Restrictive Disorders Research Articles

Current perspective of progressive-fibrosing interstitial lung disease.

Interstitial lung disease (ILD) is a parenchymal lung disease and restrictive disorder that presents as diffuse infiltrative shadows. The initial diagnosis of ILD is important because management strategies depend on the disease pathogenesis. Connective-tissue disease (CTD)-associated ILD including rheumatoid arthritis (RA), systemic sclerosis (SSc) requires a thorough evaluation of chronic respiratory symptoms such as non-productive cough and exertional dyspnea, as well as physical findings. Moreover, myeloperoxidase-positive anti-neutrophilic cytoplasmic antibody (MPO-ANCA)-associated vasculitis with ILD also shows disease progression. In CTD-associated ILD, the first-line treatment is anti-inflammatory drugs such as prednisolone or immunosuppressants. In hypersensitivity pneumonitis (HP), detailed environmental history-taking is crucial. Therefore, systematic standardized questionnaires are needed. However, the causative antigens are often not identified in daily clinical practice. When an antigen is identified or suspected, the first action is avoidance. If antigen avoidance does not contribute to clinical improvement, anti-inflammatory drugs such as prednisolone might be introduced. Regarding sarcoidosis, while most patients do not require treatment for lung involvement, some need anti-inflammatory drugs or immunosuppressants. Additionally, steroid treatment should be considered for the critical status of extrapulmonary sarcoidosis including cardiac, neurogenic and ocular sarcoidosis. Once starting treatment for ILD, multi-dimensional approaches are applied, including symptom tracking, chest imaging, pulmonary function test (PFT), and 6-min walking test. Recently, the concept of progressive-fibrosing interstitial lung disease (PF-ILD) has been proposed as a new disease entity. The definition of PF-ILD includes symptom progression, PFT decline, and extension of chest high-resolution computed tomography (HRCT) findings. This mini-review describes the background, definition, clinical characteristics, management, and challenges of PF-ILD.

EFFECT OF POSTURAL DEVIATION ON FUNCTIONAL CAPACITY IN PATIENTS WITH CHRONIC RESPIRATORY DISEASES

The WHO claims that the disorders of the airways and lungs are known as chronic lung illnesses. Among the most serious are COPD, asthma, pulmonary hypertension, occupational lung disorders, and asthma. Adults with chronic respiratory disease are categorized into two categories: obstructive and restrictive. Reduced lung volumes are a feature of restrictive lung disorders, which can be caused by lung parenchymal alterations. Postural abnormalities are a result of these presenting signs of chronic respiratory disease. It mostly affects the cervical and lumbar regions of the spine, with symptoms such as forward head position and upper thoracic kyphosis caused by the continued usage of accessory breathing muscles. The 6MWT distance is used to assess the functional capacity of patients. It is a simple way to assess the status of cardiac and pulmonary diseases. To assess postural deviation and functional capacity of the patients with chronic lung diseases and correlate 6 MWT, Vo2 peak with postural deviation. The study was observational. For the study participants were selected as per the inclusion and exclusion criteria from the AVBRH, Sawangi Meghe. The duration of the study was 6 months. The study includes posture evaluation with the help of the Reedco Posture scale and using 6 MWT to evaluate functional capacity. 6MWT distance and Vo2 peak correlation with postural Deviation. The correlation of functional capacity with postural deviation shows a correlation of 0.39 and mean of 66.31 with standard deviation of 5.41 The correlation r value for VO2 peak and postural deviation came 0.559 p-value=0.0001. We found both the correlation values significant. The present study concluded that patients with the complaints of postural deviation secondary to chronic respiratory diseases had reduced functional capacity.

Ventilation function of the lungs in patients after pneumonia associated with coronavirus disease (COVID-19): diagnostic significance of indicators

