Respiratory Reserve Research Articles

Spirographic study of functional reserves of masters’ athletes in track-and field

Background and Study Aim. The progressive aging of the global population presents significant challenges, particularly in maintaining the functional reserves of vital systems. The respiratory system is crucial for sustaining physical performance. However, it is especially vulnerable to age-related decline. This study aims to assess the impact of structured physical activity on the respiratory function of sports-active veteran track-and-field athletes aged 50–59 and 60–75 years. Material and methods. A total of 93 men were examined, including 54 in the reference group (30 men with an average age of 53.67±0.25 years and 24 with an average age of 67.08±0.35 years). These men were involved in athletics in the past but did not participate in veteran sports. The study group included 29 athletics veterans. Among them, 18 individuals had an average age of 52.27±0.18 years, and 11 had an average age of 65.64±0.16 years. These athletes engage in specifically organized physical activity 2–4 times a week and have participated in athletics competitions over the last five years. Anthropometric measurements included the assessment of chest circumference at rest, maximal inspiration, maximal exhalation, and diaphragmatic excursion (DE). The functional state of the respiratory system was assessed using the SpiroCom diagnostic complex (HAI). The data were processed using the SPSS Statistics 17.0 software. Results. Sports veterans aged 50–59 years and those over 60 years exhibit statistically significant differences compared to their peers in several indicators. These include diaphragmatic excursion, tidal volume, minute volume, respiratory rate, tidal volume maximal, respiratory rate maximal, and maximal voluntary ventilation. The respiratory reserve indicator showed a lower degree of respiratory function tension during physical exertion. Statistically significantly higher values of external respiration indicators were found in veteran athletes compared to men with no regular activity (NRA). These indicators include expiratory time, forced expiratory volume in 1 second, and forced expiratory volume maximal. Additionally, veteran athletes showed higher values in the modified Tiffeneau-Pinelli index, peak expiratory flow, and forced expiratory flow at 25%, 50%, 75%, and forced mid-expiratory flow. As a result, sports veterans with high regular activity (RA) exhibited the lowest rates of regressive-destructive changes in the respiratory system indicators overall, with the exception of HOD and BH. In contrast, men with low RA are characterized by an accelerated rate of aging in the respiratory system. Conclusions. The results of the study identified indicators that can serve as spirographic criteria for selecting functional types. These types include individuals with low, medium, and high regular activity (RA). It has been proven that systematic exercises involving specially organized cyclic motor activity form a rational, physiologically optimal type of breathing. Additionally, these exercises inhibit age-related degenerative-dystrophic processes in the human respiratory system.

The mechanism of paclitaxel induced damage on placental trophoblast cells

ObjectiveChemotherapy during pregnancy has a certain risk of causing a series of complications, such as miscarriage, premature birth, or fetal growth restriction, although the relationship between these complications and chemotherapy is currently unclear. This experiment focuses on the possible damage mechanism of the chemotherapeutic drug paclitaxel on placental trophoblast cells, and explores whether chemotherapy can affect pregnancy outcomes by directly damaging placental tissue.MethodsThis study explored the mechanism of paclitaxel induced damage on placental trophoblast cell lines JEG-3 and BEWO through immunofluorescence staining, Western blot experiments, cell flow cytometry, Seahorese cell metabolism experiments, and mouse modeling verification.ResultsThe experiment found that paclitaxel could induce JEG-3 and BEWO cells to produce reactive oxygen species (ROS), and elevate the ratio of Bax/Bcl-2 expression. Besides, paclitaxel mediated the reduction of mitochondrial membrane potential in JEG-3 and BEWO cells, causing damage and leading to mitochondrial autophagy and the occurrence of unfolded protein response. Paclitaxel inhibited the glycolysis rate of JEG-3 and BEWO cells, and leaded to impaired mitochondrial function, including decreased basal respiratory values, decreased respiratory reserve capacity, and proton leakage. In pregnant mice with tumor modeling, paclitaxel could cause DNA damage in placental tissue cells, and might lead to apoptosis of chemotherapy mice placental tissue cells and impairment of normal physiological functions.ConclusionPaclitaxel may directly or indirectly affect the normal physiological functions of placental trophoblast cells, including energy metabolism and protein synthesis dysfunction, which may be related to the adverse pregnancy outcomes caused by paclitaxel chemotherapy.

