an influx of CD68+ macrophages and destruction due to enhanced neutrophil elastase. In addition, measurements of airspace dimensions from histology were more heterogeneously distributed throughout the lung, corroborating the enhanced relative dispersion of T2*. Findings from this study suggest that the decline in lung function observed in WLFFs may be due to emphysema-like changes in the lung, which can be quantified with MRI.

Relationships of Severity of Bronchopulmonary Dysplasia with Adverse Neurodevelopmental Outcomes and Poor Respiratory Function at 7-8 Years of Age

ObjectiveTo clarify the relationships of three definitions of severity of bronchopulmonary dysplasia (BPD) with adverse neurodevelopmental and respiratory outcomes at early school-age. Study designParticipants comprised 218 consecutive survivors to 7-8 years of age born either <28 weeks’ gestation or weighing <1000 g in Victoria, Australia, in 2005. BPD was classified as none, Grade 1 (mild), Grade 2 (moderate), or Grade 3 (severe), using two commonly accepted definitions: 1) Jobe2001, and 2) Higgins2018, and our own 3) VICS2005, adapted from Jensen2019. Outcomes included major neurodevelopmental disability, low intelligence quotient and academic achievement, poor motor function, and poor respiratory function as assessed by spirometry. Outcomes for children with each grade of BPD were compared with children with no BPD. ResultsOf the 218 survivors, 132 (61%) had BPD on Jobe2001 criteria, and 113 (52%) had BPD on both Higgins2018 and VICS2005 criteria. Grade 1 on any criteria was not associated with any adverse neurodevelopmental outcomes. Grade 1 on both Higgins2018 and VICS2005 was associated with reduced spirometry. Grade 2 on both Higgins2018 and VICS2005, and Grade 3 on all criteria were associated with increased risk for both adverse neurodevelopmental and respiratory outcomes. ConclusionsCompared with no BPD, receiving additional oxygen up to 29% but no positive pressure support at 36 weeks’ postmenstrual age increased the risk of abnormal respiratory function but not adverse neurodevelopment. Receiving ≥30% oxygen or any positive pressure support at 36 weeks increased the risk of both adverse outcomes.

Quality of Life and Emotional Problems of COVID-19 Patients after Discharge: A One-Month Longitudinal Study.

The first coronavirus disease 2019 (COVID-19) outbreak in Taiwan occurred in May 2021 and many individuals were infected. All COVID-19 patients were quarantined in designated facilities until they fully recovered to prevent the spread of the disease. Prolonged quarantine could adversely affect these patients. In this study, we focused on investigating changes in the quality of life and mental health of individuals discharged from hospital after recovering from COVID-19. This study employed a longitudinal design and surveyed individuals discharged from a teaching hospital in northern Taiwan in 2021 within one week of their discharge and again after one month. An online questionnaire comprising the participants' background, respiratory function (COPD Assessment Test), quality of life (WHOQoL-BREF), and emotional problems (DASS-21) was administered to the participants. A total of 56 participants actively took part in both surveys. We observed that participants with abnormal respiratory function had a lower physical and psychological quality of life, especially those with severe symptoms requiring endotracheal intubation during the treatment period of COVID-19. Additionally, approximately 30% of participants experienced anxiety problems throughout this study period. Finally, patients with COVID-19 symptoms exhibited a lower quality of life and higher levels of severe emotional problems. According to our findings, it is necessary to monitor and provide appropriate interventions for individuals who have recovered from COVID-19, especially those who experienced severe symptoms that required endotracheal intubation during COVID-19 treatment. These interventions, such as symptom management and psychological support, can help improve their quality of life and reduce emotional problems. Therefore, after the participants are discharged, hospitals should regularly track the patients' status and provide appropriate support or referrals to help these individuals. Otherwise, future research could include more participants and follow up with them for longer to investigate the longitudinal impact of COVID-19.

