Respiratory Group Research Articles

Impact of non-invasive ventilation on microbial colonisation patterns in preterm infants: a single-centre study.

The objective of this study is to assess the relationship between non-invasive ventilation (NIV) and the colonisation of oral and nasal microbiota in preterm infants within the neonatal intensive care unit (NICU). A prospective cohort study. The NICU of Zhejiang University Children's Hospital. Patients include preterm infants with a gestational age of 28-35 weeks, enrolled within the first 24 hours of life. Infants were categorised based on respiratory support: NIV, which included nasal continuous positive airway pressure, nasal intermittent positive pressure ventilation or high-flow nasal cannula; and no respiratory support, defined as room air or low-flow nasal cannula at ≤2 L/min. The primary outcome was the colonisation of oral and nasal microbiota at 5 days post birth, measured by colony-forming units per millilitre (CFU/mL), with colonisation defined as bacterial growth >103 CFU/mL. The study included 100 preterm infants, with 50 in each group. Nasal microbial colonisation was observed in 56% (28/50) of the NIV group, significantly higher than the 28% in the no respiratory support group. No significant differences were found in oral colonisation. Adjusted binary logistic regression showed an association between NIV and increased risk of nasal colonisation (adjusted OR=2.91, 95% CI 1.12 to 7.58, p=0.028). NIV in preterm infants was linked to a higher risk of nasal microbial colonisation. This finding suggests the need for further research and consideration of infection control strategies in the NICU.

Primary healthcare professionals’ perceptions, attitudes and ideas regarding asthma management in Greece: A mixed-method study

Background Implementing asthma guideline recommendations is challenging and there is variation between countries, and different healthcare professionals (HCPs). The International Primary Care Respiratory Group (IPCRG) has introduced the Asthma Right Care (ARC) programme implemented in 24 low, middle, and high countries, including Greece. It offers a promising approach drawn from social movements for health to improve asthma care by engaging HCPs in implementing guideline-based asthma care. Objectives To explore HCPs’ perspectives on current provision of asthma care and their willingness to improve implementation of recommended guidelines using ARC programme tools in Greece. Methods A mixed methods study conducted from September 2020 to April 2021. A convenience sample of 30 pharmacists, and 10 General Practitioners (GPs), responded to a questionnaire investigating perceptions, and attitudes, towards implementation of asthma guidelines. Then, a qualitative survey followed with semi-structured interviews to evaluate the feedback obtained from HCPs to assess the content, and applicability of the ARC tools. Data were analysed using thematic analysis. Results A range of practical challenges in implementing guideline-recommended interventions, improving asthma control and management were described by all HCPs, including lack of time and education, high workload, patients’ perceptions, and poor communication contributing to poor management and inadequate follow-up of people with asthma. However, most HCPs were willing to use ARC interventions to improve guideline implementation. Conclusion HCPs in Greece encounter challenges in implementing asthma guidelines; however, they can overcome these challenges by using ARC interventions and engagement tools to address barriers and implement efficient asthma management strategies.

Understanding Comorbidities of Respiratory Models as Novel Platforms for Drug Discovery.

Chronic respiratory diseases affect over 450 million people worldwide and result in 4 million deaths per year. The majority of lung diseases are treated with drugs delivered directly to the lungs. However, there is bidirectional crosstalk between the lung and other organs/tissues in health and disease. This crosstalk supports targeting of extrapulmonary sites in addition to the lung to improve the comorbidities associated with lung disease. However, new preclinical in vivo and in vitro assays that model the human pathophysiology are required. In this review, we showcase the latest knowledge of the bidirectional relationship between the respiratory system and organs affected by comorbidities such as obesity and atherosclerosis. We also discuss the impact of new cell culture systems, including complex 3D culture models that may be used as platforms to generate disease insights and for drug discovery. This review highlights work presented by Respiratory and Inflammation Special Interest Group researchers as part of the Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists (ASCEPT) annual scientific meeting in 2023.

