History Of Respiratory Disease Research Articles

Pulmonary Function Testing (PFT) after Photon and Proton Radiotherapy for Stage II-III Breast Cancer

<h3>Purpose/Objective(s)</h3> The Breast Cancer Lung Late Effects (BELLE) study prospectively enrolled patients with breast cancer who received adjuvant photon (XRT) or proton (PT) radiotherapy (RT) to evaluate potential early markers of induced lung injury, including pulmonary function tests (PFTs). <h3>Materials/Methods</h3> Patients ≥18 years with AJCC 8^th edition anatomic stage II-III or greater breast cancer were enrolled into the BELLE study between May 27, 2016 and May 26, 2020. All patients underwent clinical evaluation, computed tomography imaging, PFTs, and QoL questionnaires at baseline, 6 months, and 12 months relative to RT start. Fisher's exact tests and Kruskal-Wallis rank sum tests were used to compare the XRT and PT groups. <h3>Results</h3> A total of 37 patients were included in the final analysis (XRT, n=21; PT, n=16). Median age at diagnosis was 51 years (range, 31-76); 26 patients identified as white (70.3%), 8 as Black (21.6%), and 3 other (7.1%). Most patients did not have pre-existing respiratory disease (83.8%) or prior smoking history (62.2%), while 35.1% were former smokers and 1 was a current smoker (2.7%). The median BMI was 29.4 (range, 18.9-44.2). Most patients received chemotherapy (75.7%) and regional nodal irradiation (RNI; 78.4%). Median lung V20 was 25.3% (range, 5.6-39.7) and median lung V5 was 59.6% (range, 29.7-86.4). XRT patients had more pre-existing respiratory disease and were less likely to receive RNI (p=0.027 and p=0.006, respectively). There was no statistically significant difference between the XRT and PT cohorts for median lung V20 or V5. The median FEV1/FVC ratio at baseline, 6 months, and 12 months were not significantly different between the XRT and PT cohorts (80.2 % vs 81.5%, p=0.81; 79.3% vs 81.3%, p=0.95; and 80.6% vs 79.4% p>0.99, respectively). Similarly, the median FVC values at baseline, 6 months, and 12 months were not significantly different between the XRT and PT cohorts (3.4 L vs 3.1 L, p=0.76; 3.2 L vs 3.0 L, p=0.38; and 3.5 L vs 3.0 L, p=0.23, respectively). While the median DLCO at baseline was significantly worse for the PT cohort (91% vs 76%, p=0.005), there was no difference between cohorts at 6 and 12 months (79.0% vs 78.0%, p=0.38; 89.0% vs 84.0%, p=0.80, respectively). Four patients developed radiation pneumonitis (RP) within a year of RT including 3 with transient grade 1 (n=1 PT; n=2 XRT) and 1 with grade 3 (XRT). <h3>Conclusion</h3> Despite high variability among patients across all PFT parameters, the median FEV1/FVC ratio and FVC were stable over time and did not cross the threshold for concern of restrictive lung disease in either cohort. Although DLCO decreased at 6 months in the XRT cohort, both cohorts showed improvement at one year without diagnosis of restrictive lung disease. Utilizing PFTs as an early marker of RT-induced lung injury, neither patients treated with XRT nor PT exhibited sustained PFT abnormalities with 1 year of follow-up.

Impact of small-airway disease on exercise intolerance and long-term outcomes in patients with heart failure and reduced or preserved ejection fraction

