Lung Volume Research Articles

Anatomic endoscopic enucleation of the prostate using a novel hybrid thulium:yttrium-aluminium-garnet laser generator: surgical technique and clinical outcomes.

We aim to report here the first clinical series of patients treated with AEEP using a novel hybrid thulium:yttrium-aluminium-garnet (Tm:YAG) laser generator (RevoLix HTL, LISA Laser Products, Germany), i.e. capable of emitting both in pulsated and continuous-wave. We included 39 consecutive patients who underwent hybrid Tm:YAG AEEP (hybrid ThuLEP) at a single center starting from July 2022 and were followed-up until 3months after surgery. Complete baseline, intraoperative, and follow-up demographic and clinical data were collected. The International Prostatic Symptoms Score (IPSS) questionnaire was used to quantify urinary symptoms at baseline and during follow-up. Post-operative follow-up further included a PSA test, uroflowmetry with post-void residual volume (PVR) measurement. Clavien-Dindo classification was used to classify complications. Median (IQR) age at surgery and prostate volume were 68 (IQR 63-74) years and 85 (60-105) cc. Both en-bloc or two-lobes technique enucleation were performed according to the intraoperative and endoscopic anatomy, with a median operative time of 85 (63-108) minutes. Bladder catheter was removed in all cases on postoperative day two. Intraoperative bleeding requiring conversion to bipolar enucleation was observed in two patients. After discharge, one patient developed arm phlebitis which was treated with anticoagulants leading to new onset haematuria requiring short term catheterisation (Clavien-Dindo grade II) and two more patients had a single episode of acute urinary retention (Clavien-Dindo grade I). Median pre- vs postoperative Qmax and IPSS were 8.0 (7.0-9.4) vs. 25.0 (22.5-32.5) ml/s and 22 (20-28) vs. 1 (0-2), whereas PVR decreased from 70 (50-115) to 0 (0-26) ml. Hybrid ThuLEP is a feasible and effective surgical procedure for the management of benign prostatic obstruction.

Preparation of MgO-MgAl2O4 refractories doped with La2O3 and the wetting permeation behavior by alkaline slag

Alkaline slags play a crucial role in modern smelting processes, underscoring the necessity for researching novel refractories and their interaction mechanisms concerning wetting and infiltration. This study investigates the influence of La2O3 doping on the wettability and infiltration behavior between MgO-MgAl2O4 refractories and alkaline slag, introducing a theoretical evaluation method. The study explored the effects of La2O3 doping on the physical properties, mechanical properties, and thermal shock resistance of the samples, as well as the interface reactions between the samples and slag. Results indicate that La2O3 doping from 0 to 3 wt% enhances sintering performance by promoting the formation of LaAlO3, thereby reducing the apparent porosity from 18.25 % to 15.01 % and increasing the bulk density from 2.85 g·cm−3 to 3.34 g·cm−3. Cold compressive strength improves from 166.24 MPa to 178.42 MPa, while the residual strength retention ratio after thermal shock rises from 86.57 % to 88.65 %. Regarding the interface reaction between slag and samples, CaO and SiO2 react with internal MgO in the samples to form low-melting compounds and high-melting solid solutions. These compounds block pores, weaken slag erosion, and enhance the slag resistance of the samples. As the La2O3 doping amount increases from 0 to 3 wt%, the contact angle between the samples and slag increases, resulting in a greater residual volume of slag and a reduced depth of the slag infiltration layer. The penetration depth of the slag gradually decreases from 102.54 μm to 47.84 μm. This study offers new strategies for optimizing the manufacturing process and selection of refractories.

Acute effects of manual breathing assist technique on lung volume and dyspnea in individuals with severe chronic obstructive pulmonary disease: A quasi-experimental study.

