Pulmonary Function Levels Research Articles

P.207 Muscle magnetic resonance imaging in Myotonic dystrophy type 1: Longitudinal study for 5 years

Myotonic dystrophy type 1 is the most common genetic muscle disease in adults, caused by increased expansion of CTG repeats in the DMPK gene. It is characterized by progressive distal dominant muscle weakness and myotonia. The aim of this study was to evaluate objective longitudinal changes in the muscle magnetic resonance imaging in DM1 patients over five years. Eighteen genetically diagnosed DM1 patients were enrolled at baseline. The mean age was 44.86±9.83, mean CTG repeat length was 465±328.86 and a disease duration of 18.29±9.43 years. The baseline motor function such as medical research council sum score, Muscular impairment rating scale and 6-minute walk test were evaluated at the baseline and after 5 years of follow up. The pulmonary function and serum creatine kinase levels were also evaluated. The muscle magnetic resonance imaging was performed at baseline and after 5 years. The individual muscles were semi-quantitatively graded using five-point Mercuri scores. The thirteen upper muscle groups and twenty one lower limb muscles were evaluated. The lower muscle groups including gluteus muscles. The fatty infiltrative changes progressed after 5 years of follow up, with significant score changes were most prominently observed in lower limb muscles including gastrocnemius, soleus, tibialis anterior, gastrocnemius and tensor fascia latae muscles. Among upper limb muscles, latissimus dorsi showed most significant fatty infiltrative changes, followed by serratus and rhomboid muscles. Bases on the longitudinal follow up of the muscle MRI, DM1 showed significant deterioration in the lower limb muscles, with prominent changes in the crural muscles. This is the first longitudinal muscle MRI study and more studies are warranted to understand muscle degeneration in DM1.

Compound glycyrrhiza oral solution alleviates oxidative stress and inflammation by regulating SRC/MAPK pathway in chronic obstructive pulmonary disease

Objectives Patients with chronic obstructive pulmonary disease (COPD) suffer from persistent cough and breathlessness, which can be ameliorated by the Chinese herbal medicine glycyrrhiza. Furthermore, the SRC/MAPK pathway is activated in the process of oxidative stress and inflammation, which afflict COPD progression. Thus, this research aimed at dissecting the mechanism of compound glycyrrhiza oral solution (CGOS) relieving oxidative stress and inflammation in COPD via the SRC/MAPK pathway. Methods After a COPD rat model was established using lipopolysaccharide and cigarette smoke, rats underwent intragastric administration with CGOS and intratracheal injection with LV-NC and LV-SRC lentivirus into lungs. Then, pulmonary function-related indexes were evaluated, followed by analyses of arterial blood and inflammatory cell number in prepared bronchoalveolar lavage fluids. Meanwhile, the contents of oxidative stress-related indicators (malondialdehyde, 3NT, 8-Isoprostane, glutathione, NO, and SOD) in pulmonary tissues were measured, along with RT-qPCR and ELISA detection of the expression of inflammatory factors (TNF-α, IL-1β, IL-4, and IL-10). Moreover, western blot assay was utilized to assess p-SRC/SRC and p-p38/p38 ratios in pulmonary tissues. Results CGOS treatment enhanced PaO2 and reduced PaCO2 in COPD rats, accompanied by declines in the number of total cells, neutrophils, and macrophages. CGOS improved pulmonary function, decreased malondialdehyde, 3NT, 8-Isoprostane, TNF-α, and IL-1β levels, and increased GSH, NO, IL-4, and IL-10 levels and SOD activity. Mechanistically, CGOS suppressed the SRC/MAPK pathway, and SRC overexpression reversed the alleviating function of CGOS in COPD rats. Conclusions In conclusion, CGOS might alleviate oxidative stress and inflammation in COPD rats by inhibiting the SRC/MAPK pathway.

A clinical investigation into the usefulness of fractional exhaled nitric oxide in guiding glucocorticoid therapy in children with bronchial asthma.

