Percentage Of Predicted Value Research Articles

Pulmonary and clinical outcomes of patients with severe rigid scoliosis and type I respiratory failure treated with halo-pelvic distraction

BackgroundThe severe rigid scoliosis patients with type I respiratory failure could not tolerate complicated corrective surgery. Preoperative halo-pelvic distraction (HPD) is used to reduce the curve magnitude and improve the pulmonary function before surgery. The present study aimed to retrospectively analyze the pulmonary and clinical outcomes of preoperative HPD in severe rigid spinal deformity with type I respiratory failure.MethodsEighteen cases of severe rigid scoliosis and type I respiratory failure treated with preoperative HPD and corrective surgery for spinal deformity between 2016 and 2018 were retrospectively reviewed. Patient demographics, major coronal curve and kyphosis, correction rates, heights, pulmonary function, distraction time, and postoperative neurological complications were recorded for all cases.ResultsThe averaged duration of distraction was 9.1 ± 2.3 months. The coronal curve was corrected from 168° ± 14° to 58° ± 11° at the end of HPD. The kyphosis curve reduced from 151° ± 29° to 65° ± 10°. Meanwhile, the mean stand body height increased by 23.9 ± 5.3 cm. Significantly increased mean FVC (1.52 ± 0.43 L vs. 0.95 ± 0.44 L) and improved percent-predicted values for FVC (37 ± 10% vs. 23 ± 9%) were observed after HPD. The pressure of oxygen (PaO2) increased from 54.5 ± 2.0 to 84.8 ± 4.7 mmHg. Scoliosis and kyphosis curve, respectively, averaged 48 ± 8°and 30 ± 14° after final fusion and instrumentation, with a mean correction of 71% and 80%, respectively. No severe complication occurred during the distraction.ConclusionsHPD may be useful for severe rigid scoliosis patients with type I respiratory failure. Pulmonary functions in patients with severe rigid scoliosis can be significantly improved by HPD. They are then better able to tolerate complicated corrective surgery.

Obesity-related Changes in Diffusing Capacity and Transfer Coefficient of the Lung for Carbon Monoxide and Resulting Patterns of Abnormality across Reference Equations.

Rationale: In 2017, an American Thoracic Society/European Respiratory Society Task Force report recommended further research on the effects that body mass index (BMI) has on diffusing capacity of the lung for carbon monoxide (DlCO), the transfer coefficient (Kco), and the alveolar volume (VA). Objectives: Our goals were to 1) quantify the magnitude and direction of change to measured and predicted DlCO values as BMI increases in patients free of cardiopulmonary disease and 2) identify how BMI and obesity-related changes differ by reference set. Methods: Using data from a prospective cohort study of service members free of cardiopulmonary disease, we modeled the effect that BMI has on measured values of DlCO, Kco, and VA, after adjusting for age, sex, hemoglobin (Hgb), and height. We then referenced DlCO, Kco, and VA to normal values using four different reference equations. Results: There were 380 patients with data available for analysis, and 130 had a BMI ⩾ 30 kg/m2 (87.7% class I obesity). After controlling for age, sex, Hgb, and height, increased BMI was significantly associated with Kco (β = 0.09, P < 0.01) and VA (β = -0.15, P < 0.01) but not DlCO. After adjustment for Hgb, for every 5-kg/m2 increase in BMI, the mean increase in percent predicted (PPD) values ranged from 4.2% to 6.5% and from 5.0% to 7.5% for DlCO and Kco, respectively; and the mean decrease in VA PPD was 3.2-4.0%. In the presence of obesity (BMI ⩾ 30 kg/m2), the prevalence of DlCO and Kco abnormalities dropped by 4.1-12.1% and 0.4-16.3%, respectively, across equations, whereas VA abnormalities increased from 7.7% to 9.9%. Eliminating 163 patients with abnormal trans-thoracic echocardiogram (TEE), high-resolution computed tomographic (HRCT) scan, or Hgb altered the magnitude of relationships, but significance was preserved. Conclusions: In an otherwise healthy population with predominantly class I obesity and normal TTE, HRCT scan, and Hgb, we found that Kco and VA were more affected by BMI than DlCO. Increases in PPD values varied across equations and were modest but significant and could change clinical decision making by reducing sensitivity for detecting gas-exchange abnormalities. BMI and obesity had the smallest effect on Global Lung Function Initiative PPD values.

What Are the Effects of Posterior Corrective Surgery, With or Without Thoracoplasty, on Pulmonary Function in Adolescent Idiopathic Scoliosis? A Systematic Review and Meta-analysis.

