Altered Pulmonary Function Research Articles

Effect of Losartan and Atenolol on Lung Function Status in Newly Diagnosed Essential Hypertensive Patients

Introduction: Essential hypertension is associated with altered pulmonary function. Antihypertensive medication and lung function are also associated. Losartan (angiotensin II receptor blocker) and atenolol (beta blocker) are commonly used antihypertensive drugs.Objective: To evaluate the effects of antihypertensive drugs on lung function status in patients with essential hypertension.Methods: This prospective observational study was carried out in the Department of Physiology of Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka, from July 2012 to June 2013 on 100 newly diagnosed essential hypertensive patients who had not received any antihypertensive medications. They were selected from the Out Patient Department (OPD) of Cardiology unit, BSMMU, Dhaka. The study sbujects of age between 30-55 were allocated in group B. Based on prescribed treatment, these study subjects were divided into two groups - B1 and B2. B1 included 50 patients who received losartan 50mg daily and B2 included 50 patients who received atenolol 50mg daily. Again basing on duration of treatment group B1 was divided into B1a (newly diagnosed hypertensive patients before treatment), B1b (after 3 months of medication with losartan) and B1c (after 6 months medication with losartan). Similarly group B2 was divided into B2a, B2b, and B2c. For assessing lung function status, FVC, FEV1 and PEFR were measured with acomputer based Spirometer. Age, sex and BMI matched 50 apparently healthy normotensive subjects were also studied as control (group A). Data were compared among subjects of different groups. For statistical analysis independent sample ‘t’ test and paired sample ‘t’ test were performed.Results: Mean systolic blood pressure and diastolic blood pressure were significantly higher and mean FVC, FEV1 and PEFR were significantly lower in newly diagnosed hypertensive patients in comparison with that of healthy normotensive subjects. Mean FVC and FEV1 were found significantly higher in the group taking losartan for 6 months when compared to newly diagnosed hypertensive patients but lower than those of controls. In addition, mean FVC and FEV1 were found significantly lower in the group taking atenolol for 6 months when compared to newly diagnosed hypertensive patients and those of controls.Conclusion: Reduced lung function occurs in newly diagnosed essential hypertensive patients which improves by treatment with losartan but decreases after treatment with atenolol.Journal of Armed Forces Medical College Bangladesh Vol.10(2) 2014

Side-stream tobacco smoke-induced airway hyperresponsiveness in early postnatal period is involved nerve growth factor

Epidemiological studies have shown that children are more susceptible to adverse respiratory effects of passive smoking than adults. The goal of this study is to elucidate the possible neural mechanism induced by exposure to passive smoking during early life. Postnatal day (PD) 2 and PD 21mice were exposed to side-stream tobacco smoke (SS), a surrogate to secondhand smoke, or filtered air (FA) for 10 consecutive days. Pulmonary function, substance P (SP) airway innervation, neurotrophin gene expression in lung and nerve growth factor (NGF) release in bronchoalveolar lavage (BAL) fluid were measured at different times after the last SS or FA exposure. Exposure to SS significantly altered pulmonary function in PD2, accompanied with an enhanced SP innervation in airway. However, exposure to SS during the later developmental period (PD21) did not appear to affect pulmonary function and SP innervation of the airways. Interestingly, SS exposure in PD2 group significantly induced an increased gene expression on NGF, and decreased NGF receptor P75 in lung; parallel with high levels of NGF protein in BAL. Furthermore, pretreatment with NGF antibody significantly diminished SS-induced airway hyperresponsivenss and the increased SP airway innervation in the PD2 group. These findings suggest that enhanced NGF released in the lung contributes to SS-enhanced SP tracheal innervation and airway responsiveness in early life.

Abnormalities in pulmonary function in infants with high-risk congenital diaphragmatic hernia.

