Breathing Function Research Articles

Prolonged intermittent hypoxia differentially regulates phrenic motor neuron serotonin receptor expression in rats following chronic cervical spinal cord injury

Low-dose (< 2 h/day), acute intermittent hypoxia (AIH) elicits multiple forms of serotonin-dependent phrenic motor plasticity and is emerging as a promising therapeutic strategy to restore respiratory and non-respiratory motor function after spinal cord injury (SCI). In contrast, high-dose (> 8 h/day), chronic intermittent hypoxia (CIH) undermines some forms of serotonin-dependent phrenic motor plasticity and elicits pathology. CIH is a hallmark of sleep disordered breathing, which is highly prevalent in individuals with cervical SCI. Interestingly, AIH and CIH preconditioning differentially impact phrenic motor plasticity. Although mechanisms of AIH-induced plasticity in the phrenic motor system are well-described in naïve rats, we know little concerning how these mechanisms are affected by chronic SCI or intermittent hypoxia preconditioning. Thus, in a rat model of chronic, incomplete cervical SCI (lateral spinal hemisection at C2 (C2Hx), we assessed serotonin type 2A, 2B and 7 receptor expression in and near phrenic motor neurons and compared: 1) intact vs. chronically injured rats; and 2) the impact of preconditioning with varied “doses” of intermittent hypoxia (IH). While there were no effects of chronic injury or intermittent hypoxia alone, CIH affected multiple receptors in rats with chronic C2Hx. Specifically, CIH preconditioning (8 h/day; 28 days) increased serotonin 2A and 7 receptor expression exclusively in rats with chronic C2Hx. Understanding the complex, context-specific interactions between chronic SCI and CIH and how this ultimately impacts phrenic motor plasticity is important as we leverage AIH-induced motor plasticity to restore breathing and other non-respiratory motor functions in people with chronic SCI.

Sex hormone supplementation improves breathing and restores respiratory neuroplasticity following C2 hemisection in rats.

In addition to loss of sensory and motor function below the level of the lesion, traumatic spinal cord injury (SCI) may reduce circulating steroid hormones that are necessary for maintaining normal physiological function for extended time periods. For men, who comprise nearly 80% of new SCI cases each year, testosterone is the most abundant circulating sex steroid. SCI often results in significantly reduced testosterone production and may result in chronic low testosterone levels. Testosterone plays a role in respiratory function and the expression of respiratory neuroplasticity. When testosterone levels are low, young adult male rats are unable to express phrenic long-term facilitation (pLTF), an inducible form of respiratory neuroplasticity invoked by acute, intermittent hypoxia (AIH). However, testosterone replacement can restore this respiratory neuroplasticity. Complicating the interpretation of this finding is that testosterone may exert its influence in three possible ways: 1) directly through androgen receptor (AR) activation, 2) through conversion to dihydrotestosterone (DHT) by way of the enzyme 5α-reductase, or 3) through conversion to 17β-estradiol (E2) by way of the enzyme aromatase. DHT signals via AR activation similar to testosterone, but with higher affinity, while E2 activates local estrogen receptors. Evidence to date supports the idea that exogenous testosterone supplementation exerts its influence through estrogen receptor signaling under conditions of low circulating testosterone. Here we explored both recovery of breathing function (measured with whole body barometric plethysmography) and the expression of AIH-induced pLTF in male rats following C2-hemisection SCI. One week post injury, rats were supplemented with either E2 or DHT for 7days. We hypothesized that E2 would enhance ventilation and reveal pLTF following AIH in SCI rats. To our surprise, though E2 did beneficially impact overall breathing recovery following C2-hemisection, both E2 supplementation and DHT restored the expression of AIH-induced pLTF 2weeks post-SCI.

Clinical thinking and instrumental diagnostics in the late stage of hypersensitive pneumonitis

The existing inertia of clinical thinking in establishing a diagnosis, even in the presence of instrumental and valid diagnostic criteria, does not always allow for a reconsideration of the diagnosis given to the patient, especially several years ago. Existing clinical recommendations for certain nosological forms, which currently play a decisive role in diagnostics, treatment, and quality assessment of medical services, may not be fully applicable to all patients with a specifi c disease. As an illustration of the above, a clinical example of a patient diagnosed with “bronchial asthma” about 15 years ago without diagnostic criteria for this condition is provided. Three years ago, on a hospitalization described in the article, a chest computed tomography scan revealed typical signs of diff use pulmonary pneumonia. However, this did not allow for a change in the stereotypical diagnostic view and the correct diagnosis and appropriate treatment, including in a specialized pulmonology department. As a result, the disease progressed with the development of complications in the form of severe respiratory and heart failure. Only a reassessment of clinical symptoms, including inspiratory crackles, chest CT scan (diffuse opacity reduction resembling ground glass), and restrictive abnormalities in external respiration function without obstructive components, allowed for a reevaluation of the diagnosis and the prescription of pathogenetic therapy with glucocorticoids in combination with treatment for respiratory and heart failure, leading to rapid clinical improvement.

