Changes In Respiratory Function Research Articles

PREDICTION OF TREATMENT EFFECTIVENESS IN PATIENTS WITH ASTHMA-COPD OVERLAP COMBINED WITH HYPERTENSION

Introduction. Recently, there has been an increase in the prevalence of comorbid conditions, including a combination of bronchial asthma and chronic obstructive pulmonary disease, called asthma-chronic obstructive pulmonary disease overlap, and their combination with hypertension. The presence of combined pathology causes an increase in the severity of symptoms and functional disorders, in numbers of exacerbations, deterioration of quality of life and tolerance to exercise, and also causes difficulties in selecting a comprehensive treatment for this group of patients. That is why the aim of our study was to optimize and predict the effectiveness of treatment of patients with bronchial asthma in combination with the chronic obstructive pulmonary disease on the background of hypertension based on assessing the dynamics of clinical and laboratory and functional status in different treatment regimens. Materials and methods. 100 patients with bronchial asthma in combination with the chronic obstructive pulmonary disease on the background of hypertension were selected. Patients underwent: general clinical examination, determination of respiratory function, clinical blood tests and enzyme-linked immunosorbent assays, questionnaires to determine symptoms and quality of life, as well as a functional study with a six-minute walk test in the dynamics of complex basic treatment with the physical rehabilitation program. Research results. Adding an active rehabilitation program to standard medical treatment significantly improves the bronchial response to the action of bronchodilators according to the spirometry, reduces clinical manifestations, shortness of breath, and improves the quality of life and exercise tolerance. The presence of such criteria as the forced expiratory volume in 1 second < 69%, the forced expiratory flow 50% < 21.6% and the forced expiratory flow 75% < 31.65%, C-reactive protein > 7.6 g / l, interleukin 8 > 18.13 pg/ml may provide tolerance to the program of physical rehabilitation and the inexpediency of its use. Conclusions. Under the influence of rehabilitation measures applied by us, patients experienced some positive changes in cardiovascular and respiratory function, exercise tolerance, and quality of life, although some patients do not respond to the addition of a comprehensive rehabilitation program associated with such baseline parameters as forced expiratory volume in 1 second, forced expiratory flow 50% and the forced expiratory flow 75%, C-reactive protein, interleukin 8

Changes in Respiratory Function and Physical Capacity among Smokers after Switching to IQOS: One Year Follow-Up

Background: Combustible cigarettes (CC) smoking is a common risk factor for chronic obstructive pulmonary disease (COPD), which is the fourth leading cause of death in Kazakhstan. Switching to "heat-not-burn" tobacco products (IQOS) has been shown to have less deleterious health effect compared to CC for those who cannot quit smoking. The goal of the study was to explore respiratory and physical effects of switching from CC to IQOS in a population of long-time smokers in Kazakhstan. Methods: Two cohorts of men and women aged between 40 and 59 residing in Almaty (a large two-million city of Kazakhstan) were recruited into two cohort of 801 CC smokers and 400 IQOS users and matched by gender, age, education, and smoking history. Analyses also included 627 CC smokers and 308 IQOS users who maintained their tobacco product use during the first year of observation. Spirometry measurements and the 6-minute walk test (6MWT) were performed as a part of the baseline and one-year comprehensive assessments. In addition to spirometry, clinical assessments included components of metabolic syndrome and anthropometry. For comparative analysis between two cohorts Student’s t-test and Chi-squared tests were used. Results: We observed significantly better outcomes for IQOS users in most of CAT scores, spirometry outcomes, and in some metabolic syndrome components. Although changes in the results between the baseline and the one-year assessments show comparable results, smokers of CC often show significantly faster decline in the health status compared to IQOS. Specifically, the changes in CAT score and in spirometry FEV1 over FVC ratios were worsening at higher pace for CC smokers compared to IQOS users. Conclusions: After one year of observation IQOS users demonstrated better outcomes for most of CAT scores and in the ratio of FEV1 over FVC in comparison to CC smokers.

The effect of gradually increased mandibular advancement on the efficacy of an oral appliance in the treatment of obstructive sleep apnea.