Systematic review and meta-analysis. This study's objective is to provide a critical review of the current literature regarding the changes in pulmonary function (PF) in Adolescent idiopathic scoliosis (AIS) patients who have undergone posterior spinal fusion and instrumentation (PSF), with and without thoracoplasty (TP). A comprehensive search was performed using the following databases: EMBASE, PubMed, EBSCOhost (CINAHL and Medline) and OpenGrey. Our focus was on studies that compared pre-and postoperative percent-predicted values of forced vital capacity (%FVC) or forced expiratory volume in 1 second (%FEV1) in AIS patients who had undergone PSF, with and without TP, with a minimum 2-year follow-up. The risk of bias for included studies was assessed using the ROBINS-I ("Risk Of Bias In Non-randomised Studies - of Interventions") tool. Mean change scores were depicted using forest plots. Fifteen studies met our inclusion criteria. The results of our analysis suggest that PSF with TP caused a significant deterioration of %FVC in individuals with moderate AIS, with no significant effect on %FEV1. It also showed a minor improvement of FEV1% in individuals with moderate AIS after PSF only, but no significant change in %FVC. PSF with TP caused a significant deterioration of % FVC while PSF alone caused a minor improvement of FEV1% in individuals with moderate AIS with a minimum 2-year follow-up.

Peak Circulatory Power during Maximal Cardiopulmonary Exercise Testing: Reference Standards from the FRIEND Registry.

Normative standards for key cardiopulmonary exercise (CPX) test variables, including peak circulatory power (CircP), are needed to guide the interpretation of clinical exercise responses in individuals with and without disease. This study aimed to establish age- and sex-specific reference standards for peak CircP derived from a healthy cohort from the Fitness Registry and the Importance of Exercise: A National Database (FRIEND). CPX test data from apparently healthy males and females from eight FRIEND United States exercise laboratories were considered. Inclusion criteria included ages 20-79 yr and a maximal, symptom-limited exercise test performed on a treadmill or cycle ergometer. CircP was calculated as the product of peak oxygen consumption and peak systolic blood pressure. Reference values were determined on both treadmill and cycle ergometer for males and females per age decade. A stepwise linear regression to predict CircP was derived from two-thirds of the sample while the remaining one-third was used as a validation cohort. A total of 6736 CPX tests (47% treadmill, 53% female) were included in the analysis. Overall, CircP was higher in males, higher on tests conducted on a treadmill, and decreased with age. Sex, exercise mode, age, and body mass index were the most significant contributors to CircP (multiple R = 0.75, R2 = 0.57, root-mean-square error = 1200 mm Hg·mL O 2 ·kg -1 ·min -1 , P < 0.001). Using the generated prediction equation, the average percent-predicted CircP for the validation cohort was 101.3% ± 28.1%. These results establish reference standards for CircP, a potentially important prognostic indicator of cardiovascular health. Future research exploring the role of percentiles and percent-predicted values for CircP is necessary as they may provide additional prognostic insight.

Is There a Correlation Between Cobb Angle and Pulmonary Function Tests at 2-year Follow-up in Patients With Severe Spinal Deformity Treated by Posterior Vertebral Column Resection?

Study design:A retrospective study.Objective:The aim was to evaluate the relationships of Cobb angle and pulmonary function tests (PFTs) changes in severe spinal deformity and underwent posterior vertebral column resection (PVCR).Summary of Background Data:No previous study focused on the correlation of deformity correction and PFTs changes in patients with cobb angle >90 degrees.Methods:PFTs values [forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and percent-predicted values FVC%, FEV1%] were evaluated preoperative and at 2 years after PVCR. FVC% <80% were defined as restrictive ventilation dysfunction (RVD), the severity of RVD were divided into mild (FEV1% ≥70%), moderate (70% > FEV1% ≥50%) and severe (FEV1% <50%). The relationships among PFTs values improvements and all possible impact factors (mainly correction cobb angle) collected in this study were analyzed. PFTs data were compared among the 3 RVD subgroups (mild vs. moderate vs. severe) and between residual >30 versus <30 degrees.Results:A total of 53 cases (28 male/25 female, mean ages 18.9 Y) underwent PVCR in one center from 2004 to 2016 were enrolled cobb angle. When 2 years after PVCR, average PFTs values showed significant improvements. PFTs values changes showed no correlation with correction rate and correction angle. The only significant impact factor in this study for FVC, FVC%, FEV1 improvements was preoperative FVC% and the only impact factor for FEV1% improvement was preoperative FEV1%, the relationships were negative. In accordance with the regression analysis, PFTs values improvements among the 3 RVD subgroups from high to low was severe>moderate>mild. However, patients with residual cobb angle <30 degrees had less PFTs values improvements than patients with residual cobb angle >30 degrees.Conclusions:Two years after PVCR, PFTs values were significantly improved. There is no linear correlation between cobb angle change and PFTs values improvements. Lower preoperative FVC% and FEV1% indicate more PFTs values improvements at 2 years post-PVCR.Level of Evidence:Level III.

Inspiratory Muscle Weakness is Related to Poor Short-Term Outcomes for Heart Transplantation.

