Pulmonary Disease Research Articles

Long-term oxygen treatment in chronic respiratory failure

Chronic respiratory failure (CRF) is the leading cause of mortality in patients with pulmonary diseases. One of the key treatments for CRF is long-term oxygen therapy (LTOT). The main purpose of LTOT is to improve the quality of life, increase physical performance, reduce the frequency of exacerbations and mortality of patients. It is recommended to use oxygen therapy for at least 15–16 hours a day, and if there is no effect, increase this time to 24 hours. Indications for LTOT have remained unchanged for a long time. The decision on the appointment of LTOT should be based on three-fold results of the gas composition of arterial blood, and the assessment of gas exchange parameters can be made only after stabilization of the condition (3–4 weeks after exacerbation). It is also worth considering the possibility of hypercapnia in patients and the likelihood of aggravation of the patient’s condition due to oxygen-induced hypercapnia and respiratory acidosis. Despite the existence of numerous studies concerning the use of LTOT, most of them have been conducted on patients with COPD, which creates the need for a deeper study of the effectiveness of this method in patients with other diseases. The use of long-term oxygen therapy has a positive effect on the quality of life, physical performance, the frequency of exacerbations, hospitalizations and patient survival. There are various methods of oxygen delivery, which allows the use of LTOT not only at rest, but also when moving the patient over long distances. It is important to note that in addition to prescribing LTOT, patients need to change their lifestyle, stop smoking, and receive adequate drug therapy for the underlying disease.

Conditional parametric bootstrap in GLARMA models

Due to situations where asymptotic results are not valid or when we do not know the true distributions of the data set, the bootstrap technique stands out as an effective alternative to make inferences about model parameters. In this context, we introduce the conditional parametric bootstrap, applied to time series data, specifically using the Generalized Linear Autoregressive Moving Average (GLARMA) model. Our interest is to use the procedure to correct possible biases and construct confidence intervals and hypothesis testing for the parameters of the GLARMA model. We conducted simulation studies to evaluate the performance of the procedure in finite samples. The results show that the proposed technique is promising and can be applied in practical situations. An example is the analysis of the monthly number of chronic obstructive pulmonary disease (COPD) cases, which illustrates the potential of the proposed approach in a real situation.

Rural Residence Associated with Receipt of Recommended Post-Discharge COPD Care among a Cohort of U.S. Veterans.

Individuals with chronic obstructive pulmonary disease (COPD) in rural areas experience inequitable access to care. To assess whether rural residence is associated with receipt of recommended post-discharge COPD care. We conducted a cohort study of all U.S. Veterans discharged from a VA Medical Center following COPD hospitalization from 2010 to 2019. Rural residence was defined by Rural Urban Commuting Area classification. Our primary outcome was the proportion of recommended care received within 90 days of hospital discharge, including: smoking cessation therapy; appropriate management of supplemental oxygen; appropriate prescription of inhaled therapy; and pulmonary rehabilitation. We conducted multi-variable linear regression between rural residence and the proportion of recommended care received, adjusting for age, sex, race, ethnicity, comorbidities, and primary care facility type. We tested multi-variable linear probability models for each of the recommended therapies. Of 67,649 patients, 7,370 (10.8%) resided in rural areas, and 2,000 (3.0%) in highly rural areas. Overall, the proportion of recommended COPD treatments received was low (mean 15.0%, standard deviation 21.0%). Compared with urban residence, patients with rural and highly rural residence received fewer recommended COPD care treatments (rural estimate [adjusted % difference (95% CI)]: -1.1 (-1.6, -0.6); highly rural estimate: -1.2 (-2.1, -0.3)). Rural and highly rural residence were associated with lower likelihood of receiving appropriate inhaled therapy escalation (rural estimate: -4.0 (-5.1, -3.0); highly rural estimate: -3.0 (-5.0, -1.1)) and pulmonary rehabilitation referral (rural estimate: -1.2 (-1.6, -0.9); highly rural estimate: -2.1 (-2.7, -1.4)), but a higher likelihood of receiving smoking cessation therapy (rural estimate: 5.4 (3.3, 7.5); highly rural estimate: 7.2 (3.3, 11.2)). There was no significant difference in appropriate oxygen management (rural estimate: -1.0 (-2.8, 0.9); highly rural estimate: 3.1 (-0.7, 6.9)). Patients across the rural-urban spectrum received few recommended post-discharge COPD treatments. Health systems approaches are needed to address widespread underutilization of evidence-based COPD care.

