Improvement In Respiratory Function Research Articles

Respiratory benefit in preterm lambs is progressively lost when the concentration of fetal plasma betamethasone is titrated below two nanograms per milliliter.

Antenatal steroid therapy is the standard of care for women at imminent risk of preterm delivery. Current dosing regimens use suprapharmacological doses to achieve extended fetal steroid exposures. We aimed to determine the lowest fetal plasma betamethasone concentration sufficient to achieve functional preterm lung maturation. Ewes with single fetuses underwent surgery to install a fetal jugular catheter. Adopting a stepwise design, ewes were randomized to either a saline-only group (negative control group; n = 9) or one of four betamethasone treatment groups. Each betamethasone group fetus received a fetal intravenous infusion to target a constant plasma betamethasone level of either 1) 2 ng/mL (2 ng/mL positive control group, n = 9); 2) 1 ng/mL, (1 ng/mL group, n = 10); 3) 0.5 ng/mL (0.5 ng/mL group, n = 10); or 4) 0.25 ng/mL (0.25 ng/mL group, n = 10). Fetuses were infused for 48 h, delivered, and ventilated. The positive control group, negative control group, and mid-point 0.5 ng/mL group animals were tested first. An interim analysis informed the final betamethasone group tested. Positive control group animals had large, statistically significant improvements in respiratory function. Based on an interim analysis, the 1.0 ng/mL group was studied in favor of the 0.25 ng/mL group. Treatment efficacy was progressively lost at plasma betamethasone concentrations lower than 2 ng/mL. We demonstrated that the acute respiratory benefit conveyed by antenatal steroid exposure in the fetal sheep is progressively lost when constant fetal plasma betamethasone concentrations are reduced below a targeted value of 2 ng/mL.NEW & NOTEWORTHY Lung maturation benefits in preterm lambs were progressively lost when fetal plasma betamethasone concentrations fell below 2 ng/mL. The effective floor threshold for a robust, lung-maturing exposure likely lies between 1 and 2 ng betamethasone per milliliter of plasma. Hypothalamic pituitary adrenal axis signaling and immunocyte populations remained materially disrupted at subtherapeutic steroid concentrations. These data demonstrate the potential to improve antenatal steroid therapy using reduced dose regimens informed by glucocorticoid pharmacokinetics and pharmacodynamics.

Something to consider: rapid palatal expansion for treatment of obstructive sleep apnea in pediatric patients.

This review examines the potential of rapid palatal expansion (RPE) as a treatment for pediatric obstructive sleep apnea (OSA). The focus is on recent findings related to its efficacy, safety, patient selection, timing, appliance options, cost considerations, and long-term outcomes. Recent studies indicate that RPE can lead to significant improvements in pediatric OSA, with a 70% reduction in the Apnea Hypopnea Index (AHI) and increased oxygen saturation levels. It has been particularly effective in children with small or absent tonsils and has been found to reduce adenoid and tonsil size. Long-term follow-up studies suggest the need for ongoing monitoring, as some patients may experience relapse over time. RPE shows promise as an additional treatment for pediatric obstructive sleep apnea. It offers improvements in respiratory function and reduced symptoms in certain patients. However, long-term efficacy and safety require further investigation. Comparative studies and patient-reported outcomes are necessary to optimize treatment approaches. Collaboration between orthodontists, sleep specialists, and ear-nose-throat (ENT) specialists may be essential for optimal outcomes in pediatric OSA patients treated with RPE.

Suitability of the Respicheck questionnaire and Epworth sleepiness scale for therapy monitoring in myotonic dystrophy type 1