Variations in respiratory and functional symptoms at four months after hospitalisation due to COVID-19: a cross-sectional study

BackgroundMuch remains unknown about complex respiratory symptoms after COVID-19. Here we aimed to describe and analyse patients’ various respiratory symptoms 4 months after discharge from hospitalisation for COVID-19, focusing on sex, previous pulmonary disease, and prolonged mechanical ventilation.MethodsThis cross-sectional study involved five hospitals and included 52 patients with self-assessed respiratory dysfunction at 4 months after discharge from hospitalisation for severe COVID-19. Their average age was 63 years, 38% were women, 15 had a previous diagnosed pulmonary disease, and 29 were current or previous smokers. Additionally, 31 had required intensive care—among whom 21 were intubated and 11 needed mechanical ventilation for ≥20 days. Respiratory function was tested concerning lung volumes, expiratory flow, muscle strength, physical capacity (including concurrent oxygen saturation), thoracic expansion, and respiratory movements.ResultsAmong 52 patients, 47 (90%) had one or several objectively measured respiratory function abnormalities. Decreased thoracic expansion was observed in 32 patients (62%), abnormal respiratory movements in 30 (58%), decreased vital capacity in 21 (40%), low physical function in 13 (26%), and desaturation during the test in 9 (17%). Respiratory inspiratory muscle strength was more commonly diminished than expiratory strength (27% vs. 8%). We did not observe differences between men and women, or between patients with versus without diagnosed pulmonary disease, except that those with pulmonary disease had significantly lower physical capacity assessed with 6MWD (70% vs. 88% predicted, p = 0.013). Compared to those who did not, patients who required ≥20 days of mechanical ventilation performed similarly on most tests, except that all thoracic breathing movements were significantly smaller (p < 0.05). The numbers and combinations of abnormal findings varied widely, without clear patterns.ConclusionPatients with remaining respiratory symptoms 4 months after discharge from hospitalization due to COVID-19 may suffer from various abnormal breathing functions, and dysfunctional breathing that is not detected using traditional measurements. These patients may benefit from multidimensional measuring of breathing movement, thoracic expansion, and respiratory muscle strength, along with traditional measurements, to assess their symptoms and enable prescription of optimal treatment interventions and rehabilitation.Trial registrationFoU i Sverige (Research & Development in Sweden, Registration number: 274476, registered 2020-05-28).

Clinical implications of respiratory ciliary dysfunction in heterotaxy patients with congenital heart disease: elevated risk of postoperative airway complications.

Cardiac surgery in Congenital Heart Disease-Heterotaxy (CHD-HTX) patients often leads to increased postoperative airway complications. Abnormal respiratory ciliary function, resembling primary ciliary dyskinesia, has been observed. We expanded the sample size by retrospectively reviewing Ciliary Dysfunction (CD) in CHD-HTX patients to verify the increased risk of post-surgical respiratory complications. We conducted a retrospective review of 69 CHD-HTX patients undergoing cardiac surgery, assessing abnormal respiratory function using nasal nitric oxide (nNO) levels and nasal ciliary motion observed in video microscopy. Data collected included demographics, surgical details, postoperative complications, length of stay, ICU hours, salvage procedures, intubation duration, and mortality. The CD and no-CD cohorts exhibited notable similarities in risk adjustment in Congenital Heart Surgery-1 (RACHS-1) risk categories, age at the time of surgery, and the duration of follow-up evaluations. We observed a trend toward an increased length of post-operative stay in the CD group (15.0 vs. 14.0; P = 0.0017). CHD-HTX patients with CD showed significantly higher rates of respiratory complications (70% vs. 44.4%; P = 0.008). There were no notable variances observed in postoperative hospitalization duration, mechanical ventilation period, or surgical mortality. Our findings suggest that CHD-HTX patients with CD may face an elevated risk of respiratory complications. These results offer guidance for perioperative management and serve as a reference for further pathological studies.