The DOSE index in chronic obstructive pulmonary disease: evaluating healthcare costs

Background and objectivesThe DOSE index, which incorporates Dyspnea, Obstruction, Smoking, and Exacerbations, is a widely used tool for assessing the severity and prognosis of Chronic Obstructive Pulmonary Disease (COPD). In addition to risk assessment, it has potential clinical utility in predicting healthcare costs, which are primarily driven by exacerbations. While several indices, such as the BODE (Body-mass index, Obstruction, Dyspnea, Exercise) and ADO (Age, Dyspnea, Obstruction) indices, exist for risk prediction, there is a lack of dedicated tools for forecasting healthcare costs. This study explores the potential of the DOSE index compared to other indices, including BODE, ADO, and the Charlson Comorbidity Index (CCI), for this purpose.Materials and methodsThis cross-sectional retrospective study analyzed data from 396 COPD cases. We examined associations between the DOSE index, BODE index, ADO index, CCI, and healthcare costs, including hospitalizations and emergency room treatments. Healthcare costs were categorized as direct medical expenses.ResultsSignificant associations were observed between the DOSE index and various healthcare parameters. DOSE quartiles showed strong correlations with outpatient visits (p = 0.013) and outpatient medical expenses (p = 0.011). In addition, hospitalization frequency, duration, and associated costs were significantly correlated with higher DOSE quartiles (p < 0.001). A significant difference was found when comparing DOSE quartiles between patients with high (CCI ≥ 3) and low (CCI < 3) comorbidity scores (p = 0.018). The DOSE index outperformed other indices, likely due to its inclusion of exacerbations, a key driver of healthcare costs.ConclusionThe DOSE index demonstrates potential in predicting healthcare costs, particularly due to its inclusion of exacerbation frequency. This study highlights the importance of considering exacerbations alongside traditional risk factors for more accurate cost forecasting in COPD management. Our findings suggest that the DOSE index may be a valuable tool in both clinical and economic assessments of COPD patients, though further research is warranted to validate these findings in larger datasets.

Osteoporosis Knowledge and Its Risk Factors in Older Adults With Upper Extremity Fragility Fractures: A National Cross-Sectional Study.

It is crucial to recognize upper extremity fragility fractures as sentinel events that allow healthcare professionals the opportunity to identify and address underlying factors contributing to poor bone health, thereby reducing the risk of future fragility fractures. This study seeks to evaluate the extent of understanding and factors influencing osteoporosis in older adults with upper extremity fragility fractures, aiming to establish a foundation for enhancing their comprehension. A total of 1443 participants in 31 provinces were included in this study as survey subjects from September to November 2023. A general information questionnaire and an osteoporosis knowledge assessment tool were used for a cross-sectional survey. The univariate analysis and logistic regression were used to analyze the risk factors. The score of osteoporosis knowledge assessment tool of participants was 10.00 (7.00, 12.00), with only 24.95% scoring above 12 points. Being in an eastern hospital, suffering from chronic obstructive pulmonary disease, being diagnosed as severe osteoporosis, having bone mineral density testing, receiving osteoporosis health education, and receiving health education by phone were associated with higher knowledge of osteoporosis. The osteoporosis knowledge of older adults with upper extremity fragility fractures needs to be improved. To help the secondary prevention of osteoporosis, the standardized osteoporosis health education should be strengthened, and attention should be paid to key groups.

A quality improvement model to identify undiagnosed heart failure at chronic obstructive pulmonary disease annual reviews