Myotonic dystrophy type 1 (DM1) is an autosomal dominant trinucleotide disorder that often leads to respiratory dysfunction resulting in hypoventilation symptoms, reduced quality of life and causing premature death if untreated. To early identify symptoms of hypoventilation, the Respicheck questionnaire was developed as a screening tool. Symptomatic therapies like inspiratory muscle training (IMT) are recommended to strengthen respiratory muscles and reduce or even prevent hypoventilation symptoms.Our study aimed to evaluate the Respicheck questionnaire's suitablility to monitor the efficacy of IMT. Patients with genetically confirmed DM1 were randomly assigned to either IMT – endurance or strength training, or control group. At baseline, end of study and four interim visits, pulmonary function tests, Respicheck questionnaire and Epworth sleepiness scale were assessed. While patients in training groups achieved a substantial improvement after nine months of regular IMT in pulmonary function tests, the Respicheck score did not improve likewise. Similarly, the ESS score did not change significantly in both training and control groups. Consequently, we conclude that either improvement of respiratory function is not necessarily associated with clinical improvement, or respiratory muscle weakness was not the only reason for hypoventilation syndrome, or both questionnaires are not sensitive enough to detect slight clinical changes.

Defining Meaningful Outcomes for Patients with Spinal Muscular Atrophy in the Era of Gene Therapy

Spinal muscular atrophy (SMA) occurs due to a mutation in the SMN1 gene. It most typically has an onset in early childhood and presents as impairment in motor, bulbar, and respiratory function. In a symposium at the European Paediatric Neurology Society’s (EPNS) 2023 congress, three leading experts in SMA discussed the findings of real-world evidence (RWE) studies of the first gene therapy approved in NMD, in 2019 in the USA, and 2020 in Europe. Onasemnogene abeparvovec combines an adeno-associated virus (AAV9) vector with a functional copy of SMN complementary DNA, and is delivered in a single infusion. While clinical trials of onasemnogene abeparvovec show its efficacy and safety in populations with SMA who are symptomatic and pre-symptomatic, RWE studies have expanded the understanding of this therapy to wider SMA patient groups in the real-world clinical practice setting. Combined, such studies show how administration of onasemnogene abeparvovec in patients with symptomatic SMA can lead to motor and respiratory function improvement or stabilisation and achievement of motor milestones in naïve or pre-treated patients, while in patients who are pre-symptomatic, administration may lead to a normal development. The experts also discussed how understanding the benefit/risk profile of this gene therapy can help with decision-making over its use in patients with SMA. They highlighted how onasemnogene abeparvovec efficacy and safety can be affected by clinical status, disease severity, weight, age, and previous treatment at the time of infusion. Recently published RWE points to improvements being best predicted by baseline Children’s Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP-INTEND) score and age at treatment initiation, and in regard to safety and tolerability profile, liver enzyme elevation is the most predominant treatment-emergent adverse event (TEAE) with onasemnogene abeparvovec; hence, a prednisolone (or equivalent) dosing regimen is administered prior to, during, and for at least 3 months following infusion. The experts discussed how careful monitoring and adequate multidisciplinary team discussion, including colleagues from other specialities, such as hepatologists and paediatric immunologists, is advised in all cases of SMA receiving an onasemnogene abeparvovec infusion.

Promising Markers of Inflammatory and Gut Dysbiosis in Patients with Post-COVID-19 Syndrome.

Post-COVID-19 syndrome is a complex of different symptoms, which results in a multisystemic impairment after the suffering from COVID-19 infection. The aim of the study was to reveal the clinical, laboratory, and gut disorders in patients with post-COVID-19 syndrome (n = 39) before and after taking part in the 14-day complex program of rehabilitation. A complete blood count, coagulation test, blood chemistry, biomarkers, and metabolites in serum samples, and gut dysbiosis were revealed in patients on the day of admission and after 14-day rehabilitation, in comparison with the variables of healthy volunteers (n = 48) or with reference ranges. On the day of discharge, patients noted an improvement in respiratory function, general well-being, and mood. At the same time, the levels of some metabolic (4-hydroxybenzoic, succinic, fumaric acids) and inflammatory (interleukin-6) variables, which were increased on admission, did not reach the level of healthy people during the rehabilitation program. Taxonomy disbalance was observed in patients' feces, namely, a high level of total bacterial mass, a decrease in the number of Lactobacillus spp., and an increase in pro-inflammatory microorganisms. The authors suggest that the post-COVID-19 rehabilitation program should be personalized, considering the patient's state together with not only the baseline levels of biomarkers, but also with the individual taxonomy of the gut microbiota.

Effects of inspiratory muscle training on respiratory muscle strength, respiratory function and functional capacity in adolescents with idiopathic scoliosis : Arandomized, controlled trial.

