Ventilatory Disorders Research Articles

Environmental and Health Impacts of Women Fish Processors Working on Traditional and Modern Fish Smoking Platforms in Braffèdon (Ivory Coast)

Smoked fish plays a significant role in food security and nutrition, represents 2/3 of the consumption of fishery products in Ivory Coast and is still obtained using outdated traditional smoking methods. These methods are not very concerned with the health of the populations and the preservation of the environment, despite the existence of improved ovens called FTT ovens (FAO-Thiaroye Processing Technique) introduced in the country. The objective of this study is to show the impact of traditional smoking on the health of fish smokers and the environment in comparison with smoking processes based on FTT ovens. It is a cross-sectional and descriptive study involving 36 female smokers who use traditional ovens, 24 female smokers who use FTT ovens, as well as 53 Braffèdon case controls. It was conducted from January 2017 to December 2018. The data collection methodology includes questionnaire surveys, interviews, and observations. For the purpose of the study, two samples were followed: these were women smokers and non-smokers of fish, all of whom volunteered at the clinical examinations conducted. The results showed that women who use traditional stoves are more affected by pathologies. Baseline spirometry did not detect a significant frequency of ventilatory disorders. Bronchial hyperreactivity was statistically more frequent in women smokers using traditional ovens. Three measurement campaigns for CO, VOC and NO were performed above the ovens, at the women's resting point and beyond the ovens. The CO levels found at the women’s resting point in the traditional sites were higher and often exceeded the limit value (50 mg/m3). This work has allowed us to identify the deleterious effects of the fish smoking activity on the health of the fish smokers and the environment.

Semi Fowler Position Adjustment to Treat Ventilation Disorders In Post Craniotomy Meningioma Patients

Meningiomas are one of the most common types of brain tumors. Interventions that can be done in cases of meningiomas are craniotomy, which is a surgical procedure performed by opening a portion of the skull bone to access the brain directly, and this will be directly related to the nerves. Impaired spontaneous ventilation is the most common problem and if it does not get treatment quickly it will be fatal, namely death. The method used in this research is descriptive with a case study approach. The results showed that after setting the semi-Fowler's position in post-craniotama patients for three days, the patient's condition had not changed, which could be seen from the absence of changes in ventilation disturbances seen from the absence of an increase in patient awareness. In conclusion, the application of semi-Fowler's position adjustment has not been able to overcome ventilation disorders that occur in post-craniotomy patients. This may be influenced by the patient's condition.

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.

Bronchial Asthma Among Synthetic Fertilizer Factory Workers Exposed to Ammonia

Background: Ammonia is colorless gaseous compound, lucid and irritating material that is water soluble with a distinctly pungent odor. About 80% of the total usage of ammonia is mainly used to produce synthetic fertilizers. One of the health problems caused by ammonia is bronchial asthma. Ammonia can act as sensitizer or irritant asthmagen depend on their properties, which increased complex interaction of inflammation, airway hyperresponsiveness, and airflow obstruction. However, the causal relationship between ammonia and bronchial asthma is still unclear, so it is necessary to look for some evidence regarding this relationship. The search for evidence also included the seven-step assessment of occupational diagnosis of diseases. Therefore, it can assist occupational medicine doctors who treat patients with bronchial asthma and with a history of ammonia exposure. Methods: The literature searching using the electronic database “PubMed”, “Scopus”, and “Cochrane” search engine. Keywords used were worker, ammonia, and bronchial asthma, ventilatory disorder, respiratory disorder. The articles were selected using the defined inclusion and exclusion criteria. The selected articles were then be critically reviewed based on etiological studies from the Oxford Center of Evidence-Based Medicine. Result: From the five literature obtained, there are differences in results. One article stated that ammonia can increase prevalence risk of bronchial asthma, and other four articles found significant associations between ammonia and reduction in the parameters of pulmonary function. Conclusion: There is a relationship between ammonia exposure and the prevalence of bronchial asthma and reduction of pulmonary function in synthetic fertilizer factory worker. But it is uncertain whether the diagnosis is occupational asthma.