Traffic-Related Air Pollution (TRAP) in relation to respiratory symptoms and lung function of school-aged children in Kuala Lumpur

ABSTRACT Traffic-Related Air Pollution (TRAP) exposure has been connected to significant health impacts among children. A cross-sectional comparative study was conducted among school children in Malaysia to determine the relationship between their exposure to TRAP and respiratory health effects. Air monitoring was conducted in schools and residences, while the children’s routines were investigated using a diary of daily activities. Respondents’ background and respiratory symptoms were obtained from a validated questionnaire, while a spirometry test was performed to determine their lung function status. The distances between schools and residences from the had contributed to the higher concentration of air pollutants in this study, which had associations with the children’s respiratory symptoms and lung function status. PM2.5 was the main predictor influencing the respondents’ respiratory symptoms and lung function abnormalities. In conclusion, exposure of school children to a high TRAP level might increase their risk of getting respiratory symptoms and lung function reduction.

Application of machine learning model based on XGBoost algorithm in early prediction of patients with acute severe pancreatitis

To establish a machine learning model based on extreme gradient boosting (XGBoost) algorithm for early prediction of severe acute pancreatitis (SAP), and explore its predictive efficiency. A retrospective cohort study was conducted. The patients with acute pancreatitis (AP) who admitted to the First Affiliated Hospital of Soochow University, the Second Affiliated Hospital of Soochow University and Changshu Hospital Affiliated to Soochow University from January 1, 2020 to December 31, 2021 were enrolled. Demography information, etiology, past history, and clinical indicators and imaging data within 48 hours of admission were collected according to the medical record system and image system, and the modified CT severity index (MCTSI), Ranson score, bedside index for severity in acute pancreatitis (BISAP) and acute pancreatitis risk score (SABP) were calculated. The data sets of the First Affiliated Hospital of Soochow University and Changshu Hospital Affiliated to Soochow University were randomly divided into training set and validation set according to 8 : 2. Based on XGBoost algorithm, the SAP prediction model was constructed on the basis of hyperparameter adjustment by 5-fold cross validation and loss function. The data set of the Second Affiliated Hospital of Soochow University was served as independent test set. The predictive efficacy of the XGBoost model was evaluated by drawing the receiver operator characteristic curve (ROC curve), and compared it with the traditional AP related severity score; variable importance ranking diagram and Shapley additive explanation (SHAP) diagram were drawn to visually explain the model. A total of 1 183 AP patients were enrolled finally, of which 129 (10.9%) developed SAP. Among the patients from the First Affiliated Hospital of Soochow University and Changshu Hospital Affiliated to Soochow University, there were 786 patients in the training set and 197 in the validation set; 200 patients from the Second Affiliated Hospital of Soochow University were used as the test set. Analysis of all three datasets showed that patients who advanced to SAP exhibited pathological manifestation such as abnormal respiratory function, coagulation function, liver and kidney function, and lipid metabolism. Based on the XGBoost algorithm, an SAP prediction model was constructed, and ROC curve analysis showed that the accuracy for prediction of SAP reached 0.830, the area under the ROC curve (AUC) was 0.927, which was significantly improved compared with the traditional scoring systems including MCTSI, Ranson, BISAP and SABP, the accuracy was 0.610, 0.690, 0.763, 0.625, and the AUC was 0.689, 0.631, 0.875, and 0.770, respectively. The feature importance analysis based on the XGBoost model showed that the top ten items ranked by the importance of model features were admission pleural effusion (0.119), albumin (Alb, 0.049), triglycerides (TG, 0.036), Ca2+ (0.034), prothrombin time (PT, 0.031), systemic inflammatory response syndrome (SIRS, 0.031), C-reactive protein (CRP, 0.031), platelet count (PLT, 0.030), lactate dehydrogenase (LDH, 0.029), and alkaline phosphatase (ALP, 0.028). The above indicators were of great significance for the XGBoost model to predict SAP. The SHAP contribution analysis based on the XGBoost model showed that the risk of SAP increased significantly when patients had pleural effusion and decreased Alb. A SAP prediction scoring system was established based on the machine automatic learning XGBoost algorithm, which can predict the SAP risk of patients within 48 hours of admission with good accuracy.