Adolescent Idiopathic Scoliosis (AIS) may impair respiratory dynamics and affect the performance of inspiratory and expiratory muscles. The benefit of inspiratory muscle training (IMT) is not well investigated in AIS. We aimed to investigate the effects of IMT on respiratory muscle strength, respiratory function and functional capacity in adolescents with mild to moderate AIS. Thirty-six adolescents were randomized into control or IMT groups. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and peak expiratory flow (PEF) were measured by spirometry; respiratory muscle strength by maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP); and functional capacity by 6-min walk test (6MWT) before and after the 8-week-long home-based exercise program. Both groups received conventional exercise program including diaphragmatic breathing exercises, resistive local expansion exercise on the collapsed areas in concave sides of scoliosis, spinal stabilization, strengthening of interscapular muscles and stretching exercises. IMT group also trained with Threshold IMT device for 15 minutes, twice a day for 8 weeks at the intensity of 30% of initial MIP value in addition to conventional exercise program. FEV1, PEF, MIP, MEP and 6MWT distance significantly improved in both groups. IMT group also showed significant improvement in FVC. The increases in FVC, MIP, MEP and 6MWT distance of IMT group were significantly higher compared to control group. IMT is found to be beneficial for patients with AIS for achieving further improvements in respiratory function, respiratory muscle strength and functional capacity compared to conventional exercise program alone.

Transthoracic robotic plication for diaphragmatic elevation.

This study aims to evaluate the feasibility, safety, and efficacy of transthoracic robot-assisted surgery for diaphragmatic plication and to describe our surgical approach in detail. Between January 2014 and January 2020, a total of 13 patients (11 males, 2 females; median age: 55 years; range, 24 to 70 years) who underwent diaphragmatic plication with the robotic system were retrospectively analyzed. The changes in the Medical Research Council dyspnea scale, forced expiratory volume in 1 sec, body mass index, and quality of life scale scores of the patients before the operation and at the first year of follow-up were examined. Twelve of the operations were performed on the left side. The median pre- and postoperative Medical Research Council dyspnea scores were 2 (range, 1 to 4) and 1 (range, 1 to 4), respectively, indicating a statistically significant improvement (p=0.008). A significant improvement was detected in the forced expiratory volume in 1 sec of the patients in the first year after surgery (p=0.036). In terms of quality of life parameters, only, in the physical health subscale, the scores were statistically significantly different in the pre- and postoperative first-year follow-up (p=0.002). Median time to chest tube removal was 1 (range 1-5, IQR=0,5) days. Median total length of hospital stay was 2 (range 2-18, IQR=3) days. Owing to its technical dexterity, the robot enables the plication to be performed easily and safely. Late improvement in respiratory functions is reflected in quality of life.

Impact of Vitamin D in the improvement of respiratory function in sickle cell disease adult patients

Abstract The study aimed to discover the role of vitamin D in improving the respiratory function in sickle cell disease patients. In this prospective study, 188 adults were enrolled, drawn from the out-patients unit of Thalassemia Cente The collected data were categorized into three groups: group 1 included the data of 100 healthy individuals of age range of 18-50 years as control; group 2 included the data of 88 (40 males and 48 females) sickle cell disease patients in steady state before supplementation of vitamin D; group 3 represented the data of the same 88 sickle cell disease patients as measured and recorded after 6 weeks of vitamin D supplementation. Laboratory measurements including pulmonary function tests and hematological parameters, while vitamin D levels were estimated for all groups to compare the data before and after supplementation of vitamin We found significant differences in the pulmonary function tests when comparing groups. Mean value of FEV1 revealed significant differences between group 1 and 2 (p >0.05), while vitamin D supplement created a significant difference between group 2 and 3 (p >0.05). The improvement in FEV1 did not reach to that of healthy (group 1), as referred by the significant variation between group 1 and group 3 (p>0.05). The same findings were indicative within most pulmonary function tests, and the percentages of combined cases (restrictive and obstructive) were also deceased in group 3. Conclusion: supplement of vitamin D in SCD patients could result in relative improvement in lung function.