Assessing nasal airway resistance and symmetry: An approach to global perspective through computational fluid dynamics.

This study aimed to explore the variability in nasal airflow patterns among different sexes and populations using computational fluid dynamics (CFD). We focused on evaluating the universality and applicability of dimensionless parameters R (bilateral nasal resistance) and ϕ (nasal flow asymmetry), initially established in a Caucasian Spanish cohort, across a broader spectrum of human populations to assess normal breathing function in healthy airways. In this retrospective study, CT scans from Cambodia (20 males, 20 females), Russia (20 males, 18 females), and Spain (19 males, 19 females) were analyzed. A standardized CFD workflow was implemented to calculate R-ϕ parameters from these scans. Statistical analyses were conducted to assess and compare these parameters across different sexes and populations, emphasizing their distribution and variances. Our results indicated no significant sex-based differences in the R parameter across the populations. However, moderate sexual dimorphism in the ϕ parameter was observed in the Cambodian group. Notably, no geographical differences were found in either R or ϕ parameters, suggesting consistent nasal airflow characteristics across the diverse human groups studied. The study also emphasized the importance of using dimensionless variables to effectively analyze the relationships between form and function in nasal airflow. The observed consistency of R-ϕ parameters across various populations highlights their potential as reliable indicators in both medical practice and further CFD research, particularly in diverse human populations. Our findings suggest the potential applicability of dimensionless CFD parameters in analyzing nasal airflow, highlighting their utility across diverse demographic and geographic contexts. This research advances our understanding of nasal airflow dynamics and underscores the need for additional studies to validate these parameters in broader population cohorts. The approach of employing dimensionless parameters paves the way for future research that eliminates confounding size effects, enabling more accurate comparisons across different populations and sexes. The implications of this study are significant for the advancement of personalized medicine and the development of diagnostic tools that accommodate individual variations in nasal airflow.

Combined therapeutic acute intermittent hypercapnic hypoxia and exercise-based respiratory training improve breathing after chronic cervical spinal cord injury

Therapeutic acute intermittent hypoxia (tAIH) is simple, safe, and effective means of inducing respiratory motor plasticity and improving breathing in rodent models of acute cervical spinal cord injury (SCI). Unfortunately, tAIH effects on breathing function are less effective with chronic injury. On the other hand, tAIH restores non-respiratory (limb) motor function with chronic SCI, but only when combined with task specific training (TST). The effcacy of combined tAIH and respiratory TST on breathing ability in rodent models (or humans) with chronic SCI has not been investigated. Here, we explore the potential for tAIH and respiratory TST to increase breathing ability; we further differentiate automatic vs. volitional TST, since the ability to sustain independent breathing is dependent on automatic (and not volitional) breathing function, which relies on distinct neural pathways. Physical exercise increases breathing automatically in direct proportion to metabolic rate, regulating arterial blood gases by a mechanism independent of chemoreceptor feedback (i.e. “exercise hyperpnea”). Thus, in ongoing studies, we are exploring treadmill training as a form of task-specific respiratory training in rats with chronic cervical SCI. We focus on a refined tAIH protocol that combines hypoxia with hypercapnia during each episode (therapeutic acute intermittent hypercapnic hypoxia; or tAIHH), since preliminary data suggests that tAIHH is a more potent stimulus to respiratory motor plasticity vs. tAIH alone. Adult Sprague-Dawley rats with chronic C2 spinal cord hemisection were treated with either 4 weeks of either tAIHH (10, 5-min episodes of 10.5% O2, 4% inspired CO2) combined with treadmill exercise (30 min total run time, 30 cm/sec) or tAIHH alone. Breathing function was assessed in awake, freely moving rats using whole-body plethysmography. In preliminary analyses, breathing capacity (i.e., minute ventilation in response to maximal chemoreflex activation) was increased in chronically injured rats treated with daily tAIHH paired with treadmill training relative to rats treated with tAIHH alone (120.7mL/min/100g vs. 98.7mL/min/100g; p=0.0018). Similar improvements in breathing function were not observed with tAIHH alone. These are the first studies to investigate the therapeutic effcacy of combined tAIH and exercise-based respiratory training targeting automatic breathing. These initial results indicate that, similar to non-respiratory motor systems, pairing tAIHH with respiratory TST improves breathing function in rodents with chronic cervical SCI. Supported by: Craig H. Neilsen Foundation (SCIRP891379), and the McKnight Brain Institute. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Tongue exercise-induced plasticity in upper airway EMG activity in a model of hypoglossal motor neuron loss

