Respiratory Pressure Research Articles

COMPARATIVE CHARACTERISTICS OF THE DYNAMICS OF CARDIOVASCULAR AND RESPIRATORY EFFECTS OF PNEUMOPERITONEUM BASED ON CARBON DIOXIDE AND ARGON IN LAPAROSCOPIC CHOLECYSTECTOMY

Pneumoperitoneum is one of the most critical components of laparoscopic surgery, which has a negative effect on gas exchange and stress to circulatory buffering system. One of the top priorities of laparoscopic technologies is to minimize the impact on the respiratory and cardiovascular systems, metabolic dynamics and compensatory abilities of homeostasis.
 The main goal of this research work is to compare the effects of carboxyperitoneum and argonoperitoneum on the intraoperative dynamics of CO2 concentration as well as cardiovascular and respiratory characteristics in patients undergoing laparoscopic cholecystectomy for various forms of cholelithiasis.
 Materials and methods. Four experimental groups involved patients based on their nosological form of cholelithiasis and the gas used to induce pneumoperitoneum. All patients underwent laparoscopic cholecystectomy by means of standard procedure. Either medical carbon dioxide or medical argon was used to induce pneumoperitoneum. Intraoperative monitoring of blood carbon dioxide levels PaCO2 was performed by taking venous blood every 15 minutes. Capnometry was performed by means of mainstream analysis using “BIOMED” BM1000C modular patient monitor by recording the discrete values of PetCO2 every 15 minutes, as well as by analyzing photocopies of capnography curves every 15 minutes.
 Intraoperative echocardiography was performed to identify the mean arterial pressure (MAP), heart rate (HR) and cardiac output (CO) in order to assess the effects of different types of pneumoperitoneum on the cardiovascular system.
 Results. The obtained data confirm the expected difference in the indices of cardiorespiratory functions between patients with acute cholecystitis and cholelithiasis without signs of inflammation. The investigation revealed that under the influence of pneumoperitoneum, heart rate and mean arterial pressure increase, while the cardiac output decreases. The respiratory pressure marker depends more on the intra-abdominal pressure and presumably the patient’s body type than on the presence of inflammatory syndrome. Argon insufflation has a slight negative impact on the cardiovascular system. Particularly, the mean arterial pressure and heart rate increase, while the cardiac output marker is less decreased as compared to the use of carbon dioxide. Abdominal pressure has a significant effect on the cardiovascular and respiratory systems regardless of the used type of gas. The combination of high intra-abdominal pressure with the elevated head end of the operating table, which is a common practise during cholecystectomy, has especially great influence on cardiovascular and respiratory functions. Operation which is carried out at decreased pressure allows reducing the deviations of practically all indices.
 Conclusions. Thus, the cardiovascular and respiratory systems adapt under the influence of pneumoperitoneum, providing compensation for the negative effects of mechanical and resorptive-metabolic character. Compensatory-adaptive abilities of the cardiovascular and respiratory systems increase with the decrease of intra-abdominal pressure. The use of argon as a working gas for insufflation into the abdominal cavity during laparoscopy reduces the negative impact of pneumoperitoneum on the cardiovascular and respiratory systems, providing a greater reserve of homeostatic and buffer systems of the body.

Estimation of Respiratory Nasal Pressure and Flow Rate Signals Using Different Respiratory Sound Features

BackgroundRespiratory sounds are associated with the flow rate, nasal flow pressure, and physical characteristics of airways. In this study, we aimed to develop the flow rate and nasal flow pressure estimation models for the clinical application, and find out the optimal feature set for estimation to achieve the optimal model performance. MethodsRespiratory sounds and flow rate were acquired from nine healthy volunteers. Respiratory sounds and nasal flow pressure were acquired from twenty-three healthy volunteers. Four types of respiratory sound features were extracted for flow rate and nasal flow pressure estimation using different estimation models. Effects of estimations using these features were evaluated using Bland-Altman analysis, estimation error, and respiratory sound feature calculation time. Besides, expiratory and inspiratory phases divided estimation errors were compared with united estimation errors. ResultsThe personalized logarithm model was selected as the optimal flow rate estimation model. Respiratory nasal flow pressure estimation based on this model was also performed. For the four different respiratory sound features, there is no statistically significant difference in flow rate and pressure estimation errors. LogEnvelope was, therefore, chosen as the optimal feature because of the lowest computational cost. In addition, for any type of respiratory sound feature, no statistically significant difference was observed between divided and united estimation errors (flow rate and pressure). ConclusionRespiratory flow rate and nasal flow pressure can be estimated accurately using respiratory sound features. Expiratory and inspiratory phases united estimation using respiratory sounds is a more reasonable estimation method than divided estimation. LogEnvelope can be used for this united respiratory flow rate and nasal flow pressure estimation with minimum computational cost and acceptable estimation error.