To analyze the effect of gradual increments of mandibular advancement on the treatment efficacy of mandibular advancement devices and identify determinants of effective and target protrusion for OSA. Patients were prospectively recruited. The mandible was titrated from 0 mm with a stepwise increment of 0.5 mm until the AHI was reduced to the lowest level. Rhinospirometry, rhinomanometry, and magnetic resonance imaging were used to observe the change of respiratory function and upper airway morphology. Forty-two patients aged 41.5 ± 9.0 years participated. There was a dose-dependent relationship between mandibular protrusion and the AHI improvement rate, the success rate, and the normalization rate; the changing curves plateaued after approximately 70% of maximal mandibular protrusion was achieved. The correlation between AHI and mandibular protrusion became stronger as the severity of OSA increased. The target protrusion for patients with mild, moderate, and severe OSA was 3.5 ± 1.8 mm (38.6 ± 19.4% maximal mandibular protrusion), 5.8 ± 1.9 mm (62.9 ± 18.8% maximal mandibular protrusion), and 5.9 ± 2.2 mm (68.8 ± 15.6% maximal mandibular protrusion), respectively. Regression analysis revealed that the factors influencing effective and target protrusion included change of maximal lateral dimension of the total upper airway with mandibular advancement devices, mean lateral dimension of the oropharynx, and soft palate length. Further protrusion brought more lateral expansion of the velopharynx, whereas the change in nasal ventilation was not significant. The dose-dependent effect of mandibular protrusion on reduction of AHI by mandibular advancement devices was nonlinear and became more pronounced with increased severity of OSA. The mandibular protrusion should be more personalized to each patient. Registry: Chinese Clinical Trial Registry; Name: Study of the Onset Point of Oral Appliance Treatment in Obstructive Sleep Apnea and Hypopnea Syndrome; URL: http://www.chictr.org.cn/showproj.aspx?proj=22291; Identifier: ChiCTR-IND-17013232.

Interleukin-1 blockade with high-dose anakinra in patients with COVID-19, acute respiratory distress syndrome, and hyperinflammation: a retrospective cohort study.

SummaryBackgroundMortality of patients with coronavirus disease 2019 (COVID-19), acute respiratory distress syndrome (ARDS), and systemic inflammation is high. In areas of pandemic outbreak, the number of patients can exceed maximum capacity of intensive care units (ICUs), and, thus, these individuals often receive non-invasive ventilation outside of the ICU. Effective treatments for this population are needed urgently. Anakinra is a recombinant interleukin-1 receptor antagonist that might be beneficial in this patient population.MethodsWe conducted a retrospective cohort study at the San Raffaele Hospital in Milan, Italy. We included consecutive patients (aged ≥18 years) with COVID-19, moderate-to-severe ARDS, and hyperinflammation (defined as serum C-reactive protein ≥100 mg/L, ferritin ≥900 ng/mL, or both) who were managed with non-invasive ventilation outside of the ICU and who received standard treatment of 200 mg hydroxychloroquine twice a day orally and 400 mg lopinavir with 100 mg ritonavir twice a day orally. We compared survival, mechanical ventilation-free survival, changes in C-reactive protein, respiratory function, and clinical status in a cohort of patients who received additional treatment with anakinra (either 5 mg/kg twice a day intravenously [high dose] or 100 mg twice a day subcutaneously [low dose]) with a retrospective cohort of patients who did not receive anakinra (referred to as the standard treatment group). All outcomes were assessed at 21 days. This study is part of the COVID-19 Biobank study, which is registered with ClinicalTrials.gov, NCT04318366.FindingsBetween March 17 and March 27, 2020, 29 patients received high-dose intravenous anakinra, non-invasive ventilation, and standard treatment. Between March 10 and March 17, 2020, 16 patients received non-invasive ventilation and standard treatment only and comprised the comparison group for this study. A further seven patients received low-dose subcutaneous anakinra in addition to non-invasive ventilation and standard treatment; however, anakinra treatment was interrupted after 7 days because of a paucity of effects on serum C-reactive protein and clinical status. At 21 days, treatment with high-dose anakinra was associated with reductions in serum C-reactive protein and progressive improvements in respiratory function in 21 (72%) of 29 patients; five (17%) patients were on mechanical ventilation and three (10%) died. In the standard treatment group, eight (50%) of 16 patients showed respiratory improvement at 21 days; one (6%) patient was on mechanical ventilation and seven (44%) died. At 21 days, survival was 90% in the high-dose anakinra group and 56% in the standard treatment group (p=0·009). Mechanical ventilation-free survival was 72% in the anakinra group versus 50% in the standard treatment group (p=0·15). Bacteraemia occurred in four (14%) of 29 patients receiving high-dose anakinra and two (13%) of 16 patients receiving standard treatment. Discontinuation of anakinra was not followed by inflammatory relapses.InterpretationIn this retrospective cohort study of patients with COVID-19 and ARDS managed with non-invasive ventilation outside of the ICU, treatment with high-dose anakinra was safe and associated with clinical improvement in 72% of patients. Confirmation of efficacy will require controlled trials.FundingNone.