Brainstem opioid peptidergic neurons regulate cough reflexes in mice

Cough is a vital defensive reflex for expelling harmful substances from the airway. The sensory afferents for the cough reflex have been intensively studied. However, the brain mechanisms underlying the cough reflex remain poorly understood. Here, we developed a paradigm to quantitatively measure cough-like reflexes in mice. Using this paradigm, we found that prodynorphin-expressing (Pdyn+) neurons in the nucleus of the solitary tract (NTS) are critical for capsaicin-induced cough-like reflexes. These neurons receive cough-related neural signals from Trpv1+ vagal sensory neurons. The activation of Pdyn+ NTS neurons triggered respiratory responses resembling cough-like reflexes. Among the divergent projections of Pdyn+ NTS neurons, a glutamatergic pathway projecting to the caudal ventral respiratory group (cVRG), the canonical cough center, was necessary and sufficient for capsaicin-induced cough-like reflexes. These results reveal that Pdyn+ NTS neurons, as a key neuronal population at the entry point of the vagus nerve to the brainstem, initiate cough-like reflexes in mice.

Korean Guidelines for the Management and Antibiotic Therapy in Adult Patients with Hospital-Acquired Pneumonia.

Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are correlated with high morbidity and mortality rates. Guidelines that consider local epidemiologic data are fundamental for identifying optimal treatment strategies. However, Korea has no HAP/VAP guidelines. This study was conducted by a committee of nine experts from the Korean Academy of Tuberculosis and Respiratory Diseases Respiratory Infection Study Group using the results of Korean HAP/VAP epidemiologic studies. Eleven key questions for HAP/VAP diagnosis and treatment were addressed. The Convergence of Opinion on Suggestions and Evidence (CORE) process was used to derive suggestions, and evidence levels and recommendation grades were in accordance with the Grading of Recommendations Assessment Development and Evaluation (GRADE) methodology. Suggestions were made for the 11 key questions pertinent to diagnosis, biomarkers, antibiotics, and treatment strategies for adult patients with HAP/VAP. Using the CORE process and GRADE methodology, the committee generated a series of recommendations for HAP/VAP diagnosis and treatment in the Korean context.

Long lasting degradation of all alkanes in soil by Pseudomonas activated after Fenton pre-oxidation

This study investigated the function and mechanism of Fenton pre-oxidation on the long lasting degradation of all alkanes in soil contaminated by petroleum. The findings demonstrated that the biological removal amount of all alkanes in the respiratory regulation group reached 4083.46 mg/kg, which was twice that of the non-regulation group, and the removal amount gradually increased in the four stages of bioremediation. In addition, the removal amount of all alkanes in the non-regulated group did not change much and showed a downward trend, indicating that long lasting degradation of all alkanes could be achieved by the respiratory regulation group, and the biodegradation cycle was saved by 251 days compared with the non-regulated group. Furthermore, the total number of bacteria in the respiratory regulation group (6.73 log CFU/g) was significantly higher than that in the non-regulation group (2.25 log CFU/g). Pseudomonas became the dominant genus in the respiratory regulation group with an average relative abundance of 32.17 %. In the respiratory regulation group, a large amount of ammonia nitrogen (1703.62 mg/kg) was consumed during the degradation process, which stimulated the tricarboxylic acid cycle respiratory metabolism process of Pseudomonas and accelerated the hydrocarbon conversion. This may be the reason why the long lasting degradation of all alkanes in soil could be achieved by the respiratory regulation group.

Characterization of the oral mycobiome of Portuguese with allergic rhinitis and asthma