The aim of our study was to assess the ventilation function of the lungs in persons who had pneumonia after COVID-19 in the Pridneprovie region in January-April 2021, and to determine the types of ventilation disorders and their severity. We examined 41 people who had pneumonia after COVID-19 not earlier than 4 weeks after the onset of clinical symptoms (the median is 48 (40; 68) days). All of them made up the main group (average age – 55.8±5.6 years, men – 21 (51.2%), women – 20 (48.8%)). Patients were divided into two subgroups depending on the severity of the coronavirus disease in the acute period: subgroup 1 included 26 people (average age – 56.1±4.2 years; men – 12 (42.2%), women – 14 (53.8%)) who had a mild course of the acute period of the disease; subgroup 2 – 15 people (average age – 55.2±5.3 years, men – 9 (60.0%), women – 6 (40.0%)), who had a severe course of the acute period of COVID-19. Clinical examination, assessment of dyspnea (The Modified Medical Research Council Dyspnea scale), level of the cough and sputum (by the Savchenko scale), oxygen saturation, spirometry with a bronchodilation test were conducted. Almost half of the patients with pneumonia after COVID-19 had various disorders of the ventilation function of the lungs. In cases with a mild course of the acute period of COVID-19, obstructive changes were significantly more frequent (p=0.035), and in patients with a severe course of the acute period of COVID-19 – restrictive disorders (p=0.002) prevailed. Bronchoobstructive changes in the post-COVID period are most often caused not by decrease in the forced expiratory volume per second but by the ratio of (FEV1)/forced vital capacity (below 0.7) and/or by the presence of visualized changes in the “flow-volume” curve.

Non-invasive ventilation in neuromuscular diseases: should we use higher levels of ventilatory support?

In patients with COPD, one of the leading indications for domiciliary non-invasive ventilation (NIV), a major paradigm shift has been observed over the past decade in the method for adjusting NIV settings, with the use of sufficient ventilatory support to achieve a significant reduction in PaCO2. Whether this approach may be relevant to other populations, especially slowly progressive neuromuscular diseases (NMD), is unknown. This study was conducted as a post hoc analysis from a previously published randomized controlled trial (NCT03458507). Patients with NMD treated with domiciliary NIV were stratified according to the level of ventilatory support: high-level tidal volume (HLVT; mL/kg of predicted body weight [PBW]) or high-level pressure support (HLPS), defined as a value above median value of the whole population (> 6.8mL/kgPBW or 9.0 cmH2O, respectively). Primary outcome was mean nocturnal transcutaneous CO2 pressure (PtcCO2). Secondary outcomes included adherence to NIV, leaks, and side effects. Of a total of26 patients, 13 were exposed to HLVT, with significantly lower nocturnal PtcCO2 (respectively 40.5 ± 4.2 vs. 46.3 ± 3.9mmHg, p = 0.002). A linear correlation between VT (mL/kgPBW) and mean nocturnal PtcCO2 was evidenced (r = - 0.59, 95%CI [- 0.80; - 0.25], p = 0.002). No significant impact of HLVT was found on secondary outcomes. Despite the lack of power of this post hoc analysis, our results suggest that higher levels of ventilatory support are correlated with lower PtcCO2 in patients with NMD. Further studies are desirable to assess the extent to which the level of assistance influences PaCO2 evolution in patients with slowly progressive NMD, as well as in restrictive thoracic disorders.

Is it Necessary to Stabilize Every Fracture in Patients with Serial Rib Fractures in Blunt Force Trauma?

IntroductionManagement of traumatic rib fractures is subject of controversial discussions. Rib fractures are common, especially after traffic accidents and falls. There is no consensus on whether and how many rib fractures need reconstruction. Not every rib fracture needs to be stabilized, but conservative treatment by internal splinting and analgesia is not effective for all patients. Deformities of the chest wall with reduced thoracic volume and restrictive ventilation disorders must be avoided. Intraoperative assessment of fractures and chest stability plays a central role.Material and methodsFrom 07/2016 to 07/2021, a total of 121 chest wall stabilizations were performed (m:f = 2:1, age 65 ± 14.5 a). Indications for surgery were the following criteria: (1) palpatory instability of the chest wall, (2) dislocated fracture endings, (3) concomitant injuries, (4) uncontrollable pain symptoms. In all patients, a computed tomography scan of the thorax was performed before the osteosynthetic treatment to assess dislocation of the fracture endings and possible concomitant injuries of intrathoracic organs.ResultsVideo-assisted thoracoscopy was performed in all patients. Hemothorax and concomitant injuries of the lung, diaphragm and mediastinum could be assessed. This was followed by an intraoperative assessment of the rib fractures, in particular penetration of fracture endings and resulting instability and deformity. Relevant fractures could be identified and subsequent incisions for rib osteosynthesis precisely defined. 6.3 (±2.7) rib fractures were detected, but 2.4 (±1.2) ribs treated osteosynthetically. Bilateral rib fractures were present in 26 patients (21.5%). Post-operative bleeding occurred in seven patients (5.8%), a breakage of the osteosynthetic material in two patients (1.7%).DiscussionIntraoperative assessment of relevant fractures and dislocation is the decisive criterium for osteosynthesis. Thoracoscopy is mandatory for this purpose – also to identify accompanying injuries. Not every fracture has to be approached osteosynthetically. Even with serial rib fractures or multiple fractures in a single rib, the thoracic contour can be restored by stabilizing only relevant fractures. Intraoperative palpation can adequately assess the stability and thus the result of the osteosynthesis. Even after surgical treatment of thoracic trauma, adequate analgesia and respiratory therapy are important to the healing process.