Does Nasal Cavity Enlargement Associated With Respiratory Function Improvement After Surgically Assisted Rapid Maxillary Expansion?

To systematically evaluate the effects of surgically assisted rapid maxillary expansion (SARME) on nasal cavity and its associated respiratory function changes. Multiple electronic databases were searched, authors were contacted as required, and reference lists of potentially relevant studies were screened. Articles that included patients older than 16 who had received SARME were considered. Data extraction and quality assessment were performed independently and in duplicate. Eight articles, including 161 patients, were finally selected and analyzed. Nasal cavity significantly augmentation after SARME has been recognized by 7 studies with moderate-quality evidence. Among them, the nasal cavity volume increased <20% in 4 studies, 20% to 40% in 1 study, and >40% in 2 studies. Totally, the range of increasing in nasal cavity volume was 7.6% to 99%. One study had recorded the nasal expiratory and inspiratory flow significantly increased 18.5% and 21.7%, respectively. SARME was found to produce meaningful volume augmentation in nasal cavity with adult patients. However, the improvement of nasal respiratory function has not been well elucidated; thus, SARME is not yet recommended for the purpose of improving nasal respiratory.

INFLUÊNCIA DE EXERCÍCIOS POSTURAIS SOBRE A FORÇA MUSCULAR RESPIRATÓRIA EM JOVENS SAUDÁVEIS

Postural changes are a public health problem that can interfere directly with ventilatory mechanics, pilates exercises and isostretching may be beneficial for postural and ventilatory improvement. To analyze effects of combined exercises of the isostretching and Pilates methods on respiratory muscle strength (RMS), lung function and postural changes. Being twenty evaluated individuals, posture, RMS, pulmonary function and reevaluated after a training for 10 weeks. Twenty individuals, classified as BMI and physical activity level showed a significant difference between RMS, when compared to pre and post training values. The MIP presented (p = 0.002) in the same way as the MEP (p = 0.006). Each postural change may interfere in a different way in mechanics and new studies may bring better understanding of this mechanics and assist in the development of effective therapies. It is determined that postural works based on isostretching and pilates methods improve respiratory muscle strength.

Addition of proprioceptive neuromuscular facilitation to cardiorespiratory training in patients poststroke: study protocol for a randomized controlled trial

BackgroundIndividuals affected by stroke present with changes in cardiovascular and respiratory functions. Cardiorespiratory training (CRT) is one of the classic intervention guidelines for cardiorespiratory fitness. CRT in association with the proprioceptive neuromuscular facilitation (PNF) technique for respiratory muscles could improve the quality of life, cardiorespiratory function and gait parameters of patients after stroke.ObjectiveTo assess the effects of respiratory and trunk patterns of CRT associated with PNF on the quality of life, gait, oxygen consumption, respiratory muscle strength and thoracic volumes.Methods/designA blind, randomized clinical trial with allocation confidentiality will be performed. Forty patients will be randomized into four groups: CRT-lower limb (LL) plus PNF; CRT-LL and respiration; CRT-upper limb (UL) plus PNF; or CRT-UL and respiration. Individuals will be evaluated at three different times (pretreatment, after 20 days of treatment and 1 month after the end of treatment). The treatment protocol consists of respiratory exercises, 30 min of CRT (cycle ergometer) and then repetition of the respiratory exercises, performed three times a week over a period of 20 days. Primary outcome measures are quality of life, gait, balance, peak oxygen uptake and rib cage compartment volumes. As secondary outcomes, respiratory function and maximal inspiratory and expiratory pressures will be measured. DiscussionThe association of PNF with CRT may be a viable and accessible alternative to increase cardiorespiratory function in patients with stroke.Trial registrationClinicalTrials.gov, NCT03171012. Registered on 6 June 2017.