Predictive factors inhibiting recovery of the respiratory function after anatomical pulmonary resection.

Some patients have worse actual observed postoperative (apo) respiratory function values than predicted postoperative (ppo) values. The present study therefore clarified the predictive factors that hinder the recovery of the postoperative respiratory function. This study enrolled 255 patients who underwent anatomical pulmonary resection for lung cancer. A pulmonary function test (PFT) was carried out before surgery and at one, three, and six months after surgery. In each surgical procedures, the forced expiratory volume in 1s (FEV1) ratio was calculated as the apo value divided by the ppo value. In addition, we investigated the predictive factors that inhibited postoperative respiratory function improvement in patients with an FEV1 ratio < 1.0 at 6months after surgery. The FEV1 ratio gradually improved over time in all surgical procedures. However, 49 of 196 patients who underwent a PFT at 6months after surgery had an FEV1 ratio < 1.0. In a multivariate analysis, right side, upper lobe, segmentectomy and pleurodesis for prolonged air leakage were independent significant predictors of a decreased FEV1 ratio (p = 0.003, 0.006, 0.001, and 0.009, respectively). Pleurodesis was the only controllable factor that might help preserve the postoperative respiratory function. Thus, the intraoperative management of air leakage is important.

Addition of Baricitinib to Usual Therapeutic Regimen in Hospitalized Patients with Severe Covid-19: A Prospective Cohort Study

Background-Purpose: The ongoing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has affected our everyday lives for the last three years, leading to in numerous patient hospitalizations all over the world and a plethora of therapeutic interventions being implemented in an effort to combat the disease. Baricitinib is an oral selective Janus kinase (JAK) inhibitor approved for the treatment of rheumatic disease that was hypothesized to bear positive effect on the more severe forms of the novel coronavirus disease 2019 (COVID-19) based on its antiviral and anti-cytokine properties. The purpose of the current prospective cohort study was to study the effect of adding baricitinib to the usual drug regimen of patients hospitalized with severe COVID-19 in the infectious disease unit of a third-level hospital. Patients-Methods: The current prospective cohort study was conducted at the Infectious Disease Unit of the 401 General Military Hospital of Athens, recruiting a total of 74 patients who were hospitalized with severe COVID-19 based on the COVID-19 severity index. Relevant demographic data, personal and family medical history and turnout of the cases was documented. Laboratory examinations as well as arterial blood gases (ABGs) were recorded and analysed both upon admission and discharge of the patients. An oral dose of 4 mg baricitinib daily (or an adjusted dose of 2 mg daily in cases of renal disease) was added to the usual therapeutic regimen of the patients. Results: For the purpose of the current study, we recruited 74 patients (male sex 81.1%, mean age 52,8±17,2 years old). Six patients (8.1%) were fully vaccinated and 32 patients (43.2%) presented at least one comorbidity (chronic cardiovascular disease, chronic liver disease, chronic kidney disease, immunosuppression, diabetes mellitus or obesity). Mean hospitalization time reached 10.9 ± 5.8 days while mean time of baricitinib administration was 9.2 ± 2.9 days. Regarding outcomes of hospitalizations, 12 patients (16.2%) needed to be transferred to the intensive care unit (ICU), with 6 of them finally succumbing to the disease. Administration of the drug led to a statistically significant drop of inflammatory markers as well as a statistically significant improvement of respiratory function as evaluated by ABGs. No serious adverse events were recorded. Conclusion: The addition of oral baricitinib to the standard drug regimen of hospitalized patients with severe COVID-19 proved safe and efficacious in managing symptoms of the disease, leading to swift clinical complaint and laboratory profile improvements.