Allergic rhinitis and asthma are two prevailing chronic airway diseases and serious public health concerns. Previous research has already described the role of the airway bacteriome in these two diseases, but almost no study so far has explored the mycobiome and its possible association to airway inflammation. Here we sequenced the internal transcribed spacers (ITS) 1 and 2 to characterize the oral mycobiome of 349 Portuguese children and young adults with allergic rhinitis alone (AR) or with asthma (ARAS), asthmatics (AS) and healthy controls (HC). Our genomic analyses showed that the two most abundant fungal phyla (Ascomycota and Basidiomycota) and 3-5 of the 14 most abundant fungal genera (Cladosporium, Aspergillus, Aleurina, Candida and Rhodotorula) in the mouth differed significantly (P≤0.04) between both rhinitic groups and HC. However, none of the same taxa varied significantly between the three respiratory disease groups (AR, ARAS and AS). The oral mycobiomes of respiratory ill patients showed the highest intra-group diversity (microbial richness and evenness), while HC showed the lowest, with all alpha-diversity indices varying significantly (P≤0.0424) between them. Similarly, all disease groups showed significant differences (P≤ 0.0052) in microbial structure (i.e., beta-diversity indices) when compared to HC samples. Thirty metabolic pathways (PICRUSt2) were differentially abundant (Wald's test) between AR or ARAS and HC patients, but only one of them (D-galactose degradation I) was over abundant (log2 Fold Change >0.75) in the ARAS group. Spiec-Easi fungal networks varied greatly among groups, which suggests chronic respiratory allergic diseases may alter fungal connectivity in the mouth. This study increases our comprehension of the role of the oral mycobiome in allergy-related conditions. It shows for the first time that the oral mycobiota changes during health and allergic rhinitis (with and without asthma comorbidity) and highlights specific taxa, metabolic pathways and fungal interactions that may relate to chronic airway disease.

Effects of preoperative respiratory muscle training for improvement of postoperative health related quality of life in mitral valve replacement patients.

A patient's defective mitral valve is replaced as part of a treatment called mitral valve replacement (MVR) with a mechanical or biological (bioprosthetic) valve. To evaluate the effects of preoperative respiratory muscle training (RMT) on the improvement of postoperative Health related quality of life in MVR patients. A quasi-experimental study was conducted at Faisalabad Institute of Cardiology. A Sample of 40 adult patients aged 25-50years of both genders who underwent MVR was selected and divided into two groups Group 1 (Respiratory Muscle Training Group) was received RMT consisting of 10-15 repetitions a day for 5days; for 3weeks. Whereas Group 2 (Conventional Group) was receive breathing exercise consisting of 10-12 repetitions a day for 5days; for 3weeks. Modified Healthy Heart Questionnaire (HHQ-GP-1) was used as screening tool. In outcome measuring tools Health Related Quality of life Questionnaire (EuroQol), New York Heart Association, was used at baseline, 3rd week and postoperatively. Duration of Postoperative Mechanical Ventilation (hours) and Hospital Stay was also noted as outcome measures of this study. Results obtained indicate that level of Self-Care in EuroQol-5-D-5L has improved in group 1 3.35±1.03 to 1.35±0.48 showing significant improvement similarly in case of Hospital Length of Stay, Mechanical ventilation 4.05±0.68 to 5.05±0.51 and Pain 65.25±8.34 to 71.50±6.70 has improved. It was concluded that Respiratory Muscle Training and Conventional Muscle Training both are effective in MVR patients. But RMT is more effective in improving self-care, reducing pain, Hospital Length of Stay and Mechanical Ventilation in postoperative period as compared to Conventional Muscle Treatment.

Development and application of a rapid research prioritisation process for identifying health research priorities in low- and middle-income countries: the RAPID-RP stakeholder analysis