Introduction:In heart transplantation (HT) recipients, several factors are critical to promptly adopting appropriate rehabilitation strategies and may be important to predict outcomes way after surgery. This study aimed to determine preoperative patient-related risk factors that could adversely affect the postoperative clinical course of patients undergoing HT.Methods:Twenty-one hospitalized patients with heart failure undergoing HT were evaluated according to respiratory muscle strength and functional capacity before HT. Mechanical ventilation (MV) time, reintubation rate, and intensive care unit (ICU) length of stay were recorded, and assessed postoperatively.Results:Inspiratory muscle strength as absolute and percentpredicted values were strongly correlated with MV time (r=-0.61 and r=-0.70, respectively, at P<0.001). Concerning ICU length of stay, only maximal inspiratory pressure (MIP) absolute and percent-predicted values were significantly associated. The absolute |MIP| was significantly negatively correlated with ICU length of stay (r=-0.58 at P=0.006) and the percent-predicted MIP was also significantly negatively correlated with ICU length of stay (r=-0.68 at P=0.0007). No associations were observed between preoperative functional capacity, age, sex, and clinical characteristics and MV time and ICU length of stay in the cohort included in this study. Patients with respiratory muscle weakness had a higher prevalence of prolonged MV, reintubation, and delayed ICU length of stay.Conclusion:An impairment of preoperative MIP was associated with poorer short-term outcomes following HT. As such, inspiratory muscle strength is an important clinical preoperative marker in patients undergoing HT.

Transvaginal Ultrasound Assessment of Cervical Length in Threatened Preterm Labor

Objectives: To determine the cut off point of cervical length usingtransvaginal ultrasonography to predict the actual occurrence ofpreterm labor in women with threatened preterm labor.&#x0D; Methods: A cross sectional study with consecutive random samplingmethod. We examined 80 women with singleton pregnancycomplaining of regular, painful uterine contraction and rupturedmembrane at 24-36 weeks of gestation. Women in active labor, definedby the presence of cervical dilatation less than or equal 3 cm, and having complicationwere excluded. When the patient was admitted, a transvaginalscan was performed to measure the cervical length. Parenteralmagnesium sulfate was given as the subsequent management.The primary outcome was delivery within 24 hours of presentation.Results: We found that the optimal cut off values for cervical lengthwas 2.65 cm with sensitivity 94.4 Percent, specificity 65.4Percent, positive predictivevalue 75.4 Percent and negative predictive value 81.8 Percent. In 69cases, the cervical length was more than or 2.65 cm, with 52 patients successfullycontinued their pregnancy until more than 24 hours. In the 11cases with cervical length less than or equal 2.65 cm, delivery within 24 hours occurredin 9 cases (81,8 Percent).&#x0D; Conclusion: The findings of this study suggest that in women withthreatened preterm labor, cervical length more than or equal 2.65 cm may help predictthe actual occurrence of preterm labor.&#x0D; Keywords: cervical length, threatened preterm labor, transvaginalultrasonography

Role of peripheral eosinophilia in acute exacerbation of chronic obstructive pulmonary disease.

Eosinophil counts are a promising guide to systemic steroid administration for chronic obstructive pulmonary disease (COPD). To study the role of peripheral eosinophilia in hospitalized patients with acute exacerbation of COPD (AECOPD). From January 2014 to May 2017, patients with AECOPD hospitalized in Taipei Tzu Chi Hospital were retrospectively stratified into two groups according to their peripheral eosinophil count: The EOS group (eosinophil count ≥ 2%) and the non-EOS group (eosinophil count < 2%). Demographics, comorbidities, laboratory data, steroid use, length of hospital stay, and COPD-related readmissions were compared between the groups. A total of 625 patients were recruited, with 176 patients (28.2%) in the EOS group. The EOS group showed a lower prevalence of infection, lower cumulative doses of prednisolone equivalents, shorter length of hospital stay, and higher number of COPD-related readmissions than the non-EOS group. There were significantly linear correlations between eosinophil percentage and number of readmissions and between eosinophil percentage and length of hospital stay (P < 0.001, Pearson's r = 0.147; P = 0.031, Pearson's r = -0.086, respectively). The EOS group and a lower percent-predicted value of forced expiratory volume in one second (FEV1) were associated with shorter time to first COPD-related readmission [adjusted hazard ratio (adj. HR) = 1.488, P < 0.001; adj. HR = 0.985, P < 0.001, respectively]. The study findings suggest that the EOS group had the features of a shorter length of hospital stay, and lower doses of systemic steroids, but more frequent readmissions. The EOS group and lower percent-predicted FEV1 values were risk factors for shorter time to first COPD-related readmission.