Abstract Introduction Exercise intolerance in patients with heart failure (HF) is a strong indicator of a poor prognosis. As the respiratory impairment in HF patients, the small airway is reportedly more susceptible than central airways, which results in increased airway resistance and may cause poor outcomes. However, the impact of small-airway disease (SAD) on exercise intolerance and prognosis in patients with HF is still unclear. Purpose We investigated the associations between SAD and exercise intolerance in patients with HF, and the clinical significance of SAD for long-term clinical events with a reduced or preserved ejection fraction. Methods We reviewed 1015 patients with HF (mean age, 66.9±14.6 years; male, 64.5%) admitted for medical treatment. Patients with a prior history of chronic respiratory disease or an obstructive lung pattern – defined as the forced expiratory volume (%) in 1 s relative to &amp;lt;70% forced vital capacity using spirometry – were excluded. Characteristics including HF aetiology, comorbidities conditions, medications, blood parameters, and echocardiographic variables were obtained from clinical records. All patients underwent spirometry at hospital discharge, and SAD was defined as the maximum mid-expiratory flow (%) relative to a &amp;lt;60% predicted value. At hospital discharge, we measured 6-min walk distance (6MWD), and &amp;lt;300 m was considered as exercise intolerance. The primary endpoint was a composite clinical event of all-cause death and/or unplanned readmission for HF. Multivariate logistic regression analysis was used to assess the association between SAD and exercise intolerance. The multivariate Cox proportional hazard model was used to clarify whether SAD was an independent predictor for the incidence of clinical events. We also performed subgroup analyses in each multivariate analysis based on a left ventricular ejection fraction (LVEF) of 40%. Result SAD was observed in 479 (47.2%) patients. LVEF subgroups included 458 (45.1%) and 518 (51.0%) patients with LVEF &amp;lt;40% and ≥40%, respectively. After adjusting for clinical characteristics, SAD was independently associated with 6MWD &amp;lt;300 m (Figure 1). Moreover, this association was consistently observed in the LVEF &amp;lt;40% and ≥40% (Figure 1). During the median follow-up period of 1.5 years, all-cause death/readmission occurred in 431 patients (42.5%), and the incidence rate was 17.5/100 person-years. In the multivariate Cox proportional hazard model, SAD was independently associated with lower event-free survival rates in all patients and the LVEF &amp;lt;40% subgroup, but not LVEF ≥40% subgroup (Figure 2A, B, and C, respectively). Conclusion This study is the first to reveal that SAD is associated with exercise intolerance in patients with HF regardless of LVEF. Moreover, SAD may have a predictive significance for long-term outcomes in patients with HF and subgroups with reduced, but not preserved ejection fraction. Funding Acknowledgement Type of funding sources: None.

Clinical effects and pharmacokinetics of nebulized lidocaine in healthy horses.

BackgroundNebulized lidocaine appears promising as a novel corticosteroid-sparing therapeutic for equine asthma, but its safety and pharmacokinetic behavior have yet to be confirmed.ObjectiveTo describe the effect of nebulized lidocaine on upper airway sensitivity, lung mechanics, and lower respiratory cellular response of healthy horses, as well as delivery of lidocaine to lower airways, and its subsequent absorption, clearance, and duration of detectability.AnimalsSix healthy university- and client-owned horses with normal physical examination and serum amyloid A, and no history of respiratory disease within 6 months.MethodsProspective, descriptive study evaluating the immediate effects of 1 mg/kg 4% preservative-free lidocaine following nebulization with the Flexineb®. Prior to and following nebulization, horses were assessed using upper airway endoscopy, bronchoalveolar lavage, and pulmonary function testing with esophageal balloon/pneumotachography and histamine bronchoprovocation. Additionally, blood and urine were collected at predetermined times following single-dose intravenous and nebulized lidocaine administration for pharmacokinetic analysis.ResultsUpper airway sensitivity was unchanged following lidocaine nebulization, and no laryngospasm or excessive salivation was noted. Lidocaine nebulization (1 mg/kg) resulted in a mean epithelial lining fluid concentration of 9.63 ± 5.05 μg/mL, and a bioavailability of 29.7 ± 7.76%. Lidocaine concentrations were higher in epithelial lining fluid than in systemic circulation (Cmax 149.23 ± 78.74 μg/L, CELF:Cmaxplasma 64.4, range 26.5–136.8). Serum and urine lidocaine levels remained detectable for 24 and 48 h, respectively, following nebulization of a single dose. Baseline spirometry, lung resistance and dynamic compliance, remained normal following lidocaine nebulization, with resistance decreasing post-nebulization. Compared to the pre-nebulization group, two additional horses were hyperresponsive following lidocaine nebulization. There was a significant increase in mean airway responsiveness post-lidocaine nebulization, based on lung resistance, but not dynamic compliance. One horse had BAL cytology consistent with airway inflammation both before and after lidocaine treatment.ConclusionsNebulized lidocaine was not associated with adverse effects on upper airway sensitivity or BAL cytology. While baseline lung resistance was unchanged, increased airway reactivity to histamine bronchoprovocation in the absence of clinical signs was seen in some horses following nebulization. Further research is necessary to evaluate drug delivery, adverse events, and efficacy in asthmatic horses.

Iatrogenic Pneumothorax During Hypoglossal Nerve Stimulator Implantation: A Large Database Analysis.

There have been case reports of adverse events of hypoglossal nerve stimulator (HNS) implantation not seen in previous clinical trials, including pneumothorax and pleural effusion. The purpose of this study was to determine the rates of these complications and potential risk factors. Retrospective case-control study during 2014 to 2021. Twenty-five health care organizations across the United States. The TriNetX Research Network was queried by using disease codes to retrospectively identify patients with obstructive sleep apnea who underwent HNS implantation. Rates of pneumothorax, pleural effusion, other complications, and need for revision/replacement or explant were determined. We identified 1813 patients from 25 health care organizations who underwent HNS implantation. The average age was 60 years, and there were 68% males and 32% females. Of the cohort, 2.4% (n = 44 from 7 implant centers) experienced a pneumothorax, and 0.6% (n = 11) were diagnosed with a pleural effusion on the day of surgery. Patients who experienced pneumothorax were more likely to have a history of chronic lower respiratory diseases when compared with those who did not (odds ratio, 2.2; 95% CI, 1.1-4.1; P = .02). The incidence of intraoperative pneumothorax and pleural effusion during HNS implantation may be greater than initially thought. Patients with chronic lower respiratory diseases may be at increased risk. This should be communicated with patients during the informed consent process.

