Compromised Pulmonary Function Research Articles

A modern approach to multiple pulmonary resections in children with recurrent metastatic pulmonary disease.

Implications of repeated resections of pulmonary metastasis (PM) are not well documented in the modern era. Fifteen children underwent two (n=8), three (n=3), or four or more (n=3) resections (total=38 procedures), most commonly for osteosarcoma (71%). Operative approach included muscle-sparing thoracotomy (71%), non-muscle-sparing thoracotomy (18%), and video-assisted thoracoscopy (11%). Median resected nodules per procedure was four (range = 1-95). Prolonged air leaks were the most common postoperative complication (29%). Median hospital stay was 4days, and no children were discharged with or have required oxygen. Event-free survival is 67% at median follow-up time of 54months, with an overall survival rate of 64%. Repeat resection of PM appears to be well tolerated, without prolonged hospital stays or compromised pulmonary function.

Determination of the Optimal Volume of 0.5% Ropivacaine in Single-Injection Retroclavicular Brachial Plexus Block for Arthroscopic Shoulder Surgery: A Phase I/II Trial.

A brachial plexus block plays an important role in providing perioperative analgesia for shoulder surgery; however, the inherent risk of phrenic nerve block and resulting hemidiaphragmatic paralysis may limit its use in patients with compromised pulmonary function. This study aimed to evaluate safety, efficacy, the maximum tolerated volume, and the optimal biological volume of 0.5% ropivacaine used in a single-injection retroclavicular brachial plexus block for arthroscopic shoulder surgery. In this seamless single-arm exploratory phase I/II trial, a novel Bayesian optimal interval design was used to guide volume escalation for determination of the maximum tolerated volume, followed by sequential volume expansion using Bayesian optimal phase 2 design to establish the optimal biological volume. Fifty-four patients who underwent arthroscopic shoulder surgery received a single-injection retroclavicular brachial plexus block with 0.5% ropivacaine ranging from 15 mL to 40 mL. The primary outcomes were complete or partial hemidiaphragmatic paralysis in phase I, measured using ultrasound 30 min after block completion, and the block success in phase II, defined as achieving a total sensorimotor score ≥12 points and the total sensory score ≥3, measured through manual sensorimotor testing. The maximum tolerated volume for the single-injection retroclavicular brachial plexus block was determined to be 35 mL of 0.5% ropivacaine, with a hemidiaphragmatic paralysis rate of 0.09 (95% credible interval, 0 to 0.29). The optimal biological volume was found to be 25 mL, with a block success rate of 1.0 (95% credible interval, 0.95 to 1.0) and a negligible hemidiaphragmatic paralysis rate of 0.01 (95% credible interval, 0 to 0.06). A single-injection retroclavicular brachial plexus block using 25 mL of 0.5% ropivacaine produced consistent block success with a minimal HDP rate, suggesting the need for further studies to confirm this result in arthroscopic shoulder surgery.

Acute Exacerbation of Interstitial Lung Disease: Definitions, Epidemiology, Prognosis and Management.

Abstract Acute exacerbation of interstitial ling disease (AE-ILD) denotes a rapid deterioration of respiratory function often leading to ICU admission due to severe hypoxemia. Definitions encompass the diverse spectrum of interstitial lung diseases and specific criteria for AE-ILD, originally established for idiopathic pulmonary fibrosis (IPF) and later expanded to other interstitial lung diseases. The incidence varies among the various interstitial lung disease subtypes, with around 10% of interstitial lung disease patients experiencing acute exacerbations within the initial two years of diagnosis. Clinical risk factors encompass advanced interstitial lung disease, compromised pulmonary function, and coexisting conditions. Prognostic markers include baseline pulmonary parameters, blood markers, and a newly developed Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) staging system. However, due to the scarcity of randomized studies, optimal treatment strategies remain uncertain. Current guidelines propose supportive care and oxygen therapy, with cautious use of corticosteroids in AE-IPF. Antibiotics are employed to manage infections, with procalcitonin-guided therapy showing potential. Management involves exposure elimination, targeted antibiotics, and antacid and antifibrotic use. For severe cases, mechanical ventilation, extracorporeal membrane oxygenation (ECMO), and even transplantation are considered. To conclude, AE-ILD poses formidable challenges and high mortality rates. Given the lack of standardized approaches, the pursuit of randomized trials is vital to enhance the understanding and management of AE-ILD, optimizing patient outcomes within the ICU setting. Keywords: acute exacerbation, interstitial lung disease, idiopathic pulmonary fibrosis, intensive care unit, definition.