Motor neuron diseases (MNDs) are a group of neuromuscular disorders in which motor neurons (MNs) required for activities of daily living are lost. Patients with MNDs often develop swallowing and breathing dysfunction due to pathology of the hypoglossal (XII) axis ( e.g., XII lower motor neurons, LMNs). These co-dependent, vital functions require reciprocal roles of the tongue during swallowing, and impaired control and coordination of these opposing behaviors can lead to aspiration pneumonia and respiratory failure. Due to a lack of research, available treatments for patients with MNDs are largely palliative, and there is a critical need for therapies targeting the preservation of upper airway function and coordination. The extensive tongue muscle weakness in patients with MNDs suggests a potential role for therapeutic exercise, but suffcient evidence is lacking to conclude if tongue exercise is beneficial or harmful. A barrier in studying the impact of XII LMN degeneration and developing therapies to improve swallowing and breathing function/coordination has been the lack of an appropriate model. We therefore developed a novel rodent model of XII LMN loss using intralingual injections of cholera toxin B conjugated to saporin (CTB-SAP), which has tongue motility and swallowing deficits that are mitigated by a high-repetition/low resistance tongue exercise paradigm for muscle growth. Here, we simultaneously studied upper airway (geniohyoid) and diaphragm EMG activity with swallowing ( via videofluoroscopy swallow studies; VFSS) and breathing ( via plethysmography) to discern whether CTB-SAP induced XII LMN loss results in upper airway deficits and discoordination of swallowing and breathing functions. We hypothesized that geniohyoid (not diaphragm) EMG activity would be decreased and swallow-breathing coordination would be altered in unanesthetized and spontaneously breathing CTB-SAP rats vs. controls, and that tongue exercise would mitigate these deficits. Using custom-made headcap implants, we embedded EMG electrodes into the geniohyoid and diaphragm muscles in adult male rats prior to intralingual injection of CTB-SAP or control (CTB unconjugated to SAP) and studied chronic EMG activity during VFSS or during plethysmography studies +/- tongue exercise (N=4-6/group). Our preliminary findings show decreased geniohyoid (but not diaphragm) EMG activity as well as swallow/breathing discoordination that appears to be reversed with tongue exercise in CTB-SAP rats vs. controls. In conclusion, tongue exercise appears to enhance XII axis plasticity to improve upper airway function and coordination in the face of XII LMN degeneration. Studies are now underway to understand the underlying mechanism of tongue exercise-induced neuroplasticity, which may help guide future translational studies in patients with MNDs. R01 HL153612 and Phi Zeta. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Pre-sympathetic C1 RVLM neurons drives sleep disordered breathing in heart failure through activation of central chemoreceptors

Sleep-disordered breathing is closely linked to heart failure (HF) morbidity and mortality. Recently, we showed that photo-stimulation of pre-sympathetic motor neurons located within the rostro ventrolateral medulla (RVLM) drive sleep-disordered breathing in healthy conditions. However, the neural circuitry required for these effects and whether this pathway is relevant for HF pathophysiology is not known. Accordingly, we aimed to determine: i) if the generation of RVLM-induced altered breathing encompasses the activation of chemoreceptor neurons from the retrotrapezoid nucleus (RTN), and ii) if selective ablation of RVLM neurons improves breathing control and sleep architecture in HF rats. Sprague-Dawley rats received stereotaxic injections of a lenti-viral vector containing a light-sensitive cation channel (Channelrhodopsin2) in the RVLM and a Substance P-saporin toxin conjugate into the RTN. Then, 200 mm fiber optics were implanted for RVLM neurons photo-stimulation. A second group underwent volume overload to induced HF and ablation of RVLM neurons was performed using a DbH-saporin toxin (DbH-SAP). EEG and EMG leads were implanted, and rats allowed to recover before sleep/breathing studies. We found that photo-stimulation of RVLM neurons triggered breathing disorders only in the presence of a functional RTN neurons. Indeed, breathing irregularity score following RVLM photo-stimulation showed a two-fold increase (9±2 vs. 20±3, pre vs. post-stimulation) and this was absent in the presence of Substance P-saporin (10±3 vs. 12±3, pre vs. post-stimulation with Substance P-saporin). Compared to Sham rats, HF animals showed overt signs of disordered breathing and sleep fragmentation and ablation of RVLM neurons using DbH-SAP significantly improves both breathing and sleep function in HF. Our results showed that RVLM drives breathing disorders through activation of the RTN and that selective ablation of RVLM neurons offer salutary benefit for the control of sleep and irregular breathing patterns in the setting of HF. Fondecyt 1220950. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Long-Term Effect of Post-Covid-19 Syndrome on Respiratory Parameters in Iraqi People