The present study aims to investigate the value of fractional exhaled nitric oxide (FeNO) combined with pulmonary function in guiding the dose adjustment of inhaled glucocorticosteroids (ICSs) in children with asthma. A total of 133 children aged 6-12 years with newly diagnosed asthma were enrolled as the study subjects and randomly divided into the experimental group (n=68) and the control group (n=65). After three months of ICS treatment, in the experimental group, the dose of ICSs was adjusted based on the control status of the children and the results of the pulmonary function tests and FeNO assays, and in the control group, the dose was adjusted based on the control status of the children and the results of the pulmonary function tests. After another three months of treatment, the number of acute asthma attacks and the Childhood Asthma Control Test (C-ACT) scores were compared between the two groups, and the outcome of pulmonary function tests and FeNO assays during treatment were analyzed. When examining pulmonary function and FeNO levels, when compared with before treatment, there were no statistically significant differences in either group or between the groups after three months of ICS treatment (P>0.05). After dose adjustment and another three months of treatment, when compared with the control group, the improvement in pulmonary function in the experimental group was greater, the reduction in FeNO levels was greater, the incidence of acute asthma attacks was lower, and the C-ACT score was higher (P<0.05). We concluded that the combination of FeNO assays and pulmonary function tests to guide the ICS dose adjustment in children with asthma could improve asthma control and reduce the risk of acute asthma attacks.

A cross-sectional study to investigate short duration toxic consequences of smoking to lungs of asymptomatic smokers through spirometry and 6 min walk test

Background: Cigarette smokers have a lower level of pulmonary function and physical fitness than non-smokers. Very little information is available for the short-term effects of smoking to lungs of asymptomatic smokers. Aims and Objectives: The main focus of this study is to evaluate short duration toxic consequences of smoking to the lungs of asymptomatic smokers through spirometry and 6 min walk test (6MWT). Materials and Methods: The present study is an observational cross-sectional study conducted in a tertiary care hospital which includes 160 individuals, 80 smokers and 80 non-smokers. The spirometric variables and 6MWT were performed to quantify smoking exposure. The whole statistics was analyzed using SPSS 21 and the mean between two groups was compared after applying standard Chi-square test. The means across more than 2 groups were compared after applying the standard analysis of variance (ANOVA) test. Results: Most of lung function parameter such as forced expiratory volume in 1 s (FEV1), FEV1%, FEV1/forced vital capacity % (FVC%), maximum mid-expiratory flow 25–75%, peak expiratory flow rate (PEFR), PEFR%, and maximum voluntary ventilation % is decreased significantly in asymptomatic smokers than non-smokers except FVC and FVC%. The 6MWT distance is also reduced gradually and significantly in asymptomatic smokers from 1–5 pack-years to 15–20 pack-years. Conclusion: Lung function parameters and 6MWT decreased significantly in asymptomatic smoker with increased quantum of pack-years. Therefore, early screening of high-risk smokers would lead to reduction of the clinical disease.

Impact of yoga breathing and relaxation as an add-on therapy on quality of life, anxiety, depression and pulmonary function in young adults with bronchial asthma: A randomized controlled trial

BackgroundThe impact of combinations of yogic practices on bronchial asthma have been studied. Such yoga modules tend to be too lengthy for comfortable practice long-term, giving high dropouts. Returning to conventional medicine despite improvement is common. This study tested a shorter, easier yoga routine to improve asthma condition. Material and methodsSixty young adults aged 18-30 years diagnosed with bronchial asthma of mild to moderate severity were randomly assigned to the Yoga Group, add-on yoga therapy and continuing prescribed medication, or the Control Group, continuing prescribed medication only. Measurements on days 0 and 90, included Asthma Quality of Life Questionnaire, Hamilton Anxiety Rating Scale, Beck’s Depression Inventory and Pulmonary Function Tests. The yoga therapy module, practised 30 mins daily, included four kinds of yoga breathing practices, and ended with guided relaxation. ResultsAll Asthma Quality of Life subdomains improved greatly for the Yoga Group as did Hamilton Anxiety and Becks Depression Inventory scores, t statistics were high (40 -75), all p<.0001. Pulmonary Function also improved greatly in all variables, with smaller t statistics from 2 to 14. The Control Group showed some small improvements. Differences observed in scores were highly significant, with large effect sizes. Finally, no dropouts occurred. DiscussionZero dropouts represents an unprecedented result. The yoga module was completely acceptable to participants, Yoga Group improvements were highly significant. The study indicates that the new yoga module effectively improves quality of life, levels of anxiety, depression and pulmonary function in young adults with above-stated bronchial asthma.

