Persistent Obstruction Research Articles

Increased neutrophil-lymphocyte ratio in patients with COPD: case-control study

Chronic obstructive pulmonary disease (COPD) is one of the major causes of chronic morbidity and mortality and one of the major public health problems worldwide that affects millions of people all over the world. It is characterized by persistent airflow obstruction associated with enhanced inflammation in the airways and the lungs in response to noxious particles or gases. The main objective of this study is to investigate the neutrophil-lymphocyte ratio in patients with COPD as a case-control study. Between November 01, 2022, and February 28, 2023, patients were admitted to Al Hussain Teaching Hospital in Al Muthanna Governorate, Department of Medicine. The study included 51 patients with an approved diagnosis of COPD the mean age was 51.5 years, and 51 patients as control with other diseases mean age was 51.3 years). The subjects in all groups were 32 male and 19 female. Complete blood count (CBC) was measured from blood samples taken from patients. In the present study 51 COPD cases and 51 controls. No significant difference was observed between COPD cases and controls regarding age (p = 0.092); the average age of COPD cases was 51.5 years. No significant differences were observed between COPD cases and controls regarding gender (p = 0.085). At baseline, 21.0%, 40.3%, 25.7%, and 13% were diagnosed as COPD grade 1, 2, 3, and 4, respectively based on the (GOLD) classification. Baseline NLR significantly increased with the severity of COPD grade (1.3 vs. 2.7 vs. 2.2 vs. 2.9), p = 0.002). The cutoff for neutrophil-to-lymphocyte ratio, CRP, WBC, and ESR were 3.28, 2.32, 1.22, and 4.21 respectively. It has 85% sensitivity for detection of COPD exacerbation. and 89% specificity (AUC 0.798, p = 0.001). In conclusion, Blood NLR is a simple, inexpensive, widely available index that has been intensively evaluated in recent years in several clinical applications and in various diseases, including COPD.

In Vivo Dynamic and Static Analysis of Lymphatic Dysfunction in Lymphedema Using Near-Infrared Fluorescence Indocyanine Green Lymphangiography.

Near-infrared fluorescence indocyanine green lymphangiography, a primary modality for detecting lymphedema, which is a disease due to lymphatic obstruction, enables real-time observations of lymphatics and reveals not only the spatial distribution of drainage (static analysis) but also information on the lymphatic contraction (dynamic analysis). We have produced total lymphatic obstruction in the upper limbs of 18 Sprague-Dawley rats through the dissection of proximal (brachial and axillary) lymph nodes and 20-Gy radiation (dissection limbs). After the model formation for 1 week, 9 animal models were observed for 6 weeks using near-infrared fluorescence indocyanine green lymphangiography by injecting 6-μL ICG-BSA solution of 20-μg/mL concentration. The drainage pattern and leakage of lymph fluid were evaluated and time-domain signals of lymphatic contraction were observed in the distal lymphatic vessels. The obtained signals were converted to frequency-domain spectrums using signal processing. The results of both static and dynamic analyses proved to be effective in accurately identifying the extent of lymphatic disruption in the dissection limbs. The static analysis showed abnormal drainage patterns and increased leakage of lymph fluid to the periphery of the vessels compared with the control (normal) limbs. Meanwhile, the waveforms were changed and the contractile signal frequency increased by 58% in the dynamic analysis. Specifically, our findings revealed that regular lymphatic contractions, observed at a frequency range of 0.08 to 0.13 Hz in the control limbs, were absent in the dissection limbs. The contractile regularity was not fully restored for the follow-up period, indicating a persistent lymphatic obstruction. The dynamic analysis could detect the abnormalities of lymphatic circulation by observing the characteristics of signals, and it provided additional evaluation indicators that cannot be provided by the static analysis. Our findings may be useful for the early detection of the circulation problem as a functional evaluation indicator of the lymphatic system.

Role of nutrition in patients with coexisting chronic obstructive pulmonary disease and sarcopenia.