Prevalence of pulmonary function abnormalities in type 2 diabetes mellitus and its association with HbA1c in nonsmokers

Background: Diabetes mellitus is a chronic metabolic disorder with vast social and economic consequences an ageing population and obesity due to sedentary lifestyle are one of the foremost reasons for the development of type 2 diabetes mellitus. Aim of the current study was to ascertain the burden of respiratory function abnormalities in type 2 diabetic subjects and its correlation with symptom and hba1c in non-smokers. Methods: This cross-sectional study was conducted in KPC medical college, Jadavpur. Patients of type 2 diabetes mellitus between the age of 30-80 years fulfilling the modified Borg dyspnoea scale were included after excluding heart failure, COPD, musculoskeletal disorders. The selected subjects were then subjected to a PFT with reversibility and DLCO assessment Pattern of PFT abnormality recorded. Total of 65 subjects were chosen for the study. Results: In our study most of the patients had Restrictive abnormality Female 24 (42.9%) and male 32 (57.1%). Rest 3 (50.0%) Female patients and 3 (50.0%) male patients had Mixed abnormality. 2 (66.7%) female patients and 1 (33.3%) male patient had normal abnormality which was not statistically significant (p=0.6939). Conclusions: Pulmonary function is reduced in type 2 diabetes. Diabetes duration seems a more important influence than glycaemic control, but the definitive direction as well as the exact pathophysiological mechanism to explain this association requires further investigation.

Pulmonary Involvement in Neuromuscular Diseases: A Review.

Neuromuscular diseases (NMDs) affect muscle function directly or indirectly by affecting nerves or neuromuscular junctions. One of the leading causes of death in patients with NMD is respiratory muscle weakness (RMW). Respiratory involvement in patients with NMD can manifest widely, from mild failure that may initially affect only sleep to severe failure that can be life-threatening. Care approaches include arranged and precise clinical follow-ups of signs of sleep-disordered breathing, daytime hypoventilation, coughing, and swallowing disturbances. This manuscript will review the mechanisms and abnormalities of respiratory function in patients with NMD and help optimize NMD management.

Persistent respiratory symptoms and lung function abnormalities in recovered patients of COVID-19.

COVID-19 is a disease caused by SARS-CoV-2 which belongs to a family of coronaviruses. After the acute phase of illness, the majority of the patients recover quickly but, in some cases, symptoms can persist for a variable duration, bringing into light another entity known as post-COVID syndrome. The objective was to estimate the burden of various persistent respiratory symptoms and lung function abnormalities among recovered patients of COVID-19 and also to correlate them with initial disease severity, demographic factors and comorbidities. Eighty-five post-COVID patients were recruited as per inclusion/exclusion criteria. Detailed history taking, physical examination and spirometry were done in all patients and data were correlated with baseline disease severity. Fatigue and breathlessness were the most common symptoms followed by cough, chest pain and fever. Persistent symptoms and their severity were significantly higher in severe/moderate cases. Spirometry was abnormal in 45.88% of subjects and the most common pattern was restrictive type. It was seen that the likelihood of persistent symptoms and abnormal lung function increased significantly with the severity of COVID-19, age, comorbidities, hospital stay duration and steroid/oxygen therapy. The current study estimated the burden and array of various pulmonary sequelae encountered by post-COVID patients and elicited various risk factors associated with their occurrence after recovery from active infection. Awareness of these symptoms/sequelae and their risk factors is necessary for their follow-up and timely management, as the threat of this relatively new virus has still not abated.

Respiratory morbidity in Schistosoma mansoni infection: a rapid review of literature.

