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Background: The World Health Organization (WHO) defines rational use of drug as a state in which medications are received by patients appropriately according to their clinical needs and individual requirement, for adequate period and at the right cost. More than 50% of all medicines are prescribed, dispensed, or sold inappropriately worldwide. This study aimed to evaluate the prescribing patterns in Adigrat general hospital, Tigrai, Ethiopia. Methods: A retrospective cross-sectional study was done to evaluate prescription patterns. A systematic random sampling technique was used to select 600 prescriptions and the prescriptions were reviewed using WHO/International Network of Rational Use of Drugs prescribing indicators. Data was collected from prescriptions dispensed from 01 March 2023 to 30 March 2024 at outpatient pharmacy of Adigrat general hospital. Data was analyzed using SPSS version 21 and a p-value < 0.05 was declared statistically significant. Results: A total of 1088 medicines were prescribed in 600 prescription encounters, giving an average number of 1.8 (± 0.83) medicines per encounter. The percentage of medicines prescribed by generic name was 91.5% while 98.7% of the medicines were prescribed from essential medicine list (EML). Besides, the percentages of encounters containing at least one antibiotic and one injection were 44.5% and 7.2%, respectively. A total of 340 antibiotics were prescribed in 267 encounters. Penicillins (34.4%), macrolides (23.8%) and fluoroquinolones (17.1%) were the most prevalent antibiotics classes. The "Access" and "Watch" groups covered 54.4% and 45.6% of the total antibiotics prescribed, respectively. Being under 18 years old [Adjusted Odds Ratio (AOR): 9.830, CI: 4.062–23.786], being prescribed with three medicines (AOR: 3.247, CI: 1.571–6.708) and certain diagnosis like diseases of the respiratory system (AOR: 3.750, CI: 2.136–6.584) were significantly associated with antibiotic prescribing. Conclusion: This study showed deviations of prescribing patterns from WHO standards. The percentage of prescriptions with antibiotic was far from WHO optimal value. The use of antibiotics from "Access" group was below WHO standard. The percentage of medicines prescribed by generic name and the percentage of encounters with injection also deviated from WHO standard. Antibiotics prescribing showed significantly association with age, number of medicines and certain diseases. [ABSTRACT FROM AUTHOR]

Background: Streptococcus salivarius is an opportunistic pathogen, and there have been no reported cases of Streptococcus salivarius pneumonia to date. Pneumomediastinum is usually secondary to tracheal or esophageal injury and is very rare as a complication of pneumonia. We report a case of Streptococcus salivarius pneumonia complicated by pneumomediastinum, aiming to enhance clinicians' awareness of rare pathogens and uncommon complications in pneumonia. Case presentation: The patient, a 36-year-old male, presented with a persistent cough and sputum production for one week, accompanied by a sore throat that had developed just one day prior. Chest computed tomography (CT) disclosed pneumomediastinum alongside obstructive atelectasis in the left lower lobe. Streptococcus salivarius infection was conclusively identified through bronchoalveolar lavage metagenomic next-generation sequencing (mNGS), as well as smear and culture analyses. The patient was administered intravenous amoxicillin-clavulanate potassium for a duration of seven days as part of the anti-infection regimen. Given the stability of the patient's respiratory and circulatory systems, a tube drainage procedure was deemed unnecessary. Post-treatment, the patient's clinical symptoms notably improved. A subsequent chest CT scan revealed the re-expansion of the left lower lung and near-complete resolution of pneumomediastinum. Conclusion: There are numerous pathogens that can cause pneumonia. While focusing on common pathogens, it is important not to overlook rare ones. When considering infections from rare pathogens, it is recommended to promptly perform a bronchoscopy and submit bronchoalveolar lavage fluid for mNGS to improve pathogen detection rates. During the diagnosis and treatment of pneumonia, it is crucial to be vigilant for rare complications. When a patient presents with symptoms such as dyspnea or subcutaneous emphysema, it is advisable to immediately perform a chest CT scan to rule out pneumomediastinum. [ABSTRACT FROM AUTHOR]

