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BACKGROUND The search for aesthetic non-surgical procedures is growing. The use of polymethylmethacrylate (PMMA) as a filling material in the nose represents one of the many options among these aesthetic procedures. Its use, however, can lead to complications. The treatment of these complications is often challenging. METHODS We performed a retrospective clinical analysis of the medical records of patients undergoing treatment of PMMA granulomas of the nose at a private clinic from January, 2015, to January, 2021. A short-pulsed neodymium-YAG (Nd:YAG) laser was applied intranasally or directly by cutaneous incision in the granulomas. Laser-tissue interaction heats the alloplastic material, fragments the product and creates cleavage paths, thereby facilitating the removal of PMMA, either by intercartilaginous removal or aspiration. RESULTS Twenty-seven patients were included in the study. All had a history of PMMA injection in the nose. All patients were treated with an intralesional pulsed 1064nm Nd:YAG laser. The material removed after laser-tissue interaction was sent for histopathological examination; this showed the presence of microparticles of exogenous material compatible with PMMA. The partial removal of the alloplastic material was shown to be effective in all cases. One patient developed a small blister in the nasal dorsum. Follow-up ranged from six to 47 months. CONCLUSIONS The use of intralesional Nd:YAG laser for the treatment of PMMA granulomas on the nose proved to be an effective and safe procedure with improvement of nasal shape, without compromising respiratory function. This technical option represents yet another alternative in the treatment of PMMA granuloma complications. J Drugs Dermatol. 2021;20(11): 1161-1166. doi:10.36849/JDD.6550.

The recognition of cardiogenic shock in the setting of myocardial ischaemia has important prognostic and therapeutic implications. Resuscitative efforts should focus on stabilizing circulatory and respiratory function, with early restoration of coronary blood flow to avoid multi-organ dysfunction and death. However, despite recent progress, the mortality rate remains high, in the order of 40–50%. This article highlights several key recent advances in the management of ischaemic cardiogenic shock, including the use of early bedside echocardiography to confirm the diagnosis, and culprit only lesion strategies of early revascularization. Furthermore, we appraise the variety of mechanical cardiac supports that are increasingly being used to assist the management of ischaemic cardiogenic shock in those cases refractory to pharmacological intervention.

Kyphosis makes abdominal surgery difficult. Here, we report a case of rectal cancer in a patient with kyphosis on whom laparoscopic surgery was adequately performed owing to preoperative simulation. An 81-year-old woman with rectal cancer was admitted to our department, and laparoscopic surgery was planned. On physical examination, the patient showed severe kyphosis. To adequately perform laparoscopic surgery, a detailed and thorough preoperative simulation was conducted. 1) Simulations of port arrangement and anatomy with 3-D CT, 2) body position simulation, 3) selection of surgical instruments, 4) preoperative discussion with the anesthesiologist were conducted. We planned to insert the first port from the umbilical region for pneumoperitoneum and the camera port from the ventral region under pneumoperitoneum. We planned to insert the ports on the right side of the patient's body from caudal regions, considering the location of the inferior mesenteric artery and the limited degrees and space due to the costal arch and the promontorium. Beach chair position was planned. We used a fan-shaped retractor and a sponge-made retractor to remove the small intestine from the surgical view. We discussed with the anesthesiologist preoperatively, and decided to keep the pneumoperitoneum pressure under 8 mmHg during the operation considering the respiratory function. Lower anterior resection with D2 lymph node dissection was performed without any intraoperative complications, and at 2 years post-surgery, the patient was healthy with no signs of recurrence. Laparoscopic surgery may be a good choice in patients with kyphosis, and we believe that preoperative simulation will result in an uneventful surgery.

Glycogen storage disease type 1a (GSD 1a) is a metabolic disorder caused by deficiency of an enzyme required for glycogen breakdown, causing hypoglycaemia and lactic acidosis. Metabolic derangements cause disease manifestations affecting the kidneys, liver and platelet function. Physiological changes in pregnancy worsen fasting intolerance and increase reliance on exogenous glucose to avoid lactic acidosis. Fetal macrosomia and declining respiratory function result in high rates of caesarean sections. We report the multidisciplinary team (MDT) management of a 25-year-old woman with GSD 1a in an unplanned pregnancy. Existing percutaneous endoscopic gastrostomy tube feeding, alongside high-calorie drinks and intravenous dextrose during labour, managed the risks of hypoglycaemia and lactic acidosis. Metabolic parameters were regularly monitored and fortnightly growth scans were assessed for macrosomia. Allopurinol was continued throughout the pregnancy to reduce the risk of hyperuricaemia. MDT management optimised maternal and fetal care throughout pregnancy and labour, resulting in a successful vaginal delivery.

Pulmonary rehabilitation is a cornerstone of management for patients after lung transplantation (LT), but the benefits of inspiratory muscle training (IMT) after LT in children are unclear. Therefore, we examined whether IMT can improve respiratory function and dyspnoea in a paediatric patient after LT.The patient was a 13-year-old boy who underwent double LT. However, mild physical activity such as walking triggered dyspnoea for the patient. The patient underwent IMT with the intensity of approximately 30% of his maximal inspiratory pressure (MIP) for 2 months.The patient’s MIP was increased by approximately 60% after 2 months, and his forced vital capacity as a percent of the predicted normal value increased from 74.6% to 83.4%, with improvement of dyspnoea.IMT may help improve dyspnoea after LT in children with respiratory muscle weakness and a decline in respiratory function.

Background: Bronchial contraction and dilation is thought to be caused by non-adrenergic non-cholinergic nerves. Objective: To investigate the effects of low-frequency (1-5 Hz) and highfrequency (50-100 Hz) electric acupuncture (EA) stimulation on bronchial dilation. Design: Prospective, single-center study Setting: Teikyo Heisei University Subjects: Seventeen healthy male adults Randomization: We randomly assigned subjects to 2-Hz EA and 100-Hz EA groups in a crossover trial. The washout period was 2 weeks. Intervention: Both groups underwent a respiratory function test, followed by a 5-minute rest, followed a 5-minute rest or EA stimulation, followed by a 5min rest. Heart rate variability was measured at rest, followed by another respiratory function test. Acupuncture was delivered near the cervical ganglia at the level of the sixth cervical vertebra on the left side. EA stimuli were set to 2-Hz or 100-Hz, and stimulation intensity was set to a level where no pain was felt. Main outcome measures: Spirometry (forced vital capacity, forced expiratory volume in 1 s, and maximum respiratory flow), autonomic nerve activity (low-frequency component, high-frequency component, and their ratio), and heart rate variability. Results: Heart rate variability analysis showed significant differences in heart rate between the 2-Hz EA and 100-Hz EA groups. The 2-Hz EA group showed a significant increase in HF.Conclusions: 2-Hz EA stimulation resulted in decreased heart rate and increased HF during stimulation. This may be more effective for regulation of the autonomic nerves of the cardiopulmonary system than 100-Hz EA stimulation. Future studies are required to confirm our findings.

Background Malignant tumors occurring around both the spinal column and posterior chest wall are uncommon. Surgical resection of chest wall tumors adjacent to the spinal column is still challenging due to the surrounding anatomical structures. The purpose of the present study was to evaluate the long-term outcomes of surgical management in malignant tumors involving the spinal column and posterior chest wall. Methods Between 1999 and 2007, 10 consecutive patients underwent en bloc resection combined with the posterior chest wall in the treatment of malignant tumors around the spinal column. There were 6 males and 4 females with a mean age at the surgery of 40.9 years old (range, 14–62 years old). The mean postoperative follow-up period was 159.7 months (range, 84–245 months). The clinical history, physical examination, laboratory data, radiological findings, and operative findings for each patient were retrospectively reviewed. Results All surgeries were performed via a combined anterior and posterior approach. The mean numbers of partially resected vertebrae and ribs were 3.1 and 4.1, respectively. Lower or upper lobectomy was performed in four patients, and the diaphragm was partially resected in two patients. The surgical margin was wide in seven patients and marginal in two patients. Although five patients had postoperative respiratory problem, all patients improved immediately without life-threatening complications. There were no patients with respiratory insufficiency after surgery. One patient with osteosarcoma died of lung metastases 99 months after surgery. At the final follow-up, only one patient had local recurrence, five had been continuously disease-free, and three were alive with no evidence of disease. Conclusions En bloc resection and reconstruction in selected patients with malignant tumors involving both the spinal column and posterior chest wall demonstrated good long-term results for local control and the respiratory function.

We report the first case of coronavirus disease 2019 (COVID-19)-associated respiratory failure requiring urgent living-donor lobar lung transplantation (LDLLTx). A 57-year-old woman with a positive viral status developed severe hypoxia requiring extracorporeal membrane oxygenation (ECMO). Her respiratory function deteriorated, with almost totally collapsed lungs. All of her other organs functioned well. After 104 days on ECMO, she received urgent LDLLTx under cardiopulmonary bypass. The grafts worked well, and she was weaned off cardiopulmonary bypass after reperfusion. LDLLTx is an option for selected patients with post-COVID-19 end-stage respiratory failure. Coronavirus disease 2019 (COVID-19) has spread worldwide since December 2019 due to the unprecedented pandemic.1 Patients with end-stage COVID-19-related respiratory failure require mechanical ventilation and/or extracorporeal membrane oxygenation (ECMO). In some countries, lung transplantation (LTx) has become a treatment option for irreversible lung function deterioration.2,3 We report the first successful case of severe respiratory failure caused by COVID-19 treated with urgent living-donor lobar lung transplantation (LDLLTx).

Hepatitis E virus (HEV)-associated neuralgic amyotrophy (NA) is often bilateral and severe, involving structures outside the brachial plexus, such as the phrenic nerves or the lumbosacral plexus. We report a case of an HEV-positive man who had presented with brachial neuritis, with significant phrenic nerve involvement, resulting in diaphragmatic paralysis requiring non-invasive ventilation. Prognosis of HEV-associated NA is often unfavourable and recovery is usually incomplete. Identifying HEV-associated NA early could potentially aid in prognostication and management planning, as clinicians and patients would be expectant of its potential features and severity. Respiratory function should be monitored in patients with HEV who suffer from NA, as diaphragmatic paralysis could potentially lead to severe respiration difficulties requiring ventilatory support.