Cardiopulmonary exercise testing in patients with precapillary pulmonary hypertension with an unfavorable prognosis

Aim. To compare clinical and hemodynamic parameters with survival of incident patients with idiopathic pulmonary arterial hypertension (IPAH) and chronic thromboembolic pulmonary hypertension (CTEPH) with a prognostically unfavorable pattern of cardiopulmonary exercise testing (CPET) parameters.Material and methods. The study included 48 incident cases with a verified diagnosis of IPAH (n=18) and CTEPH (n=30). All patients were examined in accordance with the European Society of Cardiology and the European Respiratory Society guidelines (2015). The inclusion criterion was the ventilatory equivalent for carbon dioxide (CO2) according to the CPET (VE/VCO2) >44, indicating an unfavorable prognosis for patients.Results. VE/VCO2 in the examined patients with IPAH and CTEPH averaged 70,6±0,8 and did not differ in the study groups. Hemodynamic parameters of patients with IPAH and CTEPH also indicated a high risk of adverse events as follows: cardiac index — 1,9±0,1 and 1,8±0,1 l/min/m2, respectively (p=0,3). Peak oxygen consumption, anaerobic threshold level, oxygen delivery to work performed were reduced in both groups. However, patients with IPAH did not have a decrease in dead space ventilation and desaturation severity during exercise was greater than in patients with CTEPH. Patients with CTEPH had better survival compared to patients with IPAH: 1 year — 89 vs 83%, 3 years — 84 vs 65%, 5 years — 73 vs 35%, 7 years — 55 vs 36%.Conclusion. Among patients with IPAH and CTEPH who have an unfavorable prognosis, patients with IPAH demonstrate a more pronounced decrease in cardiovascular and respiratory reserves, which negatively affects patient survival. CPET may be a valuable non-invasive method for death risk stratification in patients with IPAH and CTEPH.

Upregulation of ALOX12−12-HETE pathway impairs AMPK-dependent modulation of vascular metabolism in ApoE/LDLR−/− mice

Mitochondrial dysfunction and 12-lipoxygenase (ALOX12)-derived 12(S)-HETE production have been associated with vascular inflammation and the pathogenesis of atherosclerosis. However, the role of ALOX12 in regulating vascular energy metabolism in vascular inflammation has not been studied to date. Using mitochondrial and glycolysis functional profiling with the Seahorse extracellular flux analyzer, metabolipidomics, and proteomic analysis (LC-MS/MS), we characterized alterations in vascular energy metabolism in 2- and 6-month-old ApoE/LDLR−/− vs. control C57BL/6 mice. We identified that aorta of 6-month-old ApoE/LDLR−/− mice displayed compromised mitochondrial metabolism manifested by the reduced expression of mitochondrial enzymes, impaired mitochondrial respiration, and consequently diminished respiratory reserve capacity. An increased flux through the glycolysis/lactate shuttle, the hexosamine biosynthetic pathway (HBP), and the pentose phosphate pathway (PPP) was also recognized. Interestingly, ALOX12−12-HETE was the most upregulated axis in eicosanoid metabolism and histological examinations indicated that ApoE/LDLR−/− mice showed increased aortic expression of ALOX12, particularly in early atherosclerotic plaque areas. Remarkably, the joint blocking of ALOX12 and activation of AMPK, but not AMPK activation alone, resulted in the reprogramming of vascular metabolism, with improved mitochondrial respiration and suppressed auxiliary pathways (HBP, PPP, itaconate shunt). In conclusion, excessive activation of the ALOX12–12-HETE pathway in vascular inflammation in early atherosclerosis inhibits AMPK-dependent regulation of vascular metabolism. Consequently, ALOX12 may represent a novel target to boost impaired vascular mitochondrial function in pro-atherosclerotic vascular inflammation.

The mitochondrial function of peripheral blood mononuclear cells in frail older patients