High-Frequency Positive Pressure Ventilation as Primary Rescue Strategy for Patients with Congenital Diaphragmatic Hernia: A Comparison to High-Frequency Oscillatory Ventilation.

The aim of this article was to evaluate high-frequency positive pressure ventilation (HFPPV) compared with high-frequency oscillatory ventilation (HFOV) as a rescue ventilation strategy for patients with congenital diaphragmatic hernia (CDH). HFPPV is a pressure-controlled conventional ventilation method utilizing high respiratory rate and low positive end-expiratory pressure. Seventy-seven patients diagnosed with CDH from January 2005 to September 2019 who were treated with stepwise progression from HFPPV to HFOV versus only HFOV were included. Fisher's exact test and the Kruskal-Wallis test were used to compare outcomes. Patients treated with HFPPV + HFOV had higher survival to discharge (80 vs. 50%, p = 0.007) and to surgical intervention (95.6 vs. 68.8%, p = 0.003), with average age at repair 2 days earlier (p = 0.004). Need for extracorporeal membrane oxygenation (p = 0.490), inhaled nitric oxide (p = 0.585), supplemental oxygen (p = 0.341), and pulmonary hypertension medications (p = 0.381) were similar. In CDH patients who fail respiratory support with conventional ventilation, HFPPV may be used as an intermediary mode of rescue ventilation prior to HFOV without adverse effects. · HFPPV may be used as an intermediary mode of rescue ventilation prior to HFOV without adverse effect.. · HFPPV is more widely available and can mitigate the limitations faced when using HFOV.. · HFPPV allows for intra- or interhospital transfer of neonates with CDH..

EFFECT OF ORAL TOBACCO ON VITAL DATA

Chewing Tobacco is a global public Health hazard. oral and nasal smokeless products have been used in many countries for centuries. Smokeless tobacco use has been associated with oral cancer and leukoplakia at the site of application of tobacco . .Nicotine is cardio active , changes in heart rate, temperature respiratory rate blood pressure were observed . At present cross-sectional study was done between September 2020 to February 2021 on apparently healthy individuals of age group 20 to 40 years who have the habit of tobacco chewing for more than 2 years. Oral use of smokeless tobacco is widely prevalent in India. On chewing tobacco in any form, nicotine is released into bloodstream which in turn has effect on sympathetic nervous system Hence the present study was conducted to study the effect of oral tobacco on heart rate , respiratory rate , blood pressure and temperature

Pilot Study of the Influence of Equine Assisted Therapy on Physiological and Behavioral Parameters Related to Welfare of Horses and Patients.

Simple SummaryEquine assisted therapy is being used successfully in patients with different psychic and motor pathologies. In the present work, different physiological and behavioral parameters have been evaluated in horses and patients with psychomotor alterations during equine assisted therapy sessions. After a first anticipatory phase in which signs of stress were observed in the behavior of the horses, with increased heart and respiratory rates as well as increased blood pressure, the horses relaxed in the phase of interaction with the patients on the ground. Later, in the phase of interaction with the patient on horseback, physical activity increased the heart and respiratory rates in the horses, but these parameters decreased after finishing the sessions (recovery phase). The patients also showed some anticipatory stress with increased heart rate in the first phase, but they relaxed during the interaction phases on the ground and on horseback. In addition, the quality of sleep improved on the days of therapy. On the other hand, the patients improved their fine and gross motor function, as well as the parameters related to the cognitive, emotional and affective-social areas. The benefits in the patients had a positive influence on the quality of life of their families.Different welfare indicators were studied in three patients with psychomotor alterations and in two horses throughout 9–10 equine assisted therapy sessions in each patient. In horses, heart and respiratory rates, blood pressure, temperature and behavioral signs were studied. In patients, heart rate, oxygen saturation, temperature, sleep quality, psychomotor and emotional parameters were analyzed. Data collection was recorded in the anticipatory phase (15 min before the start of the session), two interaction phases (after 30 min of horse-patient interaction on the ground and on horseback, respectively) and the recovery phase (15 min after the end of the session). During the anticipatory phase, most of physiological parameters of patients and horses and the stress behavioral signs of horses increased, followed by a relaxing phase during the horse-patient interaction on the ground. In horse-patient riding phase the heart and respiratory rates of the horses again increased. These results showed that the horses did not seem to suffer stress attributable to the therapy sessions, but only an increase in their parameters associated with activity and external stimuli. The patients improved their gross and fine motor skills, their cognitive and perceptual-sensitive parameters and it led to an improvement in the life quality of their families.