The aim of the study was to analyze lung growth and abnormality of infant pulmonary function tests (IPFT) in congenital diaphragmatic hernia (CDH) survivors younger than three years of age with respect to unfavorable prognostic factors. Thirty high-risk CDH survivors at the age of 1.32±0.54 years, body weight 9.76±1.25 kg were examined using IPFT: tidal breathing analysis, baby resistance/compliance, whole baby body plethysmography and rapid thoraco-abdominal compression. Gore-Tex patch was used in 13% of patients (GORE group). Pulmonary hypertension was diagnosed and managed in 13% (iNO group). Standard protocols and appropriate reference values were used and obtained data were statistically analysed. High incidence of peripheral airway obstruction (70%), increased value of functional residual capacity (FRCp) 191.3±24.5 mL (126.5±36.9 % predicted; P < 0.0005), increased value of effective airway resistance (Reff) 1.71±0.93 kPa.L(-1).s (144.4±80.1 % predicted; P < 0.01) and decreased specific compliance of the respiratory system (Crs/kg) 14.1±2.3 mL.kPa.kg(-1) (i.e., 76.1±20.1 % predicted, P < 0.0005) was noted in infants with CDH in comparison with reference values. Increased value of FRCp was found in GORE group (165.7±51.9 versus 120.4±31.2, P < 0.02) and in iNO group (183.1±52.6 versus 117.8±25.7 mL; P < 0.0005). A high incidence of peripheral airway obstruction, an increased value of FRCp and decreased specific compliance of the respiratory system was noted in infants with CDH. Unfavorable prognostic factors (Gore-Tex patch, pulmonary hypertension) correlate with more severe alteration of pulmonary function in infants.

Ticagrelor-induced dyspnoea

Background Ticagrelor, a reversible P2Y12 receptor antagonist, is superior to clopidogrel in decreasing major adverse cardiac events in the setting of acute coronary syndrome. However, a high rate of drug discontinuation secondary to ticagrelor-induced dyspnoea has been observed. Clinical details This is a case of persistent and intolerable ticagrelor-induced dyspnoea in a patient requiring drug discontinuation. A review of the literature on the plausible mechanisms is also provided. Conclusion Dyspnoea is a relatively common side effect of ticagrelor, usually mild and not associated with alteration in pulmonary function. However, in cases of persistent and intolerable dyspnoea, drug discontinuation should be considered. It is imperative that healthcare professionals regularly monitor patients receiving ticagrelor therapy with the aims of maintaining medication adherence and providing appropriate alternatives if dyspnoea becomes intolerable.

The dose–response association of urinary metals with altered pulmonary function and risks of restrictive and obstructive lung diseases: a population-based study in China

ObjectiveReduced pulmonary function is an important predictor of environment-related pulmonary diseases; however, evidence of an association between exposures to various metals from all possible routes and altered pulmonary function is...

Lung function profiles and aerobic capacity of adult cigarette and hookah smokers after 12 weeks intermittent training

IntroductionPulmonary function is compromised in most smokers. Yet it is unknown whether exercise training improves pulmonary function and aerobic capacity in cigarette and hookah smokers and whether these smokers respond in a similar way as do non-smokers.AimTo evaluate the effects of an interval exercise training program on pulmonary function and aerobic capacity in cigarette and hookah smokers.MethodsTwelve cigarette smokers, 10 hookah smokers, and 11 non-smokers participated in our exercise program. All subjects performed 30 min of interval exercise (2 min of work followed by 1 min of rest) three times a week for 12 weeks at an intensity estimated at 70% of the subject's maximum aerobic capacity (). Pulmonary function was measured using spirometry, and maximum aerobic capacity was assessed by maximal exercise testing on a treadmill before the beginning and at the end of the exercise training program.ResultsAs expected, prior to the exercise intervention, the cigarette and hookah smokers had significantly lower pulmonary function than the non-smokers. The 12-week exercise training program did not significantly affect lung function as assessed by spirometry in the non-smoker group. However, it significantly increased both forced expiratory volume in 1 second and peak expiratory flow (PEF) in the cigarette smoker group, and PEF in the hookah smoker group. Our training program had its most notable impact on the cardiopulmonary system of smokers. In the non-smoker and cigarette smoker groups, the training program significantly improved (4.4 and 4.7%, respectively), v (6.7 and 5.6%, respectively), and the recovery index (7.9 and 10.5%, respectively).ConclusionsAfter 12 weeks of interval training program, the increase of and the decrease of recovery index and resting heart rate in the smoking subjects indicated better exercise tolerance. Although the intermittent training program altered pulmonary function only partially, both aerobic capacity and life quality were improved. Intermittent training should be advised in the clinical setting for subjects with adverse health behaviors.