Introduction: Obstructive sleep apnea syndrome is a common condition in childhood and if left untreated can result in many health problems. An accurate diagnosis of the etiology is crucial for obstructive sleep apnea treatment success. Functional orthodontic appliances that stimulate mandibular growth by forward mandibular positioning are an alternative therapeutic option in growing patients. Objective: To perform a literature review about the effects of functional orthodontic appliances used to correct the mandibular deficiency in obstructive sleep apnea treatment. Methods: The literature search was conducted in June 2020 using Cochrane Library; PubMed, EBSCO (Dentistry & Oral Sciences Source), LILACS Ovid; SciELO Web of Science; EMBASE Bireme and BBO Bireme electronic databases. The search included papers published in English, until June 2020, whose methodology referred to the types and effects of functional orthopedic appliances on obstructive sleep apnea treatment in children. Results: The search strategy identified thirteen articles; only four articles were randomized clinical studies. All studies using the oral appliances or functional orthopedic appliances for obstructive sleep apnea in children resulted in improvements in the apnea-hypopnea index score. The cephalometric (2D) and tomographic (3D) evaluations revealed enlargement of the upper airway and increase in the upper airspace, improving the respiratory function in the short term. Conclusion: Functional appliances may bean alternative treatment for obstructive sleep apnea, but it cannot be concluded that they are effective in treating pediatric obstructive sleep apnea. There are significant deficiencies in the existing evidence, mainly due to absence of control groups, small sample sizes, lack of randomization and no long-term results. Resumo Introdução: A síndrome da apneia obstrutiva do sono é uma condição comum na infância e, se não tratada, pode resultar em muitos problemas de saúde. Um diagnóstico preciso da etiologia é crucial para o sucesso do tratamento dessa condição clínica. Aparelhos ortodônticos funcionais que estimulam o crescimento mandibular através do anteroposicionamento mandibular são uma opção terapêutica para pacientes em crescimento. Objetivo: Fazer uma revisão da literatura sobre os efeitos do aparelho ortodôntico funcional usado para corrigir a deficiência mandibular no tratamento da apneia obstrutiva do sono. Método: A pesquisa bibliográfica foi feita em junho de 2020 nos os bancos de dados eletrônicos da Cochrane Library; PubMed, EBSCO (Dentistry & Oral Sciences Source), Lilacs Ovid; SciELO Web of Science; Embase Bireme e BBO Bireme. A busca incluiu artigos publicados em inglês, até junho de 2020, cuja metodologia referia-se aos tipos e efeitos dos aparelhos ortopédicos funcionais no tratamento da apneia obstrutiva do sono em crianças. Resultados: A estratégia de busca identificou 19 artigos; apenas quatro eram estudos clínicos randomizados. Todos os estudos que usaram aparelhos orais ou aparelhos ortopédicos funcionais para apneia obstrutiva do sono em crianças resultaram em melhorias no índice de apneia-hipopneia. As avaliações cefalométrica (2D) e tomográfica (3D) mostraram alargamento das vias aéreas superiores e aumento do espaço das vias aéreas superiores, que melhoraram a função respiratória em curto prazo. Conclusão: Os aparelhos funcionais podem ser um tratamento opcional para apneia obstrutiva do sono, mas não é possível concluir que sejam eficazes na população pediátrica. Existem deficiências significativas nas evidências existentes, principalmente devido à ausência de grupos de controle, tamanho pequeno das amostras, falta de randomização e ausência de resultados em longo prazo.

Postoperative pulmonary complications and acute respiratory failure are among the leading causes of adverse postoperative outcomes. Noninvasive ventilation may safely and effectively prevent acute respiratory failure in high-risk patients after cardiothoracic surgery and after abdominal surgery. Moreover, noninvasive ventilation can be used to treat postoperative hypoxemia, particularly after abdominal surgery. Noninvasive ventilation also can be helpful to prevent or manage intraoperative acute respiratory failure during non-general anesthesia, primarily in patients with poor respiratory function. Finally, noninvasive ventilation is superior to standard preoxygenation in delaying desaturation during intubation in morbidly obese and in critically ill hypoxemic patients. The few available studies in children suggest that noninvasive ventilation could be safe and valuable in treating hypoxemic or hypercapnic acute respiratory failure after cardiac surgery; on the other hand, it could be dangerous after tracheoesophageal correction.

Summary Background and objective Presbyphonia is an age-related voice disorder characterized by vocal fold atrophy and incomplete glottal closure during phonation. The extent to which the effects of presbyphonia may be compounded by age-related declines in the respiratory system and further impact communication and quality of life remains unknown. Therefore, the objective of this study was to determine how variations in respiratory function impacts voice measures in a sample of participants with presbyphonia. Methods In this pilot study, 21 participants with presbyphonia underwent respiratory assessments (spirometry and respiratory muscle strength testing) and voice assessments (videostroboscopy, acoustic analysis, auditory-perceptual ratings, aerodynamic assessment, and self-assessments). Factor and cluster analyses were conducted to extract voice and respiratory constructs and to identify groups of participants with similar profiles. Correlations and regression analyses were conducted to better describe the relationships between voice and respiratory function. Results Respiratory function was found to impact voice via two main pathways: through its physiological effect on voice and through its impact on general health and impairment. A lower respiratory function was associated with a lower vocal fold pliability and regularity of vibration and with an elevated aerodynamic resistance accompanied by laryngeal hyperfunction. Standardized measures of respiratory function were associated with perceived voice-related handicap. Respiratory function did not associate with voice quality, which was mostly influenced by the severity of vocal fold atrophy. Conclusion Poor respiratory health exacerbates the burden of vocal fold atrophy and, therefore, implementation of respiratory screening prior to starting voice therapy may significantly affect the treatment plan and consequently the outcomes of voice therapy in this patient population.

The aim of this study was to investigate the relationship between mitochondrial content and respiratory function and whole-body insulin resistance in high-fat diet (HFD) fed rats. Male Wistar rats were given either a chow diet or an HFD for 12 weeks. After 4 weeks of the dietary intervention, half of the rats in each group began 8 weeks of interval training. In vivo glucose and insulin tolerance were assessed. Mitochondrial respiratory function was assessed in permeabilised soleus and white gastrocnemius (WG) muscles. Mitochondrial content was determined by the measurement of citrate synthase (CS) activity and protein expression of components of the electron transport system (ETS). We found HFD rats had impaired glucose and insulin tolerance but increased mitochondrial respiratory function and increased protein expression of components of the ETS. This was accompanied by an increase in CS activity in WG. Exercise training improved glucose and insulin tolerance in the HFD rats. Mitochondrial respiratory function was increased with exercise training in the chow-fed animals in soleus muscle. This exercise effect was absent in the HFD animals. In conclusion, exercise training improved insulin resistance in HFD rats but without changes in mitochondrial respiratory function and content. The lack of an association between mitochondrial characteristics and whole-body insulin resistance was reinforced by the absence of strong correlations between these measures. Our results suggest that improvements in mitochondrial respiratory function and content are not responsible for improvements in whole-body insulin resistance in HFD rats.

The impact of concomitant lung resection during esophagectomy on short-term outcomes is not well characterized. This study tests the hypothesis that lung resection at the time of esophagectomy is not associated with increased perioperative morbidity or mortality.Perioperative outcomes for esophageal cancer patients who underwent esophagectomy alone (EA) were compared to patients who had concurrent esophagectomy and lung resection (EL) using the NSQIP database between 2006-2017. Predictors of morbidity and mortality, including combined surgery, were evaluated using multivariable logistic regression.Among the 6,225 study patients, 6,068 (97.5%) underwent EA and 157 (2.5%) underwent EL. There were no differences in baseline characteristics between the two groups. Operating time for EL was longer than EA (median 416 versus 371 minutes, P0.01). Median length of stay was 10 d for both groups. Perioperative mortality was not significantly different between EL and EA patients (5.1% versus 2.8%, P = 0.08). EL patients had higher rates of postoperative pneumonia (22.3% versus 16.2%, P = 0.04) and sepsis (11.5% versus 7.1%, P = 0.03), however major complication rates overall were similar (40.8% versus 35.3%, P = 0.16). Combining lung resection with esophagectomy was not independently associated with increased postoperative morbidity (AOR 1.21 [95% CI 0.87-1.69]) or mortality (AOR 1.63 [95% CI 0.74-3.58]).Concurrent lung resection during esophagectomy is not associated with increased mortality or overall morbidity, but is associated with higher rates of pneumonia beyond esophagectomy alone. Surgeons considering combined lung resection with esophagectomy should carefully evaluate the patient's risk for pulmonary complications and pursue interventions preoperatively to optimize respiratory function.

In previous studies, researchers have used singing to treat respiratory function in patients with spinal cord injury. However, few studies have examined the way in which vocal training affects respiratory neural plasticity in patients with spinal cord injury. Vocal respiratory training (VRT) is a type of vocal muscle-related treatment that is often a component of music therapy (MT) and focuses on strengthening respiratory muscles and improving lung function. In this randomized controlled study, we analyzed the therapeutic effects of VRT on respiratory dysfunction at 3 months after cervical spinal cord injury. Of an initial group of 37 patients, 26 completed the music therapy intervention, which comprised five 30-minute sessions per week for 12 weeks. The intervention group (n = 13) received VRT training delivered by professional certified music therapists. The control group (n = 13) received respiratory physical therapy delivered by professional physical therapists. Compared with the control group, we observed a substantial increase in respiratory function in the intervention group after the 12-week intervention. Further, the nerve fiber bundles in the respiratory center in the medulla exhibited a trend towards increased diversification, with an increased number, path length, thickness, and density of nerve fiber bundles. These findings provide strong evidence for the effect of music therapeutic VRT on neural plasticity. This study was approved by the Ethics Committee of China Rehabilitation Research Center (approval No. 2020-013-1) on April 1, 2020, and was registered with the Chinese Clinical Trial Registry (registration No. ChiCTR2000037871) on September 2, 2020.

Background Pulmonary disorders and poor functional capacity are common complications in patients under hemodialysis. Although breathing exercise is frequently prescribed to improve respiratory function, its efficacy in this patient community is not well established. Purpose Our study was designed to determine the effectiveness of a breathing exercise on respiratory function and 6-minute walk (6MW) distance in patients under hemodialysis. Methods A randomized controlled trial approach was used. The sample consisted of 52 patients under hemodialysis from a university teaching hospital in Iran. The experimental group (n = 26) received the breathing exercise program and was encouraged to perform incentive spirometry for 2 months. The control group (n = 26) received only routine hospital care. The respiratory function test and 6MW test were performed at baseline and at 2 months after the intervention (posttest). Results The two groups were homogeneous in terms of respiratory function parameters, 6MW distance, and demographic characteristics at baseline. Forced expiratory volume in 1 second and forced vital capacity were significantly better in the experimental group compared with the control group at 2 months after intervention. No significant difference was found in 6MW distance between the groups at the 2-month posttest. Conclusions/implications for practice The 2-month breathing exercise effectively improved pulmonary function parameters (forced vital capacity, forced expiratory volume in 1 second) in patients under hemodialysis but did not affect 6MW distance. Hemodialysis nurses should strengthen their clinical health education and apply breathing exercise programs to reduce the pulmonary complications experienced by patients under hemodialysis.

The effects of untreated obstructive sleep apnea (OSA) on cardiopulmonary function remain unclear. Cardiorespiratory fitness (CRF), commonly reflected by VO(2) max measured during cardiopulmonary exercise testing, has gained popularity in evaluating numerous cardiopulmonary conditions and may provide a novel means of identifying OSA patients with the most clinically significant disease. This emerging testing modality provides simultaneous assessment of respiratory and cardiovascular function with results helping uncover evidence of evolving pathology in either organ system. In this review, we highlight the current state of the literature in regard to OSA and CRF with a specific focus on changes in cardiovascular function that have been previously noted. While OSA does not appear to limit respiratory function during exercise, studies seem to suggest an abnormal cardiovascular exercise response in this population including decreased cardiac output, a blunted heart rate response (ie, chronotropic incompetence), and exaggerated blood pressure response. Surprisingly, despite these observed changes in the cardiovascular response to exercise, results involving VO(2) max in OSA remain inconclusive. This is reflected by VO(2) max studies involving middle-aged OSA patients showing both normal and reduced CRF. As prior studies have not extensively characterized oxygen desaturation burden, we propose that reductions in VO(2) max may exist in OSA patients with only the most significant disease (as reflected by nocturnal hypoxia). Further characterizing this relationship remains important as some research suggests that positive airway pressure therapy or aerobic exercise may improve CRF in patients with OSA. In conclusion, while it likely that severe OSA, via an abnormal cardiovascular response to exercise, is associated with decreased CRF, further study is clearly warranted to include determining if OSA with decreased CRF is associated with increased morbidity or mortality. CITATION: Powell TA, Mysliwiec V, Brock MS, Morris MJ. OSA and cardiorespiratory fitness: a review. J Clin Sleep Med. 2022;18(1):279–288.