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.

COVID-19 Lung Damage in a Preterm Newborn

AbstractThe new coronavirus disease 2019 (COVID-19) was declared responsible for a global pandemic by the World Health Organization (WHO) on March 11, 2020. It created, since its emergence, a special concern in neonates given their immature immune system and their frequent contact with caregivers.Monochorionic very preterm female neonate (315/7 weeks of gestation) with growth retardation had at 3 weeks of age severe lung damage following an acute respiratory failure caused by horizontally transmitted severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia. Before this acute episode, she was without respiratory support apart from 7 days of positive airway pressure following a respiratory distress syndrome. Both of her parents, her twin sister, and her referent nurse tested positive for SARS-CoV-2. Chest radiographs showed bilateral alveolar infiltration. Chest computed tomography (CT) scan detected multiple ground-glass opacifications in both lungs along with ventilation disorders and bronchial wall thickening. Neonate paraclinical tests showed a negative C-reactive protein and hypogammaglobulinemia. Mechanical ventilation was needed for 1 week along with sedation, pharmaceutically induced paralysis, and inhaled nitric oxide. Severe bronchopulmonary dysplasia revealed by oxygen dependency at 36 weeks of gestation was treated with steroids and noninvasive respiratory support. The neonate was discharged with free oxygen at home.Her twin sister, also SARS-CoV-2–positive, only needed noninvasive ventilation for 19 days.Severe forms of COVID-19 in premature neonates, with long-term respiratory sequelae, are possible. Considering the lack of data in this age group, more studies are needed to investigate the risk factors associated with severe symptoms, the effects of specific treatments, and the long-term prognosis of the disease.

Mechanical Ventilation and Its Association with Ocular Surface Disorders among Patients Admitted In Adult Intensive Care Unit of a Tertiary Care Hospital

Background: Present study was done to evaluate the Mechanical ventilation and its association with Ocular Surface Disorders among Patients admitted in Adult Intensive Care Unit. Material and Methods: It was a prospective observational study carried in AICU over period of one year by Department of Ophthalmology, Dr. RPGMC Kangra at Tanda. All the patients who were admitted in AICU greater than 48 hours between ages of 18-65 years were included and evaluated for socio-demographic information like age, gender, Mechanical ventilation etc. Thorough ophthalmic examination was also done for ocular surface disorders and analysed using epi info v7 software. Results: A total of 126 patients were included in the study. Mean age of the study participants was 41.8 years. Maximum patients, 23.8% of the patients were in age group of 51 and 60 years followed by 23% between 21 and 30 years and 41 and 50 years each. 64.3% of the patients were males while 35.7% were females. 74 (58.7%) of the patients had ocular surface disorders. In the present study, 66.7% of the patients were on mechanical ventilation at 48 hours. At the end of first week, 63% patients were on mechanical ventilation while at the end of second week, 54.5% patients were on mechanical ventilation. At the end of fourth and fifth week, none of the patients was on mechanical ventilation. In the present study, the association between presence of mechanical ventilation and ocular surface disorders was statistically significant. Conclusion: The present study concluded that the patients who were on mechanical ventilation had significantly higher number of ocular surface disorders.

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.