Background: The long-term sequelae of COVID-19 are thought to be a novel area of research due to variances in the epidemiology and therapy. Nevertheless, the follow-up time interval (6 or 12 months) was excessively long, and the time point of the follow-up period varied from 3 to 24 months in the prior research. More research is required to understand better COVID-19's effects, including their long-term effects on the lungs and how they may affect pulmonary function. Therefore, this study aims to investigate the long-term impact of post-COVID-19 syndrome on pulmonary function tests. Methods: This research was a case-control study conducted from 13 October 2023 to 13 November 2023 at the Al-Sader Teaching Hospital in Maysan City. There are fifty-eight patients and fifty-eight controls included. This study comprised patients who visited a pulmonary consulting clinic and had COVID-19 symptoms, matched by controls who were chosen at random. The controls had to meet the same criteria as the cases, with the exception that they did not have COVID-19 disease. The most popular kind of breathing or pulmonary function test is spirometry, spirometry was used to measure: FVC, FEV, and FEV1/FVC ratio. Result: Sixty-six post COVID-19 syndrome with ages (34.1 ± 9.8) years and sixty-seven controls were enrolled. The results of FVC and FEV parameters indicate a significant difference (P&lt;0.05) between cases and control groups. However, no significant differences existed between groups for the FEV1/FVC ratio. In the comparison of lung function tests between cases and control across different age groups (18-29, 30-39, 50-65) years, we found that mean FVC is significantly lower for the age group 18-29 years than for 30-39 and 50-65 years, and the mean FEV is significantly lower for the age group 18-29 years than for 30-39. Conclusion: After COVID-19, a significant number of patients continue to have symptoms, with respiratory symptoms accounting for the majority of complaints. Patients with continuing symptoms were younger and presented a significantly lower FVC and FEV.

Evaluation of Photobiomodulation on myocardial function of patients with advanced ischemic cardiomyopathy, A case series

BackgroundHeart failure is a growing cardiovascular disease burden with high mortality rates, primarily attributed to myocardial ischemia. Previous studies have shown promising effects of Photobiomodulation in heart failure treatment. In this study, we aimed to investigate the effect of Photobiomodulation on myocardial function of patients with advanced ischemic heart failure. MethodA non-randomized case series study involving 10 advanced heart failure patients was conducted. Patients received 15 sessions of transcutaneous and intravenous Photobiomodulation therapy using low-level red (658 nm) and infrared lasers (810 nm). All participants were evaluated by six-minute walk tests, dyspnea function classes, and echocardiography. 3 months after the sessions, the mentioned tests were reevaluated ResultThe study included ten cardiomyopathic patients, 90 % male and the mean age was 63.20±6.01 years. The six-minute walk test change and shortness of breath function class change has 0.852 (p-value=0.006) correlation and the correlation between the Six-minute walk test change and the Systolic ejection fraction rate change, was 0.73 (p-value=0.025). ConclusionBased on the results of the study, it can be concluded that interventions in cardiomyopathic patients have shown promising improvements in certain cardiac function parameters. Specifically, the significant enhancement in the six-minute walk test post-intervention (p = 0.013) suggests a positive impact on functional capacity. Although the increase in systolic ejection fraction rate was not statistically significant (p = 0.197), the correlations identified provide valuable insights into the interplay between variables such as shortness of breath function class and the six-minute walk test. These findings underscore the complexity of managing cardiomyopathy and highlight the importance of further research to elucidate the relationships between different clinical parameters and patient outcomes in this population.