Evaluation of Risk Factors for Chronic Obstructive Pulmonary Disease in the Middle-Aged and Elderly Rural Population of Northeast China Using Logistic Regression and Principal Component Analysis.

PurposeTo investigate the environmental, immune, and inflammatory factors associated with chronic obstructive pulmonary disease (COPD) in middle-aged and older Chinese individuals.Patients and MethodsA community-based case–control study was conducted among 471 patients with COPD and 485 controls. The information on COPD of the participants was collected through face-to-face interviews, and serum samples were measured at the laboratory. The main risk factors for COPD were analyzed using principal component analysis (PCA) and logistic regression.ResultsNine hundred and fifty-six respondents were included in the analysis. The results of the PCA-logistic regression analysis showed significant differences in the environmental factors, medical history, and serum C-reactive protein (CRP) levels between patients and controls. COPD was markedly more usual in those with smoking index >200 (OR, 1.42; 95% CI, 1.28–1.57); exposure to outdoor straw burning (OR, 1.64; 95% CI, 1.47–1.83); use of coal, wood, and straw indoors (OR, 2.31; 95% CI, 1.92–2.78); history of respiratory disease and coronary heart disease (OR, 3.58; 95% CI, 3.12–4.10), congestive heart failure (OR, 1.23; 95% CI, 1.09–1.38), and cerebrovascular disease (OR, 1.15; 95% CI,1.02–1.31); and higher serum level of CRP (OR, 1.20; 95% CI, 1.11–1.30). Compared to the logistic regression analysis, PCA logistic regression analysis identified more important risk factors for COPD.ConclusionPCA-logistic regression analysis was first utilized to explore the influencing factors among rural residents in Northeast China Environmental aged 40 years and above, it was found that environmental factors, medical history, and serum CRP levels mainly affected the prevalence of COPD.

CN16 Lung cancer risk prediction nomogram in Chinese female non-smokers

About 53% of lung cancers in females are not attributable to smoking worldwide. The aim was to develop and validate a simple and non-invasive model which could assess and stratify lung cancer risk in female non-smokers in China. A large-sample size, population-based study was conducted under the framework of a population-based Cancer Screening Program in Urban China (CanSPUC). Data on the lung cancer screening in Henan province, China, from October 2013 to October 2019 were used and randomly divided into the training and validation sets. Related risk factors were identified through multivariable Cox regression analysis, followed by establishment of risk prediction nomogram. Discrimination [area under the curve (AUC)] and calibration were further performed to assess the validation of risk prediction nomogram in the training set, and then validated by the validation set. A total of 151,834 eligible subjects were included, with a mean age of 55.34 years. Subjects were randomly divided into the training (75,917) and validation (75,917) sets. Elder age, history of chronic respiratory disease, first-degree family history of lung cancer, menopause, and history of benign breast disease were the independent risk factors for lung cancer. Using these five variables, we plotted 1-year, 3-year, and 5-year lung cancer risk prediction nomogram. The AUC was 0.762, 0.718, and 0.703 for the 1-, 3- and 5-year lung cancer risk in the training set, respectively. In the validation set, the model showed a good predictive discrimination, with the AUC was 0.646, 0.658, and 0.650 for the 1-, 3- and 5-year lung cancer risk. We developed and validated a simple and non-invasive lung cancer risk model in female non-smokers. This model can be applied to identify and triage patients at high risk for developing lung cancers in female non-smokers.

Роль факторов риска в детском возрасте на формирование хронической обструктивной болезни легких