Background Health research should be locally prioritised by key stakeholders to ensure the best use of available resources, maximum likelihood of research leading to uptake into policy and practice and relevance to the needs of the potential beneficiaries. Established approaches are complex and time-consuming, therefore not feasible in settings where prioritisation is uncommon and time is limited. Objectives We developed and applied a simple, rapid research prioritisation approach to elicit the views of stakeholders. Setting and participants This was a collaboration between a multidisciplinary group of United Kingdom academics, the International Primary Care Respiratory Group and primary care respiratory researchers from four low- and middle-income countries: Brazil, China, Georgia and North Macedonia. We identified 10 topics for research prioritisation through workshops involving 26 topic, methods and local context experts, and considering the programme remit, to develop, adapt and evaluate culturally appropriate community and behavioural approaches for the prevention, early identification and management of chronic obstructive pulmonary disease in primary care. Design and methods In each setting, local research teams convened stakeholder groups of patients, clinicians, managers/policymakers and researchers. Each group briefly discussed the 10 potential research study topics. Discussions were facilitated using short vignettes for each topic, and participants were encouraged to consider importance, feasibility and equity. Individual participants rated each study on a three-point traffic light scale, then ranked them following a facilitated discussion on what drove the ratings. The research team rated then ranked each study considering three further criteria (international novelty, potential for future funding and capacity building on a five-point scale). Within each group, ranks were summed to create a final rank order which guided our research programme and provided insight for future projects. Results In each country, four to eight members attended each stakeholder group. The engagement process was completed in less than 4 hours and feedback was very positive, especially from patients who valued the opportunity to contribute to research decision-making about their own condition. Ranking varied to some extent between groups and settings, but there was consistency around topics that were prioritised among the top five in all groups (identifying efficient chronic obstructive pulmonary disease screening test strategies, evaluations of lung age to aid smoking cessation, feasibility of locally adapted pulmonary rehabilitation, clinical education for primary care staff) and study topics that consistently ranked low (use of e-cigarettes for smoking cessation, weight management to improve chronic obstructive pulmonary disease symptoms and handwashing to reduce infections). Limitations Despite attempts to maximise inclusivity and diversity, stakeholders were mainly limited geographically to the centres where researchers were based, potentially limiting generalisability of views across the countries. Facilitator styles varied and may have influenced some of the discussions and potentially the ranking. Conclusions Despite some limitations, we demonstrated the feasibility and acceptability of the rapid research prioritisation approach stakeholder analysis for identifying locally relevant research priorities in low- and middle-income country settings. Future work Further validation is needed for aspects of the process. We have identified some useful lessons from our evaluation of the process, to facilitate future use of this approach. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Global Health Research programme as award number 16/137/95.

Role of the pontine respiratory group in the suppression of cough by codeine in cats

Codeine was microinjected into the area of the Kölliker-Fuse nucleus and the adjacent lateral parabrachial nucleus, within the pontine respiratory group in 8 anesthetized cats. Electromyograms (EMGs) of the diaphragm (DIA) and abdominal muscles (ABD), esophageal pressures (EP), and blood pressure were recorded and analyzed during mechanically induced tracheobronchial cough. Unilateral microinjections of 3.3 mM codeine (3 injections, each 37 ± 1.2 nl) had no significant effect on the cough number. However, the amplitudes of the cough ABD EMG, expiratory EP and, to a lesser extent, DIA EMG were significantly reduced. There were no significant changes in the temporal parameters of the cough. Control microinjections of artificial cerebrospinal fluid in 6 cats did not show a significant effect on cough data compared to those after codeine microinjections. Codeine-sensitive neurons in the rostral dorsolateral pons contribute to controlling cough motor output, likely through the central pattern generator of cough.

Combined effects of a Mediterranean diet and respiratory muscle training on higher education woodwind musicians: A randomized controlled trial

A two-factor within subjects and randomized controlled was conducted with three groups (two experimental and one control) to explore the effects of the Mediterranean diet and respiratory muscle training on ventilatory fatigue, stress, and emotional performance of woodwind musicians. 70 students from the Valencia Conservatory of Music were recruited and randomized into three groups: respiratory training group + nutrition program (RTG; n = 17), control group (CG; n = 35) and nutrition program group (NPG; n = 18). The nutritional program was based on Mediterranean a diet. Body composition, emotional intelligence, physiological stress and ventilatory response were assessed for all groups before and after intervention. Mixed ANOVA showed main effects of diet and training interventions on emotional attention (F = 8.042; p = 0.006), clarity (F = 9.306; p = 0.003), repair (F = 5.527; p = 0.022), Forced-Expiratory-Volume (F = 30.196; p < 0.000) and Forced-Vital-Capacity (F = 21.052; p < 0.000), with both interventions improving emotional intelligence and ventilatory variables. Bonferroni post-hoc analysis revealed significant differences of RTG and CG for emotional attention (MD = 4.60; p = 0.023), comprehension (MD = 5.734; p = 0.005), repair (MD = 8.576; p < 0.000), FEV1 (MD = 0.862; p = 0.005), and FCV (MD = 1.608; p < 0.001); with similar results when comparing NTG and CG: emotional attention (MD = 4.156; p = 0.041), comprehension (MD = 4.473; p = 0.033), repair (MD = 6.511; p = 0.001), Forced-Expiratory-Volume (MD = 1.608; p < 0.001), and Forced-Vital-Capacity (MD = 1.183; p < 0.001). No significant effects of experimental groups were observed for physiological stress variables (p > 0.05). This results suggests that respiratory training enhances emotional intelligence and lessens respiratory fatigue in musicians, and a combination of a Mediterranean diet and respiratory muscle training further boosts emotional intelligence, albeit with limited impact on physiological stress. This study represents a novel investigation into the approach by dietary interventions and respiratory muscle training in wind musicians since there are no studies that analyze it.