Manual breathing assist technique (MBAT) is a common physical therapy technique used to facilitate airway clearance and improve ventilation and oxygenation. The effects during and immediately after intervention in individuals with chronic obstructive pulmonary disease (COPD) are unknown. This study aimed to investigate the acute effects and potential mechanisms of MBAT on lung volume, dyspnea, and oxygenation in individuals with COPD. This non-randomized quasi-experimental pre-test/post-test study included participants from pulmonary rehabilitation programs at Tagami Hospital (COPD group) and a community exercise program (Healthy group). During a single session, MBAT was applied during the expiration of every breath for 10 minutes. Dyspnea and lung volumes (tidal volume; VT, inspiratory capacity; IC, inspiratory reserved capacity; IRV, expiratory reserve capacity; ERV) were collected at baseline and after MBAT. Pulse oximetry (SpO2), skeletal muscle oxygenation (SmO2), and oxy- and deoxy-hemoglobin (O2Hb and HHb) using near-infrared spectroscopy (NIRS) were collected at baseline, during, and after MBAT. Between-group comparisons were conducted using the Mann-Whitney U-test and chi-square analyses. Within-group changes before and after MBAT were analyzed using the Wilcoxon signed-rank test. The Kruskal-Wallis test was used to detect differences in NIRS variables in each phase and over time. Thirty participants with COPD, matched for age and sex, were included, with 15 individuals per group. The difference scores of VT, IRV, and IC were significantly higher in the Healthy group than in the COPD group, but improvements in dyspnea and SpO2 were significantly higher in the COPD group. Compared to baseline, ERV decreased significantly in both groups, with dyspnea and SpO2 improving significantly only in the COPD group. Inspiratory accessory muscle ΔO2Hb and ΔHHb were significantly higher and lower (respectively) during MBAT in the COPD group compared to the Healthy group. Additionally, only the COPD group had increased SmO2 during and after MBAT compared to baseline. MBAT in patients with COPD had acute physiological effects in reducing dyspnea by facilitating expiration and decreasing the recruitment of accessory respiratory muscles. MBAT may help individuals with COPD reduce dyspnea before exercise therapy in a pulmonary rehabilitation program.

Función pulmonar en post COVID-19

Introduction: Infection by SARS-CoV-2 affects multiple organs, but the lung is the most affected organ and can have sequelae. The diagnosis of sequelae includes: medical history, physical examination, chest radiography and/or tomography, and pulmonary function tests (spirometry, carbon monoxide diffusing capacity, 6-minute walk test, and lung volumes). The objective of this study was to describe lung function in post COVID-19 patients at the Center for Diagnosis and Treatment of Respiratory Diseases CEDITER. Methodology: We conducted a descriptive, retrospective, and cross-sectional study of patients over 18 years of age, with a history of SARS-CoV-2 infection, who had undergone any pulmonary function tests and were found in the CEDITER database, from March 2020 to December 2021. Results: 246 cases were included, of which 57.7% were male and 43.3% were female. The mean age was 50.8 years with a standard deviation of 13.2. 46.1% had a body mass index (BMI) between 30 and 39.9, classified as obesity. 207 spirometries were analyzed, of which 34.3% were abnormal. Out of the 236 carbon monoxide diffusion tests, 53% showed mild to moderate decreases. Conclusions: The pulmonary function test that was most affected was carbon monoxide diffusion (DLCO), in a predominantly male population, with overweight or obesity, and with a mean age of 50 years.

Preserved prenatal lung growth assessed by fetal MRI in the omicron-dominated phase of the SARS-CoV-2 pandemic.

With SARS-CoV-2 evolving, disease severity and presentation have changed due to changes in mechanisms of entry and effector site as well as due to effects of vaccination- and/or infection-acquired immunity. We re-assessed fetal lung pathology in pregnancies with uncomplicated SARS-CoV-2 infections during the late, omicron-dominated pandemic phase to inform disease understanding and pregnancy consultation. In this case-control study, fetal lung volumes were assessed by fetal MRI in 24 pregnancies affected by mild maternal SARS-CoV-2 infection during the omicron-dominated pandemic phase with prevailing immunity through vaccination and/or prior SARS-CoV-2 infection. Fetal lung volumes (normalized to estimated fetal weight) in 24 pregnancies (GA 33.3 ± 3.8, 12 female fetuses) following mild, uncomplicated SARS-CoV-2 infection did not differ significantly from both, published reference values (96.3% ± 22.5% of 50th percentile reference values, p = 0.43), or fetal lung volumes of a site-specific, non-COVID control group (n = 15, 94.2% ± 18.5%, p = 0.76). Placental assessment revealed no group differences in thrombotic changes or placental heterogeneity (p > 0.05, respectively), and fetal lung volume did not correlate with placental heterogeneity when adjusting for gestational age at scan (p > 0.05). Assessment of fetal lung volume by MRI revealed unaffected lung growth in pregnancies affected by uncomplicated SARS-CoV-2 infection in the omicron-dominated pandemic phase in the presence of prevailing hybrid immunity. This finding contrasts sharply with the observed reduction in fetal lung volume following maternal alpha-variant infection in the pre-vaccination era and might reflect tropism- as well as immunity-related effects. Question: Is fetal lung development affected by mild maternal SARS-CoV-2 infection during the omicron-dominated phase of the pandemic? Fetal lung volume in 24 affected pregnancies did not differ significantly from published reference values or fetal lung volumes in 15 site-specific, non-COVID-affected control pregnancies. Preserved fetal lung volume following mild maternal SARS-CoV-2 infection during the omicron-dominated phase contrasts with previous findings of reduced volume in unvaccinated pregnancies during the alpha-dominated pandemic phase. These observations might reflect tropism- as well as immunity-related effects.