Physical Therapy Management of a COVID-19 Patient on Extracorporeal Membrane Oxygenation: A Case Report

Coronavirus Disease-2019 (COVID-19) can be classified as a respiratory disease that ranges from pneumonia to critically ill cases. Extracorporeal Membrane Oxygenation (ECMO) is a therapeutic procedure that can treat severe cases of respiratory failure. Hereby, the authors present, a 28-year-old case of Acute Respiratory Distress Syndrome (ARDS) young patient with COVID-19 on ECMO therapy, presenting with complaints of weakness, decreased mobility and function, and depression. The patient has received physical therapy interventions during the hospitalisation period. Respiratory, mobility, activity level, and psychological assessments were done before and after treatment using blood gases, the Intensive Care Unit (ICU) Mobility Scale, the University of Michigan scale, and the Hamilton Anxiety and Depression Rating Scale, respectively. There was an improvement in respiratory function, mobility (scores increased from 0 to 1), activity level (scores increased from 0 to 3), and psychological well-being (depression scores decreased from 18 to 15, and anxiety scores decreased from 20 to 14) after physical therapy. The treatment resulted in better recovery and prevented the worsening of the COVID-19 disease scenario.

Percutaneous mechanical pulmonary thrombectomy: An emerging opportunity for vascular surgeons

ObjectivePercutaneous pulmonary artery (PA) mechanical thrombectomy is a minimally invasive treatment for patients with submassive pulmonary emboli (PE). Recent registry data suggest that only approximately 12% of these procedures are being performed by vascular surgeons. We conducted a single center, 1-year, prospectively collected, retrospectively reviewed original study of all patients who had percutaneous PA aspiration mechanical thrombectomy (PPAAMT) performed by vascular surgeons to treat acute, submassive PE. MethodsBetween January 2020 and January 2021, 5 vascular surgeons performed 21 percutaneous PPAAMTs, representing 72% of all the PPAAMT performed at our institution. The remaining 28% were performed by interventional radiology and cardiology physicians (4 patients each). Vascular surgeons used the Inari Flowtriever aspiration catheter in 90.4% of our cases. For the remaining 10% of cases, the Penumbra Indigo thrombectomy device was used. Device choice was determined by the surgeon. ResultsWe analyzed prospectively collected data and reviewed postprocedural outcomes including PA mean arterial pressures, interval improvement of respiratory function, and mortality. Among the patients treated with PPAAMT by vascular surgeons in this series, 76% demonstrated an improvement in oxygen requirements and 83% saw an improvement in their post-thrombectomy PA mean arterial pressure. There were three mortalities (16%), none of which were procedure related or attributable to the patients' acute presentation or to PE recurrence. ConclusionsIn this prospectively collected, retrospectively analyzed original study, vascular surgeons performed the majority of percutaneous PPAAMT to treat submassive PE at a single institution, with no procedure-related mortality and a high rate of clinical improvement as measured by improvements in oxygen requirements and PA mean arterial pressures. These results suggest that PPAAMT performed by vascular surgeons is safe and effective and can be strategically incorporated into an already busy tertiary care vascular surgery practice.

목척수손상환자의 호흡근훈련의 효과

Purpose: This systematic review was designed to analyze studies examining the effects of respiratory muscle training on cervical spinal cord injury.&#x0D; Methods: Randomized controlled trials on the rehabilitation of patients with cervical spinal cord injury were searched using four databases: Physiotherapy Evidence Database (PEDro), PubMed, and Google Scholar. Five studies were selected according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, and the PEDro scale was used for qualitative analysis. For rehabilitation, a protocol including respiratory training and physical activity was selected.&#x0D; Results: Of the 135 studies identified in the 2019-2022 period, three were finally selected. All studies performed respiratory muscle training for 30-40 min a day, 5 days a week, for 6-12 weeks. Performing a meta-analysis was difficult because of differences in the study design, and all studies reported significant improvement in respiratory function compared with that in the control group.&#x0D; Conclusion: The literature on various respiratory muscle training for cervical spinal cord injury is scarce. However, it is confirmed that respiratory muscle training has a positive effect on not only respiratory function but also neuroplasticity, cardiovascular autonomic function, and quality of life in patients with cervical spinal cord injury.