Chronic obstructive pulmonary disease (COPD) is one of the most common chronic diseases in the elderly population and is characterized by persistent respiratory symptoms and airflow obstruction. During COPD progression, a variety of pulmonary and extrapulmonary complications develop, with sarcopenia being one of the most common extrapulmonary complications. Factors that contribute to the pathogenesis of coexisting COPD and sarcopenia include systemic inflammation, hypoxia, hypercapnia, oxidative stress, protein metabolic imbalance, and myocyte mitochondrial dysfunction. These factors, individually or in concert, affect muscle function, resulting in decreased muscle mass and strength. The occurrence of sarcopenia severely affects the quality of life of patients with COPD, resulting in increased readmission rates, longer hospital admission, and higher mortality. In recent years, studies have found that oral supplementation with protein, micronutrients, fat, or a combination of nutritional supplements can improve the muscle strength and physical performance of these patients; some studies have also elucidated the possible underlying mechanisms. This review aimed to elucidate the role of nutrition among patients with coexisting COPD and sarcopenia.

Assessment of the protective role of submucosal saline injection of the inferior turbinates prior to submucosal diathermy or coblation techniques

BackgroundInferior turbinate hypertrophy is a common cause of chronic nasal obstruction with many procedures for management including submucosal diathermy and coblation with a variation in their techniques. The aim of this study was to assess the protective role of submucosal saline injection in the inferior turbinates prior to submucosal diathermy or coblation techniques. A prospective cohort study was conducted on 80 patients diagnosed with bilateral hypertrophied inferior turbinates causing persistent nasal obstruction and not responding to medical treatment. The patients were distributed randomly and equally between 2 groups. Group I included 40 patients operated on with coblation of the inferior turbinates. Group II included 40 patients operated on with submucosal diathermy of the inferior turbinates. The right side of the nose of both groups had a saline injection of the inferior turbinates before the procedure and the left side of the nose did not have such injection. Each side of the nose in every patient was assessed for the degree of nasal crusting at 1 week postoperative, the presence of turbinate gangrene at 3 weeks postoperative, and the visual analog scale (VAS) of four symptoms (nasal discomfort, nasal pain, nasal obstruction, and thick nasal discharge) at 1 week postoperative.ResultsIn the coblation group, there was a significant difference between the right and left sides regarding the degree of crusting at 1 week postoperative, and a non-significant difference between the two sides regarding the presence of gangrene at 3 weeks postoperative. In the diathermy group, there was a significant difference between the right and left sides regarding the same parameters. Comparison between the injection and non-injection sides in each group regarding the nasal symptoms showed a highly significant difference between the two sides in each group favoring the injection side.ConclusionSaline injection prior to inferior turbinate coblation or submucosal diathermy had a protective effect against crusting with both techniques and gangrene formation with submucosal diathermy. This was reflected on better postoperative nasal symptoms.

Cryptotanshinone alleviates lipopolysaccharide and cigarette smoke-induced chronic obstructive pulmonary disease in mice via the Keap1/Nrf2 axis

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity worldwide. Cigarette smoking, which leads to abnormalities in the airways or alveoli and persistent obstruction of the airway's flow, is a significant risk factor of COPD. Cryptotanshinone (CTS) is the active ingredient in Salvia miltiorrhiza (Danshen) and has many pharmacological properties including anti-inflammatory, antitumor, and antioxidant properties, but its impact on COPD is uncertain. In the present study, the potential effect of CTS on COPD was investigated in a modified COPD mice model induced with cigarette smoke (CS) and lipopolysaccharide (LPS) exposure. CTS significantly reversed the decline in lung function, emphysema, inflammatory cell infiltration, small airway remodeling, pulmonary pathological damage, and airway epithelial cell proliferation in CS- and LPS-exposed mice. Additionally, CTS decreased inflammatory cytokines such as tumor necrosis factor α (TNF α), interleukins IL-6 and IL-1β, and keratinocyte chemoattractant (KC), increased the activities of superoxide dismutase (SOD), Catalase (CAT) and L-Glutathione (GSH), and repressed the expression of protein hydrolases matrix metalloprotein (MMP)− 9 and − 12 in pulmonary tissue and bronchoalveolar lavage fluid (BALF). The protective effects of CTS were also observed in human bronchial epithelial cell line BEAS-2B simulated with cigarette smoke condensate (CSC) and LPS. Mechanistically, CTS can repress the protein level of Keap1, resulting to activation of erythroid 2-related factor (Nrf2), finally alleviating COPD. In summary, the present findings demonstrated that CTS dramatically ameliorates COPD induced by CS and LPS via activating Keap1/Nrf2 pathway.