The ratio of maximal handgrip force and maximal cycloergometry power as a diagnostic tool to screen for metabolic myopathies

Metabolic myopathies comprise a diverse group of inborn errors of intermediary metabolism affecting skeletal muscle, and often present clinically as an inability to perform normal exercise. Our aim was to use the maximal mechanical performances achieved during two functional tests, isometric handgrip test and cycloergometer, to identify metabolic myopathies among patients consulting for exercise-induced myalgia. Eighty-three patients with exercise-induced myalgia and intolerance were evaluated, with twenty-three of them having a metabolic myopathy (McArdle, n = 9; complete myoadenylate deaminase deficiency, n = 10; respiratory chain deficiency, n = 4) and sixty patients with non-metabolic myalgia. In all patients, maximal power (MP) was determined during a progressive exercise test on a cycloergometer and maximal voluntary contraction force (MVC) was assessed using a handgrip dynamometer. The ratio between percent-predicted values for MVC and MP was calculated for each subject (MVC%pred:MP%pred ratio). In patients with metabolic myopathy, the MVC%pred:MP%pred ratio was significantly higher compared to non-metabolic myalgia (1.54 ± 0.62 vs. 0.92 ± 0.25; p < 0.0001). ROC analysis of MVC%pred:MP%pred ratio showed AUC of 0.843 (0.758–0.927, 95% CI) for differentiating metabolic myopathies against non-metabolic myalgia. The optimum cutoff was taken as 1.30 (se = 69.6%, sp = 96.7%), with a corresponding diagnostic odd ratio of 66.3 (12.5–350.7, 95% CI). For a pretest probability of 15% in our tertiary reference center, the posttest probability for metabolic myopathy is 78.6% when MVC%pred:MP%pred ratio is above 1.3. In conclusion, the MVC%pred:MP%pred ratio is appropriate as a screening test to distinguish metabolic myopathies from non-metabolic myalgia.

Effects of nursing based on health belief model on respiratory function exercise compliance among lung cancer patients

Objective To explore the effects of nursing based on health belief model on respiratory function exercise compliance and respiratory function among lung cancer patients. Methods From September 2017 to August 2018, we selected 84 lung cancer patients planed surgery at the First Affiliated Hospital of Zhengzhou University as subjects by convenience sampling. All of patients were divided into two groups according to admission time, 40 cases in control group (from September 2017 to February 2018) and 44 in experimental group (from March to August 2018) . Control group carried out routine nursing and health education. On the basis of that, experimental group implemented nursing care based on health belief model. Respiratory function of patients between two groups after surgery was compared with the percentage of predicted value of forced expiratory volume in one second shared by forced vital capacity (FEV1%) and percentage of predicted value of forced vital capacity (FVC%) ; respiratory function exercise compliance after surgery was compared with the Breathing Exercise Compliance Questionnaire. Results One week after surgery, the scores of respiratory function exercise compliance of patients in experimental group and control group were (42.1±8.4) and (36.8±10.2) with a statistical difference (t=-2.609, P<0.05) ; the FEV1% and FVC% of patients in experimental group were (63.8±12.1) and (57.5±11.3) , higher than those in control group with statistical differences (t=-2.167, -2.617; P<0.05) . Conclusions Nursing based on health belief model can improve respiratory function exercise compliance and respiratory function among lung cancer patients, which is worthy of clinical popularization. Key words: Lung neoplasms; Respiratory function exercise; Compliance; Respiratory function; Health belief

Impulse Oscillometry to Evaluate Lung Function in Young Children Under Five Years with Sickle Cell Disease

BACKGROUND Young children with sickle cell disease (SCD) aged 2 - 5 years old are at the highest risk of acute chest syndrome (ACS), a leading cause of morbidity and mortality. In addition to severe forms of SCD (HbSS and HbSβ0 thalassemia), asthma and airway hyper-responsiveness are also known risk factors for ACS, and are three to five times more prevalent in older children and adults with SCD. However in SCD children under 5 years there are only a few studies describing airway function, due to limitations in spirometry and other common pulmonary function tests (PFTs). Impulse oscillometry, a passive, non-invasive technique to evaluate airway function via pulmonary resistance and reactance, has been validated in children as young as 3 years, but has not been used widely in children with SCD. OBJECTIVE We sought to describe baseline airway function in children under 5 years with SCD using impulse oscillometry, as part of an ongoing observational study to evaluate lung function in young SCD children over time. METHOD Following IRB approval, participation in the ongoing prospective study was offered to patients aged 3 - 5 years old with HbSS and HbSβ0 thalassemia followed at the Pediatric Sickle Cell Clinic at Augusta University. Parents of the consented patients completed a modified ISAAC questionnaire assessing reported asthma symptoms and tobacco smoke exposure. Baseline IOS was obtained within 6 months of consent, with other clinical data obtained from medical records. Airway function was assessed using airway resistance at 5Hz and 20Hz (R5, R20), and reactance at 5Hz (X5). Percent predicted values were computed using NHANES (National Health and Nutrition Examination Survey) reference criteria for age, height, gender and ethnicity. RESULTS Out of 9 consented patients, 7 completed the ISAAC questionnaire and 6 successfully performed IOS. One patient consented but deferred participation to next visit and 1 patient with HbSC was excluded from analysis. All remaining patients had sickle cell anemia (HbSS). Age range at study enrolment was 3.7 - 5.4 years (mean 4.6 years). All participants were African American, 4/7 were male. Four out of 7 survey participants were already on Hydroxyurea therapy for their disease with therapy duration ranging from 2 - 41 months. None had preceding history of ACS. One survey respondent reported asthma symptoms (wheezing, dry cough at night) in preceding 12 months and 1 reported passive tobacco exposure. None reported a prior asthma diagnosis. Of the 6 participants with PFT data, baseline percent-predicted values for IOS parameters R5 and R20 were 114.83 ± 22.37 and 97.83 ± 23.11 respectively. Baseline X5 (%pred) was 76.33 ± 48.59. DISCUSSION Our preliminary results show normal baseline airway function in this subset of young SCA patients, with R5 representing total airway resistance, and R20 representing resistance in large airways. Small airway function can be deduced from differences between R5 and R20. Airway resistance decreases with age, and early changes in small airway resistance can be seen in children with asthma and obstructive symptoms. Low frequency reactance serves as a measure of airway distensibility, especially in the distal airways. Therefore, conditions affecting lung elasticity would result in abnormal X5. Ongoing data collection and follow-up will help us study how airway function evolves in young children with SCA with or without underlying asthma. We will also assess the effects of Hydroxyurea and other disease-modifying therapies on airway function over time. Disclosures No relevant conflicts of interest to declare.