A comparison of the effects of inspiratory muscle strength and endurance training on exercise capacity, respiratory muscle strength and endurance, and quality of life in pacemaker patients with heart failure: A randomized study

BackgroundStudies have widely investigated the effects of inspiratory muscle strength training in patients with heart failure (HF). The effects of inspiratory muscle strength or endurance training on outcomes in patients with pacemakers have not been adequately studied. ObjectivesThe aim was to compare the effects of inspiratory muscle strength and endurance training on exercise capacity, quality of life (QoL), peripheral and respiratory muscle strength, respiratory muscle endurance, pulmonary function, dyspnea, fatigue, and physical activity levels in pacemaker patients with HF. MethodsA randomized, controlled, double-blind study was conducted. Fourteen pacemaker patients with HF received inspiratory muscle strength training (IMST) at 50% of maximal inspiratory pressure (MIP), and 18 patients received endurance training (IMET) at 30% of MIP 7 days/8 weeks. Exercise capacity [6 min. walking test (6MWT) and the Incremental Shuttle Walking Test (ISWT)], pulmonary function, respiratory muscle strength [MIP, maximal expiratory pressure (MEP)], endurance, peripheral muscle strength, dyspnea, fatigue, QoL, and physical activity level were evaluated before and after. ResultsDemographic characteristics were similar in IMST (3F/11M, 56.92 ± 7.61y, EF: 25%, ICD/CRT:11/3) and IMET (4F/14M, 56 ± 10.77y, EF: 30%, ICD/CRT:16/2) groups (p > 0.05). Significant improvements were present in MIP, MEP, respiratory muscle endurance, peripheral muscle strength, 6MWT and ISWT walking distances, dyspnea, QoL, physical activity level, fatigue scores within groups (p ≤ 0.05). However, there were no significant differences between the groups (p > 0.05). There were no significant improvements in FEV1%, FVC%, FEV1/FVC%, and FEF25-75 within and between the groups (p > 0.05). ConclusionsInspiratory muscle strength and endurance training similarly improves respiratory and peripheral muscle strength, exercise capacity, QoL, physical activity level, and decreases dyspnea and fatigue and are safe and effective in pacemaker patients with HF. Trial registrationwww.ClinicalTrials.gov; study number: NCT03501355.

Relationships among pulmonary function, anxiety and depression in mild asthma: An exploratory study

In a secondary analysis of data from a prior study, we calculated the relationships among depression (PHQ-8), anxiety (GAD-7), and measures of asthma in 69 steroid-naïve patients with mild and moderate symptomatic asthma. Average levels of pulmonary function, depression and anxiety tended to be in the normal range, and asthma tended to be well controlled (Asthma Control Test). Nevertheless, PHQ-8 scores were significantly correlated with forced oscillation (FO) measures of airway reactance (AX) and resistance at a low frequency of stimulation (Rrs5 Hz). GAD-7 scores also were significantly related to Rrs5 Hz. Exploratory analyses in Supplementary data provide no evidence for vagal mediation of the association. Further research is necessary to discover mechanisms for the associations found here. Future studies might examine the utility of assessing and treating mild anxiety and depression in mild to moderate asthma.