Immediate effects of upper limb exercises with and without deep breathing on lung function after cardiac surgery – a randomized crossover trial

BackgroundOpen heart surgery, involving median sternotomy, may cause diminished chest wall motion and restrictive pulmonary function in the early postoperative period. Thoracic and upper extremity range of motion (ROM) exercises are often recommended after surgery but have not been evaluated regarding effect on lung volumes and oxygenation. The objective of this study was to evaluate the immediate effect of upper limb elevations, with or without simultaneous deep breathing, on lung function after cardiac surgery.MethodsIn a randomized 2 × 2 crossover trial, 22 adult patients (> 18 years old) were assessed during one of the first days after surgery in the spring of 2022 at Örebro University Hospital, Sweden. Exercises involving five bilateral upper limb elevations, performed either with simultaneous deep breathing (ROM-DB) or without (ROM), while sitting in an upright position at the edge of the bed, were evaluated. Peripheral oxygen saturation (Rad-5v; Masimo, Irvine, USA) was the primary outcome. Tidal volume and respiratory rate were recorded continuously during the exercises (Spiropalm; Cosmed, Rome, Italy). Heart rate, pain, exertion and dyspnoea were evaluated before and after the exercises.ResultsBoth ROM-DB and ROM momentarily increased peripheral oxygen saturation (+ 1% ± 1, p = 0.004 and + 1% ± 1, p < 0.001, respectively), with no significant differences between these exercises (p = 0.525). ROM-DB significantly increased the VT compared with ROM (798 ± 316 vs. 602 mL ± 176, p = 0.004). However, ROM-DB induced more pronounced pain (p = 0.012), exertion (p = 0.035) and dyspnoea (p = 0.013) than ROM.ConclusionsUpper limb elevations improved oxygenation momentarily, both performed with and without simultaneous deep breathing, with no significant differences between these exercises. The additive deep breathing improved tidal volume compared with upper limb elevations alone, but induced more pain, exertion and dyspnoea during the performance of exercise.Trial registrationClinicalTrials.gov (NCT05278819).

Duration of α-1 adrenergic antagonist administration after low-dose-rate brachytherapy for prostate cancer.

Urinary dysfunction is an adverse event of low-dose-rate brachytherapy (LDR-BT) in patients with prostate cancer. We aimed to examine the time to α-1 adrenergic antagonist withdrawal after LDR-BT initiation. We retrospectively evaluated 1663 patients who underwent LDR-BT at our hospital during 2004-2022. Overall, 1485/1663 (89.3%) patients were able to stop using α-1 adrenergic antagonists, 1111 (66.8%) of them within 1year of LDR-BT. Risk factors for prolonged time to withdrawal were age ≥70years, taking agents for lower urinary tract symptoms prior to LDR-BT, an International Prostate Symptom Score≥8, an Overactive Bladder Symptom Score≥3 and a residual urine volume≥20ml. Of the patients who were able to stop taking α-1 adrenergic antagonists, 357/1485 (24.0%) required resumption, 218 (61.1%) of whom did so between 1 and 3years after LDR-BT. This period matched the period of transient worsening of the urinary symptom score. Finally, multivariable analysis identified supplemental external beam radiotherapy and an Overactive Bladder Symptom Score≥3 as independent risk factors for α-1 adrenergic antagonist resumption. Withdrawal of α-1 adrenergic antagonists was possible in 66.8% of patients within 1year of LDR-BT. Our results suggest that patients who are older or have pre-treatment LUTS may have prolonged deterioration of urinary dysfunction after treatment. Resumption of α-1 adrenergic antagonists 1-3years after treatment may be associated with urinary symptom flares, and close attention is necessary for patients with supplemental external beam radiotherapy and a high pretreatment Overactive Bladder Symptom Score.