316. Is there a correlation between Cobb angle and pulmonary function tests in severe scoliosis patients with respiratory impairment and treated by posterior vertebral column resection?

BACKGROUND CONTEXT Surgical treatment of spinal deformity based on the severity of curves and with a view to improve physical performance and respiratory function. However, there was still controversial in the correlation of deformity correction rate and pulmonary function tests (PFTs) change in AIS, and no more study focused on patients with >90° scoliotic curves. PURPOSE To evaluate the relationships of Cobb angle and PFTs change in severe scoliosis with RI and underwent posterior vertebral column resection (PVCR). STUDY DESIGN/SETTING A retrospective study. PATIENT SAMPLE This study enrolled severe scoliosis (Cobb angle>90°) with moderate or severe RI underwent PVCR in one center from 2004 to 2016. Exclude criteria including neuromuscular or syndromic scoliosis. OUTCOME MEASURES PFTs values, forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were used as both absolute values and percent-predicted values. Radiographic measurements of deformities included Cobb magnitude of major curve and deformity morphological classification. METHODS PFTs and radiographic data had been calculated preop and at 2yrs after PVCR. Patients were grouped according scoliosis angle (90°-130° vs >130°), age (pediatric vs adult), with >90° kyphosis or not, preop RI levels (FVC% 41-60%/moderate RI, 0-40%/severe RI). Pearson's correlation coefficients (r) and two-sample t test were used. RESULTS A total of 62 cases (29 male/33 female, mean age 18.9Yr) was enrolled. Preoperatively, the average scoliotic angle was 118.5, with apex T4-10(54, 87.1%) and T11-L1(8, 12.9%). Respiratory impairments were restrictive (FVC=1.409L, FVC%=40.85%; FEV1=1.283L, FEV1%=44.12%), and 28(45.2%) had FVC% 60 had less improvement of PFTs than angle CONCLUSIONS Severe scoliosis may reveal severe respiratory dysfunction, but preoperative PFTs values did not related to Cobb angle. Age of deformity onset, illegible etiological factors, and lung infection may play an important role for PFTs impairment. After PVCR, most of patients had significant PFTs improvement, and correlated with Cobb angle change in patients with preop moderate respiratory impairment. Much lower of preoperative FVC%, more increase PFTs at 2 years postoperative. But, residual angle 60° or less did not ultimately influence PFTs change. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Correlation between pulmonary infection and preoperative pulmonary function indexes in patients with esophageal cancer undergoing thoracotomy