Abstract Introduction Heart failure (HF) is a common comorbidity in people with chronic obstructive pulmonary disease (COPD). The estimated prevalence of HF comorbidity in patients with COPD is up to 40%1. COPD and HF have overlapping symptoms which could delay the diagnosis of HF. Studies have shown that in UK primary care, HF treatment for COPD patients is delayed by almost twelve months compared to patients without COPD2. Early diagnosis and management of HF for COPD patients in primary care could reduce risk of recurrent exacerbation and subsequent hospitalisation. HF screen is not currently emphasised in the primary care COPD annual reviews. NICE guidance for COPD diagnosis mentions the use of serum natriuretic peptides to aid differential diagnosis of HF3. Pharmacists in general practice are the patients’ first point of contact, they are able to take leading roles in the holistic management of long-term conditions such as HF and COPD. Aim Reduce HF related complication including exacerbations and subsequent hospital admissions for COPD patients through early HF identification programme at COPD annual review. Methods Electronic Emis search was conducted on the practice database to identify patients on the COPD register. Patients with existing diagnosis of HF or NT-ProBNP in the last 12 month were excluded. Patients were invited for COPD annual review and screened for HF symptoms (breathlessness, fluid retention, fatigue, lightheadness) as per NICE guidance for HF identification. NT-ProBNP test was added to routine annual blood test for patients experiencing any of the HF symptoms. Patients with elevated NT-ProBNP &amp;gt;400ng/L were referred for further assessment for suspected HF. The project was a small scale service improvement project, it did not require ethical approval, this was confirmed with the Broad Street Health Centre clinical lead. Results Twenty six patients were screened out of 48 (54 %). Six patients (23%) had NT-pro BNP results over 400ng/L and were referred for further investigation for suspected HF. Diagnosis was confirmed for three patients 11%. Two of the newly diagnosed patients had an MRC score of 3, while one had and MRC score of 2. No patients with MRC score 1, 4 or 5 where among the newly diagnosed group. Discussion Results analysis correlates with published data regarding the prevalence of HF in COPD patients. Screening for HF in primary care might be most beneficial for patients with MRC of 2 or 3. Patients with score of 1 might have milder symptoms however annual screening will allow early detection of future deterioration. There were no newly diagnosed patients from the MRC score of 4 and 5 groups as they might have already been diagnosed if their symptoms were related to underlying HF. The three patients diagnosed with HF were treated for HF as per NICE guidance. Patients’ spontaneous feedback was positive regarding the new management approach. Conclusion Pharmacists in general practice can play a dynamic role in early identification of existing co-morbidities while conducting annual long-term conditions reviews. This in return facilitates vital early interventions to improve prognosis and reduce further complications along the way.

Prevalence and predictors of coronary heart disease among individuals with and without obesity in North Dakota.

Coronary heart disease (CHD) is the most common cardiovascular disease in the United States and heart disease is the leading cause of death in North Dakota. Although obesity is a major risk factor for CHD, some studies have reported an inverse relationship between body mass index (BMI) and CHD outcomes. Understanding the epidemiology of CHD among individuals with and without obesity is essential to guide health planning. Therefore, the objectives of this study were to estimate the prevalence and identify predictors of CHD among North Dakota adults with and without obesity. Behavioral Risk Factor Surveillance System data from 2017 to 2021 were provided by the North Dakota Department of Health and Human Services. Weighted prevalence estimates and 95% confidence intervals (CIs) were computed for CHD and potential risk factors among respondents with and without obesity (BMI ≥30 kg/m2). Multivariable logistic regression was used to identify significant predictors of CHD in both groups. A total of 17,092 respondents were included in the study. Respondents with obesity had a higher prevalence of CHD (4.7%, 95% CI: 4.2-5.4) than those without obesity (3.0%, 95% CI: 2.7-3.4). Predictors of CHD among both groups included age, sex, self-reported general health, high blood pressure, high cholesterol, chronic obstructive pulmonary disease, and diabetes. Having a personal doctor (Odds Ratio [OR] = 1.91, 95% CI: 1.13-3.23) and arthritis (OR = 1.72, 95% CI: 1.34-2.22) were significant predictors of CHD among respondents without obesity, but not among those without obesity. While the prevalence of CHD was significantly higher among adults with obesity compared to those without obesity, the findings of the stratified analysis indicated that predictors of the condition tended to be similar for the two groups. This study provides useful information to guide health planning and control programs that aim to reduce the burden of CHD in North Dakota.

