Decrease In Forced Vital Capacity Research Articles

Ambient air pollution, lung function and COPD: cross-sectional analysis from the WHO Study of AGEing and adult health wave 1

BackgroundLong-term exposure to ambient air pollution leads to respiratory morbidity and mortality; however, the evidence of the effect on lung function and chronic obstructive pulmonary disease (COPD) in older adult...

Safety and Stability of Pulmonary Function in Patients with Decreased Respiratory Function Treated for Spasticity with OnabotulinumtoxinA.

Two randomized, placebo-controlled studies evaluated the pulmonary function safety of onabotulinumtoxinA (onabotA) for treatment of upper and/or lower limb spasticity. Patients with stable baseline respiratory status received one or two treatments with placebo, 240 U, or 360 U of onabotA. Pulmonary function tests, adverse events, and efficacy were measured at least every 6 weeks for 18 weeks (Study 1) or 30 weeks (Study 2). Study 1 enrolled 109 patients (n = 36–37/group) and Study 2 enrolled 155 patients (n = 48–54/group). Mean baseline forced vital capacity (FVC) was 76–78% of predicted per group in Study 1 and 71% of predicted per group in Study 2. In Study 1, change from baseline FVC values were significantly (p < 0.05) decreased vs. placebo at weeks 3 (240 U −57 mL vs. placebo +110 mL) and 12 (360 U −6 mL vs. +167 mL placebo). In Study 2, change from baseline FVC values were significantly decreased in the 360 U group vs. placebo at weeks 6 (−78 mL vs. +49 mL placebo), 13 (−60 mL vs. +119 mL placebo), 18 (−128 mL vs. +80 mL placebo), and 24 (−82 mL vs. +149 mL placebo). Individual pulmonary function-related adverse events were not correlated with PFT decreases. The most frequent pulmonary-related adverse events were nasopharyngitis (Study 1) and upper respiratory tract infection (Study 2). Ashworth scores were significantly improved at multiple time points in both studies. Injection of onabotA for spasticity in patients with decreased pulmonary function, at single and repeated doses of up to 360 U, was associated with small but statistically significant decreases in FVC or forced expiratory volume 1 s (FEV1) (>12% and 200 mL) that were subclinical and not correlated with any adverse clinical pulmonary events.

Long-term exposure to PM2.5 and Children's lung function: a dose-based association analysis.

BackgroundThe current literature is still not consist regarding the effect of long-term exposure to PM2.5 and children’s lung function, partly due to inadequate or inaccurate exposure assessment. In this study, we aim to investigate the associations between long-term exposure to PM2.5, estimated as average daily dose (ADD), and lung function in school-age children.MethodsWe recruited 684 participants of 7–12 years old from the city of Lanzhou located in northwestern China. Participants underwent spirometric tests for lung function and responded to a questionnaire survey. Detailed information about individual air exposure and personal information were collected, including length of school hours, home address, age, gender, etc. Combining the spatial distribution of PM2.5 concentrations in the past 5 years and individual time-activity data, we estimated annual ADD for 5 years preceding the lung function tests and 5-year average ADD, respectively. We used multiple linear regression models to examine the associations between ADD values and lung function, controlling for a range of individual-level covariates.ResultsThe 5-year average ADD among all the participants was 50.5 µg/kg-d, with higher values estimated for children living in the urban area than the suburban area, for boys than girls, and for children whose parents received a lower education attainment. We found that a 1 μg/kg-d increment in ADD of PM2.5 was associated with a 10.49 mL (95% CI: −20.47, −0.50) decrease in forced vital capacity (FVC) and a 7.68 mL (95% CI: −15.80, −0.44) decrease in forced exploratory volume in 1 second (FEV1). Among the annual ADDs estimated for the preceding 5 years, the immediate past year prior to lung function measurement had the greatest effect on lung function. The effect was greater in girls than in boys. We found no associations between annual exposure of PM2.5 (instead of ADD) and lung function when defined concentration was used as an exposure variable.ConclusionsLong-term PM2.5 exposure, when estimated as exposure dose averaged over a year or longer, was associated with statistically significant reductions in FVC and FEV1 in children of elementary-school age. Future studies may consider the use of individual-level dose estimates (as opposed to exposure concentrations) to improve the dose-response assessment.