Sleep and Avoidant Restrictive Food Intake Disorder (ARFID): Correlation With Psychopathology, Gender, and Academic Performance.

ObjectiveNo studies have investigated sleep disturbance in avoidant/restrictive food intake disorder (ARFID). We examined sleep disturbance in ARFID and its association with eating problems, body mass index (BMI), gender, internalizing and externalizing symptoms, cognitive performance, and academic difficulties.MethodsData from 71 ARFID patients from our partial hospitalization program (PHP) for children and adolescents were examined. Sleep data were extracted from measures administered at admission including Achenbach Child Behavior Checklist (CBCL), Children's Depression Inventory (CDI), and Revised Children's Manifest Anxiety Scale (RCMAS). Correlational analyses were conducted to evaluate the convergent validity of parent-reported and participant-reported sleep problems. Association with the severity of eating problems, BMI, percentage of median body weight (% MBW), age, gender, psychotropic medication, psychopathology, and academic difficulties was examined using analysis of variance (ANOVA) and Pearson’s correlation. ResultsFifty-two percent of parents and 74% of participants reported two or more sleep symptoms. Trouble sleeping was reported by 46.48% and nightmares by 35.21% of parents. Parent-reported trouble sleeping highly correlated with internalizing disorders. Parent-reported trouble sleeping and participant-reported difficulty sleeping positively correlated with attention and attention-deficit/hyperactivity disorder (ADHD) problems. Parent-reported less sleep and feeling tired correlated with sluggish cognitive tempo, while walking/talking in sleep negatively correlated with school performance. Gender differences were noted in parent-reported sleep problems. Sleep disturbances were not associated with lower BMI or median body weight at intake. Parent-reported talking/walking in sleep and participant-reported bad dreams and bedtime worries positively correlated with Children's Eating Attitudes Test (ChEAT) scores at intake and discharge.DiscussionOur results provide compelling evidence to screen for sleep disturbance in ARFID patients regardless of median body weight and BMI. Exploration of sleep disturbances in ARFID using objective measures is warranted.

Lung Function and Respiratory Symptoms Features of Smoker among University Students

Introduction: Smoking habit still becomes one of the problems in Indonesia with the high number of active smokers in university students. Smoking is one of the causes of several conditions of respiratory symptoms and risk factor of multiple case of lung function impairment. This study aimed to examine characteristic of lung function and respiratory symptoms and its relationship in active smokers among university student in Depok, Indonesia. Methods: This was a cross-sectional study using American Thoracic Society (ATS) questionnaire for respiratory symptoms and Brinkman index for smoking habits. Lung function was examined using EasyOne® Air Spirometer. Results: This study was participated by 116 male university students who are active smokers. This study found that majority of respondents fell into the mild category of smoking habit (96.56%) and complained of respiratory symptoms (74.14%). This study found lung function impairment in 15.5% respondents (8.6% obstructive and 6.9% restrictive disorder). There was no significant relationship between smoking habits with respiratory symptoms and lung function impairment among respondents. Conclusion: This study found the characteristics of smoking habits in male university students were categorized as mild smoking habit, followed by the appearance of respiratory symptoms and lung function impairment. However, there was no significant relationship between smoking habits and respiratory symptoms or lung function. This issue needs to be paid attention to strengthen the campaign to prevent smoking initiation and to help smoking cessation among young adults as early as possible.

Diallyl Trisulfide Promotes Placental Angiogenesis by Regulating Lipid Metabolism and Alleviating Inflammatory Responses in Obese Pregnant Mice.