Long-term health outcomes of COVID-19 in ICU- and non-ICU-treated patients up to 2 years after hospitalization: a longitudinal cohort study (CO-FLOW)

BackgroundMany patients hospitalized for COVID-19 experience long-term health problems, but comprehensive longitudinal data up to 2 years remain limited. We aimed to (1) assess 2-year trajectories of health outcomes, including comparison between intensive care unit (ICU) treated and non-ICU-treated patients, and (2) identify risk factors for prominent health problems post-hospitalization for COVID-19.MethodsThe CO-FLOW multicenter prospective cohort study followed adults hospitalized for COVID-19 at 3, 6, 12, and 24 months post-discharge. Measurements included patient-reported outcomes (a.o., recovery, symptoms, fatigue, mental health, sleep quality, return to work, health-related quality of life [HRQoL]), and objective cognitive and physical tests. Additionally, routine follow-up data were collected.Results650 patients (median age 60.0 [IQR 53.0–67.0] years; 449/650 [69%] male) surviving hospitalization for COVID-19 were included, of whom 273/650 (42%) received ICU treatment. Overall, outcomes improved over time. Nonetheless, 73% (322/443) of patients had not completely recovered from COVID-19, with memory problems (274/443; 55%), concentration problems (259/443; 52%), and dyspnea (251/493; 51%) among most frequently reported symptoms at 2 years. Moreover, 61% (259/427) had poor sleep quality, 51% (222/433) fatigue, 23% (102/438) cognitive failures, and 30% (65/216) did not fully return to work. Objective outcome measures showed generally good physical recovery. Most outcomes were comparable between ICU- and non-ICU-treated patients at 2 years. However, ICU-treated patients tended to show slower recovery in neurocognitive symptoms, mental health outcomes, and resuming work than non-ICU-treated patients, while showing more improvements in physical outcomes. Particularly, female sex and/or pre-existing pulmonary disease were major risk factors for poorer outcomes.Conclusions73% (322/443) of patients had not completely recovered from COVID-19 by 2 years. Despite good physical recovery, long-term neurocognitive complaints, dyspnea, fatigue, and impaired sleep quality persisted. ICU-treated patients showed slower recovery in neurocognitive and mental health outcomes and resumption of work. Tailoring long-term COVID-19 aftercare to individual residual needs is essential. Follow-up is required to monitor further recovery.Trial registration: NL8710, registration date 12-06-2020.

Clinical and biologic profiles of patients with acute respiratory distress syndrome by prevalence of chronic obstructive pulmonary disease or emphysema; a cohort study

IntroductionAcute respiratory distress syndrome (ARDS) is characterized by diffuse lung injury. The impact of pre-existing chronic obstructive pulmonary disease (COPD) or emphysema on ARDS pathogenesis is not well characterized.MethodsSecondary analysis of ARDS patients enrolled in the Acute Lung Injury Registry and Biospecimen Repository at the University of Pittsburgh between June 2012 and September 2021. Patients were categorized into two mutually exclusive groups by the prevalence of COPD or emphysema at the time of ARDS diagnosis. The COPD/emphysema group comprised ARDS patients with radiological evidence of emphysema, chart diagnosis of COPD, or both. Demographics, lung mechanics, and clinical outcomes were obtained from the electronic medical record. Host-response biomarkers known to have validated associations with ARDS were previously measured in plasma and lower respiratory tract samples using a customized Luminex assay. Continuous and categorical variables were compared between groups with and without COPD/emphysema.Results217 patients with ARDS were included in the study, 57 (27%) had COPD/emphysema. Patients with COPD/emphysema were older (median 62 [interquartile range 55–69] versus 53 [41–64] years, p < 0.01), more likely to be male (62% vs. 44%, p = 0.02) and had a higher prevalence of congestive heart failure (25% vs. 4%, p < 0.01) compared to patients without COPD/emphysema. Baseline demographics, laboratory parameters, and mechanical ventilatory characteristics were otherwise similar between the two groups. No difference in 90-day mortality was observed between groups; however, patients with COPD/emphysema had shorter duration of intensive care unit (ICU) stay (median 10 [7–18] versus 16 [9–28] days, p = 0.04) and shorter duration of mechanical ventilation (median 7 [4–16] vs. 12 [6–20] days, p = 0.01). Host response biomarkers in serum and lower respiratory tract samples did not significantly differ between groups.ConclusionARDS patients with COPD or emphysema had similar respiratory mechanics, host response biomarker profiles, and mortality compared to those without COPD or emphysema but with a shorter median duration of mechanical ventilation and ICU length of stay. Future studies should address differences in clinical and biological responses by disease severity, and should investigate the impact of severity of COPD and emphysema on mechanical ventilation and targeted therapeutic strategies in ARDS.Clinical trial numberNot applicable