Viral pneumonia is characterized by inflammation in the lungs triggered by respiratory viruses. Dayuan Yin (DYY), a traditional Chinese medicine formula known for treating infectious diseases, is hypothesized to offer therapeutic benefits in treating viral pneumonia, although its specific molecular impacts remain understudied. This study aimed to evaluate the therapeutic effects of DYY in mitigating HCoV-229E virus-induced pneumonia in mice. This study employed an HCoV-229E virus-infected mouse model to investigate the therapeutic potential and underlying molecular mechanisms of DYY on virus-induced pneumonia. The respiratory function and organ indices post-treatment were assessed. Lung tissue and tracheal lesions were evaluated via immunohistochemistry. Spleen immune cell composition was analyzed using flow cytometry. Inflammatory cytokines and viral loads were quantified using hypersensitive multiplex electrochemiluminescence method and PCR analysis, respectively. The expression levels of MAS1, Ras, Raf1, MEK1/2, and ERK1/2 in lung tissues were determined through western blot analysis. DYY significantly improved respiratory function, and reduced organ pathology in infected mice. It effectively decreased viral loads and inflammatory cytokines such as IL-6, IL-1β, and TNF-α in lung tissues. Enhancements in immune response were evidenced by increased CD4/CD8 ratios in the spleen. DYY also notably upregulated MAS1 protein levels and suppressed the activation of the Ras/Raf1/MEK/ERK signaling pathway. DYY enhanced respiratory function and exerted significant antiviral and immunomodulatory effects in mice infected with the HCoV-229E virus, primarily by modulating MAS1 expression and inhibiting the Ras/Raf1/MEK/ERK pathway. [ABSTRACT FROM AUTHOR]

Objective • Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) and Laryngopharyngeal Reflux Disease (LPRD) are interrelated medical conditions affecting the respiratory system. This article aimed to investigate the potential correlation between the two. Methods • This cross-sectional study was carried out on a total of 52 participants diagnosed with both OSAHS and LPRD. Clinical data of baseline demographics of year, sex, BMI, including clinical indicators such as AHI (Apnea Hypopnea Index), OSAHS severity grading, RFS (Reflux Finding Score), RSI (Reflux Symptom Index), and 24-hour pH level were collected. Statistical analysis was then conducted to evaluate the correlation between OSAHS and LPRD. Results • Among the 52 patients, the the average age was 43.3±11.6 years with a mean 24.7±2.9 kg/m2 BMI level. The mean duration of OSAHS was 4.1±1.7 years with mean 38.7±12 AHI scores and 30.8% mild OSAHS, 51.9% moderate OSAHS, and 17.3% severe OSAHS. Mean LPRD duration was 3.2±1.5 years with a mean 15.9±4.9 RFS score, mean 28.0±6.8 RSI score, and mean 3.9±0.8 24-hour pH level. There was a strong positive correlation between AHI scores and both the RFS score (r>0.9, P < .01) and RSI score (r>0.9, P < .01). While a strong negative correlation between AHI scores and 24-hour pH level was observed (r < -0.8, P < .01). And there was a strong positive correlation between OSAHS severity levels and both the RSF score (r>0.8, P < .01) and RSI score (r>0.79, P < .01). While a significant negative correlation between OSAHS severity and 24-hour pH level was detected (r < -0.7, P < .01). Conclusions • The findings of this cross-sectional study demonstrate a strong positive correlation between the severity of OSAHS, as indicated by AHI scores, and the severity of LPRD, as measured by RFS and RSI scores. A negative correlation was also observed between AHI scores and 24-hour pH level, indicating a connection between these two medical conditions. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has brought significant attention to the respiratory system, with much focus on lung-related disorders. However, the diaphragm, a crucial component of respiratory physiology, has not been adequately studied, especially in the context of long COVID. This review explores the multipotential role of the diaphragm in both respiratory health and disease, emphasizing its involvement in long-term complications following SARS-CoV-2 infection. The diaphragm's fundamental role in respiratory physiology and its impact on balance and posture control, breathing patterns, and autonomic nervous system regulation are discussed. This review examines complications arising from COVID-19, highlighting the diaphragm's involvement in neurological, musculoskeletal, and inflammatory responses. Particular attention is given to the neuroinvasive impact of SARS-CoV-2, the inflammatory response, and the direct viral effects on the diaphragm. The diaphragm's role in long COVID is explored, with a focus on specific symptoms such as voice disorders, pelvic floor dysfunction, and sleep disturbances. Diagnostic challenges, current methods for assessing diaphragmatic dysfunction, and the complexities of differentiating it from other conditions are also explored. This article is the first to comprehensively address diaphragmatic dysfunction resulting from COVID-19 and long COVID across various physiological and pathological aspects, offering a new perspective on its diagnosis and treatment within a multisystem context. [ABSTRACT FROM AUTHOR]