Correction of severe bifid nose deformity using an open W-shaped incision

Bifid nose is a rare congenital anomaly. Because of its low incidence, few cases of surgical treatment have been reported. We propose a surgical method using an open W-shaped incision as a treatment option for severe bifid nose. Based on our 10-year experience, we describe the technique and discuss outcomes, patient selection, and complications. From May 2009 to December 2020, 32 patients with bifid nose underwent surgical correction of the nasal deformity characterized by dorsal hypertelorism, midline cleft of nasal bone and cartilage, and shortened nose using an open W-shaped surgical incision. Nasal subunit morphology before and after surgery was measured by three-dimensional simulation technology. Indications, outcomes, and complications including possible underlying reasons were analyzed. Patient satisfaction was evaluated using a self-assessment survey. Correction of the bifid nasal deformity was successfully achieved using an open W-shaped surgical incision with increased nasal length and improved nasal appearance. Patients were followed-up for a period of 10 months on average, ranging from 6 months to 10 years. Follow-up examinations demonstrated stable results. The overall complication rate was 1.9%. Complications included temporary scar, ventilation disorder, and mild infection of the nasal skin. The majority of patients (98.1%) rated their outcome as improved and much improved (Table 1). The open W-shaped incision technique is an effective therapeutic approach for the correction of severe bifid nose. This is a simple and safe method for the treatment of bifid noses with a high patient acceptance and stable postoperative results.

Diaphragm impairment in patients admitted for severe COVID-19.

Among patients affected by the virus COVID-19, physicians have observed ventilation disorders. It is relevant to assess neurological involvement, including the role of diaphragmatic function. Its possible impairment could be related to the systemic inflammatory response and disease progression that both typify COVID-19 infection. We distinguished two groups (severe group (SG) and mild group (MG)) according to the severity of respiratory symptomatology. We performed neurophysiological and sonography studies to evaluate the diaphragmatic function. Regarding the sonography variables, we identified statistically significant differences in the right mean diaphragmatic thickness along with the expiration, showing 1.56 mm (SEM: 0.11) in the SG vs 1.92 mm (SEM: 0.19) in the MG (p = 0.042). The contractibility of both hemidiaphragms was 15% lower in the severe group, though this difference is not statistically significant. In our examination of the neurophysiological variables, in the amplitude responses, we observed a greater difference between responses from both phrenic nerves as follows: the raw differences in amplitude were 0.40 μV (SEM: 0.14) in the SG vs 0.35 μV (SEM: 0.19) in the MG and the percentage difference was 25.92% (SEM: 7.22) in the SG vs 16.28% (SEM: 4.38%) in the MG. Although diaphragmatic dysfunction is difficult to detect, our combined functional and morphological approach with phrenic electroneurograms and chest ultrasounds could improve diagnostic sensitivity. We suggest that diaphragmatic dysfunction could play a relevant role in respiratory disturbance in hospitalised patients with severe COVID-19.

Restrictions of VC and DLCO in relation to asbestos-related computed tomographic findings quantified by ICOERD-based parameters

BackgroundEven almost 30 years after the ban on the use of asbestos in Germany, the effects of asbestos are still highly relevant in everyday clinical practice in occupational medicine. The aim of this study was to further investigate the significance of essential parameters of both pulmonary function diagnostics and imaging techniques (low-dose HR-TCT) for the prevention and early detection of asbestos-related morphological and functional lung changes.MethodsData from spirometry, body plethysmography and diffusion capacity, as well as CT images of the thorax, were retrospectively studied from 72 patients examined between 2017 and 2019 at the Institute for Occupational and Maritime Medicine (ZfAM), Hamburg, Germany. The subjects were divided into four subgroups according to the presence of comorbidities (concomitant cardiac diseases, obstructive ventilatory disorder, pulmonary function pattern consistent with emphysema, and no other pulmonary or cardiac diseases). These subgroups were analysed in addition to the overall collective. The CT images were evaluated according to the International Classification of Occupational and Environmental Respiratory Diseases (ICOERD) with radiological expertise. In addition, some asbestos-related parameters were newly quantified, and corresponding scores were defined based on ICOERD. Statistical analysis included the use of correlations and fourfold tables with calculation of Spearman's rho (ρ), Cohen’s κ, and accuracy.ResultsVital capacity (VC) is slightly reduced in the total collective compared to the normal population (mean 92% of predicted value), while diffusion capacity for CO (DLCO) shows predominantly pathological values, mean 70% of the respective predicted value. The CO transfer coefficient (DLCO/VA), which refers to alveolar volume (VA), also shows slightly decreased values (mean 87% pred.). Seventy-nine percent of patients (n = 57) had signs of pulmonary fibrosis on CT scans, and pleural plaques appeared in 58 of 72 patients (81%). Of the newly quantified additional parameters, particularly frequently described findings are subpleural curvilinear lines (SC, n = 39) and parenchymal bands (PB, n = 29). VC correlates well with the expression of pleural plaques (ρ = − 0.273, P < 0.05), and DLCO measures show a better correlation with fibrosis score (ρ = − 0.315, P < 0.01). A third, newly developed score, which includes the extent of pleural plaques and additional subpleural parameters instead of fibrosis parameters, shows significant correlations for both VC and DLCO (ρ = − 0.283, − 0.274, resp.; both P < 0.05).DiscussionThe importance of spirometry (VC) and diffusion capacity measurement (DLCO) as essential diagnostic procedures for the early detection of asbestos-related changes ‒ also including patients with relevant concomitant cardiac or pulmonary diseases ‒ was confirmed. Significant and better correlations between lung function changes (VC and DLCO) and abnormal CT findings are seen when parenchymal bands (PB), subpleural curvilinear lines (SC), and rounded atelectasis (RA) are quantitatively included into the evaluation, in addition to assessing the extent of pleural plaques alone. Therefore, when assessing CT images according to ICOERD, these parameters should also be quantified.