Acupoint thread-embedding as adjuvant therapy for bronchial asthma in children and its effect on pulmonary function, serum IgA and IgE levels

To observe the efficacy of acupoint thread-embedding combined with fluticasone propionate aerosol for chronic persistent bronchial asthma of lung-spleen qi deficiency and spleen-kidney yang deficiency in children and its effect on pulmonary function and serum levels of IgA and IgE. A total of 120 children with chronic persistent bronchial asthma were randomly divided into an observation group (60 cases, 9 cases dropped off) and a control group (60 cases, 7 cases dropped off). The control group was treated with fluticasone propionate aerosol (125 μg per inhalation), twice a day; based on the control group treatment, the observation group was treated with acupoint thread-embedding at Dingchuan (EX-B 1), Feishu (BL 13), Zusanli (ST 36) and Danzhong (CV 17), once half a month. Both groups were treated for 3 months. The pulmonary function, serum IgA, IgE levels and TCM symptom score were compared between the two groups before and after treatment, and the clinical efficacy was evaluated. After treatment, the large airway function (peak expiratory flow [PEF], forced expiratory volume at the first second [FEV1]) and small airway function (maximal expiratory flow at 25% of the forced capacity [MEF25%], maximal expiratory flow at 50% of the forced capacity [MEF50%], maximal expiratory flow at 75% of the forced capacity [MEF75%] and midexpiratory flow 25%-75% [MEF25%-75%]) were higher than those before treatment (P<0.05), and the pulmonary function in the observation group was higher than that in the control group (P<0.05). After treatment, the serum IgA levels in the two groups were higher than those before treatment (P<0.05), and the serum IgE levels and TCM symptom scores were lower than those before treatment (P<0.05); the serum IgA level in the observation group was higher than that in the control group (P<0.05), and the serum IgE level and TCM symptom score in the observation group were lower than those in the control group (P<0.05). The total effective rate was 94.1% (48/51) in the observation group, which was higher than 88.7% (47/53) in the control group (P<0.05). Acupoint thread-embedding combined with fluticasone propionate aerosol could improve the pulmonary function, TCM symptoms and serum IgA and IgE levels in children with chronic persistent bronchial asthma of lung-spleen qi deficiency and spleen-kidney yang deficiency. The curative effect is better than fluticasone propionate aerosol alone.

Urinary levels of Phthalate metabolite mixtures and pulmonary function in adolescents

Although an association between urinary phthalate (PAE) metabolites and respiratory symptoms and diseases has been reported, knowledge regarding its effect on pulmonary function is limited, especially in adolescents. Using cross-sectional data from 1389 adolescents (aged 10–19 years) in the 2007–2012 National Health and Nutrition Examination Survey, the association of mixed urinary PAE metabolites with pulmonary function was evaluated using the weighted quantile sum. Moreover, multivariate linear regression was performed to investigate associations between each urinary PAE metabolite and pulmonary function indicators and to estimate the interaction effects between urinary PAE metabolites and demographic characteristics. We found that mixed urinary PAE metabolites were negatively associated with forced expiratory volume at the 1 s (FEV1, p < 0.001) and forced vital capacity (FVC, p = 0.008) levels. In individual PAE metabolite analyses, mono (carboxynonyl) pthalate (MCNP), mono-n-butyl pthalate (MnBP), mono-isobutyl pthalate (MiBP), mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP) and mono-benzyl phthalate (MBzP) correlated negatively with both FVC and FEV1 values (Holm-Bonferroni corrected p < 0.05). Mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) was negatively associated with the FVC value. Significant interactions between sex and urinary MnBP or MBzP levels for the risk of FEV1 decrease in girls were found (p = 0.005), as was a significant interaction between sex and urinary MBzP level for the risk of FVC decline. Our findings suggest that higher PAE exposure is associated with respiratory dysfunction; the association is more pronounced among girls.