The placental tissue serves as an exchanger between the mother and the fetus during pregnancy in mammals. Proper placental angiogenesis is central to the health of both the mother and the growth and development of the fetus. Maternal obesity is associated with impaired placental function, resulting in restricted placental blood vessel development and fetal developmental disorders. Hydrogen sulfide (H2S) is a ubiquitous second messenger in cells that has many biological effects such as promoting angiogenesis, anti-inflammation, anti-oxidation and promoting lipid metabolism. However, in the case of maternal obesity, whether H2S can be used as an important signaling molecule to regulate body metabolism, alleviate placental inflammation levels and promote placental angiogenesis is still unclear. In this study, diallyl trisulfide (DATS), which is a well-known H2S donor, was derived from garlic and used to treat obese pregnant mice induced by a high-fat diet, to determine its effects on lipid metabolism and inflammation, as well as placental morphology and placental angiogenesis. Here, we show that DATS treatment increased litter size and alive litter size. DATS improved the H2S level in the serum and placenta of the mice. In addition, DATS treatment improved insulin resistance and lipid metabolism, reduced the inflammatory response and alleviated placental vascular dysplasia caused by obesity in obese mice. In summary, our research revealed that H2S is an important signaling molecule in vivo, which can regulate placental angiogenesis and improve the reproductive performance in maternal obesity. The addition of H2S donor DATS during pregnancy promoted placental angiogenesis by regulating lipid metabolism and alleviating inflammatory responses in obese pregnant mice.

Avoidant restrictive food intake disorder emerging during COVID-19 pandemic resulting in superior mesenteric artery syndrome

The COVID-19 pandemic has significantly increased the prevalence of psychiatric disorders within pediatric populations. However, only a limited number of studies have sought to understand the correlation between the pandemic and increased incidence of eating disorders. This case study highlights the hospital course of an 18-year-old female who presented with restrictive eating patterns and intensive exercise regimen, self-attributed to the COVID-19 pandemic, leading to superior mesenteric artery syndrome. In understanding the patient’s avoidant restrictive food intake disorder (ARFID), this case study seeks to inform readers of this newer DSM-V diagnosis with the intent of educating pediatric providers of the severity and long-term impact of this disease. Moreover, the case study highlights the importance of gaining a more holistic view of psychiatric disorders emerging as a result of the COVID-19 pandemic.

Monitoring Long Term Noninvasive Ventilation: Benefits, Caveats and Perspectives.

Long term noninvasive ventilation (LTNIV) is a recognized treatment for chronic hypercapnic respiratory failure (CHRF). COPD, obesity-hypoventilation syndrome, neuromuscular disorders, various restrictive disorders, and patients with sleep-disordered breathing are the major groups concerned. The purpose of this narrative review is to summarize current knowledge in the field of monitoring during home ventilation. LTNIV improves symptoms related to CHRF, diurnal and nocturnal blood gases, survival, and health-related quality of life. Initially, patients with LTNIV were most often followed through elective short in-hospital stays to ensure patient comfort, correction of daytime blood gases and nocturnal oxygenation, and control of nocturnal respiratory events. Because of the widespread use of LTNIV, elective in-hospital monitoring has become logistically problematic, time consuming, and costly. LTNIV devices presently have a built-in software which records compliance, leaks, tidal volume, minute ventilation, cycles triggered and cycled by the patient and provides detailed pressure and flow curves. Although the engineering behind this information is remarkable, the quality and reliability of certain signals may vary. Interpretation of the curves provided requires a certain level of training. Coupling ventilator software with nocturnal pulse oximetry or transcutaneous capnography performed at the patient's home can however provide important information and allow adjustments of ventilator settings thus potentially avoiding hospital admissions. Strategies have been described to combine different tools for optimal detection of an inefficient ventilation. Recent devices also allow adapting certain parameters at a distance (pressure support, expiratory positive airway pressure, back-up respiratory rate), thus allowing progressive changes in these settings for increased patient comfort and tolerance, and reducing the requirement for in-hospital titration. Because we live in a connected world, analyzing large groups of patients through treatment of “big data” will probably improve our knowledge of clinical pathways of our patients, and factors associated with treatment success or failure, adherence and efficacy. This approach provides a useful add-on to randomized controlled studies and allows generating hypotheses for better management of HMV.

