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Study Objectives: Oral appliance therapy is an increasingly common option for treating obstructive sleep apnea (OSA) in patients who are intolerant to continuous positive airway pressure (CPAP). Clinically applicable tools to identify patients who could respond to oral appliance therapy are limited. Method(s): Data from three studies (N = 81) were compiled, which included two sleep study nights, on and off oral appliance treatment. Along with clinical variables, airflow features were computed that included the average drop in airflow during respiratory events (event depth) and flow shape features, which, from previous work, indicates the mechanism of pharyngeal collapse. A model was developed to predict oral appliance treatment response (>50% reduction in apnea-hypopnea index [AHI] from baseline plus a treatment AHI <10 events/h). Model performance was quantified using (1) accuracy and (2) the difference in oral appliance treatment efficacy (percent reduction in AHI) and treatment AHI between predicted responders and nonresponders. Result(s): In addition to age and body mass index (BMI), event depth and expiratory "pinching" (validated to reflect palatal prolapse) were the airflow features selected by the model. Nonresponders had deeper events, "pinched" expiratory flow shape (i.e. associated with palatal collapse), were older, and had a higher BMI. Prediction accuracy was 74% and treatment AHI was lower in predicted responders compared to nonresponders by a clinically meaningful margin (8.0 [5.1 to 11.6] vs. 20.0 [12.2 to 29.5] events/h, p < 0.001). Conclusion(s): A model developed with airflow features calculated from routine polysomnography, combined with age and BMI, identified oral appliance treatment responders from nonresponders. This research represents an important application of phenotyping to identify alternative treatments for personalized OSA management.Copyright © Sleep Research Society 2020. Published by Oxford University Press on behalf of the Sleep

Study Objectives: Oral appliance therapy is an increasingly common option for treating obstructive sleep apnea (OSA) in patients who are intolerant to continuous positive airway pressure (CPAP). Clinically applicable tools to identify patients who could respond to oral appliance therapy are limited. Method(s): Data from three studies (N = 81) were compiled, which included two sleep study nights, on and off oral appliance treatment. Along with clinical variables, airflow features were computed that included the average drop in airflow during respiratory events (event depth) and flow shape features, which, from previous work, indicates the mechanism of pharyngeal collapse. A model was developed to predict oral appliance treatment response (>50% reduction in apnea-hypopnea index [AHI] from baseline plus a treatment AHI <10 events/h). Model performance was quantified using (1) accuracy and (2) the difference in oral appliance treatment efficacy (percent reduction in AHI) and treatment AHI between predicted responders and nonresponders. Result(s): In addition to age and body mass index (BMI), event depth and expiratory "pinching" (validated to reflect palatal prolapse) were the airflow features selected by the model. Nonresponders had deeper events, "pinched" expiratory flow shape (i.e. associated with palatal collapse), were older, and had a higher BMI. Prediction accuracy was 74% and treatment AHI was lower in predicted responders compared to nonresponders by a clinically meaningful margin (8.0 [5.1 to 11.6] vs. 20.0 [12.2 to 29.5] events/h, p < 0.001). Conclusion(s): A model developed with airflow features calculated from routine polysomnography, combined with age and BMI, identified oral appliance treatment responders from nonresponders. This research represents an important application of phenotyping to identify alternative treatments for personalized OSA management.Copyright © Sleep Research Society 2020. Published by Oxford University Press on behalf of the Sleep