An analysis of literature on COPD in children has shown that COPD arises from an accelerated decline in lung function, an inability to achieve normal lung function after childhood, or a combination of the two. Risk factors for the development of COPD are considered negative environmental influences; maternal smoking, intrauterine development disorders, prematurity, low birth weight, bronchopulmonary dysplasia, as well as frequent or severe respiratory infections in childhood (especially respiratory syncytial virus and rhinovirus) that prevent the full growth and development of the lungs; asthma in childhood; early allergic sensitization and/or a rare genetic disorder (alpha‑1 antitrypsin deficiency), childhood chronic cough, parental history of respiratory disease, and low educational attainment. Particularly vulnerable are children from socio-economically low strata of the population, in particular, from among the indigenous population of multi-ethnic countries. In low- and middle-income countries, diagnosing COPD is difficult, and the disease may go undiagnosed. Bronchial asthma in childhood can be considered as an independent risk factor for COPD in adulthood. At the same time, the asthma-COPD overlap syndrome is widespread, the risk of which is especially high among individuals with persistent and severe childhood asthma, which is highly dependent on genetics. Targeted programs are needed to reduce the risk of adverse pulmonary outcomes in disadvantaged children, as well as the integration of specialized outreach services into primary health care. The WHO COPD core package includes protocols for assessing, diagnosing and managing COPD, as well as modules on healthy lifestyles, including smoking cessation and self-help, and development of rehabilitation services.

Chronic Obstructive Pulmonary Disease Prevalence and Associated Risk Factors in Adults Aged 40 Years and Older in Southeast China: A Cross-Sectional Study During 2019-2020.

PurposeChronic obstructive pulmonary disease (COPD) is one of many major public health problems in China, and its prevalence and associated risk factors in the southeast of China need to be determined to facilitate disease control and prevention.MethodsA multistage stratified cluster sampling method was used to select 5486 participants aged ≥ 40 years from nine COPD monitoring districts in Fujian Province during 2019–2020. Participants were interviewed using a laptop-based questionnaire and underwent pulmonary function tests. COPD was diagnosed according to the 2019 Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria.ResultsFinal analysis was conducted using data from 4999 participants with qualified post-bronchodilator results. The prevalence of COPD was 11.6% (95% confidence interval [CI]: 10.5–12.7). Risk factors for COPD in the logistic regression model were being male (odds ratio [OR] = 2.83, 95% CI: 2.01–3.98), > 70 years old (OR = 16.16, 95% CI: 8.14–32.08), having a low body mass index (BMI) (OR = 1.81, 95% CI: 1.13–2.89), parental history of respiratory disease (OR = 1.78, 95% CI: 1.50–2.10), being a current (OR = 2.82, 95% CI: 1.83–4.36) or former (OR = 2.47, 95% CI: 1.45–4.19) smoker, and indoor exposure to biomass (OR = 1.28, 95% CI: 1.05–1.58).ConclusionThe estimated prevalence of COPD in southeast China is high. COPD was strongly associated with sex, aging, a low BMI, parental history of respiratory diseases, smoking, and indoor exposure to biomass in adults aged ≥ 40 years. The government should urgently implement comprehensive measures to reduce the risk factors for COPD.

98. Disparities in trauma care: the association of insurance status with diagnostic and therapeutic procedure administration in spine trauma

<h3>BACKGROUND CONTEXT</h3> Research has suggested substantial disparities in the care of uninsured patients, manifesting as greater delays in care, fewer procedures conducted and greater postoperative complication rates when compared to insured patients. The manifestation of such disparities in the acute trauma setting pertaining to the spine is less understood and remains an issue of debate. <h3>PURPOSE</h3> To investigate the association of lack of insurance with the probability of diagnostic and therapeutic procedure administration to patients undergoing spine trauma in Level I-IV trauma centers. <h3>STUDY DESIGN/SETTING</h3> This was a retrospective cohort study. <h3>PATIENT SAMPLE</h3> A total of 222,602 patients who were registered in National Trauma Data Bank (NTDB) from 2011 to 2019 and initially evaluated in the emergency department of Level I-IV trauma centers in the United States for spine trauma were included. <h3>OUTCOME MEASURES</h3> The outcome measures were rates of select diagnostic and therapeutic procedures being administered to patients. <h3>METHODS</h3> We performed a retrospective cohort study involving spine trauma patients aged 18 to 64 years who were registered in the National Trauma Data Bank (NTDB) between 2011 and 2019. Patients who were missing insurance information, dead on arrival, or had an injury severity score (ISS) less than 9 were excluded. Baseline patient characteristics were compared using bivariate analysis, and multivariate logistic analysis was employed to investigate the association of insurance status with mortality and probability of select diagnostic and therapeutic procedures, adjusting for age, sex, race, ethnicity, ISS, presence of shock, mechanism of injury, intent of injury, Glasgow Coma Scale (GCS) motor score, significantly different comorbidities and year of admission. <h3>RESULTS</h3> Overall, 39,421 patients (17.71%) were uninsured and 183,181 patients (82.29%) were insured. Comorbidity analyses revealed significant differences in alcoholism, bleeding disorder, congestive heart failure, current smoker status, chronic renal failure, stroke, diabetes mellitus, functionally dependent health status, history of myocardial infarction, hypertension, respiratory disease, cirrhosis, and dementia. No differences existed in terms of ISS (17 vs 17; p=0.95), but the uninsured were more likely to present in shock (6.41% vs 5.62%; p <0.001). Mortality rate was greater in uninsured patients compared to their insured counterparts (7.19% vs. 4.70%; p < 0.001). Multivariable logistic regression analysis demonstrated an association of uninsured status with decreased likelihood of receiving magnetic resonance imaging of the spine (odds ratio [OR] = 0.98; p < 0.001) and operative spinal fixation (OR=0.98; p <0.001) and with increased likelihood of receiving computed tomography (CT) of the spine (OR=1.02, p 0.001) compared to insured patients. There were no differences in the likelihood of receiving plain radiography (OR=1.00; p=0.80) or packed red blood cell (PRBC) transfusion within 4 hours (OR=1.00; p=0.21). Subgroup analysis of Level I trauma centers demonstrated persistent insurance-based disparities in the likelihood of operative spinal fixation (OR=0.98; p <0.001) and withdrawal of care (OR=1.01; p <0.001) for the uninsured. <h3>CONCLUSIONS</h3> In summary, lack of insurance was associated with decreased probability of select diagnostic and therapeutic procedures and increased probability of withdrawal of care in spine trauma, with such disparities more pronounced for resource-intensive procedures such as MRI and operative fixation. Differences in care, especially pertaining to therapeutic procedures, continue to persist in Level I trauma centers. Disparities in diagnostic and therapeutic work-up in the acute post-trauma setting may contribute to insurance-based disparities in spine trauma outcomes. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Association between sleep-disordered breathing and periodontal diseases: A systematic review protocol.