Functional disorders of the respiratory system in patients with penetrating lung wounds: study prospective design

Background. Lung function tests should be performed to patients with penetrating wounds of the lungs to identify lung function disorders, and the data obtained should be taken into account when correcting medical treatment and prescribing individual medical rehabilitation programs.
 The aim was to study the impact of penetrating lung wounds on the lung function in the early recovery period.
 Materials and methods. 13 patients were enrolled in the study, 100% male, median age 26 [21; 31] years. Spirometry, body plethysmography, and a diffusion test were performed on an average of 14 days from the injury.
 Results. A prospective cross-sectional study was performed. A moderate decrease in the vital capacity (VC), the forced vital capacity (FVC), the volume of forced exhalation in the first second (FEV1) was revealed while the total lung capacity (TLCpl) and the FEV1/FVC ratio were within normal values. However, in 2 (15.4%) and 3 (23%) patients, a restrictive ventilation disorders (TLC lower limit of normal) was detected when using Global Lung Function Initiative (GLI) and European Community for Steel and Coal (ECSC) 1993 predicted value system, respectively. The residual lung (RV) and RV/TLCpl were increased. Functional residual capacity (FRC), FRCpl/TLCpl, airway resistance remained within normal values. The diffusion lung capacity impairment was detected in 92.3% and 61.5% cases according to the ECSC 1993 and the GLI system, respectively.
 Conclusion. In the early period of recovery after penetrating lung wounds, a nonspecific pattern of ventilation disorders was the most often abnormality namely a decrease in VC while TLC and FEV1/FVC were within normal values. Less frequently, the classic restrictive pattern of ventilation disorders was diagnosed. Besides, the diffusion lung capacity impairment was detected. The system of predicted values has a significant impact on the frequency of detection of the lung function disorders. The revealed functional disorders should be taken into account for adjusting medical and rehabilitation interventions.

Prevalence of post-intensive care syndrome in mechanically ventilated patients with COVID-19

Coronavirus disease 19 (COVID-19) patients usually require long periods of mechanical ventilation and sedation, which added to steroid therapy, favours a predisposition to the development of delirium and subsequent mental health disorders, as well as physical and respiratory sequelae. The aim of this study was to determine the prevalence of post-intensive care syndrome (PICS) at 3 months after hospital discharge, in a cohort of mechanically ventilated patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). An ambispective, observational study was conducted in three hospitals with intensive care unit (ICU) follow-up clinics. We studied adults who survived a critical illness due to SARS-CoV-2 infection requiring invasive mechanical ventilation. A physical (muscle strength and pulmonary function), functional [12-Item Short Form Health Survey (SF-12), and Barthel score], psychological [hospital anxiety and depression (HADS) and posttraumatic stress disorder symptom severity scales], and cognitive [Montreal cognitive assessment (MoCA) test] assessment were performed. A total of 186 patients were evaluated at 88 days (IQR 68–121) after hospital discharge. Mean age was 59 ± 12 years old, 126 (68%) patients were men, and median length of mechanical ventilation was 14 days (IQR 8–31). About 3 out of 4 patients (n = 139, 75%) met PICS criteria. Symptoms of cognitive and psychiatric disorders were found in 59 (32%) and 58 (31%) patients, respectively. Ninety-one (49%) patients had muscle weakness. Pulmonary function tests in patients with no respiratory comorbidities showed a normal pattern in 93 (50%) patients, and a restrictive disorder in 62 (33%) patients. Also, 69 patients (37%) were on sick leave, while 32 (17%) had resumed work at the time of assessment. In conclusion, survivors of critical illness due to SARS-CoV-2 infection requiring mechanical ventilation have a high prevalence of PICS. Physical domain is the most frequently damaged, followed by cognitive and psychiatric disorders. ICU follow-up clinics enable the assistance of this vulnerable population.

Prevalence of diagnosed eating disorders in US transgender adults and youth in insurance claims.

We estimated the prevalence of diagnosed eating disorders, overall and by select demographics, among commercially insured individuals identified as transgender in a national claims database. From the 2018 IBM® MarketScan® Commercial Database, there were 10,415 people identifiable as transgender based on International Classification of Disease (ICD-10) codes and procedure codes, specific to gender-affirming care, from inpatient and outpatient claims. Eating disorders were identified from ICD-10 codes and included anorexia nervosa, bulimia nervosa, binge eating disorder, eating disorder not otherwise specified, avoidant restrictive feeding and intake disorder, and other specified feeding and eating disorders. We estimated the prevalence of specific eating disorders diagnoses by selecting patient characteristics. Of individuals receiving some form of gender-affirming care, 2.43% (95% confidence interval: 2.14%-2.74%) were diagnosed with an eating disorder: 0.84% anorexia nervosa, 0.36% bulimia nervosa, 0.36% binge eating disorder, 0.15% avoidant restrictive feeding and intake disorder, 0.41% other specified feeding and eating disorders, and 1.37% with an unspecified eating disorder. Among transgender-identifiable patients aged 12-15 years, 5.60% had an eating disorder diagnosis, whereas 0.52% had an eating disorder diagnosis in patients aged 45-64 years. In patients identifiable as transgender, with receipt of gender-affirming care, the prevalence of diagnosed eating disorders was low compared to extant self-reported data for eating disorder diagnosis in transgender individuals. Among this population, eating disorders were highest in adolescents and young adults. Clinically verified prevalence estimates for eating disorder diagnosis in transgender people with a history of gender-affirming care warrant further investigation. The present study aims to provide clinically validated, contemporary prevalence estimates for diagnosed eating disorders among a medically affirmed population of transgender adults and children in the United States. We report low prevalence of having any eating disorder relative to prevalence estimates reported in prior literature without clinical validation. These findings may be explained by access to affirming care and medical care generally.