Surface EMG-based quantification of inspiratory effort: a quantitative comparison with Pes

BackgroundInspiratory patient effort under assisted mechanical ventilation is an important quantity for assessing patient–ventilator interaction and recognizing over and under assistance. An established clinical standard is respiratory muscle pressure textit{P}_{mathrm{mus}}, derived from esophageal pressure (textit{P}_{mathrm{es}}), which requires the correct placement and calibration of an esophageal balloon catheter. Surface electromyography (sEMG) of the respiratory muscles represents a promising and straightforward alternative technique, enabling non-invasive monitoring of patient activity.MethodsA prospective observational study was conducted with patients under assisted mechanical ventilation, who were scheduled for elective bronchoscopy. Airway flow and pressure, esophageal/gastric pressures and sEMG of the diaphragm and intercostal muscles were recorded at four levels of pressure support ventilation. Patient efforts were quantified via the textit{P}_{mathrm{mus}}-time product ({mathrm{PTP}}_{mathrm{mus}}), the transdiaphragmatic pressure-time product ({mathrm{PTP}}_{mathrm{di}}) and the EMG-time products (ETP) of the two sEMG channels. To improve the signal-to-noise ratio, a method for automatically selecting the more informative of the sEMG channels was investigated. Correlation between ETP and {mathrm{PTP}}_{mathrm{mus}} was assessed by determining a neuromechanical conversion factor textit{K}_{mathrm{EMG}} between the two quantities. Moreover, it was investigated whether this scalar can be reliably determined from airway pressure during occlusion maneuvers, thus allowing to quantify inspiratory effort based solely on sEMG measurements.ResultsIn total, 62 patients with heterogeneous pulmonary diseases were enrolled in the study, 43 of which were included in the data analysis. The ETP of the two sEMG channels was well correlated with {mathrm{PTP}}_{mathrm{mus}} (textit{r}={0.79pm 0.25} and textit{r}={0.84pm 0.16} for diaphragm and intercostal recordings, respectively). The proposed automatic channel selection method improved correlation with {mathrm{PTP}}_{mathrm{mus}} (textit{r}={0.87pm 0.09}). The neuromechanical conversion factor obtained by fitting ETP to {mathrm{PTP}}_{mathrm{mus}} varied widely between patients (textit{K}_{mathrm{EMG}}= {4.32pm 3.73},{hbox {cm}hbox {H}_{2}hbox {O}/upmu hbox {V}}) and was highly correlated with the scalar determined during occlusions (textit{r}={0.95}, textit{p}<{.001}). The occlusion-based method for deriving {mathrm{PTP}}_{mathrm{mus}} from ETP showed a breath-wise deviation to {mathrm{PTP}}_{mathrm{mus}} of {0.43pm 1.73},{hbox {cm}hbox {H}_{2}hbox {O},hbox {s}} across all datasets.ConclusionThese results support the use of surface electromyography as a non-invasive alternative for monitoring breath-by-breath inspiratory effort of patients under assisted mechanical ventilation.

Tripartite intensive intervention for prevention of rebleeding in elderly patients with hypertensive cerebral hemorrhage.

BACKGROUNDHypertensive cerebral hemorrhage (HICH) is the rupture and bleeding of vessels of the cerebral parenchyma caused by continuously elevated or violently fluctuating blood pressure. The condition is characterized by high disability and high mortality. Hematoma formation and resulting space-occupying effects following intracerebral hemorrhage are among the key causes of impaired neurological function and disability. Consequently, minimally invasive clearance of the hematoma is undertaken for the treatment of HICH because it can effectively relieve intracranial hypertension. Therefore, special attention should be given to the quality of medical and nursing interventions in the convalescent period after minimally invasive hematoma clearance.AIMThe study aim was to determine the value of intensive intervention, including doctors, nurses, and patient families, for the prevention of rebleeding in elderly patients with HICH during the first hospitalization for rehabilitation after the ictal eventMETHODSA total of 150 elderly HICH patients with minimally invasive hematoma evacuation in our hospital between May 2018 and May 2020 were selected and equally divided into two groups of 75 each by their planned intervention. The control group was given conventional nursing intervention and the observation group was given tripartite intensive intervention. The length of hospital stay, cost, complication rate, satisfaction rate, and rebleeding rate during hospitalization were recorded. Changes in cerebral blood flow indicators were recorded in both groups. Changes in the National Institutes of Health Stroke Scale (NIHSS) score, quality of life index (QLI) score, and health behavior score were evaluated at the National Institutes of Health.RESULTSDuration of hospitalization was shorter in the in the observation group than in the control group, the hospitalization cost was less than in the control group, and the rate of rebleeding during hospitalization was lower than in the control group (all P < 0.05). There were no significant differences between the two groups before treatment (all P > 0.05). The mean flow rate (Qmean) and mean velocity (Vmean) of the two groups increased (P < 0.05), and the dynamic resistance and peripheral resistance decreased (P < 0.05). The Qmean and Vmean in the intervention group were higher than those in the control group (P < 0.05). Moreover, the dynamic resistance and peripheral resistance of the blood vessels were also lower in the intervention group than in the control group (P < 0.05). The difference in health behavior scores between the two groups before treatment was not significant (P > 0.05). In both groups, the scores for healthy behaviors such as emotion control, medication adherence, dietary management, exercise management, and self-monitoring were higher after than before treatment (P < 0.05), and the scores of healthy behaviors in the intervention group were higher than those in the control group (P < 0.05). There was no significant difference in the NIHSS and QLI scores between the two groups before treatment (P > 0.05). The QLI scores of the two groups increased (P < 0.05), and the NIHSS scores decreased (P < 0.05). The QLI scores of the intervention group were higher than those of the control group (P < 0.05), and the NIHSS score was correspondingly lower than that of the control group (P < 0.05). The incidence of respiratory infections, pressure sores, central hyperpyrexia, and deep venous thrombosis was lower in the intervention group than in the control group. Accordingly, the satisfaction rate was higher in the treatment group than that in the control group (P < 0.05).CONCLUSIONIntensive intervention by doctors, nurses, and families of elderly patients with HICH reduced the rate of rebleeding during hospitalization. It also reduced the incidence of complications, promoted rehabilitation, improved the quality of life, and enhanced nerve function. Additionally, it improved satisfaction and promoted healthy behaviors.