BackgroundSleep-disordered breathing (SDB) is a chronic sleep-related breathing disorder, considered associated with increased risk of cardiovascular disorders, metabolic disorders, cognitive dysfunction and behavior changes. Periodontal diseases are chronic infectious diseases that are also believed to be associated with cardiovascular diseases, metabolic syndrome and cognitive dysfunction. Several studies have indicated that SDB may be associated with periodontal diseases through certain mechanisms such as inflammation response, oxidative stress and oral dryness. The aim of this systematic review is to explore the association between SDB and periodontal diseases in an integrated approach.Materials and MethodsThis systematic review will include cohort studies, cross-sectional studies and case-control studies that are identified by electronic and manual searches. Electronic searches will be conducted in the following databases: PubMed, Embase, Scopus and Web of Science. Our search will cover articles published from inception of databases to March 2022 without restrictions in language and settings. Pre-determined eligibility criteria include: participants (participants without a history of respiratory diseases, history of periodontal treatment within the past 6 months and history of medication that is known to influence SDB or periodontal diseases); exposure (participants who have been diagnosed with SDB or at high-risk for SDB); comparison (participants without SDB); and outcome (periodontal parameters, such as probing depth, clinical attachment level, bleeding on probing, radiographic bone loss). Two authors will perform study screening and data extraction independently and in duplicate. All discrepancies will be solved by discussion. The methodological quality of included studies will be assessed using the Newcastle-Ottawa Scale.DiscussionThis systematic review will summarize the existing evidence on the association between SDB and periodontal diseases, a topic of controversy and clinical significance. Its findings can provide evidence for the development of relevant prevention and treatment strategies. The results will be disseminated through peer-reviewed journals.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022313024. Registered on March 28th 2022.

High SARS-CoV-2 seroprevalence in Karaganda, Kazakhstan before the launch of COVID-19 vaccination.

COVID-19 exposure in Central Asia appears underestimated and SARS-CoV-2 seroprevalence data are urgently needed to inform ongoing vaccination efforts and other strategies to mitigate the regional pandemic. Here, in a pilot serologic study we assessed the prevalence of SARS-CoV-2 antibody-mediated immunity in a multi-ethnic cohort of public university employees in Karaganda, Kazakhstan. Asymptomatic subjects (n = 100) were recruited prior to their first COVID-19 vaccination. Questionnaires were administered to capture a range of demographic and clinical characteristics. Nasopharyngeal swabs were collected for SARS-CoV-2 RT-qPCR testing. Serological assays were performed to detect spike (S)-reactive IgG and IgA and to assess virus neutralization. Pre-pandemic samples were used to validate the assay positivity thresholds. S-IgG and -IgA seropositivity rates among SARS-CoV-2 PCR-negative participants (n = 100) were 42% (95% CI [32.2-52.3]) and 59% (95% CI [48.8-69.0]), respectively, and 64% (95% CI [53.4-73.1]) of the cohort tested positive for at least one of the antibodies. S-IgG titres correlated with virus neutralization activity, detectable in 49% of the tested subset with prior COVID-19 history. Serologically confirmed history of COVID-19 was associated with Kazakh ethnicity, but not with other ethnic minorities present in the cohort, and self-reported history of respiratory illness since March 2020. Overall, SARS-CoV-2 exposure in this cohort was ~15-fold higher compared to the reported all-time national and regional COVID-19 prevalence, consistent with recent studies of excess infection and death in Kazakhstan. Continuous serological surveillance provides important insights into COVID-19 transmission dynamics and may be used to better inform the regional public health response.

