Restrictive Ventilatory Disorder Research Articles

Lung function and quality of life one year after severe COVID-19 in Brazil.

To evaluate symptoms, lung function, and quality of life of a cohort of patients hospitalized for severe COVID-19 12 months after hospital admission. This was a cross-sectional study. We included severe COVID-19 survivors hospitalized in one of three tertiary referral hospitals for COVID-19 in the city of Belo Horizonte, Brazil. Participants were submitted to lung function and six-minute walk tests and completed the EQ-5D-3L questionnaire. The whole sample comprised 189 COVID-19 survivors (mean age = 59.6 ± 13.4 years) who had been admitted to a ward only (n = 96; 50.8%) or to an ICU (n = 93; 49.2%). At 12 months of follow-up, 43% of patients presented with dyspnea, 27% of whom had a restrictive ventilatory disorder and 18% of whom presented with impaired DLCO. There were no significant differences in FVC, FEV1, and TLC between the survivors with or without dyspnea. However, those who still had dyspnea had significantly more impaired DLCO (14.9% vs. 22.4%; p < 0.020) and poorer quality of life. After one year, survivors of severe COVID-19 in a middle-income country still present with high symptom burden, restrictive ventilatory changes, and loss of quality of life. Ongoing follow-up is needed to characterize long COVID-19 and identify strategies to mitigate its consequences.

Updated national guidelines for spirometry. Part 2. An Approach to Interpreting Spirometry

The second part of the article discusses the spirometry interpretation using the latest international and national recommendations. Different systems of predicted values were considered, attention was paid to the GLI‑2012 reference equations advantages and the z-score assessment. The severity classification, obstructive disorders, extrathoracic and intrathoracic airway obstruction and possible spirometry indications of restrictive and mixed ventilation disorders were considered. The algorithm for spirometry evaluation was also presented, and the most common errors in the spirometry interpretation were discussed.

REHABILITATION OF SPINAL DEFORMITIES IN ADOLESCENTS – THE FAMILY DOCTOR'S POINT OF VIEW

The spinal deformities that are commonly detected in the adolescent years has a significant impact on public health. In recent years, additional risk factors have been identified such as the modern lifestyle, sedentary lifestyle, online school during the Covid 19 pandemic. The spinal deformities that are commonly detected in the teenagers are scoliosis - with the special form adolescent idiopathic scoliosis and kyphosis – the special form Scheuermann kyphosis. The risk for spinal deformity among teenagers whose parents had a spinal deformity is higher in most situations. The family physician usually monitors both parents and children. Considering this, the family physician performs targeted screening on teenagers whose parents suffer from a spinal deformity, due to their genetic predisposition. Teenagers with spinal deformities without further limitations or pain have to be treated according to the indication guidelines. Kinetotherapy alone or in combination with medical massage, orthopaedic approaches, are approach to correct of posture, improve and maintain flexibility, to reduce the pain, the pulmonary dysfunction. Adolescents and adults with restrictive ventilation disorders can only be addressed in specialized centres for rehabilitation of breathing. The role of the family physician is to identify spinal deformities early, to intervene through physical therapy in order to correct the posture and reduce complications. Keywords: spinal deformities, rehabilitation, adolescent, family physician.

Trajectory of lung function in diabetic adults: A 16-year follow-up study of community-based prospective cohorts.

To investigate the difference in lung function according to diabetes status in a community-based prospective study. Individuals aged 40-69 years from two community-based cohorts were followed prospectively for 16 years. A spirometer was used to evaluate lung function at baseline, and lung function tests were carried out biennially thereafter. Multivariable linear regression analysis was performed for the cross-sectional and longitudinal analyses based on diabetes status. Among the 6483 subjects, 2114 (32.6%) had prediabetes and 671 (10.4%) had diabetes. The prediabetes and diabetes groups had lower baseline % predicted values of forced expiratory volume in 1 s (FEV1) (mean, -1.853; 95% confidence interval [CI] -2.715 to -0.990 for prediabetes and mean, -4.088; 95% CI -5.424 to -2.752 for diabetes) and forced vital capacity (FVC) (mean, -2.087; 95% CI -2.837 to -1.337 for prediabetes and mean, -4.622; 95% CI -5.784 to -3.460 for diabetes) compared to the normoglycemia group after adjusting for relevant covariates. The rate of decline in FEV1% predicted (mean, -0.227; 95% CI -0.366 to -0.089) and FVC % predicted (mean, -0.232; 95% CI -0.347 to -0.117) during follow-up were faster in the diabetes group than in the normoglycemia group. The diabetes group had a lower proportion of normal ventilation (ptrend = 0.048) and higher proportions of restrictive (ptrend = 0.001) and mixed (ptrend = 0.035) ventilatory disorders at the last follow-up. Diabetes is associated with a lower baseline lung function and a faster rate of deterioration.