The amygdala via the paraventricular nucleus regulates asthma attack in rats

AimsThis study aimed to investigate the functions of the amygdala in rat asthma model.Main methodsWheat germ agglutinin‐horseradish peroxidase (WGA‐HRP) was used for tracing from the paraventricular nucleus (PVN) to the amygdala, and nuclear lesions were performed to observe changes in respiratory function and airway inflammation.ResultsThis study showed that the extracellular neuronal discharged in the medial amygdala (MeA) and central amygdala (CeA), and the expression of Fos significantly increased in asthmatic rat compared to control group. The distribution of Fos‐ and oxytocin (OT)‐positive neurons and Fos/OT dual‐positive neurons evidently increased in the PVN. WGA‐HRP was injected into the PVN for tracing, and Fos/HRP‐dual‐positive neurons were observed to be distributed in the MeA. By using kainic acid (KA) to injure the MeA and CeA in asthmatic rats, expiratory and inspiratory times (TE/TI) and airway resistance (Raw) decreased, and minute ventilation volume (MVV) and dynamic pulmonary compliance (Cdyn) increased accordingly. In the bronchoalveolar lavage fluid (BALF), the number of eosinophils and the concentration of IL‐4 were lower than those of the control group, and the ratio of Th1/Th2 cells was higher than that of the control group. In the PVN, the distribution of Fos‐, OT‐positive cells and Fos/OT double‐positive cells decreased compared with those of the control group. The activities of the MeA and CeA and of OT neurons in the PVN of the rats were correlated with the occurrence of asthma.ConclusionsAsthma attack could induce neural activities in the MeA and CeA, and OT neurons in the PVN may be involved in the process of asthma attack.

Effects of "3S2E" nursing management model in patients with severe pneumonia in ICU

Objective To explore the effects of 3S2E nursing management model in patients with severe pneumonia. Methods Totally 168 patients with severe pneumonia enrolled in the ICU of the First Affiliated Hospital of Zhengzhou University from February 2017 to February 2019 were selected by convenient sampling, and numbered according to the order of admission. Patients with odd numbers were divided into the observation group (n=84) , while patients with even numbers were divided into the control group (n=84) . Patients in the control group received interventions based on the routine nursing protocol for the ICU, while patients in the observation group received 3S2E nursing model on the basis of routine nursing. Changes in respiratory function and vital signs, Self-Anxiety Scale (SAS) , Self-Depression Scale (SDS) and Pittsburgh Sleep Quality Index (PSQI) scores, mechanical ventilation time, length of hospital stay were compared between the two groups before and after the intervention. Results After the intervention, the ventilatory capacity per minute, respiratory rate, rapid shallow breathing index (RSBI) , oxygenation index, mean arterial pressure, central arterial pressure and heart rate of the observation group were lower than those of the control group, the differences were statistically significant (P<0.05) . The SAS, SDS and PSQI scores of the observation group were lower than those of the control group , the differences were statistically significant (P<0.05) . The mechanical ventilation time and length of hospital stay in the observation group were shorter than those in the control group, the differences were statistically significant (P<0.05) . Conclusions The intervention of 3S2E nursing management model in patients with severe pneumonia can effectively improve the patient's respiratory function, reduce their anxiety and depression, improve their sleep quality. Key words: Intensive care; Pneumonia; Anxiety; Depression; Sleep; Nursing management

Changes in respiratory movement and function by posture

Changes in respiratory movement and function by posture

Effect of resistance exercises applying maximum expiration on the respiratory muscle strength of elderly women.

Respiratory-muscle weakness is an important clinical problem. The respiratory system's health is a decisive factor in the physical and social life of the elderly. Changes in respiratory muscular strength and function activate the torso's adjustment ability, which affects daily activities. This study aimed to investigate the effects of resistance exercises combined with breathing exercises on the respiratory-muscle strength of elderly women. This study included 26 elderly woman, who were randomly divided into two sub-groups of 13 participants each. The experimental group performed breathing exercises and dynamic upper- and lower-extremity exercises, and the control group practiced only dynamic upper- and lower-extremity exercises. The maximum expiratory pressure (MEP) and maximum inspiratory pressure (MIP) were measured both before and at the end of the six-week study. In both groups, both the post-test MIPs and MEPs were significantly higher than the pre-intervention ones (p< 0.05). For MIPs, the between-group difference was not statistically significant, either before the intervention or post-test (p> 0.05). For MEPs, the between-group difference was statistically significant at post-intervention points (p< 0.05). The results showed that resistance exercises applying maximum expiration improved the respiratory-muscle strength of elderly women. These findings indicate that resistance exercises applying maximum expiration as described here in should be considered in patients who require breathing therapy, because the combination seems to significantly increase the strength of the respiratory muscles.