The clinical application value of dual source CT quantification volume imaging to forecast lung cancer patients' postoperative pulmonary function changing: a prospective study

To probe the clinical application and value of dual source CT quantification volume imaging to forecast lung cancer patients' postoperative pulmonary function changing. Between June 2012 and June 2013, there were 233 patients (121 male patients and 112 female patients, with a mean age of (53 ± 16) years) who accepted the thoracoscope lobectomy or unilateral holo-lungs pneumonectomy accepted pulmonary function test before and after 3 months of the surgery. CT scan was conducted at both inspiration phase and expiration phase before the surgery and the lung volume of the single lobe, the pixel exponential distribution histogram, and the average lung density were measured after CT scan. The discrepancy and correlation between the preoperative lung volume accepted by CT and preoperative, postoperative pulmonary function index were compared. The CT volume scan showed that average lung density of the superior part at decubitus position is -(870 ± 22) HU, the inferior part was -(767 ± 16) HU (t = 3.13, P < 0.01). The volume ratio of the right upper lobe, right middle lobe, right lower lobe, left upper lobe, left lower lobe were 20.5%, 10.3%, 23.1%, 24.6%, 21.5%, whole-right lung was 53.9% and whole-left was 46.1%. There were high correlation between CT volume index and preoperative routine pulmonary function index such as total lung capacity, forced vital capacity (FVC), forced expiratory volume in the first second (FEV(1)), residual volume, and FEV(1)/FVC. The highest correlation coefficient were 0.92, 0.76, 0.70, 0.85, 0.56 (t = 3.14, 3.05, 2.86, 3.09, 2.68; all P < 0.01). The highest correlation coefficient for the postoperative pulmonary function index were 0.87, 0.68, 0.75, 0.81, -0.64 (t = 3.10, 2.85, 3.05, 3.02, 2.79; all P < 0.01). It is feasible to use dual source CT quantification volume imaging to predict lung cancer patients' postoperative pulmonary function alteration, which can provide precise predictive value of these patients. CT quantification volume imaging technology has important clinical application value.

Oxygen Challenge Test in Septic Shock Patients

Transcutaneous oxygen pressure (PtcO2) value in response to an increase of FiO2 or oxygen challenge test (OCT) in ventilated patients has been reported to be related to peripheral perfusion and outcome during septic shock. However, patients with sepsis-related acute respiratory distress syndrome could demonstrate compromised arterial oxygenation with OCT impairment decoupled to circulatory failure. The aims of this study were to confirm the prognostic value of OCT and to explore the influence of respiratory status on OCT results. This was a prospective study set in an intensive care unit of a tertiary teaching hospital. Fifty-six mechanically ventilated patients with septic shock criteria were studied. Transcutaneous oxygen pressure was measured at baseline and after OCT, at intensive care unit admittance (T0), and 24 h later (T24). Survival at day 28 and hemodynamic and respiratory parameters were analyzed and compared according to outcome and respiratory status. Central hemodynamic parameters or static transcutaneous data did not differ between survivors and nonsurvivors at enrollment. The OCT was statistically different at T24 according to outcome (P < 0.001), but sensitivity was low (53%). Moreover, patients with low OCT results at T24 exhibited more severe respiratory failure (P < 0.01). The OCT at T24 is related to outcome but is influenced by the severity of respiratory failure. Our results suggest considering with caution hemodynamic management based on OCT in septic shock patients with altered pulmonary function.

Impact of an altered preoperative pulmonary function on the postoperative evolution in liver transplanted patients

Impact of an altered preoperative pulmonary function on the postoperative evolution in liver transplanted patients

Association of pulmonary function with adiposity and metabolic abnormalities in urban minority adolescents.