Update in postinfectious bronchiolitis obliterans.

Postinfectious bronchiolitis obliterans (PiBO) is a rare and severe form of chronic obstructive lung disease caused by an infectious injury to the lower respiratory tract. The most commonly recognized inciting stimuli leading to PiBO are airway pathogens, such as adenovirus and Mycoplasma. PiBO is characterized by persistent and nonreversible airway obstruction, with functional and radiological evidence of small airway involvement. The literature has limited information on the aetiology, clinical profile, treatment, and outcome of PiBO.

Long-term outcomes following Bipolar Transurethral Plasma Enucleation of the Prostate (B-TUEP).

The aim of our study is to assess the long-term outcomes and safety of Bipolar Transurethral Plasma Enucleation of the Prostate (B-TUEP) in patients with Lower Urinary Tract Symptoms (LUTS) in a single-center cohort study. Our focus is to evaluate the impact on outcomes after ten years of follow-up in terms of recurrence, LUTS, and patients' Quality of Life (QoL) after B-TUEP in prostates between 30 and 80 mL. Between May 2010 and December 2011, all consecutive patients with benign prostatic hyperplasia (BPH) undergoing B-TUEP were prospectively enrolled in our study. Data on patients' history, physical examination, prostate volumes, Erectile Function, prostate-specific antigen (PSA) levels, International Prostate Symptoms Score (IPSS), and uroflowmetry were collected at 0, 1, 3, 6, 12, 24, 36, 60, and 120 months. Early and long-term complications were recorded. A total of 50 consecutive patients underwent B-TUEP in our facility, all performed by a single surgeon (R.G.). Twelve patients were excluded during the ten years. No patients had persistent Bladder Outlet Obstruction (BOO) requiring reoperation. In terms of results, the improvement in IPSS was sustained throughout five years, and the mean difference from baseline at five years was 17 points, with similar results at ten years. Erectile function was also slightly improved after surgery and maintained for the next 5 years, with a slight age-related decrease at ten years. Furthermore, the improvements in Qmax were maintained at 5 years, with a mean improvement of 16 mL/s, while at ten years, it settled on a mean improvement from baseline of 12 mL/s. In our ten years' experience, B-TUEP is a safe and highly effective technique for relieving BOO, with excellent outcomes and no recurrence at ten years of follow-up. Further multicenter studies should confirm our results.

Definitions of Chronic Obstructive Pulmonary Disease and Chronic Obstructive Pulmonary Disease Exacerbation: A Modified Delphi Survey.

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) update 2023 proposed new definitions of chronic obstructive pulmonary disease (COPD) and COPD exacerbation. However, an agreement on the definitions has not been made, either internationally or domestically. This study aimed to reach an agreement between experts on the new definitions of COPD and COPD exacerbation in South Korea. A modified Delphi method was used to make an agreement on the definitions of COPD and COPD exacerbation proposed by the GOLD update 2023. We performed two rounds of the survey including 15 Korean experts on COPD, asthma, and tuberculosis. More than two-thirds of the experts agreed on 12 of the 13 statements related to the definitions of COPD and COPD exacerbation in the two rounds of the survey. The experts agreed on the definitions of COPD and COPD exacerbation that should be revised in line with the definitions proposed by the GOLD update 2023. However, the experts showed an uncertain opinion on the statement that the definition of COPD includes patients with persistent airflow obstruction due to bronchiectasis. Based on this Delphi survey, experts' agreement was made on the definitions of COPD and COPD exacerbation proposed by the GOLD update 2023.