Objective To explore the correlation between the occurrence of pulmonary infection after thoracotomy and preoperative pulmonary function indexes in patients with esophageal cancer, and to provide clinical theoretical basis for reducing the incidence of pulmonary infection after thoracotomy. Methods The clinical data of 80 patients with esophageal cancer who underwent thoracotomy from May 2017 to May 2018 in Qinhuangdao Military Industrial Hospital of Hebei Province were retrospectively analyzed. The patients were divided into infected group and uninfected group according to whether pulmonary infection occurred after operation. The preoperative maximal voluntary ventilation (MVV), MVV as a percentage of predicted value (MVV%pred), forced vital capacity (FVC), FVC as a percentage of predicted value (FVC%pred), forced expiratory volume in one second (FEV1), FEV1 as a percentage of predicted value (FEV1%pred), peak expiratory flow (PEF), PEF as a percentage of predicted value (PEF%pred) of the two groups were compared and analyzed. Logistic regression was used to analyze the correlation between pulmonary function indexes and postoperative pulmonary infection. Results Postoperative pulmonary infection occurred in 24 out of 80 patients (30.00%). There was no correlation between gender (t=1.755, P=0.086), nationality (t=2.125, P=0.073) and the severity of pulmonary infection after operation. Age (t=4.084, P=0.024), smoking history (t=5.881, P=0.001), operation duration (t=3.583, P=0.041), intraoperative bleeding volume (t=5.115, P=0.003) and combined basic diseases (t=4.574, P=0.018) were significantly correlated with the severity of pulmonary infection after operation. MVV (χ2=4.242, P=0.039), MVV%pred (χ2=4.405, P=0.036), FVC (χ2=17.500, P<0.001), FVC%pred (χ2=12.382, P<0.001), FEV1 (χ2=12.070, P=0.001) were associated with pulmonary infection. FVC (OR=9.102, 95%CI: 2.691-28.213, P=0.027), FEV1 (OR=21.621, 95%CI: 8.956-81.145, P=0.002) and MVV%pred (OR=5.648, 95%CI: 2.979-15.248, P=0.001) were high risk factors for pulmonary infection. Conclusion Partial pulmonary function indexes are significantly associated with postoperative pulmonary infection. It is necessary to strengthen the detection and improvement of preoperative pulmonary function in order to reduce the incidence of pulmonary infection. Key words: Esophageal neoplasms; Respiratory function tests; Pneumonia

Quantitative assessment of airway remodelling and response to allergen in asthma.

In vivo evaluation of the microstructural differences between asthmatic and non-asthmatic airways and their functional consequences is relevant to understanding and, potentially, treating asthma. In this study, we use endobronchial optical coherence tomography to investigate how allergic airways with asthma differ from allergic non-asthmatic airways in baseline microstructure and in response to allergen challenge. A total of 45 subjects completed the study, including 20 allergic, mildly asthmatic individuals, 22 non-asthmatic allergic controls and 3 healthy controls. A 3-cm airway segment in the right middle and right upper lobe were imaged in each subject immediately before and 24 h following segmental allergen challenge to the right middle lobe. Relationships between optical airway measurements (epithelial and mucosal thicknesses, mucosal buckling and mucus) and airway obstruction (FEV1 /FVC (forced expiratory volume in 1 s/forced vital capacity) and FEV1 % (FEV1 as a percentage of predictive value)) were investigated. Significant increases at baseline and in response to allergen were observed for all four of our imaging metrics in the asthmatic airways compared to the non-asthmatic airways. Epithelial thickness and mucosal buckling exhibited a significant relationship to FEV1 /FVC in the asthmatic group. Simultaneous assessments of airway microstructure, buckling and mucus revealed both structural and functional differences between the mildly asthmatic and control groups, with airway buckling seeming to be the most relevant factor. The results of this study demonstrate that a comprehensive, microstructural approach to assessing the airways may be important in future asthma studies as well as in the monitoring and treatment of asthma.

Spirometry in adult systemic lupus erythematosus and its relation with disease duration: A cross-sectional study in Eastern India

Background: Although symptomatic interstitial lung disease (ILD) complicates in 3–8% of patients with systemic lupus erythematosus (SLE), subclinical ILD is common and has been described in up to one-third of patients. Aims and Objectives: Objective was spirometric evaluation of adult SLE patients having no pulmonary symptoms. Materials and Methods: A cross-sectional study was carried out involving adult SLE. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC ratio, forced expiratory flow (FEF) between 25 and 75% of vital capacity (FEF25–75%), and peak expiratory flow rate (PEFR) were measured. Pearson’s correlation analysis was used to determine the correlation of disease duration with spirometric parameters. Results: Of 74 patients (age 18–50 years), six were male. Mean age, height, and weight were 29.65 years, 154.1 cm, and 52.75 kg, respectively. Mean duration of the disease was 4.5 years. Sixty patients (five males among them) were in remission with SLE Disease Activity Index score of 0. None had chronic cough or any respiratory distress at rest or with day-to-day activities. Overall, 34 (46%) patients had normal spirometry. About 56% of female and 33% of male patients had abnormal spirometry. About 49% of female patients had restrictive pattern of abnormality while 9% had obstructive disease. All patients had normal PEFR. Disease duration did not significantly correlate with any of the spirometric parameters or their percent-predicted values. Conclusion: Periodic spirometry of adult SLE patients can be a cost-effective alternative in detecting subclinical pulmonary changes.