Neoadjuvant anlotinib combined with penpulimab for resectable locally advanced esophageal squamous cell carcinoma (ESCC): Updated data from a prospective, phase II trial.

e16079 Background: Neoadjuvant chemoradiation therapy followed by radical surgery has been extensively recommended for locally advanced esophageal squamous cell carcinoma (ESCC). However, toxicities and challenges to the subsequent surgery limit its wide clinical application. Immune checkpoint inhibitors combined with antiangiogenesis have synergistic effects and have shown good therapeutic effects in previous studies, as well as fewer side effects. Here, we tested a novel combination of anlotinib (an antiangiogeneic kinase inhibitor) and penpulimab (an anti-PD-1 antibody), devoid of radio- or chemo-therapy, for the neoadjuvant therapy of locally advanced ESCC. Methods: In this prospective, single-arm, phase II clinical trial (ChiCTR2200064848), patients(pts) with resectable locally advanced ESCC (clinical stage III-IVa) were recruited. The study was designed using a two-stage minimax approach. The planned sample size was 40 pts would provide 80% power at a one-sided alpha error of 5%, threshold pathological complete response (pCR) of 16% and expected pCR of 30%. Pts received neoadjuvant therapy with anlotinib (8 mg, po, D1-14, Q3W) combined with penpulimab (200 mg, ivgtt, Q3W) for 2 cycles. Six to eight weeks later, pts underwent radical surgery after exclusion of contraindications. The primary endpoint was pCR rate. Secondary endpoints included tumor regression grade (TRG), R0 resection rate, objective response rate (ORR) and safety profile. Results: From Jan 2023 to Nov 2023, 25 pts (19 males and 6 females) were enrolled with a median age of 67 years (range: 50-74). A concerning 92% were diagnosed with lymph node metastasis. Moreover, 85% (22/25) pts exhibited medical contraindications, including pure red cell aplasia, compromised pulmonary function, and poor nutritional status, etc.) rendering them ineligible for standard neoadjuvant chemoradiotherapy or chemotherapy. All pts were available for efficacy assessment, ORR and DCR were 48.0% and 96.0%, respectively. Of these, 21 pts underwent esophagectomy, with an R0 resection rate of 90.5% (19/21). The study's initial phase successfully achieved its primary endpoint, with a pCR rate of 19.0% (4/21). Furthermore, the major pathological response (MPR) was 28.6% (6/21). The most common TRAEs (≥10%) included hypertension (28.0%), hand-foot syndrome (20%), fatigue (20%), abdominal pain (12%), toothache (12%). Grade 3-4 TRAEs were observed in 12.0% of the patients (3/25), and no reports of grade 5 TRAEs. Conclusions: Preliminary results from the initial stage suggest that anlotinib combined with penpulimab as a neoadjuvant treatment for ESCC showed promising safety and efficacy, especially for those deemed unsuitable for neoadjuvant chemoradiation or chemotherapy. More ESCC pts would be recruited in the future. Clinical trial information: ChiCTR2200064848.

Early smoking lead to worse prognosis of COPD patients: a real world study

BackgroundSmoking remains a major risk factor for the development and progression of chronic obstructive pulmonary disease (COPD). Due to the adolescent smoking associated with worse health state, the age, at which an individual started smoking, might play a key role in shaping the trajectory of COPD development and the severity.MethodsWe conducted an observational study from September 2016 through January 2023 of eligible patients hospitalized with COPD. Patients who started smoking during the alveolar development stage (ADS, smoking initiation ≤ 24 years old) were defined as early smoking patients, and patients who started smoking after ADS (smoking initiation > 24 years old) were defined as late smoking patients. We collected demographic and clinical data characterizing the patients and documented their condition from hospital discharge to follow-up. The primary endpoints were short-term (within one year), 3-year, and long-term (beyond 3 years) all-cause mortality after discharge.ResultsAmong 697 COPD patients, early smoking patients had a lower smoking cessation rate (P < 0.001) and a higher smoking index (P < 0.001) than late smoking patients. Although adjusted smoking index, early smoking patients still had poorer lung function (P = 0.023), thicker left ventricular diameters (P = 0.003), higher frequency of triple therapy use during stable stage (P = 0.049), and more acute exacerbations in the past year before enrollment (P < 0.05). Survival analysis showed that they had a higher risk of death after discharge within three years (P = 0.004) and beyond three years (P < 0.001). Furthermore, even in early smoking COPD patients who quit smoking after adjusting the smoking index had poorer lung function (P < 0.05) and thicker left ventricular diameters (P = 0.003), and survival analysis also showed that they had a higher long-term mortality rate (P = 0.010) and shorter survival time (P = 0.0128).ConclusionEarly smoking COPD patients exhibited multiple adverse clinical outcomes, including heavy cigarette addiction, compromised pulmonary function, augmented left ventricular diameter, and elevated mortality risk. Additional, smoking cessation could not bring enough improvement of health state in early smoking COPD patients as late smoking COPD patients. Consequently, early intervention and specialized cessation approaches for younger smokers are of paramount importance in this context.