Childhood obesity is a known risk factor for pulmonary diseases, likely due to obesity-mediated alteration of pulmonary function. Inflammation and mechanical fat load are two proposed causative mechanisms for altered pulmonary function among obese children; however, the association of metabolic abnormalities with pulmonary function among children is poorly understood. We investigated the independent association of truncal and general adiposity and metabolic abnormalities with pulmonary function in a sample of urban minority adolescents. Spirometry and lung volume indices were compared between adolescents with general (body mass index [BMI] > 95th percentile) or truncal adiposity (waist circumference > 90th percentile) and normal-weight (BMI < 85th percentile or waist circumference ≤ 90th percentile) and between those with metabolic abnormalities (homeostatic model assessment of insulin resistance [HOMA-IR] in the top quartile or high-density lipoprotein [HDL] < 40 mg/dl) and those with a normal metabolic profile. Obese adolescents had lower lung volumes, including residual volume (RV), RV/TLC ratio, expiratory reserve volume (ERV), and FRC, and higher inspiratory capacity (IC) than normal-weight adolescents, but did not differ in measures of lower airway obstruction, FEV1/FVC ratio, and mid-expiratory flow rate. Adolescents with high HOMA-IR had lower FEV1/FVC ratio, RV, RV/TLC ratio, ERV, and FRC and higher IC, whereas those with low HDL had lower FEV1/FVC and RV/TLC ratios. After adjusting for adiposity, HOMA-IR remained a predictor of ERV (β = -1.4; P = 0.02) and FEV1/FVC ratio (β = -0.5; P = 0.03), and HDL remained a predictor of FEV1/FVC ratio (β = 0.1; P = 0.01). General adiposity was a predictor of FRC (β = -0.5; P < 0.001), IC (β = 0.3; P < 0.001), RV (β = -0.8; P < 0.0001), and RV/TLC ratio (β = -0.2; P < 0.0001), and truncal adiposity was a predictor of RV (β = -20.3; P = 0.03) and FRC (β = -13.8; P = 0.004). Thus, adiposity and metabolic abnormalities were independent predictors of ERV, but only metabolic abnormalities independently predicted FEV1/FVC ratio. Although general adiposity predicted RV and RV/TLC ratio, truncal adiposity was predictive of RV and FRC, conferring additional risk above general adiposity. These results suggest that metabolic abnormalities and adiposity are independently associated with pulmonary function deficits among urban adolescents. Metabolic assessment of obese adolescents may identify those at risk of developing obesity-associated pulmonary morbidity.

Lung volume quantified by MRI reflects extracellular-matrix deposition and altered pulmonary function in bleomycin models of fibrosis: effects of SOM230.

Idiopathic pulmonary fibrosis is a progressive and lethal disease, characterized by loss of lung elasticity and alveolar surface area, secondary to alveolar epithelial cell injury, reactive inflammation, proliferation of fibroblasts, and deposition of extracellular matrix. The effects of oropharyngeal aspiration of bleomycin in Sprague-Dawley rats and C57BL/6 mice, as well as of intratracheal administration of ovalbumin to actively sensitized Brown Norway rats on total lung volume as assessed noninvasively by magnetic resonance imaging (MRI) were investigated here. Lung injury and volume were quantified by using nongated or respiratory-gated MRI acquisitions [ultrashort echo time (UTE) or gradient-echo techniques]. Lung function of bleomycin-challenged rats was examined additionally using a flexiVent system. Postmortem analyses included histology of collagen and hydroxyproline assays. Bleomycin induced an increase of MRI-assessed total lung volume, lung dry and wet weights, and hydroxyproline content as well as collagen amount. In bleomycin-treated rats, gated MRI showed an increased volume of the lung in the inspiratory and expiratory phases of the respiratory cycle and a temporary decrease of tidal volume. Decreased dynamic lung compliance was found in bleomycin-challenged rats. Bleomycin-induced increase of MRI-detected lung volume was consistent with tissue deposition during fibrotic processes resulting in decreased lung elasticity, whereas influences by edema or emphysema could be excluded. In ovalbumin-challenged rats, total lung volume quantified by MRI remained unchanged. The somatostatin analog, SOM230, was shown to have therapeutic effects on established bleomycin-induced fibrosis in rats. This work suggests MRI-detected total lung volume as readout for tissue-deposition in small rodent bleomycin models of pulmonary fibrosis.