Characterization of impaired left ventricular mitral filling in HCM: A 4D-flow CMR study

Diastolic dysfunction is common and contributes to many clinical manifestations in hypertrophic cardiomyopathy (HCM). 4-dimensionnal (4D) flow cardiac magnetic resonance (CMR) sequence can assess left ventricular mitral filling. The purpose of this study was to determine if the peak early filling rate normalized to the filling volume (PEFR/FV), estimated from 4D-flow sequence can accurately assess impaired left ventricular mitral filling and predict clinical outcomes. This monocentric study included 44 HCM patients from a prospective HCM register and 44 healthy volunteers, who all underwent CMR with 4D-Flow sequence. Median follow-up time of HCM cohort patients was 2.3 years (interquartile range: 1.7 to 3.3 years). The predefined primary endpoint was a composite criteria that included syncope, onset of atrial fibrillation, admission for congestive heart failure with administration of diuretics, decision to perform septal reduction therapy due to persistent symptomatic obstruction, stroke, ventricular tachycardia or fibrillation and cardiac death. PEFR/FV was significantly lower in HCM cohort compared to healthy volunteers (P < 0.001). PFR/FV significantly correlated with BNP (r = −0.31, P < 0.001) and with E/E’ ratio (r = −0.56, p < 0.001). PEFR/FV according to NYHA status in HCM cohort was statistically different (P = 0.001). Primary endpoint occurred in 14 patients (32%). In univariate and bivariate adjusted cox-model analysis PEFR/FV < 2.61 s -1 was significantly associated with primary endpoint with Hazard Ratio ranging from [HR = 9.46 (95% CI 2.61–45.17, P < 0.001) to 15.21 (95%CI 3.51–80.22, P < 0.001)] according to succesive bivariate models. 4D-Flow can accurately assess left ventricular mitral filling with a good predictive value of clinical outcomes in HCM patients. Relation of PEFR/FV calculated with 4D flow in HCM.

A Prospective Clinical Evaluation of Adhesive Small Bowel Obstruction in Infants and Children

Background: Adhesive small bowel obstruction is a significant cause of postoperative morbidity in children. There are limited studies on the epidemiology and scope of conservative management for adhesive small bowel obstruction in children. The purpose of this study was to determine the presentation, risk factors, and management, including the role of Gastrografin, for adhesive small bowel obstruction in children. Methods: Between June 2015 and June 2020, 90 patients with an adhesive small bowel obstruction presented to our pediatric surgery department. Out of these, 10 patients underwent upfront surgery and were excluded, while the rest were put on conservative treatment. Patients who failed to improve after 24 hours of conservative management in the absence of signs of strangulation were administered Gastrografin. Patients were evaluated clinically and radiologically to determine the resolution of the obstruction. Results: The mean age was 9.04 ± 3.89 with sex a ratio of 2.6:1. Vomiting was the most symptom (90% cases), followed by pain abdomen (87.5%). Appendectomy (50%) and enterotomy for worm obstruction (17.5%) were the most common previous surgical procedures leading to acute small bowel obstruction. Recurrent obstruction was seen in 7.5% of the cases. Thirty eight (47.5%) patients were successfully managed conservatively by standard decompression therapy. Oral administration of Gastrografin successfully resolved the obstruction in 43% patients who failed standard decompression therapy, whereas 24 (30%) patients with persistent obstruction required laparotomy. Conclusion: Adhesive small bowel obstruction is a common surgical emergency in children. It can occur at any age and after laparotomy for any surgical condition; however, history of appendectomy is associated with high incidence of adhesion obstruction. Vomiting and abdominal pain are constant symptoms. Conservative management with standard decompressive therapy followed by using water-soluble contrast agents (Gastrografin) is a safe and effective approach in managing adhesion obstruction in selected children without signs of bowel ischemia.