Objectives: To analyze the relationship between manual grasping force (FPM) and Maximum expiratory flow (FEM), and to verify how these parameters together can contribute to bone health in children and adolescents. Methodology: A descriptive (correlational) study was carried out. A total of 253 children and adolescents (134 boys and 119 girls) were selected probabilistically. The age range is 6.0 to 15.0 years old. Weight, standing height, sitting height, right forearm length, right biepicondylar femur diameter, right and left FPM, and peak FEM were evaluated. Bone mineral density (BMD) and bone mineral content (CMD) were calculated by means of anthropometric regression equations. Results: Positive correlations were observed between FPM and FEM in both sexes (R2adjust = 30 to 37%). FPM individually explains BMD and CMD by 58% to 69%, while FEM by 35% to 42%. Both variables together (right and left FPM + FEM) explain BMD and CMD by 67% to 68%. Conclusion: Positive correlations were observed between FPM and FEM in schoolchildren of both sexes. Both variables are determinant to predict children’s and adolescents’ bone health. These results suggest that both parameters can serve as indicators of functional aptitude to identify bone fragility among children and adolescents., Objetivos: Analizar la relación de la fuerza de prensión manual FPM con el Flujo espiratorio Máximo FEM y verificar como estos parámetros en conjunto pueden contribuir sobre la salud ósea en niños y adolescentes. Metodología: Se efectuó un estudio descriptivo (correlacional). Se estudió de forma probabilística a 253 niños y adolescentes (134 hombres y 119 mujeres). El rango de edad fue de 6,0 hasta 15,0 años. Se evaluó el peso, la estatura de pie, estatura sentada, longitud del antebrazo derecho, el diámetro del fémur derecho, la fuerza de prensión manual FPM derecha e izquierda y el flujo espiratorio máximo FEM. Se calculó la densidad mineral ósea DMO y el contenido mineral óseo CMO por medio de ecuaciones de regresión antropométrica. Resultados: Se observó correlaciones positivas entre FPM con el FEM en ambos sexos (R2 adjust = 30 a 37%). La FPM de forma individual explica la DMO y el CMO entre 58 a 69%, mientras que el FEM entre 35 a 42%. Ambas variables en conjunto (FPM derecha e izquierda + FEM) explican la DMO y el CMO entre 67 a 68%. Conclusión: Se observó correlaciones positivas entre la FPM y FEM en escolares de ambos sexos. Ambos variables son determinantes para predecir la salud ósea de niños y adolescentes. Estos resultados sugieren que ambos parámetros pueden servir como indicadores de aptitud funcional para identificar la fragilidad ósea entre niños y adolescentes.

Los objetivos de este trabajo fueron: a) analizar la relación entre las variables antropométricas, edad cronológica, maduración somática y flujo espiratorio máximo con la Masa libre de grasa (MLG) de jóvenes nadadores y b) proponer ecuaciones de regresión que permitan predecir la MLG de nadadores por edad biológica y sexo. Se estudió a 36 nadadores (21 hombres y 15 mujeres) entre los 10.0 a 16.9 años, de la selección de Natación del Maule (Chile). Se evaluó el peso, estatura, estatura sentada, longitud del antebrazo, circunferencia de la pantorrilla y el Flujo espiratorio Máximo (FEM). Se calculó la edad cronológica y edad biológica por antropometría. Se obtuvo los valores de la composición corporal (MLG, Masa ósea y masa grasa) por medio de la Absorciometría dual de rayos X (DXA). La MLG se relacionó con la edad cronológica (R2 = 0.46), biológica (R2 = 0.69), Peso (R2 = 0.86), estatura (R2 = 0.77), estatura sentada (R2 = 0.66) longitud del antebrazo (R2 = 0.69), circunferencia del brazo derecho (R2 = 0.55) y FEM (R2 = 0.69). Se generaron cuatro ecuaciones de regresión para cada sexo las que evidenciaron un R2 Ajustado entre 86 a 90% en hombres y en mujeres entre 95 a 97%. La edad biológica, la longitud del antebrazo, la circunferencia de la pantorrilla y el FEM son excelentes predictores de la MLG. Las ecuaciones generadas sirven para controlar, diagnosticar, monitorizar la MLG de los jóvenes nadadores por edad biológica y sexo., The objectives of this work were: a) to analyze the relationship between anthropometric variables, chronological age, somatic maturation and maximum expiratory flow with Fat Free Mass (MLG) of young swimmers and b) propose regression equations that allow to predict MLG of swimmers by biological age and sex. We studied 36 swimmers (21 men and 15 women) between 10.0 and 16.9 years old, from the selection of Maule Swimming (Chile). Weight, height, sitting height, forearm length, calf circumference and Maximum Expiratory Flow (FEM) were evaluated. Chronological age and biological age were calculated by anthropometry. The values of body composition (MLG, Bone Mass and fat mass) were obtained by means of Dual X-ray Absorptiometry (DXA). MLG was related to chronological age (R2 = 0.46), biological age (R2 = 0.69), weight (R2 = 0.86), height (R2 = 0.77), sitting height (R2 = 0.66) forearm length (R2 = 0.69), circumference of the right arm (R2 = 0.55) and FEM (R2 = 0.69). Four regression equations were generated for each sex, which showed an adjusted R2 between 86% and 90% in men, and in women between 95% and 97%. The biological age, the length of the forearm, the circumference of the calf and the FEM are excellent predictors of MLG. The generated equations serve to control, diagnose, and monitor the MLG of young swimmers by biological age and sex.