Man-made load of industrial environment and its impact on human microbiota

People are exposed to a significant amount of man-made hazards upon contact with technological systems, and foundry engineering industrial sites belong undoubtedly to such systems. Foundry shops are characterized by high noise and temperature thresholds that affect the human body. Unsatisfactory condition of the air is considered to be an acute problem in foundry engineering. In this connection, the state of air and its composition change, which can certainly affect health of workers, and the latter may be seen in the respiratory, cardiovascular, nervous systems, and digestive organs functional changes. However, up to date, the effect of health hazards of foundry engineering on the microbiocenosis of human intestine remains poorly studied. The paper apprizes the microbiota of human large intestine being exposed to integrated effects of foundry engineering factors. A structural change of the intestinal coenotype accompanied by a change of absolute dominants and opportunistic microorganisms appearance is established. Intestinal microbiocenosis disorder is accompanied by a high detectability of parasitic protozoa Blastocystis spp. in the sampling material. The obtained blastocyst isolates have pathogenic properties of varying degree of manifestation, which indicates their unequal etiological significance in the development of the pathological process. The isolated strains of protozoa have a high anti-interferon activity characterizing their persistent properties. This characteristic brings along the displacement of normal symbionts by blastocysts and colonization of the intestinal mucous membranes with these protozoa.

The Effects of McKenzie Exercise on Forward Head Posture and Respiratory Function

Purpose: This study sought to investigate the effects of the McKenzie exercise program on forward head posture and respiratory function. Methods: Thirty adult men and women with forward head posture, aged 20-29 years, were randomly assigned to the experimental group (N=15) or the control group (N=15). Subjects in the experimental group performed the McKenzie exercises three times a week for four weeks, while subjects in the control group did not receive any intervention. Craniovertebral angle (CVA) was measured to quantify forward head posture, and forced vital capacity (FVC), FVC % predicted, forced expiratory volume at one second (FEV1), and FEV1 % pre­ dicted were measured to determine changes in respiratory function. The Mann-Whitney U-test was used to analyze pre-test differences in forward head posture and respiratory function between the two groups, and the Wilcoxon signed-rank test was used to analyze dif­ ferences in forward head posture and respiratory function within the groups before and after intervention. The significance level (α) was set to 0.05. Results: A comparison of pre- and post-test measures showed that CVA significantly increased in the experimental group (p=0.001) de­ noting postural improvement, whereas no significant difference was found in the control group (p=0.053). All respiratory measures, i.e.,FVC, FVC %pred, FEV1, and FEV1 %pred, were significantly improved in the experimental group, whereas there were no significant dif ­ferences in the control group. Conclusions: McKenzie exercise can be effective in improving forward head posture and respiratory function.

Cell-based therapies for amyotrophic lateral sclerosis/motor neuron disease.