Physiological responses in different intensities of resistance exercise – Critical load and the effects of aging process

ABSTRACTAim was to identify critical load (CL) in young and elderly apparently healthy male cohorts. To contrast the metabolic, cardiovascular and perceptual responses on CL according to age. We evaluated 12 young (23 ± 3 years) and 10 elderly (70 ± 2 years) apparently healthy active males, who underwent: (1) 1 repetition maximum (1RM) test on a 45° Leg Press; (2) on different days, three high-intensity resistance exercise constant load tests (60%, 75% and 90% 1RM) until fatigue (Tlim). Absolute values of both the CL asymptote and curvature constant (kg) were significantly lower in elderly subjects (P < 0.05). In contrast, elderly subjects demonstrated a significantly higher number of repetitions at CL when compared with young subjects (P < 0.05). As expected, oxygen uptake (VO2) and heart rate (HR) during maximal aerobic exercise testing were significantly reduced in older subjects. However, percent-predicted aerobic capacity were higher in older subjects (P < 0.05). In addition, blood lactate ([La−]) corrected to Tlim and rating of perceived exertion values were greater in younger subjects at all intensities (P < 0.05). These findings, despite reduced force production in older subjects, endurance-related parameters are well preserved according to age-adjusted percent-predicted values in apparently healthy males.

Modifiable Cardiovascular Risk Factors in Adults with Sickle Cell Disease

Introduction:Body composition, cardiorespiratory fitness (CRF) and muscular strength(MusS) are important predictors of cardiovascular (CV) mortality and morbidity. Poor CRF, body composition and MusS are each associated with higher rates of musculoskeletal injury, inflammation, heart disease, and all-cause mortality. Fortunately, these parameters in the general population, are partly influenced by lifestyle habits and can improve with modifying unhealthy behaviors such as increasing activity levels. Few studies have examined fitness parameters, in particularly MusS, in adults with sickle cell disease (SCD). As cardiopulmonary disease is a leading cause of death in SCD, we sought to better characterize fitness and body composition in adults with SCD. The objective of this study is to describe modifiable CV risk factors of fitness along with other risk factors of smoking, hypertension, and cholesterol in a population of adults with SCD.Methods:Forty-six participants (ages 21-66 yrs.; 74% female; sickle cell anemia n =29, sickle variant genotype n=17) were recruited from a comprehensive adult sickle center. Non-pregnant adults in steady-state SCD disease without an absolute contraindications to exercise were eligible to participate. CRF was measured using symptom-limited exercise testing performed on a cycle ergometer following an incremental ramp protocol. Maximal oxygen uptake (VO2 max), a key measure of CRF, was calculated during exercise testing. MusS was assessed using an isokinetic dynamometer, the Biodex system 3, the gold standard to measure MusS in rehabilitative medicine. Peak isokinetic torques of knee extension and flexion were determined at 60 degrees per second, and adjusted for body weight on the Biodex system 3. A medical history, fitness assessments, anthropometric testing, and laboratory testing were completed on all SCD participants. Sixteen SCD participants had dual energy x-ray absorptiometry imaging to assess fat, lean, and bone mass. The remaining 30 SCD patients underwent isokinetic CRF and MusS testing. Lean muscle mass and body fat of participants were compared to US national guidelines, VO2max was compared to predicted norms. As there are no well-established normative values for MusS, we compared values to a cohort of 60 adults without SCD (age 21-40 yrs.; 63% female) who underwent MusS testing as a part of a separate study. For muscle strength, multivariate regression was performed to control for the effects of age, BMI, gender, and SCD status on peak torques.Results:All SCD and control participants were able to complete testing safely without any adverse events. 34.7% of SCD participants (n=16) had a smoking history with a mean pack year history of 9 years (Table 1). 18% of participants (n=10) received medical treatment for hypertension (Table 1). 64% (n=32) of participants had reduced HDL levels and 8% (n=3) had elevated triglycerides. Median (IQR) waist-hip circumference (F=0.89(0.14), M=0.93 (0.11)) and total percent body fat (F=37.7(11.5), M=22.3(11.5)) for SCD participants were higher than national normative values and 66% were classified as obese (Table 1). SCD participants had reduced mean (SD) VO2max, 16.77 (3.29) and 19.56 (7.27) ml/min/kg for females and males respectively compared with norms. In 90% of SCD participants (n=28), percent-predicted VO2max was less than normal (i.e. < 84 percent-predicted) with 4 adults having markedly reduced VO2max with a percent-predicted value less than 50%. Hemoglobin, hydroxyurea use and SCD genotype were not predictive of VO2max. Compared to controls, mean (SD) peak torque values for knee extension (82.7 Nm (19) vs 44.33 Nm (18.85), p<0.0001) and flexion ( 38.6 Nm (9.03)vs 19.19 Nm (13.2), p<0.0001) at 60 degrees were lower in SCD participants even after adjusting for age, sex, and body mass index (BMI) (Table1).Limitations: Study limitations include a small sample size, and the lack of controls matched for race, age, BMI, and hemoglobin.Conclusion:In this pilot study we show that both CRF and MusS are decreased in adults with SCD. Additionally, this cohort had a number of CV risk factors including smoking, hypertension and reduced HDL levels. As we know these are important predictors of poor CV outcomes additional research is needed to determine whether a carefully designed exercise and diet program can improve these modifiable CV risk factors and ultimately health status in adults living with SCD. [Display omitted] DisclosuresWang:PCORI: Research Funding. Lanzkron:Pfizer: Consultancy, Research Funding; NHLBI: Research Funding; Ironwood: Research Funding; PCORI: Research Funding; GBT: Consultancy, Research Funding; Selexys: Research Funding; Prolong: Research Funding.