Understanding the Importance of Capsules in Dry Powder Inhalers.

Pulmonary drug delivery is currently the focus of research and development because of its potential to produce maximum therapeutic benefit to patients by directing the drug straight to the lung disease site. Among all the available delivery options, one popular, proven and convenient inhaler device is the capsule-based dry powder inhaler (cDPI) for the treatment of an increasingly diverse range of diseases. cDPIs use a hard capsule that contains a powder formulation which consists of a mixture of a micronized drug and a carrier usually the lactose, known for its good lung tolerance. The capsule is either inserted into the device during manufacturer or by the patient prior to use. After perforating, opening or cut the capsule in the device, patients take a deep and rapid breath to inhale the powder, using air as the vector of drug displacement. The system is simple, relatively cheap and characterized by a lower carbon footprint than that of pressurized metered dose inhalers. This article reviews cDPI technology, focusing particularly on the importance of capsule characteristics and their function as a drug reservoir in cDPIs.

Comparison of Two Protocols for the Assessment of Maximal Respiratory Pressures: Spanish Society of Pulmonology and Thoracic Surgery Versus American Thoracic Society/European Respiratory Society.

BackgroundThe measurement of maximal respiratory pressures (MRPs) is commonly used to assess respiratory muscle strength. However, in Spain, there is no consensus on which is the most adequate measurement protocol, as theSpanish Society of Pneumology and Thoracic Surgery (SEPAR) protocol differs from the one endorsed by the American Thoracic Society/European Respiratory Society(ATS/ERS). This study compared the absolute and predictive values of maximal expiratory and inspiratory pressures (MEP and MIP) in healthy adults obtained with the two protocols.MethodsA cross-sectional study with a sample of healthy adults was conducted. Lung function and MRPs were assessed. MEP and MIP were measured using a digital manometer according to the SEPAR and ATS/ERS. Protocols were applied in random order by the same trained physiotherapist. The comfort experienced with each protocol was assessed through a short questionnaire. Paired t-tests were used to compare the results from both protocols.ResultsA total of 31 subjects (mean age 35.7±12.4 years; 14 females; FEV1=108.3±10.5%; FVC=103.7±10%) were included. There was a significant difference between MRPs favouring the SEPAR protocol, with the mean difference being 34.9±28.1 cmH2O (p˂0.001) for MEP and 8±11.6 cmH2O (p=0.001) for MIP. ATS/ERS protocol was, however, considered more comfortable than SEPAR (p<0.005).ConclusionsThis study shows that, in healthy adults, higher MRPs are obtained using the SEPAR protocol. Yet, the ATS/ERS protocol is experienced as more comfortable. Future studies are needed to analyse the application of both protocols in other populations and their associated comfort.

A new ratio with PaO2/FiO2 and pulmonary arterial systolic pressure in the prognosis of intermediate high risk pulmonary embolism