Association of Respiratory Morbidities with Particulate Air Pollution in Delhi, India- A Prospective Study

Abstract Background: Elevated levels of air pollution and long-term exposure can lead to detrimental health conditions, mainly affecting cardiorespiratory systems. Materials and Methods: A prospective observational study was conducted in five sampled hospitals in Delhi. A pre-designed, pre-tested, semi-structured questionnaire was filled out for each patient with data from hospital records. The admission rates were recorded daily over the study period along with the air quality with reference to particulate matter (PM). The trends of the hospital admissions for respiratory morbidity were corroborated with PM 2.5. Descriptive statistics and correlation amongst emergency admissions and air pollutants were analysed using Microsoft Excel. The impact of air quality on the rate of hospitalisation due to respiratory conditions was projected by mathematical modelling. Results: The rate of hospitalisation due to bronchial asthma, chronic obstructive pulmonary disease, bronchitis and lower respiratory tract infections was found to be directly proportional to an increase in PM2.5. Conclusion: The healthcare system is increasingly strained and thus, the additional burden due to rising air pollution needs to be prevented by making people aware about the methods of reducing air pollution.

A higher mortality in men compared to women with heart failure in primary care and ejection fraction equal to or more than 40%

ABSTRACT The aim of this study was to describe gender-related differences in characteristics and mortality in heart failure (HF) patients managed in primary care (PC). We included 1802 hF patients aged 77.5 ± 8.8 years (47% women) with ejection fraction (EF) ≥ 40% from the Swedish Heart Failure (SwedeHF) registry. The patients were divided by gender, and by heart failure with mildly reduced ejection fraction (HFmrEF; EF 40–49%) or heart failure with preserved ejection fraction (HFpEF; EF ≥ 50%). Men included in the study were younger (mean-age 76.4 vs 78.7 years, p < 0.0001) and showed a higher age-adjusted mortality (p < 0.0001). Men more often showed ischemic heart disease, 49% vs. 38% (p < 0.0001), atrial fibrillation, 56% vs. 50%, and diabetes, 25% vs. 17% (both p < 0.01). Women had higher blood pressure compared to men (p < 0.01), more commonly had kidney dysfunction (p < 0.01), and a worse functional capacity (p < 0.01). Cardiovascular diseases were the dominating causes of death in men and women (60% and 56%) but were less dominating in individuals with EF ≥ 50%, especially among women (56% in men vs. 46% in women). Among women with EF ≥ 50%, the mortality was dominated of mixed and unspecified diseases. Other important causes of death were cancer (15%) and chronic obstructive pulmonary disease (13%). Men managed in PC with HF and EF ≥ 40% have a higher age-adjusted mortality than women. Cardiovascular disease is the dominating cause of death in both genders. Other frequent causes of death were malignant tumors and respiratory diseases, illustrating the need to carefully diagnose and treat all associated comorbidities.

Vitamin D metabolism-related single nucleotide polymorphisms in Chronic Obstructive Pulmonary Disease risk

IntroductionChronic obstructive pulmonary disease (COPD) is one of the world’s major public health problems. It is characterized by a major inflammatory response, where vitamin D, due to its role in regulating the immune system, and genetic variants involved in its metabolism may play an essential role. The aim of this study is to evaluate the association between 13 polymorphisms related to vitamin D metabolism and the COPD risk.Material and methodsA retrospective longitudinal study was designed in which 152 cases of COPD diagnosed at the University Hospital Virgen de las Nieves and 456 controls without the pathology, matched by age and sex, were included. The determination of the 13 polymorphisms was carried out using TaqMan™ probes.ResultsStatistical analysis showed that the AA genotype and the A allele of the CYP27B1 rs4646536 polymorphism may be associated with an increased risk of developing COPD according to genotypic models (OR = 2. 6; 95% CI = 1.38-5.22; p = 0.004), dominant (OR = 1.69; 95% CI = 1.15-2.5; p = 0.008), recessive (OR = 2.24; 95% CI = 1.22-4.41; p = 0.013) and additive (OR = 1.56; 95% CI = 1.18-2.08; p = 0.020) models. Likewise, the AA genotype and the A allele of the CYP2R1 rs10741657 polymorphism were also associated with the risk of developing COPD according to the genotypic (OR = 1.9; 95% CI = 1.06-3.36; p = 0.028) and additive (OR = 1.37; 95% CI = 1.04-1.81; p = 0.027) models. Likewise, an association was found between GATG (p = 0.002; OR = 2.05; 95%CI = 1.32-3.20) and AGGT (p &amp;lt; 0.0001; OR = 2.1e46; 95%CI = 2.1e46-2.1e46) haplotypes and an increased risk of COPD.ConclusionsWe can therefore conclude that those variants could be used in the early detection of the disease in the future.