External Respiratory Function, Inflammation Markers, and Life Quality Depending on the Volume of Tuberculosis Lung Lesion

Tuberculosis is a common disease in many countries, so understanding of its impact on life quality and respiratory function as well as study of correlations of these parameters with biochemical markers of tuberculosis course and treatment effectiveness is important in evaluating new methods of treatment and prevention. Objective — to investigate the relationships between the function of external respiration, the level of Human-beta-defensin-1, ferritin, interleukin-6, quality of life and the volume of tuberculosis lung lesions. Materials and methods. 100 patients with pulmonary tuberculosis were included in the study. Patients were divided into groups depending on the volume of tuberculous lesions: Group 1 (n = 36) had lesions within one lung, Group 2 (n = 64) had lesions of both lungs. Examination of patients was carried out according to the current standards of providing medical care to tuberculosis patients. In addition, patients underwent determination of ferritin, interleukin-6 (IL-6), and Human-beta-defensin-1 (HBD-1) levels in the blood by ELISA test. Spirography was performed to determine the parameters of the function of external breathing. Interviews were provided using SF-36 questionnaire with the determination of the main indicators of quality of life. Statistical data processing was carried out using the Statistica 8.0. Results and discussion. Comparison of spirometry parameters between groups showed significantly lower respiratory function parameters in patients with bilateral tuberculous lesions compared to patients with unilate­ral lesions. A decrease in external respiratory function indicators was accompanied by a corresponding significant decrease in the quality of life, which was more pronounced in Group 2. The described changes occurred against the background of a significant increase in the studied biochemical markers in Group 2 compared to Group 1. Thus, the level of HBD-1 in Group 1 was (8.11 ± 1.78) pg/ml, in Group 2 it was (30.14 ± 3.89) pg/ml (p &lt; 0.05). Ferritin level in Group 1 was (94.19 ± 1.18) ng/ml, in Group 2 — (113.45 ± 4.77) ng/ml (p &lt; 0.05). The level of IL-6 in Group 1 was (81.43 ± 1.14) pg/ml, in Group 2 — (103.34 ± 3.46) pg/ml (p &lt; 0.05). When investigating the correlations between the levels of HBD-1, ferritin, IL-6 and quality of life indicators according to the SF-36 scale, reliable inverse relationships were found between all quality of life parameters and the levels of HBD-1 and ferritin. When investigating the correlations between the levels of HBD-1, ferritin, IL-6 and parameters of the function of external respiration, it was found that HBD-1 demonstrates negative reliable correlations with both volume and speed indicators (– 0.24…– 0.32). IL-6 shows negative relationships only in FVC (rs = – 0.42) and FEV1 (rs = – 0.41), however, these correlations are stronger compared to HBD-1. Conclusions. An increase in the volume of tuberculous lesions of the lungs leads to a more pronounced violation of the function of external breathing and, as a result, a decrease in the patients life quality. The described changes are accompanied by an increase in the levels of HBD-1, ferritin and IL-6, which makes the studied biomarkers promising predictors of deterioration of external respiratory function and quality of life. HBD-1 and ferritin demonstrated more pronounced correlations with parameters of life quality. The investigated markers have negative correlations with indicators of both restrictive and obstructive ventilation disorders.

Dynamics of functional changes in the respiratory system after COVID-19-associated lung injury at one year after hospital discharge

Morphological examination reveals microcirculation disorders in combination with small areas of lung damage in the long term after COVID-19. Therefore, the function of the respiratory system should be assessed after COVID-19. Aim of this study was to evaluate the dynamics of respiratory dysfunction in patients with COVID-19-associated lung injury using a complex examination of lung function (spirometry, body plethysmography, and lung diffusion testing) one year after hospital discharge. Methods. 60 patients (38 men/22 women, aged 39 to 80 years) with a diagnosis of “COVID-19-associated interstitial process in the lungs” were examined. Lung function (spirometry, body plethysmography, and lung diffusion capacity testing) was examined in all patients twice, at 1 – 6 months (visit 1) and at 12 – 24 months (visit 2) after hospital discharge. Results. At visit 1, 60% of patients had restrictive pulmonary ventilation disorders. Obstructive ventilation disorders were detected in only 1 patient. Decreased lung diffusion capacity (D CO corr.) was found in 78% of patients. At visit 2, obstructive disorders were detected in 1 patient, and the frequency of restrictive ventilation disorders was 29%. Decreased DLCO corr. was noted in 57% of cases. The parameters of pulmonary ventilation and pulmonary gas exchange function differed significantly between visits. Significant correlations were found between changes in the functional parameters of the respiratory system and disorders identified at visit 1 after hospital discharge. Conclusion. Thus, there is a decrease in the lung diffusion capacity and the rate of restrictive ventilation disorders even one year after severe COVID-19-associated lung injury. However, our results suggest a marked improvement in respiratory system function over time.