Retrospectively gated ultrashort-echo-time MRI T1 mapping reveals compromised pulmonary microvascular NO-dependent function in a murine model of acute lung injury.

This study sought to develop noninvasive, in vivo imaging schemes that allow for quantitative assessment of pulmonary microvascular functional status based on the combination of pulmonary T1 mapping and dynamic contrast-enhanced (DynCE) imaging. Ultrashort-echo-time (UTE) imaging at 9.4 T of lung parenchyma was performed. Retrospective gating was based on modulation of the first point in each recorded spoke. T1 maps were obtained using a series of five consecutive images with varying RF angles and analyzed with the variable flip angle approach. The obtained mean T1 lung value of 1078 ± 38 ms correlated well with previous reports. Improved intersession variability was observed, as evident from a decreased standard deviation of motion-resolved T1 mapping (F-test = 0.051). Animals received lipopolysaccharide (LPS) and were imaged at t= 2, 6, and 12 h after administration. The nitric oxide (NO)-dependent function was assessed according to changes in lung T1 after L-NAME injection, while microvascular perfusion and oxidant stress were assessed with contrast-enhanced imaging after injection of gadolinium or 3-carbamoyl-proxyl nitroxide radical, respectively. Retrospectivel gated UTE allowed robust, motion-compensated imaging that could be used for T1 mapping of lung parenchyma. Changes in lung T1 after L-NAME injection indicated that LPS induced overproduction of NO at t= 2 and 6 h after LPS, but NO-dependent microvascular function was impaired at t= 12 h after LPS. DynCE imaging at t= 6 h after LPS injection revealed decreased microvascular perfusion, with increased vascular permeability and oxidant stress. MRI allows to visualize and quantify lung microvascular NO-dependent function and its concomitant impairment during acute respiratory distress syndrome development with high sensitivity. UTE T1 mapping appears to be sensitive and useful in probing pulmonary microvascular functional status.

Feasibility of Performing Supine Percutaneous Nephrolithotomy for Solitary Renal Pelvic Stones (1.5-3 cm) Under Spinal Anaesthesia: A Single-Centre Study.

Introduction Percutaneous nephrolithotomy (PCNL) procedure has evolved over the yearsand one such evolution has been the introduction of supine PCNL by Valdivia in 1987. This approach offers the added advantage of safe access in patients with compromised cardiovascular and pulmonary function. General anesthesia is the preferred anesthetic technique for PCNL. However, in the last decade, there has been an increase in the usage of regional anesthesia for this procedure. We share our experience of supine PCNL for solitary renal pelvic stones under regional anesthesia. Aim and objective To assess the feasibility, safety, and efficacy of supine PCNL for solitary renal pelvic stones sized1.5 to 3 cm under spinal anesthesia. Material and methods This was a retrospective record review of 35 patients (21 male) who underwent supine PCNL under regional anesthesia between January 2022 till December 2022 at our institute. All patients had asolitary renal pelvic calculus sized 1.5-3 cm. Intraoperative and postoperative data were analyzed. Results The mean age of patients was 38.5 ± 15 years. The postoperative pain visual analog scale (VAS) score was <5 in 31 (89%) and >5 in 4 (11%) patients. The mean hospital stay was 3.33 ± 0.88 days. Mean fall in hemoglobin level was 0.49 ± 0.43 mg/dL. Postoperatively, mild hematuria occurred in three patients (8.5%) and fever occurred in two (5.7%) patients. There was no injury to adjacent organs in this series. Blood transfusion was required only in one patient. Complete stone clearance was achieved in all patients. Conclusion In experienced hands, supine PCNL under regional anesthesia is a feasible, safe, and effective approach with minimal morbidity.

Prolonged air leak after segmentectomy: incidence and risk factors.

We designed this study to investigate the rate and risk factors of prolonged air leak (PAL) in patients undergoing pulmonary segmentectomy in our unit. We performed a retrospective cohort study on 191 patients undergoing pulmonary segmentectomy (January 2017-August 2021). A PAL was defined as an air leak >5 days. One hundred and sixty-eight segmentectomies were performed using video-assisted thoracoscopic surgery (VATS), 13 were open operations and 10 were robotic. PAL occurred in 36 patients (19%). Their average post-operative stay was 2.4 days longer than those without PAL. Logistic regression analysis showed that a low preoperative carbon monoxide lung diffusion capacity (DLCO) (OR 0.98, P<0.001), low body mass index (BMI) (OR 0.95, P=0.002) and the performance of complex segmentectomies (OR 2.2, P<0.001). were significantly associated with PAL. Pulmonary segmentectomies are associated with a not negligible risk of PAL when using real world data, especially in patients with compromised pulmonary function and after complex segmentectomies. This finding is useful to inform the decision-making process.