Expert consensus on clinical application of inhaled nitric oxide therapy (2024 edition)

Inhaled nitric oxide (iNO) is a selective pulmonary vasodilator that has been used in newborns, children, and adults with various cardiopulmonary diseases to reduce pulmonary artery pressure and improve oxygenation. Currently, there are numerous brands of iNO devices on the market with significant differences in performance, as well as variations in connection and setup. Additionally, adverse reactions such as methemoglobinemia may occur during iNO treatment. Therefore, the safety and efficacy of this treatment need to be ensured in clinical practice. To address these concerns and standardize the clinical application of iNO therapy, the Respiratory Care Group of Chinese Thoracic Society and Respiratory Therapist Working Group of Respiratory Career Development Committee, Chinese Association of Chest Physician have organized relevant experts to develop an expert consensus on the clinical application of iNO therapy based on the latest research progress and clinical operational experience. This consensus includes 11 expert consensus recommendations on indications and contraindications of iNO, selection and connection of iNO devices, dose selection and therapeutic effect evaluation of iNO, adverse effects and occupational protection during iNO treatment, transport of patients with iNO, weaning of iNO, cleaning, disinfection and maintenance of iNO devices, and iNO clinical use process and records. The aim is to improve the cognitive and practical ability of clinical practitioners for the standardized application of iNO therapy, so as to ensure the safety and effectiveness of clinical application of iNO therapy.

Noninvasive pressure-strain loop quantitative assessment of left ventricular function in anemic preterm infants with different modes of respiratory support

To investigate noninvasive pressure-strain loop (PSL) combined with two-dimensional speck tracking imaging and left ventricular pressure measurement in the evaluation of cardiac function changes in anemia of prematurity (AOP) with different modes of respiratory support, and to explore its value in detecting subclinical myocardial injury in preterm infants. This retrospective study included 79 preterm infants with anemia, according to different modes of respiratory support, who were divided into invasive respiratory support group (39 cases) and noninvasive respiratory support group (40 cases). A control group of 40 nonanemic preterm infants with matched age, sex, and gestational age were also included. Complete echocardiography was performed for each included infant. There are PSL parameters that used to evaluate cardiac function, including global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) among the three groups were compared. Compared with the control group, the value of GWI, GCW, and GWE were significantly lower and GWW was higher in the AOP groups (P < 0.05), and GWI, GCW and GWE were much significantly lower in the invasive respiratory support group than in the noninvasive respiratory support group (P < 0.05). There was no significant difference in GLS among the three groups (P > 0.05). Noninvasive PSL analysis can quantitatively assess myocardial work in AOP with different respiratory support, which is more sensitive than other conventional echocardiographic indices. This technique may provide a new method for monitoring subclinical myocardial injury with AOP.

Predictive value of hematocrit, serum albumin level difference, and fibrinogen-to-albumin ratio for COVID-19-associated acute respiratory failure