During respiration, mechanical stress can initiate biological responses that impact the respiratory system. Mechanical stress plays a crucial role in the development of the respiratory system. However, pathological mechanical stress can impact the onset and progression of respiratory diseases by influencing the extracellular matrix and cell transduction processes. In this article, we explore the mechanisms by which mechanical forces communicate with and influence cells. We outline the basic knowledge of respiratory mechanics, elucidating the important role of mechanical stimulation in influencing respiratory system development and differentiation from a microscopic perspective. We also explore the potential mechanisms of mechanical transduction in the pathogenesis and development of respiratory diseases such as asthma, lung injury, pulmonary fibrosis, and lung cancer. Finally, we look forward to new research directions in cellular mechanotransduction, aiming to provide fresh insights for future therapeutic research on respiratory diseases. [ABSTRACT FROM AUTHOR]

Background and objectives: Viral respiratory infections significantly affect young children, particularly extremely premature infants, resulting in high hospitalization rates and increased health‐care burdens. Nasal epithelial cells, the primary defense against respiratory infections, are vital for understanding nasal immune responses and serve as a promising target for uncovering underlying molecular and cellular mechanisms. Methods: Using a trans‐well pseudostratified nasal epithelial cell system, we examined age‐dependent developmental differences and antiviral responses to influenza A and respiratory syncytial virus through systems biology approaches. Results: Our studies revealed differences in innate‐receptor repertoires, distinct developmental pathways, and differentially connected antiviral network circuits between neonatal and adult nasal epithelial cells. Consensus network analysis identified unique and shared cellular‐viral networks, emphasizing highly relevant virus‐specific pathways, independent of viral replication kinetics. Conclusion: This research highlights the importance of nasal epithelial cells in innate antiviral immune responses and offers crucial insights that allow for a deeper understanding of age‐related differences in nasal epithelial cell immunity following respiratory virus infections. [ABSTRACT FROM AUTHOR]

• Oral acute and subchronic toxicities of Ziziphus jujuba were evaluated in rats. • No major signs of toxicity were observed in the liver and kidney. • Repeated oral administration is safe at up to 1000 mg kg-1 bw over a 28-day period. • Ziziphus jujuba bark is relatively safe at lower dose. Ziziphus jujuba is a medicinal botanical with various pharmacological properties against cardiovascular diseases, respiratory system diseases, gastrointestinal problems, dysentery, and diarrhea. Despite its exhaustive use for medicinal aims, no study has yet been directed to evaluate this plant's potentially toxic profile. The present work focused on the acute and subchronic toxicity of Z. jujuba bark extract. The acute oral toxicity was performed using the OECD guideline 425; Z. jujuba bark extract was administered to female rats at a single dose of 5000 mg kg-1 body weight. The subchronic acute oral toxicity was carried out according to OECD guidelines 407; Z. jujuba bark extract was administered to male and female rats at doses of 250, 500, and 1000 mg kg-1 bw; after 28 days of Z. jujuba bark extract daily administration, the animals were sacrificed. Hematological parameters, serum and urinary biochemical parameters, and histological sections of the liver and kidneys were assessed. Administration of the single-oral dose of Z. jujuba bark methanolic extract did not cause any death in rats, and the LD 50 was found to be greater than 5000 mg kg-1 bw. The repeated administration of Z. jujuba bark methanolic extract at 250, 500, and 1000 mg kg-1 bw did not induce any significant perturbation of the white blood cells, lymphocytes, red blood cells, hemoglobin, hematocrit, and platelets in rats as compared to the controls. For the lipid parameters, namely triglycerides and cholesterol, no significant difference was recorded between the profiles of the treated and untreated groups of animals. Likewise, we registered non-significant changes in renal parameters such as creatinine, urea, and proteins; this was confirmed by the histological sections, which showed a normal kidney structure. Besides, we did not observe any significant modification in the values of liver parameters, ALT and AST. This finding was further confirmed by the histological examination of the liver, which revealed the organ's normal structure. Finally, for single-oral administration, Z. jujuba bark extract is almost non-toxic. For repeated oral administration, Z. jujuba bark extract is safe at doses up to 1000 mg kg-1 bw over a 28-day period. [ABSTRACT FROM AUTHOR]