Complement Drives Acute Chest Syndrome in a Model of Sickle Cell Disease

Background: Despite being the first genetic disease described, sickle cell disease (SCD) continues to afflict millions of individuals worldwide. Patients with SCD can experience severe complications, including vasoocclusive crisis (VOC), which can progress to acute chest syndrome (ACS), a form of acute lung injury. While VOC can cause significant morbidity, ACS is the leading cause of mortality in patients with SCD. Despite the devastating consequences of ACS, no interventions exist that directly treat this complication. As a result, when patients present with ACS, options often remain limited to supportive care. The lack of optimal treatment options for patients with SCD experiencing ACS directly contributes to their morbidity and mortality. Using a combined approach of prospective observational studies in patients with SCD that experienced ACS and a novel preclinical model specifically designed to define the role of complement in SCD pathophysiology, we tested the hypothesis that complement plays a central role in the pathophysiology of ACS. Methods: Samples from patients with SCD experiencing ACS were compared to baseline measurements for the same patient obtained at outpatient follow up 4-6 weeks later. ELISA based assays were used to measure Ba, Bb, C3a, C5a, C5b-9 (membrane attack complex (MAC)) in each sample. SCD mice (HbSS) and control mice (HbAA) were injected with 7.5 units of cobra venom factor (CVF), a potent complement activator, followed by evaluation of hematocrit (Hct) measured by a Sysmex veterinary hematology analyzer, free heme by calorimetric assay, and complement deposition on red blood cells (RBCs) by flow cytometry or pulmonary endothelial cells by confocal analysis. Respiratory rate and O2 saturation were measured using a MouseOx pulse oximeter. HbSS or HbAA mice were crossed with complement component 3 (C3) knock out (KO) mice to generate HbSS x C3 KO and HbAA x C3 KO mice. Hemin (70 to 210 mmol/kg concentration) or CVF (7.5 units/mouse) were injected into HbSS, HbAA, HbSS x C3 KO or HbAA x C3 KO followed by evaluation of hemolysis, C3 deposition and pulmonary function. A one-way ANOVA with a Tukey's post hoc with a p value <0.05 was considered significant. Results: During ACS in patients, significant elevations in Ba and Bb, complement activation products unique to the alternative pathway, and downstream activation of complement, including C3a, C5a and MAC, were observed (p<0.0001). Changes in complement activation were accompanied by a drop in hemoglobin during ACS when compared to baseline (p<0.001), suggesting that complement activation results in hemolysis. To formally test this, the impact of complement activation in a preclinical model of SCD was defined. Injection of CVF or hemin resulted in rapid C3 deposition on RBCs and pulmonary endothelium in HbSS, but not HbAA, recipients. In addition, CVF or hemin injection was accompanied by increased hemolysis and ACS manifested by increased respiratory rate, drop in oxygen saturation and death within 2 hours in the majority of recipients (p<0.001). In contrast, control Hb AA mice were unaffected by CVF or hemin injection. Given the role of free heme in the development of ACS, we next defined the role of complement in hemin-induced lung injury. To accomplish this, SCD mice were crossed with C3 KO mice to generate HbSS x C3 KO. HbSS x C3 KO mice displayed a mild increase in Hb values at baseline (p<0.01), suggesting a role of C3 even in steady-state SCD-related hemolysis. Equally important, injection of HbSS x C3 KO mice with CVF or hemin failed to result in the same levels of C3 deposition, hemolysis, compromised pulmonary function, or mortality (p<0.001) as HbSS recipients. Discussion: These results demonstrate a critical role for C3 in the development of acute lung injury in SCD. The sensitivity of HbSS RBCs to complement-induced hemolysis and C3 deposition observed following hemin injection in SCD recipients suggests that C3 plays a key role in decreased hematocrits and pulmonary injury that accompanies ACS. As treatment of ACS largely relies on supportive care, these results suggest that approaches aimed at targeting complement activation may represent a useful prophylactic or treatment strategy for ACS. In doing so, these results hold promise in providing a more direct approach at reducing one of the most severe complications of patients with SCD.