Schistosomiasis contributes to 2.5 million disability-adjusted life years globally. Acute and chronic respiratory morbidity of Schistosoma mansoni (S. mansoni) is poorly documented in the literature. We conducted a rapid literature review of the burden of respiratory symptoms and lung function abnormalities among patients with S. mansoni. We also report the immunologic and lung imaging findings from the studies reviewed. We carried out a comprehensive literature search in Embase and MEDLINE from the inception of the databases to 13th March 2023. A total of 2243 patients with S. mansoni were reported from 24 case reports, 11 cross-sectional studies, 7 case series, 2 cohort studies and 2 randomized controlled trials. The prevalence of any respiratory symptom was 13.3-63.3% (total number of patients studied, n = 149). The prevalence of the individual symptoms among patients with S. mansoni in whom respiratory symptoms were sought for was as follows: cough (8.3-80.6%, n = 338), dyspnea (1.7-100.0%, n = 200), chest pain (9.0-57.1%, n = 86), sputum production (20.0-23.3%, n = 30) and wheezing (0.0 - 20.0%, n = 1396). The frequency of the symptoms tended to be higher in acute schistosomiasis. Restrictive lung disease was prevalent in 29.0% (9/31). The commonest chest imaging findings reported were nodules (20-90%, n = 103) and interstitial infiltrates (12.5-23.0%, n = 89). Peripheral blood eosinophilia was prevalent in 72.0-100.0% of patients (n = 130) with acute schistosomiasis and correlated with symptoms and imaging abnormalities. Three case reports in chronic S. mansoni reported elevated C-reactive protein, leucocyte, neutrophil and absolute eosinophil counts, eosinophil percentage, IgE and IgG4. There is a high prevalence of respiratory morbidity among patients with S. mansoni, particularly in the acute stage of the infection, although the studies are relatively small. Larger studies are needed to characterize respiratory morbidity in chronic schistosomiasis and determine the underlying clinical and immunological mechanisms.

1076. The Role of Bronchoalveolar Lavage in COVID-19 Diagnoses and Management

Abstract Background In the diagnosis of SARS-COV-2, upper respiratory tract specimens are primarily used for PCR testing. This study aims to evaluate the clinical and diagnostic role of bronchoalveolar lavage (BAL) in diagnosing and managing COVID-19. Methods Patients admitted to Keck Medical Center (Los Angeles, CA) during March 2020-May 2021 who had SARS-CoV-2 PCR tested on both nasopharyngeal swab (NPS) and BAL specimens (QIAGEN QIAstat-Dx RP) were included. Four patient groups were designated by PCR results: (A) NPS+/BAL+ (n=34), (B) NPS+/BAL- (n=26), (C) NPS-/BAL+ (n=5), (D) NPS-/BAL- (n=89). Clinical and laboratory data were retrospectively reviewed. Statistical analysis included the use of one-way ANOVA with Tukey HSD and Fisher’s exact test. Results 154 inpatients had NPS and BAL tested for SARS-CoV-2 RNA (mean age 55.1 y, 59.6% male). BAL was performed mainly to further assess abnormal respiratory function (n=43) or chest imaging findings (n=27), or for COVID-19 work-up (n=17). Mean turnaround time for BAL PCR was 4 h 5 min. Ct values, available on 28 BAL+ samples, did not significantly differ between patients who died (mean Ct 29.9, n=18) vs. survived (mean Ct 28.7, n=10). Time from symptom onset to BAL was significantly longer in Group B (34.2 d) vs. D (13.7 d, p&amp;lt; 0.01) or C (12.8 d, p&amp;lt; 0.05) but not vs. A (23.9 d). Groups did not differ significantly in patient comorbidities, mortality, length of hospital stay, or immunosuppressive status. SARS-CoV-2 NPS+/BAL+ patients were more likely to have diffuse or bilateral chest radiographic opacities (p&amp;lt; 0.01), respiratory culture with Aspergillus spp. (p&amp;lt; 0.05), and ARDS diagnosis than those who were NPS+/BAL- (p&amp;lt; 0.01). Conclusion BALs were an important specimen source for the detection of SARS-CoV-2 in the lower respiratory tract particularly when NPS at admission was PCR-negative and for ruling out COVID-19 pneumonia as a cause of abnormal pulmonary findings or declining respiratory status. BAL positivity for SARS-CoV-2 RNA was associated with higher frequency of diffuse or bilateral opacities on CXR, culture recovery of Aspergillus spp., and ARDS. Ct values of BAL+ samples did not predict mortality though sample size was limited. Further studies on the role of viral detection in BALs in patient management and prognosis are warranted. Disclosures All Authors: No reported disclosures.