Introduction Laryngospasm is an involuntary sustained closure of sphincter musculature that leads to an unpleasant subjective experience of dyspnea and choking. It is an underreported symptom in amyotrophic lateral sclerosis (ALS). This study aimed to better characterize the prevalence and clinical characteristics of laryngospasm in ALS patients. Methods The medical records of 571 patients with ALS followed between 2008-2018 were searched for evidence of laryngospasm. A total of 23 patients with laryngospasm were identified and data related to patient and laryngospasm characteristics were extracted. Results Laryngospasm was reported in 4% of ALS patients. Females comprised 57% of patients and mean age was 63.4 years. Laryngospasm frequently manifested in patients with moderate bulbar dysfunction and seemed independent of respiratory function. Among laryngospasm patients, 26% were cigarette smokers and 13% had a history of gastroesophageal reflux. The most common reported trigger was excessive saliva irritating the vocal cords (35%) followed by eating a meal (17%). There was significant variation in laryngospasm frequency (up to 5 per hour) and duration (seconds to minutes). Most patients could not identify an effective coping mechanism, although 13% reported that drinking water was effective. Discussion Despite its low prevalence in ALS, laryngospasm should be included in the symptom enquiry. This study may improve patient care through increased recognition of the clinical features of laryngospasm in ALS patients, identifying a link between laryngospasm and moderate bulbar dysfunction, and highlighting trigger avoidance as a management strategy. Additional research is required to understand the pathophysiology and optimal treatment.

Background/aim: There is limited information about peripheral blood eosinophilia (PBE) and airway obstruction in sarcoidosis. Since pulmonary sarcoidosis affects the airways, it is often confused with asthma. The aims of the study are to investigate airway obstruction and PBE in sarcoidosis patients and to examine the similarity of clinical presentation with asthma. Materials and methods: The patients matching the ATS/ERS/WASOG diagnosis criteria and were between 18 and 80 years of age were included consecutively between 2018 and 2020. Other diseases causing granulomas were excluded. Results: A total of 84 patients were included of which 26 (31%) had a PBE level of >= 300 mu L with no significant difference seen between sarcoidosis stage and PBE (p > 0.05). A significant (p < 0.05) decrease was only seen in FEV1 as the stage of sarcoidosis progressed. Respectively 31 (36.9%), 12 (14.3%) and 4 (4.8%) patients had an obstructive, restrictive and mixed respiratory function disorder. Twenty-four (28.6%) subjects with sarcoidosis had history of asthma. Spring fever, eczema, and skin/nose allergy were noticed in 17 (20.2%) of the patients. Conclusion: Mild PBE may be seen in sarcoidosis. Patients applying with PBE, airway obstruction, bronchial hyperreactivity along with spring fever, eczema, skin/nose allergy, wheezing, chest tightness, shortness of breath and cough may be also evaluated in terms of sarcoidosis.

Bronchial Asthma is outlined as a chronic irritation of the airways in children. Vitamin D is a real immune system regulator which has a potential part in allergy. Asymmetric Dimethyl Arginine (ADM...

This study was to optimize the exercise preconditioning (EP) intensity in protecting from exhaustive exercise-induced cardiac injury (EECI). A total of 98 male Sprague-Dawley rats were divided into 7 groups (n ​= ​14): the control group (C), the exhaustive exercise group (EE) and the EP ​+ ​EE groups, which include the V10 (53.0%̇O2max), V15 (58.4%̇O2max), V20 (67.0%̇O2max), V26 (74.0%̇O2max) and V30 (80.0%̇O2max) groups. Except the C group, the other groups were subjected to treadmill running. The serum contents of N terminal pro B type natriuretic peptide (NT-proBNP) and cardiac troponin I (cTn-I) were detected by the enzyme-linked immunosorbent assay method, ECG was recorded, heart function was detected by pressure volume catheter and the activities of mitochondrial electron transfer pathway (ET pathway) complexes I, Ⅱ and IV were measured by high-resolution respiration instrument. Compared to the EE group, the EP groups have shown decrease of NT-proBNP and cTn-I, improvement of mitochondrial respiratory function and cardiac function. Compared to other EP groups, the V26 group has shown significant decrease of myocardial enzymes and improvement of mitochondrial function. The correlation analysis showed the EP effect was proportional to EP intensity in the range of 53.0%̇O2max-74.0%̇O2max. High intensity and long duration of exhaustive exercise caused cardiac injury and EP could decrease serum level of NT-proBNP and cTn-I, improve electrical derangement and the left ventricular function, and raise the activities of ET pathway complexes I, Ⅱ and IV. The protection of EP on EECI was improved as the EP intensity was increased from 53.0%̇O2max to 74.0%̇O2max and when EP intensity was 74.0%̇O2max, the effect was the most obvious among all the setting EP groups.

Objectives The aim of this cross-sectional study was to assess the effects of past occupational activity on muscle strength and respiratory function among retirees. Methods A total of 205 community-dwelling older adults participated in the study. Age (≥60 years) and cessation of professional activity (retirement) constituted the inclusion criteria. The International Standardized Classification of Occupations (ISCO-08) was used to stratify the participants into white-or blue-collar groups. Forced vital capacity (FVC), forced expiratory volume (FEV) in the first second, inspiratory vital capacity (IVC) parameters, and hand grip strength were tested. Results Statistically significant differences in IVC and FVC scores were found in white- and blue-collar workers after adjusting for sex and age (ANCOVA). White-collar men had significantly higher IVC as compared to blue-collar men. Conclusions Blue-collar male workers may be prone to deteriorating respiratory function in older age. It is vital to promote physical activity and educate blue-collar workers about the need to use respiratory protective equipment.

Summary Background Pompe disease is a rare disorder characterised by progressive loss of muscle and respiratory function due to acid α-glucosidase deficiency. Enzyme replacement therapy with recombinant human acid α-glucosidase, alglucosidase alfa, is the first approved treatment for the disease, but some patients do not respond, and many do not show a sustained benefit. We aimed to assess the safety and efficacy of an investigational two-component therapy (cipaglucosidase alfa, a novel recombinant human acid α-glucosidase, plus miglustat, an enzyme stabiliser) for late-onset Pompe disease. Methods We did a randomised, double-blind, parallel-group, phase 3 trial at 62 neuromuscular and metabolic medical centres in 24 countries in the Americas, Asia-Pacific, and Europe. Eligible participants were aged 18 years or older with late-onset Pompe disease, and had either been receiving alglucosidase alfa for at least 2 years or were enzyme replacement therapy-naive. Participants were randomly assigned (2:1) using interactive response technology software, stratified by 6-min walk distance and previous enzyme replacement therapy status, to intravenous cipaglucosidase alfa (20 mg/kg) plus oral miglustat or to intravenous alglucosidase alfa (20 mg/kg) plus oral placebo once every 2 weeks for 52 weeks. Patients, investigators, and outcome assessors were masked to treatment assignment. The primary endpoint was change from baseline to week 52 in 6-min walk distance, assessed using a mixed-effect model for repeated measures analysis for comparison of superiority in the intention-to-treat population (all patients who received at least one dose of study drug). This study is now complete and is registered with ClinicalTrials.gov , NCT03729362 . Findings Between Dec 3, 2018, and Nov 26, 2019, 130 patients were screened for eligibility and 125 were enrolled and randomly assigned to receive cipaglucosidase alfa plus miglustat (n=85) or alglucosidase alfa plus placebo (n=40). Two patients in the alglucosidase alfa plus placebo group did not receive any dose due to absence of genotype confirmation of late-onset Pompe disease and were excluded from analysis. Six patients discontinued (one in the alglucosidase alfa plus placebo group, five in the cipaglucosidase alfa plus miglustat group), and 117 completed the study. At week 52, mean change from baseline in 6-min walk distance was 20·8 m (SE 4·6) in the cipaglucosidase alfa plus miglustat group versus 7·2 m (6·6) in the alglucosidase alfa plus placebo group using last observation carried forward (between-group difference 13·6 m [95% CI −2·8 to 29·9]). 118 (96%) of 123 patients experienced at least one treatment-emergent adverse event during the study; the incidence was similar between the cipaglucosidase alfa plus miglustat group (n=81 [95%]) and the alglucosidase alfa plus placebo group (n=37 [97%]). The most frequently reported treatment-emergent adverse events were fall (25 [29%] patients in the cipaglucosidase alfa plus miglustat group vs 15 [39%] in the alglucosidase alfa plus placebo group), headache (20 [24%] vs 9 [24%]), nasopharyngitis (19 [22%] vs 3 [8%]), myalgia (14 [16%] vs 5 [13%]), and arthralgia (13 [15%]) vs 5 [13%]). 12 serious adverse events occurred in eight patients in the cipaglucosidase alfa plus miglustat group; only one event (anaphylaxis) was deemed related to study drug. One serious adverse event (stroke) occurred in the alglucosidase alfa plus placebo group, which was deemed unrelated to study drug. There were no deaths. Interpretation Cipaglucosidase alfa plus miglustat did not achieve statistical superiority to alglucosidase alfa plus placebo for improving 6-min walk distance in our overall population of patients with late-onset Pompe disease. Further studies should investigate the longer-term safety and efficacy of cipaglucosidase alfa plus miglustat and whether this investigational two-component therapy might provide benefits, particularly in respiratory function and in patients who have been receiving enzyme replacement therapy for more than 2 years, as suggested by our secondary and subgroup analyses. Funding Amicus Therapeutics.

PURPOSE OF REVIEW This review aims to summarize the current literature describing vestibular-autonomic interactions and to describe their putative role in various disorders' clinical presentations, including orthostatic dizziness and motion sensitivity. RECENT FINDINGS The vestibular-autonomic reflexes have long been described as they relate to cardiovascular and respiratory function. Although orthostatic dizziness may be in part related to impaired vestibulo-sympathetic reflex (orthostatic hypotension), there are various conditions that may present similarly. A recent clinical classification aims to improve identification of individuals with hemodynamic orthostatic dizziness so that appropriate recommendations and management can be efficiently addressed. Researchers continue to improve understanding of the underlying vestibular-autonomic reflexes with recent studies noting the insular cortex as a cortical site for vestibular sensation and autonomic integration and modulation. Work has further expanded our understanding of the clinical presentation of abnormal vestibular-autonomic interactions that may occur in various conditions, such as aging, peripheral vestibular hypofunction, traumatic brain injury, and motion sensitivity. SUMMARY The vestibular-autonomic reflexes affect various sympathetic and parasympathetic functions. Understanding these relationships will provide improved identification of underlying etiology and drive improved patient management.