Beware of Dog: Practical Consideration in Asthmatic Patients with Poor Perception of Respiratory Symptoms

Symptoms are often difficult to quantify, represent and depict for the patients and sometime also for the attending physicians. Anyway their role is crucial in influencing the relationship patient/physician in many ways. Respiratory symptoms (cough, thoracic pain, dispnoea) are not free of this challenging drawback. In asthmatic patients the subjective awareness of their disease condition, expecially their insight in the quality of breathing pattern, is critical to assess severity and control of their disease: under-perception of respiratory symptoms make this task problematic for patients and physicians. To estimate the magnitude of problem two set of reports have been examined: one on “real life” patients with chronic stable asthma and secondly studies evaluating the level of perception in selected asthmatic patients in a laboratory setting using bronchial provocation tests tool. Cumulatively a rough percentage of 20% asthmatic patients showed a reduced ability to be aware of their low level of pulmonary function. This impaired ability to perceive and report symptoms could also be a harbinger of undesirable and sometimes dangerous consequences. These data show that poor perception in asthma is a challenging problem affecting a large proportion of patients, with the potential of severe outcomes that need to be accurately addressed.

Effect of Methylation Status of lncRNA-MALAT1 and MicroRNA-146a on Pulmonary Function and Expression Level of COX2 in Patients With Chronic Obstructive Pulmonary Disease.

This study aimed to investigate the role of methylation of MALAT1 and miR-146a in the pathogenesis of chronic obstructive pulmonary disease (COPD). COPD patients were grouped according to their methylation status of MALAT1 and miR-146a promoters, and we found that forced vital capacity, volume that has been exhaled at the end of the first second of forced expiration, and diffusion capacity for carbon monoxide were the highest in the MALAT1 HYPO + miR-146a HYPER group and lowest in the MALAT1 HYPER + miR-146a HYPO group, and COPD patients with hypermethylated MALAT1 showed lower expression of MALAT1 than that in the COPD patients with hypomethylated MALAT1. Meanwhile, miR-146a was the most significantly upregulated in the MALAT1 HYPER + miR-146a HYPO group and the most significantly downregulated in the MALAT1 HYPO + miR-146a HYPER group. Both prostaglandin E1 and cyclooxygenase 2 (COX2) expression were the highest in the MALAT1 HYPO + miR-146a HYPER group and the lowest in the MALAT1 HYPER + miR-146a HYPO group. In conclusion, our results established a MALAT1/miR-146a/COX2 signaling axis. The overexpression of MALAT1 could increase the expression of COX2 by inhibiting the expression of miR-146a, thus affecting the pulmonary function of COPD patients.

Obstructive sleep apnea predicts 10-year cardiovascular disease-related mortality in the Sleep Heart Health Study: a machine learning approach.

Obstructive sleep apnea (OSA) is considered to be an important risk factor for the development of cardiovascular disease (CVD). This study aimed to develop and evaluate a machine learning approach with a set of features for assessing the 10-year CVD mortality risk of the OSA population. This study included 2,464 patients with OSA who met study inclusion criteria and were selected from the Sleep Heart Health Study. We evaluated the importance of potential features by mutual information. The top 9 features were selected to develop a random forest model. We evaluated the model performance on a test set (n = 493) using the area under the receiver operating curve with 95% confidence interval and confusion matrix. A random forest model awarded the highest area under the receiver operating curve of 0.84 (95% confidence interval: 0.78-0.89). The specificity and sensitivity were 73.94% and 81.82%, respectively. Sixty-three years old was a threshold for increased risk of 10-year CVD mortality. Persons with severe OSA had higher risk than those with mild OSA. This study demonstrated that a random forest model can provide a quick assessment of the risk of 10-year CVD mortality. Our model may be more informative for patients with OSA in determining their future CVD mortality risk. Li A, Roveda JM, Powers LS, Quan SF. Obstructive sleep apnea predicts 10-year cardiovascular disease-related mortality in the Sleep Heart Health Study: a machine learning approach. J Clin Sleep Med. 2022;18(2):497-504.