BackgroundAcute respiratory failure is the main clinical manifestation and a major cause of death in patients with COVID-19. However, few reports on its prevention and control have been published because of the need for laboratory predictive indicators. This study aimed to evaluate the predictive value of hematocrit level, serum albumin level difference, and fibrinogen-to-albumin ratio for COVID-19-associated acute respiratory failure. Material and methodsA total of 120 patients with COVID-19 from the First Affiliated Hospital of Anhui Medical University were selected between December 2022 and March 2023. Patients were divided into acute respiratory failure and non-acute respiratory failure groups and compared patient-related indicators between them using univariate and multivariate logistic regression analyses. Receiver operating characteristic analysis was performed to determine the discrimination accuracy. ResultsIn total, 48 and 72 patients were enrolled in the acute respiratory failure and non-acute respiratory failure groups, respectively. The Quick COVID-19 Severity Index scores, fibrinogen-to-albumin ratio, hematocrit and serum albumin level difference, fibrinogen, and hematocrit levels were significantly higher in the acute respiratory failure group than in the non-acute respiratory failure group. A Quick COVID-19 Severity Index >7, fibrinogen-to-albumin ratio >0.265, and hematocrit and serum albumin level difference >12.792 had a 96.14 % positive predictive rate and a 94.06 % negative predictive rate. ConclusionBoth fibrinogen-to-albumin ratio and hematocrit and serum albumin level difference are risk factors for COVID-19-associated acute respiratory failure. The Quick COVID-19 Severity Index score combined with fibrinogen-to-albumin ratio, and hematocrit and serum albumin level difference predict high and low risks with better efficacy and sensitivity than those of the Quick COVID-19 Severity Index score alone; therefore, these parameters can be used collectively as a risk stratification method for assessing patients with COVID-19.

PTEN inhibition promotes robust growth of bulbospinal respiratory axons and partial recovery of diaphragm function in a chronic model of cervical contusion spinal cord injury

High spinal cord injury (SCI) leads to persistent and debilitating compromise in respiratory function. Cervical SCI not only causes the death of phrenic motor neurons (PhMNs) that innervate the diaphragm, but also damages descending respiratory pathways originating in the rostral ventral respiratory group (rVRG) located in the brainstem, resulting in denervation and consequent silencing of spared PhMNs located caudal to injury. It is imperative to determine whether interventions targeting rVRG axon growth and respiratory neural circuit reconnection are efficacious in chronic cervical contusion SCI, given that the vast majority of individuals are chronically-injured and most cases of SCI involve contusion-type damage to the cervical region. We therefore employed a rat model of chronic cervical hemicontusion to test therapeutic manipulations aimed at reconstructing damaged rVRG-PhMN-diaphragm circuitry to achieve recovery of respiratory function. At a chronic time point post-injury, we systemically administered: an antagonist peptide directed against phosphatase and tensin homolog (PTEN), a central inhibitor of neuron-intrinsic axon growth potential; an antagonist peptide directed against receptor-type protein tyrosine phosphatase sigma (PTPσ), another important negative regulator of axon growth capacity; or a combination of these two peptides. PTEN antagonist peptide (PAP4) promoted partial recovery of diaphragm motor activity out to nine months post-injury (though this effect depended on the anesthetic regimen used during recording), while PTPσ peptide did not impact diaphragm function after cervical SCI. Furthermore, PAP4 promoted robust growth of descending bulbospinal rVRG axons caudal to the injury within the denervated portion of the PhMN pool, while PTPσ peptide did not affect rVRG axon growth at this location that is critical to control of diaphragmatic respiratory function. In conclusion, we find that, when PTEN inhibition is targeted at a chronic time point following cervical contusion, our non-invasive PAP4 strategy can successfully promote significant regrowth of damaged respiratory neural circuitry and also partial recovery of diaphragm motor function.

First Report of Porcine Parvovirus 2 (PPV2) in Pigs from Colombia Associated with Porcine Reproductive Failure (PRF) and Porcine Respiratory Disease Complex (PRDC)