Does Posterior Scoliosis Correction Improve Respiratory Function in Adolescent Idiopathic Scoliosis? A Systematic Review and Meta-analysis.

Study Design:A systematic review and meta-analysis.Objectives:Pulmonary dysfunction is often advocated among the indications for surgical correction of adolescent idiopathic scoliosis (AIS). Previous studies have discussed the effect of scoliosis correction on respiratory function without reaching a definitive conclusion: Some showed that the respiratory function can improve after scoliosis surgery without defining the precise role of anterior, posterior, and combined approaches on this improvement; furthermore, the majority of these studies did not take normal growth into account. As a result, the role of surgery remains to be clarified. The object of the present study was to synthesize the current knowledge regarding changes in respiratory function after posterior corrective surgery for AIS.Methods:A comprehensive systematic search was performed to identify all relevant studies in the following electronic databases: MEDLINE, EMBASE, CINAHL (EBSCO). We focused on the studies (1) that discussed posterior fusion surgery for AIS without thoracoplasty, (2) that discussed comparisons of pre- and postoperative percent-predicted values of forced vital capacity (%FVC) or forced expiratory volume (%FEV), and (3) with minimum 2-year follow-up. Forest plots were depicted and Z value was calculated as a test for overall effect.Results:Ten studies (6 prospective and 4 retrospective studies) met our inclusion criteria. The overall effect showed that there was no significant difference in %FVC or %FEV between pre- and postoperative measurements (very low evidence).Conclusions:Posterior correction surgery for mild to moderate AIS patients showed no significant improvement of postoperative respiratory function measured by relative, percent-predicted values at minimum 2-year follow-up.

Development of a recombinant TaSP-based Dot-ELISA for detection of Theileria annulata infection in cattle

The study was conducted to develop and validate Dot-ELISA for the diagnosis of Theileria annulata infection in cattle using recombinant Theileria annulata surface protein (r-TaSP). The r-TaSP based indirect plate-ELISA was used as a reference test to compare the efficacy of the Dot-ELISA. The Dot-ELISA was optimized with 500 ng of antigen per dot, 1:150 dilution of serum and 1:1000 dilution of secondary antibody for positive and negative reaction. A total of 17 confirmed positive, 25 negative and 129 field sera samples were used to calculate the diagnostic accuracy of Dot-ELISA in comparison with indirect plate-ELISA. The diagnostic sensitivity and specificity of the Dot-ELISA was 95.8 per cent (95% CI, 93.1–97.2) and 80 per cent (95% CI, 48.1–96.2), respectively. The positive predictive value (PPV) of Dot-ELISA was 98.2 percent (95% CI, 95.5–99.7) and negative predictive value (NPV) was 61.6 percent (95% CI, 37–74). The positive and negative likelihood ratios were 4.79 (95% CI, 1.8–25.69) and 0.053 (95% CI 0.03–1.4), respectively. The Dot-ELISA showed moderate agreement (k value, 0.67, 95% CI, 0.36– 0.82) with indirect plate-ELISA. The developed Dot-ELISA is less expensive and convenient for the diagnosis of T. annulata infection in cattle under field conditions.

Association between high-density lipoprotein cholesterol level and pulmonary function in healthy Korean adolescents: the JS high school study

BackgroundAccumulating evidence suggests that high-density lipoprotein (HDL) cholesterol is associated with pulmonary function and pulmonary disorders. The aim of this study was to evaluate the association between HDL cholesterol and pulmonary function in healthy adolescents.MethodsThis cross-sectional study was based on data collected for the JS High School study. The analysis included 644 adolescents (318 male and 326 female) aged 15–16 years old and free from asthma or chronic obstructive pulmonary disease. Fasting blood samples were collected for hematologic and biochemical assessment. Forced vital capacity volume (FVC) and forced expiratory volume in the 1 s (FEV1) were measured using dry-rolling-seal spirometry. The associations between HDL cholesterol and pulmonary function were analyzed using multiple linear regression models.ResultsAmong male adolescents, an increase of 1.0 mg/dL in HDL cholesterol was associated with 10 mL decrease in FVC (p = 0.013) and FEV1 (p = 0.013) after adjusting for age, height, weight, alcohol drinking, smoking, physical activity, systolic blood pressure, total cholesterol, triglyceride, and monthly household income. Percent predicted values of FVC (p = 0.036) and FEV1 (p = 0.017) were also inversely associated with HDL cholesterol. However, among female adolescents, HDL cholesterol level was not significantly associated with absolute or percent predictive value of FVC and FEV1.ConclusionsHigher HDL cholesterol level may be associated with decreased pulmonary function among healthy male adolescents. The sex differences observed in the association between HDL cholesterol and pulmonary function need further investigation.