BackgroundFrailty increases the incidence of geriatric syndromes and even the risk of death in old adults. However, the diagnostic criteria for frailty are inconsistent because of complex pathological processes and diverse clinical manifestations. To determine the effective biomarker and recognize frail status early, we investigated the correlation of mitochondrial morphology and function of human peripheral blood mononuclear cells (PBMCs) with frailty status in older adults. MethodsThis Cross-sectional study followed 393 participants (aged 25–100 years, female 31.04 %) from the First Affiliated Hospital of Nanjing Medical University. The frailty status of subjects was assessed by the physical frailty phenotype (PFP) scale. We analyzed mitochondria functions including mitochondria copy number (mtDNAcn), the mRNA expressions of mitochondrial dynamics-related genes mitofusin 1(MFN1), mitofusin 2(MFN2), optic atrophy protein-1(OPA1), fission protein-1(FIS1) and dynamin-related protein 1(DRP1), mitochondrial oxidative respiration and reactive oxygen species(ROS) levels in PBMCs. Mitochondria morphology, size, and number were observed by transmission electron microscopy (TEM). ResultsAfter adjustment for sex and BMI, mtDNAcn, the mRNA expression of FIS1, mitochondrial respiratory function (proton leak, maximum oxygen consumption, and respiratory reserve) and ROS level were significantly correlated with age (P = 0.031, 0.030, 0.042, 0.003, 0.002, 0.022, respectively). After correcting for age, sex, and BMI, mtDNAcn and the mRNA expression of OPA1 were correlated with 4 m gait speed respectively (P = 0.003, 0.028, respectively). Compared with non-frail people, mtDNAcn, the mRNA expression of MFN1, mitochondrial basal respiration, proton leak, maximum oxygen consumption, ATP production and space capacity were significantly decreased in frail older adults (P = 0.013, 0.036, 0.026, 0.024, 0.012, 0.032, 0.020, respectively). ROS levels were significantly increased in the frail group (P = 0.016). Compared with non-frail people, the number, length, and perimeter, area of mitochondria were reduced in frail group under TEM (all P < 0.001). ConclusionMitochondrial dysfunctions (decreased mtDNAcn, impaired mitochondrial morphology, imbalanced mitochondrial dynamic, impaired mitochondrial respiratory function, and increased ROS levels) were significantly correlated with frail status.

Maxillomandibular Fixation Verses Open Reduction and Internal Fixation in Mandibular Fractures-Effect on Pulmonary Functions.

Mandibular fractures have significant influence on oropharyngeal and laryngopharyngeal portions of the upper airway. They can be managed by MMF or ORIF. To quantify and compare the effects of MMF with ORIF on the pulmonary functions of the patients undergoing treatment for mandibular fractures. Total 42 patients with isolated mandibular fractures were randomly divided into two treatment groups. Group A comprised of 21 patients planned for ORIF under LA and Group B comprised of 21 patients planned for MMF under LA. Pulmonary function tests (PFT) were done in all participants preoperatively 24h before, postoperatively after 24h, 1week, 4weeks and 6weeks using spirometry. FVC, FEV1, FEV1/FVC, and PEFR were determined and compared. PFT values in both the groups were comparable preoperatively 24h before and were significantly lower than their predicted values showing adverse effect of mandibular fractures on airways. Postoperatively after 24h, 1week and fourweeks, PFT values were significantly lower in group B (MMF) than in group A (ORIF). At sixweeks postoperatively, when MMF was removed, there was no statistically significant difference in PFT values of both the groups. Mandibular fracture patients presented with abnormal PFT values. Patients treated by MMF had obstructive pulmonary pattern, while those treated by ORIF had normal pulmonary pattern concluding that MMF can be dangerous to the patients with limited respiratory reserve and the use of ORIF in pulmonary comorbidity is justified. The online version contains supplementary material available at 10.1007/s12663-024-02327-w.

Sekwencja szybkiej intubacji. Aktualny stan wiedzy

Rapid sequence intubation is a widely practiced method for handling the airway during anaesthesia induction in patients with gastric problems or those susceptible to regurgitation or aspiration. Preparation involves gathering essential equipment and medications for emergency intubation, including oxygen, suction, bag-valve mask, laryngoscope, endotracheal tubes with stylets, resuscitation gear, and rescue tools. Despite its consistent use for over five decades, debates persist regarding the efficacy of specific elements of the method, such as cricoid pressure and the assessment of fasting in urgent surgical cases. The absence of standardised rapid sequence intubation techniques and universally accepted guidelines has resulted in discrepancies in published data. Cricoid pressure, also known as the Sellick manoeuvre, is a controversial element of rapid sequence intubation that has both supporters and critics. While it has been used for decades and is recommended by many countries to prevent pulmonary aspiration during anaesthesia, recent research has raised questions about its effectiveness. In patients undergoing emergency surgery, ultrasound of the gastric antrum may help evaluate the size of gastric contents in order to minimise the risk of aspiration pneumonia. Techniques and variants of anaesthetic induction in the rapid sequence intubation algorithm should be adapted to a wide range of clinical groups – particularly in children, obese patients and pregnant women. In paediatric anaesthesia and for obese patients, the traditional rapid sequence intubation with apnoea is not commonly used due to their limited respiratory reserve. Despite its numerous side effects, succinylcholine remains the most frequently employed drug for rapid sequence intubation.