Pigs are affected by various parvoviruses (PPVs); eight have been reported to date (PPV1–PPV8). Porcine parvovirus 1 is considered a primary agent of porcine reproductive failure (PRF), while it is unknown whether other PPVs impact porcine health. Recently, the presence of PPV2 has been confirmed in the lung, either as a single agent or in the form of coinfection with other respiratory; therefore, it has been proposed as a potential participant in the porcine respiratory disease complex (PRDC). In the present study, the presence of PPV2 alone and coinfection with other viruses (PCV2, PCV3, and PRRSV) was evaluated in lung samples obtained from pigs with respiratory signs (respiratory group: RG) (n = 146) and stillborn lungs (stillborn group: SG) (n = 19) from 82 farms in the five regions with the highest swine production in Colombia. The overall PPV2 prevalence was 37.6% (62/165), with the highest proportion mainly detected in grow-finisher pigs (62.5%), while its herd prevalence was 51.2% (42/82). The most prevalent virus was PRRSV in both groups, while PPV2 alone was found only in the RG group. The most common dual coinfection in the RG and SG was PCV2/PRRSV (17.8% and 10.5%), while the most frequent coinfections involving PPV2 in the RG were PPV2/PCV2 (7.5%) and PPV2/PRRSV (4%) and PPV2/PCV2 (5.3%) in the SG. The most common triple coinfection was PPV2/PCV2/PRRSV at 15% in the RG and 21% in the SG, while quadruple coinfection PVV2/PCV2/PCV3/PRRSV was detected only in the RG (5.5%). Histopathological evaluation of 21 PPV2-positive lungs showed variable degrees of histiocytic or lymphohistiocytic interstitial pneumonia (9%) in the RG, while no significant changes were observed in SG; in addition, neutrophilic bronchopneumonia was observed in 73.7% if cases evaluated. In situ hybridization-RNAScope® confirmed the presence of PPV2 within pulmonary lesions in 2/19 RG pigs, while no in situ detection was observed in the SG pigs. The phylogenetic evaluation of seven PPV2 sequences detected in Colombia was compared with another 102 reported sequences, indicating that the Colombian strains are located in clade 2. Our results confirm the presence of PPV2 in pigs with PRDC alone and pigs coinfected with PCV2, PCV3, and PRRSV. Likewise, its presence alone or in coinfection in stillbirths suggests that PPV2 is also involved in PRF.

Logistic regression analysis of the value of biomarkers, clinical symptoms, and imaging examinations in COVID-19 for SARS-CoV-2 nucleic acid detection.

The detection of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) nucleic acid detection provides a direct basis for diagnosing Coronavirus Disease 2019. However, nucleic acid test false-negative results are common in practice and may lead to missed diagnosis. Certain biomarkers, clinical symptoms, and imaging examinations are related to SARS-CoV-2 nucleic acid detection and potential predictors. We examined nucleic acid test results, biomarkers, clinical symptoms, and imaging examination data for 116 confirmed cases and asymptomatic infections in Zhuhai, China. Patients were divided into nucleic acid-positive and -false-negative groups. Predictive values of biomarkers, symptoms, and imaging for the nucleic acid-positive rate were calculated by Least Absolute Shrinkage and Selection Operators regression analysis and binary logistic regression analysis, and areas under the curve of these indicators were calculated. Hemoglobin (OR = 1.018, 95% CI: 1.006-1.030; P = .004) was higher in the respiratory tract-positive group than the nucleic acid-negative group, but platelets (OR = 0.996, 95% CI: 0.993-0.999; P = .021) and eosinophils (OR = 0.013, 95% CI: 0.001-0.253; P = .004) were lower; areas under the curve were 0.563, 0.614, and 0.642, respectively. Some biomarkers can predict SARS-CoV-2 viral nucleic acid detection rates in Coronavirus Disease 2019 and are potential auxiliary diagnostic tests.

Impacts of heat exposure in utero on long-term health and social outcomes: a systematic review