Clinical, radiological and evolutionary aspects of non-specific interstitial Pneumonia

Introduction: Non-specific interstitial pneumonia (NSIP) is an interstitial lung disease that may be idiopathic or secondary to connective tissue disease, toxins or numerous other causes. Materials and methods: This is a retrospective study of 30 cases of non-specific interstitial lung disease collected in the radiology and pneumology departments of the Hassan II University Hospital of Fez, spread over a period of 4 years. Results: We collected 30 cases followed for NSIP. The mean age was 49.5 years, with extremes ranging from 26 to 70 years. A clear female predominance was noted (83%). Smoking intoxication was found in 13% of cases. Clinical symptoms were dominated by dyspnea in 26 cases, cough in 19 patients, chest pain in 4 cases and fever in only 1 patient. A restrictive ventilatory disorder was present in 87% of cases. The radiological appearance was in favor of cellular NSIP in 10 patients and fibrosing NSIP in 20 cases. Elemental scanographic lesions were dominated by intralobular reticulations in 97% of cases, presence of ground glass in 83% of cases, bronchiectasis in 87% and septal lines in 80% of cases. Honeycomb and micronodules were present in 20%. Abnormalities were bilateral with basal topography predominant in 26 cases (87%). Lung biopsy was performed in 4 patients. NSIP was idiopathic in 11 cases and associated with a connective tissue disease in 19 cases. The etiologies were dominated by systemic scleroderma found in 11 cases, followed by anti-synthetase syndrome (4 cases), rheumatoid arthritis (3 cases), Gougerot Sjogren's syndrome (2 cases), systemic lupus erythematosus (1 case). Systemic corticosteroid therapy was prescribed in 26 patients and immunosuppressants in second intention in 21 cases, 4 patients were lost to follow-up and did not receive treatment. The evolution under treatment was marked by a clear clinical improvement in 14 patients, a stability in 8 patients and an aggravation in 4 patients. Conclusion: The final diagnosis of NSIP relies on a multidisciplinary discussion between clinicians, radiologists and expert pathologists; it is essential to make the differential diagnosis with UIP as the majority of patients with NSIP have a better prognosis and respond well to corticosteroid treatment.

Respiratory function of workers at some wood factories in Bac Tu Liem district, 2022

Objectives: This study aimed to assess the respiratory function status and associated factors among workers in wood factories in Bac Tu Liem district. Methods: A total of 80 workers from six woodworking establishments participated in this cross-sectional study. Respiratory symptom questionnaires based on ECCS-87 and ATS-DLD-78a were used to collect data on symptoms experienced within the past 12 months. Respiratory function measurements were also conducted during breaks and at the end of shifts. Results: Workers with 3-5 years of experience accounted for 63.8% of the total sample. The majority (92.5%) were exposed to harmful workplace factors for more than 8 hours per day. Only 13.8% reported using full personal protective equipment. Concentrations of respiratory particles and Total Suspended Particulate (TSP) in wood facilities exceeded allowable standards. Cough was the most commonly reported respiratory symptom, with a prevalence of 28.8%. Approximately 66.3% of subjects had normal respiratory function, while restrictive ventilation disorder accounted for the highest proportion of respiratory disorders at 21.3%. Statistical analysis revealed significant associations between respiratory dysfunction and work experience (OR=2.56, p&lt;0.01), duration of exposure to hazardous factors (OR=1.8, p&lt;0.05), use of personal protective equipment (OR=7.12, p&lt;0.05), and the occurrence of respiratory symptoms (OR=1.73, p&lt;0.01). Conclusions: workers in furniture manufacturing facilities in Bac Tu Liem district face exposure to high concentrations of total particles, respiratory particles, and toxic gases that surpass permissible standards. The study also found a significant relationship between respiratory dysfunction and employee characteristics. Keywords: Respiratory function, wood workers, wood factories.