Supplemental Digital Content is available in the text., Background. Uncontrolled donation after circulatory death (DCD) donors are an extraordinary resource to increase the number of lungs available for transplantation. However, the risk of the warm ischemia resulting from cardiac arrest to irreversibly damage the organs is considerable. Moreover, graft preservation issues and organizational problems often worsen the dangerous effects of warm ischemia. Ex vivo lung perfusion (EVLP) enables us to evaluate and recondition lungs whose functionality is doubtful, as well as to overcome the difficulties related to time and logistics. Methods. We report the case of uncontrolled DCD lungs successfully treated with an exceptionally prolonged EVLP. Because the donor’s blood count and liver biopsy showed signs of possible leukemia, EVLP was protracted up to 17 h while waiting for immunohistochemical analyses to rule out this diagnosis; eventually, the results came back negative, and the lungs were judged suitable for transplantation. Results. The recipient was a 32-y-old male individual with cystic fibrosis, colonized by Pandoraea pnomenusa. Bilateral transplantation required central extracorporeal membrane oxygenation. The patient was extubated after 36 h and was discharged 21 d after the operation. Despite early recolonization by Pandoraea pnomenusa and airway complications requiring pneumatic dilatation, he is alive and has a satisfactory respiratory function 15 mo after transplantation. Conclusions. Uncontrolled DCD represents a challenge due to both logistical issues and the complexity of graft evaluation before procurement. EVLP with cellular perfusate could be a valuable tool to overcome these limits. Nonetheless, caution should be exercised when interpreting the effects of this technique on airway healing.

Many coronavirus disease 2019 (Covid-19) survivors show symptoms months after acute illness. The aim of this work is to describe the clinical evolution of Covid-19, one year after discharge. We performed a prospective cohort study on 238 patients previously hospitalized for Covid-19 pneumonia in 2020 who already underwent clinical follow-up 4 months post-Covid-19. 200 consented to participate to a 12-months clinical assessment, including: pulmonary function tests with diffusing lung capacity for carbon monoxide (DLCO); post-traumatic stress (PTS) symptoms evaluation by the Impact of Event Scale (IES); motor function evaluation (by Short Physical Performance Battery and 2 min walking test); chest Computed Tomography (CT). After 366 [363–369] days, 79 patients (39.5%) reported at least one symptom. A DLCO

The term "early-onset scoliosis" (EOS) refers to spinal deformities that develop before the age of 10 years. The aim of surgical treatment for EOS is stopping the progression of the curvature, maintaining the correction, ensuring the maximum growth of the vertebrae, and ensuring that the vertebrae remain mobile. Using magnetically controlled growing rods (MCGRs) in the treatment of EOS is intended to protect the patient from the negative effects of repetitive surgeries, increase patient compliance and satisfaction, and increase the speed of return to normal social life. Our aim was to report the early radiological evaluation findings and detect the changes in the quality of life of patients and their parents after the diagnosis of EOS and treatment with MCGRs.We performed a retrospective clinical study (level 4 case series) of 20 patients with a surgical indication for the treatment of EOS. The 20 patients had undergone treatment with MCGRs and lengthening procedures at 3-month intervals from August 2014 to August 2016. The mean patient age at surgery was 7.9 years (range, 4-10 years), and the mean length of follow-up was 14.9 months (range, 6-30 months). The preoperative, early postoperative, and final follow-up radiographs of all patients were obtained. The Cobb angle, thoracic kyphosis, spinal height, thoracic height, sagittal balance, coronal balance, shoulder balance, and pelvic balance were measured from the radiographs. All the patients had undergone preoperative and final follow-up respiratory function tests, and all the patients completed the Early Onset Scoliosis 24-item questionnaire (EOSQ-24). The outcome measures were the Cobb angle, thoracic kyphosis, spinal height, thoracic height, sagittal balance, coronal balance, shoulder balance, and pelvic balance. All the patients had undergone preoperative and final follow-up respiratory function tests, and the parents of every patient completed the Turkish version of the EOSQ-24.The preoperative, early postoperative and final follow-up mean Cobb angles were 56.6° (range, 38°-93°), 30.5° (range, 13°-80°), and 33.5° (range, 14°-86°), respectively. These findings showed statistically significant improvement in the Cobb angle (P0.05). The thoracic height was also significantly increased. The preoperative, early postoperative, and final follow-up mean height was 181 mm (range, 123-224 mm), 200 mm (range, 164-245 mm), and 212 mm (range, 167-248 mm), respectively (P0.05). The measurements for spinal height had also increased significantly, with preoperative, early postoperative, and final follow-up values of 219 mm (range, 213-366 mm), 315 mm (range, 260-402 mm), and 338 mm (range, 261-406 mm), respectively (P0.05). The thoracic kyphosis measurement was 41° (range, 5°-65°) preoperatively, which had decreased significantly to 32.5° (range, 0°-53°) at the final follow-up (P0.05). Our measurements showed no statistically significant differences in the coronal and sagittal balance, pelvic balance, or shoulder balance. No significant differences were found between the preoperative and postoperative respiratory function test results. The assessment of the EOSQ-24 scores had demonstrated significant improvements in the mean scores at the final follow-up (P0.05). When different categories in the EOSQ-24 were evaluated separately, no statistically significant differences were found between the preoperative and final follow-up scores for general health, pain and discomfort, respiratory function, movement capability, physical function, or effects on daily life (P0.05). However, the exhaustion and energy levels, emotional state, effect of the disease on the parents and patient, and parent satisfaction scores had increased significantly from the preoperative assessment to the final follow-up (P0.05). The financial effect had decreased significantly at the final follow-up compared with the preoperative values (P0.05). Four patients had developed complications requiring further treatment, and none of the patients had developed infection that required surgical intervention.Our study showed that insertion of a MCGR is a safe procedure for treatment of EOS to correct the deformity and improve function in daily life. This method reduces the need for repetitive surgery and the likelihood of complications associated with other treatments. Thus, treatment with MCGRs increases patient satisfaction and facilitates patient compliance.

Background Children and adolescents with cerebral palsy often have poor respiratory function, which is often not addressed. Objective To examine if adding inspiratory muscle training to sensorimotor exercises would improve mobility capacity and respiratory function in children and adolescents with cerebral palsy. Methods Forty school-children and adolescents with cerebral palsy aged 8–15 years with Gross Motor Function Classification System I–III, participated in this randomized controlled trial. The experimental group received 45 min of sensorimotor physical therapy in addition to 15 min of inspiratory muscle training for 18 sessions over six weeks. In contrast, the control group received 45 min of sensorimotor training session, three times a week over six weeks. The primary outcome measure was the six-minute walk test. The secondary outcome measures were maximal inspiratory and maximal expiratory pressure, as well as pulmonary function tests. Results Time by group interaction showed no statistical significance between the groups in any outcome measures except for peak expiratory flow. The mean difference of 9.6 cm H2O (95% CI: 3.2, 35.5) in the MIP from baseline to 2-month follow-up supports the experimental intervention. Post-training, the between-group mean difference was 19.8 (95% CI: -18, 57.6) meter in the six-minute walk test. Conclusion Adding inspiratory muscle training to sensorimotor physical therapy did not impact mobility capacity in children and adolescents with cerebral palsy.

Swallowing impairments co-occur with chronic obstructive pulmonary disease (COPD) leading to aspiration, disease exacerbations, and malnutrition. This pilot survey study aimed to identify current clinical practice patterns for swallowing evaluation and treatment in persons with COPD. A 35-question Qualtrics survey was deployed to medical speech-language pathology (SLP) social media sites and professional boards; flyers were distributed at a professional conference. Forty-eight SLPs completed the study. SLPs routinely include a clinical swallow examination (96%), videofluoroscopic swallowing study (79%), adjunctive respiratory measures (respiratory rate [83%], and pulse oximetry [67%], respiratory–swallow pattern [77%]) but less frequently include fiberoptic endoscopic evaluation of swallowing (23%). Self-reported advanced clinical experience and expert respiratory analysis skills were associated with adjunctive respiratory measure (respiratory rate, pulse oximetry) inclusion during assessment. Compensatory strategy training (77%) is a preferred treatment for dysphagia in COPD; however, respiratory–swallow pattern training and expiratory muscle strength training are increasing in use. SLPs self-report a comprehensive, individualized patient-centered care approach with inclusion of adjunctive respiratory-focused methods in dysphagia evaluation and treatment practice in persons with COPD. Advances in the identification of the integral role of respiratory function in swallowing integrity may be translating to clinical practice methods for dysphagia management in persons with COPD.

Virus corona atau COVID 19 merupakan virus yang menyebabkan penyakit pada hewan atau manusia. COVID-19 lebih sering menyerang saluran pernapasan. Peningkatan imunitas pasien COVID-19, sangat diperlukan dikarenakan pengobatan COVID-19 belum ditemukan. Vitamin C merupakan vitamin yang dapat mencegah dan mengobati infeksi pernapasan dengan meningkatkan berbagai fungsi sel kekebalan tubuh. Vitamin C bertindak sebagai antioksidan kuat dan membantu mengganti sel-sel yang rusak sehingga dapat membantu pada COVID-19. Studi literatur ini bertujuan untuk mengetahui penggunaan vitamin C sebagai imunomodulator pada pasien dewasa COVID-19. Metode pengambilan data diperoleh dengan mereview 10 jurnal dengan menggunakan google scholar dan Pubmed dengan menggunakan jurnal berbahasa inggris. Adapun kata kunci yang digunakan yaitu vitamin C, COVID-19, treatment. Hasil yang diperoleh berupa pemberian vitamin C secara intravena dengan dosis tinggi dapat meningkatkan perbaikan kehidupan pasien COVID-19 dengan meningkatkan kekebalan tubuh pasien yang terinfeksi. Hal tersebut terlihat dari dihambatnya perkembangan dari sitokin dan meningkatkan limfosit serta sel T CD4+. Selain itu, meningkatkan fungsi pernafasan pasien dengan terjadi peningkatan pada PiO2/FiO2.