Abstract Background Intermediate high (IH) risk pulmonary embolism (PE) defines a category of patients (P) at increased risk of haemodynamic decompensation. Therefore, it is important to develop tools to identify P who will have an unfavourable outcome. The ratio between arterial oxygen partial pressure (PaO2) to fractional inspired oxygen (FiO2) – P/F ratio - is associated with in-hospital mortality (IHM) in PE. Pulmonary arterial systolic pressure (PASP) is another prognostic factor, related with right ventricular (RV) pressure overload. This study evaluates the usefulness of a new ratio with P/F divided by PASP (P/F:PASP), reflecting both severity of respiratory failure and pressure overload, in the prognosis of P with IH risk PE. Methods All P admitted for IH risk PE in an Intensive Cardiac Care Unit (ICCU) for 10 years were included. P/F ratio was calculated with admission blood gas analysis and PASP was obtained with echocardiography at admission in ICCU. P/F:PASP ratio was considered low if inferior to its median. Need for fibrinolysis and IHM were assessed. Follow-up (FU) of 2 years for all-cause mortality was done. Statistical analysis used chi-square and Mann-Whitney U tests, binary logistic regressions and Kaplan-Meier curves. Results 101 P were studied (mean age 63±17 years; 35.6% male). Mean P/F, PASP and P/F:PSAP were 264±68, 45±15 mmHg and 6.7±3.3, respectively. P/F:PASP was considered low if inferior to 5.9. There was no difference in age, gender, comorbidities or Pulmonary Embolism Severity Index (PESI) between P with low or high P/F:PASP. However, low P/F:PASP ratio was associated with tachypnea at admission (p=0.034), higher BNP level (p=0.011), right precordial leads T-wave inversion (p=0.029), presence of echocardiographic right ventricle dilation (p=0.002) and lower TAPSE (p=0.002). Among P who underwent fibrinolysis, 60.4% had low P/F:PASP and 39.6% had high P/F:PASP ratio (χ2=3.32, p=0.05). P/F:PASP ratio was a predictor of fibrinolysis (OR 0.83, 95% CI 0.72–0.96, p=0.011), with lower ratio increasing the probability of fibrinolysis. This result was independent from PESI (OR 0.84, 95% CI 0.72–0.97, p=0.015). P/F:PASP ratio was also a predictor of IHM (OR 0.62, 95% CI 0.38–1, p=0.05). During FU, there was no difference in mortality between P with low or high P/F:PASP ratio (8.5% vs. 10.4%, respectively; Kaplan-Meier χ2=0.095; p=0.758). Conclusions In IH risk PE, low P/F:PASP ratio was associated with analytical, electrocardiographic and echocardiographic risk features. In this study, P/F:PASP ratio was a predictor of short term prognosis, allowing identification of P at higher risk of fibrinolysis and IHM, but it was not useful for long term prognosis, as 2-year mortality was similar between the groups. Therefore, this ratio, as a measure of both respiratory failure and pressure overload, might allow refinement in risk stratification of P with IH risk PE. Funding Acknowledgement Type of funding sources: None.

Maximal Respiratory Pressures and Maximum Voluntary Ventilation in Young Arabs: Association with Anthropometrics and Physical Activity.

BackgroundMaximum inspiratory pressure (MIP), maximum expiratory pressure (MEP) and maximum voluntary ventilation (MVV) measurements assist in determining the respiratory muscle strength and endurance. These determinants of respiratory muscles vary significantly by age, gender, height, and ethnic origin. Normative values for maximum respiratory pressures (MRPs) and MVV would aid in evaluating respiratory muscle function in athletes, estimating performance, and assisting in rehabilitation. In addition, the reference values may aid in determining the efficacy of therapeutic interventions in young people with chronic respiratory diseases. The purpose of this study was to see how respiratory muscle strength indices correlated with anthropometric and physical activity characteristics in young Arabs.MethodologyThe study included 80 male volunteers and 85 female volunteers ranging in age from 18 to 30 years. MicroRPM was used to measure MIP and MEP, and pulmonary function test data, including MVV values, were recorded. All subjects completed the Global Physical Activity Questionnaire (GPAQ) and anthropometric measurements. Unpaired t-tests or Mann–Whitney U-tests were used to determine male-female differences. Using the Pearson correlation coefficient and Spearman Rho correlation coefficient tests, MIP and MEP values were correlated with body composition and physical activity. Using stepwise multiple linear regression analysis, the relationships between respiratory function (MVV, MIP, and MEP) and PFT values (FVC, FEV1, and FEV1/FVC), physical activity, and sedentary behavior were investigated.ResultsMIP, MEP, and MVV values were significantly lower in females than in males. MIP, MEP, and MVV values had a moderate correlation with forced vital capacity, forced expiratory volume in 1 second, and height, but not with weight, BMI, or GPAQ. Age, gender, and body mass index were found to be significant predictors of maximal respiratory pressures in a young Arab population.ConclusionMaximum respiratory pressures and maximal voluntary ventilation were significantly lower in young Arabs than in other ethnic groups; these values were influenced by gender and height but not by levels of physical activity.

The Effects of Lumbar Stabilization Exercise Program Using Respiratory Resistance on Pain, Dysfunction, Psychosocial Factor, Respiratory Pressure in Female Patients in ’40s with Low Back Pain: Randomized Controlled Trial

The Effects of Lumbar Stabilization Exercise Program Using Respiratory Resistance on Pain, Dysfunction, Psychosocial Factor, Respiratory Pressure in Female Patients in ’40s with Low Back Pain: Randomized Controlled Trial

Predictive equations for ventilatory muscle strength in the Brazilian population: a systematic review