Liver-Directed Adeno-Associated Virus–Mediated Gene Therapy for Mucopolysaccharidosis Type VI

BackgroundMucopolysaccharidosis type VI (MPS VI) is an inherited multisystem lysosomal disorder due to arylsulfatase B (ARSB) deficiency that leads to widespread accumulation of glycosaminoglycans (GAG), which are excreted in increased amounts in urine. MPS VI is characterized by progressive dysostosis multiplex, connective tissue and cardiac involvement, and hepatosplenomegaly. Enzyme replacement therapy (ERT) is available but requires life-long and costly intravenous infusions; moreover, it has limited efficacy on diseased skeleton and cardiac valves, compromised pulmonary function, and corneal opacities.MethodsWe enrolled nine patients with MPS VI 4 years of age or older in a phase 1/2 open-label gene therapy study. After ERT was interrupted, patients each received a single intravenous infusion of an adeno-associated viral vector serotype 8 expressing ARSB. Participants were sequentially enrolled in one of three dose cohorts: low (three patients), intermediate (two patients), or high (four patients). The primary outcome was safety; biochemical and clinical end points were secondary outcomes.ResultsThe infusions occurred without severe adverse events attributable to the vector, meeting the prespecified end point. Participants in the low and intermediate dose cohorts displayed stable serum ARSB of approximately 20% of the mean healthy value but returned to ERT by 14 months after gene therapy because of increased urinary GAG. Participants in the high-dose cohort had sustained serum ARSB of 30% to 100% of the mean healthy value and a modest urinary GAG increase that did not reach a concentration at which ERT reintroduction was needed. In the high-dose group, there was no clinical deterioration for up to 2 years after gene therapy.ConclusionsLiver-directed gene therapy for participants with MPS VI did not have a dose-limiting side-effect and adverse event profile; high-dose treatment resulted in ARSB expression over at least 24 months with preliminary evidence of disease stabilization. (Funded by the Telethon Foundation ETS, the European Commission Seventh Framework Programme, and the Isaac Foundation; ClinicalTrials.gov number, NCT03173521; EudraCT number, 2016-002328-10.)

Segmental Thoracic Spinal for Modified Radical Mastectomy in Carcinoma of Breast

Segmental Thoracic spinal anesthesia for modified Radical Mastectomy in patients with compromised Pulmonary Function Test provides good hemodynamic stability, and adequate intraoperative and postoperative analgesia, with patient satisfaction. Here, we present a 60 years old patient with carcinoma of the breast posted for Modified Radical Mastectomy under Segmental Thoracic Spinal Anaesthesia.

High frequency percussive ventilation: An asset to existing ventilation modi in intraoperative care?

High frequency percussive ventilation (HFPV) is a ventilation mode that combines positive pressure ventilation with some advantages of high frequency ventilation. During HFPV, a pulsatile flow is generated with high frequency and low volumes. HFPV has been used in the intensive care unit (ICU) for several decades, in case of insufficient conventional positive pressure ventilation. However, literature on its use in intraoperative care is scarce. We hypothesize that HFPV might be a better alternative to existing ventilation modi during selected operative procedures or in patients with severely compromised pulmonary and/or cardiac function. In this paper, we explain the HFPV system, we zoom in on the physiological effects of HFPV, and we describe its potential role in the intraoperative setting. Results of existing studies show that, compared to other conventional ventilation modes, HFPV improves oxygenation and ventilation without jeopardizing hemodynamics. However, because of the low quality evidence regarding physiological effects and clinical effectiveness, and due to the complicated design and set-up of the HFPV ventilator, the use of HFPV in intraoperative care is currently very limited. We conclude that HFPV could potentially be an interesting ventilation mode for procedures requiring minimal respiratory motion or low airway pressures, however larger (comparative) study trials are required to evaluate its usability in the operating room in patients with compromised pulmonary and/or cardiac function.

Abstract No.: ABS3215: Superior trunk block: An unorthodox alternative to interscalene block for proximal humerus surgeries in patients with significant pulmonary disease