Can Patient-Reported Symptoms Be Used to Measure Disease Activity in Systemic Sclerosis?

To evaluate the association between patient-reported symptoms and changes in disease activity over time in systemic sclerosis (SSc). Using data from 1,636 patients enrolled in the Australian Scleroderma Cohort Study, we used generalized estimating equations to determine the relationship between patient-reported worsening of Raynaud's phenomenon (RP), skin involvement, and breathlessness in the month preceding each study visit and features of disease activity in the corresponding organ systems. The associations between the following parameters were analyzed: patient-reported worsening RP and the presence of new-onset digital pitting and digital ulcers; patient-reported worsening skin involvement and increasing modified Rodnan skin thickness score (MRSS); new areas of skin involvement and new-onset joint contractures; patient-reported worsening breathlessness and deteriorating respiratory functions test (RFT) results, indicated by a 10% decrease in forced vital capacity (FVC) and a 15% decrease in diffusing capacity for carbon monoxide (DLco), new-onset interstitial lung disease (ILD), and new-onset pulmonary arterial hypertension (PAH). We found a significant association between patient-reported worsening RP and the presence of digital ulcers (odds ratio [OR] 1.53 [95% confidence interval (95% CI) 0.60-0.93]), patient-reported worsening skin involvement and increasing MRSS (OR 2.10 [95% CI 1.54-2.86]), and worsening patient breathlessness and deteriorating RFTs (FVC OR 2.12 [95% CI 1.70-2.65]; DLco OR 1.97 [95% CI 1.34-2.02]), new-onset ILD (OR 1.91 [95% CI 1.40-2.61]), and new-onset PAH (OR 5.08 [95% CI 3.59-7.19]). These results demonstrate that patient-reported symptoms are associated with clinically meaningful changes in disease activity in patients with SSc. This suggests that when objective measures of change in disease status are unavailable, patient-reported symptoms could be used to indicate a change in SSc disease activity.

Cross-sectional and longitudinal associations between urinary zinc and lung function among urban adults in China

BackgroundExposure to zinc was suggested to be associated with pulmonary damage, but whether zinc exposure affects lung function remains unclear.ObjectivesTo quantify the association between urinary zinc and lung function and...

Comparison of survival analysis between surgical and non-surgical treatments in Duchenne muscular dystrophy scoliosis