Amyotrophic lateral sclerosis (ALS), which is also known as motor neuron disease (MND), is a fatal disease associated with rapidly progressive disability, for which no definitive treatment exists. Current treatment approaches largely focus on relieving symptoms to improve the quality of life of those affected. The therapeutic potential of cell-based therapies in ALS/MND has not been fully evaluated, given the paucity of high-quality clinical trials. Based on data from preclinical studies, cell-based therapy is a promising treatment for ALS/MND. This review was first published in 2015 when the first clinical trials of cell-based therapies were still in progress. We undertook this update to incorporate evidence now available from randomised controlled trials (RCTs). To assess the effects of cell-based therapy for people with ALS/MND, compared with placebo or no treatment. On 31 July 2019, we searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, and Embase. We also searched two clinical trials registries for ongoing or unpublished studies. We included RCTs that assigned people with ALS/MND to receive cell-based therapy versus a placebo or no additional treatment. Co-interventions were allowed, provided that they were given to each group equally. We followed standard Cochrane methodology. Two RCTs involving 112 participants were eligible for inclusion in this review. One study compared autologous bone marrow-mesenchymal stem cells (BM-MSC) plus riluzole versus control (riluzole only), while the other study compared combined intramuscular and intrathecal administration of autologous mesenchymal stem cells secreting neurotrophic factors (MSC-NTF) to placebo. The latter study was reported as an abstract and provided no numerical data. Both studies were funded by biotechnology companies. The only study that contributed to the outcome data in the review involved 64 participants, comparing BM-MSC plus riluzole versus control (riluzole only). It reported outcomes after four to six months. It had a low risk of selection bias, detection bias and reporting bias, but a high risk of performance bias and attrition bias. The certainty of evidence was low for all major efficacy outcomes, with imprecision as the main downgrading factor, because the range of plausible estimates, as shown by the 95% confidence intervals (CIs), encompassed a range that would likely result in different clinical decisions. Functional impairment, expressed as the mean change in the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) score from baseline to six months after cell injection was slightly reduced (better) in the BM-MSC group compared to the control group (mean difference (MD) 3.38, 95% CI 1.22 to 5.54; 1 RCT, 56 participants; low-certainty evidence). ALSFRS-R has a range from 48 (normal) to 0 (maximally impaired); a change of 4 or more points is considered clinically important. The trial did not report outcomes at 12 months. There was no clear difference between the BM-MSC and the no treatment group in change in respiratory function (per cent predicted forced vital capacity; FVC%; MD -0.53, 95% CI -5.37 to 4.31; 1 RCT, 56 participants; low-certainty evidence); overall survival at six months (risk ratio (RR) 1.07, 95% CI 0.94 to 1.22; 1 RCT, 64 participants; low-certainty evidence); risk of total adverse events (RR 0.86, 95% CI 0.62 to 1.19; 1 RCT, 64 participants; low-certainty evidence) or serious adverse events (RR 0.47, 95% CI 0.13 to 1.72; 1 RCT, 64 participants; low-certainty evidence). The study did not measure muscle strength. Currently, there is a lack of high-certainty evidence to guide practice on the use of cell-based therapy to treat ALS/MND. Uncertainties remain as to whether this mode of therapy is capable of restoring muscle function, slowing disease progression, and improving survival in people with ALS/MND. Although one RCT provided low-certainty evidence that BM-MSC may slightly reduce functional impairment measured on the ALSFRS-R after four to six months, this was a small phase II trial that cannot be used to establish efficacy. We need large, prospective RCTs with long-term follow-up to establish the efficacy and safety of cellular therapy and to determine patient-, disease- and cell treatment-related factors that may influence the outcome of cell-based therapy. The major goals of future research are to determine the appropriate cell source, phenotype, dose and method of delivery, as these will be key elements in designing an optimal cell-based therapy programme for people with ALS/MND. Future research should also explore novel treatment strategies, including combinations of cellular therapy and standard or novel neuroprotective agents, to find the best possible approach to prevent or reverse the neurological deficit in ALS/MND, and to prolong survival in this debilitating and fatal condition.

Complicaciones pulmonares asociadas al procedimiento de cirugía cardiovascular en la Unidad de Cuidados Intensivos

Los procesos quirúrgicos, junto con la aplicación de anestesia, producen cambios en la función respiratoria, que aumentan el riesgo de sufrir complicaciones pulmonares postoperatorias (CPP), Las cuales son consideradas como una de las principales causas de morbilidad y mortalidad en el postoperatorio inmediato en cirugía de tórax y abdomen. A partir de lo anterior, se realizó una revisión bibliográfica de 70 artículos comprendidos entre el año 2002 al año 2018 en las bases de datos Proquest, Unitri. El Sevier, Scielo, Pubmed, Pubmed, Intramed, Medigraphic, Redalyc, Dialnet, Science Direct y BMC, que identificaran las principales complicaciones pulmonares asociadas a cirugía cardiovascular. Se encontraron 22 artículos que cumplieron con los criterios de inclusión, donde se identificó que los tipos de complicaciones pulmonares más frecuente es la Neumonía y las Atelectasias, que se asocian a cirugías cardiovasculares como la Revascularización Miocárdica y el Cambio Valvular.