Background and Aims:Proximal shoulder surgery in patients with compromised pulmonary function stipulated the utilisation of superior trunk block, which spares phrenic nerve,as an alternative to interscalene block. This modificationallows patients to execute normal respiration perioperatively.This case series reports the efficacy of the block.Methods:Eight patients aged between 40 years to 80 years with significant restrictive, obstructive pulmonary disease and post-COVID 19 sequelae, posted for proximal humerus surgeries received the block. The block was performed under ultrasound guidance using 23 gauge Quincke spinal needle with 1:1 local anaesthetic mixture of 2% lignocaine+adrenaline and 0.5% bupivacaine with total volume injected being 15ml. The outcomes measured were loss of shoulder abduction, numbness of shoulder and pain relief, numbness of arm ,sonographic assessment of diaphragm movement, oxygen saturation perioperatively and closed-circuit measurement of the tidal volume generated.Results:Seven patients with superior trunk block achieved complete surgical anaesthesia of proximal shoulder. There was solitary use of dexmedetomidine for a patient with severe anxiety. Two patients required oxygen supplementation throughout the intraoperative period extending to post-operative period as well. Sonographic assessment intraoperatively and post-operatively disclosed adequate diaphragmatic excursion in all patients (table 1). Post-operative pain scores revealed satisfactory pain relief.Table 1Description of clinical variables in the case seriesCaseAnaesthesia of shoulder and upper armOxygen saturationTidal volume Diaphragmatic movementRescue analgesia 1Yes94%420 mlAdequateNo2Yes93%445 mlAdequateNo3Yes92%430 mlAdequateNo4Yes93%400 mlAdequateNo5Yes90%415 mlAdequateNo6Yes88%370 mlAdequateNo7Partial89%380 mlAdequateYes8Yes92%460 mlAdequateNoConclusion:Effective surgical anaesthesia and analgesia is delivered considerably with superior trunk block for surgeries of proximal humerus in patients with compromised pulmonary function by sparing phrenic nerve and is an appropriate substitute for interscalene block.

Persistent Nutritional Deficiency in Pancreatic-Insufficient Children and Adolescents with Cystic Fibrosis Despite Therapeutic Intervention

Abstract Background Cystic fibrosis (CF) is caused by mutations in the gene encoding the CF Transmembrane Conductance Regulator (CFTR) protein, resulting in compromised pulmonary function, malabsorption, and pancreatic insufficiency. The sequelae of CF are heterogeneous, and contributing factors are multifactorial. Nutritional deficiencies, particularly in essential fatty acids (EFA) and vitamins, are known to alter the trajectory of CF unfavorably. The current treatment modalities focus on proactive management of the pulmonary, gastrointestinal, and pancreatic functions; however, information on the monitoring and treatment of nutritional deficiencies in CF patients is scant. The objective of our study was to evaluate the effects of pancreatic function and CFTR modulator therapy on pertinent nutritional deficiencies in children and adolescents diagnosed with CF. Methods The study was approved by our institutional IRB and included 77 non-fasted CF participants, 10.4 + 5.2 years of age (range: 4 months-18 years), and an equal ratio of both sexes. Participants were stratified as pancreatic sufficient (PS, n=6), and pancreatic insufficient with (PI, n=48) or without CFTR modulator treatment (PI-M, n=23). Twenty-two fatty acids were measured in plasma by GC-MS, including omega-6 linoleic acid (LA), and omega-3 α-linoleic acid (ALA). Medical records and 24-hour dietary recalls were reviewed to correlate biochemical and clinical findings. Vitamins A and E and zinc levels of the participants were also obtained. Data analyses were performed by one-way ANOVA and Tukey’s multiple comparisons using Prism software (LaJolla, CA). Results There were no significant differences in BMI and caloric intake among the groups. The concentrations of EFA, LA, and ALA were significantly higher in the PS group (3904±229 nmol/mL and 149±24 nmol/mL) compared to the PI (2387±89 nmol/mL and 53±4 nmol/mL, p&amp;lt;0.01) and PI-M (2335±159 nmol/mL and 58±7 nmol/mL, p&amp;lt;0.01) groups, respectively. Similarly, the biologically active omega-6 arachidonic acid and omega-3 docosahexaenoic acid were lower in the PI and PI-M groups compared to the PS group (p&amp;lt;0.05). Interestingly, EFA deficiency biomarkers, omega-9 mead acid, and the Triene:Tetraene ratio, were significantly higher in the PI group (17±2 nmol/mL and 0.033±0.003) vs PS group (13±3 nmol/mL and 0.019±0.002, p&amp;lt;0.05), respectively. Higher concentrations of vitamins A and E were observed in the PS group vs PI-M groups (p&amp;lt;0.05), and zinc concentrations were not different among the groups. There were no associations between the concentrations of EFA and BMI, age, total caloric intake, and % calories from fat in PS, PI, and PI-M patients. Conclusion While advances in CF therapeutics are remarkable, our data show the persistence of nutritional deficiencies in pancreatic insufficient CF patients regardless of CFTR modulator therapy and support the clinical utility of EFA and vitamins as potential adjuvant biomarkers to assess the severity and assist in the clinical monitoring of CF.