Investigation of newly diagnosed pneumoconiosis from artificial quartz stone manufacturers

Artificial quartz dust exposure may cause associated pneumoconiosis. From November 2019 to July 2020, a total of 27 cases of silicosis associated with artificial quartz stone manufacturers were diagnosed and treated in the Occupational disease Department of Suzhou Fifth People's Hospital. The average age of onset was (46.8±6.6) years, and the average working age of dust exposure was (5.7±1.7) years.The main feature of high KV chest radiography is P/S shadow with strip shadow. CT imaging findings showed diffuse small nodules and ground glass shadows with band shadows. The lesions were mainly distributed in the upper lung, accompanied by pleural thickening, lymphadenopathy and calcification. The pulmonary function impairment was mainly mild restrictive ventilation disorder, and the bronchial mucosa longitudinal plica was the main manifestation under tracheoscopy. The age of silicosis of workers in artificial quartz stone production enterprises is younger, the working age of dust exposure is short, the lung function and bronchial mucosa have a certain degree of damage, and effective preventive measures should be taken in time.

Functional changes in the respiratory system after COVID-19-associated lung injury

Since the beginning of the pandemic, COVID-19 (COronaVIrus Disease-2019) has been viewed as a respiratory disease with characteristic symptoms including cough, shortness of breath, and difficulty breathing. However, some patients still have respiratory complaints and post-inflammatory changes in the lung tissue according to high-resolution computed tomography of the chest organs (CT scan) even after discharge from the hospital.The aim. To assess the functional changes in the respiratory system in patients who had COVID-19-associated lung injury using a comprehensive testing of the respiratory function (spirometry, body plethysmography and diffusion test) in the first 6 months after discharge from the hospital.Methods. The study included 434 patients (252 men and 182 women, aged 20 to 79 years), who were divided into 3 groups depending on the time interval between discharge from the hospital and the respiratory function test: Group 1 – 15 – 45 days; Group 2 – 46 – 93 days; Group 3 – 94 – 183 days. All patients underwent a comprehensive testing of respiratory function.Results. The average pulmonary ventilation indicators remained within the normal range both in the general group and in separate groups. A decrease in DLCO was found in most patients: in 53% of people in the general group, in 54, 54 and 51% of cases in Groups 1, 2 and 3, respectively. Restrictive ventilation disorders (reduction of TLC below the lower limit of normal (LLN)) were detected in 29 % of people in the general group, 33, 27 and 26% in Groups 1, 2 and 3, respectively. Obstructive ventilation disorders (decrease in FEV1/FVC below LLN) were detected in 2 % in the general group, and in 3, 1 and 1% in groups 1, 2 and 3, respectively. Statistically significant correlations were found between the maximum volume of lung tissue damage in the acute period of COVID-19, the age of the patients, and the respiratory function indicators.Conclusion. The pulmonary ventilation indicators normalized within 6 months after COVID-19, while a decrease in lung diffusion capacity persisted in most patients and required further active follow-up.

Clinical characteristics, radiological features, and disease severity of bronchiectasis according to the spirometric pattern

Bronchiectasis show various ventilatory disorders in pulmonary function. The characteristics and severity of patients with bronchiectasis according to these pulmonary dysfunctions are still very limited. This study aimed to evaluate the clinical, radiologic feature and the disease severity of patients with bronchiectasis according to spirometric patterns. We retrospectively evaluated 506 patients with bronchiectasis who underwent pulmonary lung function test (PFT) at a referral hospital between 2014 to 2021. The results showed that cylindrical type was the most common (70.8%) type of bronchiectasis on chest Computed tomography (CT), and 70% of patients had bilateral lung involvement. On the other hand, obstructive ventilatory disorder was the most common (51.6%), followed by normal ventilation (30%) and restrictive ventilatory disorder (18.4%). The modified Medical Research Council (mMRC) was highest in patients with obstructive ventilatory disorders, Modified Reiff score [median (interquartile range)] [6 (3–10), P < 0.001], FACED (FEV1, Age, Chronic colonization, Extension, and Dyspnea) score [3 (1–4), P < 0.001], and Bronchiectasis Severity (BSI) score [8 (5–11), P < 0.001] showed significantly highest values of obstructive ventilatory disorder rather than restrictive ventilatory disorder and normal ventilation. More than half of patients with bronchiectasis had obstructive ventilatory disorder. Bronchiectasis with obstructive ventilatory disorders has more dyspnea symptom, more disease severity and more radiologic severity. There was no significant association between spirometric pattern and radiologic type, but the more severe the radiologic severity, the more severe the lung function impairment.