BACKGROUND CONTEXTThere are still controversies about the effects of spinal surgeries for Duchenne muscular dystrophy (DMD) scoliosis on functional outcome, respiratory function, and the survival rate. PURPOSEThe purpose of this retrospective investigation was to compare the clinical course over time between the patients who were treated surgically and those who were treated nonsurgically. Through this comparison, we tried to determine how surgical treatment could affect the functional status, pulmonary function, and survival rate in patients with DMD scoliosis. STUDY DESIGN/SETTINGSingle-center retrospective cohort study. PATIENT SAMPLEWe reviewed the clinical data of 199 male patients with DMD scoliosis who were followed up at our center for an average of 6.4 years between 2003 and 2017. OUTCOME MEASURESThe basic radiologic parameters evaluated include the Cobb angle and pelvic obliquity on a whole spine X-ray. Further, the Swinyard scale for functional status, forced vital capacity (FVC) for respiratory function, and mortality were compared between the surgical group and nonsurgical group. METHODSThe radiologic parameters and Swinyard scale stage were compared between the surgical group and nonsurgical group at baseline and 2, 5, and 10 years. For the FVC, serial changes every year were investigated in both groups. Mortality was surveyed between the surgical group and nonsurgical group. RESULTSOf the 199 patients, 99 patients underwent the instrumented spinal fusion surgery and 100 patients in the nonsurgical group opted for conservative management. Radiologic results of the two groups were not different at baseline, but during the follow-up periods, the surgical group demonstrated better Cobb angles and pelvic obliquities. The surgical group showed a better functional status than did the nonsurgical group (6.7±0.9 versus [vs.] 7.2±0.7, p<.001). These functional differences between the groups were continuously observed during the follow-up period. Similarly, the FVC at baseline was higher in the surgical group than in the nonsurgical group (1005.7±421.4 mL vs. 787.3±574.1 mL, p=.005). Although FVC in the nonsurgical group consistently decreased during the follow-up (4.8% decrease/year), FVC in the surgical group increased up to the 2-year follow-up period compared with the baseline value and decreased during the follow-up period (2.8% decrease/year). Mortality was higher in the nonsurgical group than in the surgical group (n=22/100, 22.0% vs. n=8/99, 8.1%; p<.001) during an average follow-up duration of 6.4 years. Mean survival was longer in the surgical group than in the nonsurgical group (12.2 years vs. 8.3 years, hazard ratio=2.43, p=.02). CONCLUSIONSSpinal surgery for DMD scoliosis improved the FVC for approximately 2 years postoperatively compared to non-surgical treatment. The surgical group had a better functional status and FVC at baseline than the non-surgical group. The positive effect of surgical treatment on the FVC is owing to scoliosis correction, which delayed the decrease of FVC and consequently extended the survival rate of the patients with DMD scoliosis.

Lung function changes in patients with chronic obstructive pulmonary disease (COPD) and asthma exposed to secondhand smoke in outdoor areas

Background Further evidence is needed on the effects that short- and long-term exposure to secondhand smoke (SHS) have on the respiratory health of patients with lung disease. Within the TackSHS project we aimed to assess the acute respiratory effects in lung function that result from short-term SHS exposure among patients with asthma and chronic obstructive pulmonary disease (COPD). Methods The study design was an intervention trial with measurements before/after exposure to SHS in legal outdoor smoking areas. We studied patients with asthma or COPD from Czechia, Ireland, and Spain. Forced spirometry, peak flow and carbon monoxide (CO) measurements were performed pre- and 24 h post- exposure. Results Overall, 60 patients were studied, 30 with asthma, and 30 with COPD; 35 (58.3%) were female. There were no significant differences observed in exhaled CO between pre- and 24 h post-exposure neither in women (p = 0.210), nor in men (p = 0.169). A statistically significant decrease in forced vital capacity (FVC) was seen, overall, in asthma participants (p = 0.02) and in forced expiratory volume in the first second (FEV1), (p = 0.02), FVC (p = 0.04) and peak expiratory flow rate (PEFR) (p = 0.04) in female asthmatic participants. The observed decreases in respiratory measurements in COPD were not significant. There were no reported increases in symptoms, respiratory medication, or use of health services 24 h after the exposure. Conclusion We conclude that acute, short-term SHS exposure had a statistically significant effect on spirometry in female asthma patients but did not significantly modify spirometric indices 24 h later in COPD patients.

Pulmonary function decline in immediate postoperative period is not necessarily related to residual neuromuscular block