Impact of Persistent Microvascular Obstruction Late After STEMI on Adverse LV Remodeling: A CMR Study

BackgroundLittle is known about the occurrence and implications of persistent microvascular obstruction (MVO) after reperfused ST-segment elevation myocardial infarction (STEMI). ObjectivesThe authors used cardiac magnetic resonance (CMR) to characterize the impact of persistent MVO on adverse left ventricular remodeling (ALVR). MethodsA prospective registry of 471 STEMI patients underwent CMR 7 (IQR: 5-10) days and 198 (IQR: 167-231) days after infarction. MVO (≥1 segment) and ALVR (relative increase >15% at follow-up CMR) of left ventricular end-diastolic index (LVEDVI) and left ventricular end-systolic volume index (LVESVI) were determined. ResultsOne-week MVO occurred in 209 patients (44%) and persisted in 30 (6%). The extent of MVO (P = 0.026) and intramyocardial hemorrhage (P = 0.001) at 1 week were independently associated with the magnitude of MVO at follow-up CMR. Compared with patients without MVO (n = 262, 56%) or with MVO only at 1 week (n = 179, 38%), those with persistent MVO at follow-up (n = 30, 6%) showed higher rates of ALVR-LVEDVI (22%, 27%, and 50%; P = 0.003) and ALVR-LVESVI (20%, 21%, and 53%; P < 0.001). After adjustment, persistent MVO at follow-up (≥1 segment) was independently associated with ΔLVEDVI (relative increase, %) (P < 0.001) and ΔLVESVI (P < 0.001). Compared with a 1:1 propensity score–matched population on CMR variables made up of 30 patients with MVO only at 1 week, patients with persistent MVO more frequently displayed ALVR-LVEDVI (12% vs 50%; P = 0.003) and ALVR-LVESVI (12% vs 53%; P = 0.001). ConclusionsMVO persists in a small percentage of patients in chronic phase after STEMI and exerts deleterious effects in terms of LV remodeling. These findings fuel the need for further research on microvascular injury repair.

Closed reduction of nasoseptal fractures: key concepts for predictable results

Nasal complex injuries are the most common facial fracture encountered in the trauma population. Multiple surgical techniques for treatment of these fractures have been described with varying results. The goal of this study was to review the efficacy of closed reduction of nasal and septal fractures using a technique based upon several key concepts. We reviewed the records of patients who had undergone isolated nasal and/or septal fractures with closed reduction at our institution between January 2013 and November 2021. Inclusion criteria consisted of preoperative CT imaging, surgical treatment within fourteen days of initial injury, and follow up of at least one year. All patients were treated under general or deep sedation. The same surgical technique was applied with closed reduction of the septum and nasal bones with internal and external postoperative splints. Of the 232 records initially reviewed, 103 met inclusion criteria. Four patients had undergone revision septorhinoplasty (3.9%). Mean (range) follow up was 2.7 (1–8.2) years. Three patients had undergone revision nasal repair due to persistent airflow obstruction with complete resolution of symptoms after revision. The other patient received multiple revisions at another institution as a result of their dissatisfaction with cosmesis without improvement. Closed reduction of nasal and septal fractures can be a highly successful procedure and yield predictable results, limiting the need for post-traumatic open septorhinoplastic surgery. Five critical concepts of nasal fracture repair can help surgeons achieve predictable functional and cosmetic results: selection, timing, anaesthesia, reduction, and support.