525. PALLIATIVE MULTIMODALITY-THERAPY, EVEN WITH ABBREVIATED IMMUNOTHERAPY CAN MAKE CURATIVE SURGERY FOR SYNCHRONOUS LUNG AND ESOPHAGEAL CANCER POSSIBLE: A CASE REPORT

Abstract Background Synchronous lung and esophageal carcinomas are problematic. When both cancers are locally advanced, combined surgical treatment is rarely possible because of high-risk or insufficient respiratory reserve. Palliative treatment including immunotherapy can sometimes offer significant tumor response and potentially prolong survival in patients with PDL-1 tumor expression. However the place of immunotherapy for potentially rendering inoperable patients operable is still unknown. Methods Case report: A 78-year-old male with smoking history was diagnosed with synchronous locally advanced adenocarcinoma of the Gastroesophageal Junction (GEJ) cT3cN1cM0 and bilateral lung adenocarcinomas stage 4a, cT2cN1cM1a (right lower lobe 43mm confirmed by CT-guided biopsy, left upper lobe 32mm and additional S6 left lower lobe nodule). The patient was considered incurable by MDT and palliative treatment was offered as both cancers had significant PDL-1 expression (GEJ: CPS score &amp;gt;1, Lung: PDL-1 expression 90%). Pembrolizumab immunotherapy was started but poorly tolerated (severe myositis) and stopped again after only 6 weeks. The left-sided lung cancer had by then already regressed and stereotactic irradiation (SBRT 5x12Gy) of the right-side lung cancer was administered resulting in further local tumor control (figure). Endoscopic tumor re-evalution showed a Siewert type 2 tumor (uT3N1) similar to the initial endoscopy 15 months before. Both side lung adenocarcinomas remained regressed and the left lower lobe nodule was unchanged (6mm). Mediastinal lymph node staging by EBUS was negative. Thirteen months after initial diagnosis, 4 cycles of neo-adjuvant chemotherapy (FLOT) were administered. Combined synchronous surgery was finally done 16 months after initial diagnosis. A minimally invasive combined resection included a laparoscopic &amp; thoracoscopic Ivor-Lewis MIE, left thoracoscopic wedge of the lower lobe nodule and a right lower lobectomy with radical lymph node dissection. Post-operative course was smooth: Clavien-Dindo score 1, hospital stay 18 days. Final pathology Distal third adenocarcinoma (1.5x1.2cm above Z-line) with major partial response ypT2N0M0, R0, 0/43 lymph nodes (subcarinal signs of nodal response), right lower lobe tumor of 60x55mm with residual 1.2mm focus of residual viable adenocarcinoma (ypTisN0M0, R0) and left lower lobe hamartoma (6mm). Follow-up showed no recurrence 9 months after surgery (25 months from initial diagnosis). Conclusions: 1) Despite much abbreviated palliative immunotherapy (6 weeks), SBRT and FLOT our patient was down-staged within 16 months from an initially palliative situation to a potential cure with complete resection of all tumors. 2) Synchronous combined radical laparoscopic &amp; thoracoscopic Ivor-Lewis esophagectomy with lung lobectomy can be feasible after immuno-, chemo- and radiotherapy even in elderly patients.

Anaesthetic management in neonate with rare finding of absent ribs as a part of Jacho Levin syndrome posted for thoracolumbar meningomyelocele repair: A case report

The congenital absence of ribs is a very rare finding. It can manifest as a standalone anomaly or as part of the syndrome. We came across a case in which the absence of ribs was associated with a neural tube defect. These findings were in favor of Jarcho Levin syndrome. Jarcho Levin syndrome, also known as spondylocostal dysostosis, is an uncommon genetic disorder with a global incidence of 1/40000 births. Very few case reports of it are in the Indian literature. It is characterized by vertebral malformations and the congenital absence of ribs, resulting in a crab-like appearance in the chest. It is linked to a wide range of non-skeletal abnormalities, including hydrocephalus, neural tube defects, tracheal anomalies, and abnormalities in the cardiac, renal, gastrointestinal, and urinary systems. The preoperative evaluation should be thoroughly done with a detailed systemic examination for the multisystem affliction of this syndrome. The anesthetic challenges in neonates with Jarcho Levin syndrome includes challenging airways due to defects in skeletal growth and hydrocephalus, proper positioning to avoid sac rupture, prone position ventilation, temperature control and fluid management. The prone position ventilation can be complicated by the absence of ribs and decreased respiratory reserve due to associated scoliosis and kyphosis. This case report highlights the anesthetic management of a three-day-old neonate with Jarcho Levin syndrome posted for thoracolumbar meningomyelocele repair.

Astragaloside IV Reduces Lung Epithelial Cell Pyroptosis via TXNIP-NLRP3-GSDMD pathway.