BackgroundClimate change, particularly global warming, is amongst the greatest threats to human health. While short-term effects of heat exposure in pregnancy, such as preterm birth, are well documented, long-term effects have received less attention. This review aims to systematically assess evidence on the long-term impacts on the foetus of heat exposure in utero.MethodsA search was conducted in August 2019 and updated in April 2023 in MEDLINE(PubMed). We included studies on the relationship of environmental heat exposure during pregnancy and any long-term outcomes. Risk of bias was assessed using tools developed by the Joanna-Briggs Institute, and the evidence was appraised using the GRADE approach. Synthesis without Meta-Analysis (SWiM) guidelines were used.ResultsEighteen thousand six hundred twenty one records were screened, with 29 studies included across six outcome groups. Studies were mostly conducted in high-income countries (n = 16/25), in cooler climates. All studies were observational, with 17 cohort, 5 case-control and 8 cross-sectional studies. The timeline of the data is from 1913 to 2019, and individuals ranged in age from neonates to adults, and the elderly. Increasing heat exposure during pregnancy was associated with decreased earnings and lower educational attainment (n = 4/6), as well as worsened cardiovascular (n = 3/6), respiratory (n = 3/3), psychiatric (n = 7/12) and anthropometric (n = 2/2) outcomes, possibly culminating in increased overall mortality (n = 2/3). The effect on female infants was greater than on males in 8 of 9 studies differentiating by sex. The quality of evidence was low in respiratory and longevity outcome groups to very low in all others.ConclusionsIncreasing heat exposure was associated with a multitude of detrimental outcomes across diverse body systems. The biological pathways involved are yet to be elucidated, but could include epigenetic and developmental perturbations, through interactions with the placenta and inflammation. This highlights the need for further research into the long-term effects of heat exposure, biological pathways, and possible adaptation strategies in studies, particularly in neglected regions. Heat exposure in-utero has the potential to compound existing health and social inequalities. Poor study design of the included studies constrains the conclusions of this review, with heterogenous exposure measures and outcomes rendering comparisons across contexts/studies difficult.Trial RegistrationPROSPERO CRD 42019140136.

Mapping inhibitory and excitatory projections to the preBӧtzinger complex

Breathing relies on rhythmic activity generated by the preBӧtzinger complex (preBӧtC), a small brainstem region. Because breathing is influenced by many different physiological, behavioral, and emotional contexts, the preBӧtC is not only highly connected with nearby respiratory related regions in the hindbrain, but also has widespread connections with other mid-and forebrain regions not generally implicated in the regulation of breathing. The specific functions for many of these preBӧtC inputs remain unclear. Although afferent pathways indiscriminately target excitatory and inhibitory neurons in the preBӧtC, we hypothesized that inputs to the preBӧtC would map to distinct brain regions based on the inhibitory or excitatory phenotype of the projecting neurons. To test this, mice that express tdTomato only when both Cre and FlpO recombinases are present (Ai65) were bred with mice that express Cre in inhibitory neurons ( VgatCre). Adult offspring ( VgatCre; Ai65) received a unilateral preBӧtC injection of a retrograde AAV that expresses FlpO recombinase (AAVrg-Flpo), thereby specifically activating tdTomato expression in any inhibitory neurons that project directly to the preBӧtC. Whole-brain imaging revealed many labeled neurons along the ipsilateral ventral respiratory column (VRC), far rostral and caudal of the injection site, extending along the intermediate reticular zone (IRt) from the VII nucleus through the caudal end of the ventral respiratory group (VRG). Interestingly, this well-defined and continuous column of labeled neurons was confined to the ventral IRt at its caudal end but moved dorsally at its rostral end. Only a small number of neurons were labeled along the contralateral VRC. Sparse labeling was present in the medial parabrachial, Kolliker-Fuse, and reticular regions of the pons. Many projecting neurons were observed across subregions of the amygdala, which were almost exclusively ipsilateral. The hypothalamus contained diffuse projecting neurons along its rostral-caudal extent that were also mostly ipsilateral. However, denser labeling was present in a distinctly curved cluster of the lateral hypothalamus, which was observed on both the ipsilateral and contralateral side. Consistent with the preBӧtC having distinct inhibitory and excitatory input pathways, we did not observe significant labelling in other regions with known projections to the preBotC identified previously using non-cell-type specific tracing strategies. These included cortex, lateral parabrachial, NTS, and RVM. This will be tested further by replicating this experiment with targeting of glutamatergic ( Vglut2) neurons. Defining these cell-type-specific inputs to the preBӧtC will provide an essential foundation for future functional studies to determine how these circuits may regulate breathing. R01 HL1660317 (Baertsch) R00 HL145004 (Baertsch). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Home spirometry appears accurate and feasible for monitoring chronic respiratory disease.

Spirometry is underutilised and can be difficult to access. This study assessed the accuracy and feasibility of home spirometry compared to gold standard. Findings suggest home spirometry is accurate and feasible across many respiratory disease groups. https://bit.ly/42TLoYd.