Management &amp; Caring for Patients of COPD with COVID-19: A Current Perspective

Currently passing pandemic of SARS COVE-2, that started on December 2019 has been taken nearly 2.8 million lives till April 2021, with a highest mortality among males, older individuals and patients with comorbidities. COPD patients are included in shielding strategies due to their susceptibilityto virusinduced exacerbations, compromised pulmonary function and highprevalence of associated comorbidities. Based on our existing knowledge, Experience of last one year &amp;Metaanalysis of different study report, thisreview has taken the initiative to find the answer of few key question : FirstlyIs the Covid19 infection causing AECOPD like any other viralinfection.Secondly, do systemic corticosteroids offer protection againstCOVID-19 with COPD ? And, finally , what is the evidence regarding use ofMDI or nebulization &amp; NIV as standard treatment .This up-to-date review will make scope for some of the key issues whichhave significant impact on the long-term outlook for COPD patients in thecontext of COVID-19.&#x0D; Bangladesh J Medicine July 2021; 32(2) : 165-169

English

Transmission of COVID-19 is facilitated by uptake of droplets containing coronavirus from the breath, sneeze or cough of infected persons. This represents the commonest mode of coronavirus infection and spread to mucous membranes of the respiratory system. The virus rapidly replicates in alveolar cells, triggering a strong immune response, resulting in cytokine storm syndromes and pulmonary tissue damage. These pathologic processes contribute to a compromised pulmonary function. Thus, evaluation of pulmonary function would give insights into modulatory effect of agents that may be beneficial in ameliorating this pathology. The study evaluated effects of Cov-Pla1 and Cov-Pla3 (polyherbal products of the research team, positioned for treatment of Covid-19) on pulmonary function in bleomycin-induced lung injury in rabbits. Rabbits of both sexes were divided into six groups and treated with the extracts alone or the extract following pre-treatment with bleomycin. Targeted respiratory function parameters were monitored at baseline and on day three. Vital capacity, tidal volume, inspiratory reserve volume and inspiratory capacity in the groups treated with Cov-Pla1 and Cov-Pla3 at 125 and 500 mg/kg respectively were compared with the bleomycin only group. In bleomycin pre-treated groups, the two preparations at 125 mg/kg showed increased vital capacity compared to the bleomyicn only group. This pattern was repeated with the other parameters that were evaluated. These results imply that Cov-Pla1 and Cov-Pla3 at the 125 mg/kg dose have ameliorative effects on bleomycin induced lung injury and could be beneficial in situations such as COVID-19 where there are active insults to the respiratory system. Keywords:&nbsp; COVID-19, Cov-Pla, Herbal Preparation, Respiratory function

Successful Lung Cryoablation for a Bulky Lung Carcinoma

A 49-year-old man was referred for ablation of a 6.3-cm lung tumor (Fig 1). Prior history included Hodgkin disease (1992), tobacco use, right upper lobectomy for lung adenocarcinoma (2013), and chemotherapy for a contralateral recurrence (2015), with a complete response. A recurrence occurred in 2017; he was contraindicated for additional surgery and radiotherapy because of prior radiation and compromised pulmonary function: forced expiratory volume in 1 second (FEV1) = 68% and maximal oxygen uptake (VO2max) = 41%. Lung cryoablation was planned. Using computed tomographic guidance, 7 cryoprobes (IceRoad-Cx, Galil Medical, Yokne'am Illit, Israel) (Figs 2, 3) were successfully placed and activated for 3 freeze-thaw cycles. A 24-hour intensive care unit recovery and chest tube were required due to a pneumothorax and lung consolidation. He was discharged 12 days later. Positron emission tomography-computed tomography after 2 years of follow-up showed a complete metabolic response and the shrinkage of the ablation scar (Fig 4). Figure 2Computed tomography volume rendering reformation demonstrated the 7 cryoprobes coursing through the chest wall into the mass. View Large Image Figure Viewer Download Hi-res image Figure 3Multiplanar reconstruction orthogonal to the long axis of the probes shows their distribution within the tumor in order to create an encompassing ice ball with safety margins. View Large Image Figure Viewer Download Hi-res image Figure 4Axial computed tomography with positron emission tomography fusion obtained 2 years after treatment shows the absence of metabolic activity and the shrinkage of the ablation scar. View Large Image Figure Viewer Download Hi-res image

Altered cervical posture kinematics imposed by heavy school backpack loading: A literature synopsis (2009-2019).