Preoperative inhalation therapy for patients with chronic obstructive pulmonary disease undergoing lung surgery: a retrospective study

BackgroundResearch shows that even the short-term administration of inhaled drugs immediately before surgery can improve respiratory function in surgical candidates with chronic obstructive pulmonary disease (COPD). However, the long-term efficacies of different types of long-acting inhaled agents when used during a short preoperative period remain unclear. Therefore, we evaluated the efficacies of short-term, preoperative long-acting muscarinic antagonists (LAMAs), inhaled corticosteroids with long-acting β2-agonists (ICSs/LABAs), and long-acting muscarinic antagonists with long-acting β2-agonists (LAMAs/LABAs) in patients with COPD after lung resection.MethodsPatients who underwent anatomical lung resections between April 2010 and March 2020 were divided into the non-COPD (193 patients) and COPD (241 patients) groups. The COPD group underwent preoperative treatment with either a LAMA (51 patients), an ICS/LABA (112 patients), or a LAMA/LABA (78 patients) for almost 1 month, with pulmonary function tests performed initially, just before surgery, and at 1 and 6 months after surgery. Improvement in preoperative respiratory function by inhalation therapy and the maintenance of improvement in respiratory function after surgery were examined in each group.ResultsThe COPD group had significantly higher proportions of men, older patients, smokers, and histopathologic types except for adenocarcinoma than the non-COPD group; however, there were neither differences in sex, age, percentage of smokers, or histopathologic type among the inhalant groups within the COPD group nor were there differences in percentage of GOLD stage, preoperative inhalation period, or percentage of resected lobes in lobectomy. Preoperative increases in forced expiratory volume in 1.0 s (FEV1.0) were significantly higher in the COPD group (129.07 ± 11.29 mL) than in the non-COPD group (-2.32 ± 12.93 mL) (p < 0.0001). At 6 months, there was no significant difference in residual FEV1.0 between the COPD-LAMA/LABA (2017.46 ± 62.43 mL) and non-COPD groups (2046.93 ± 40.53 mL). The FEV1.0 reduction rate was more suppressed in the COPD-LAMA/LABA group than in the non-COPD group at 1 and 6 months after surgery.ConclusionsShort-term, preoperative, inhaled pharmacotherapies, particularly LAMAs/LABAs, were effective at improving respiratory function in patients with COPD; thus, these agents are recommended for use in this population.

Diaphragm dysfunction after severe COVID-19: An ultrasound study.

BackgroundSARS-CoV-2 infection can impair diaphragm function at the acute phase but the frequency of diaphragm dysfunction after recovery from COVID-19 remains unknown.Materials and methodsThis study was carried out on patients reporting persistent respiratory symptoms 3–4 months after severe COVID-19 pneumonia. The included patients were selected from a medical consultation designed to screen for recovery after acute infection. Respiratory function was assessed by a pulmonary function test, and diaphragm function was studied by ultrasonography.ResultsIn total, 132 patients (85M, 47W) were recruited from the medical consultation. During the acute phase of the infection, the severity of the clinical status led to ICU admission for 58 patients (44%). Diaphragm dysfunction (DD) was detected by ultrasonography in 13 patients, two of whom suffered from hemidiaphragm paralysis. Patients with DD had more frequently muscle pain complaints and had a higher frequency of prior cardiothoracic or upper abdominal surgery than patients with normal diaphragm function. Pulmonary function testing revealed a significant decrease in lung volumes and DLCO and the dyspnea scores (mMRC and Borg10 scores) were significantly increased in patients with DD. Improvement in respiratory function was recorded in seven out of nine patients assessed 6 months after the first ultrasound examination.ConclusionAssessment of diaphragm function by ultrasonography after severe COVID-19 pneumonia revealed signs of dysfunction in 10% of our population. In some cases, ultrasound examination probably discovered an un-recognized pre-existing DD. COVID-19 nonetheless contributed to impairment of diaphragm function. Prolonged respiratory physiotherapy led to improvement in respiratory function in most patients.Clinical trial registration[www.cnil.fr], identifier [#PADS20-207].