Função pulmonar e força muscular respiratória na alta hospitalar em pacientes com COVID-19 pós internação em Unidade de Terapia Intensiva

ABSTRACT This study describes the pulmonary function and respiratory muscle strength (RMS) at hospital discharge of severe COVID-19 patients, correlating them with peripheral muscle strength, duration of mechanical ventilation (MV), length of hospital stay, and use of medication. A cross-sectional study was conducted with COVID-19 patients admitted to the Intensive Care Unit. Assessment at hospital discharge included the following variables: RMS, pulmonary function, and peripheral muscle strength (Medical Research Council score [MRC] and handgrip dynamometry). A total of 25 patients with mean age of 48.7±12.3 years were assessed. Out of these, 72% presented restrictive ventilatory disorder, in addition to reduced RMS (maximum inspiratory pressure [MIP] of 74% and maximum expiratory pressure [MEP] of 78% of the predicted value). RMS (MIP and MEP, respectively) correlated negatively with duration of MV (r=−0.599, p=0.002; r=−0.523, p=0.007) and length of hospital stay (r=−0.542, p=0.005; r=−0.502, p=0.01); and positively with FVC (r=0.825, p=0.000; r=0.778, p=0.000), FEV1 (r=0.821, p=0.000; r=0.801, p=0.000), PEF (r=0.775, p=0.000; r=0.775, p=0.000), and handgrip strength (r=0.656, p=0.000; r=0.589, p=0.002). At hospital discharge, severe COVID-19 patients presented: reduced RMS; changes in lung function; negative correlation between RMS and duration of invasive mechanical ventilation (IMV), and length of hospital stay; and a positive correlation with lung function and hand grip strength.

Spirometric profile of patients in the chronic phase of Covid-19

Introduction: The SARS-CoV-2 virus that generates COVID-19 was the protagonist of the most impacting pandemic experienced by humanity. Responsible for thousands of infections, deaths and multisystem sequelae. The respiratory system, being the main route of viral contamination, was also the most compromised, with chronic repercussions regardless of the severity of the acute condition. Therefore, this article aims to critically review the studies that evaluated lung function through spirometry in the chronic phase of COVID-19. Methods: This is a systematic review carried out in six databases, where, through the PICO strategy in English, Spanish and Portuguese, articles that used spirometry as a pulmonary assessment instrument in patients in the post-acute phase of COVID-19 between the years 2020 and 2022. Four reviewers independently analyzed the works regarding data, methodology used and quality of publication. Results: Initially, a total of 2,205 articles related to the topic were searched, after careful selection 50 works were evaluated in full text, leaving 15 studies included in the review at the end. The data pointed to a higher prevalence of restrictive ventilatory disorders as the main pulmonary impairment after COVID-19.

Long-term personal PM2.5 exposure and lung function alternation: A longitudinal study in Wuhan urban adults

BackgroundThe effect of long-term PM2.5 exposure on lung function has not been well established. ObjectivesTo investigate the effects of long-term personal PM2.5 exposure on lung function decline, obstructive, and restrictive ventilatory disorders. MethodPersonal PM2.5 concentrations were evaluated using an estimation model. Lung function parameters including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1) and peak expiratory flow (PEF) were measured in 3053 Wuhan participants from the Wuhan-Zhuhai cohort and were repeated every 3 years. Participants were classified into persistently high exposure group, persistently low exposure group and inconsistent exposure group according to the median of PM2.5 concentration of each visit. Mixed linear models with subject-specific random intercept were used to assess the association of 3-year change of lung function with personal PM2.5 exposure, and generalized linear models were used to assess the association of 6-year change of lung function with personal PM2.5 exposure. Cox regression models were applied to assess the associations of PM2.5 with obstructive and restrictive ventilatory disorders. ResultsThe medians of personal PM2.5 concentrations at baseline and two follow-ups were 153.18, 209.57 and 83.78 μg/m3, respectively. Compared with participants in the persistently low exposure group, participants in the persistently high exposure group showed a 2.99 % (95 % CI: 0.91, 5.08), a 380.15 mL/s (95 % CI: 32.82, 727.48) and a 5.98 % (95 % CI: 0.84, 11.11) additional decline in FEV1/FVC, PEF and PEFpred after 6 years, respectively. Stratified analyses showed that age, gender, body mass index, smoking status and drinking status had no significant modification effect on the associations. The associations of PM2.5 exposure with obstructive and restrictive ventilatory disorders were not significant, except for a positive association between persistently high PM2.5 exposure and restrictive ventilatory disorder among ever drinkers. ConclusionLong-term high PM2.5 exposure was associated with FEV1/FVC, PEF and PEFpred declines.