Spinal muscular atrophy (SMA) is a rare, progressive neuromuscular disease that affects individuals with a broad age range. SMA is typically characterised by symmetrical muscle weakness but is also associated with cardiac defects, life-limiting impairments in respiratory function and bulbar function defects that affect swallowing and speech. Despite the advent of three innovative disease-modifying therapies (DMTs) for SMA, the cost of DMTs in addition to the costs of standard of care can be a barrier to treatment access for patients. Health Technology Assessment (HTA) decision makers evaluate the cost effectiveness of a new treatment before making a reimbursement decision. The primary objective was to conduct a systematic literature review (SLR) to identify the modelling approaches used in economic evaluations that assess current approved treatments in SMA, with a secondary objective to widen the scope and identify economic evaluations assessing other (non-SMA) neuromuscular disorders. An SLR was performed to identify available economic evaluations associated with any type of SMA (Type 1, 2, 3 and/or 4). Economic evaluations associated with other (non-SMA) neuromuscular disorders were identified but not further analysed. Electronic searches were conducted in Embase, MEDLINE, Evidence-Based Medicine Reviews and EconLit via the Ovid platform in August 2019, and were supplemented by searches of the grey literature (reference lists, conference proceedings, global HTA body websites and other relevant sources). Eligibility criteria were based on the population, interventions, comparators and outcomes (PICO) framework. Quality assessment of full publications was conducted with reference to a published checklist. Nine publications covering eight unique studies met all eligibility criteria for inclusion in the SLR, including four conference abstracts, two peer-reviewed original research articles and three HTA submissions (conducted in Canada, the US and the UK). Evaluations considered patients with early infantile-onset (most likely to develop Type 1 or Type 2 SMA), later-onset SMA and both infantile- and later-onset SMA. Data for the identified economic models were collected from literature reviews and relatively short-term clinical trials. Several intent-to-treat clinical trial populations were used in the studies, which resulted in variation in cycle length and different outcome measures to determine clinical efficacy. The results of the quality assessment on the five full-text, peer-reviewed publications found that they generally provided clear descriptions of objectives, modelling methods and results. However, key decisions, such as choice of economic evaluation, model type and choice of variables for sensitivity analysis, were often not adequately justified. This SLR highlights the need for economic evaluations in SMA to better align in modelling approaches with respect to (i) consistency in model structure and use of motor function milestones as health states; (ii) consensus on measuring quality of life to estimate utilities; (iii) consistency in data collection by registries; and (iv) consensus on SMA-type classification and endpoints that determine intervention efficacy. Future economic evaluations should also incorporate the review group critiques of previous HTA submissions relating to data inputs and approaches to modelling and should include patient data reflective of the SMA population being modelled. Economic evaluations would also be improved with inclusion of long-term efficacy and safety data from clinical trials and valid patient and caregiver utility data.

Összefoglaló. A COVID–19-fertőzésen átesett betegek közül többen elhúzódó panaszokról számolnak be a felépülést követően, sokaknál tartósan fennáll a köhögés, a nehézlégzés, a mellkasi fájdalom, a légszomj attól függetlenül, hogy enyhe vagy súlyosabb tüneteket okozott a koronavírus. A betegek erőtlennek érzik magukat, erős fáradtságérzetre panaszkodnak, míg mások gyomor-bél rendszeri panaszokra, fejfájásra, depresszióra, a szaglás- és ízérzékelés elvesztésére. Számtalan kutatás leírja, hogy a fertőzés még akár hónapokkal később is hatással lehet a tüdő működésére, és korábban egészséges tüdőn is látható a koronavírus-fertőzés a gyógyulás után három hónappal készült kontroll-mellkas-CT-leleten. Éppen ezért szükség van a fertőzés lezajlását követően tüdőgyógyászati kivizsgálásra, ha a betegnek elhúzódó panaszai vannak, vagy ha a betegség tüdőgyulladást okozott. Szükség van a jelenleg működő fekvőbeteg-légzőszervi rehabilitáció mellett a kezelés ambuláns kiterjesztésére is, melynek célja újabb kórházi ápolás nélkül a teljes gyógyulás elérése a betegeknél. A COVID–19-fertőzésen átesett betegeknél a komplex rehabilitáció hatására javul a terhelhetőség, az életminőség, javulnak a légzésfunkciós értékek, csökkennek a panaszok, javul a betegek fizikai és pszichikai állapota. Összefoglaló kutatásunk célja áttekinteni, hogy milyen COVID–19 ambuláns rehabilitációs programok indultak el a koronavírus-fertőzésen átesett betegek esetében nemzetközi és hazai színtereken. Orv Hetil. 22021; 162(42): 1671–1677. Summary. Several patients with COVID-19 infection report prolonged complaints after recovery and many of them suffer from persistent cough, dyspnea, chest pain and shortness of breath regardless of whether the coronavirus caused mild or more severe symptoms. They complain of severe fatigue and weakness while others grizzle about gastrointestinal complaints, headache, depression, loss of sense of smell and taste. Numerous studies describe that the infection can affect lung function even in months and coronavirus infection can be detectable in previously healthy lungs by taking a control chest CT scan three months after recovery. Therefore, chest follow-up is required after the infection if the patient has prolonged complaints or if the disease has caused pneumonia. In addition to the currently operating inpatient respiratory rehabilitation, there is also a need for an outpatient extension of treatment to achieve complete recovery in patients without further hospitalization. For those patients who have had the COVID-19 infection complex rehabilitation can improve their workload, quality of life, improves their respiratory function values, reduces their complaints and also improves their physical and mental condition. The aim of our summary research is to review what COVID-19 outpatient rehabilitation programs have been initiated for patients who went through coronavirus infection on international and domestic scenes. Orv Hetil. 2021; 162(42): 1671–1677.

Objective The aim of this study was to elucidate the relationship between atrial fibrillation (AF) and chronic obstructive pulmonary disease (COPD) classification based on clinical severity determined in current guidelines. AF is the most common chronic arrhythmia that requires treatment. COPD is one of the risk factors for AF, but this relationship was only explored through respiratory function test results. Methods Patients who received inpatient treatment for COPD between November 2019 and January 2017 were screened. Patients with coronary artery disease, heart failure, valvular heart disease, diabetes, chronic kidney disease, hypertension, thyroid dysfunction, and sleep apnea syndrome were excluded. According to the 2019 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, patients with COPD were divided into groups A, B, C, and D, and the relationship between AF and these groups was investigated. Results There was no difference between the two groups (depending on the presence of AF) in terms of sex and body mass index. There was a significant difference between the two groups in terms of age, left ventricular ejection fraction (LVEF), left atrium, right atrium, right ventricle, and systolic pulmonary artery pressure. When patients with COPD were classified according to clinical and symptomatic severity, the frequency of AF increased as the clinical severity increased. Conclusion Regardless of the forced expiratory volume - first second (FEV1) value in the respiratory test, the incidence of AF is higher in patients with COPD with a clinically more severe picture.

Nowadays, cheilorhinoseptoplasty is one of the most efficient methods of cleft lip primary surgical treatment eliminating both functional and esthetic issues. In this work, we have proposed, developed, and experimentally tested a new thermography-based algorithm for studying the efficiency and symmetry of nasal breathing prior to and after the surgery. To investigate and analyze the external respiration function of an infant with unilateral cleft lip after surgical respiration symmetry restoration followed by anatomically shaped postoperative endonasal retainer installation, we have applied contactless thermal imaging in real time. The developed algorithm enables effective analysis of the respiratory function in infants before and after the surgery. Its combination with applied surgical technique experimentally demonstrated the potential of this approach for improving further the efficiency and symmetry of the airflows through the patient's nasal passages after the primary cheilorhinoseptoplasty. The results of our study constitute a novel and promising avenue of investigation into the breathing function in infants and young children prior to and after their surgery for unilateral cleft lip. The adaptation of our technique to the conditions of a pediatric hospital will make it a safe and informative tool for noninvasive diagnosing the respiratory function in infants in the early postoperative period.

Introduction. Possible causes of chronic bronchitis are anatomically incorrect location of internal organs, the presence of congestion, impaired blood circulation, impaired mobility level, disorders of innervation and metabolic processes in the respiratory organs, decreased mobility of the chest, tension of the thoracic diaphragm, imbalance of the myofascial system, diseases of the spine (osteochondrosis, scoliosis, etc.). These disorders and dysfunctions are extremely rarely taken into account in the prescription of conventional therapy regimens in children with chronic bronchitis. At the same time, it is known that many drugs and various therapeutic effects in some cases are not able to give long-term remission and recovery. This causes the need to search for new methods of treating chronic bronchitis in children, one of which could be osteopathic correction. At the same time, in the available literature sources, there is very little information on this problem, and the presented data are sometimes contradictory.The aim of the study is to evaluate the clinical effectiveness of osteopathic correction in the treatment of children with chronic bronchitis in a sanatorium.Materials and methods. The controlled randomized trial was conducted from June 2020 to April 2021. The study included 40 patients with chronic bronchitis at the age from 6 to 16 years, 24 boys, 16 girls, who were undergoing sanatorium-resort treatment in the children′s sanatorium «Raduga» (Sterlitamak). Depending on the applied treatment method, the patients were divided by simple randomization into two comparable groups (main and control) of 20 people each. All patients received sanatorium resort treatment, which included physical therapy, halotherapy, inhalations, phytotherapeutic procedures. Patients of the main group, in addition to the above-described therapy, received osteopathic correction. In total, 2 sessions were carried out with an interval of 7 days. All patients, regardless of the group, before the start of treatment, as well as after the completion of the therapy course, underwent an assessment of the osteopathic status, chest excursion and respiratory function.Results. During the treatment with inclusion of osteopathic correction, in patients of the main group, there is a significant decrease in the frequency of detection of somatic dysfunctions (global rhythmogenic disorder, neck region, chest region), as well as a significant positive dynamics of indicators characterizing the external respiration function (chest excursion, forced vital capacity of lungs, peak exhalation rate), compared with patients receiving only conventional therapy. Positive changes in the chest excursion and peak exhalation rate against the background of osteopathic correction persist reliably even 3 months after the completion of the therapy course, and it allows to suppose the prolonged effect of the therapy.Conclusion. The study showed that osteopathic correction increases the clinical effectiveness of the conventional methods of sanatorium resort treatment for pediatric patients with chronic bronchitis. This allows to recommend the inclusion of osteopathic methods of correction in complex treatment programs for this group of patients in a sanatorium.

BACKGROUND Ultrasonography (USG) of the diaphragm is a promising alternative to pulmonary function tests (PFT) for assessing respiratory function in amyotrophic lateral sclerosis/motor neuron disease (ALS/MND). METHODS We studied 33 patients fulfilling Awaji criteria (definite = 14; probable = 12; possible = 7) and 33 age and gender-matched controls. Diaphragm thickness was measured using USG at the end of expiration (DTex) and end of inspiration (DTin). The thickness ratio (TR) was calculated as DTin/DTex. The mean age at onset and duration were 49.73 ± 12.7 years and 13.57 ± 9.7 months, respectively. Men = 25 (75.8%); Limb onset ALS/MND = 24 patients (72.7%); bulbar onset = 9 (27.3%). RESULTS Compared to controls, ALS/MND patients had reduced mean DTex (2.22 ± 0.29 mm vs. 2.02 ± 0.32 mm, p = .012) and DTin (4.0 ± 0.71 mm vs. 3.41 ± 0.38 mm, p

Актуальность. Сроки выведения пациентов с политравмой из состояния травматического шока оказывают серьезное влияние на количество осложнений, длительность пребывания пациентов в отделении интенсивной терапии и стоимость лечения. Ранее показано, что применение гипертонического раствора магния сульфата способствует ускорению стабилизации гемодинамики у пациентов с политравмой. Цель исследования: определение концентрации основных электролитов в плазме крови в процессе применения гипертонического раствора магния сульфата у пострадавших с политравмой, которые находились в состоянии гиповолемического шока. Материалы и методы. У 24 пациентов с политравмой, поступивших в клинику в состоянии гиповолемического травматического шока, в условиях операционной проводилась коррекция гемодинамики гипертоническим раствором магния сульфата в физиологическом растворе. 25% раствор магния сульфата вводился внутривенно из расчета 0,35 ± ± 0,05 мл/кг массы тела с целью создания осмотического градиента между внутрисосудистой и интерстициальной жидкостью, а также с целью блокирования поступления натрия и кальция во внутриклеточное пространство. В процессе применения указанной методики изучены изменения содержания электролитов в плазме крови. Определяли концентрацию магния, калия, кальция, натрия и хлоридов. Кровь для изучения содержания электролитов забирали на следующих этапах: 1) перед применением гипертонического раствора магния сульфата; 2) через 5–10 минут после полного окончания инфузии магния сульфата в физиологическом растворе; 3) через 25–35 минут после полного окончания инфузии магния сульфата в физиологическом растворе; 4) через 1 час после полного окончания инфузии магния сульфата в физиологическом растворе; 5) через 2 часа; 6) через 6 часов; 7) через 24 часа. Результаты. Исследование показало, что применение этой методики не было ассоциировано с опасным повышением концентрации магния в плазме крови до уровня 4,0 ммоль/л и более. А значит, не возникала опасность угнетения сердечной деятельности. Высокое содержание магния в плазме крови наблюдали на 2-м этапе исследования — через 5–10 минут после полного окончания инфузии 25% раствора магния сульфата в физиологическом растворе. В среднем концентрация магния составила 2,15 ± 0,17 ммоль/л. Такое повышение концентрации магния в плазме крови было закономерно ассоциированное с угнетением сухожильных рефлексов и функции внешнего дыхания. К концу исследования содержание магния в плазме крови постепенно нормализовалось и составило 0,98 ± 0,09 ммоль/л. Выводы. Быстрое введение в организм высокой дозы ионизированного магния и сульфата приводило по принципу Гэмбла к временному уменьшению концентрации в плазме крови других электролитов. На определенных этапах исследования выявлено достоверное уменьшение содержания в плазме крови калия, натрия, хлоридов. Меньше всего изменялось содержание в плазме крови кальция.