A combined therapy for the repair of alar defects that consists of a modified spiral flap and postoperative nasal stent

BackgroundThe repair of alar defects is challenging in clinics. Although skin grafts and nasolabial flaps are reliable, they can cause secondary post-surgical deformities. MethodsIn this report, we describe an alar spiral advancement flap with a subcutaneous pedicle combined with postoperative nasal stent therapy for the repair of alar defects. ResultsAll cases showed slight asymmetry immediately after surgery, but at a median follow-up of 24 months, no cases of dissatisfaction with the nose shape or abnormal respiratory function were found. Almost all incision scars subsided within 12 months. In addition, all flaps that were dissected and rotated during the surgeries healed, and no signs of necrosis or development of vascular compromise were observed. ConclusionOur preliminary experience suggests that the alar spiral flap followed by nasal stent therapy provides stable recovery of appearance and function for alar defects during follow-ups and shows promise for future therapies.

Respiratory function and CT abnormalities among survivors of COVID-19 pneumonia: a nationwide follow-up study

IntroductionConsidering the pulmonary burden caused by acute COVID-19, questions remain of respiratory consequences after recovery. The aim of the study was to describe respiratory function of COVID-19 pneumonia survivors at...

Cardiopulmonary testing in adult patients with β-thalassemia major in comparison to healthy subjects

β-Thalassemia patients often have a reduced capacity of exercise and abnormal respiratory function parameters, but the reasons are unclear. In order to identify the causes of the exercise limitation, we performed a cardiopulmonary exercise testing (CPET) in a group of 54 adult β-thalassemia major (TM) patients without pulmonary arterial hypertension and in a group of healthy control subjects. All subjects underwent cardiac echocardiography and carried out pulmonary function tests. TM patients also filled an IPAQ questionnaire on usual physical activity (PA).Overall, TM patients have a diminished exercise performance in comparison to control subjects. In fact, peak oxygen uptake (V’O2 peak), expressing maximum exercise capacity, was decreased in 81.5% of the patients; similarly, anaerobic threshold (V’O2@AT) and O2 pulse also resulted lowered. In multivariable regression models adjusted for gender, age, BMI, and mean haemoglobin, V’O2 peak and O2 pulse were positively associated with cardiac iron overload (T2*). No ventilatory limitation to exercise was observed. The most important causes of exercise limitation in these patients were muscular deconditioning and reduced cardiac inotropism due to iron deposition. Only 15/54 (27.8%) TM patients used to perform vigorous physical activity. These results suggest that a program of regular physical activity may be useful to increase the tolerance to effort and therefore to improve the quality of life in these patients.

A Comparison Of Critical Power And Respiratory Compensation Point In COPD: Coincidence Or Equivalence?

Power output at the respiratory compensation point (RCP), measured as the breakpoint in the linear ventilation-carbon dioxide output (V̇E-V̇CO2) relationship during ramp-incremental exercise, is proposed to be equivalent to critical power (CP): the asymptote of the hyperbolic power-duration relationship (P-tLIM). For RCP to be used as a valid index of CP, their values should remain equivalent, even under pulmonary mechanical constraint (e.g., in patients with chronic obstructive pulmonary disease [COPD]). PURPOSE: To determine power output (W) and oxygen uptake (V̇O2) at RCP and CP measured using gold-standard protocols in patients with COPD. METHODS: Ten COPD patients (4 female) volunteered (FEV1 = 41 ± 16% predicted). Power output and V̇O2 at gas exchange threshold (GET) and RCP were measured during ramp-incremental cycle ergometry (5-10 W/min). Critical power was estimated from the asymptote of the hyperbolic P-tLIM relationship from 3-4 constant power exercise tests. Oxygen uptake was measured at 15 and 20 min of a constant power ride at CP. RESULTS: Gas exchange threshold was observed in 9/10 patients and occurred at a V̇O2 of 0.91 ± 0.19 L/min (71 ± 28% V̇O2peak). Respiratory compensation point was identified in 1/10 patients and occurred at a V̇O2 of 1.57 L/min (87% V̇O2peak) versus 1.45 L/min at CP (90 W vs. 67 W, respectively). At intolerance, group mean V̇O2peak was 1.15 ± 0.34 L/min and V̇Epeak was 42.7 ± 20.0 L/min (90 ± 15% of estimated MVV). Ramp-incremental V̇O2peak was not different to that obtained in the 3-4 tests used to characterize the P-tLIM relationship (p = 0.419) and with no differences among tests (p = 0.102; mean V̇O2peak = 1.17 ± 0.32 L/min). Critical power was 37 ± 17 W. In the 9/10 patients who completed the 20 min CP validation ride, V̇O2 reached a steady-state (no difference in values at 15 vs. 20 min; p = 0.47) and was calculated as 1.02 ± 0.27 L/min (90 ± 7 % of ramp-incremental V̇O2peak). CONCLUSIONS: CP was identified in all COPD patients, and the steady-state V̇O2 at CP was sub-maximal. The absence of RCP in 9/10 patients, despite exercise gas-exchange responses consistent with a metabolic acidosis, shows that RCP and CP do not occur at equivalent power output or V̇O2 under conditions of abnormal metabolic, respiratory, and/or ventilatory function. RCP should not be used as a valid surrogate for CP.

