Normal Lung Function Research Articles

Normal lung attenuation distribution and lung volume on computed tomography in a Chinese population.

Backgroud and objectives: Although lung attenuation distribution and lung volume on computed tomography (CT) have been widely used in evaluating COPD and interstitial lung disease, there are only a few studies regarding the normal range of these indices, especially in Chinese subjects. We aimed to describe the normal range of lung attenuation distribution and lung volume based on CT.Methods: Subjects with normal lung function and basically normal chest CT findings (derivation group) at Ruijin Hospital, Shanghai (from January 2010 to June 2014) were included according to inclusion and exclusion criteria. The range of the percentage of lung volume occupied by low attenuation areas (LAA%), percentile of the histogram of attenuation values (Perc n), and total lung volume were analyzed. Relationships of these measures with demographic variables were evaluated. Participants who underwent chest CT examination for disease screening and had basically normal CT findings served as an external validation group.Results: The number of subjects in the derivation group and external validation groups were 564 and 1,787, respectively. Mean total lung volumes were 4,468±1,271 mL and 4,668±1,192 mL, and median LAA%(-950 HU) was 0.19 (0.03–0.43) and 0.17 (0.01–0.41), in the derivation and external validation groups, respectively. Reference equations for lung volume and attenuation distribution (LAA% using -1,000–210 HU, Perc 1 to Perc 98) were generated: Lung volume (mL) = -1.015 *10^4+605.3*Sex (1= male, 0= female)+92.61*Height (cm) –12.99*Weight (kg) ±1766; LAA% (-950 HU)=[0.2027+0.05926*Sex (1= male, 0= female) –4.111*10^-3*Weight (kg) +4.924*10^-3*Height (cm) +8.504*10^-4*Age]^7.341–0.05; Upper limit of normal range: [0.2027+0.05926*Sex-4.111*10^-3*Weight+4.924*10^-3*Height+8.504*10^-4*Age+0.1993]^7.341–0.05.Conclusion: This large population-based retrospective study demonstrated the normal range of LAA%, Perc n, and total lung volume measured on CT scans among subjects with normal lung function and CT findings. Reference equations are provided.

Reduced exercise ventilatory efficiency in adults with cystic fibrosis and normal to moderately impaired lung function.

Despite being a hallmark and an independent prognostic factor in several cardiopulmonary diseases, ventilatory efficiency-i.e., minute ventilation/carbon dioxide output relationship (V̇e/V̇co2)-has never been systematically explored in cystic fibrosis (CF). To provide a comprehensive frame of reference regarding measures of ventilatory efficiency in CF adults with normal to moderately impaired lung function and to confirm the hypothesis that V̇e/V̇co2 is a sensitive marker of early lung disease. CF patients were divided into three groups, according to their spirometry: normal (G1), mild impairment (G2), and moderate impairment (G3) in lung function. All participants underwent incremental cardiopulmonary exercise testing on a cycle ergometer. Lowest V̇e/V̇co2 ratio (nadir) and the slope and the intercept of the linear region of the V̇e/V̇co2 relationship were contrasted in a two-center retrospective analysis, involving 72 CF patients and 36 healthy controls (HC). Compared with HC, CF patients had significantly higher V̇e/V̇co2 nadir, slope, and intercept (P < 0.001, P < 0.001, and P = 0.049, respectively). Subgroup analysis revealed significant differences in nadir (P = 0.001) and slope (P = 0.012) values even between HC and G1. Dynamic hyperinflation related negatively with slope (P = 0.045) and positively with intercept (P = 0.001), while no impact on nadir was observed. Ventilatory inefficiency is a clear feature of adults with CF, even among patients with normal spirometry. V̇e/V̇co2 nadir seems to be the most reliable metric to describe ventilatory efficiency in CF adults. Further prospective studies are needed to clarify whether V̇e/V̇co2 could represent a useful marker in the evaluation of early lung disease in CF.NEW & NOTEWORTHY This is the first study to investigate ventilatory efficiency in a cohort of adult cystic fibrosis (CF) patients with nonsevere lung disease. The finding of impaired ventilatory efficiency in patients with normal lung function confirms the higher sensitivity of exercise testing in detecting early lung disease compared with spirometry. Dynamic hyperinflation plays a significant role in determining the behavior of V̇e/V̇co2 slope and intercept values with increasing lung function impairment. Apparently free from interference from mechanical constraints, V̇e/V̇co2 nadir seems the most reliable parameter to evaluate ventilatory efficiency in CF adults.