Background Maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP) and maximum voluntary ventilation (MVV) measurements assist in determining the respiratory muscle strength and endurance. These determinants of respiratory muscles vary significantly by age, gender, height, and ethnic origin. Normative values for maximum respiratory pressures (MRPs) and MVV would aid in evaluating respiratory muscle function in athletes, estimating performance, and assisting in rehabilitation. In addition, the reference values may aid in determining the efficacy of therapeutic interventions in young people with chronic respiratory diseases. The purpose of this study was to see how respiratory muscle strength indices correlated with anthropometric and physical activity characteristics in young Arabs. Methodology The study included 80 male volunteers and 85 female volunteers ranging in age from 18 to 30 years. MicroRPM was used to measure MIP and MEP, and pulmonary function test data, including MVV values, were recorded. All subjects completed the Global Physical Activity Questionnaire (GPAQ) and anthropometric measurements. Unpaired t-tests or Mann-Whitney U-tests were used to determine male-female differences. Using the Pearson correlation coefficient and Spearman Rho correlation coefficient tests, MIP and MEP values were correlated with body composition and physical activity. Using stepwise multiple linear regression analysis, the relationships between respiratory function (MVV, MIP, and MEP) and PFT values (FVC, FEV1, and FEV1/FVC), physical activity, and sedentary behavior were investigated. Results MIP, MEP, and MVV values were significantly lower in females than in males. MIP, MEP, and MVV values had a moderate correlation with forced vital capacity, forced expiratory volume in 1 second, and height, but not with weight, BMI, or GPAQ. Age, gender, and body mass index were found to be significant predictors of maximal respiratory pressures in a young Arab population. Conclusion Maximum respiratory pressures and maximal voluntary ventilation were significantly lower in young Arabs than in other ethnic groups; these values were influenced by gender and height but not by levels of physical activity.

Objective Neuroinflammation is an important pathogenic mechanism in amyotrophic lateral sclerosis (ALS), with regulatory T cells (Tregs) mediating a slower rate of disease progression. Dimethyl fumarate enhances Treg levels and suppresses pro-inflammatory T cells. The present study assessed the safety and efficacy of dimethyl fumarate in ALS. Methods Phase-2, double-blind, placebo-controlled randomised clinical trial recruited participants from May 1, 2018 to September 25, 2019, across six Australian sites. Participants were randomised (2:1 ratio) to dimethyl fumarate (480 mg/day) or matching placebo, completing visits at screening, baseline, weeks 12, 24 and 36. The primary efficacy endpoint was a change in Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) at week 36. Secondary outcome measures included survival, neurophysiological index (NI), respiratory function, urinary neurotrophin-receptor p75 and quality of life. Results A total of 107 participants were randomised to dimethyl fumarate (n = 72) or placebo (n = 35). ALSFRS-R score was not significantly different at week 36 (−1.12 [−3.75 to 1.52, p = 0.41]). Dimethyl fumarate was associated with a reduced NI decline week 36 (differences in the least-squares mean: (0.84 [−0.51 to 2.22, p = 0.22]). There were no significant differences in other secondary outcome measures. Safety profiles were comparable between groups. Interpretation Dimethyl fumarate, in combination with riluzole, was safe and well-tolerated in ALS. There was no significant improvement in the primary endpoint. The trial provides class I evidence for safety and lack of efficacy of dimethyl fumarate in ALS.

Background: The differential effects of PM2.5 fractions on children’s lung function remain inconclusive. This study aimed to examine whether lung function in asthmatic children was associated with increased PM2.5 fractions in urban areas in Nagasaki prefecture, Japan, where the air pollution level is relatively low but influenced by transboundary air pollution. Methods: We conducted a multiyear panel study of 73 asthmatic children (boys, 60.3%; mean age, 8.2 years) spanning spring 2014–2016 in two cities. We collected self-measured peak expiratory flow (PEF) twice a day and daily time-series data for PM2.5 total mass and its chemical species. We fitted a linear mixed effects model to examine short-term associations between PEF and PM2.5, adjusting for individual and time-varying confounders. A generalized linear mixed effects model was also used to estimate the association for worsening asthma defined by severe PEF decline. Back-trajectory and cluster analyses were used to investigate the long-range transboundary PM2.5 in the study areas. Results: We found that morning PEFs were adversely associated with higher levels of sulfate (− 1.61 L/min; 95% CI: − 3.07, − 0.15) in Nagasaki city and organic carbon (OC) (− 1.02 L/min; 95% CI: − 1.94, − 0.09) in Isahaya city, per interquartile range (IQR) increase at lag1. In addition, we observed consistent findings for worsening asthma, with higher odds of severe PEF decline in the morning for sulfate (odds ratio (OR) = 2.31; 95% CI: 1.12, 4.77) and ammonium (OR = 1.73; 95% CI: 1.06, 2.84) in Nagasaki city and OC (OR = 1.51; 95% CI: 1.06, 2.15) in Isahaya city, per IQR increase at lag1. The significant chemical species were higher on days that could be largely attributed to the path of Northeast China origin (for sulfate and ammonium) or both the same path and local sources (for OC) than by other clusters. Conclusions: This study provides evidence of the differential effects of PM2.5 fractions on lung function among asthmatic children in urban areas, where the Japanese national standards of air quality have been nearly met. Continuous efforts to promote mitigation actions and public awareness of hazardous transboundary air pollution are needed to protect susceptible children with asthma., Environmental Health, 20, art. no. 110; 2021

Acute respiratory distress syndrome (ARDS) is characterized by the severe inflammation and destruction of the lung air-blood barrier, leading to irreversible and substantial respiratory function damage. Patients with coronavirus disease 2019 (COVID-19) have been encountered with a high risk of ARDS, underscoring the urgency for exploiting effective therapy. However, proper medications for ARDS are still lacking due to poor pharmacokinetics, non-specific side effects, inability to surmount pulmonary barrier, and inadequate management of heterogeneity. The increased lung permeability in the pathological environment of ARDS may contribute to nanoparticle-mediated passive targeting delivery. Nanomedicine has demonstrated unique advantages in solving the dilemma of ARDS drug therapy, which can address the shortcomings and limitations of traditional anti-inflammatory or antioxidant drug treatment. Through passive, active, or physicochemical targeting, nanocarriers can interact with lung epithelium/endothelium and inflammatory cells to reverse abnormal changes and restore homeostasis of the pulmonary environment, thereby showing good therapeutic activity and reduced toxicity. This article reviews the latest applications of nanomedicine in pre-clinical ARDS therapy, highlights the strategies for targeted treatment of lung inflammation, presents the innovative drug delivery systems, and provides inspiration for strengthening the therapeutic effect of nanomedicine-based treatment., Graphical abstract Nanomedicine has demonstrated great potential in achieving specific targeting and amplifying therapeutic efficiency. This review focuses on the recent breakthroughs and targeting strategies to provide insights into nanomedicine for acute respiratory distress syndrome treatment.Image 1

Summary Background There is an urgent unmet need for new therapies in amyotrophic lateral sclerosis. In a clinical study with healthy volunteers, levosimendan, a calcium sensitiser, was shown to improve neuromechanical efficiency and contractile function of the human diaphragm. We aimed to evaluate the safety and efficacy of oral levosimendan in people with amyotrophic lateral sclerosis, with a focus on respiratory function. Methods The REFALS study is a randomised, double-blind, placebo-controlled phase 3 trial at 99 amyotrophic lateral sclerosis specialist centres in 14 countries worldwide. People with amyotrophic lateral sclerosis were eligible for participation if they were at least 18 years of age and had a sitting slow vital capacity (SVC) of 60–90% predicted. Participants were randomly assigned (2:1) by interactive web-response system to receive either levosimendan or placebo. The capsules for oral administration were identical in appearance to maintain blinding of participants and investigators. The primary endpoint was the change from baseline in supine SVC at 12 weeks, assessed as the percentage of predicted normal sitting SVC. The key secondary endpoint was the combined assessment of function and survival (CAFS) up to 48 weeks. Analyses were done in the intention-to-treat population, comprising all participants who were randomly assigned. This trial is registered at ClinicalTrials.gov (NCT03505021) and has been completed. An extension study (REFALS-ES; NCT03948178 ) has also been completed, but will be reported separately. Findings Between June 21, 2018, and June 28, 2019, 871 people were screened for the study, of whom 496 were randomly assigned either levosimendan (n=329) or placebo (n=167). Participants were followed up between June 27, 2018 and June 26, 2020, for a median duration of 50·1 (IQR 37·5–51·1) weeks. The median duration of treatment was 47·9 (IQR 26·4–48·1) weeks. Change from baseline in supine SVC at 12 weeks was –6·73% with levosimendan and –6·99% with placebo, with no significant difference between the treatments (estimated treatment difference 0·26%, 95% CI –2·03 to 2·55, p=0·83). Similarly, at week 48, CAFS did not differ between treatment groups (least squares mean change from baseline 10·69, 95% CI –15·74 to 37·12; nominal p value=0·43). The most frequent adverse events were increased heart rate (106 [33%] of 326 receiving levosimendan vs 12 [7%] of 166 receiving placebo), fall (85 [26%] vs 48 [29%]), headache (93 [29%] vs 36 [22%]), and dyspnoea (59 [18%] vs 32 [19%]). 33 (10%) participants allocated levosimendan and 20 (12%) assigned placebo died during the trial, mainly due to respiratory failure or progression of amyotrophic lateral sclerosis. Interpretation Levosimendan was not superior to placebo in maintaining respiratory function in a broad population with amyotrophic lateral sclerosis. Although levosimendan was generally well tolerated, increased heart rate and headache occurred more frequently with levosimendan than with placebo. The possibility of a clinically relevant subgroup of responsive individuals requires further evaluation. Funding Orion Corporation.