PD33-11 IMPACT OF PERSISTENT BLADDER OUTLET OBSTRUCTION ON BLADDER FUNCTION IN MALE BPH PATIENTS

You have accessJournal of UrologyCME1 Apr 2023PD33-11 IMPACT OF PERSISTENT BLADDER OUTLET OBSTRUCTION ON BLADDER FUNCTION IN MALE BPH PATIENTS Minsoo Choo, Junghoon Lee, Sangjun Yoo, Min Chul Cho, Hwancheol Son, and Hyeon Jeong Minsoo ChooMinsoo Choo More articles by this author , Junghoon LeeJunghoon Lee More articles by this author , Sangjun YooSangjun Yoo More articles by this author , Min Chul ChoMin Chul Cho More articles by this author , Hwancheol SonHwancheol Son More articles by this author , and Hyeon JeongHyeon Jeong More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003326.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bladder outlet obstruction (BOO) is a common problem among elderly men. It is known that persistent BOO can affect bladder function. We aimed to evaluate the long-term impact of persistent BOO on bladder function using urodynamic profiles. METHODS: We analyzed the prospectively collected urodynamic database of Seoul National University Hospital about 19000 cases over 20 years. We included male patients aged 40 years or older with non-neurogenic LUTS/BPH who have repeated urodynamic studies 2 or more times and had persisted BOO in both studies. BOO defined as BOO index (PdetQmax – 2Qmax) >40. First and repeat UDS profiles were compared, including post-void residual, bladder sensation, bladder compliance, bladder capacity, involuntary detrusor contraction, bladder contractility index (PdetQmax+5Qmax), and voiding efficiency (post-void residual/(voided volume+post-void residual)). The student’s t-test and Chi-square test were used as appropriate. RESULTS: A total of 37 patients were included in our analysis. The mean age at repeat UDS was 69. The mean time interval between the two studies was 61 months. UDS profiles tended to deteriorate over time. Mean bladder compliance decreased from (64.53ml/cmH2O) to (41.92ml/cmH2O) (p<0.01). The mean volume to induce normal desire to void decreased from (247.78ml) to (185.23ml) (p=0.01). Mean bladder capacity decreased from (359.84ml) to (283.75ml) (p=0.01). The mean bladder contractility index decreased from (108.36) to (99.08), though not reaching statistical significance (p=0.13). Rate of involuntary detrusor contraction increased from (24.32%) to (69.44%) (p<0.01). CONCLUSIONS: Our results show that persistent BOO induced functional-urodynamic deteriorations in the bladder function, such as reduced capacity, decreased compliance, and induced detrusor overactivity. In patients with LUTS/BPH with confirmed BOO, more active treatment should be considered. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e918 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Minsoo Choo More articles by this author Junghoon Lee More articles by this author Sangjun Yoo More articles by this author Min Chul Cho More articles by this author Hwancheol Son More articles by this author Hyeon Jeong More articles by this author Expand All Advertisement PDF downloadLoading ...

The submucosal approach influences long-term outcomes of refractory obstructive rhinitis: A prospective study and a STROBE analysis

ObjectiveThe surgical approach to refractory hypertrophy of the inferior turbinates is the main therapeutic choice in the management of its symptoms. Although submucosal approaches have demonstrated efficacy, long-term results are debated in the literature and show variable stability. Therefore, we compared the long-term outcomes of three submucosal turbinoplasty methods with regard to the efficacy and stability managing the respiratory disorders. DesignMulticenter prospective controlled study. A computer-generated table was used to allocate participants to the treatment. SettingTwo teaching and university medical centers. MethodsWe used the EQUATOR network for guidelines describing design, conduct, and reporting of studies and searched the references of these guidelines to identify further relevant publications reporting adequate study protocols.Patients with persistent bilateral nasal obstruction due to lower turbinate hypertrophy were prospectively recruited from our ENT units. Participants were randomly assigned to each treatment and then underwent symptom assessment by visual analog scales, endoscopic assessment at baseline and 12, 24 and 36 months after treatment. ResultsOf the 189 patients with bilateral persistent nasal obstruction initially assessed, 105 met the study requirements; 35 were located in the MAT group, 35 in the CAT group and 35 in the RAT group. Nasal discomfort was significantly reduced after 12 months with all the methods. The MAT group presented better outcomes for all VAS scores at the 1-year follow-up, greater stability at the 3-year follow-up for VAS results (p < 0.001 in all cases) and lower disease recurrence (5/35; 14.28 %). At the 3-year follow-up intergroup analysis, a statistically significant difference was confirmed except for RAA scores (H = 2.88; p = 0.236). Rhinorrhea (r = −0.400; p < 0.001) was demonstrated as a predictive factor of 3-year recurrence, while sneezing (r = −0.25; p = 0.011), and operative time needed (r = −0.23; p = 0.016) did not reach statistical significance. ConclusionsLong-term symptomatic stability varies depending on the turbinoplasty method used. MAT demonstrated greater efficacy in controlling nasal symptoms, presenting better stability in reducing turbinate size and nasal symptoms. In contrast, radiofrequency techniques presented a higher rate of disease recurrence both symptomatically and endoscopically.