EnhancedNet, an End-to-End Network for Dense Disparity Estimation and its Application to Aerial Images

Recent developments in deep learning technology have boosted the performance of dense stereo reconstruction. However, the state-of-the-art deep learning-based stereo matching methods are mainly trained using close-range synthetic images. Consequently, the application of these methods in aerial photogrammetry and remote sensing is currently far from straightforward. In this paper, we propose a new disparity estimation network for stereo matching and investigate its generalization abilities in regard to aerial images. First, we propose an end-to-end deep learning network for stereo matching, regularized by disparity gradients, which includes a residual cost volume and a reconstruction error volume in a refinement module, and multiple losses. In order to investigate the influence of the multiple losses, a comprehensive analysis is presented. Second, based on this network trained with synthetic close-range data, we propose a new pipeline for matching high-resolution aerial imagery. The experimental results show that the proposed network improves the disparity accuracy by up to 40% in terms of errors larger than 1 px compared to results when not including the refinement network, especially in areas containing detailed small objects. In addition, in qualitative and quantitative experiments, we are able to show that our model, pre-trained on a synthetic stereo dataset, achieves very competitive sub-pixel geometric accuracy on aerial images. These results confirm that the domain gap between synthetic close-range and real aerial images can be satisfactorily bridged using the proposed new deep learning method for dense image matching.

Effects of different parenting styles on the physical health of Chinese university students.

Annual declines in university students' physical health have an impact on social stability and the nation's long-term growth. Parenting style, which is crucial to a child's growth and development, may have a big influence on physical health. This study delves into the effects of different parenting styles on the physical fitness of Chinese college students under gender differences. Through random allocation and stratified sampling methods, this study comprehensively investigated 3,151 undergraduate students (male = 1,365; female = 1786) with an average age of 18.44 years (SD = 1.46), from a university in Jiangsu Province, China. Parenting styles of college students were evaluated by the Parental Bonding Instrument (PBI). Physical fitness tests were based on the Chinese National Student Physical Fitness Standards including body mass index, lung capacity, standing-long-jump, bent-leg-sit-up, seated forward bend, pull-ups, 50 m sprint, and 800/1,000 m run. Further investigations focused on the relationship between parenting styles and physical health by statistical analysis methods such as Pearson correlation and multiple linear regression. Significant differences were identified in gender, family members, and academic majors in most of the correlation indicators between different parenting styles and physical health among college students. Further analysis showed that the parenting styles of democratic and authoritative mothers and democratic fathers were more conducive to the promotion of physical health among female university students. The combination of a democratic fathering style and a permissive mothering style is considered an ideal parenting model for male students. This study confirmed that different parenting styles have a significant impact on the physical health of college students. Positive parenting styles may improve physical health, while negative ones are likely to have adverse effects, especially among female students. It is also important to notice differentiated parenting styles with respect to male and female university students. Therefore, more attention should be raised on parenting styles to enhance physical health of the student population.

Study of antibacterial properties of extracts of the herb Speranskia tuberculata (Bunge) Baill

The article deals with the problem of developing antibacterial drugs of plant origin, focusing on the properties of the herb Speranskia Tuberculata (Bunge) Baill, which is still understudied. The aim was to determine the antibacterial activity of preparations of the herb Speranskia Tuberculata (Bunge) Baill, extracted with different solvents. Materials and methodology. Crude extracts were obtained using four solvents: petroleum ether, ethyl acetate, n-butanol, and aqueous solutions. Subsequently, the dried extracts were weighed and dissolved in dimethylsulfoxide to prepare working solutions with 10 to 500 µg/mL concentrations. Colonies of three types of bacteria, Staphylococcus aureus, Escherichia coli, and Propionibacterium Acnes, were used as the object of the study. The degree of antibacterial activity was determined by measuring the antibacterial zone formed after treating bacteria with different concentrations of extracts compared to the control group (treatment with distilled water). In addition, the total content of phenolic compounds and flavonoids was determined by chemical methods. Antioxidant activity, volume of the dry residue of crude extracts, and content of flavonoids and phenolic compounds were compared with the results of liquid chromatography-mass spectrometry on the presence of antibacterial substances in the extracts known from the literature. It was shown that the ethyl acetate extract among the 4 studied extracts had a clearly expressed antibacterial effect. The calculated value of IC50 for this extract varied between 112‒135 μg/mL for different bacteria. Other solvents did not show a pronounced antibacterial effect. The weakest effect was associated with petroleum ether extracts. At the same time, the mass of the dry residue, when extracted with petroleum ether, was the maximum among all solvents; on the contrary, with ethyl acetate, it was the minimum. Regarding the content of phenolic compounds and flavonoids, the results of the studies were opposite; namely, the maximum concentrations were characteristic of the ethyl acetate extract, and the minimum concentrations were characteristic of the petroleum ether extract. According to the literature, twelve compounds found in the extracts have pronounced antibacterial activity. Suppose the presence of an aromatic ring and a carbon-linked hydroxyl group OH- is taken as the main sign of belonging to phenolic compounds. In that case, 8 of 12 invented antibacterial compounds belong to phenols and flavonoids. Experimentally proven high antibacterial activity of preparations of the herb Speranskia Tuberculata (Bunge) Baill based on ethyl acetate extracts. This property is related to the extract's high content of phenolic compounds and flavonoids.