Avoidant Restrictive Food Intake Disorder (ARFID) and Body Image: a case report

BackgroundAvoidant Restrictive Food Intake Disorder (ARFID) is a relatively new eating disorder diagnosis, and there is need to better understand this disorder’s presentation. Diagnostic criteria for ARFID require that there are no body image distortions. People with ARFID symptoms may have body image concerns that require careful consideration and more information about the interplay of these is needed to help clinicians appropriately diagnose and manage ARFID.Case presentationThis clinical observation reports a case of ARFID in a nine-year-old with severe malnutrition who positively views her small size and values thinness. The patient reported that her own desire for thinness was influenced by social media beauty ideals and praise of thinness witnessed in social situations. Despite this, the motivation for avoidant and restrictive eating behaviors was low appetitive drive, fear of trying new foods, and fear of adverse consequences from eating.ConclusionsAlthough concerning, the patient’s body image was not of clinical significance as a motivating factor for the disordered eating behaviors. Body image dissatisfaction is common. The requirement to exclude body image distortions in the diagnostic criteria for ARFID may require consideration of the pervasiveness of societal body ideals to which young people are exposed.

A comparison of informative between 6-minute walking test and sit-to-stand test in patients with fibrosing interstitial lung diseases

Physical intolerance is an important sign of many chronic respiratory diseases. The most useful tool for clinical evaluation of physical status is six-minute walking test (6-MWT), but sometimes its technical requirements are not feasible. By this reason, a search for alternative field tests have being going on in the last years, but the diagnostic yield of the new exercise tests for most chronic bronchopulmonary diseases is not clear.The aim of this study was to compare results of 6-MWT and 30-seconds sit-to-stand (30-s-STS) test in patients with fibrosing interstitial lung diseases (ILDs) and restrictive abnormalities of lung function.Methods. This was a cross-sectional non-randomized open comparative study. Patients with ILDs were asked to perform 6-MWT and 30-s-STS test with 30 min interval. We also analyzed medical history, lung function, and dyspnea assessed with Medical Research Council (MRC).Results. The study included 25 ILD patients (11 males; 14 women); 75% of patients had restrictive lung function disorders. The mean distance walked in 6-MWT (6MD) was 380.4 ± 111.9 m (M ± SD), 14 (56%) patients desaturated during the test. The mean number of repetitions in 30-s-STS test was 12 (10 – 13) during 30 s; 5 (20%) patients desaturated during the test. 6MD showed moderate correlation with the number of repetitions in 30-s-STS test and to dyspnea on exertion. The number of repetitions in the 30-s-STS test was not associated with any clinical or functional parameters. To the end of exercise, the number of patients who desaturated increased, the desaturation was greater, and post-exercise SpO2 was lower in 6-MWT compared to 30-s-STS test.Conclusion. 30-s-STS test was less informative in terms of reduced physical tolerance and desaturation on exertion compared to 6-MWT in patients with fibrosing ILDs and restrictive abnormalities of lung function.