Chirurgie d'une géante liposarcome avec l’anesthésie générale chez le patient ayant la fonction respiratoire normale: Etude de cas à l'hôpital de Thanh Nhan

Chirurgie d'une géante liposarcome avec l’anesthésie générale chez le patient ayant la fonction respiratoire normale: Etude de cas à l'hôpital de Thanh Nhan

Lung function deterioration predicts elevated troponin levels in apparently healthy individuals throughout a 5-year follow-up.

Lung function is inversely associated with coronary heart disease and cardiovascular disease. High-sensitive cardiac troponin T (hs-cTnT) was recently found to represent early subclinical cardiac disease even in healthy individuals. We explored the inter-relationship between lung function and hs-cTnT and the changes over time in these two measurements. Lung function test and hs-cTnT were determined in apparently healthy individuals from the Tel Aviv Medical Center Inflammatory Survey. Participants with normal lung function were followed up for 5 years in order to evaluate the effect of lung function deterioration on hs-cTnT levels. The correlation between annual Forced vital capacity (FVC) % predicted decline and hs-cTnT levels were analyzed. A 5-year follow-up of 2,618 participants with normal lung function at baseline revealed a mean annual FVC deterioration of 31.9 (±91.3) ml/year. Lung function decline >5% was associated with an increased risk of having hs-cTnT >5 ng/L (Exp. β = 1.55 1.20-1.99, p = 0.001). Delta FVC between two consecutive visits was inversely correlated with an increase of hs-cTnT (r = -0.24, p < 0.001). Deterioration of lung function predicts elevated troponin levels and may be a sign of early subclinical cardiac disease.

The KCNE2 potassium channel β subunit is required for normal lung function and resilience to ischemia and reperfusion injury.

The KCNE2 single transmembrane-spanning voltage-gated potassium (Kv) channel β subunit is ubiquitously expressed and essential for normal function of a variety of cell types, often via regulation of the KCNQ1 Kv channel. A polymorphism upstream of KCNE2 is associated with reduced lung function in human populations, but the pulmonary consequences of KCNE2 gene disruption are unknown. Here, germline deletion of mouse Kcne2 reduced pulmonary expression of potassium channel α subunits Kcnq1 and Kcnb1 but did not alter expression of other Kcne genes. Kcne2 colocalized and coimmunoprecipitated with Kcnq1 in mouse lungs, suggesting the formation of pulmonary Kcnq1-Kcne2 potassium channel complexes. Kcne2 deletion reduced blood O2, increased CO2, increased pulmonary apoptosis, and increased inflammatory mediators TNF-α, IL-6, and leukocytes in bronchoalveolar lavage (BAL) fluids. Consistent with increased pulmonary vascular leakage, Kcne2 deletion increased plasma, BAL albumin, and the BAL:plasma albumin concentration ratio. Kcne2-/- mouse lungs exhibited baseline induction of the reperfusion injury salvage kinase pathway but were less able to respond via this pathway to imposed pulmonary ischemia/reperfusion injury (IRI). We conclude that KCNE2 regulates KCNQ1 in the lungs and is required for normal lung function and resistance to pulmonary IRI. Our data support a causal relationship between KCNE2 gene disruption and lung dysfunction.-Zhou, L., Köhncke, C., Hu, Z., Roepke, T. K., Abbott, G. W. The KCNE2 potassium channel β subunit is required for normal lung function and resilience to ischemia and reperfusion injury.

Rate of normal lung function decline in ageing adults: a systematic review of prospective cohort studies

ObjectiveTo conduct a systematic review investigating the normal age-related changes in lung function in adults without known lung disease.DesignSystematic review.Data sourcesMEDLINE, Embase and Cumulative Index to Nursing and Allied Health...