Inheritance patterns of lower urinary tract symptoms in adults: a systematic review.

To compile and evaluate the heritability and inheritance patterns of lower urinary tract symptoms (LUTS) in adult cohorts. Searches of five databases (PubMed, Embase, APA PsycInfo, Global Health, and OVID Medline) commenced on 6 July 2024, resulting in 736 articles retrieved after deduplication. Studies evaluating heritability patterns, gene frequencies, and familial aggregation of symptoms were included for review. Screening and predefined eligibility criteria produced 34 studies for final review. A descriptive analysis of synthesised data was performed, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Cochrane Risk of Bias in Non-Randomised Studies of Interventions (ROBINS-I) tool and the Johanna Briggs Institute checklist were used to evaluate these studies. Ten of the 34 studies (29%) described general LUTS, 14 (41%) described symptoms due to benign prostatic enlargement (BPE), nine (26%) described urinary incontinence (UI; urge UI [UUI], stress UI [SUI] and mixed UI [MUI]), four (12%) described nocturia alone, two (6%) described overactive bladder (OAB), and four (13%) described other specific symptoms (frequency, postvoid residual urine volume). BPE symptoms, UI (MUI and UUI), nocturia alone, and frequency alone were associated with genetic predisposition, whilst OAB and SUI had more modest inheritance. The pathogenetic and pharmacological mechanisms fundamental to LUTS manifestation are highly heterogeneous. Further work is required to evaluate the inheritance patterns of LUTS more extensively.

One hundred cases of Rezum water vapor thermal therapy for benign prostatic hyperplasia: Real-world data at a single institution in Japan.

The objective of our study was to assess the efficacy of Rezum, a minimally invasive surgical treatment, for patients with lower urinary tract symptoms related to benign prostatic hyperplasia (BPH) in real-world clinical practice at a single institution in Japan. We conducted a prospective study involving 100 patients who underwent the Rezum procedure between October 2022 and February 2024. We analyzed patient backgrounds that are compliant with Japanese regulations and assessed descriptive outcomes such as symptom scores, peak flow in uroflowmetry, post-void residual (PVR) volume, and prostate volume (PVol). These data were collected at 1 and/or 3 months postoperatively. On average, 4.7 water vapor injections were administered during the Rezum procedures, with a mean operative time of 6.3 min. Patients experienced significant relief in symptoms, with reductions of 55% in International Prostate Symptom Score, 53% in quality of life score, and 30% in Overactive Bladder Symptom Score. There was also a significant decrease in mean PVR volume (50% reduction) and PVol (27% reduction). Among the subgroup of 23 pre-interventional catheter-dependent patients, 91% achieved catheter independence. Our single-center analysis demonstrates that Rezum is an effective and safe minimally invasive therapeutic option for patients with BPH. This promising novel technique can be particularly beneficial for patients at an augmented risk of bleeding or those considered high risk for anesthesia.

Blood glucose and β-hydroxybutyrate predict significant brain injury after hypoxia-ischemia in neonatal mice.

The Vannucci procedure is widely used to model cerebral hypoxic-ischemic (HI) injury in neonatal rodents. Identifying minimally invasive biomarkers linked to brain injury would improve stratification of pups to experimental treatments. We hypothesized that extreme blood glucose (BG) and β-hydroxybutyrate (bHB) levels immediately after HI will correlate with severity of brain injury in this model. C57BL6 mice of both sexes underwent the Vannucci procedure with BG and bHB measured immediately after hypoxia. GFAP and α-fodrin were measured to assess injury severity at 4h, P11, P18 and P40. Open field (OF), Y-maze (YM), and Object-location task (OLT) were tested at P40. Clinical seizures-like stereotypies during hypoxia were associated with lower post-hypoxia BG in HI-injured mice. Low BG after HI was related to higher GFAP expression, higher α-fodrin breakdown, lower residual regional volume, and worse working memory. BG was superior to bHB in ROC analysis with BG threshold of <111 mg/dL providing 100% specificity with 72% sensitivityfor hippocampal HI-injury. Post-hypoxic BG is a minimally invasive screening tool to identify pups with significant HI brain injury in the Vannucci model modified for mice improving our ability to stratify pups to experimental treatments to assess effectiveness. End hypoxic-ischemic blood glucose levels are a reliable and inexpensive biomarker to detect hypoxic-ischemic brain injury in mice. Screening with blood glucose levels post-hypoxia allows appropriate stratification of those mouse pups most likely to be injured to experimental treatments improving validity and translatability of the results. These findings provide biological plausibility to the clinical observation that extreme blood glucose levels relate to worse outcomes after hypoxia-ischemia.