Evaluation of Clinical and Instrumental Results of Lung Examination in Patients with Diabetes Mellitus, Coronary Artery Disease, and Obesity

BACKGROUND: There are a large number of works devoted to the study of the state of the bronchopulmonary system in diabetes mellitus in the literature in the last 20 years. However, these studies are often conflicting. Some researchers identify a deterioration in the function of external respiration and a connection with metabolic changes and complications of the disease, others associate it with vascular pathology. There are a number of reports of increased pulmonary ventilation in diabetes.
 AIM: To assess the structural and functional state of the lungs in patients with diabetes mellitus and in combination with coronary heart disease and obesity.
 METHODS: 395 patients with type 1 and type 2 diabetes mellitus were under observation. The diagnosis of diabetes mellitus was verified in accordance with International Programs and was based on WHO criteria. The glycemic level of patients was determined using a One Touch® basic glucometer (Johnson&Johnson, USA). The degree of carbohydrate metabolism compensation was assessed by the level of glycated hemoglobin (HbA1c), determined using a laboratory analyzer DCA-2000 MT (BAYER, Germany). The concentration of C-peptide in the blood serum was determined by the method of immunoluminometric analysis "Immunotech" (Czech Republic). Caro and HOMA-IR indices were calculated to identify and assess the insulin resistance (IR). The indices of hormone metabolism were determined by ELISA using DSL kits (USA) with subsequent measurement of optical density on a Spectra Classic reader from Tecan (Austria): corticotropic hormone (CTG), adrenaline, noradrenaline, cortisol, free hydrocortisone; 17-ketosteroids, 17-oxycorticosteroids, glucogone, insulin, somatotropic hormone (STH); thyroid stimulating hormone (TSH); thyroxine (T4); thyroxine (T3).
 Instrumental-functional and radiation research methods:
 X-ray methods for lungs examining, computer spirography, fibrobronchoscopy of the bronchi was performed in all patients. Morphological changes were assessed using histological and morphometric methods.
 
 RESULTS: Pathogenetic mechanisms of the bronchopulmonary system disorders in patients with type 1 diabetes mellitus are associated with a decrease in the function of external respiration due to the volumetric air flow rates of the predominantly central airways and an increase in bronchial resistance. Alveolar hypoventilation of a restrictive type with impaired diffusion of gases through the alveolar-capillary membrane was detected in patients with type 2 diabetes mellitus. Restrictive and obstructive type disorders with impaired ventilation-perfusion ratios and pulmonary blood flow are formed in patients with type 2 diabetes mellitus combined with coronary artery disease and obesity.
 
 CONCLUSION:
 
 A decrease in the function of external respiration due to the central respiratory tract and an increase in bronchial resistance were noted in 38.4% of patients with type 1 diabetes mellitus. Restrictive alveolar hypoventilation was registered in 23.3% of patients with type 2 diabetes mellitus, catarrhal endobronchitis – in 21.31% of patients with type 2 diabetes mellitus.
 Damage and fibrosis of the alveolar tissue, damage to the endothelium and disorganization of the connective tissue of the lungs were characteristic of microscopic examination of the ultrastructure of the lungs in patients with diabetes mellitus.

EEG Biomarkers in Children and Adolescents With Feeding and Eating Disorders: Current Evidence and Future Directions.

IntroductionElectroencephalography (EEG) represents a powerful tool to detect abnormal neural dynamics in child and adolescent psychiatry. Feeding and Eating Disorders (FEDs), such as anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and avoidant restrictive food intake disorder (ARFID) onset in childhood and adolescence. EEG has rarely been used to examine cortical brain activity in children and adolescents with FEDs. This review aims to summarize EEG findings in FEDs amongst children and adolescents, and to highlight areas deserving further research.MethodsWe searched the literature for EEG studies on children and adolescents with FEDs using Google Scholar, PsycINFO, Medline, and PubMed.ResultsTwelve studies were identified, the majority focusing on AN (N = 10). The identified studies suggest reduced action monitoring control (preparatory waves, N200, P300), specific perceptual-cognitive styles to body/face perception (late positive potentials/early posterior negativity), as well as fundamental changes in posterior theta oscillations in AN. Behavioral traits of BN/BED (i.e., loss of control eating, emotional eating), and AN seem to be associated with an increased attentional reactivity (P300) to visual food stimuli.ConclusionElectroencephalography research in children and adolescents with FEDs is limited and mostly focused on AN. While EEG abnormalities seem consistent with a reduced top-down control and attentional allocation deficits in AN, altered attention specific to food cues emerges across FEDs. Overcoming conventional EEG analyses, and investigating spatial properties (i.e., electrical neuroimaging), will enhance our understanding of FEDs neurobiology.

Mapping the gaps: A scoping review of research on pediatric feeding disorder.