Post-Operative Pulmonary Function : A Comparison between Upper Abdominal Open Cholecystectomy and Laparoscopic Cholecystectomy

Postoperative Pulmonary Complications (PPCs) is one of the major cause of perioperative mortality and morbidity in thoracic and upper abdominal surgery. Preoperative risk assessment enables clinicians to reduce perioperative risk in high risk patients.. In upper abdominal surgery, there is a larger alteration in pulmonary functions. This study was performed in 30 patients scheduled for laparoscopic cholecystectomy and for upper abdominal open cholecystectomy. The study revealed that after both laparoscopic &amp; open upper abdominal cholecystectomy there was significant alteration of pulmonary function. There was significant alteration at six hours and after operation which then gradually improved, but it took about 24 hours for its complete recovery. The alteration was more evident in open cholycystectomy. Nevertheless these alterations did not cause any clinical derangement as expressed by SpO2, HR, &amp; BP. The study also showed a significant dose reduction of opioid in case of laparoscopic cholecystomy. The lung function at postoperative ward correlated well with the level of analgesia. But persistent alteration of pulmonary function indicated presence of other mechanical factors. Key Words: Surgery-Lap.Cholecystectomy, Surgery- Upper abdominal, Complication-post- Operative, complication-pulmonary, Patient control analgesia Journal of BSA, Vol. 17, No. 1 &amp; 2, 2004 p.12-16DOI: http://dx.doi.org/10.3329/jbsa.v17i1.4045

Spirometric Evaluation in Juvenile Idiopathic Arthritis: Data from Eastern India

To evaluate lung function in juvenile idiopathic arthritis (JIA) patients. This was a case control study carried out at Institute of Post-Graduate Medical Education & Research, Kolkata, involving JIA patients between 5 and 12 y. They were diagnosed and classified on the basis of International League of Associations for Rheumatology (ILAR) criteria and compared with same number of age, sex, height and weight matched controls. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC ratio, forced expiratory flow between 25 and 75% of vital capacity (FEF25-75%) and peak expiratory flow rate (PEFR) of cases were compared to those of matched controls. Among 36 JIA patients initially recruited, 9 were excluded. Of the remaining 27 patients, male: female ratio was 17:10. Mean age, height and weight of JIA patients were 9.15 y, 124.67 cm and 23.78 kg respectively. Six patients had oligoarthritis, 3 had rheumatoid factor positive (RF+) polyarthritis, 10 had rheumatoid factor negative (RF-) polyarthritis and 8 had systemic JIA. Eleven patients had active disease and 15 patients required methotrexate. None had respiratory symptoms. Mean duration of the disease was 2.96 y. Mean FVC and FEV1 were significantly less in JIA patients compared to controls (p value=0.0003 and 0.0007, respectively). FEV1/FVC in both the groups was similar (p value=0.96). Mean Z scores for FVC and FEV1 were significantly higher in JIA patients (p value=0.0064 and 0.0030, respectively). Spirometry in JIA patients demonstrated statistically significant restrictive pattern of alteration in pulmonary function.

Altered Pulmonary Function among the Transport Workers in Dhaka City

Motor vehicular exhaust is threatening to human health in Dhaka city. To find out the extent of respiratory problem among a particular cadre of transport workers, the human hauler helpers (HHH) of Dhaka city, we conducted a cross sectional study from March 2006 to June 2006. We enrolled 108 HHH from Mirpur to Mohakhali and Gabtoli to Mohakhali routes and collected data using a pre tested questionnaire including interview and physical examination. The pulmonary functions of the participants were measured with electronic spirometer. Among the participants with current respiratory problems 69% complained of gradual increase in respiratory problems and 38% gave history of feeling better on weekly holidays. Occurrence of hoarseness of voice (90%) and wheeze (71%) was extremely high among the helpers followed by cough (50%) and nasal irritation (50%). Spirometry showed 41.7% had obstructive and 4.6% had combined features of pulmonary impairment. Logistic regression analysis showed that respondents who worked 24 months or more were 6.9 times more likely to develop respiratory problem than the less exposed group (OR 6.9; 95% CI 3.42, 8.41). This study provides new information on respiratory health of a specific group of transport workers in Dhaka city which warrants further evaluation with a representing sample covering other areas of Dhaka city among all transport workers.