ABSTRACT Maximal inspiratory and expiratory pressures (MIP and MEP) assess the strength index of the respiratory muscles. These measures are relevant to assess respiratory muscle strength and for clinical monitoring. This study evaluates papers that suggest predictive equations of MIP and MEP for the Brazilian population. We included studies that established prediction equations for MIP and MEP for the healthy Brazilian population, aged from 4 to 90 years old, both men and women and that had the maximum respiratory pressures measured in a sitting position. A search was carried out in March 2020 on MEDLINE, LILACS, Cochrane, SciELO, CINAHL, Web of Science, and SCOPUS databases, without date or language filters. The descriptors used were “muscle strength,” “equations,” “predictive respiratory muscles” and their respective synonyms. Out of the 3,920 studies found in databases, 963 were duplicates, 2,779 were excluded, 178 had their full texts analyzed, and only 9 met the inclusion criteria. The predictive equations of ventilatory muscle strength analyzed in this review used age, weight, and stature as variables. However, the studies showed methodological weaknesses, such as lack of cross-validation of the equation, exclusion of outliers, and lack of familiarization of MIP and MEP.

Ethnic Sensitivity Study of the Extrafine, Single-Inhaler, Triple Therapy Beclomethasone Dipropionate, Formoterol Fumarate, and Glycopyrronium Bromide Pressurized Metered Dose Inhaler in Japanese and Caucasian Healthy Individuals: A Randomized, Double-Blind, Single-Dose Crossover Study

PurposeA number of single-inhaler, fixed-dose, triple combinations are available for the management of chronic obstructive pulmonary disease and/or asthma. One of these is the extrafine formulation beclomethasone dipropionate, formoterol fumarate, glycopyrronium bromide (BDP/FF/GB). Given that differences in ethnicity can result in differences in systemic exposure, we evaluated the relative pharmacokinetic (PK) profiles of BDP/FF/GB in Japanese vs Caucasian healthy volunteers to assess the need for dose adjustment. MethodsThis randomized, double-blind, single-dose, 4-way crossover study recruited healthy men and women 20 to 55 years of age; for each Japanese person a Caucasian was enrolled who matched in terms of sex, age, and weight. Study treatments included BDP/FF/GB 200/12/25 and 400/12/25 μg (therapeutic), 800/48/100 μg (supratherapeutic), and placebo. PK blood samples were taken up to 24 hours for evaluation of BDP, beclomethasone 17-monopropionate (B17MP, an active metabolite of BDP), and formoterol and up to 48 h for GB. The primary objective was to characterize the PK profiles of BDP, FF, and GB after administration of a single dose of BDP/FF/GB in Caucasian and Japanese healthy volunteers in terms of the AUC0–t and Cmax of B17MP, formoterol, and GB. FindingsOf the 32 recruited participants (16 Japanese and 16 Caucasian ), 30 completed the study. A clear plasma exposure dose-response relationship was found for all 4 molecules. B17MP Cmax geometric mean ratios for Japanese vs Caucasian participants for the 3 study treatments ranged from 1.17 to 1.26, and AUC0–t ratios ranged from 1.16 to 1.22; thus, the findings were comparable between the ethnicities. Formoterol exposure was higher in Japanese than Caucasian participants (Cmax, 1.22–1.53; AUC0–t, 1.23–1.40). The GB Cmax with BDP/FF/GB 400/12/25 μg (1.09) and AUC0–t values for all three doses (0.98–1.17) were comparable in the 2 populations, but Cmax with 200/12/25 and 800/48/100 μg were higher in Japanese participants (1.32 and 1.42, respectively). Pharmacodynamic (cortisol, potassium, glucose, blood pressure, heart rate, and QT interval with the Fridericia correction) and safety profile results were similar in the 2 ethnicities, with most patients not experiencing any adverse events. ImplicationsExposure to BDP/FF/GB pressurized metered dose inhaler at therapeutic and supratherapeutic doses was associated with higher plasma levels in Japanese versus Caucasian healthy volunteers. These PK differences did not translate into meaningful differences in the safety or pharmacodynamic parameters assessed in this study and were consistent with the results of other long-term (52-week) published studies. Dose adjustments in Japanese people are not deemed necessary. ClinicalTrials.gov identifierNCT03859414.

Respiratory muscle strength and exercise capacity of children and adolescents with chronic liver diseases Exercise capacity in liver disease

Introdution: Chronic liver diseases are characterized by inflammatory and fibrotic lesions of the liver that cause systemic complications. These complications can negatively interfere with the respiratory muscle strength and exercise capacity of developing children and adolescents. Objectives: To compare respiratory muscle strength and exercise capacity in children and adolescents with chronic hepatopathy, using reference values from healthy individuals of the same age. Methods: A cross-sectional study was performed. Children and adolescents from 6 to 16 years old with chronic hepatopathies were included. For the evaluation of respiratory muscle strength, the maximal respiratory pressures were measured through manovacuometry. A six-minute walk test was used to assess exercise capacity. The Wilcoxon test was used to verify the difference between the evaluated and predicted values of the distance traveled. Results: In total, 40 subjects were analyzed; 57.5% of the subjects were female, and the subjects had a mean age of 11.68±2.82 years. In the comparison between the measured and predicted maximal respiratory pressures, a difference of -17.71 cmH2O (p&lt; 0.001) was found for the maximal inspiratory pressure, and a difference of -30.68 cmH2O (p&lt; 0.001) was found for the maximal expiratory pressure. Regarding exercise capacity, the measured average distance traveled was 346.46±49.21 m, which was 185.54m (p&lt; 0.001) less than the predicted value. Conclusions: Children and adolescents with chronic liver disease have reduced respiratory muscle function and exercise capacity.