Reference equation for the incremental shuttle walk test in Portuguese children and adolescents

BackgroundThe incremental shuttle walk test (ISWT) is one of the most widely used field tests to assess cardiorespiratory fitness in clinical and research settings. Reference equations to predict ISWT distance in different populations and age cohorts have been established. However, an equation for the Portuguese pediatric population is not available. This study aimed to develop a reference equation for predicting ISWT in Portuguese children and adolescents. MethodHealthy children and adolescents aged between 5 and 17 years old were recruited. Sociodemographic (sex, age), anthropometric (height, weight) and physical activity (Physical Activity Index) data were collected. Lung function was assessed through spirometry and quadriceps muscular strength through hand-held dynamometry. The ISWT was performed twice. A reference equation was established with a multiple linear regression. Results130 (60 male; 13.66±2.61y) participants with normal lung function (forced expiratory volume in one second 102.73±15.09% predicted), body mass index (BMI) (20.27±3.59kg/m2) and quadriceps muscular strength (19.75±6.84kgf), completed the assessment. 50.8% (n=66) of the participants were moderately active. Participants walked on average 1165.08±327.19m in the ISWT. Sex, age and BMI were independent contributors to the ISWT, explaining 54% of its variability (p<0.001). The derived reference equation was: ISWT=342.06+(283.07×sex)+(83.61×age)−(22.22×BMI), with female=0 and male=1. ConclusionSex, age and BMI were found to be contributors to the ISWT predictive equation for pediatric population, providing a simple reference to assess their cardiorespiratory fitness.

Determinants of the Appearance and Progression of Early-Onset Chronic Obstructive Pulmonary Disease in Young Adults. A Case–Control Study With Follow-Up

Introduction and ObjectivesDeterminants of chronic obstructive pulmonary disease (COPD) in the early stages of its natural history are not well known. Improving our knowledge of these factors will help to design interventions that can modify prognosis.Study objectives are: (a) to characterize a COPD population of young adults aged 35–50 years from a multidimensional point of view; (b) to compare these patients with smokers with normal lung function; and (c) to create a cohort of young adults aged 35–50 years (smokers or former smokers), with and without COPD, who will be followed in the future to improve understanding of the natural history of the disease. Participants and MethodThis is a case–control multicenter study aimed at establishing a well-characterized cohort of young adults, smokers or former-smokers, with and without COPD, for subsequent follow-up.A total of 311 participants (101 cases and 210 controls) were selected from approximately 30 primary care settings and 12 hospitals in 8 Spanish regions. Subjects were smokers or former smokers (>10 pack-years) aged 35–50 years. Diagnosis of COPD was based on a post-bronchodilator result of FEV1/FVC<70%.The main study variables were: questionnaires on health, symptoms, exacerbations and daily physical activity, lung function tests, blood and sputum samples, and low-dose computed tomography. In the statistical analysis, COPD patient characteristics will be described and compared with control subjects using a logistic regression analysis.

Metabolic Syndrome Biomarkers of World Trade Center Airway Hyperreactivity: A 16-Year Prospective Cohort Study.

Airway hyperreactivity (AHR) related to environmental exposure is a significant public health risk worldwide. Similarly, metabolic syndrome (MetSyn), a risk factor for obstructive airway disease (OAD) and systemic inflammation, is a significant contributor to global adverse health. This prospective cohort study followed N = 7486 World Trade Center (WTC)-exposed male firefighters from 11 September 2001 (9/11) until 1 August 2017 and investigated N = 539 with newly developed AHR for clinical biomarkers of MetSyn and compared them to the non-AHR group. Male firefighters with normal lung function and no AHR pre-9/11 who had blood drawn from 9 September 2001–24 July 2002 were assessed. World Trade Center-Airway Hyperreactivity (WTC-AHR) was defined as either a positive bronchodilator response (BDR) or methacholine challenge test (MCT). The electronic medical record (EMR) was queried for their MetSyn characteristics (lipid profile, body mass index (BMI), glucose), and routine clinical biomarkers (such as complete blood counts). We modeled the association of MetSyn characteristics at the first post-9/11 exam with AHR. Those with AHR were significantly more likely to be older, have higher BMIs, have high intensity exposure, and have MetSyn. Smoking history was not associated with WTC-AHR. Those present on the morning of 9/11 had 224% increased risk of developing AHR, and those who arrived in the afternoon of 9/11 had a 75.9% increased risk. Having ≥3 MetSyn parameters increased the risk of WTC-AHR by 65.4%. Co-existing MetSyn and high WTC exposure are predictive of future AHR and suggest that systemic inflammation may be a contributor.