Tracheomalacia, tracheobronchomalacia, and excessive dynamic airway collapse are all terms used to describe tracheal narrowing in expiration. The first two describe luminal reduction from cartilage softening and the latter refers to luminal reduction from exaggerated posterior membrane movement. Expiratory tracheal narrowing is a frequent occurrence that can cause symptoms of airway obstruction, such as dyspnoea, wheeze, and exercise intolerance. The accurate diagnosis and quantification of expiratory tracheal narrowing has important aetiological, therapeutic, and prognostic implications. The reference standard for diagnosis has traditionally been bronchoscopy; however, this method has significant limitations. Expiratory tracheal disorders are readily detected by four-dimensional dynamic volume multidetector computed tomography (4D-CT), an emerging, non-invasive method that will potentially enable detection and quantification of these conditions. This review discusses the morphological forms of expiratory tracheal narrowing and demonstrates the utility of 4D-CT in the diagnosis, quantification, and treatment of these important conditions. © 2013 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Tracheomalacia, tracheobronchomalacia, and excessive dynamic airway collapse are all terms used to describe tracheal narrowing in expiration. The first two describe luminal reduction from cartilage softening and the latter refers to luminal reduction from exaggerated posterior membrane movement. Expiratory tracheal narrowing is a frequent occurrence that can cause symptoms of airway obstruction, such as dyspnoea, wheeze, and exercise intolerance. The accurate diagnosis and quantification of expiratory tracheal narrowing has important aetiological, therapeutic, and prognostic implications. The reference standard for diagnosis has traditionally been bronchoscopy; however, this method has significant limitations. Expiratory tracheal disorders are readily detected by four-dimensional dynamic volume multidetector computed tomography (4D-CT), an emerging, non-invasive method that will potentially enable detection and quantification of these conditions. This review discusses the morphological forms of expiratory tracheal narrowing and demonstrates the utility of 4D-CT in the diagnosis, quantification, and treatment of these important conditions. © 2013 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Background: Asthma is a process of chronic allergic inflammation that may be worsened by the activation of neutrophils during acute exacerbations. Objective(s): We investigated our hypothesis that changes in cellular activation may be detectable in peripheral blood (PB) during late-phase asthma and during clinical exacerbations. Method(s): Twenty-one stable asthmatics (9 on treatment with beta2-agonists only, 12 using inhaled corticosteroids) and 10 nonasthmatic volunteers were first compared using flow cytometry to measure beta2-integrin (CD11b/CD18) expression. Production of reactive oxygen species (ROS) was evaluated employing chemiluminescence. Next, 8 mild asthmatics were assessed using similar methods before and after allergen-induced late asthmatic reactions (LARs). Finally, 4 asthmatic subjects were evaluated over 3 months, and symptoms, peak expiratory flow (PEF) and ROS production were measured. Episodes of respiratory morbidity (exacerbations) were identified and their association with ROS production was examined. Result(s): No differences were detected in adhesion molecule expression and ROS production comparing the normal and asthmatic groups. However, after development of the LAR, significant reductions in CD11b neutrophil expression (mean fluorescence intensity; MFI) were observed [before: 994 +/- 102 MFI (mean +/- SEM) versus after: 424 +/-81 MFI; p < 0.01]. Furthermore, strong associations were found between decreases in CD11b and the severity of the LAR (r =0.9; p < 0.02). In the clinical study, ROS production was significantly lower during exacerbations (median 43%; p < 0.05). Again, this measurement was significantly associated with reductions in PEF (r =0.5, p < 0.03). Conclusion(s): In patients with mild stable asthma, no differences in the activation of circulating neutrophils were detectable compared to nonasthmatic individuals. During episodes of asthmatic airway obstruction, in the laboratory and in clinical disease, neutrophil activation d