Development of a New Questionnaire to Assess the Social Impact of Non-communicable Diseases

Abstract Background: Non-communicable diseases (NCDs) have a considerable impact on an individual’s social life. Life-long medication, fear of death, dietary restrictions, hospital admissions, dependency on caregivers, and strained interpersonal relationships play a role. The available questionnaires measure only individual aspects of social impact. The aim of the study was to develop and validate a comprehensive questionnaire to assess the social impact of NCDs. Material and Methods: A cross-sectional study was conducted among patients and caregivers seeking care at a tertiary care hospital for diabetes, hypertension, chronic obstructive pulmonary disease (COPD), stroke, coronary artery disease (CAD), and cancer. Thirty patients each with the above diseases were administered Cousineau Self-Perceived Burden Scale to assess perceived burden among patients, Caregiver Burden Scale to assess caregiver burden, EuroQol-5D-3L to assess the quality of life, and face validated questions of sociodemographic details, cost of healthcare, and stress due to disease. Rasch analysis was performed to identify items that lie within the traditional bounds of mean-square item fit. The Delphi method with 10 subject experts was used to identify the questions that would be included in the final tool. Results: The data consists of 150 observations, with 77 categorical questions subdivided into various domains. From this, a total of 30 questions were extracted by Rasch analysis. The new questionnaire had good internal consistency (Cronbach’s alpha: 0.969, 95% confidence interval: 0.96–0.98). The questionnaire was finalized after reaching a consensus among subject experts. Conclusion: The social impact questionnaire developed consisted of 30 questions, has good internal consistency, and can be used to measure the social impact of NCDs.

TAp73 regulates mitochondrial dynamics and multiciliated cell homeostasis through an OPA1 axis

Dysregulated mitochondrial fusion and fission has been implicated in the pathogenesis of numerous diseases. We have identified a novel function of the p53 family protein TAp73 in regulating mitochondrial dynamics. TAp73 regulates the expression of Optic Atrophy 1 (OPA1), a protein responsible for controlling mitochondrial fusion, cristae biogenesis and electron transport chain function. Disruption of this axis results in a fragmented mitochondrial network and an impaired capacity for energy production via oxidative phosphorylation. Owing to the role of OPA1 in modulating cytochrome c release, TAp73−/− cells display an increased sensitivity to apoptotic cell death, e.g., via BH3-mimetics. We additionally show that the TAp73/OPA1 axis has functional relevance in the upper airway, where TAp73 expression is essential for multiciliated cell differentiation and function. Consistently, ciliated epithelial cells of Trp73−/− (global p73 knock-out) mice display decreased expression of OPA1 and perturbations of the mitochondrial network, which may drive multiciliated cell loss. In support of this, Trp73 and OPA1 gene expression is decreased in chronic obstructive pulmonary disease (COPD) patients, a disease characterised by alterations in mitochondrial dynamics. We therefore highlight a potential mechanism involving the loss of p73 in COPD pathogenesis. Our findings also add to the growing body of evidence for growth-promoting roles of TAp73 isoforms.

Do Antidepressants Worsen COPD Outcomes in Depressed Patients with COPD?

The coexistence of depression with chronic obstructive pulmonary disease (COPD) has been associated with poorer outcomes. Studies have questioned the safety of antidepressants in patients with COPD. This review shows the potential relationships and the possible mechanisms and gives us good warnings on how to approach this problem. Treatment should be both non-pharmacological and pharmacological, but importantly tailored to the individual patient.