Аcupuncture as a means of rehabilitation for people with bronchial asthma

The article considers the possibility of using acupuncture as a means of acupuncture in the rehabilitation of adolescents with bronchial asthma. It is noted that bronchial asthma remains one of the dangerous diseases that cause significant mortality among children and adults. The purpose of the study was to study the effect of acupuncture on the state of the function of external breathing during respiratory rehabilitation among people with bronchial asthma in remission. Research methods: analysis of scientific and methodical literature; analysis of outpatient charts of patients, surveys, traditional and calculation methods of determining the main indicators of the external respiratory system, methods of mathematical statistics. It has been shown that adolescents with bronchial asthma have a decrease in external respiratory function indicators. In adolescents with bronchial asthma, there is a decrease in the indicators of the function of external breathing. The deviation of the actual indicators from the appropriate ones was: LVEF – 27%, FLVEF – 38%, FEV1 – 44%, Ntype – 33%, respectively; Tiffno index – 79%, Tweed – 23 p. The expansion of the motor regime and the use of acupuncture reflexology during the remission period contributed to the increase in the indicators of the function of external breathing in the main group compared to the control group: LVEF by 10.47% and 2.36%, LVEF – 13.32% and 1.96%, FEV1 – 19 ,24% and 7.14%, Ntype – 13.72% and 5.34%, IT – 3.7% and 0.17%, Tweed – 11.58% and 5.89%, respectively.&#x0D; The use of needle reflexology as a means of acupuncture in respiratory rehabilitation and timely correction of the motor regime will improve bronchial patency, improve the functioning of the respiratory system of the body, increase the work capacity of the younger generation, will contribute to reducing the severity of the disease, limiting the use of drug therapy, and longer remission.

Liquid respiratory desaturation. The first experience of application on large biological objects

Introduction. This article is a continuation of the publication of the experimental studies results of prevention of acute decompression sickness (aDCS) in laboratory animals by the method of liquid respiratory desaturation (LRDS). LRDS is a method of preventing decompression disorders by the excretion of metabolically indifferent gases (in particular nitrogen) from the body during spontaneous respiration with liquid or artificial liquid lung ventilation (ALLV), by dissolved gas concentration gradient "from tissues to respiratory fluid". The method allows to provide rapid desaturation of the body from metabolically indifferent gases in the process of liquid respiration before and/or during decompression, thereby creating conditions for application of ultra-fast decompression profiles without the risk of decompression disorders.&#x0D; The aim of the study was to confirm the possibility of LRDS being a method of DCS prevention on large laboratory animals (minipigs).&#x0D; Materials and methods. The studies were performed on Wiessenau minipigs (n=8) — male and female, aged 4–5.5 months and weighing 7.1–11.2 kg. Animals of the control (n=4) and experimental (n=4) groups were subjected by compression by keeping in an air environment under high pressure (absolute 0.5 MPa for 60 minutes) to saturate tissues with indifferent gas (nitrogen). After compression experimental group was exposed to 30-minute ALLV with a liquid (perfluorodecalin) saturated with an oxygen under normobaric conditions. Air environment pressure during procedure of artificial lung ventilation was kept at 0.5 MPa. Decompression of the control and experimental groups was carried out in non-stop manner for 80 and 40 seconds respectively. The investigation of severity of clinical manifestations of DCS (changes in hemodynamic and respiratory parameters) including ultrasonic examination of gas bubbles in the heart and large vessels of the liver and as well as survival of animals in groups and pathoanatomical changes was performed.&#x0D; Results of the study. Clinical manifestations, ultrasonic scanning of the heart and venous vessels of the liver, as well as morphological examination data indicated the development of severe acute post-decompression disorders (PDD) in animals of the control group, which caused deaths in 100% of cases. Meanwhile all animals in experimental group survived and their state was stable. According to ultrasonic examination, the presence of small number of gas bubbles in the right-side heart chambers and liver's venous vessels being noted, but they disappeared after several hours. Deviations of the respiration's parameters function from background values (shortness of breath of a mixed type with the participation of auxiliary muscles, etc.) observed from the 2nd to the 4th day after ALLV, as well as compensatory reactions from the cardiovascular system (heart rate variability and instability of hemodynamic parameters) were caused by ALLV.&#x0D; Conclusions. Compressed air exposure 0.5 MPa for 60 minutes followed by 80 seconds of non-stop decompression allows to provoke the severe acute PDD minipigs model, manifested by pronounced intravascular gas formation, the development of acute respiratory and cardiovascular insufficiency causing the development of adverse outcomes.&#x0D; The ultrasound method of visual assessment of intravascular gas formation severity, adapted for minipigs, together with the dynamics of changes in the indicators of respiratory and cardiovascular systems makes possible to assess not only state of animal under anesthesia, but also the effectiveness of PDD prevention measures.&#x0D; The usage of ALLV with PFC liquid completely saturated with 100% oxygen under normobaric conditions makes possible partial removal of indifferent gas (nitrogen) dissolved in tissues of experimental animals during exposition in a compressed air environment before decompression and thereby carry out the prevention of DCS by LRDS method. It makes possible to implement successfully ultra-fast decompression profiles, incompatible with life in the control group.&#x0D; The state of animals from experimental group after LRDS is characterized by lung impairment caused by ALLV in hyperbaric conditions accompanied by temporary changes of external respiration function and compensatory reactions of cardiovascular system, observed during first 4 days.&#x0D; Ethics. The study was conducted in accordance with the ethical principles of the Declaration of Helsinki. The Clinical Study Protocol was approved by local Ethics Committee of The Federal State Budgetary Scientific Institution «Izmerov Research Institute of Occupational Health».