PReS-FINAL-2077: Lung function evaluation in a juvenile idiopathic arthritis cohort

Juvenile idiopathic arthritis (JIA) is the most common rheumatologic disorder of childhood. It is a group of diseases characterized by chronic synovitis, associated with many extra-articular manifestations including pulmonary involvement, usually in the systemic type. Alterations of pulmonary function in JIA may be a complication of the underlying disease or related to treatment with methotrexate. Numerous reports have documented the association of rheumatoid arthritis and pulmonary abnormalities. Also, methotrexate may cause severe adverse pulmonary side-effects in adults with rheumatoid arthritis. While respiratory function in adults with rheumatoid arthritis has been extensively investigated, few studies have been carried out in JIA children.

Análisis de la curva flujo-volumen en niños y adolescentes con rinitis alérgica sin asma

There is epidemiological, functional and pathologic evidence that relates upper and lower airways, clinically known as a single respiratory tract. Patients with allergic rhinitis without asthma may present subclinical abnormal spirometry parameters. To describe the results of the flow-volume curve in a group of patients with allergic rhinitis without asthma and analyze the possible associations between anthropometric, clinical and biochemical outcome measures with abnormal spirometry results. Observational, descriptive study including children and adolescents aged 6 to 18 years old with symptoms of allergic rhinitis without asthma. Age, gender, body mass index and duration of rhinitis were determined as per the subject's medical record. Allergen skin tests, flow-volume curve spirometry, determination of eosinophil count in blood and in nasal secretions, and total serum IgE were performed. A total of 84 patients were studied; 21 (25%; 95% CI: 15.1-34.8) presented at least one altered spirometry outcome measure. The FEV1/FVC ratio was the most affected outcome measure (10/84; 12%; 95% CI: 4.3-19.4). The multiple logistic regression analysis determined that spirometry alterations were associated with the number of blood eosinophils (OR: 1.00229; 95% CI: 1.00022-1.00436; p= 0.03) and the body mass index (OR: 1.31282; 95% CI: 1.08611-1.58685; p= 0.0049). Our results showed spirometry alterations in a considerable percentage of children and adolescents with allergic rhinitis without asthma. The blood eosinophil count and the body mass index could be associated with a sub-clinical alteration of pulmonary function.

What are the bacteria in the lower airways of athletic horses telling us?

Lower airway inflammation (LAI) is a common condition in racehorses (Wood and others 2005a, Allen and others 2006, Couetil and others 2007) and is associated with reductions in performance and...

Alteration of pulmonary function in diabetic nephropathy

BackgroundType 2 diabetes mellitus is increasing worldwide with an alarming rate. It is associated with the development of various chronic complications. The aim of this study was to explore the alteration of pulmonary function, and its association with renal complications in people with type 2 diabetes mellitus.MethodsThis cross-sectional study was conducted on three groups; 40 diabetic subjects without nephropathy (urinary albumin<30 mg/day), 40 subjects with nephropathy (urinary albumin≥30 mg/day), and 40 healthy subjects as the control group. The subjects with nephropathy were divided into those with microalbuminuria (urinary albumin=30-300 mg/day) and those with macroalbuminuria (urinary albumin>300 mg/day) .Diabetic subjects were matched to the control group in terms of age, sex, and BMI. Pulmonary function tests were performed and the results were compared between groups.ResultsForced vital capacity (FVC; % predicted), forced expiratory volume in 1 second (FEV1; % predicted), and peak expiratory flow (PEF; % predicted) were significantly lower in subjects with diabetic nephropathy compared to the healthy controls (P<0.05). Meanwhile, in diabetic subjects, FVC and FEV1 were lower in those with diabetic nephropathy compared to those with normal albumin excretion (P<0.05). On the other hand, FEV1/FVC was significantly higher in diabetic people with nephropathy.Furthermore, a significant difference was observed between FVC and FEV1 in diabetic people with microalbuminuria compared to those with macroalbuminuria.ConclusionsThis study showed that the pulmonary function was impaired in people with Diabetes. The progression of diabetic nephropathy to more advanced stages was also associated with more impairment of pulmonary function.