Characterization of sleep-disordered breathing in children with Duchenne muscular dystrophy by the American Academy of Sleep Medicine criteria vs disease-specific criteria: what are the differences?

Individuals with Duchenne muscular dystrophy (DMD) frequently develop sleep-disordered breathing. Noninvasive ventilation is often prescribed for sleep-disordered breathing treatment based on the American Academy of Sleep Medicine (AASM) criteria. In 2018, DMD disease-specific criteria for sleep-disordered breathing were established. Our study aimed to examine the clinical interpretation differences using these different criteria. We performed a multicenter, retrospective chart review of children with DMD followed at The Hospital for Sick Children, Toronto, Canada, and Rady Children's Hospital, San Diego, California, who underwent polysomnography from August 1, 2012, to February 29, 2020. Baseline characteristics and polysomnography data were summarized using descriptive statistics. Agreement for the diagnosis of sleep-disordered breathing evaluated by kappa statistics and sensitivity/specificity analysis was assessed. One hundred five male children with DMD (mean ± SD age: 12.1 ± 3.8 years; body mass index z score: 0.2 ± 2.3) were included. The proportions of children with DMD that met at least 1 AASM criterion and at least 1 DMD criterion were 45.7% and 67.6%, respectively. We found that 32.4% of children met neither AASM nor DMD criteria. Overall agreement between AASM and DMD criteria was moderate (k = 0.57). There was almost perfect agreement in sleep apnea diagnosis (k = 0.90); however, there was only slight agreement in hypoventilation diagnosis (k = 0.12) between AASM and DMD criteria. There were more children with DMD diagnosed with nocturnal hypoventilation and prescribed noninvasive ventilation using DMD criteria compared with AASM criteria. Future studies should address whether the prescription of noninvasive ventilation for children with DMD based on both criteria is associated with different clinical outcomes. Hurvitz MS, Sunkonkit K, Massicotte C, Li R, Bhattacharjee R, Amin R. Characterization of sleep-disordered breathing in children with Duchenne muscular dystrophy by the American Academy of Sleep Medicine criteria vs disease-specific criteria: what are the differences? J Clin Sleep Med. 2022;18(2):609-615.

Ontogenetic variation in human nasal morphology.

Internal nasal cavity morphology has long been thought to reflect respiratory pressures related to heating and humidifying inspired air. Yet, despite the widely recognized importance of ontogeny in understanding climatic and thermoregulatory adaptations, most research on nasal variation in modern and fossil humans focuses on static adult morphology. This study utilizes cross-sectional CT data of three morphologically distinct samples (African, European, Arctic) spanning from infancy to adulthood (total n=321). Eighteen landmarks capturing external and internal regions of the face and nose were subjected to generalized Procrustes and form-space principal component analyses (separately conducted on global and individual samples) to ascertain when adult-specific nasal morphology emerges during ontogeny. Across the global sample, PC1 (67.18% of the variation) tracks age-related size changes regardless of ancestry, while PC2 (6.86%) differentiates between the ancestral groups irrespective of age. Growth curves tracking morphological changes by age-in-years indicate comparable growth trajectories across all three samples, with the majority of nasal size and shape established early in ontogeny (<5 years of age). Sex-based trends are also evident, with females exhibiting a more truncated growth period than males, particularly for nasal height dimensions. Differences are also evident between the anterior and posterior nose, with the height and breadth dimensions of the anterior nasal aperture and nasal cavity showing differential ontogenetic patterns compared to the choanae. Cumulatively, these results suggest that multiple selective pressures influence human nasal morphology through ontogenetic processes, including metabolic demands for sufficient oxygen intake and climatic demands for adequate intranasal air conditioning.

Relationship between cardiorespiratory fitness and preoperative evaluation findings in patients with morbid obesity undergoing sleeve gastrectomy: A cross-sectional study.