This study aimed to investigate the detrimental impact of cigarettes on lung cells and the potential effects of astragaloside IV on lung epithelial cell oxidative stress and pyroptosis. The research utilized cigarette smoke extract (CSE) to stimulate lung epithelial cells BEAS-2B, assessed cytotoxicity using the CCK-8 method, and measured changes in reactive oxygen species (ROS) and mitochondrial membrane potential with a probe method. Additionally, Seahorse XF24 was employed to analyze the impact of CSE on mitochondria in lung epithelial cells. Furthermore, LPS and cigarette combination-treated mice were created, alveolar damage was evaluated using HE staining, and changes in the key protein GSDMD of pyroptosis were detected using western blot (WB). The study also utilized the CCK-8 method to assess the potential toxic effects of astragaloside IV on lung epithelial cells, and the probe method to monitor changes in ROS and mitochondrial membrane potential. WB analysis was conducted to observe protein alterations in the TXNIP/NLRP3/GSDMD pathway. CSE concentration-dependently reduced cell activity, increased cellular ROS levels, and decreased mitochondrial membrane potential. CSE also decreases basal respiratory capacity, respiratory reserve capacity, and ATP production levels in cells. In LPS and cigarette combination-treated mice, cigarette smoke caused the alveolar septum to break and alveoli to enlarge, while increasing the expression of pyroptosis-related protein GSDMD. Astragaloside IV did not show significant cytotoxic effects within 48 h of treatment and could reduce CSE-induced ROS levels while increasing mitochondrial membrane potential. WB results indicated that astragaloside IV reduced the activation of the TXNIP/NLRP3/GSDMD signaling pathway in lung epithelial cells exposed to CSE. Our study demonstrates that CSE induces oxidative stress and impairs mitochondrial function in pulmonary epithelial cells, while astragaloside IV can potentially reverse these effects by inhibiting the TXNIP-NLRP3-GSDMD signaling pathway, thereby mitigating CSE-induced pulmonary disease and epithelial cell pyroptosis.

O105: Evaluating Surgical Approaches in Non-Small Cell Lung Cancer: Lobectomy vs Sublobar Resection

Abstract Background Lung Cancer remains the leading cause of cancer-related mortality, with non-small cell lung cancer (NSCLC) accounting for 85% of cases. Lobectomy has long been regarded as the gold-standard treatment for early-stage NSCLC. A shifting paradigm towards lung-sparing procedures such as sublobar resection, may benefit patients with limited respiratory reserve or high comorbidity index. This study aims to compare survival outcomes between patients undergoing lobectomy and sublobar resection. Methods This was a tertiary retrospective cohort study comparing disease-free survival (DFS), overall survival (OS) and postoperative outcomes in lobectomy and sublobar patients between 2013 and 2023 (n=3983). Propensity matched analysis was employed to adjust for treatment selection bias, calculated using a logistic regression model and incorporated eight covariates (n=528). Baseline, post-operative, and survival data were extracted from the hospital database. Comparison of baseline and post-operative characteristics involved Wilcoxon rank sum test, Fisher’s exact test and Pearson’s Chi-squared test. Kaplan Meier estimates and Multivariate Cox Regression were used to evaluate survival. p&amp;lt;0.05 was considered significant. Results No significant inter-cohort differences were observed in either DFS (log-rank p=0.32), OS (log-rank p=0.47), or 90-day mortality (log-rank p=0.78). Sublobar resection exhibited shorter post-operative length of stay (p&amp;lt;0.05). Conversely, both approaches demonstrated comparable resection margins and complication rates. Significant predictors of survival were age, gender and low Eastern Cooperative Oncology Group (ECOG) performance status (p&amp;lt;0.05). Conclusion These findings further support the non-inferiority of sublobar resection to lobectomy for stage 1 lung cancer. Additionally, improved perioperative outcomes may make sublobar resection more desirable for higher risk patients.

Surgical strategies in the management of atlantoaxial dislocation in Down syndrome.

To study the clinicoradiological features and treatment outcomes of atlantoaxial dislocation (AAD) in Down syndrome. Retrospective case series. A retrospective chart and radiology review of 9 Down syndrome patients with AAD managed at our center from 2007 to 2018. Chi-squared/Fisher's exact test. There were 4 males and 5 females (n = 9). The median age was 14 years (interquartile range [IQR]: 7-15.5). 77.7% (7/9) of patients had severe spasticity (Nurick Grades 4 and 5). The median duration of symptoms was 9 months (IQR: 5-39). The AAD was reducible in all (n = 9) cases. Eight (88.8%) patients had os odontoideum. The mean atlantodental interval (ADI) was 8.5 mm (±2.9). T2W cord hyperintensity was seen in 66.6% (6/9). Posterior C1-2 transarticular fixation was done in 8 and occipitocervical fusion in 1 patient. Follow-up of more than 6 months (7-57 months) was available in 8/9 (88.9%) patients. There was a significant improvement in spasticity (n = 8, mean Nurick Grade 1.7 (±1.1), P = 0.003). Follow-up radiographs (n = 8) showed good reduction and fusion. A preoperative bedbound patient with poor respiratory reserve expired at 10 months following surgery. There were no other complications. Posterior surgical approach for AAD in Down syndrome resulted in good alignment and fusion, with excellent clinical improvement. Patients with elevated PCO2 are poor surgical candidates and require home ventilation facility.