Reactive oxygen species as therapeutic targets in pulmonary hypertension

Pulmonary hypertension (PH) is characterized by a progressive elevation of pulmonary arterial pressure due to alterations of both pulmonary vascular structure and function. This disease is rare but life-threatening, leading to the development of right heart failure. Current PH treatments, designed to target altered pulmonary vascular reactivity, include vasodilating prostanoids, phosphodiesterase-5 inhibitors and endothelin-1 receptor antagonists. Although managing to slow the progression of the disease, these molecules still do not cure PH. More effective treatments need to be developed, and novel therapeutic strategies, targeting in particular vascular remodelling, are currently under investigation. Reactive oxygen species (ROS) are important physiological messengers in vascular cells. In addition to atherosclerosis and other systemic vascular diseases, emerging evidence also support a role of ROS in PH pathogenesis. ROS production is increased in animal models of PH, associated with NADPH oxidases increased expression, in particular of several Nox enzymes thought to be the major source of ROS in the pulmonary vasculature. These increases have also been observed in vitro and in vivo in humans. Moreover, several studies have shown either the deleterious effect of agents promoting ROS generation on pulmonary vasculature or, conversely, the beneficial effect of antioxidant agents in animal models of PH. In these studies, ROS production has been directly linked to pulmonary vascular remodelling, endothelial dysfunction, altered vasoconstrictive responses, inflammation and modifications of the extracellular matrix, all important features of PH pathophysiology. Altogether, these findings indicate that ROS are interesting therapeutic targets in PH. Blockade of ROS-dependent signalling pathways, or disruption of sources of ROS in the pulmonary vasculature, targeting in particular Nox enzymes, represent promising new therapeutic strategies in this disease.

Low-pressure pneumoperitoneum could decrease postoperative alterations of hemodynamic variables and pulmonary function tests after laparoscopic cholecystectomy

Objectives: To evaluate the impact of pneumoperitoneum on pulmonary fimctions, hemodynamic variables and frequency and intensity of shoulder tip pain (STP) in patients undergoing laparoscopic cholecystectomy (LC). Patients & methods: Fifty chronic calcular cholecystitis patients were allocated to high­ pressure (HP) group (13-15 mmHg) and low-pressure (LP) group (9-11 mmHg). Mean arterial pressure (MAP), and heart rate (HR) measurements were obtained before (I'1), after induction of anesthesia (I'2), 5 min. before (T3), after insufflation (T4), 5 min. after tilting in reverse Trendelburgposition (T5) and after exsu.fflation of C02 (T6). Duration of surgery, occurrence of intraoperative complications and conversion to laparotomy, time till first ambulation, first oral intake and length of postoperative (PO) hospital stay were recorded. Severity of PO STP was assessed using visual analogue scale at 3, 6, 12, 24, and 48 hours. Forced vital capacity (FVC),forced expiratory volume in 1 sec (FEVJ) and FEVJ/FVC ratio were estimated 24 hours prior to and after surgery. Results: All patients passed smooth intraoperative course without complications or conversion to laparotomy. Mean operative data showed non-significant difference between both groups. At T4 and T5 HR and MAP measurements were significantly higher in HP group despite the significant difference compared to other measures in both groups. Twenty-three patients had STP with significantly higher frequency and intensity in HP group.Mean duration till request of analgesia was significantly longer in LP group. Pneumoperitoneum altered PO pulmonary function tests compared to preoperative values with significantly altered FEV1 evaluated as the percentage of change in HP group. Conclusion: Pneumoperitoneum irrespective of the pressure used affects pulmonary function tests andinduces hemodynamic changes with precipitation ofSTP,· however LP allowed significant amelioration of these effects despite that it could not abolish it, so it allows getting the advantages of laparoscopic surgery with minimal hazards.