SAT-159 Hltf-Deletion Causes Immune Destruction of Pancreatic Beta Cells during Development

Immune destruction that causes the failure of β cell insulin secretion in type I diabetes (T1D) results from an imbalance in genetic, epigenetic and environmental factors that can begin in utero. A key unanswered question is how and why immune cells are targeted to specifically destroy insulin-producing pancreatic β cells while selectively excluding other islet-resident cells. One possibility is an epigenetic alteration in the transcriptome of developing β cells that causes activation/homing of immune cells. The helicase-like transcription factor (HLTF), a known target for epigenetic silencing in colorectal cancer and autoimmune diseases, is a likely candidate in this initiating event. The methylation status of HLTF DNA in serum and stools is a prognostic biomarker in colorectal cancer patients mainly because HLTF is a bona fide tumor suppressor in intestinal epithelium. The methylation status of HLTF DNA is a putative biomarker of pre-diabetes and undiagnosed diabetes. However, in order to authenticate the prognostic value of the methylation status of HLTF in diabetes, it is necessary to define the regulatory role of HLTF in pancreatic β cells. To this end we developed a global Hltf-deleted mouse model to recapitulate the effects of HLTF inactivation. Newborn Hltf-deleted mice and their littermate controls are bright pink in color and breathe freely suggesting normal lung and diaphragm function. Collectively, they display a sucking reflex immediately after birth, and milk is visible in their stomachs. However, after 6-8 hours, three of four Hltf-deleted pups are postprandial hypoglycemic. Seventy-five percent succumb to severe hypoglycemia not caused by elevated insulin. Serum insulin levels of these mice are negligible and their pancreatic β cells are devoid of insulin. We next developed β cell-specific Hltf-deleted mice to eliminate the potential effects of Hltf-deletion on other aspects of glucose homeostasis. These mice have the same phenotype as the global Hltf-deleted mice suggesting the phenotype is solely attributable to alterations in islet β cells. When the Hltf-deletion was bred into an immunodeficient background (no T, B and NK cells) to evaluate the potential involvement of the immune system, newborn Hltf-deleted mice are euglycemic and normoinsulinemic with survival rates equivalent to controls. RNA-seq differential expression analysis was used to test the hypothesis that Hltf deletion-induced alterations in the transcriptome of pancreatic β cells triggered an immune response that compromised glucose homeostasis and postpartum survival. Bioinformatics analysis showed Hltf-deletion activated the interleukin-33 (IL-33, pro-inflammatory cytokine) receptor (ST2) signaling pathway via increased IL33 transcription in β cells. Increased IL33 protein in β cells was confirmed by immunolabeling. Aspects of this mouse model phenocopy early-onset T1D in children.

Faal Paru Statis

Respiration or breathing is the body’s attempt to meet the needs of O2 in the metabolic process and emit CO2 as a result of intermediary metabolism by lung and respiratory organs together so that the resulting cardiovascular oxygen rich blood. Respiration has three phases: ventilation, diffusion, perfusion. The situation is said to somebody normal lung function if the work process of ventilation, diffusion, perfusion, and the relationship between ventilation to perfusion of the person is in a relaxed state resulted in the partial pressure of arterial blood gas (PaO2 and PaCO2) were normal. Examination of lung function has an important role in assessing a lung function. However, the thing to know that these checks are supporting and quite helpful in making a specific diagnosis. With spirometry examination can be known or determined all the static volume except residual volume and respiratory capacity than the capacity of residual volume that contains components such as total lung capacity and functional residual capacity. Functional residual capacity measured by special methods such as by using the inert gas helium (helium dilution test), N2 washout and bodyplethysmograph. Some static pulmonary function parameters can interpret any kind of disturbance in the lungs. In restrictive disorders in general decreased static lung volumes. While the obstruction interference parameters are quite significant, namely an increase in residual volume (RV), functional residual capacity (FRC) and the ratio of residual volume and total lung capacity (RV/TLC)

Use of Recordings of Real Patients to Improve Clinical Integration of a First Year Medical Student Pulmonary Function Testing Laboratory