Effects of menstrual cycle phases on heart rate variability indicators and external respiratory function of female Muay Thai athletes

Effects of menstrual cycle phases on heart rate variability indicators and external respiratory function of female Muay Thai athletes

Effectiveness of Asthmagan administration in the complex therapy of chronic obstructive pulmonary disease

Ganoderma is a medicinal mushroom that has been used in traditional Chinese medicine for centuries. It contains a wide range of biologically active therapeutic molecules that have an anti‑inflammatory, immunomodulatory effect and contribute to the normalization of respiratory tract function.&#x0D; Objective — to evaluate the effectiveness of the Asthmagan drug in the complex therapy of chronic obstructive pulmonary disease (COPD).&#x0D; Materials and methods. Examinations involved 40 hospitalized patients with a verified diagnosis of COPD, aged 18 to 70 years. In addition to standard examinations, leukotriene B4 (LTB4) was determined. Asthmagan capsules were added to the scheme of complex inpatient and outpatient treatment.&#x0D; Results. On admission, patients complained of breathlessness and cough with wheezing and sputum production. Blood tests showed leukocytosis, elevated ESR, hyperfibrinogenemia, and increased C‑reactive protein levels. According to the results of the correlation analysis, positive correlations were found between pro‑inflammatory markers and negative correlations between LTB4 and external respiration indicators. A tendency to LTB4 reduction was noted. After the treatment, positive dynamics were observed in all patients, and in the group of patients with Asthmagan inclusion, there was a significant improvement in external respiration function and all components of the quality of life according to the St. George’s Respiratory Questionnaire (SGRQ). Tolerability of Asthmagan was positive, side effects were not recorded.&#x0D; Conclusions. During the inpatient treatment of patients with COPD with the inclusion of the drug Asthmagan, regression of complaints and clinical manifestations of COPD, a decrease in the level of pro‑inflammatory markers and a tendency to LTB4 levels reduction were noted. Improvement in the quality of life along with a significant increase in the external respiration indicators testified the increase in the effectiveness of COPD treatment by including Asthmagan in the complex treatment.&#x0D;

Study of the Activity of Indicators of Systemic Inflammation and Surfactant Protein D in Chronic Obstructive Pulmonary Disease, their Relationship with the Nutritional Status of Patients

Abstract. Studying the levels of biomarkers of inflammation and surfactant protein D (SDP) in the peripheral blood of patients with chronic obstructive pulmonary disease (COPD) depending on the nutritional status (NS) of patients is relevant, since they are important factors in the progression of the disease. Aim. To study the relationship between tumor necrosis factor-α (TNF-α), transforming growth factor β1 (TGFβ1), C-reactive protein (CRP), surfactant protein D (SPD) and NS in patients with COPD. Materials and methods. 210 patients with COPD with different body mass index (BMI) were examined. Laboratory, instrumental (spirography, bioimpedansometry, pulse oximetry), spectrophotometric and immunoenzyme research methods were used. Results. It is shown that in patients with COPD during an exacerbation of the disease, regardless of NS, there is an increase in the levels of TNFα, TGFβ1, CRP, as well as SDP in the blood serum, which is most pronounced when COPD is combined with obesity. A moderate correlation has been established between the level of SDP in the blood serum and the duration of smoking, as well as between SDP and BMI in patients with COPD; a negative correlation has been established between the level of SDP and indicators of external respiratory function. Conclusion. The degree of increase in serum levels of TNF-α, TGFβ1 and CRP directly correlates with concomitant obesity in patients with COPD. The level of SDP in COPD depends on the patient’s NS and can serve as a diagnostic marker of the disease. Multivariate analysis confirms the dependence of the level of SDP in the blood serum on the parameters of bioimpedance analysis in COPD.