Post COVID-19 환자들의 재활

Purpose: Data on clinical and prognosis of patients post coronavirus disease-2019 (COVID-19) and interest in rehabilitation are still insufficient. Contagious isolation causes respiratory, physical, and psychological dysfunction. Therefore, we synthesized and analyzed the effect of rehabilitation on patients with COVID-19 studied abroad. Methods: Randomized controlled trials on the rehabilitation of patients with COVID-19 were searched using four international databases: CINAHL, Embase, MEDLINE, and PEDro. For rehabilitation, a protocol including breathing training and physical activity was selected, and usual care or prior values were used for the control group. The quality of randomized controlled trials was assessed using the risk-of-bias tool provided by the Cochrane Library. Analysis was performed using RevMan 5.4, and data were weighted and pooled with a random-effects model. Results: Of the 129 studies identified, 4 were finally selected. A total of 227 patients with COVID-19 were evaluated, and significant improvements were seen in forced expiratory volume in one second (SMD = 0.75; 95% confidence interval [CI] 0.10-1.40; overall effect [Z = 2.25]) and depression (SMD = 3.46; 95% CI, 1.21-5.71; overall effect [Z = 3.02]), excluding forced vital capacity (SMD = 0.28; 95% CI −0.09 to 0.65; overall effect [Z = 1.48]). Conclusion: Rehabilitation showed improvement in respiratory function through breathing training, but a more effective protocol is required for tele-rehabilitation. In addition, interventions involving physical activity will have a beneficial effect on muscle loss and depression caused by quarantine because of coronavirus infection.

Effect of body position on the redistribution of regional lung aeration during invasive and non-invasive ventilation of COVID-19 patients

Severe COVID-19-related acute respiratory distress syndrome (C-ARDS) requires mechanical ventilation. While this intervention is often performed in the prone position to improve oxygenation, the underlying mechanisms responsible for the improvement in respiratory function during invasive ventilation and awake prone positioning in C-ARDS have not yet been elucidated. In this prospective observational trial, we evaluated the respiratory function of C-ARDS patients while in the supine and prone positions during invasive (n = 13) or non-invasive ventilation (n = 15). The primary endpoint was the positional change in lung regional aeration, assessed with electrical impedance tomography. Secondary endpoints included parameters of ventilation and oxygenation, volumetric capnography, respiratory system mechanics and intrapulmonary shunt fraction. In comparison to the supine position, the prone position significantly increased ventilation distribution in dorsal lung zones for patients under invasive ventilation (53.3 ± 18.3% vs. 43.8 ± 12.3%, percentage of dorsal lung aeration ± standard deviation in prone and supine positions, respectively; p = 0.014); whereas, regional aeration in both positions did not change during non-invasive ventilation (36.4 ± 11.4% vs. 33.7 ± 10.1%; p = 0.43). Prone positioning significantly improved the oxygenation both during invasive and non-invasive ventilation. For invasively ventilated patients reduced intrapulmonary shunt fraction, ventilation dead space and respiratory resistance were observed in the prone position. Oxygenation is improved during non-invasive and invasive ventilation with prone positioning in patients with C-ARDS. Different mechanisms may underly this benefit during these two ventilation modalities, driven by improved distribution of lung regional aeration, intrapulmonary shunt fraction and ventilation-perfusion matching. However, the differences in the severity of C-ARDS may have biased the sensitivity of electrical impedance tomography when comparing positional changes between the protocol groups.Trial registration: ClinicalTrials.gov (NCT04359407) and Registered 24 April 2020, https://clinicaltrials.gov/ct2/show/NCT04359407.

Drinking Water Containing Platinum-Palladium (Functional Nutrient Water) Improved Interstitial Pneumonia and COPD: A Case Report

In this case, when a patient with interstitial pneumonia was given platinum palladium, improvement in respiratory function was observed. Generally, various treatment methods are used for interstitial pneumonia, but conservative therapy has been the main focus and no curative solution has been reached. In this case, there was a tendency for improvement in patients who took platinum palladium, so we reported it. Since it is only drunk, it is not invasive and has great benefits for patients. It has also been reported that COPD, which is also a respiratory disease, showed an improvement tendency by drinking platinum palladium. Although the mechanism is still unknown, it is considered that it is largely due to the antioxidant action by platinum palladium and the activation of AMPK. In the future, we would like to examine further cases and improve the mechanism.

Improvements of lung volumes and respiratory symptoms after weight loss through laparoscopic sleeve gastrectomy.