The Lewis Katz School of Medicine at Temple University annually welcomes 200 students to the MD program. We aim to create an interactive and collaborative experience to promote deep levels of learning for large groups of students. The curriculum is being transitioned from a two‐pass to a single‐pass model (AY 2020–21) with early integration of the basic and clinical sciences.The pulmonary function testing (PFT) laboratory in a first year organ systems course has been redeveloped. Previously, the lab utilized Collins spirometers to allow students to gain experience recording and determining lung volumes and capacities and discussing concepts related to lung function testing and respiratory system mechanics. Advantages of the lab included visualization of the mechanics of the test, and hands‐on data collection and analysis. Disadvantages included frequent technical difficulties with aged spirometers and the lack of direct observation of abnormal lung mechanics, and therefore a disconnect to the pathophysiology learned in a subsequent course.Our goal was to address these issues while encouraging collaboration of basic science and clinical faculty, therefore better connecting physiology concepts with pathophysiologic mechanisms of disease. We redeveloped the lab to use the existing structure of calculations and discussion questions while adding the data and experiences of real patients from the Temple Lung Center who underwent modern pulmonary function testing. A patient with obstructive lung disease, a patient with restrictive lung disease, and a person with normal lung function, were recruited to participate in a video recording.In the session, the students watch a video which includes an explanation of the equipment, review of the procedure, and review of lung volumes/capacities previously learned in lecture format. The footage includes patients performing the lung function testing alongside real time flow‐volume loops and volume‐time graphs. The patients with abnormal lung function are introduced in vignette form with radiographic images. Students discuss each case with faculty and predict what they expect to observe with regards to lung volumes/capacities before watching the patients perform the tests. Students are then asked to use and apply real data collected from the patient in the video with normal lung function and complete discussion questions in their small groups (6/group).The reimagined PFT laboratory allows first year students the opportunity to apply basic science knowledge to real and relevant patient cases. This session allows students to achieve the learning objectives as per the APS Medical Curriculum Objectives Project (www.the‐aps.org/MedPhysObj).This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Sodium‐coupled neutral amino acid transporter SNAT2 is critical for alveolar fluid transport and resolution of pulmonary edema

ObjectiveIn the intact lung, constant movement of Na+ and Cl− across the epithelial barrier regulates alveolar liquid volume and maintains a balance between fluid secretion and clearance, which is critical for normal lung function. Dysregulation or inhibition of Na+ transport can lead to accumulation of fluid in the airspace resulting in impaired gas exchange and respiratory failure. Previous studies have largely focused on the critical role of the amiloride‐sensitive epithelial sodium channel (ENaC) in alveolar fluid transport, yet activation of ENaC failed to reverse edema formation in clinical trials. Since 40–50% of alveolar fluid clearance is amiloride‐insensitive, sodium channels other than ENaC such as sodium‐coupled neutral amino acid transporter (SNAT, Slc38a2) 2 may provide for new potential therapeutic targets. SNAT2 co‐transports a neutral amino acid along with Na+ and may promote alveolar fluid clearance by mediating epithelial Na+ uptake. Here, we studied the role of SNAT2 in a murine model of lung injury, in isolated perfused lungs (IPL) and in a pulmonary epithelial cell culture System.MethodsFor functional in vitro analyses, L‐alanine transport across NCI‐H441 cells was analyzed by ELISA, with cells cultured in the presence or absence of amino acids, and following treatment with HgCl2, a SNAT inhibitor, or siRNA (control or siSNAT2).In IPL of slc38a2+/− and wildtype mice, edema formation was induced by hydrostatic stress (7 cm H2O) and fluid transport was assessed in the absence or presence of the SNAT2 inhibitor methylaminoisobutyric acid (MeAIB) or SNAT2 substrate L‐alanine in the alveolar instillate. Edema formation was assessed after 30 min of perfusion and ventilation by measurement of wet‐to‐dry lung weight ratio (W/D).For in vivo measurements of edema formation and resolution, acid (HCl) or saline was instilled intratracheally in slc38a2+/− and wildtype mice. After 2 h of mechanical ventilation, lungs were collected for W/D measurement.ResultsIn vitro, L‐alanine transport was significantly decreased in H441 cells treated with HgCl2 or SNAT2‐siRNA as compared to respective controls.In vivo, SNAT2 knockout (slc38a2−/−) mice were found to be sublethal and newborn pups typically succumbed to cyanotic dyspnea.In IPL, lungs of slc38a2+/− showed elevated W/D ratio as compared to wildtype lungs in response to hydrostatic stress and after treatment with the SNAT2 inhibitor MeAIB.Similarly, in HCl‐induced ALI, W/D ratio was increased in slc38a2+/− mice.ConclusionIn its function as Na+ transporter, we propose a crucial role for SNAT2 in alveolar fluid transport. Our results indicate that SNAT2 is functional relevant for alveolar fluid absorption and may contribute to the resolution of pulmonary edema. Hence, activation of SNAT2 may, provide a new therapeutic strategy to counteract and/or reverse formation of pulmonary edema.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Évaluation de complication respiratoire du traitement d'une tumeur hépatique primaire par ondes haute fréquence selon les directives de la chirurgie par ultrasons chez les patients ayant la fonction pulmonaire normale