Pediatric feeding disorder (PFD) is defined as impaired oral intake that is not age-appropriate, and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction. As PFD is prevalent and increasing, so are publications on the topic; however, the research literature is often disparate in terminology used and siloed by discipline. Greater understanding of the current research concerning PFD will help identify areas in need of further study. The purpose of this scoping review is to examine the extent, range, and nature of research activities concerning PFD and to identify gaps in the empirical literature. Three electronic databases (PubMed/Medline, CINAHL, PsycINFO) were searched using terms related to pediatric feeding disorder, which include, but not limited to, "feeding disorder/problem/difficulty", "avoidant restrictive food intake disorder (ARFID)", "dysphagia", "selective/picky eating", "problematic mealtime behaviors" or "food refusal". The following limits were placed on the search: full text, humans, English, and age limit (up to 18 years old), and publication date (last 10 years). Covidence software was used to facilitate a systematic data management/analysis. Two people in the research team independently reviewed each result (screening titles and abstracts first, then moving to the full texts) to identify studies that met our inclusion/exclusion criteria and conflicts were resolved through a team discussion. Data were charted regarding disciplines of the authors, study purposes, study settings/locations, study methodologies, and study participants. Descriptive statistics and thematic analyses were used to summarize the characteristics of the studies. The initial search resulted in 5354 articles after removing duplicates between the databases. With a final set of articles (n=415), data charting was completed. The majority of studies were completed by authors from Psychology (n=171) and Medicine (n=123). The most studied aims were to examine attributes of feeding problems (n=168) and/or factors associated with feeding problems (n=183). Sample size median was 53. A total of 166 of the 415 studies examined the effect of an intervention, treatment, or program, but dose of the intervention was difficult or impossible to report across studies. Feeding was studied as an outcome in 400 out of the 415 studies. A closer accounting of the systematically developed parent-report tools revealed 50 distinct parent report tools used across the subset of studies utilizing parent report outcomes (n=123). The results of this scoping review highlight the designs and methods used in research on PFD. This reveals critical gaps in knowledge generation and barriers to intervention replication.

Remimazolam enabled safe anesthetic management during tracheostomy in a patient with amyotrophic lateral sclerosis: a case report

BackgroundAmyotrophic lateral sclerosis (ALS) is known to cause generalized muscle atrophy and respiratory complications. Anesthetic agents and methods for patients with ALS are extremely important because they critically influence postoperative outcomes. In this clinical case, we mainly used remimazolam for safe anesthesia management.Case presentationA 66-year-old man had a gradual onset of numbness and weakness in his extremities over 2 years. He was diagnosed with ALS after the appearance of dysarthria and restrictive ventilation disorder. Due to the rapid progression of respiratory dysfunction, the patient was placed on artificial respiration, and a tracheostomy was planned. General anesthesia was induced with remimazolam (6 mg/kg/h) and remifentanil (0.5 μg/kg/min). Tracheal intubation was performed without muscle relaxants, followed by total intravenous anesthesia (TIVA) with continuous administration of remimazolam 0.8–1.2 mg/kg/h and remifentanil 0.3–0.5 μg/kg/min. At the end of the surgery, the anesthetic effect of remimazolam was reversed with 0.4 mg of flumazenil. The patient was discharged from the operating room with stable breathing, and changes to preoperative ventilator settings were not necessary.ConclusionsWe safely performed tracheostomy for a patient with ALS using remimazolam during general anesthesia.

The proteasome-dependent degradation of ALKBH5 regulates ECM deposition in PM2.5 exposure-induced pulmonary fibrosis of mice

Long-term inhalation of fine particulate matter (PM2.5) can cause serious effects on the respiratory system. It might be attributed to the fact that PM2.5 could directly enter and deposit in lung tissues. We established models of PM2.5 exposure in vivo and in vitro to explore the adverse effects of ambient PM2.5 on pulmonary and its potential pathogenic mechanisms. Our results showed that PM2.5 exposure promoted the deposition of ECM and the increased stiffness of the lungs, and then led to pulmonary fibrosis in time- and dose- dependent manners. Pulmonary function test showed restrictive ventilation function in mice after PM2.5 exposure. After PM2.5 exposure, ALKBH5 was recognized by TRIM11 and then degraded through the proteasome pathway. ALKBH5 deficiency (ALKBH5-/-) aggravated restrictive ventilatory disorder and promoted ECM deposition in lungs of mice induced by PM2.5. And the YAP1 signaling pathway was more activated in ALKBH5-/- than WT mice after PM2.5 exposure. In consequence, decreased ALKBH5 protein levels regulated miRNAs and then the miRNAs-targeted YAP1 signaling was activated to promote pulmonary fibrosis induced by PM2.5.