A retrospective study to show the effectiveness of homoeopathic medicine in bronchitis among children

Bronchitis is a sudden swelling in the major airways into the lungs, called bronchi. It is usually caused by a virus, but it can also be caused by breathing in things that irritate the lungs, such as tobacco smoke, fumes, dust, and air pollution. Bacteria sometimes cause bronchitis.Children are more prone to bronchitis and it accounts for about 25% of the OPD visits. Hence, this retrospective study is done to focus on the prevalence of bronchitis in children. A retrospective clinical study is done with 129 cases taken between July 2021 and December 2021 in the OPD of Sarada Krishna Homoeopathic Medical College. After a thorough study, it is evident that there is an increased prevalence of bronchitis in children and it has been treated based on totality of the symptoms.Much about acute bronchitis in children is uncertain even its definition. This study was undertaken to help build a clinical definition to serve as a guide for further research. Charts of 129 children 0 to 18 years old were reviewed. In a child with a cough bronchitis is more likely to be diagnosed if there is a history of sputum production Rales or rhonchi on examination and a past history of lower respiratory disease. Commonly used Homoeopathic medicines to treat bronchitis in children are Arsenicum album, Bryonia alba, Rhus toxicodendron, Pulsatilla, Antimonium tartaricum which showed their marked improvement in improving the sufferings of the children.

The state of the barrier function of the oral cavity of patients with a history of acute respiratory disease of COVID-19

ABSTRACT. The entrance gate for the SARS-CoV virus is the system of mucous membranes of the upper respiratory tract and oral cavity, which creates the first line of defense of the body against the invasion of foreign agents. Objective to the study is the nature of insemination of the oral mucosa, the density of bacterial population and the adsorption capacity of the buccal epithelium in the post-covid period. Materials and methods. 162 patients who suffered acute respiratory disease of COVID-19 took part in the study, including 54 people. - light form, 69 people. - of medium difficulty and 39 persons. - heavy form. The control group consisted of 30 healthy patients. The clinical and laboratory examination was conducted on the basis of the dental department of the University Hospital of Ternopil during 2020-2022. The results. In patients with a history of a mild form of COVID-19, there is only a quantitative increase in the autochthonous microflora. The colonization index of the buccal epithelium is lower (1.54±0.09) um. units, than in patients of the control group. In patients with a medium-severe form, there are qualitative and quantitative changes in the microflora of the oral cavity, pathogenic and opportunistic microorganisms are often released in large quantities. The colonization index decreases to 1.23±0.01 um. With a severe form of COVID-19, significant changes in the microecology of the mucous membrane are observed - a decrease in the colonization index to 0.57 units. and significant deviations in the character of the microflora, a feature of which was the presence of associations of pathogenic microorganisms. Significant disturbances in the microecology of the mucous membrane of the oral cavity, the development of grade III-IV dysbacteriosis are signs of a significant decrease in the protective barrier properties of the mucous membrane. Conclusions. The intensive growth of pathogenic and conditionally pathogenic non-resident microorganisms is accompanied by the growth of "quorum sensing", which stimulates the manifestation of their pathogenic properties and reduces the barrier function of the mucous membrane of the oral cavity. The obtained results of the assessment of the state of the barrier function of the oral mucosa, the detected violations in the colonization resistance of the oral mucosa of the post-covid syndrome dictate the need to develop and implement in clinical practice an algorithm for the examination of a dental patient with post-covid syndrome.

Discordant Spirometry and Impulse Oscillometry Assessments in the Diagnosis of Small Airway Dysfunction.

Background and objective: Spirometry is commonly used to assess small airway dysfunction (SAD). Impulse oscillometry (IOS) can complement spirometry. However, discordant spirometry and IOS in the diagnosis of SAD were not uncommon. We examined the association between spirometry and IOS within a large cohort of subjects to identify variables that may explain discordant spirometry and IOS findings. Methods: 1,836 subjects from the ECOPD cohort underwent questionnaires, symptom scores, spirometry, and IOS, and 1,318 subjects were examined by CT. We assessed SAD with R5-R20 > the upper limit of normal (ULN) by IOS and two of the three spirometry indexes (maximal mid-expiratory flow (MMEF), forced expiratory flow (FEF)50%, and FEF75%) < 65% predicted. Multivariate regression analysis was used to analyze factors associated with SAD diagnosed by only spirometry but not IOS (spirometry-only SAD) and only IOS but not spirometry (IOS-only SAD), and line regression was used to assess CT imaging differences. Results: There was a slight agreement between spirometry and IOS in the diagnosis of SAD (kappa 0.322, p < 0.001). Smoking status, phlegm, drug treatment, and family history of respiratory disease were factors leading to spirometry-only SAD. Spirometry-only SAD had more severe emphysema and gas-trapping than IOS-only SAD in abnormal lung function. However, in normal lung function subjects, there was no statistical difference in emphysema and gas-trapping between discordant groups. The number of IOS-only SAD was nearly twice than that of spirometry. Conclusion: IOS may be more sensitive than spirometry in the diagnosis of SAD in normal lung function subjects. But in patients with abnormal lung function, spirometry may be more sensitive than IOS to detect SAD patients with clinical symptoms and CT lesions.