Évaluation de complication respiratoire du traitement d'une tumeur hépatique primaire par ondes haute fréquence selon les directives de la chirurgie par ultrasons chez les patients ayant la fonction pulmonaire normale

Quantitative Assessment of Mucociliary Clearance in Smokers with Mild-to-Moderate Chronic Obstructive Pulmonary Disease and Chronic Bronchitis from Planar Radionuclide Imaging Using the Change in Penetration Index.

Background: Mucociliary clearance (MCC) rate from the lung has been shown to be reduced in chronic obstructive pulmonary disease (COPD). This study compared the use of change in penetration index (PI) with conventional whole lung clearance in assessing MCC in mild-to-moderate disease. Methods: Measurement of lung MCC using planar gamma camera imaging was performed in three groups: (1) healthy nonsmoking controls (n = 9), (2) smoking controls who were current smokers with normal lung function (n = 10), and (3) current smokers with mild-to-moderate COPD and bronchitis (n = 15). The mean (±standard deviation) forced expiratory volume at 1 second (FEV1) for the three groups was 109 (±18), 94 (±5), and 78 (±12), respectively. Following inhalation of a technetium-99m labeled aerosol, planar imaging was performed over 4 hours and then at 24 hours. Total lung clearance and tracheobronchial clearance (TBC; normalized to 24-hour clearance) were calculated. A novel parameter, the normalized change in PI (NOCHIP), was also evaluated. PI is the ratio of counts between outer and inner lung zones normalized to lung volume. Results: More aerosol was deposited in central airways in COPD compared to nonsmoking controls, using 24-hour clearance measurements (p < 0.001). Smoking controls had intermediate values. The optimal endpoint for MCC assessment was chosen to be 3 hours, when intersubject variability was minimal, while preserving a measure of early clearance. There was no statistical difference between the three groups in mean total lung clearance, or TBC, at 3 hours. NOCHIP at 3 hours was reduced significantly, compared to nonsmoking controls, in both smoking controls (p = 0.007) and COPD (p < 0.0001). It also correlated with FEV1 (p = 0.003). A higher proportion of smoking control subjects had NOCHIP values in the nonsmoking control range than in the COPD group. Conclusions: NOCHIP was a more sensitive measure of MCC than whole lung clearance and TBC in mild-to-moderate COPD.

Pulmonary function abnormalities are common in patients with multiple myeloma and are independently associated with worse outcome.