Background: Asthma is a process of chronic allergic inflammation that may be worsened by the activation of neutrophils during acute exacerbations. Objective(s): We investigated our hypothesis that changes in cellular activation may be detectable in peripheral blood (PB) during late-phase asthma and during clinical exacerbations. Method(s): Twenty-one stable asthmatics (9 on treatment with beta2-agonists only, 12 using inhaled corticosteroids) and 10 nonasthmatic volunteers were first compared using flow cytometry to measure beta2-integrin (CD11b/CD18) expression. Production of reactive oxygen species (ROS) was evaluated employing chemiluminescence. Next, 8 mild asthmatics were assessed using similar methods before and after allergen-induced late asthmatic reactions (LARs). Finally, 4 asthmatic subjects were evaluated over 3 months, and symptoms, peak expiratory flow (PEF) and ROS production were measured. Episodes of respiratory morbidity (exacerbations) were identified and their association with ROS production was examined. Result(s): No differences were detected in adhesion molecule expression and ROS production comparing the normal and asthmatic groups. However, after development of the LAR, significant reductions in CD11b neutrophil expression (mean fluorescence intensity; MFI) were observed [before: 994 +/- 102 MFI (mean +/- SEM) versus after: 424 +/-81 MFI; p < 0.01]. Furthermore, strong associations were found between decreases in CD11b and the severity of the LAR (r =0.9; p < 0.02). In the clinical study, ROS production was significantly lower during exacerbations (median 43%; p < 0.05). Again, this measurement was significantly associated with reductions in PEF (r =0.5, p < 0.03). Conclusion(s): In patients with mild stable asthma, no differences in the activation of circulating neutrophils were detectable compared to nonasthmatic individuals. During episodes of asthmatic airway obstruction, in the laboratory and in clinical disease, neutrophil activation d

Background. Gas trapping in emphysema results in resting and dynamic hyperinflation. We tested the hypothesis that a direct connection between the lung parenchyma and the atmosphere could increase expiratory flow and thereby potentially improve dyspnea through the relief of gas trapping. Methods. Ex vivo we studied 7 emphysematous lungs and 3 fibrotic lungs (as controls) and measured expiratory flow before and after airway bypass insertion during a forced maneuver in an artificial thorax. Pilot studies were conducted in vivo in 6 patients with advanced emphysema using a size 9 endotracheal tube as a bypass surgically placed through the chest wall into the upper lobe. Results. In the ex vivo emphysematous lungs the volume expelled during a forced expiratory maneuver increased from 169 to 235 mL (p < 0.05). In the in vivo group 4 patients retained the bypass tube for 3 months or more; total lung capacity was reduced, and the forced expiratory volume in 1 second increased by 23% (mean percent predicted at baseline versus 3 months, 24.4% versus 29.5%). Conclusions. An extrapulmonary airway bypass increases expiratory flow in emphysema. This may be a useful approach in hyperinflated patients with homogeneous emphysema. (Ann Thorac Surg 2010;89:899-906), QC 20110210

We have shown that expiratory flows increase when expirations are rapidly interrupted in stable asthmatic patients. We hypothesized that a similar increase could be obtained in patients with acute exacerbation of bronchial asthma treated in the Emergency Room. A total of 30 asthmatic patients were randomly allocated into two groups, the study and the control groups. Patients in the study group were connected to a device with an inspiratory line designed to administer pressurized aerosols. The expiratory line passed through a valve completely interrupting flow at 4 Hz, with an open/closed time ratio of 10/3. The control group patients were also connected to the device, but with the valve kept open. Mean expiratory flow at tidal volume (MEFTV) was measured under basal conditions and at 4, 8 and 12 minutes after connecting the patients to the device. All patients received standard treatment throughout the procedure. At all time points MEFTV increased more in the study than in the control group (p < 0.003 by two-way ANOVA). There was no residual effect after disconnection from the device. We conclude that TEFI can rapidly improve expiratory flows in patients with acute exacerbations of asthma, while pharmacologic interventions proceed.