This study evaluated the improvement of respiratory function and airway volumes using spirometry and computed tomography (CT) in severely obese Japanese patients undergoing laparoscopic sleeve gastrectomy (LSG). We also evaluated the quality of life (QOL) of enrolled patients using questionnaires. A total of 71 patients who underwent LSG at Iwate Medical University Hospital between October 2013 and September 2020 were enrolled. The changes and relationships between respiratory parameters including CT volumetry and weight-loss effects were evaluated. Improvements to QOL and bronchial asthma (BA) were also assessed before LSG and 1year after LSG. The mean excess weight loss percentage (%EWL) and total weight loss percentage (%TWL) were measured at 55.1% and 26.1%, respectively. The attack frequency of BA significantly decreased (6.1/month vs. 1.5/month; P < 0.001), and the disease severity decreased according to severity classification (P = 0.032). Almost spirometric parameters, lung volume (LV) (4905.0mL vs. 5490.3mL; P < 0.001), and airway volume (AV) (108.6mL vs. 119.3mL; P = 0.022) significantly improved. The change of functional residual capacity (FRC) was correlated with both %EWL (ρ = 0.69, P < 0.001) and %TWL (ρ = 0.62, P < 0.001). The increase of LV (ρ = 0.79, P < 0.001) and AV (ρ = 0.69, P < 0.001) were correlated with the increase of FRC. Scores of QOL questionnaires dramatically became better owing to improvements in dyspnea. Weight loss effects and the reduction of body fat mass correlated significantly with increase in LV and AV. Improvements of respiratory functions after LSG contributes to QOL and BA symptoms.

Efficacy of anti-IL-5 therapy with mepolizumab for severe bronchial asthma and concomitant inflammatory nasal diseases in real clinical practice

BACKGROUND. T2 inflammation underlies non-allergic eosinophilic severe bronchial asthma and chronic rhinosinusitis with nasal polyposis (CRSwNP). Existing targeted anti-IL-5 drugs can improve clinical and functional parameters in patients with a combination of severe asthma and CRSwNP.&#x0D; AIM: to evaluate mepolizumab efficacy in patients with non-allergic severe asthma and concomitant inflammatory nasal diseases (CIND) in real clinical practice.&#x0D; MATERIALS AND METHODS. The study was conducted without a control group, by comparing related populations (before-after analysis) and based on the Sverdlovsk regional register of adult patients with severe asthma and CIND. The primary endpoint was asthma control achievement (ACT questionnaire) and decrease in the proportion of patients with uncontrolled severe asthma. The number of asthma exacerbations, emergency calls and hospitalizations, quality of life according to AQLQ questionnaire, peripheral blood eosinophils level and respiratory function (FEV1, FVC, FEV1/FVC) were also assessed. Dynamics of nasal symptoms was assessed using SNOT22 questionnaire and visual analogue scale (VAS).&#x0D; RESULTS. During 12 months of therapy with mepolizumab, ACT increased from 9 (Q1-Q3: 7-11) to 22 points (Q1-Q3: 21-24) (p0.001). The proportion of patients with uncontrolled asthma decreased from 100% to 10% (p0.001). The number of asthma exacerbations decreased from 3.182.8 per patient per year to 0 (p0.001) and hospitalizations from 0.570.9 per patient per year to 0 (p=0.007). Quality of life according to AQLQ increased from 3.481.05 (95% CI 2.734.24) to 5.590.88 (95% CI 4.966.22) points (p0.001). The number of blood eosinophils decreased from 442 (Q1-Q3: 336-853) to 90 (Q1-Q3: 73-117) cells/l (p0.001). There was increase in FEV1 from 63.9%24.2 (95% CI 46.681.2) to 80.5%18.3 (95% CI 67.493.6) (p=0.015). There was decrease in SNOT22 questionnaire score by 33 points (from 4530 to 2215) (p=0.006) and decrease in VAS score by 5 points (from 8 (Q1-Q3: 5-8) to 3 (Q1-Q3: 3-5)) (p=0.017).&#x0D; CONCLUSIONS. According to the study results, there were asthma control improvement, asthma exacerbations decrease, quality of life improvement according to AQLQ. Statistically significant peripheral blood eosinophils decrease and respiratory function improvement were also revealed. In patients with CIND, significant improvement in nasal breathing was noted, which was confirmed by scores of SNOT22 and VAS questionnaires.