Pre-existing pulmonary disease may affect treatment choices, toxicity, and survival of patients with multiple myeloma (MM). However, data on the prognostic value of pulmonary function tests (PFTs) in myeloma patients' outcome, at the time of initial assessment of newly diagnosed patients, are scarce. Here, we prospectively performed PFTs in 121 newly diagnosed MM patients, before initiation of treatment, and we evaluated possible associations of lung function with their outcomes. Fifty-four patients (44.63%) had either obstructive or restrictive pulmonary function defects, even among those not reporting a history of lung disease. The survival was significantly worse in those with obstructive pulmonary defect (median OS 32.8months) vs. those with restrictive (median OS 52.5months) or normal lung function (median not reached, 3-year survival 76%) (p= 0.013), independently of other myeloma-related factors. Forced vital capacity (FVC) (lt) (p= 0.012), forced expiratory volume in 1s (FEV1) (lt) (p= 0.018), peak expiratory flow (PEF) (lt/min) (p= 0.008), carbon monoxide diffusion capacity (DLCO) (p= 0.012), and expiratory/inspiratory pressures (Pe) (kPa) (p= 0.032)/(Pi) (kPa) (p= 0.023) were significantly associated with OS. Myeloma-related factors associated with survival included ISS stage (p= 0.008), hypercalcemia (p= 0.064), and high-risk cytogenetics (p= 0.004). In the multivariate analysis, only the presence of high-risk cytogenetics and presence of either or both PEF and DLCO < 65% of predicted were independent prognostic factors. We conclude that PEF and DLCO could be useful in the initial assessment of newly diagnosed MM patients as significant predictors of survival. Further research is needed to evaluate if respiratory screening should be included in the routine initial evaluation of myeloma patients, despite the presence or absence of respiratory symptoms or abnormal clinical respiratory examination.

Eosinophil levels predict lung function deterioration in apparently healthy individuals.

BackgroundWhile chronic respiratory diseases are among the leading causes of mortality and morbidity worldwide, little is known about the effect of blood eosinophil levels on lung function trajectories among healthy individuals.MethodsWe analyzed data of apparently healthy individuals (n=18,089) recruited for the Tel Aviv Medical Center Inflammation Survey. Blood eosinophil levels were compared between participants with normal and those with abnormal lung function. Multivariate regression was used to assess the OR of forced expiratory volume in 1 second (FEV1) deterioration according to baseline eosinophils in subjects with normal lung function (n=4,141) during a follow-up period of 4 years.ResultsParticipants with an abnormal, as opposed to a normal, pulmonary function test (PFT) (n=1,832, 10.1%) had significantly higher eosinophil levels, expressed as a percentage or count (2.99%±2.00% compared to 2.67%±1.88% and 0.2210e3/µL±0.163/µL compared to 0.1810e3/µL±0.183/µL, respectively; P<0.001 for both). Among participants with a normal PFT at baseline, those with an eosinophil percentage higher than 4% showed a higher risk for FEV1 decline above 60 mL/year (OR=1.199, 95% CI=1.005–1.431, P=0.044).ConclusionOur study suggests that higher blood eosinophil levels can predict PFT deterioration even in apparently healthy subjects, implying that these individuals could benefit from frequent lung function evaluation.

The correlation between the changes in pulmonary function and chronic cough in children with Mycoplasma pneumoniae pneumonia

Objective To discuss the correlation between dynamic changes in pulmonary function and chronic cough in 5-to-14-year-old children with Mycoplasma pneumoniae pneumonia (MPP) after acute period (about 2 weeks after admission). Methods One hundred and fifty-six hospitalized children diagnosed with MPP from Lianyungang Maternal and Child Health Care Hospital Affiliated to Yangzhou University from February 2014 to May 2017 were selected.According to the results of routine ventilatory pulmonary function before discharge (10-14 days in hospital; acute phase group), there were 50 patients with normal pulmonary function and 106 patients with abnormal pulmonary function.All patients continued to take oral azithromycin for 2 to 3 courses after discharge, and the indexes of lung function were dynamically tracked in 1 month (1-month group) and 2 months (2-month group) in the group of abnormal lung function after leaving the hospital, and the incidences and causes of chronic cough were followed up. Results (1)There were 106 cases with abnormal pulmonary function in 156 cases with MPP in acute phase group, and the rate of incidence was 67.95%.Twenty-seven (29.35%) out of 97 children were still abnormal in pulmonary functional testing 1 month after leaving hospital ( 1-month group). Among the 27 cases, about 18.52% (5/27 cases) of them still did not return to normal 2 months after discharge( 2-month group ). There were significant differences in the occurrence of abnormal pulmonary function among 3 groups mentioned above(χ2=162.64, P<0.001). (2)Ratios of measured values and predicted ones of forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow (PEF) and maximum mid-expiratory flow (MMEF 25%-75%) in the lung function of 2-month group after the acute phase of MPP were significantly higher than those of 1-month group and acute phase group, and the values of 1-month group were better than those in acute phase one, which were statistically different among 3 groups (P<0.01). (3)The rate of occurrence of chronic cough in normal lung function group was about 18.00%(9/50 cases), and in abnormal pulmonary function group, it was about 70.75%(75/106 cases). There was a significant difference between them(χ2=35.96, P<0.05). Abnormal pulmonary functions were the influencing factors of chronic cough (r=0.55, P<0.01). (4)There were 5 cases with upper airway cough syndrome(UACS) and 4 cases with post-infection cough(PIC) found in the normal lung function group.By contrast, 75 cases suffered from chronic cough in abnormal pulmonary functions group, of which 36 cases with cough variant asthma (CVA), 24 cases with UACS, 8 cases with comorbidity of CVA and UACS and 7 cases with PIC. Conclusions Abnormal lung function after acute period of MPP may last 4 to 8 weeks, or probably even longer.In normal lung function group, UACS is the most common cause, then followed by PIC.On the contrary, the main cause of chronic cough in abnormal pulmonary function group is CVA, followed by UACS.Chronic cough is related to abnormal lung function after acute phase of MPP. Key words: Child; Mycoplasma pneumoniae pneumonia; Pulmonary function; Chronic cough