Pulmonary Function, Aerobic Capacity, Obesity and Stress Level in Bus Drivers and Conductors in Gujarat State Road Transport Corporation: An Evidence Based Study

Background: In rapidly growing cities there is increased use of motor vehicles. Bus drivers are exposed to toxic gases from the diesel exhaust and atmospheric pollutants, there is an increased risk of decrease in pulmonary function in bus drivers as well as bus conductors. They have irregular shift patterns; prolonged period of driving in congested areas there is an increased stress level thus an increase in cardiovascular risk factors in bus drivers. Due to prolonged period of sitting during driving and irregular meals there is increased risk of obesity in bus drivers and conductors. Purpose: To conduct an evidence based study to find whether pulmonary function, aerobic capacity, obesity and stress level is increased bus drivers and conductors in Gujarat state. Methodology: The study was conducted according to Preferred Reporting Items for systematic reviews and meta-analysis guidelines. Evidences selected since year 1994-February 2020 from PubMed, Google Scholar, Physiotherapy Evidence Database (PEDro), ResearchGate, ScienceDirect and Cumulative Index of Nursing and Allied Health Literature. Key words used were: Pulmonary function test, Aerobic capacity, Stress level, Obesity, Bus drivers and Bus conductors. Analysis was done using Modified Sackett Scale Version 4.0. Total 30 articles were found, out of which 20 articles were relevant and from those 14 articles were included in the study and other articles were excluded as per eligibility criteria. Results: 8 studies showed high prevalence of reduced lung volumes. 2 studies showed prevalence of high level of stress. 2 studies showed prevalence of Overweight and obesity. Conclusion: Based on evidences from search engines like Google scholar, PubMed, PEDro, ScienceDirect and ResearchGate from the year 1994- 2020, it can be concluded that bus drivers and conductors may suffer from chronic respiratory disease, high stress level and may have obesity and there is no evidence on aerobic capacity. Keywords: Pulmonary function test, Aerobic capacity, Stress level, Obesity, Bus drivers and Bus conductors.

Identification of Metabolism-Associated Molecular Subtypes of Chronic Obstructive Pulmonary Disease.

PurposeThis study aimed to identify the COPD molecular subtypes reflecting pulmonary function damage on the basis of metabolism-related gene expression, which provided the opportunity to study the metabolic heterogeneity and the association of metabolic pathways with pulmonary function damage.MethodsUnivariate linear regression and the Boruta algorithm were used to select metabolism-related genes associated with forced expiratory volume in the first second (FEV1) and FEV1/forced vital capacity (FVC) in the Evaluation of COPD to Longitudinally Identify Predictive Surrogate Endpoints (ECLIPSE) cohort. COPD subtypes were further identified by consensus clustering with best-fit. Then, we analyzed the differences in the clinical characteristics, metabolic pathways, immune cell characteristics, and transcription features among the subtypes.ResultsThis study identified two subtypes (C1 and C2). C1 exhibited higher levels of lower pulmonary function and innate immunity than C2. Ten metabolic pathways were confirmed as key metabolic pathways. The pathways related to N-glycan, hexosamine, purine, alanine, aspartate and glutamate tended to be positively associated with the abundance of adaptive immune cells and negatively associated with the abundance of innate immune cells. In addition, other pathways had opposite trends. All results were verified in Genetic Epidemiology of COPD (COPDGene) datasets.ConclusionThe two subtypes reflect the pulmonary function damage and help to further understand the metabolic mechanism of pulmonary function in COPD. Further studies are needed to prove the prognostic and therapeutic value of the subtypes.

Positive change in asthma control using therapeutic patient education in severe uncontrolled asthma: a one-year prospective study

BackgroundSevere asthma is difficult to control. Therapeutic patient education enables patients to better understand their disease and cope with treatment, but the effect of therapeutic patient education in severe uncontrolled asthma is unclear. We evaluated whether therapeutic patient education is effective in improving asthma control and decreasing the frequency of exacerbations in severe uncontrolled asthma.MethodsThis was a prospective, observational, and self-controlled study that enrolled 40 subjects with severe uncontrolled asthma. Patients were seen at a clinic four times (on day 1 and after 3, 6, and 12 months). After baseline data collection, the subjects completed a therapeutic patient education program and were also followed-up via telephone after 1, 2, 4, 5, 7, 8, 9, 10, and 11 months to monitor asthma medication adherence and collect asthma-related information.ResultsWithin the 1-year study period, a total of 23 exacerbations were recorded in 14 patients, seven of whom required emergency treatment and two of whom were hospitalized. Twelve months after the standardized therapeutic patient education program, pulmonary function and fractional exhaled nitric oxide levels improved significantly in all 40 patients. Moreover, the scores from three standardized asthma questionnaires and indices suggested improved quality of life in these patients with severe uncontrolled asthma. Serum levels of biomarkers reflecting asthma immune responses did not change between baseline and the 1-year follow-up time point.ConclusionsTherapeutic patient education is effective in improving asthma control and decreasing exacerbations in patients with severe uncontrolled asthma.