Inpatient Complication Rates of Bronchoscopic Lung Volume Reduction in the United States

Early randomized controlled trials (RCTs) of bronchoscopic lung volume reduction (BLVR) have shown clinically meaningful benefits in lung function, dyspnea, and quality of life in patients with severe emphysema. Safety outcome data following BLVR in the US are scarce outside the RCTs. What is the rate of inpatient complications after BLVR in the real world in the US? We used The National In-patient Sample (NIS) database to identify in-hospital complications post-BLVR from 2018 to 2020. Complications were defined as pneumothorax, COPD exacerbation, pneumonia, hemoptysis, acute respiratory failure, and valve removal. We also analyzed all-cause in-hospital mortality and length of stay (LOS). We identified 467 admissions related to BLVR procedures. The number of procedures doubled between 2019 and 2020 (from 153 to 295 procedures). The median age was 67.9 years (IQR 61.1 - 72.8), 210 (45.0%) were female, 401 (85.8%) were white, and Medicare was the primary expected payer in 72.8% of cases. Most procedures were done in urban teaching hospitals (56.9%). The rate of pneumothorax was 26.3%, acute respiratory failure 19.5%, COPD exacerbation 8.8%, pneumonia 7.3%, and hemoptysis 5.3%. Chest tube placement was required in 84 out of 123 (68.3%) cases of pneumothorax. The endobronchial valve had to be removed in 69 cases (14.8%). The median LOS was 2.8 days (IQR 2.3 -4.5). The number of in-hospital deaths was less than 11 cases (< 2.3%). Overall, the subgroup who had in-hospital complications did not differ significantly from the others in terms comorbidities, demographics, and hospital characteristics. The real-world complication rate after BLVR was similar to the published complication rates from early randomized clinical trials. In-hospital mortality was low, suggesting that aside from the commonly anticipated complications, BLVR is a safe treatment option for severe emphysema.

Preoperative Atelectasis in Patients with Obesity Undergoing Bariatric Surgery: A Cross-Sectional Study.

Pulmonary atelectasis is present even before surgery in patients with obesity. We aimed to estimate the prevalence and extension of preoperative atelectasis in patients with obesity undergoing bariatric surgery and to determine if variation in preoperative Spo2 values in the seated position at room air is explained by the extent of atelectasis coverage in the supine position. This was a cross-sectional study in a single center specialized in laparoscopic bariatric surgery. Preoperative chest computed tomographies were reassessed by a senior radiologist to quantify the extent of atelectasis coverage as a percentage of total lung volume. Patients were classified as having atelectasis when the affection was ≥2.5%, to estimate the prevalence of atelectasis. Crude and adjusted prevalence ratios (aPRs) and odds ratios (aORs) were obtained to assess the relative prevalence of atelectasis and percentage coverage, respectively, with increasing obesity category. Inverse probability weighting was used to assess the total, direct (not mediated), and indirect (mediated through atelectasis) effects of body mass index (BMI) on preoperative Spo2, and to quantify the magnitude of mediation (proportion mediated). E-values were calculated, to represent the minimum magnitude of association that an unmeasured confounder with the same directionality of the effect should have to drive the observed point estimates or lower confidence intervals (CIs) to 1, respectively. In 236 patients with a median BMI of 40.3 kg/m2 (interquartile range [IQR], 34.6-46.0, range: 30.0-77.3), the overall prevalence of atelectasis was 32.6% (95% CI, 27.0-38.9) and by BMI category: 30 to 35 kg/m2, 12.7% (95% CI, 6.1-24.4); 35 to 40 kg/m2, 28.3% (95% CI, 17.2-42.6); 40 to 45 kg/m2, 12.3% (95% CI, 5.5-24.3); 45 to 50 kg/m2, 48.4% (95% CI, 30.6-66.6); and ≥50 units, 100% (95% CI, 86.7-100). Compared to the 30 to 35 kg/m2 group, only the categories with BMI ≥45 kg/m2 had significantly higher relative prevalence of atelectasis-45 to 50 kg/m2, aPR = 3.52 (95% CI, 1.63-7.61, E-value lower bound: 2.64) and ≥50 kg/m2, aPR = 8.0 (95% CI, 4.22-15.2, E-value lower bound: 7.91)-and higher odds of greater atelectasis percentage coverage: 45-50 kg/m2, aOR = 7.5 (95% CI, 2.7-20.9) and ≥50 kg/m2, aOR = 91.5 (95% CI, 30.0-279.3). Atelectasis percent alone explained 70.2% of the variation in preoperative Spo2. The proportion of the effect of BMI on preoperative Spo2 values <96% mediated through atelectasis was 81.5% (95% CI, 56.0-100). The prevalence and extension of atelectasis increased with higher BMI, being significantly higher at BMI ≥45 kg/m2. Preoperative atelectasis mediated the effect of BMI on Spo2 at room air in the seated position.