Computational Modelling of the Interaction of Gold Nanoparticle with Lung Surfactant Monolayer

ABSTRACTLung surfactant (LS), a thin layer of phospholipids and proteins inside the alveolus of the lung is the first biological barrier to inhaled nanoparticles (NPs). LS stabilizes and protects the alveolus during its continuous compression and expansion by fine-tuning the surface tension at the air-water interface. Previous modelling studies have reported the biophysical function of LS monolayer and its role, but many open questions regarding the consequences and interactions of airborne nano-sized particles with LS monolayer remain. In spite of gold nanoparticles (AuNPs) having a paramount role in biomedical applications, the understanding of the interactions between bare AuNPs (as pollutants) and LS monolayer components still unresolved. Continuous inhalation of NPs increases the possibility of lung ageing, reducing the normal lung functioning and promoting lung malfunction, and may induce serious lung diseases such as asthma, lung cancer, acute respiratory distress syndrome, and more. Different medical studies have shown that AuNPs can disrupt the routine lung functions of gold miners and promote respiratory diseases. In this work, coarse-grained molecular dynamics simulations are performed to gain an understanding of the interactions between bare AuNPs and LS monolayer components at the nanoscale. Different surface tensions of the monolayer are used to mimic the biological process of breathing (inhalation and exhalation). It is found that the NP affects the structure and packing of the lipids by disordering lipid tails. Overall, the analysed results suggest that bare AuNPs impede the normal biophysical function of the lung, a finding that has beneficial consequences to the potential development of treatments of various respiratory diseases.

STUDI FAAL PARU DAN FAKTOR DETERMINANNYA PADA PEKERJA DI INDUSTRI SAWMILL

Sawmill industry processes log into sawmill and also results wood dust as by-product . Dust can be potentially inhaled by workers and cause impaired lung function. In addition, several other factors can effect lung function such as age, body mass index status, smoking habit and using respiratory protective equipment habits. The purpose of this study was to describe lung function on workers in sawmill industry and the determinant factors. This research was an observational type with descriptive method. This study used total population with 36 workers. The data were obtained from interview, dust measurement, body mass index measurement and lung function test, meanwhile the instruments were questionnaire, high volume dust sampler (hvds), microtoise, weight scale and spirometer. This data were analyzed by cross tabulation. The results of this study showed that the time weighted average concentration in UD. Sinar Abadi was 1.59 mg/m3, meanwhile spirometry test showed 42.8% had normal lung function and 52.8% had impaired lung function. Workers who had impaired lung function were 64.7% exposed to doses &gt;5mg/m3.tahun, 60% were &gt;44 years old, 100% were obese, 69.9% were smoker and 76.5% never used respiratory protective equipment. The time weighted average concentration was above from threshold limit value and most of the workers had impaired lung function. Workers with impaired lung function are more likely to be exposed to dose &gt;5mg/m3.years, older, obese, smoker, and didn’t use respiratory protective equipment. Keywords: determinant factors, lung function, wood dust