Effect of Diaphragm Strengthening Exercise on Pulmonary Function, Pain, and Disability Level in Chronic Low Back Pain Patients

Purpose : In this study, we investigated the effects of a diaphragm-strengthening exercise on pulmonary function, pain, and disability level in patients with chronic low back pain (CLBP). Methods : A total of 10 patients with CLBP were enrolled in this study. These patients performed diaphragm-strengthening exercise for 30 minutes per day, 5 times a week, for 4 weeks. We measured pulmonary function using spirometry, assessed CLBP using a visual analog scale, and measured disability level using Korean Oswestry disability index. We used paired t test to compare within-group changes before and after the diaphragm-strengthening exercise. Results : After the exercise, a significant within-group change occurred in pulmonary function, pain, and disability level (p < 0.05). Conclusion : The application of a diaphragm-strengthening exercise can be used for patients with CLBP, considering its positive effects on pulmonary function, pain, and disability level.

Cord blood soluble Fas ligand linked to allergic rhinitis and lung function in seven-year-old children.

Serum or cord blood soluble Fas ligand (FasL) has been related to asthma, allergic rhinitis, and atopic dermatitis in cross-sectional and short-term follow-up studies. However, the association of cord blood soluble FasL with long-term allergic outcomes has seldom been investigated. The Prediction of Allergies in Taiwanese Children birth cohort study recruited healthy newborns upon delivery. At birth, blood was collected from the umbilical cords of these children, and the cord blood soluble Fas ligand levels were measured. At the age of seven years, the allergic outcome of each child was diagnosed by pediatric allergists and pulmonologists. Tests were conducted to measure the specific immunoglobulin E, fractional exhaled nitric oxide (FeNO), and pulmonary function levels of each child. Cord blood soluble FasL levels were higher in seven-year-old children with allergic rhinitis (Odds ratio [OR]=2.41, p=0.012) and expiratory airway obstruction (the highest forced expiratory volume in 1second/forced vital capacity<90%, OR=2.11, p=0.022). The FeNO and Dermatophagoides pteronyssinus-specific immunoglobulin E levels of seven-year-old children were positively correlated with cord blood soluble FasL levels (p=0.006 and 0.02, respectively). In this birth cohort, the cord blood soluble FasL levels were associated with allergic rhinitis, obstructive-type lung function, FeNO, and house dust mite sensitization in 7-year-old children. The cord blood soluble FasL level might be used as a predictor for allergic diseases in children who are 7 years old.

Analysis of the therapeutic effect and prognosis in 86 cases of rib fractures and atelectasis