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.

Short- and long-term outcomes of thoracoscopic esophagectomy in the prone position for esophageal squamous cell carcinoma in patients with obstructive ventilatory disorder: a propensity score-matched study.

Many patients with esophageal squamous cell carcinoma (ESCC) have obstructive ventilatory disorder (OVD), which is considered a risk factor for postoperative pneumonia. It has been reported that thoracoscopic esophagectomy in the prone position (TEP) is less invasive and is associated with fewer postoperative respiratory complications compared with open esophagectomy. This matched-cohort study aimed to elucidate the safety and oncologic outcomes of ESCC patients with OVD who undergo TEP. In this matched-cohort study, 237 patients with ESCC who underwent TEP between 2010 and 2018 were divided into two groups based on forced expiratory volume in 1s/forced vital capacity. Postoperative complications (Clavien-Dindo classification grade II or higher), overall survival (OS), and disease-free survival (DFS) were compared between the two groups. Based on their propensity scores, 75 patients with normal respiratory function (NRF) and 75 with OVD were selected. The rates of postoperative pneumonia were not significantly different between the two groups (NRF group vs OVD group: 18.7% vs 18.7%; P = 1.000). The rates of recurrent laryngeal nerve palsy and anastomotic leakage were also not significantly different (NRF group vs OVD group: 12.0% vs 18.7%, P = 0.365; 18.7% vs 18.7%, P = 1.000). The 5-year OS and DFS rates in the NRF vs OVD groups were 66.2% vs 54.9% and 63.5% vs 52.9%, respectively, with no significant differences (P = 0.421, 0.197). TEP can be safely performed on ESCC patients with OVD and can result in an oncological efficiency equal to that of the NRF group.

Homotypic Neonatal and Adult Inflammation Primes Adult Microglia Without Impairing Adult Breathing