Previous studies have reported an association between the use of neuromuscular blocking (NMB) agents and postoperative pulmonary complications. Postoperative pulmonary function is a key indicator for postoperative pulmonary complications. Several sites can be used to assess depth and recovery from NMB. To investigate postoperative pulmonary function change in relation to train-of-four measurements at the adductor pollicis and corrugator supercilii muscles, and anaesthesia-related variables in orthopaedic patients undergoing hip or knee arthroplasty. Observational study. University hospital. Orthopaedic patients undergoing hip or knee arthroplasty. Postoperative pulmonary function tests in the postanaesthesia care unit. Patients scheduled for elective hip or knee arthroplasty received simultaneous corrugator supercilii and adductor pollicis measurements during anaesthesia conducted according to clinical standards. Forced expiratory volume in 1 s and forced vital capacity (FVC) were measured at the time of inclusion and postoperatively on the postanaesthesia care unit. Linear regression analysis was performed for association between risk factors and pulmonary function change. A total of 35 patients were included. After exclusions, 20 patients remained for final analysis. Corrugator supercilii showed earlier NMB recovery than adductor pollicis. FVC decreased significantly after surgery from 2.9 ± 1.0 to 2.3 ± 1.0 (P < 0.01) and forced expiratory volume in 1 s decreased from 2.3 ± 0.9 to 1.6 ± 0.8 l (P < 0.01). Patient age was the only factor significantly related to FVC decrease after surgery (P = 0.019) with a cut-off value of 65 years. Both corrugator supercilii and adductor pollicis failed to indicate recovery of pulmonary function after NMB. Age seems to be a risk factor for postoperative decline in pulmonary function. German Clinical Trials registry, DRKS-ID: DRKS00014305.

Obstruction-related dysphagia in inclusion body myositis: Cricopharyngeal bar on videofluoroscopy indicates risk of aspiration

ObjectiveTo show the predictive risk factors for aspiration pneumonia and prognostic importance of a cricopharyngeal bar (CPB) on videofluoroscopic examination of swallowing (VFS) in inclusion body myositis (IBM). MethodsIn this retrospective study, we examined a consecutive series of 37 patients with clinico-pathologically defined IBM based on the European Neuromuscular Center diagnostic criteria for IBM from 2013. The Swallowing Disturbance Questionnaire was used for the evaluation of dysphagia. A standard VFS was performed at diagnosis. The primary outcome was aspiration pneumonia. Secondary outcomes included IBM Functional Rating Scale score, forced vital capacity (FVC), and body mass index. ResultsAspiration pneumonia occurred in 10 of 37 IBM patients (27%). Based on univariate analysis, 4 factors increased aspiration pneumonia risk: BMI < 18.5 (n = 5; hazard ratio [HR], 10.7; 95% CI, 2.50–46.0; p = .001); aspiration (n = 7; HR, 7.57; 95% CI, 1.82–31.6; p = .005); insufficient opening of the upper esophageal sphincter (n = 11; HR, 4.53; 95% CI, 1.12–18.3; p = .03); and CPB presence (n = 15; HR, 11.6; 95% CI, 1.46–91.8; p = .02). Clinical features of IBM-CPB(+) were elderly onset, obstruction-related dysphagia, and mild decreases in FVC, resulting in aspiration pneumonia in 1.3 years (interquartile range, 0.9–5.2); 67% of IBM-CPB(+) patients underwent interventional procedures for dysphagia. IBM-CPB(+) patients had a lower FVC than IBM-CPB(−). ConclusionsA CPB in IBM largely contributes to obstruction-related dysphagia and is a risk factor that predicts aspiration pneumonia and refractory dysphagia requiring aggressive therapy.

Effects of Transcutaneous Electrical Nerve Stimulation on Pain, Pulmonary Function, and Respiratory Muscle Strength After Posterolateral Thoracotomy: A Randomized Controlled Trial.

To evaluate the effects of transcutaneous electrical nerve stimulation (TENS) compared to placebo TENS and a control group on pain, pulmonary function, respiratory muscle strength, and analgesic medications in the postoperative period of thoracotomy in an Intensive care unit (ICU). Patients who had undergone posterolateral thoracotomy were randomly allocated to receive TENS during ICU stay, or placebo TENS, or into the control group. All groups received conventional physiotherapy. We analysed the intensity of pain, pulmonary function, respiratory muscle strength, and use of analgesia medications. Outcomes were evaluated before surgery, immediately after, 24 and 48h after ICU admission. Forty-five patients were included. Regarding pain perception, there was no difference between groups (p = 0.172), but there was a significant reduction in pain intensity for patients receiving TENS after first physiotherapy session compared to baseline (4.7 ± 3.2 vs 3.3 ± 2.6; p < 0.05). All groups had a decrease in forced vital capacity (FVC) after surgery (p < 0.001). There was no difference between the groups regarding the use of analgesic medications, but a higher intake of morphine and acetaminophen were observed for the control (p = 0.037) and placebo group (p = 0.035), respectively. The use of TENS provides a little benefit of pain (in the first 12h) but failed to demonstrate any improvement in the recovery of ICU patients after 48h of posterolateral thoracotomy. NCT02438241.