Endothelial dysfunction in combination of occupational pathology of the respiratory system and atherosclerosis in coal industry workers

Introduction. The increasing prevalence of cardiovascular pathology among industrial workers determines the importance of studying not only occupational diseases, but also their combination with diseases of the circulatory system. Endothelial dysfunction is a key link in the pathogenesis of atherosclerosis. Evaluation of endothelial function indicators in occupational respiratory diseases in combination with atherosclerosis in workers of the coal mining industry is an urgent task. The study aims to consider the indicators of endothelial function in miners with occupational respiratory diseases in combination with atherosclerosis. Materials and methods. The authors have examined 88 miners with previously diagnosed occupational respiratory diseases (chronic dust bronchitis, anthracosilicosis, chronic obstructive pulmonary disease), 45 of them showed signs of atherosclerosis. There were two comparison groups without signs of atherosclerosis: 44 miners who work long-term in harmful working conditions, without lung pathology (control group) and 42 residents of Novokuznetsk who have never worked in harmful working conditions, and without lung pathology (unexposed group). Results. We found that miners with occupational respiratory diseases in combination with atherosclerosis had several forms of endothelial dysfunction: vasomotor (decreased synthesis of nitric oxide, increased endothelin-1 levels), hemostatic (increased levels of Willebrand factor), adhesive (increased levels of endothelial adhesion molecules sVCAM-1). The development of respiratory insufficiency in miners with occupational respiratory diseases increases endothelial dysfunction: miners with respiratory insufficiency have lower levels of nitric oxide (NO), higher levels of endothelin-1 and endothelial adhesion molecules sVCAM-1 than miners without respiratory insufficiency. There are correlations between indicators of endothelial function and production factors: with work experience in harmful working conditions, the level of the average concentration of coal-rock dust in the workplace and the frequency of exceeding the maximum permissible concentration of coal-rock dust. Limitations. The study is limited to a sample of workers in the main professions of coal mines who were examined at the Research Institute of Complex Hygiene Problems and Occupational Diseases, aged 40 to 54 years, with more than 15 years of experience working in underground dust conditions. Conclusion. Miners with occupational respiratory diseases in combination with atherosclerosis develop several forms of endothelial dysfunction: vasomotor, hemostatic, adhesive. The development of respiratory failure increases endothelial dysfunction. Ethics. This medical study involving a human as a subject was carried out in compliance with the Ethical principles presented in the latest version of the Helsinki Declaration, developed by the World Medical Association.

What are Juvenile-onset systemic sclerosis providers thoughts, experiences, and reasons for autologous stem cell transplant? Result of a multinational survey.

Juvenile-onset systemic sclerosis (jSSc) is a rare and life-threatening disease with no formal studies evaluating the indications for, access to, or benefits of autologous stem cell transplantation (ASCT). As a first step toward understanding pediatric jSSc specialist thoughts and experiences with ASCT, we conducted a multinational survey. An electronic survey was developed and distributed in November 2023 to members of the Pediatric Rheumatology European Society (PRES) and/or Childhood Arthritis and Rheumatology Research Alliance (CARRA) pediatric scleroderma workgroups. Twenty-nine (69%) jSSc specialists completed the survey. All participants have considered or would consider ASCT referral for a jSSc patient. Nearly all respondents indicated disease-modifying anti-rheumatic drugs (DMARDs) should be trialed prior to ASCT referral, with most indicating two to four DMARDs. The most common reasons selected for referral were rapidly progressive disease (despite DMARD) (90%), followed by severe disease status (83%), and significant impact on quality of life (83%). All respondents selected pulmonary disease as an indication for referral, followed by cardiac (93%), gastrointestinal (72%), and skin disease (66%). While pulmonary and cardiac involvement were considered individually sufficient for referral for ASCT, only a minority considered musculoskeletal involvement (28%) sufficient on its own. This survey is the first explore thoughts and experience with ASCT for jSSc. Results indicate pediatric rheumatologists were aware of and would consider ASCT for their patients. Our results indicate there is likely some variability in clinical practice regarding who is referred for ASCT, and further research is needed to guide development of evidence-based clinical care guidelines.