A population of adults are predisposed to breathing deficits during subsequent illness and disease, yet it is unknown what factor(s) contribute to this adult vulnerability. Since neonatal inflammation primes adult microglia in non‐respiratory control regions and augments peripheral immune responses, we hypothesized that neonatal and adult homotypic inflammation (same inflammatory stimulus at both ages) primes male and female microglia in respiratory control regions, contributing to impairments in adult breathing during subsequent inflammatory challenges. Using lipopolysaccharide (LPS) to induce homotypic inflammation in neonates (1mg/kg LPS, P4) and adults (24µg/kg LPS, i.p.), medullary microglia were primed in adult males (neonatal LPS + adult LPS: 25±4% microglia, n=9; neonatal LPS + adult saline: 18±2% microglia, n=9; neonatal saline + adult saline: 10±1% microglia, n=9; p&lt;0.01) and adult females (neonatal LPS + adult LPS: 25±3% microglia, n=9; neonatal LPS + adult saline: 14±2% microglia, n=6; neonatal saline + adult saline: 10±2% microglia, n=8; p&lt;0.0001). However, spinal cord microglia were only primed in adult males (neonatal LPS + adult LPS: 13±2% microglia, n=9; neonatal LPS + adult saline: 9±2% microglia, n=9; neonatal saline + adult saline: 10±2% microglia, n=9; p&lt;0.01) and not adult females (neonatal LPS + adult LPS: 13±2% microglia, n=9; neonatal LPS + adult saline: 9±1% microglia, n=6; neonatal saline + adult saline: 9±1% microglia, n=8; p&lt;0.01). Thus, neonatal and adult homotypic inflammation region‐ and sex‐dependently prime microglia in respiratory control regions. To test whether primed microglia in respiratory control regions contribute to deficits in adult breathing, breathing was assessed by plethysmography in adults at two time points: during the peak inflammatory response (3hrs) and peak microglial migration and proliferation (24hrs). Neither adult eupneic breathing nor chemoreflexes (hypercapnic ventilatory response, HCVR, and hypoxic ventilatory response, HVR) were primed in males or females by neonatal and adult homotypic inflammation at either time point. Interestingly, adult female chemoreflexes were time‐dependently increased by neonatal and adult homotypic inflammation. In adult females, neonatal and adult homotypic inflammation increased the peak HCVR at 3hrs (neonatal LPS + adult LPS: 298±112% ∆VE from baseline, n=6) compared to 24hrs (neonatal LPS + adult LPS: 169±41% ∆VE from baseline, n=6, p=0.04), and increased the peak HVR at 3hrs (neonatal LPS + adult LPS: 159±37% ∆VE from baseline) compared to 24hrs (neonatal LPS + adult LPS: 62±23% ∆VE from baseline, n=6, p=0.02). Thus, adult female chemoreflexes were time‐dependently impacted by the combination of neonatal and adult homotypic inflammation, suggesting time‐specific effects of adult inflammation. Despite no significant impact of primed microglia on baseline breathing and chemoreflexes, primed respiratory control microglia have the potential to significantly impair respiratory control during more severe inflammatory challenges associated with illness and disease. Further, sex differences in primed respiratory control microglia suggest sex‐specific vulnerability to adult ventilatory control disorders.

Нуреrsensitivity pneumonitis combined with arterial hypertension: clinical, radiological, functional features

The aim of the study was to explore the clinical, radiological, functional indicators of hypersensitivity pneumonitis (HP) in combination with arterial hypertension, to assess the effect of these diseases on each other.Methods. The study included 50 patients with hypersensitivity pneumonitis (HP) and 49 patients with arterial hypertension (AH). The patients were divided into three groups. The main group included 24 patients with hypersensitivity pneumonitis combined with AH. The comparison group was 26 patients with HP without AH; the control group was 25 patients with arterial hypertension alone. Clinical symptoms, radiological findings, and results of instrumental tests were analyzed.Results. The intensity of clinical symptoms (shortness of breath, cough) was significantly higher in the main group than in the control and comparison groups. Exercise tolerance estimated from the six-minute walk test was significantly lower in the main group. The clinical status correlated with the functional testResults. Volumetric and velocity spirometry values tended to decrease more in the main group compared to the other two groups. The lung diffusion capacity was significantly lower in the group of patients with HP in combination with AH compared to the group of patients with hypertension only. A similar trend was observed when assessing the chest CT: significantly more pronounced changes were found in the main group. EchoCG showed a significant increase in pulmonary hypertension and volumes of the right heart in the main group compared to the group of patients with AH alone.Conclusion. The present study provides evidence of the greater intensity of respiratory symptoms, decreased functional status, ventilation disorders, dilated heart cavities, greater risk of fatal vascular complications in patients with HP associated with hypertension.