Systemic Inflammation Mediates the Associations Between Abdominal Obesity Indices and Lung Function Decline in a Chinese General Population.

BackgroundPrevious studies reported that obesity indices were inversely associated with lung function. However, the underlying mechanisms remain unclear. We aimed to assess the potential mediating effect of systemic inflammation in the associations between obesity indices and lung function decline among a general population.MethodsWe conducted a cross-sectional study among 3442 participants from the Wuhan-Zhuhai cohort. Plasma C-reactive protein (CRP) was assayed as a marker of systemic inflammation. The relationships among several obesity indices (body mass index, BMI; waist circumference, WC; waist-to-hip ratio, WHR; waist-to-height ratio, WHtR), plasma CRP and lung function were assessed by generalized linear models. The role of CRP in the associations between obesity indices and lung function was analyzed using mediation analysis.ResultsWe observed inverse associations between abdominal obesity indices (WC, WHR and WHtR) and lung function parameters, including forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) (all P<0.05). Each 1-unit increase in WC was associated with a 3.39 mL decrease in FEV1 and a 3.96 mL decrease in FVC (all P<0.05). Each 1% increase in WHR and WHtR was associated with a 5.42 mL and a 14.23 mL decrease in FEV1, and a 5.70 mL and a 16.92 mL decrease in FVC (all P<0.05). Mediation analysis indicated that plasma CRP partly mediated the associations between abdominal obesity and lung function. The mediated proportions of CRP in associations of WC, WHR and WHtR with FEV1 were 7.96%, 9.59% and 5.76%, respectively. The mediated proportions of CRP in associations of WC and WHR with FVC were 8.33% and 11.40%, respectively.ConclusionAbdominal obesity indices were negatively associated with lung function, and the associations may be partly mediated by systemic inflammation.

Effects of a heat and moisture exchanger on respiratory function and symptoms post-cold air exercise.

PurposeExercise at temperatures below −15°C induces drying and cooling of lung airways which causes exercise‐induced bronchoconstriction (EIB) and respiratory symptoms, especially in winter sport athletes. The objective of this study was to evaluate whether a heat and moisture exchanger (HME) worn during intense cold air exercise improves lung function and reduces respiratory symptoms in healthy winter sport athletes.MethodsSeven active males and six active females (maximum oxygen uptake 61.9 ± 6.9 and 52.2 ± 5.3 mL/kg/min), all active or former winter sport athletes, completed running trials with and without HME in random order on 2 days in an environmental chamber (−20°C temperature, humidity 46.2%). Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), forced expiratory flow at 25%‐75% (FEF25%‐75%), and FEF at 50% (FEF50%) were measured pre‐ and post‐exercise (3, 6, 10, 15, and 20 minutes). Respiratory symptoms were reported after exercise.ResultsSignificant interaction effects were observed for FEV1 and FEF25%‐75%. Mean decrease of FVC (−5.9%, P ≤ .001) and FEV1 (−4.2%, P = .003) was largest 3 minutes post‐exercise without HME. There was an increase of FEV1, FEF25%‐75%, and FEF50% post‐exercise compared to pre‐exercise with HME. More respiratory symptoms overall were reported without HME (P = .046).ConclusionIntense cold air exercise likely causes transient acute bronchoconstriction and symptoms of cough in individuals participating in winter sports. However, this study finds that the application of an HME during intense cold air exercise improves lung function and reduces prevalence of EIB‐associated symptoms compared to unprotected intense cold air exercise.