YKL-40 and the Cellular Metabolic Profile in Parkinson's Disease.

Parkinson's disease (PD) is the second most common neurodegenerative disease worldwide. A growing body of evidence suggests that mitochondrial dysfunction and inflammation play a crucial role as a pathogenetic mechanism in PD. The glycoprotein YKL-40 (CHI3L1) is a potential biomarker involved in inflammation and tumor processes. The aim of the present study was to investigate the metabolic profile of PBMCs from PD patients and to search for a possible relationship between cellular bioenergetics and YKL-40. The study included 18 naïve PD patients and an age-matched control group (HC, n = 7). Patients were diagnosed according to the MDS-PD, the UPDRS, and the Hoen-Yahr scales. Mitochondrial activity was measured by a metabolic analyzer on isolated PBMCs from PD patients. Gene (qPCR) and protein (ELISA) expression levels of YKL40 were investigated. New data are reported revealing changes in the mitochondrial activity and YKL-40 levels in PD patients. Bioenergetic parameters showed increased respiratory reserve capacity in PD compared to HC. The protein levels of YKL-40 were threefold higher in PD. We found a correlation between the YKL-40 protein levels and basal respiration and between YKL-40 and ATP production. These observations suggest an interplay between YKL-40 and mitochondrial function in PD. We assume that the YKL-40 gene and protein levels in combination with changes in mitochondrial function might serve as an additional tool to monitor the clinical course of PD.

ECMO in trauma care: What you need to know.

Over the past 10 years, extracorporeal membrane oxygenation (ECMO) use in trauma patients has increased significantly. This includes adult and pediatric trauma patients and even combat casualties. Most ECMO applications are in a venovenous (VV ECMO) configuration for acute hypoxemic respiratory failure or anatomic injuries that require pneumonectomy or extreme lung rest in a patient with insufficient respiratory reserve. In this narrative review, we summarize the most common indications for VV ECMO and other forms of ECMO support used in critically injured patients, underscore the importance of early ECMO consultation or regional referral, review the technical aspects of ECMO cannulation and management, and examine the expected outcomes for these patients. In addition, we evaluate the data where it exists to try to debunk some common myths surrounding ECMO management.

Transesophageal endoscopic ultrasound with bronchoscope-guided fine-needle aspiration for diagnostic and staging purposes: a narrative review.

Transesophageal endoscopic ultrasound with bronchoscope-guided fine-needle aspiration (EUS-B-FNA) is a feasible and well-tolerated modality that is increasingly used to diagnose intrathoracic lesions. This narrative review summarizes the current application of EUS-B-FNA for diagnosing lung cancer, thoracic sarcoidosis, and metastases from extrathoracic malignancies. A comprehensive and systematic online literature search via Medline/PubMed for the period January 2005 to December 2022 was conducted for articles published using the keywords "EUS-B-FNA", "endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA)", "endoscopic ultrasound fine-needle aspiration (EUS-FNA)", "lung cancer", "staging", and "sarcoidosis". Recent data prove the efficacy and safety of EUS-B-FNA for providing complete lung cancer staging, when combined with EBUS-TBNA, and in the evaluation of para-esophageal lesions. EUS-B-FNA allows access to inferior mediastinal lymph nodes and para-esophageal masses that are not accessible by EBUS-TBNA. Additional advantages of using EUS-B-FNA include significantly lower doses of anesthetics and sedatives, a shorter procedural time, fewer incidents of oxygen desaturation due to a poor respiratory reserve, significantly less cough, and higher operator satisfaction. Moreover, this procedure can be performed sequentially in the same setting with EBUS-TBNA by one operator. Other benefits include a lower cost, a single setting, and scope use. As EUS-B-FNA and EBUS-TBNA have complementary access to the mediastinum, the diagnostic yield of EUS-B-FNA combined with EBUS-TBNA is higher than that of endosonographic techniques alone in the diagnostic workup of intrathoracic lesions.

Extracorporeal life support use in limited lung function: a narrative review.