Effectiveness of Swallowing Exercises on Dysphagia Among Patients with Cerebrovascular Accident

Background: Cerebrovascular disease is defined by the World Health Organization from rapidly progressing clinical signs of focal impairment of brain function lasting more than 24 hours or clinical signs of focal neuropathy due to persistent obstruction of the blood supply or intracerebral haemorrhage. Dysphagia, or difficulty swallowing, is a serious, life-threatening condition that affects many patients in the first hours and days after a stroke.Objective:To determine the effectiveness of swallowing exercise on dysphagia among patient with Cerebrovascular accident in experimental group.Methods:A Quasi-experimental research design was adopted for the study with 60 samples who met the inclusion criteria at Saveetha Medical College and Hospital. Samples were selected by using purposive sampling technique and samples were assigned into the experimental group(N=30) and the control group (N=30). The samples are selected by using Gugging swallowing screen scale to pre-test assessment both experimental and control group. The experimental group receivedthe swallowing exercises for 10 minutes per day before breakfast in the morning for five consecutive days. The control group received hospital routine care. The post assessments were done by using Gugging Swallowing Screen at the end of 5th day of intervention to both the experimental and control group. Results:Out of 30 samples in experimental group the pretest mean score of dysphagia among dysphagia was 14.0±3.21 and the posttest mean score was 17.0±3.25. The mean difference score was 3.0. The calculated paired‘t’ test value was found to be statistically significant at p

Pharmacology and non-pharmacology treatment in a way of well controlled childhood asthma

Introduction and purpose: Asthma is a chronic disease of air pathways which is characterized by episodic or persistent reversible airflow obstruction with chronic inflammation of respiratory tract and increased bronchial reactivity. Our aim is to broaden patients’ knowledge concerning suitable diet and exercises which can help in controlling asthma symptoms. Description of the state of knowledge: A diet rich in vegetables and fruit contains a huge amount of fiber and anti-inflammatory flavonoids. introducing plant products into the diet of children with asthma improves parameters such as FEV1, FVC and PEF. Dairy products, on the other hand, are associated with worsening of these parameters and are not recommended for patients with asthma. The aforementioned effects are related to the presence of cow's milk protein and increased activity of interleukin 17. The Western diet being rich in animal fats and low in fiber is not recommended for patients with asthma. This is primarily due to resulting difficulty in maintaining a healthy body weight and the pro-inflammatory properties of animal fats. Conclusions: In light of the impact of a suitable diet on the reduction of asthma symptoms, it is recommended to increase the share of vegetables and fruit in the daily menu of asthmatics and to limit their consumption of animal fats. In addition, young patients are encouraged to undertake physical activity adapted to their individual abilities.

Highlights from the International Chronic Thromboembolic Pulmonary Hypertension Congress 2021.

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare complication of acute pulmonary embolism. It is caused by persistent obstruction of pulmonary arteries by chronic organised fibrotic clots, despite adequate anticoagulation. The pulmonary hypertension is also caused by concomitant microvasculopathy which may progress without timely treatment. Timely and accurate diagnosis requires the combination of imaging and haemodynamic assessment. Optimal therapy should be individualised to each case and determined by an experienced multidisciplinary CTEPH team with the ability to offer all current treatment modalities. This report summarises current knowledge and presents key messages from the International CTEPH Conference, Bad Nauheim, Germany, 2021. Sessions were dedicated to 1) disease definition; 2) pathophysiology, including the impact of the hypertrophied bronchial circulation, right ventricle (dys)function, genetics and inflammation; 3) diagnosis, early after acute pulmonary embolism, using computed tomography and perfusion techniques, and supporting the selection of appropriate therapies; 4) surgical treatment, pulmonary endarterectomy for proximal and distal disease, and peri-operative management; 5) percutaneous approach or balloon pulmonary angioplasty, techniques and complications; and 6) medical treatment, including anticoagulation and pulmonary hypertension drugs, and in combination with interventional treatments. Chronic thromboembolic pulmonary disease without pulmonary hypertension is also discussed in terms of its diagnostic and therapeutic aspects.