Preliminary Experience Using Axolotl (Ambystoma mexicanum) Dermis Patches as a Biologic Agent for Wound Management After Neurosurgical Procedures

In the US, chronic wounds affect more than 6.5 million people annually-a mean cost of $23,755 among neurosurgery patients. Current wound management solutions have disadvantages, including rejection, disease transmission from mammalian-sources, and cultural issues prohibiting some products. Here, we describe preliminary use of xenograft tissue derived from axolotl (Ambystoma mexicanum) dermis for use in wound management after neurosurgical procedures. Our prospective database was retrospectively searched for consecutive patients who underwent wound closures using axolotl dermis patches (NeoMatriX, NeXtGen Biologics, Alachua, FL). Patient demographics, daily alcohol and tobacco use, radiation history, operation type, and antibiotic regimens post-closure were collected. Rates of postoperative infection, wound dehiscence, and wound revision or repeated irrigation were collected for outcomes assessment. Twenty-three patients underwent wound closure with the patches. At least one comorbidity related to delayed wound closure was present in included patients: obesity=8(34.8%), diabetes=3(13%), chronic obstructive pulmonary disease=3(13%), hypertension=11(47.8%), hyperlipidemia=10(43.5%), hypothyroidism=3(13%), benign prostatic hyperplasia=3(13%), HIV=1(4.3%), cancer=7(30.4%), daily alcohol use=4(17.4%), and current smoking=7(30.4%). Wounds treated were from decompressive laminectomy, microvascular decompression, thoracolumbar instrumentation revision, and pseudoaneurysm ligation/resection in 1(4.3%) patient each. Three (13%) patients had wounds from aneurysm clippings, 6(26.1%) each from craniotomies and wound dehiscence treatments, and 4(17.4%) from cranioplasties. Patches were applied for primary wound closure in 14(60.9%) patients and secondary wound closure in 9(39.1%) patients. Post-application wound infection or wound dehiscence and/or revision occurred in 2(8.7%) patients. Axolotl dermis patches support mammalian wound management, demonstrating favorable potential in improving neurosurgical wound closure and healing and overall outcomes.

Long-Term Ozone Exposure, COPD, and Asthma Mortality: A Retrospective Cohort Study in the Republic of Korea

Ozone concentrations have increased in recent decades, and several studies have reported that long-term exposure to ozone increases the mortality risk induced by respiratory conditions. However, research on cause-specific mortality related to ozone exposure and respiratory diseases remains scarce. We constructed a retrospective cohort of 5,360,032 adults aged ≥ 65 years from the National Health Insurance Service of Republic of Korea, and death certificates were obtained from Statistics Republic of Korea to determine the cause of death between 2010 and 2019. The daily maximum 8 h average levels of ozone during the warm season annually (May–September) and other air pollutants were determined for the residential district. We analyzed the data using a time-varying Cox proportional hazards model with individual- and district-level covariates, incorporating a competing risk framework to address deaths from causes other than chronic obstructive pulmonary disease (COPD) and asthma. In our single-pollutant model with a 3-year moving average, a 1 ppb increase in ozone exposure was associated with a hazard ratio (HR) of 1.011 (95% confidence interval [CI]: 1.008–1.013) for COPD mortality and an HR of 1.016 (95% CI: 1.011–1.022) for asthma mortality. In our model adjusted for the presence of underlying diseases and district-level variables, the HRs were 1.009 (95% CI: 1.008–1.014) for COPD and 1.017 (95% CI: 1.011–1.023) for asthma, respectively. These associations remained robust in our two-pollutant model, except for NO2 and COPD. A linear concentration–response relationship was identified between ozone concentration, COPD, and asthma mortality. In this large nationwide cohort study, long-term exposure to ozone was associated with an increased risk of death from COPD and asthma in older Korean adults.

Expanding Naloxone Coprescribing at a Regional VA Medical Center.

Veterans are disproportionately affected by chronic pain and are more likely to be prescribed opioids. As a means of risk mitigation, the Centers for Disease Control and Prevention and Department of Defense recommend naloxone for patients on opioids with risk factors, including use of ≥50 morphine milligram equivalents daily, concurrent benzodiazepine/sedative use, and pulmonary or liver disease. An interprofessional quality improvement team consisting of 6 residents, a pharmacist, a nurse educator, and a faculty mentor was formed to increase naloxone coprescriptions at a regional VA medical center Continuity of Care Clinic. Primary intervention identified eligible patients via the VA Primary Care Almanac's Opioid Therapy Risk Report and alerted providers by email and secure messaging. Naloxone coprescription rates increased from 42% initially in June 2022 to 82% by June 2023 (29/69 to 41/50 patients, P < 0.0001). This project demonstrates that notifying providers of high-risk patients can significantly increase naloxone coprescriptions.