Background. Spinal anesthesia methods are rele­vant and tend to spread in modern anesthetic practice. At that time, sympatholytic and toxic effects of local anesthetics, such as arterial hypotension, bradycardia, tremor and other neurological disorders, can lead to patient’s discomfort and somatic dangerous effects. The transient neurologic syndrome, which manifests itself as a local nerve root syndrome, is quite common, when using hyperbaric concentrations of local anesthetics. Post-puncture headache is a common consequence of spinal anesthesia, the pathogenesis of which, in addition to cerebrospinal fluid leak, also includes the toxicity of anesthetics. The purpose was to study of the influence of low-dose unilateral spinal anesthesia (USA) with hyperbaric bupivacaine solutions on cardiohemodynamics, respiratory function, muscle tremor, postpuncture headache, transient neurological syndrome and the need for additional sedation. Materials and methods. The study involved 68 patients, 41 women and 27 men, with the average age of 44.92 ± 6.38 years. Thirty-eight patients underwent a unilateral spinal anesthesia with 6.25–11.65 (7.50 ± 1.25) mg of 0.5% hyperbaric bupivacaine. Thirty patients were assigned to receive a standard USA, 15.0 ± 1.3 mg of isobaric bupivacaine solution was injected. On 5 perioperative stages, the number of cardiac contractions, blood pressure, the number of respiratory movements, SaO2, and the presence of shivering (yes/no) were determined. Dangerous changes on the haemodynamics were considered to be bradycardia below 55 beats per minute, or re-administration of cholinolytics, hypotension (mean blood pressure ≤ 60 mmHg), and re-administration of mesatone despite preoperative infusion preparation. Depression of respiration was considered to be present if SaO2 was ≤ 94 %, and the number of respiratory movements was ≤ 8 or above 22 per 1 minute. 24, 48 and 72 hours after the end of the operation, the presence of post-puncture headache and transient neurological syndrome (paresthesia) was evaluated by means of Numerical Rating Scale of pain — from 0 to 10 points. The Bromage scale was used to assess the effectiveness of sensorimotor block. Results. The Numeric Rating Scale did not demonstrate a significant difference on the early stages of the study. The statistically significant difference can be seen 3 hours after the surgery and on day 2 postoperatively in favour of the low-dose USA. After a day, the difference was not reliable, and in 3 days, the difference was also within the limits of statistical error. The quality of anesthesia on the Bromage scale had no significant differences in the comparison groups. Patients’ requests for additional intravenous sedation also did not have significant differences. Intraoperatively, 8 cases of minor sympatholytic muscle tremor were observed in the study group. In patients after standard USA, shivering of varying degrees, from single fasciculations to sweeping tremor, was observed in 11 cases (36.66 %, i.e., 1.5 times more often). After surgery, chills and shivering in the study group (3 cases) were observed almost 2.5 times less frequently than with the standard method (6 cases). After the introduction of a low dose of hyperbaric bupivacaine for unilateral anesthesia, cases of hypotension, bradycardia on the main stage of surgical intervention were found to be significantly less likely. With low-dosage technique, they were detected in every 9 patient (11.53 %), whereas in the standard method — in every 3–4 persons (31.25 %). After surgical treatment against nonselective spinal anesthesia, hemodynamic deviations were observed in 12.5 % of cases, with low-dose unilateral one — only in 4 %. Stable hemodynamics on the stages of surgical treatment, when using low-dose USA, was observed on average 3 times more often than with the standard USA. Cases of transient neurological syndrome were not observed in both groups. Low dose of local anesthetic 2 times decreases the number of dangerous changes in respiratory function, and by the end of the surgical intervention — 4 times. Conclusions. Low-dose spinal anesthesia showed a greater protective effect on cardiohemodynamics: a stable hemodynamics on the stages of surgical treatment with unilateral approach was observed on average 3 times more often than with a standard USA. The use of unilateral technique prevented the dangerous changes of respiratory function in the main stage 2 times, and by the end of the surgery — 4 times more often. Chills and shivering in USA on the main stage were observed 1.5 times less often, and after the end of operative treatment —2.4 times less often than with a standard USA.

Background: Cow’s milk allergy is among the most frequent food allergies in young children and one of the risk factors of asthma. Objective: The study aimed to assess the role of Cow’s milk allergy (CMA) to induce asthma and to study the effect cow milk protein on asthmatic and non-allergic children to prevent occurrence of asthma among children. Patients and methods: A case-control study that was carried out in Pulmonology Unit of Pediatric Department, Faculty of Medicine, Zagazig University Hospital. The patients were investigated at Medical Community and Immunology Department. The study included 154 child divided equally into two groups. Group A included patients with bronchial asthma and group B (control) included age- and sex-matched healthy individuals. Iinvestigations: complete blood picture, renal and liver function tests, skin prick test, total immunoglobulin (IgE) was done for all participants. Results: There was high statistically significant difference between the two studied groups as regards skin pick test. There was statistically significant increase in the levels of both total and specific Ig E in allergic group compared to control group. There was high significant increase in the severity recorded in respiratory function test in allergic group compared to control group. There was non-significant difference between the two groups regarding GIT manifestation. There was high statistically significant difference between the two groups regarding skin and respiratory manifestations. Conclusion: CMA can exacerbate the symptoms in children with asthma. Therefore, it is worth considering a possible role of food allergy in asthma in young children, particularly when asthma is not adequately controlled in spite of proper routine management.

Introduction: The aim of this study is to investigate the relationship between shooting performance and pulmonary functions and respiratory muscle strength in archers. Material and methods: The research was conducted with 31 boy and 11 girl archers aged 9-12. The forced vital capacity (FVC), forced expiration volume in one second (FEV1), FEV1/FVC, peak expiratory flow (PEF), maximum voluntary ventilation (MVV), maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP) of the archers were measured. To determine the shooting performance, a total of 30 shots (15+15) were taken from an 18-meter distance in closed shooting range. Results: A significant difference was found between the 15 shots done in each half and the total shot point and the averages of FVC (r=0.375, 0.353, 0.378 respectively) and FEV1 (r=0.368, 0.339, 0.367 respectively). However, a significant difference was not found among these shot points and other respiratory parameters (p>0.05). A relationship was detected between the second 15-shot points of boy archers and MEP (r=0.370). Conclusions: A strong correlation was not found between the respiratory parameters and shooting performances of the archers in this study. However, it is thought that this level of relationship will rise as training level and age increases.