Cardiorespiratory interactions during the transitional period in extremely preterm infants: a narrative review.

We aimed to review the physiology and evidence behind cardiorespiratory interactions during the transitional circulation of extremely preterm infants with fragile physiology and to propose a framework for future research. Cord clamping strategies have a great impact on initial haemodynamic changes, and appropriate transition can be facilitated by establishing spontaneous ventilation before cord clamping. Mechanical ventilation modifies preterm transitional haemodynamics, with positive pressure ventilation affecting the right and left heart loading conditions. Pulmonary vascular resistances can be minimized by ventilating with optimal lung volumes at functional residual capacity, and other pulmonary vasodilator treatments such as inhaled nitric oxide can be used to improve ventilation/perfusion mismatch. Different cardiovascular drugs can be used to provide support during transition in this population, and it is important to understand both their cardiovascular and respiratory effects, in order to provide adequate support to vulnerable preterm infants and improve outcomes. Current available non-invasive bedside tools, such as near-infrared spectroscopy, targeted neonatal echocardiography, or lung ultrasound offer the opportunity to precisely monitor cardiorespiratory interactions in preterm infants. More research is needed in this field using precision medicine to strengthen the benefits and avoid the harms associated to early neonatal interventions. IMPACT: In extremely preterm infants, haemodynamic and respiratory transitions are deeply interconnected, and their changes have a key impact in the establishment of lung aireation and postnatal circulation. We describe how mechanical ventilation modifies heart loading conditions and pulmonary vascular resistances in preterm patients, and how hemodynamic interventions such as cord clamping strategies or cardiovascular drugs affect the infant respiratory status. Current available non-invasive bedside tools can help monitor cardiorespiratory interactions in preterm infants. We highlight the areas of research in which precision medicine can help strengthen the benefits and avoid the harms associated to early neonatal interventions.

DeepBreath: Breathing Exercise Assessment with a Depth Camera

Practicing breathing exercises is crucial for patients with chronic obstructive pulmonary disease (COPD) to enhance lung function. Breathing mode (chest or belly breathing) and lung volume are two important metrics for supervising breathing exercises. Previous works propose that these metrics can be sensed separately in a contactless way, but they are impractical with unrealistic assumptions such as distinguishable chest and belly breathing patterns, the requirement of calibration, and the absence of body motions. In response, this research proposes DeepBreath, a novel depth camera-based breathing exercise assessment system, to overcome the limitations of the existing methods. DeepBreath, for the first time, considers breathing mode and lung volume as two correlated measurements and estimates them cooperatively with a multitask learning framework. This design boosts the performance of breathing mode classification. To achieve calibration-free lung volume measurement, DeepBreath uses a data-driven approach with a novel UNet-based deep-learning model to achieve one-model-fit-all lung volume estimation, and it is designed with a lightweight silhouette segmentation model with knowledge transferred from a state-of-the-art large segmentation model that enhances the estimation performance. In addition, DeepBreath is designed to be resilient to involuntary motion artifacts with a temporal-aware body motion compensation algorithm. We collaborate with a clinical center and conduct experiments with 22 healthy subjects and 14 COPD patients to evaluate DeepBreath. The experimental result shows that DeepBreath can achieve high breathing metrics estimation accuracy but with a much more realistic setup compared with previous works.