Establishment of a Simple Pediatric Lower Respiratory Tract Infections Database Based on the Structured Electronic Medical Records

ObjectiveThis study aimed to establish a pediatric lower respiratory tract infections (PLRTIs) database based on the structured electronic medical records (SEMRs), to provide a brief overview and the usage process of the SEMRs and the database.MethodsAll the medical information is recorded by a clinical information system developed by Eureka Systems Company. A plugin of the software was used to set the properties of items of the SEMR. Children with lower respiratory tract infections (LRTIs) who were admitted to the department of respiratory medicine of our hospital from May 2020 were included. PostgreSQL 13.1 software was used to construct the PLRTIs database.ResultsSeven kinds of SEMRs were established, and the admission record was the most important and complex among them. It was mainly composed of 10 parts, i.e., basic information, history of present illness, past history (without respiratory disease), past history of respiratory diseases, personal history, family history, physical examination, the score of LRTIs, auxiliary examination, and diagnosis. With the three-level doctor ward round, the recorded information of the SEMR would be checked repeatedly, thus guaranteeing the correctness of the information. The data of the SEMR and laboratory tests could be extracted directly from the hospital information system (HIS) by PostgreSQL 13.1 software with the specific structured query language (SQL) code. After manually checking the original records, the datasets were imported into PostgreSQL 13.1 software, and a simple PLRTIs database was constructed. According to the inclusion criteria of this study, a total of 1,184 children with LRTIs were included in this database from 1 May 2020 to 30 April 2021.ConclusionA series of SEMRs for PLRTIs were designed and used during the hospitalization. A simple PLRTIs database was established based on the SEMR. The SEMRs will provide complete and high-quality data on LRTIs in children.

Social Disparities among Sudden Death victims with HIV.

Although cardiovascular death is a growing source of mortality for people living with human immunodeficiency virus (HIV), the risk factors and circumstances surrounding sudden death in this population are poorly understood. We compared 399 adult sudden death victims reported by Emergency Medical Services in North Carolina to 1,114 controls. Sudden death was more common among HIV-positive than HIV-negative individuals (OR: 2.59, 95% CI: 1.15-5.83). In a multivariable model of sudden death victims including Black race, BMI, and history of divorce, incarceration, substance abuse, and respiratory disease, HIV-positive individuals were more likely to be Black (adjusted OR [aOR]: 6.04, 95% CI: 1.08-33.7) or divorced (aOR: 4.71, 95% CI: 1.04-21.3), adjusted for all other variables in the model. Compared to controls with HIV, sudden death victims with HIV were more likely to have a history of incarceration, divorce, respiratory disease, alcohol abuse, or dyslipidemia. A qualitative assessment of victims suggested that many died in isolation, suffering from past and current substance abuse and depression. HIV infection appears to be an important risk factor for sudden death, and incarceration history, social isolation, and medical comorbidities contribute to sudden death risk for HIV-positive individuals.

Prevalence of bronchial wall thickening and collapse in brachycephalic dogs with and without brachycephalic obstructive airway syndrome and in nonbrachycephalic dogs.