BackgroundThe aim of the present study was to explore the therapeutic effect and prognosis in patients with rib fractures and atelectasis after thoracic trauma in order to provide a basis for clinical decision-making in primary hospitals.MethodsA retrospective study was conducted on 86 patients admitted to our hospital between January 2016 and May 2020 with rib fractures and atelectasis after thoracic trauma. On the basis of the chest computed tomography scans taken at the time of discharge, the patients were divided into two groups: the reexpansion group and the non-reexpansion group. The two groups were compared with respect to the changes observed in the patients’ levels of blood oxygen saturation (SpO2) and pulmonary function, the presence of secondary pulmonary or thoracic infection, the time of chest tube drainage, the length of hospitalization, the cost of hospitalization, and the patients’ level of satisfaction with their quality of life 3 months after discharge.ResultsIn the reexpansion group, there were significant differences in the levels of SpO2 and pulmonary function measured before and after pulmonary reexpansion (P < 0.05). Compared with the non-reexpansion group, the patients in the reexpansion group had a lower incidence of secondary pulmonary and thoracic infection and a higher level of satisfaction with their quality of life after discharge; these differences were statistically significant (P < 0.05). There was no statistical significance between the two groups with respect to the time of chest tube drainage or the length of hospitalization (P > 0.05). However, the cost of hospitalization was significantly higher in the reexpansion group than in the non-reexpansion group (P < 0.05).ConclusionsThe patients in the pulmonary reexpansion group had a lower incidence of complications and a better prognosis than the patients in the non-reexpansion group.

Clash of the two titans - COVID-19 and type 2 diabetes mellitus

COVID-19 has infected more than 32 million people globally in more than 100 countries. Diabetes mellitus (DM) has emerged as an important factor involved in the fatal outcomes of COVID-19. Accumulating evidence suggests that that reciprocal relationship may exist between these two raging pandemics, thus making COVID-19 more challenging for people with diabetes. Furthermore, poorly managed glycaemia in diabetes patients leads to increased risk of severe complications and higher mortality rate. The association between COVID-19 severity and DM can be supported by several pathophysiological mechanisms, such as compromised innate immune system, deranged cell-mediated immunity and adipose tissue infiltration of pro-inflammatory macrophages. Exaggerated coagulation and pro-thrombotic milieu in diabetes can predispose to thromboembolic complications associated with fatal outcomes in diabetic patients with COVID-19. Impaired pulmonary function and elevated levels of furin associated with diabetes can increase the chances of COVID-19 infection in patients with diabetes. In addition, SARS-CoV-2 infection can trigger stress hyperglycaemia leading to augmented viral replication and severity of infection associated with poor clinical outcomes in diabetic patients with COVID-19. Endothelial dysfunction associated with virus-induced endothelialitis can lead to organ ischaemia and life-threatening complications associated with COVID-19 with underlying DM. Vitamin D deficiency and insulin resistance worsened by SARS-CoV2 can lead to higher mortality and morbidity observed in diabetic patients with COVID-19. Therefore, COVID-19 patients should be adequately monitored for the development of new-onset diabetes, due to deranged glycaemic control, owing to underlying COVID-19 disease, and diabetic patients with COVID-19 should be kept under strict glycaemic control to avoid life-threatening complications.

Effects of Sublingual Duster Mite Drops on Lung Function and Exhaled Nitric Oxide in Children with Multiple and Single Allergic Respiratory Diseases.

Objective To evaluate the efficiency of sublingual immunotherapy with Dermatophagoides Farinae Drops in children with single and multiple respiratory allergic diseases. Methods Seventy-one children with allergic respiratory diseases who had been treated with Dermatophagoides Farinae Drops for one year or more were divided into a single allergic group (12 cases) and multiple allergic group (59 cases). The rhinitis score, daytime and night symptom score of asthma, VAS score, drug score, pulmonary function, and FeNO level before and after treatment were evaluated and compared between the two groups. Results The rhinitis score, night symptom score, VAS score, and drug score in the single allergic group after treatment were significantly lower than those before treatment (p < 0.05), but there was no significant difference in the daytime symptom score before and after treatment (p > 0.05). The rhinitis score, VAS score, and drug score in the multiple allergic group after treatment were significantly lower than those before treatment (p < 0.05), but there was no significant difference in the scores of daytime symptoms and nighttime symptoms before and after treatment (p > 0.05). In both the single allergic group and multiple allergic group, the pulmonary function indexes of the patients were significantly improved after treatment, and the FeNO after treatment was significantly lower than that before treatment (p < 0.05). There was no significant difference in scores, pulmonary function, and FeNO between the two groups (p > 0.05). Conclusion Sublingual specific immunotherapy is effective in treating multiple and single allergic respiratory diseases in children.