In thoracic surgery, different modalities of extracorporeal life support (ECLS) can be used for cardiorespiratory support in complex scenarios. Decades of learning in clinical practice and physiology associated with technological development led to a great variety of ECLS technologies available. Thoracic surgery procedures with difficult or impossible single lung ventilation may still be performed using different ECLS modalities. The aim of this review is to describe the use of ECLS, with its different modalities, as a solution to perform complex surgeries in a patient with difficult or impossible single lung ventilation. A literature review was conducted using the terms "extracorporeal life support pulmonary resection" and "extracorporeal life support thoracic surgery", and articles were selected according to defined criteria. To support lung function during thoracic surgery, the most efficient and popular variety of ECLS is venovenous extracorporeal membrane oxygenation. Lung resection on a single lung after pneumonectomy, surgery in a patient with severe hypercapnia and/or low respiratory reserve, carinal and airway surgery, and severe thoracic trauma are the main examples of situations where ECLS may be the solution to provide a safe surgical environment in patients who cannot tolerate single lung ventilation. Multidisciplinarity, selection of patients and careful surgical planning are cornerstones in defining the situations that may benefit from ECLS support. Knowledge on techniques of ECLS are essential for every thoracic surgeon. Although rarely used, these techniques of cardiorespiratory support should be considered when planning complex cases with difficulties in ventilation and emergent situations.

Cardiovascular capacity in adults with obstructive sleep apnoea.

BACKGROUND: Obstructive sleep apnoea (OSA) patients have a decreased exercise capacity. Potential cardiovascular capacity in patients with OSA with different severity without known cardiovascular disease has not been described.OBJECTIVE: To evaluate impaired potential exercise cardiovascular capacity during cardiopulmonary exercise testing (CPET) in OSA patients and to compare cardiovascular performance reaction with different severity during graded exercise stages.DESIGN: All participants were accompanied without cardiovascular disease, especially hypertension and arrhythmia. Parameters of different stages were compared between subjects with and without OSA, and among OSA patients with varied severity.RESULTS: Despite having significantly higher peak exercise diastolic blood pressure (DBP) and ventilatory equivalent for CO2 (EQCO₂), patients with OSA had a lower peak oxygen uptake (VO₂), heart rate (HR), heart rate recovery (HRR) and respiratory reserve (BR) than normal subjects. Furthermore, significant correlations were found between VO₂, DBP, EQCO₂, HRR, BR and the apnoea-hypopnea index. In severe OSA, there was a greater difference in HR and HRR during the anaerobic threshold stages.CONCLUSIONS: OSA patients demonstrate reduced potential cardiovascular capacity, even without documented cardiovascular disease. Patients with severe OSA develop impaired exercise capacity at early stage during exercise. These data point to exaggerated haemodynamic response to graded exercise and delayed post-exercise cardiovascular response recovery in OSA patients. CPET can be a supplement for assessment of OSA severity.

The combined use of parasternal intercostal muscle thickening fraction and P0.1 for prediction of weaning outcomes

BackgroundA variety of parameters and diaphragmatic ultrasound in ventilator weaning has been studied extensively, and the findings yield inconsistent conclusions. The parasternal intercostal muscle holds important substantial respiratory reserve capacity when the central drive is enhanced, the predictive value of combining parasternal intercostal muscle ultrasound parameters with P0.1(airway occlusion pressure at 100 msec) in assessing ventilator weaning outcomes is still unknown. ObjectivesOur study aimed to evaluate the predictive efficacy of parasternal intercostal muscle ultrasound in conjunction with P0.1 in determining weaning failure. MethodsWe recruited patients who had been admitted to ICU and had been receiving mechanical ventilation for over two days. All patients underwent a half-hour spontaneous breathing trial (SBT) with low-level pressure support ventilation (PSV). They were positioned semi-upright for parasternal intercostal muscle ultrasound evaluations, including parasternal intercostal muscle thickness (PIMT), and parasternal intercostal muscle thickening fraction (PIMTF); P0.1 was obtained from the ventilator. Weaning failure was defined as the need for non-invasive positive pressure ventilation or re-intubation within 48 h post-weaning. ResultsOf the 56 enrolled patients with a mean age of 63.04 ± 15.80 years, 13 (23.2%) experienced weaning failure. There were differences in P0.1 (P = .001) and PIMTF (P = .017) between the two groups, but also in patients with a diaphragm thickness ≥ 2 mm. The predictive threshold values were PIMTF ≥ 13.15% and P0.1 ≥ 3.9 cmH2O for weaning failure. The AUROC for predicting weaning failure was 0.721 for PIMTF, 0.792 for P0.1, and 0.869 for the combination of PIMTF and P0.1. ConclusionsThe parasternal intercostal muscle thickening fraction and P0.1 are independently linked to weaning failure, especially in patients with normal diaphragm thickness. The combination of parasternal intercostal muscle thickening fraction and P0.1 can serve as a valuable tool for the precise clinical prediction of weaning outcomes. Trial registrationChinese Clinical Trial Registry website (ChiCTR2200065422).