Changes in the relationship between ambient fine particle concentrations and childhood lung function over 5 years

BackgroundExposure to ambient fine particles, particulate matter with an aerodynamic diameter of ≤2.5 μm (PM2.5), is a public health concern. Concentrations of ambient PM2.5 have changed temporally in the past 10 years after a series of action policies for improving air quality were implemented in Taiwan. In this study, temporal changes in the relationship between PM2.5 and lung function among children were investigated. MethodsA nationwide respiratory health survey was conducted among Taiwanese elementary and middle school students in 2011 and again in 2016–2017. A questionnaire was administered to students, for whom forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were measured using spirometry. During the study period, monthly concentrations of ambient PM2.5 were obtained from the monitoring stations of the Environmental Protection Administration. Lung function measurements were compared with ambient PM2.5 exposure using mixed-effects models. ResultsIn the 2011 survey (mean PM2.5: 40.6 μg/m3), exposure to PM2.5 in the preceding 1–2 months was associated with a 2.2% decrease (95% confidence interval [CI]: −4.1%, −0.3%) in FVC and a 2.3% decrease (95% CI: −4.0%, −0.5%) in FEV1. By contrast, a significant relationship between PM2.5 concentrations and lung function was not observed in the 2016–2017 survey (mean PM2.5: 30.0 μg/m3). ConclusionsAs improvement in air quality over time, the negative relationship between PM2.5 and childhood lung function tend to be not significant.

Acute effects of personal exposure to fine particulate matter on pulmonary health

TPS 683: Short-term health effects of air pollutants 2, Exhibition Hall, Ground floor, August 28, 2019, 3:00 PM - 4:30 PM Background: The association of personal exposure to fine particulate matter (PM2.5) with pulmonary health in children is still largely unknown. We aimed to investigate the short-term effects of PM2.5 exposure on various lung function outcomes among healthy Chinese children during their normal activities. Methods: A longitudinal panel study was performed among 282 children aged 4-13 years from different schools of urban (Wuhan) and rural (Henan) areas in China with up to three repeated visits across three seasons from 2017 to 2018. Personal and real-time exposure to PM2.5 for 72h preceding each of health examination was measured by personal samplers. Lung function test was performed by trained physicians. We used linear mixed-effects models to estimate the effects of PM2.5 exposure on lung function over various lag times. Results: Acute exposure to PM2.5 was associated with an immediate lung function decline in both areas, but the effects were inconsistent in different areas. Among children in Wuhan, the percent changes associated with an increase of 10 μg/m3 in 13-24 h average exposure to PM2.5 was 0.40% for FEV1/FVC ratio, 0.82% for forced expiratory flow 25-75% (FEF25–75%), 0.80% for forced expiratory flow of 50% of FVC (FEF50) and 1.28% for forced expiratory flow of 50% of FVC (FEF75); similarly, an increase of 10 µg/m3 in 49-72 h average exposure to PM2.5 was associated with a 0.38% decrease in forced vital capacity (FVC), 0.41% decrease in forced expiratory volume in 1 s (FEV1) and 1.34% decrease in FEF75 among children in Henan. In addition, the effect of exposure to PM2.5 on lung function decline was stronger in those used coal fuels and lived proximity to major roadways less than 300 miles compared with their counterparts. Conclusion: Our findings suggest that acute exposure to PM2.5 might contribute to lung function decline among healthy Chinese children.

Results of Phrenic Nerve Transfer to the Musculocutaneous Nerve Using Video-Assisted Thoracoscopy in Patients with Traumatic Brachial Plexus Injury: Series of 28 Cases.