Indicators of lung function in children with chronic nonspecific lung diseases with pulmonary fibrosis

Introduction. The pathogenesis of most chronic nonspecific lung diseases (CNSLD) in children is based on a long-term inflammatory process, often leading to the formation of pulmonary fibrosis in the structurally altered tissue, which requires dynamic monitoring of patients, including the study of lung function.Aim. To assess the indicators of the lung function in children with chronic bronchopulmonary pathology accompanied by pulmonary fibrosis.Materials and methods. 84 children with CNSLD were examined. The main group consisted of 45 children with CNSLD with pulmonary fibrosis (bronchopulmonary dysplasia, congenital malformations of the lungs, chronic bronchitis, and post pneumonia fibrosis). The comparison group consisted of 39 children with CNSLD without pulmonary fibrosis. The average age of children in the study groups was 9,3±0,48 years. The patients underwent multispiral computed tomography of the lungs with a virtual bronchoscopy program and intravenous bolus contrast enhancement. Evaluation of lung function was carried out by spirometry.Results. In patients in remission, the average values of the ventilation capacity of the lungs in both groups were within the predicted values. However, in patients with fibrotic changes, pulmonary dysfunction was detected 2 times more often than in children with CNSLD without pulmonary fibrosis (35.5% and 15.4%, respectively, p&lt;0.05). Restrictive ventilation disorders were diagnosed only in the group of patients with pulmonary fibrosis. In children with pulmonary fibrosis, the risk of reduced ventilation capacity is significantly higher than in children with CNSLD without pulmonary fibrosis (OR=3.04, 95% CI 1.049–8.78).Conclusion. The data obtained can serve as a prerequisite for further development of predicting the nature of the course of the disease, identifying “risk groups” for the development of fibrotic changes for a personalized approach to the treatment and follow-up of patients with CNSLD.

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.

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.&#x0D; The aim was to study the impact of penetrating lung wounds on the lung function in the early recovery period.&#x0D; 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.&#x0D; 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.&#x0D; 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.

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.

Respiratory Disorders Related to e-Waste Exposure among Workers in the Informal Sector in a Sub-Saharan African City: An Exposed Nonexposed Study.

Introduction Exposure to electrical and electronic equipment waste (e-waste) has become a growing health concern. The objective of this study was to measure the effect of exposure to e-waste on respiratory symptoms and on lung function parameters in workers involved in informal recycling activities in Cotonou city, Benin. Methods This was a cross-sectional study, in which exposed e-waste workers in Cotonou city were randomly selected. A matching nonexposed group based on age and sex was recruited from the general population. Respiratory symptoms were investigated using a questionnaire adapted from the British Medical Research Council's standardized respiratory questionnaire. Participants underwent lung function test using a portable spirometer (MIR SPIROBANK). Data were analyzed with STATA version 15 software. Results The overall prevalence of respiratory symptoms in e-waste workers was statistically higher in the exposed group (33.1% vs. 21.6%; p = 0.027). Chest tightness (11.8% vs. 2.1%; p = 0.003) and breathlessness (6.8% vs. 1.4%; p = 0.018) were the most reported symptoms by e-waste workers. Lung function testing showed a higher proportion of disorders among e-waste workers (25.0% vs. 14.9%, p = 0.029), with a higher proportion of probable restrictive (10.8% vs. 2.7, p = 0.005) and mixed (4.1% vs. 0%, p = 0.013) ventilatory disorders. Handling or working with e-waste was found associated with a significant reduction in forced expiratory volume in one second (FEV1) by 0.4 L (95% CI: 0.3-0.6) and forced vital capacity (FVC) by 0.75 L (95% CI: 0.6-0.9) after adjustment for age, BMI, smoking habits, asthma history, and daily income. Conclusion Work involving e-waste is associated with a higher prevalence of respiratory symptoms and with an increased risk of FEV1 and FVC decline, as well as of lung function impairment, particularly of restrictive disorders. Further studies to better clarify this association are needed. Awareness on this major public health threat should be raised in other sub-Saharan and Asian urban areas.