P2.17-21 A Post-Hoc Analysis of TROG 09.02 (CHISEL) Phase III Trial Investigating Pulmonary Function Changes After SABR and Conformal Radiation Therapy

The TROG 09.02 (CHISEL) trial compared conventional radiotherapy (CRT) administered over a period of four to six weeks with stereotactic ablative body radiotherapy (SABR).(1) Patients randomised to the SABR arm had superior freedom from local failure and longer overall survival.(1) The aim of this analysis was to assess differences in lung function and spirometry tests between SABR and CRT and describe longitudinal changes in respiratory function. We conducted a post-hoc analysis of all patients recruited to the CHISEL trial. During this trial patients underwent serial Respiratory Function Tests (RFT) including Forced Expiratory Volume in one second (FEV1), Diffusing capacity of the lungs for carbon monoxide (DLCO), Distance Walked in 6 minutes (SMWT) and Forced Vital Capacity (FVC). These were performed at baseline then 3-6 monthly post-treatment. Patients were assessed per treatment received. Linear regression models were used to compare FEV1, FVC and DLCO between SABR and CRT. Separate models at 3 and 12 months post-treatment were created to assess the two different processes impacting lung function post radiation therapy (acute pneumonitis and chronic fibrosis). Linear regression models were used to assess the association of baseline PFT Measures with decline in respiratory function at 3 and 12 months. Between December 2009 and June 2015, 101 patients were treated in 11 centres in Australia and New Zealand. 34 patients were treated with CRT and 63 with SABR. On regression analysis at 3 months there was no evidence of a difference between arms in the change from baseline in absolute values of FEV1 (beta 0.037, 95% CI [-0.063, 0.14], p=0.47), DLCO (beta -0.5, 95% CI [-1.4, 0.37], p=0.26) nor forced VC (beta 0.024, 95% CI [-0.17, 0.22], p=0.81). At 12 months there were no differences observed in change from baseline of FEV1 (beta0.031, 95% CI [-0.12, 0.18], p=0.69), DLCO (beta -0.43, 95% CI [-1.7, 0.84], p=0.51) nor forced VC (beta 0.047, 95% CI [-0.28, 0.18], p=0.69) between arms.There was no evidence of a difference in the change from baseline in SMWT (m) between two arms at 3 months (beta 35.9, 95% CI [-10, 82.3], p=0.13).Patients in both arms demonstrated similar deterioration in all RFT parameters with time. Despite the considerably higher biologically effective doses delivered to the tumour in SABR there was no difference in decline in respiratory function observed between the two groups. This is likely due to the higher integral dose, steep dose gradients and reduced margins possible with SABR relative to CRT.

The use of fixed-effects regression to assess work activities and protective measures associated with changes in respiratory function in a prospective industrial hog worker cohort, North Carolina, USA

The use of fixed-effects regression to assess work activities and protective measures associated with changes in respiratory function in a prospective industrial hog worker cohort, North Carolina, USA

Exposure to Particulate Matter and Respiratory Health among Electronic Waste Workers at Agbogbloshie, Accra, Ghana

PDS 63: Chemicals and metals: health effects, Exhibition Hall (PDS), Ground floor, August 27, 2019, 10:30 AM - 12:00 PM Background/Aim: Particulate matter (PM) exposure has been linked to informal electronic waste (e-waste) recycling activities, and PM inhalation has been associated with several respiratory health problems, including increased prevalence of respiratory symptoms and lung function changes. This study investigated the association between measured personal exposure levels of PM (1 and 2.5 µm) and the respiratory health of e-waste workers at the large Agbogbloshie, Ghana, site. Methods: 100 e-waste workers engaged in informal e-waste recycling at Agbogbloshie and 51 control subjects from Madina–Zongo were recruited and studies from March to April 2017. Each participant provided self-reported respiratory symptoms, diseases and work and home respiratory exposures. Lung function, including forced vital volume in one second (FEV1), forced vital capacity (FVC) and ratio (FEV1/FVC), was measured using a portable spirometer (Easy One) and personal breathing zone PM exposures (I and 2.5µm) were measured using an optical instrument (MetOne Aerocet 831). Multiple regression analysis was performed to test the association between the PM and lung function measures. Results: Higher mean concentrations of PM1, PM2.5 and PM10 were recorded among the e-waste recyclers (41± 2 and 84 ±7) compared to the control group (14 ± 1 and 33 ± 2). Overall, burners recorded the highest mean concentrations of PM1, PM2.5 and PM10, (49 ± 6 and 112 ±18) compared to dismantlers (34 ±3 and 54 ±7). No significant association was found between the PM (I, and 2.5µm) concentrations and lung function (FEV1) measures (-0.25, P=0.806; 0.41, P=0,685). Conclusion: While e-waste workers had significantly higher exposure to PM in the breathing zone, associations with lung function measurements were not significant. This may be due to the short term (4-hours) measurements of PM among the workers. PM exposure patterns and e-waste tasks are being studied over time, to better understand the associated respiratory health effects.