The phrenic nerve can be transferred to the musculocutaneous nerve using video-assisted thoracoscopy, aiming at the recovery of elbow flexion in patients with traumatic brachial plexus injuries. There are few scientific papers in the literature that evaluate the results of this operative technique. To evaluate biceps strength and pulmonary function after the transfer of the phrenic nerve to the musculocutaneous nerve using video-assisted thoracoscopy. A retrospective study was carried out in a sample composed of 28 patients who were victims of traumatic injury to the brachial plexus from 2008 to 2013. Muscle strength was graded using the British Medical Research Council (BMRC) scale and pulmonary function through spirometry. Statistical tests, with significance level of 5%, were used. In total, 74.1% of the patients had biceps strength greater than or equal to M3. All patients had a decrease in forced vital capacity and forced expiratory volume in 1 s, with no evidence of recovery over time. Transferring the phrenic nerve to the musculocutaneous nerve using video-assisted thoracoscopy may lead to an increase in biceps strength to BMRC M3 or greater in most patients. Considering the deterioration in the parameters of spirometry observed in our patients and the future effects of aging in the respiratory system, it is not possible at the moment to guarantee the safety of this operative technique in the long term.

Prenatal exposure to organochlorine compounds and lung function during childhood

IntroductionPrenatal exposure to organochlorine compounds (OCs) can increase the risk of reported respiratory symptoms in children. It remains unclear whether these compounds can also impact on lung function. We assessed the association between prenatal exposure to OCs and lung function during childhood. MethodsWe included 1308 mother-child pairs enrolled in a prospective cohort study. Prenatal concentrations of p,p′-dichlorodiphenyltrichloroethane [p,p′-DDT], p,p′-dichlorodiphenyldichloroethylene [p,p′-DDE], hexachlorobenzene [HCB], and seven polychlorinated biphenyls [PCBs] were measured in cord blood. Spirometry was performed in the offspring at ages 4 (n = 636) and 7 years (n = 1192). ResultsMore than 80% of samples presented quantifiable levels of p,p′-DDE, HCB, PCB-138, PCB-153, and PCB-180; p,p′-DDE was the compound with the highest median concentrations. At 4 years, prenatal p,p′-DDE exposure was associated with a decrease in forced expiratory volume in 1 s (FEV1) in all quartiles of exposure (e.g., third quartile [0.23–0.34 ng/mL]: β for FEV1 −53.61 mL, 95% CI −89.87, −17.35, vs. the lowest). Prenatal p,p′-DDE levels also decreased forced vital capacity (FVC) and FEV1/FVC, but associations did not reach statistical significance in most exposure quartiles. At 7 years, p,p′-DDE was associated with a decrease in FVC and FEV1 in only the second quartile of exposure (e.g. β for FEV1 −36.96 mL, 95% CI −66.22, −7.70, vs. the lowest). Prenatal exposure to HCB was associated with decreased FVC and FEV1, but in only the second quartile and at 7 years (e.g. [0.07–0.14 ng/mL]: β for FEV1 −25.79 mL, 95% CI −55.98, 4.39, vs. the lowest). PCBs were not consistently associated with lung function. ConclusionPrenatal exposure to p,p′-DDE may decrease lung function during childhood, especially FEV1 and at medium levels of exposure. Further and deeper knowledge on the impact of environmental chemicals during pregnancy on lung development is needed.

Comparison of Pulmonary Function After Selective Anterior Versus Posterior Fusion for the Correction of Thoracolumbar and Lumbar Adolescent Idiopathic Scoliosis.

Study Design:Retrospective multicenter study.Objectives:To compare the selective anterior spinal fusion (ASF) versus posterior spinal fusion (PSF) on postoperative pulmonary function testing (PFT) whether thoracotomy with separation of the diaphragm by anterior approach influences the PFT in thoracolumbar and lumbar adolescent idiopathic scoliosis (AIS).Methods:A multicenter series of AIS patients who underwent selective spinal fusion were retrospectively reviewed. Seventy-nine female patients were included (mean 15.8 years). There were 35 patients in the ASF group and 44 patients in the PSF group. Patient demographics, radiographic measurements, and PFT data from preoperative to 2-year follow-up were analyzed.Results:Preoperatively, there were no significant differences in PFTs between the groups. The ASF group patients were more likely to undergo shorter fusions (4.5 instrumented vertebral levels) than those in the PSF group (5.2 levels). At 2-year follow-up, forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) in ASF group were statistically lower than those in PSF group. When comparing preoperative and 2-year changes on each procedure, only %FVC showed significant difference in ASF while FVC, FEV1, and %FEV1 did not. Meanwhile, the ASF group showed a significant decrease in FVC at 6 and 12 months compared to preoperative values. In PSF group, there was a decrease at 6 months, returned to preoperative value at 1-year follow-up.Conclusions:Pulmonary function after ASF and PSF was similar at 2 years; however, anterior group did not return to the baseline at 6 months and 1 year suggesting anterior approach may affect early postoperative pulmonary function.