Impact of radiomics features, pulmonary emphysema score and muscle mass on the rate of pneumothorax and chest tube insertion in CT-guided lung biopsies

Iatrogenic pneumothorax is a relevant complication of computed tomography (CT)-guided percutaneous lung biopsy. The aim of the present study was to analyze the prognostic significance of texture analysis, emphysema score and muscle mass derived from CT-imaging to predict postinterventional pneumothorax after CT-guided lung biopsy. Consecutive patients undergoing CT-guided percutaneous lung biopsy between 2012 and 2021 were analyzed. Multivariate logistic regression analysis included clinical risk factors and CT-imaging features to detect associations with pneumothorax development. Overall, 479 patients (178 females, mean age 65 ± 11.7 years) underwent CT-guided percutaneous lung biopsy of which 180 patients (37.5%) developed pneumothorax including 55 patients (11.5%) requiring chest tube placement. Risk factors associated with pneumothorax were chronic-obstructive pulmonary disease (COPD) (p = 0.03), age (p = 0.02), total lung capacity (p < 0.01) and residual volume (p = 0.01) as well as interventional parameters needle length inside the lung (p < 0.001), target lesion attached to pleura (p = 0.04), and intervention duration (p < 0.001). The combined model demonstrated a prediction accuracy of the occurrence of pneumothorax with an AUC of 0.78 [95%CI: 0.70–0.86] with a resulting sensitivity 0.80 and a specificity of 0.66. In conclusion, radiomics features of the target lesion and the lung lobe CT-emphysema score are predictive for the occurrence of pneumothorax and need for chest insertion after CT-guided lung biopsy.

Optimisation de la prise en charge par l’activité physique des patients atteints d’un syndrome d’Ehlers-Danlos hypermobile

IntroductionHypermobile Ehlers-Danlos syndrome (hEDS) is a hereditary connective tissue disorder with a wide phenotypic variability. The aim of this thesis was to optimize the management by physical activity of hEDS patients. MethodsTo meet this objective, five studies were conducted. The first study (questionnaire with Delphi method) showed that pain, fatigue and sleep disorders, as well as musculoskeletal disorders, were among the most important symptoms to assess according to patients. ResultsTwo studies (retrospective and prospective) were conducted on the effects of a rehabilitation program, demonstrating the benefits of this form of care in many health areas. Finally, two studies on respiratory physiology showed ventilatory mechanical constraints during exercise and altered perception of lung volume and erratic ventilation when performing a cognitive task.

GOLD-Grade Specific Disease Characterization and Phenotyping of COPD Using Quantitative Computed Tomography in the Nationwide COSYCONET Multicenter Trial in Germany

Introduction: The aim of this study was to apply quantitative computed tomography (QCT) for GOLD-grade specific disease characterization and phenotyping of air-trapping, emphysema, and airway abnormalities in patients with chronic obstructive pulmonary disease (COPD) from a nationwide cohort study. Methods: As part of the COSYCONET multicenter study, standardized CT in ex- and inspiration, lung function assessment (FEV1/FVC), and clinical scores (BODE index) were prospectively acquired in 525 patients (192 women, 327 men, aged 65.7 ± 8.5 years) at risk for COPD and at GOLD1–4. QCT parameters such as total lung volume (TLV), emphysema index (EI), parametric response mapping (PRM) for emphysema (PRMEmph) and functional small airway disease (PRMfSAD), total airway volume (TAV), wall percentage (WP), and total diameter (TD) were computed using automated software. Results: TLV, EI, PRMfSAD, and PRMEmph increased incrementally with each GOLD grade (p < 0.001). Aggregated WP5–10 of subsegmental airways was higher from GOLD1 to GOLD3 and lower again at GOLD4 (p < 0.001), whereas TD5–10 was significantly dilated only in GOLD4 (p < 0.001). Fifty-eight patients were phenotyped as “non-airway non-emphysema type,” 202 as “airway type,” 96 as “emphysema type,” and 169 as “mixed type.” FEV1/FVC was best in “non-airway non-emphysema type” compared to other phenotypes, while “mixed type” had worst FEV1/FVC (p < 0.001). BODE index was 0.56 ± 0.72 in the “non-airway non-emphysema type” and highest with 2.55 ± 1.77 in “mixed type” (p < 0.001). Conclusion: QCT demonstrates increasing hyperinflation and emphysema depending on the GOLD grade, while airway wall thickening increases until GOLD3 and airway dilatation occur in GOLD4. QCT identifies four disease phenotypes with implications for lung function and prognosis.