Method of Selecting Surgical Treatment for Children with Congenital Deformity of the Spine and Thorax

Introduction. Spinal anomalies are considered to be the most severe pathology of the axial skeleton. Intrauterine formation of deformity with its subsequent progression during growth is the reason for the need for surgical intervention. The prevalence of patients with congenital scoliosis in the total structure of spinal deformities is up to 2%. In terms of the malignancy of the course of the disease, children with unsegmented rod and rib synostosis represent one of the most unfavorable groups of patients. Aim. To perform a comparative analysis of the results of surgical treatment of children with congenital scoliosis with unilateral lateral vertebral segmentation disorder and rib synostosis using different techniques. Methods. The work is a monocenter cohort study of “case-control” type (III level of evidence). The design of the work is a monocenter cohort retro and prospective study. The results of surgical treatment of patients between 2010 and 2020 were analyzed. The study included 45 patients aged 3 to 7 years with the diagnosis of congenital scoliosis with unilateral lateral segmentation disorder of vertebral bodies and rib synostosis. The patients were divided into 2 groups depending on the surgical treatment method applied. In the first group (n = 24), patients underwent thoracoplasty with implantation of an individual rib/rib/vertebral distractor; in the second group (n = 21), patients underwent spinal surgery in the scope of vertebrotomy at the apex of the curvature and correction of the deformity with a multifocal spinal system. The data of medical records, as well as MSCT, radiographs, and pulse oscillometry were included in the analysis of the results. Results. Me (median) of scoliosis before treatment in group 1 patients 58.5, IQR = 19.75; after treatment — Me = 40.0, IQR = 20.0. Me of kyphosis before surgery 22, IQR = 4.5; after surgery Me = 26.0, IQR = 4.0. In the second group, Me of scoliosis before treatment 58.0, IQR = 3.0; after treatment, Me = 20.0, IQR = 6.0. Me of kyphosis before surgery 22, IQR = 2.0; after surgery Me 28.0, IQR = 4.0. When comparing MSCT data, group 1 patients showed an increase in lung tissue volume by 21% of the initial lung volume, in group 2 the increase amounted to 27%. The analysis of external respiratory function indices demonstrates improvement of reactive component indices by 21.1%, frequency dependence of resistive component by 46.4%, resistive component by 50% in group 1 patients, in group 2 there is an improvement of reactive component indices by 21.1%, resistive component by 50.9% and frequency dependence of reactive component by 46.7%. Conclusion. Corrective intervention on the spine at an early age makes it possible to achieve effective correction of the deformity; similar changes are observed both in lung volume and functional state of the respiratory system due to the mediated correction of the thorax shape.

Significant Spontaneous Pneumomediastinum and Extensive Subcutaneous Emphysema in a COVID-19 Patient

A 64-year-old man, who had no pre-existing health conditions, was admitted to the intensive care unit due to progressive shortness of breath resulting from COVID-19. Initially, the patient responded to non-invasive mechanical ventilation, which improved his breathing function. However, after six days, his respiratory function worsened significantly, requiring invasive ventilation. Out of nowhere, the person experienced spontaneous pneumomediastinum and extensive subcutaneous emphysema. The next day, a spontaneous pneumothorax occurred and was successfully drained later. It became evident that there was extensive subcutaneous emphysema also. The CT scan of the chest confirmed the presence of spontaneous pneumomediastinum, but it did not have any effect on the patient’s hemodynamics. The physicians performed a bronchoscopy and imaging with a contrast medium, which ruled out any lesions to the trachea or esophagus. No other issues related to the problem were identified during the examination. Unfortunately, microscopic bullae of interstitial emphysema, or micro air leaks, are visible when they are an adequate size on computed tomography. Recent literature and studies not available during the case report have shown that if the Macklin effect is detected on the baseline CT scan, it could predict the occurrence of pneumothorax or pneumomediastinum.