Effect of inhaled nitric oxide with mechanical ventilation in persistent pulmonary hypertension of newborn

Objective To study the clinical effect of inhaled nitric oxide(iNO) with mechanical ventilation for the neonates with persistent pulmonary hypertension of newborn(PPHN). Methods A total of 40 neonates with PPHN poorly responding with routine treatment were treated with iNO therapy.Pulmonary artery pressure, blood gas ion analysis and respiratory function changes were observed at different time points before and after iNO. Results Treatment with iNO resulted in a rapid decrease in pulmonary artery pressure from(54.95±17.08) mmHg(1 mmHg=0.133 kPa) to(20.40±14.26) mmHg.Oxygenation of 40 cases improved in the first 0.5~1 hour after iNO therapy, the values of mean airway pressure(MAP)declined from(13.98±2.40)cmH2O(1 cmH2O=0.098 kPa) to(12.44±2.69)cmH2O, oxygenation index(OI)decreased from 26.89±18.62 to 13.84±5.52, PaO2/FiO2 increased from(60.34±23.49) mmHg to(144.46±23.49) mmHg, and the value of pH increased from 7.31±0.14 to 7.37±0.07.Furthermore, within 48 hours after treatment, PaO2/FiO2 and pH increased gradually, while MAP and OI decreased gradually, which all had statistical differences(P<0.01). Conclusion Mechanical ventilation combined with iNO therapy in the treatment of PPHN can rapidly improve the oxygenation status of neonates, reduce pulmonary vascular resistance, and then improve the survival rate and long-term prognosis. Key words: Mechanical ventilation; Inhaled nitric oxide; Persistent pulmonary hypertension of newborn

Chronology and Determinants of Respiratory Function Changes Following Administration of Systemic Postnatal Corticosteroids in Extremely Preterm Infants

To describe the effect of systemic corticosteroids administered to treat evolving bronchopulmonary dysplasia on oxygen diffusion and ventilation efficiency. This was a retrospective cohort study of ventilated infants who received a 9-day course of dexamethasone in a tertiary neonatal unit. We calculated the transcutaneous oxygen saturation-to-fraction of inspired oxygen (FiO2) ratio (SFR), the ventilation perfusion ratio (VA/Q), and the ventilation efficiency index (VEI) before, during, and after the course of corticosteroids. The response to corticosteroids was calculated as the difference between the FiO2 percentage before starting steroids and the lowest FiO2 value during the course of steroid treatment. Seventy infants (38 males) with a median gestational age (GA) of 25.0weeks (IQR, 24.3-26.0weeks) and a median birth weight of 0.70kg (IQR, 0.63-0.82kg) were studied at a median postnatal age of 39days (IQR, 29-48days). The median SFR before treatment was 1.42 (IQR, 1.19-1.72), and the highest SFR was 2.35 (IQR, 1.87-2.83) after 9days of treatment. The median VA/Q before treatment was 0.14 (IQR, 0.11-0.18) and was significantly higher at 72hours after the start of treatment (0.22; IQR, 0.15-0.29; P<.001). The median VEI was 0.06 (IQR, 0.04-0.08) before treatment and was highest, 0.10 (IQR, 0.07-0.13) at 48hours after starting treatment. The median rate of response to corticosteroids was 28% (IQR, 20%-37%). GA was significantly related to the response to corticosteroids (ρ=0.283; P=.019). Oxygen diffusion continues to improve throughout the entire duration of a 9-day course of systemically administered corticosteroids in ventilated extremely preterm infants. More immature infants are less responsive to corticosteroids.