Effect of extrapleural silicone filling on lung function in patients with bilateral destructive tuberculosis

BACKGROUND: Despite the success of the fight against tuberculosis, the proportion of patients with multidrug- and extensively drug-resistant pathogens continues to grow. According to the World Health Organization, the effectiveness of treating patients with multidrug- and extensively drug-resistant mycobacterium tuberculosis (MBT) worldwide is 48% and 34%, respectively. The lack of efficiency of chemotherapy in this category of patients leads to complex surgical treatment of tuberculosis.&#x0D; AIM: To investigate the effect of surgery on respiratory function of staged surgical treatment with extrapleural silicone filling (ESF) in patients with bilateral destructive pulmonary tuberculosis.&#x0D; METHODS: From 2012 to 2022, extrapleural pneumolysis with silicone implant filling in combination with lung resection on the opposite side was performed in 14 patients with extensive bilateral destructive tuberculosis. The control group included 29 patients who underwent lung resection on both sides. The groups were comparable in terms of sex, age, form of the underlying disease, and spectrum of MBT drug sensitivity. External respiratory function was studied by forced spirometry on Master Screen Pneumon devices by Viasys Healthcare with determination of forced volume vital capacity (FVVC) and forced expiratory volume per 1 s (FEF1).&#x0D; RESULTS: The dynamics of spirometric parameters after surgical treatment were as follows: FVVC was 1.050.47 and 1.740.76 liters (p 0.05), and SPH1 was 0.950.6 and 1.330.5 liters (p 0.05) in the ESF group and in the resection group, respectively. In the main group 10 (70%) patients showed diverse changes of the ventilatory function. Thus, 5/14 (35%) patients had worsening, whereas 5/14 (35%) patients had increased functional indices. In the main group, the decrease in respiratory indices was significantly lower compared with the control group, indicating the effectiveness of the proposed technique. Staged surgical treatment with both bilateral consecutive resections and the use of ESF in combination with resection on the opposite side was accompanied by a decrease in pulmonary ventilatory function. In the group of ESF patients, a moderate decrease in the indices was observed.&#x0D; CONCLUSIONS: When choosing surgical treatment using extrapleural pneumolysis with silicone implant filling, ESF should be performed at the first stage to preserve the maximum ventilatory function of the lungs. The use of ESF in staged surgical treatment of patients with extensive destructive tuberculosis allows expanding the functional operability of patients with limited respiratory reserves.

Anticancer–drug-induced interstitial lung disease (DIILD): With great power comes great responsibility.

e18699 Background: DIILD accounts for 3-5% of all ILD cases, with Anticancer agents accounting for 23-51% of all cases, and Case-Fatality Rates of 51.3%. Guidelines for anticancer therapy-related DIILD are lacking. DIILD was not often identified as an adverse event until late in drug development or after launch. Methods: Publications till Feb 2023 were reviewed for incidence, time to onset, prevention and early identification of anticancer DIILD. Results: Highest reportedincidence of DIILD was associated with targeted therapies [mTOR Inhibitors (9.5- 58%), Anti-EGFR (0.9 - 5.9%), MEK inhibitors (2.4%), CDK 4/6 inhibitors (1.6%), PARP inhibitors (0.79%)]; Chemotherapy [Bleomycin (6.8-21%), Gemcitabine(1.1-3.9%), Irinotecan (0.74%)]; ADCs (11.4%); CTLA4 inhibitors (5.44%); and Check-point inhibitors [(CPIs: 1.1-3.6%), PD-1 inhibitors (3.6%), PD-L1 inhibitors (1.3%)]. The rates of DIILD were higher in combinations compared to single-agents. Higher Mortality rates were associated with Anti-EGFR (18-51.3%), Irinotecan (24%), Bleomycin (8.1-23%), Gemcitabine (0-22%), mTOR Inhibitors (0-20%), Check-point inhibitors (all CPIs: 8-9.4%). The time of onset was as early as a week for CPIs (42% occurred within first two months), 28 days for EGFR:TKIs, 60-172 days for MEK Inhibitors, and 14-638 days for ADCs. Risk-mitigation strategies for DIILD: Identification of high-risk patients – (multiple prior lines of therapy, combination therapy, lung comorbidities, poor respiratory reserve, smokers). Early radiological diagnosis accompanied by Monitoringfor early signs of ILD with wearable technology. Conclusions: Research in Genomics and biomarkers to identify patients at risk, development of Artificial Intelligence (AI) algorithms for PFT interpretation, early radiological detection and audiometry analysis are ongoing and urgently needed.