Abstract WP308: TGFBR2 Knockdown Improves Cognitive Function and Breathing in AD Mice

Introduction: Respiratory disorders, including sleep apnea, are an independent risk factor for the development of cognitive dysfunction and dementia. Disordered breathing occurs frequently in patients with AD (Alzheimer’s Disease). Disruption of the brainstem breathing centers, including the Retro-trapezoid nucleus (RTN), leads to breathing disorders. Our previous work showed that upregulation of Transforming Growth Factor Beta Receptor 2 (TGFBR2) signaling in the RTN leads to respiratory dysfunction in mice. The present study investigated if inhibiting TGFBR2 selectively in the RTN region could improve breathing and cognitive function in AD mice. Methods: We used 20 WT and 20 TG2576 mice (15 months old). Mice were randomly assigned into two sub-groups; treatment with a shTGFBR2 vector (knockdown) or vector control with scrambled shRNA. After baseline behavior and breathing testing, lentiviral stereotaxic injections of vehicle and shTGFBR2 were done directly into the RTN. After 6 weeks, behavior and breathing testing was performed, and then brain tissues were collected for histological analysis. All the data are presented as Mean±SEM. Results: Tg2576 mice had significantly higher number of apnea (7.91±0.95) than WT mice (4.10±0.85) with a p -value of 0.0079. When injected with shTGFBR2 into the RTN, Tg2576 had improved recognition of a novel object (69.24%±5.75) as compared to the Tg2576 vehicle-treated group (51.02%±4.88) in the NORT ( p =0.0213). They also showed a significant improvement in the latency to escape (64.94±15.56) compared to the Tg2576 vehicle-treated group (136.4±20.90) in the Barnes maze ( p =0.0109). The number of apneas was also significantly reduced in TG2675 mice treated with shTGFBR2 in the RTN (3.33±0.69), when compared to the Tg2576 vehicle-treated group (8.22±1.30) with a p -value of 0.0029. Conclusions: Our study revealed that the knockdown of TGFBR2 in the RTN, a brainstem nucleus involved in respiratory control, improved both the cognitive and breathing phenotypes in AD-model mice. Our work suggests that improving respiratory control and reducing apnea in AD may be a potential treatment for the disease. This is especially relevant as new treatments for central apnea, such as phrenic nerve stimulation, are available.

Assessment of the respiratory function of patients after COVID-19 pneumonia for medical rehabilitation

Aim. To study the indicators of external respiration function in older patients after coronavirus pneumonia (COVID-19) with the purpose of creating personalized rehabilitation programs.Materials and methods. A study of respiratory function after coronavirus pneumonia (COVID-19) was conducted in 109 patients with the average age of 63.7 ± 2.2 (51.3% men and 48.7% women) and the lung damage of more than 25%.Results. The patients after coronavirus pneumonia (COVID-19) show a decrease in respiratory function indicators, such as VC, FVC, FEV1, and SPO2, as well as an increased Tiffeneau –Pinelli index.Conclusion. Timely detection of respiratory disorders in patients after COVID-19 pneumonia allows timely diagnosis of respiratory failures and selection of adequate rehabilitation measures.

Сombined rehabilitation after COVID-19 coronavirus infection

Aim. To study the efficacy of personalized combined rehabilitation of PCS patients in the setting of a day hospital.Materials and methods. The study involved 68 patients with PCS (49 women and 19 men) aged from 36 to 76 years. Bronchial asthma (BA) was detected in 26 patients, chronic obstructive pulmonary disease (COPD)– in 9 patients, and stage II hypertension– in 12 patients. Depending on severity of PCS, the treatment program included drug therapy and physiotherapeutic treatment. The rehabilitation course lasted for 14 days. The efficacy of medical rehabilitation was assessed by the dynamics of clinical and functional indicators.Results. After the rehabilitation course, asthenic syndrome decreased in all patients. The majority of patients reported improvement in dyspnea according to the mMRC scale. In COPD patients, the CAT test score decreased by 26%. After rehabilitation, the asthma patients showed a decrease in the ACQ test score by 45%, with the peakflowmetry indicators having improved. Improvements in spirometry and peripheral oxygen saturation of capillary blood were recorded.Conclusion. Personalized medical rehabilitation of patients after coronavirus infection can reduce the severity of PCS signs. The rehabilitation methods used contributed to the restoration of external respiratory function, stabilization of the patients’ emotional state, reduction of shortness of breath, hypoxemia, and other impaired functions in patients after COVID-19.

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

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