Impact of persistent bladder outlet obstruction on bladder function in male BPH patients

Impact of persistent bladder outlet obstruction on bladder function in male BPH patients

Revealing EXPH5 as a potential diagnostic gene biomarker of the late stage of COPD based on machine learning analysis

Chronic obstructive pulmonary disease is a kind of chronic lung disease characterized by persistent air flow obstruction, which was the third leading cause of death in China. The incidence of COPD is steadily and increasing and has been a globally sever disease. Accordingly, it is urgently needed to explore how to diagnose and treat COPD timely. This study aims to find key genes to diagnose COPD as soon as possible to avoid COPD processing and analyze immune cell infiltration between COPD early stage and late stage. Two GEO datasets were merged as the merge data for analyses. 157 DEGs were used for GSEA analysis to find the pathway between COPD early stage and late stage. Above all, gene EXPH5 stood out from the screen as the most likely candidate diagnosis biomarker of COPD indicating the late-stage by least LASSO and SVM-RFE. ROC curves of EXPH5 were applied to represent the discriminatory ability through the area under the curve which is the gold standard to evaluate the accuracy of diagnosis and survival rate. The CIBERSORT algorithm was used to assess the distribution of tissue-infiltrating immune cells between two COPD stages. The diagnosis biomarker, gene EXPH5 had a positive correlation with NK cells resting; mast cell resting, eosinophils, and negative correlation with T cell gamma delta, macrophages M1, which underscore the role of gene and immune cell infiltration. To make results more reliable, we further analyzed the gene EXPH5 expression in single-cell transcriptome data and showed again that EXPH5 genes significantly downregulated in the late stage of COPD especially in the main lung cell types AT1 and AT2. In a word, our study identified genes EXPH5 as a marker gene, which adds to the knowledge for clinical diagnosis and pharmaceutical design of COPD.

Ureteral stricture after pediatric kidney transplantation: Is there a role for percutaneous antegrade ureteroplasty?

Ureteral obstruction following pediatric kidney transplantation occurs in 5-8% of cases. We describe our experience with percutaneous antegrade ureteroplasty for the treatment of ureteral stricture in pediatric kidney transplant patients. We retrospectively reviewed all pediatric kidney transplantation patients who presented with ureteral stricture and underwent percutaneous antegrade ureteroplasty at our institution from July 2009 to July 2021. Variables included patient demographics, timing of presentation, location and extent of stricture, ureteroplasty technique and clinical outcomes. Our primary outcome was persistent obstruction of the kidney transplant. Twelve patients met inclusion criteria (4.2% of all transplants). Median age at time of ureteroplasty was 11.5 years (range: 3-17.5 years). Median time from kidney transplantation to ureteroplasty was 3 months. Patency was maintained in 50% of patients. Seven patients (58.3%) required additional surgery. Four patients developed vesicoureteral reflux. Patients with persistent obstruction had a longer time from transplant to ureteroplasty compared to those who achieved patency (19.3 vs 1.3 months, p=0.0163). Of those treated within 6 months after transplantation, two patients (25%) required surgery for persistent obstruction (p=0.06). All patients treated >1 year after transplantation had persistent obstruction following ureteroplasty (p=0.06). Percutaneous antegrade ureteroplasty can be considered a viable minimally invasive treatment option for pediatric patients who develop early ureteral obstruction (<6 months) following kidney transplantation. In patients who are successfully treated with ureteroplasty, 67% can develop vesicoureteral reflux into the transplant kidney. Patients who fail early percutaneous ureteroplasty or develop obstruction >1 year after transplantation are best managed with surgical intervention.