Clinical evaluation of indicators of respiratory function in patients with stage 5 chronic kidney disease

Background . Chronic kidney disease affects almost all organ systems. Respiratory lesions in these patients are often underestimated in clinical practice. THE AIM. Diagnosis and clinical evaluation of the respiratory system in patients with high-flux hemodialysis to optimize the treatment of patients with chronic kidney disease. Patients and methods . There were 60 patients examined. Two groups were considered: the main group - patients with chronic glomerulonephritis (in 17 patients, the diagnosis was confirmed morphologically) with stage 5 chronic kidney disease (CKD), receiving hemodialysis therapy (n = 30), and the comparison group - patients not receiving dialysis (n = 30). Experience of smoking, results of clinical, biochemical blood tests and respiratory tests - vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC and maximum voluntary ventilation (MVV) were studied in all patients. Results. The mean body mass index (BMI) in the main group of patients was 28 ± 6 kg/m 2 , and in the comparison group, the average BMI was 24 ± 3 kg/m 2 . BMI in groups as a whole was not significantly different (p = 0.40). In the general group, 29% had an increased level of triglycerides. No significant differences were found between the results of the respiratory tests of the two group (p&gt;0.05). Conclusion . FVC decreases in women receiving hemodialysis treatment; there is a decrease in FEV1/FVC in proportion to the duration of hemodialysis treatment in men. Increasing levels of C-reactive protein in patients on hemodialysis accompanied by a decrease in FVC; an increase in triglyceride levels accompanied by a decrease in the FEV1/FVC index.

Effect of the components of the metabolic syndrome on pulmonary function. The unexpected role of high-density lipoprotein cholesterol

Metabolic syndrome is a condition that predisposes to cardiovascular disease and diabetes mellitus. In addition, it can have effects over neoplastic pathologies, liver and pulmonary function. Our objective is to analyze the effect of the metabolic syndrome and its components on pulmonary function. 110 subjects from Mexico City were evaluated and anthropometric measurements, glucose determination, triglycerides and high-density lipoprotein (HDL) cholesterol were made. They underwent a simple spirometry. Diagnosis of metabolic syndrome was made following the NCEP-ATPIII criteria. Of 110 individuals, 90 (82%) were women and 20 men (18%); 71 subjects (65%) presented metabolic syndrome. Subjects with central obesity had a forced vital capacity (FVC) lower than subjects without central obesity (2.72 vs. 3.11 liters; p < 0.05). Those with low HDL had better spirometric results than subjects with normal HDL (FEV1 2.36 vs. 1.85 liters; p < 0.05), FVC (2.95 vs. 2.45 liters; p < 0.05) and FEV1/FVC ratio (0.78 vs.74; p < 0.05). Hypertensive subjects presented lower volumes in FEV1 (1.91 vs. 2.38; p < 0.05) and FVC (2.49 vs. 2.99; p < 0.05). There is no difference between the spirometry volumes of patients with metabolic syndrome versus the metabolically healthy subjects. The only factors associated with a decrease in FEV1 and FVC are central obesity and arterial hypertension. An unexpected finding was the negative correlation between HDL levels and lung function.

Outcomes of patients with systemic sclerosis treated with rituximab in contemporary practice: a prospective cohort study

ObjectiveTo assess the safety and efficacy of rituximab in systemic sclerosis (SSc) in clinical practice.MethodsWe performed a prospective study including patients with SSc from the European Scleroderma Trials and Research...