Background. Mechanical ventilation (MV) can cause diaphragmatic injury, which is called ventilator-induced diaphragmatic dysfunction and is associated with adverse treatment outcomes, prolonged weaning from respiratory therapy, and prolonged stay in the intensive care unit. The purpose of the study was to determine the prevalence of diaphragmatic dysfunction in children depending on the strategy of mechanical ventilation. The study hypothesis was that the occurrence of diaphragmatic dysfunction does not depend on the strategy of mechanical ventilation. Materials and methods. We conducted a prospective cohort single-center study at the Department of Anesthesiology and Intensive Care at Lviv Regional Children’s Clinical Hospital “OHMATDYT”. We included patients with acute respiratory failure who were mechanically ventilated for more than 3 days. Exclusion criteria for the study were: the refusal of the patient’s legal representatives to participate in the study at any of its stages, the patient’s agonizing state upon admission, and the onset of MV less than 48 h after prior weaning. The study included 89 indivi­duals aged 1 month — 18 years. All patients were randomly divided into 2 groups (using random.org). Group I included people who received lung-protective ventilation strategy, group II — patients who received diaphragm-protective in addition to lung-protective ventilation strategy. Eighty-two patients were included in the data analysis. We studied indicators of diaphragmatic function (amplitude of diaphragm movement, thicke­ning fraction, and it was considered that decrease of this indicator for less than 15 % was a marker of diaphragmatic weakness; its increase up to more than 35 % was a marker of high respiratory function and a potentially damaging factor for diaphragm; and inspiration time), parameters of acid-base balance and mechanical ventilation. To assess age-dependent data, patients were divided into age subgroups: subgroup 1— children aged 1 month — 1 year; subgroup 2 — children aged 1–3 years; subgroup 3 — children aged 3–6 years; subgroup 4 — children 6–13 years; subgroup 5 — children aged 13–18 years. Stages of the study: days 1 (d1), 3 (d3), 5 (d5), 7 (d7), 9 (d9), 14 (d14), 28 (d28). Results. Thus, we identified age-specific features of diaphragmatic dysfunction during MV: in patients of the first age subgroup in group I, there were found weakness for the right hemidiaphragm with compensatory excessive level of work for the left dome at the beginning of weaning and at stage d9, while in group II diaphragmatic overload was registered only at stage d5. In patients of the second age subgroup in group I, changes were the opposite to those described previously: we found excessive work of the right hemidiaphragm with low contractions of left dome at all stages of study in group I, while in group II the only episode of diaphragmatic weakness was in stage d3. In the third age subgroup, the proper diaphragmatic activity in group I of patients was restored later than in II group. In the fourth age subgroup in group I, there was an episode of high work of the diaphragm at stage d5, whereas in group II all data of diaphragmatic function were within the recommended parameters for diaphragm-protective strategy of MV at all stages of our study. In the fifth age subgroup in group I, an excessive work of both right and left domes of the diaphragm was significantly more often registered during weaning than in group II; however, in group II episodes of both types of changes — diaphragmatic weakness and excessive work — were detected. It was found that adding diaphragm-protective strategy of weaning from mechanical ventilation in comprehensive intensive care allowed us to reduce the duration of mechanical ventilation: in patients of the first age subgroup — by 1.5 times (p = 0.08); in patients of the second subgroup — by 2.4 times (p = 0.18); in the fourth age subgroup — by 1.75 times (p = 0.1); in fifth age subgroup — by 4.25 times (p = 0.009). In patients of the third age subgroup, duration of mechanical ventilation increased by 1.1 times (p = 0.68). The frequency of complications (reintubations) was reduced in the first age subgroup by 4.3 times (p = 0.02); in the second age subgroup — by 3.4 times (p = 0.04). Conclusions. The prevalence and variety of manifestations of diaphragmatic dysfunction depend on the strategy of mechanical ventilation. Comprehensive approach during weaning from respiratory therapy, which includes diaphragm-protective strategy of ventilation, reduces the incidence of diaphragmatic dysfunction and the duration of weaning from MV., Актуальность. Искусственная вентиляция легких (ИВЛ) может приводить к повреждению диафрагмы, которое называют вентилятор-индуцированной диафрагмальной дисфункцией и связывают с неблагоприятными результатами лечения, длительным отлучением от респираторной терапии и длительным пребыванием в отделении интенсивной терапии. Целью нашего исследования было установить распространенность диафрагмальной дисфункции среди детей в зависимости от стратегии ИВЛ. Рабочей была гипотеза, что возникновение диафрагмальной дисфункции не зависит от стратегии проведения ИВЛ. Материалы и методы. Нами проведено проспективное когортное одноцентровое исследование в отделении анестезиологии с койками интенсивной терапии КНП «Львовская областная детская клиническая больница «ОХМАТДЕТ». В исследование включали пациентов с острой дыхательной недостаточностью, требующих ИВЛ более 3 суток. Критериями исключения из исследования были: отказ законных представителей пациента от участия в исследовании на любом из его этапов, агональное состояние пациента при поступлении на лечение. В исследование были включены 89 пациентов в возрасте от 1 мес. до 18 лет. Все пациенты были разделены случайным образом на 2 группы (с помощью сервиса random.org). В I группу вошли пациенты, у которых применяли легочно-протективную стратегию ИВЛ, во II группу — пациенты, у которых применяли легочно-протективную и диафрагм-протективную стратегии ИВЛ. В анализ данных включены 82 пациента. Для оценки показателей, зависящих от возраста, пациенты были разделены на возрастные подгруппы: 1-я подгруппа — дети в возрасте 1 мес. — 1 год; 2-я подгруппа — дети 1–3 лет; 3-я подгруппа — дети 3–6 лет; 4-я подгруппа — дети 6–13 лет; 5-я подгруппа — дети 13–18 лет. Этапы исследования: 1-е сутки (d1), 3-и сутки (d3), 5-е сутки (d5), 7-е сутки (d7), 9-е сутки (d9), 14-е сутки (d14), 28-е сутки (d28). В обеих группах пациентов изучали: изменения амплитуды движений диафрагмы в ходе исследования; контрактильные свойства диафрагмы с помощью определения фракции ее истончения и динамику в ходе исследования; рассматривали снижение данного показателя менее 15 % как маркер диафрагмальной слабости; повышение его более 35 % как маркер высокой работы дыхания и потенциально повреждающий фактор для диафрагмы; время вдоха по ультразвуковым данным; мониторировали показатели кислотно-щелочного равновесия крови и параметры искусственной вентиляции легких. Результаты. Нами выявлены специфические возрастные особенности: среди пациентов 1-й возрастной подгруппы в І группе мы регистрировали слабость правого купола диафрагмы с компенсаторным чрезмерным сокращением левого купола в начале отлучения и на этапе d9, тогда как во II группе эпизод чрезмерной работы диафрагмы был зарегистрирован только на этапе d5. Среди пациентов 2-й возрастной подгруппы I группы изменения были диаметрально противоположными по сравнению с 1-й возрастной подгруппой — преобладала чрезмерная работа правого купола с низкими показателями сокращения левого купола на всех этапах исследования, тогда как во II группе был зарегистрирован эпизод диафрагмальной слабости на этапе d3. В 3-й возрастной подгруппе достоверно позже восстанавливалась надлежащая диафрагмальная активность в І группе пациентов по сравнению со II группой. В 4-й возрастной подгруппе среди пациентов I группы отмечен эпизод высокой работы диафрагмы на этапе d5, тогда как во II группе все показатели были в пределах, рекомендованных диафрагм-протективной стратегией. В 5-й возрастной подгруппе в І группе достоверно чаще регистрировали чрезмерную работу как правого, так и левого куполов диафрагмы, во II группе были эпизоды как диафрагмальной слабости, так и чрезмерной ее работы. Использование в комплексе интенсивной терапии диафрагм-протективной стратегии при проведении отлучения от ИВЛ позволило снизить продолжительность ИВЛ: у пациентов 1-й возрастной подгруппы — в 1,5 раза (p = 0,08); у пациентов 2-й возрастной подгруппы — в 2,4 раза (p = 0,18); в 4-й возрастной подгруппе — в 1,75 раза (p = 0,1); в 5-й возрастной подгруппе — в 4,25 раза (p = 0,009). У пациентов 3-й возрастной подгруппы продолжительность ИВЛ возросла в 1,1 раза (p = 0,68). Выводы. Распространенность и разнообразие проявлений диафрагмальной дисфункции зависят от стратегии проведения механической вентиляции легких. Комплексный подход на этапе отлучения от респираторной терапии, включающей проведение диафрагм-протективной стратегии ИВЛ, позволяет уменьшить инцидентность возникновения дисфункции диафрагмы и снизить продолжительность отлучения от ИВЛ., Актуальність. Штучна вентиляція легень (ШВЛ) може призводити до ушкодження діафрагми, що називають вентилятор-індукованою діафрагмальною дисфункцією та пов’язують з несприятливими результатами лікування, тривалим відлученням від респіраторної терапії і тривалим перебуванням у відділенні інтенсивної терапії. Метою нашого дослідження було встановити поширеність діафрагмальної дисфункції серед дітей залежно від стратегії проведення ШВЛ. Робочою була гіпотеза, що виникнення діафрагмальної дисфункції не залежить від стратегії проведення ШВЛ. Матеріали та методи. Нами проведено проспективне когортне одноцентрове дослідження у відділенні анестезіології з ліжками інтенсивної терапії КНП «Львівська обласна дитяча клінічна лікарня «ОХМАТДИТ». До дослідження включали пацієнтів із гострою дихальною недостатністю, які потребували ШВЛ понад 3 доби. Критеріями виключення з дослідження були: відмова законних представників пацієнта від участі у дослідженні на будь-якому з його етапів, агональний стан пацієнта при надходженні на лікування. До дослідження було включено 89 пацієнтів віком від 1 міс. до 18 років. Усіх пацієнтів було розподілено випадковим чином на 2 групи (за допомогою сервісу random.org). До І групи ввійшли пацієнти, у яких застосовували легенево-протективну стратегію ШВЛ, до ІІ групи — пацієнти, у яких застосовували легенево-протективну та діафрагм-протективну стратегії ШВЛ. До аналізу даних включені 82 пацієнти. Для оцінювання показників, що залежали від віку, пацієнтів було розподілено на вікові підгрупи: 1-ша підгрупа — діти віком 1 міс. — 1 рік; 2-га підгрупа — діти 1–3 років; 3-тя підгрупа — діти 3–6 років; 4-та підгрупа — діти 6–13 років; 5-та підгрупа — діти 13–18 років. Етапи дослідження: 1-ша доба (d1), 3-тя доба (d3), 5-та доба (d5), 7-ма доба (d7), 9-та доба (d9), 14-та доба (d14), 28-ма доба (d28). В обох групах пацієнтів вивчали: зміни амплітуди рухів діафрагми впродовж дослідження; конт­рактильні властивості діафрагми за допомогою визначення фракції її стоншення та динаміку впродовж дослідження; розглядали зниження даного показника менше 15 % як маркер діафрагмальної слабкості; підвищення його понад 35 % як маркер високої роботи дихання та потенційно ушкоджуючий чинник для діафрагми; час вдиху за ультразвуковими даними; моніторували показники кислотно-лужної рівноваги крові та параметри штучної вентиляції легень. Результати. Нами виявлено специфічні вікові особливості: серед пацієн­тів 1-ї вікової підгрупи в І групі реєстрували слабкість для правого купола діафрагми з компенсаторним надмірним рівнем скорочень лівого купола на початку відлучення та на етапі d9, тоді як у ІІ групі епізод надмірної роботи діафрагми був зареєстрований лише на етапі d5. Серед пацієнтів 2-ї вікової групи І групи зміни були діаметрально протилежними порівняно з 1-ю віковою підгрупою щодо куполів діафрагми — переважала надмірна робота правого з низькими показниками скорочення лівого купола на всіх етапах дослідження, тоді як у ІІ групі — епізод діафрагмальної слабкості на етапі d3. У 3-й віковій підгрупі вірогідно пізніше відновлювалася належна діафрагмальна активність у І групі пацієнтів порівняно з ІІ групою. У 4-й віковій підгрупі серед пацієнтів І групи відмічено епізод високої роботи діафрагми на етапі d5, тоді як у ІІ групі всі показники були в рекомендованих діафрагм-протективною стратегією межах. У 5-й віковій підгрупі в І групі вірогідно частіше реєстрували надмірну роботу як правого, так і лівого купола діафрагми, у ІІ групі були епізоди як діафрагмальної слабкості, так і надмірної її роботи. Використання в комплексній інтенсивній терапії діафрагм-протективної стратегії дозволило знизити тривалість відлучення від ШВЛ: у пацієнтів 1-ї вікової підгрупи — в 1,5 раза (p = 0,08); у пацієнтів 2-ї вікової підгрупи — у 2,4 раза (p = 0,18); у 4-й віковій підгрупі — в 1,75 раза (p = 0,1); у 5-й віковій підгрупі — у 4,25 раза (p = 0,009). У пацієнтів 3-ї вікової підгрупи тривалість ШВЛ зросла в 1,1 раза (p = 0,68). Висновки. Поширеність та різноманітність проявів діафрагмальної дисфункції залежить від стратегії проведення механічної вентиляції легень. Комплексний підхід на етапі відлучення від респіраторної терапії, що включає проведення діафрагм-протективної стратегії ШВЛ, дозволяє зменшити інцидентність виникнення дисфункції діафрагми та знизити тривалість відлучення від ШВЛ.

Introduction/aims In this study, researchers evaluated the effects of lung volume recruitment treatment (LVR) - a low-tech, low-cost, manual 'breath stacking' technique used to help people cough with enough force to clear their airways, thereby reducing the risk of aspiration and choking - on five volitional airway clearance and protection behaviors used by people living with amyotrophic lateral sclerosis (PwALS). Methods Using a repeated-measures cross-over design, 29 PwALS performed five volitional airway clearance and protection behaviors in LVR treatment and in no-treatment, control conditions. Peak cough flow (PCF) was used to measure maximum expiratory rate during forced expiration, throat clearing, hawking, post-swallow coughing and the supraglottic swallowing maneuver. Comparisons were made as a function of condition (treatment or control) and three time-points (pre-treatment, and 15- and 30-minutes post-treatment). Results LVR treatment had a significant positive effect on maximum expiratory rates during all tested airway clearance and protection behaviors. Increased PCF values lasted for up to 30 minutes post-LVR for all tested behaviors in the treatment condition. Discussion Findings demonstrate that LVR treatment can increase control over airway clearance in PwALS, as well as provide improved airway protection for up to 30 minutes, the duration of a typical meal. This study has implications for patient care. These include offering patients control over some of the most feared symptoms of ALS, particularly choking during activities of daily living, and enhanced ALS respiratory care in low-resource settings. Findings may have implications for other neurodegenerative disorders in which dysphagia occurs with retained sensory function. This article is protected by copyright. All rights reserved.

Asthma and chronic obstructive pulmonary disease (COPD) are major causes of morbidity and mortality worldwide. Optimal control of these conditions is a constant challenge for both physicians and patients. Poor inhaler practice is widespread and is a substantial contributing factor to the suboptimal clinical control of both conditions. The practicality, dependability, and acceptability of different inhalers influence the overall effectiveness and success of inhalation therapy. In this paper, experts from various European countries (Finland, Germany, Hungary, Italy, Poland, Spain, and Sweden) address inhaler selection with special focus on the Easyhaler® device, a high- or medium-high resistance dry-powder inhaler (DPI). The evidence examined indicates that use of the Easyhaler is associated with effective control of asthma or COPD, as shown by the generally accepted indicators of treatment success. Moreover, the Easyhaler is widely accepted by patients, is reported to be easy to learn and teach, and is associated with patient adherence. These advantages help patient education regarding correct inhaler use and the rational selection of drugs and devices. We conclude that switching inhaler device to the Easyhaler may improve asthma and COPD control without causing any additional risks. In an era of climate change, switching from pressurized metered-dose inhalers to DPIs is also a cost-effective way to reduce emissions of greenhouse gases. Enhanced feature (slides, video, animation) (MP4 43768 kb).