BackgroundHabitual school backpack carriage causes neuro-musculoskeletal vertebral, shoulder and hand pain; deviated posture compromised cardiopulmonary function and proprioception.ObjectivePresent a novel literature summary of the influence of backpack carriage associated with deviated cervical posture and compromised pulmonary function.MethodAn electronic literature appraisal adopting the Preferred Reporting Items for Systematic Reviews, using Google Scholar, Science Direct, EMBASE, AMED, OVID, PubMed and Sabinet search engines, was instituted during 2009–2019. Key search words: schoolbag, backpack, carriage, cervical posture and children. The quality of the studies was assessed using the Downs and Black Appraisal Scale.Results583 records were initially identified which was reduced to 14 experimental and observational studies. A total of 1061 participants were included across the 14 studies, with an average age of 11.5 ± 1.3 years, body mass of 37.8 ± 6.6 kilograms (kg), height of 1.41 ± 0.05 meters (m), backpack mass of 5.2 ± 0.9 kg and percentage backpack mass to child’s body mass of 13.75%. The studies mean rating according to the Downs and Black Appraisal Scale was 76.3%. The average craniovertebral angle (CVA) was 53.9° ± 14.6° whilst standing without carrying a backpack was reduced to 50.4° ± 16.4° when loaded (p < 0.05). Backpack loads carried varied from 5% – 30% of the participant’s body mass that produced a mean CVA decline of 3.5°.ConclusionBackpack carriage alters cervical posture, resulting in smaller CVA and compromised pulmonary function. There is no consensus of the precise backpack mass that initiates postural changes. Girls’ posture begin changes when carrying lighter backpacks as compared to boys of the same age strata.

Altered cervical posture kinematics imposed by heavy school backpack loading: A literature synopsis (2009–2019)

Background: Habitual school backpack carriage causes neuro-musculoskeletal vertebral, shoulder and hand pain; deviated posture compromised cardiopulmonary function and proprioception. Objective: Present a novel literature summary of the influence of backpack carriage associated with deviated cervical posture and compromised pulmonary function. Method: An electronic literature appraisal adopting the Preferred Reporting Items for Systematic Reviews, using Google Scholar, Science Direct, EMBASE, AMED, OVID, PubMed and Sabinet search engines, was instituted during 2009–2019. Key search words: schoolbag, backpack, carriage, cervical posture and children. The quality of the studies was assessed using the Downs and Black Appraisal Scale. Results: 583 records were initially identified which was reduced to 14 experimental and observational studies. A total of 1061 participants were included across the 14 studies, with an average age of 11.5 ± 1.3 years, body mass of 37.8 ± 6.6 kilograms (kg), height of 1.41 ± 0.05 meters (m), backpack mass of 5.2 ± 0.9 kg and percentage backpack mass to child’s body mass of 13.75%. The studies mean rating according to the Downs and Black Appraisal Scale was 76.3%. The average craniovertebral angle (CVA) was 53.9° ± 14.6° whilst standing without carrying a backpack was reduced to 50.4° ± 16.4° when loaded ( p &lt; 0.05). Backpack loads carried varied from 5% – 30% of the participant’s body mass that produced a mean CVA decline of 3.5°. Conclusion: Backpack carriage alters cervical posture, resulting in smaller CVA and compromised pulmonary function. There is no consensus of the precise backpack mass that initiates postural changes. Girls’ posture begin changes when carrying lighter backpacks as compared to boys of the same age strata.

Study of pulmonary function test in hypothyroidism

Introduction: thyroid disorders are very common worldwide and there is steep rise in thyroid disorders in India as well.1 There are very few studies done in past to evaluate effect of thyroid disorder on pulmonary function. This study is focused on estimating effects of hypothyroidism on pulmonary function of affected individual. Aim: To study pulmonary function test in hypothyroid patients and to assess correlation of compromised pulmonary function with Thyroid stimulating hormone levels, duration of hypothyroidism, age of patient and body mass index values. Materials and Methods: A total of 67 hypothyroid patients were selected. This study was approved by the Ethical Committee. The present study was carried out in accordance with the Helsinki declaration all participants participated voluntarily after being given a detailed explanation of the purpose of the study. All hypothyroid patients visiting medicine OPD and those hospitalised were included in study. Smokers, former smokers, patients suffering from lifestyle disease and all patients suffering from pulmonary diseases were excluded from study. Pulmonary function tests were evaluated by computerised spirometer HELIOS 702 of recorders and medicare systems private limited (RMS). Data so obtained was analysed with the help of SPSS. Results: both FVC and FEV1 means were decreased. 44% of patients were having restrictive type of lung disease. Forced vital capacity (FVC) and forced expiratory volume in one sec (FEV1) showed strong negative correlation with Thyroid stimulating hormone levels (TSH), duration of hypothyroidism and Body mass Index (BMI). Conclusion: Findings of this study were consistent with restrictive type of lung disease in hypothyroid patients. Hypothyroidism compromises the pulmonary function of affected individual to variable degree depending upon duration of disease and higher levels of TSH and BMI. All hypothyroid patients must be screened for abnormalities of pulmonary function and all patients