To assess the prevalence of bronchial wall thickening (BWT) and collapse in brachycephalic dogs with and without brachycephalic obstructive airway syndrome (BOAS) and in nonbrachycephalic dogs. 85 dogs with no history of lower respiratory tract disease that underwent CT of the thorax. Electronical medical records for March 2011 through August 2019 were reviewed to identify brachycephalic dogs with BOAS (BOAS group) and brachycephalic dogs without BOAS (BDWB group) that did not have any evidence of lower respiratory tract disease and had undergone thoracic CT. A population of nonbrachycephalic dogs of similar weight (control dogs) was also retrospectively recruited. BWT was identified in 28 of 30 (93.3%; 95% CI, 80.3% to 98.6%) dogs in the BOAS group, 15 of 26 (57.7%; 95% CI, 38.7% to 75.0%) dogs in the BDWB group, and 10 of 28 (35.7%; 95% CI, 20.1% to 54.2%) control dogs. On multivariable analysis, only brachycephalic conformation (P < 0.01) and body weight (P = 0.02) were significantly associated with the presence of BWT. Bronchial collapse was identified in 17 of 30 (56.7%; 95% CI, 39.0% to 73.1%) dogs in the BOAS group, 17 of 26 (65.4%; 95% CI, 46.3% to 81.3%) dogs in the BDWB group, and 3 of 28 (10.7%; 95% CI, 3.1% to 25.9%) control dogs. On multivariable analysis, only brachycephalic conformation was significantly (P < 0.01) associated with the presence of bronchial collapse. A relationship between brachycephalic conformation and body weight with BWT was established, with heavier dogs having thicker bronchial walls. However, further studies are required to investigate the cause. Bronchial collapse was also more common in dogs with brachycephalic conformation, which is in agreement with the previously published literature.

Lung cancer risk prediction nomogram in Chinese female non-smokers.

10530 Background: About 53% of lung cancers in females are not attributable to smoking worldwide. The aim was to develop and validate a simple and non-invasive model which could assess and stratify lung cancer risk in female non-smokers in China. Methods: A large-sample size, population-based study was conducted under the framework of a population-based Cancer Screening Program in Urban China (CanSPUC). Data on the lung cancer screening in Henan province, China, from October 2013 to October 2019 were used and randomly divided into the training and validation sets. Related risk factors were identified through multivariable Cox regression analysis, followed by establishment of risk prediction nomogram. Discrimination [area under the curve (AUC)] and calibration were further performed to assess the validation of risk prediction nomogram in the training set, and then validated by the validation set. Results: A total of 151,834 eligible subjects were included, with a mean age of 55.34 years. Subjects were randomly divided into the training (75,917) and validation (75,917) sets. Elder age, history of chronic respiratory disease, first-degree family history of lung cancer, menopause, and history of benign breast disease were the independent risk factors for lung cancer. Using these five variables, we plotted 1-year, 3-year, and 5-year lung cancer risk prediction nomogram. The AUC was 0.762, 0.718, and 0.703 for the 1-, 3- and 5-year lung cancer risk in the training set, respectively. In the validation set, the model showed a good predictive discrimination, with the AUC was 0.646, 0.658, and 0.650 for the 1-, 3- and 5-year lung cancer risk. Conclusions: We developed and validated a simple and non-invasive lung cancer risk model in female non-smokers. This model can be applied to identify and triage patients at high risk for developing lung cancers in female non-smokers.

Impaired lung function and mortality in Eastern Europe: results from multi-centre cohort study

BackgroundThe association between impaired lung function and mortality has been well documented in the general population of Western European countries. We assessed the risk of death associated with reduced spirometry indices among people from four Central and Eastern European countries.MethodsThis prospective population-based cohort includes men and women aged 45–69 years, residents in urban settlements in Czech Republic, Poland, Russia and Lithuania, randomly selected from population registers. The baseline survey in 2002–2005 included 36,106 persons of whom 24,993 met the inclusion criteria. Cox proportional hazards models were used to estimate the hazard ratios of mortality over 11–16 years of follow-up for mild, moderate, moderate-severe and very severe lung function impairment categories.ResultsAfter adjusting for covariates, mild (hazard ratio (HR): 1.25; 95% CI 1.15‒1.37) to severe (HR: 3.35; 95% CI 2.62‒4.27) reduction in FEV1 was associated with an increased risk of death according to degree of lung impairment, compared to people with normal lung function. The association was only slightly attenuated but remained significant after exclusion of smokers and participants with previous history of respiratory diseases. The HRs varied between countries but not statistically significant; the highest excess risk among persons with more severe impairment was seen in Poland (HR: 4.28, 95% CI 2.14‒8.56) and Lithuania (HR: 4.07, 95% CI 2.21‒7.50).ConclusionsReduced FEV1 is an independent predictor of all-cause mortality, with risk increasing with the degree of lung function impairment and some country-specific variation between the cohorts.

Using Big Data to Identify Impact of Asthma on Mortality in Patients with COVID-19.

The goal of this paper was to assess if mortality in COVID-19 positive patients is affected by a history of asthma in anamnesis. A total of 48,640 COVID-19 positive patients were included in our analysis. A propensity score matching was carried out to match each asthma patient with two patients without history of chronic respiratory diseases in one stratum. Matching was based on age, comorbidity score, and gender. Conditional logistics regression was used to compute within each strata. There were 5,557 strata in this model. We included asthma, ethnicity, race, and BMI as risk factors. The results showed that the presence of asthma in anamnesis is a statistically significant protective factor from mortality in COVID-19 positive patients.