Hydrocortisone to Improve Survival Without Bronchopulmonary Dysplasia

(N Engl J Med. 2022;386:1121–1131) The diagnosis of bronchopulmonary dysplasia (BPD) in extremely preterm infants portends potentially abnormal growth, neurodevelopment, and respiratory function. This prevalent condition affects half of extreme preterm birth survivors and likely has a multiplicity of causes: prematurity, oxygen exposure, mechanical ventilation, and inflammatory processes. Dexamethasone was previously widely used until adverse neurological effects including cerebral palsy and cognitive impairment became apparent in the patient population later in life. Despite these complications, many extremely premature infants continue to receive dexamethasone therapy for BPD. Hydrocortisone, another steroid, when administered to extremely premature neonates has produced advantageous characteristics and has shown promising test results in neonates who are developing BPD. Administration of hydrocortisone showed mitigating effects on neonatal inflammation and decreased adverse neurodevelopmental effects. This extended trial, beginning in 2011, investigates the efficacy of high-dose hydrocortisone treatment at improving life expectancy without BPD by monitoring for severe neurodevelopmental disorder through 22 to 26 months.

Experienced Respiratory Symptoms and the Impact on Daily Life from the Perspective of People with Parkinson's Disease: A Grounded Theory.

Background:Abnormal respiratory function tests can be observed early in the course of Parkinson’s disease (PD). A better understanding of the impact of respiratory dysfunction on daily life in PD is needed to prevent later occurring complications as a (aspiration) pneumonia.Objective:To explain which respiratory symptoms people with PD or a form of atypical parkinsonism experience and how these symptoms impact on their daily lives.Methods:This qualitative study used a grounded theory approach. A purposeful sample strategy was used to capture information-rich cases. Data were collected in semi-structured interviews with participants diagnosed with either PD (n = 11) or atypical parkinsonism (n = 3), all of whom had confirmed respiratory symptoms. Data were analyzed using grounded theory analysis by creating codes, categories, theoretical themes, and, ultimately, a conceptual model.Results:Four respiratory profiles emerged, describing different types of respiratory dysfunction, with various positive and negative influencing factors. First, a loss of breathing automatism was experienced. Second, episodes of breathlessness or a rapid, shallow breathing pattern were triggered by either physical exertion, fatigue, or postural deformities. Third, stress and anxiety also triggered episodes of breathlessness. Fourth, a decreased cough strength and frequent coughing. Based on these findings, we constructed a conceptual model that visualizes the relations between these four types of respiratory dysfunction and their impact on daily life, with ‘discomfort’ and ‘avoidance of social activities’ as crucial elements.Conclusion:A tailored approach for each profile of respiratory dysfunction is recommended to improve respiratory dysfunction and to reduce its social impact in people with PD.