Evaluating various parameters, including preoperative cardiorespiratory fitness markers, is critical for patients with morbid obesity. Also, clinicians should prescribe suitable exercise and lifestyle guideline based on the tested parameters. Therefore, we investigated cardiorespiratory fitness and its correlation with preoperative evaluation in patients with morbid obesity scheduled for laparoscopic sleeve gastrectomy.A retrospective cross-sectional study was conducted with 38 patients (13 men and 25 women; mean age, 34.9 ± 10.9 years) scheduled for laparoscopic sleeve gastrectomy. Cardiopulmonary exercise stress tests were also performed. Measured cardiopulmonary responses included peak values of oxygen consumption (VO2), metabolic equivalents (METs), respiratory exchange ratio, heart rate (HR), and rate pressure product. Body composition variables were analyzed using bioimpedance analysis, laboratory parameters (hemoglobin A1c, lipid profile, inflammatory markers), and comorbidities. In addition, self-reported questionnaires were administered, including the Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HDRS), Short-Form Health Survey (SF-36), and Moorehead-Ardelt Quality of Life Questionnaire (MAQOL).The average body mass index (BMI) and percent body fat were 39.8 ± 5.7 kg/m−2 and 46.2 ± 6.1%, respectively. The VO2peak/kg, METs, RERpeak, HRpeak, RPPpeak, age-predicted HR percentage, and VO2peak percentage were 18.6 ± 3.8 mL/min−1/kg−1, 5.3 ± 1.1, 1.1 ± 0.1, 158.5 ± 19.8, 32,414.4 ± 6,695.8 mm Hg/min−1, 85.2 ± 8.8%, and 76.1 ± 14.8%, respectively. BMI (P = .026), percent body fat (P = .001), HRpeak (P = .018), erythrocyte sedimentation rate (P = .007), total BDI (P = .043), HDRS (P = .025), SF-36 (P = .006), and MAQOL (P = .007) scores were significantly associated with VO2peak/kg. Body fat percentage (P < .001) and total SF-36 score (P < .001) remained significant in the multiple linear regression analysis.Various cardiorespiratory fitness markers were investigated in patients with morbid obesity who underwent the sleeve gastrectomy. Peak aerobic exercise capacity was significantly associated with preoperative parameters such as body fat composition and self-reported quality of life in these patients. These results could be utilized for preoperative and/or postoperative exercise strategies in patients with morbid obesity scheduled for laparoscopic sleeve gastrectomy.

Effects of Progressive Relaxation Exercises on Vital Signs and Fatigue in Liver Transplant Patients: A Randomized Controlled Trial.

This randomized controlled study was conducted to evaluate the effects of progressive relaxation exercises on vital signs and fatigue level. Ninety patients with liver transplantation (experimental group = 45, control group = 45) were included in the study. The patients in the experimental group performed progressive relaxation exercises for 25 to 30 minutes every day for 4 weeks. Before the progressive relaxation exercises, the vital signs and fatigue level of the patients were recorded. Vital signs were recorded again immediately after the progressive relaxation exercises and at the end of the second week. At the end of the fourth week, the final measurement of vital signs was performed along with the second fatigue level assessment. In the experimental group, pulse and respiratory rates, systolic and diastolic blood pressure values, and fatigue severity mean scores were found to be lower and oxygen saturation level was higher than those of the control group. The improvement in vital signs in the experimental group was evident at week 3 (p < .05).

Study of pressurised metered dose inhalers for the purpose of standardization of quality attributes characterizing uniformity of dosing

Aim. The purpose was to provide the rationale of test in regard to uniformity of fine particles dose for pressurised metered dose inhalers (pMDIs). Materials and methods. The pMDIs containing suspensions of salbutamol sulfate (SS) or solutions of beclometasone dipropionate (BD) were studied by laser diffraction and high performance liquid chromatography (HPLC). The particle size distribution of SS, the average dose mass and uniformity of dose mass, the average delivered dose and the uniformity of delivered dose, the average fine particles dose and uniformity of fine particles dose were determined. Apparatus A was used for assessment of fine particles dose. Results. The two analytical procedures for the quantitative determination of SS and BD by HPLC were validated in the ranges with low concentrations of these substances. The 5 medicinal products in pMDI dosage form were studied: 3 preparations were with SS and 2 ones contained BD. It was shown that three products with SS were very similar in regard to particle size distribution in containers and the average values of delivered dose were almost the same, but these products were different in the average dose mass and fine particle dose. According to the research results, the expediency of determining the average dose mass and the tests concerning uniformity of dosing of preparations by dose mass and by fine particle dose was substantiated. It was shown that in the case of pMDI the dosing of solutions of BD was more uniform compared to suspensions of SS. The approaches of leading and other pharmacopoeias concerning uniformity of dosing for pMDIs were critically discussed. The expediency of determination of uniformity of fine particle dose at the stage of pharmaceutical development was substantiated, as the therapeutic effect depends on fine particle dose. Issues concerning standardization pMDIs in regard to uniformity of fine particle dose were discussed. Conclusions. The expediency of standardization and quality control of pMDIs in regard to such attributes as the average dose mass, which characterizes the volume of the metering chamber of the valve as well as the uniformity of the dose mass and the uniformity of fine particle dose, which assure the therapeutic effect of each dose of the product was substantiated