Mouse alveolar macrophages actively patrol the alveolar airspace and mask microbial antigens to limit damaging inflammation. Restraining human neutrophil expansion during viral upper respiratory infections can avoid excessive inflammation and prevent worsened clinical outcomes. The role and landscape of type I and type III interferons during human viral respiratory infections is context, age, and anatomical region dependent. Human lungs contain long-lived tissue-resident memory T and B cells with diverse phenotypes and functions. To preserve constant air exchange and host survival, the immune system of the mammalian respiratory tract is required to balance its capacity to tolerate commensal microorganisms with protection against pathogens, while avoiding excessive and damaging inflammation. These immune functions are further influenced by the highly divergent anatomical and functional characteristics of the upper airways, trachea, and lungs. New research offers key insights into mechanisms of immune system adaptation to each unique environment, increasing our understanding of the pathogenesis of respiratory infection and (excessive) inflammation. The respiratory tract is exposed to infection from inhaled pathogens, including viruses, bacteria, and fungi. So far, a comprehensive assessment that integrates common and distinct aspects of the immune response along different areas of the respiratory tract has been lacking. Here, we discuss key recent findings regarding anatomical, functional, and microbial factors driving regional immune adaptation in the mammalian respiratory system, how they differ between mice and humans, and the similarities and differences with the gastrointestinal tract. We demonstrate that, under evolutionary pressure, mammals evolved spatially organized immune defenses that vary between the upper and lower respiratory tract. Overall, we propose that the functional specialization of the immune response along the respiratory tract has fundamental implications for the management of infectious or inflammatory diseases. [ABSTRACT FROM AUTHOR]

COVID-19 is an RNA virus belonging to the SARS family of viruses and includes a wide range of symptoms along with effects on other body organs in addition to the respiratory system. The high speed of transmission, severe complications, and high death rate caused scientists to focus on this disease. Today, many different investigation types are performed on COVID-19 from various points of view in the literature. This review summarizes most of them to provide a useful guideline for researchers in this field. After a general introduction, this review is divided into three parts. In the first one, various transmission ways COVID-19 are classified and explained in detail. The second part reviews the used biological samples for the detection of virus and the final section describes the various methods reported for the diagnosis of COVID-19 in various biological matrices. [ABSTRACT FROM AUTHOR]

Sulfur dioxide (SO2) belongs to the highly reactive group of gases familiar as "Oxides of Sulfur". SO2 has lots of adverse effects on plants, respiratory system and many other environmental issues. Sulfur dioxide is a primary pollutant which is regulated worldwide, due to the combustion of fuel. Different approaches are adopted to economically control the SO2 in the environment which causes the production of sulfuric acid that is reflected in acid rain. The aim of this study is to investigate the invariant regions and solution pathways for the formation of H2SO4 in a multi-step reaction mechanism. The employed Model Reduction Techniques (MRTs) such as Spectral Quasi Equilibrium Manifold (SQEM) and Intrinsic Low Dimensional Manifold (ILDM) give the solution curves, which functions as a primary approximation to invariant manifold. It is achieved that each chemical specie can be assessed rather than taking the overall mechanism. The new discovery suggests that we could achieve the invariant regions for SO2 and H2SO4. SO2 emissions, along with emission norms, will be disclosed. The comparison of MRTs is depicted through tabular and graphical representations, while theoretical results are demonstrated through computer simulations using MATLAB. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the airborne exposure to aerosols according to the particle size distribution of three different spray types (nano-nozzled spray gun, low-temperature steam spray, and fogger) and compare the concentrations of inhaled aerosols between children and adults. Airborne aerosols released from three products were observed using size-segregated particle measurements, and particle concentrations deposited in the respiratory tracts of adults and children were estimated using multi-path particle dosimetry lung deposition models. All types of sprayers generated the most nanoparticles (~100 nm). Due to their higher respiratory rate than adults, a larger number of particles <1.0 μm deposited in the children's respiratory tracts was higher. The sequences of the total number of particles in the respiratory regions after spraying nano-nozzled spray gun and fogger were alveolar (AL)>tracheobronchial (TB)>head airway (HA) in adults and AL>HA>TB in children. Meanwhile, the trend of low-temperature steam spray was AL>TB>HA in adults and AL>TB>HA in children. [ABSTRACT FROM AUTHOR]

Summary: Background: The VIDIAC score, a prospectively developed universal classification for videolaryngoscopy, has shown excellent diagnostic performance in adults. However, there is no reliable classification system for videolaryngoscopic tracheal intubation in children. We aimed to develop and validate a multivariable logistic regression model and easy‐to‐use score to classify difficult videolaryngoscopic tracheal intubation in children and to compare it with the Cormack and Lehane classification. A secondary aim was to externally validate the VIDIAC score in children. Methods: We conducted a prospective observational study within a structured universal videolaryngoscopy implementation programme. We used C‐MAC™ videolaryngoscopes in all children undergoing tracheal intubation for elective surgical procedures. We validated the VIDIAC score externally and assessed its performance. We then identified eligible co‐variables for inclusion in the PeDiAC score, developed a multivariable logistic regression model and compared its performance against the Cormack and Lehane classification. Results: We studied 809 children undergoing 904 episodes of tracheal intubation. The VIDIAC score outperformed the Cormack and Lehane classification when classifying the difficulty of videolaryngoscopic tracheal intubation, with an area under the receiver operating characteristic curve of 0.80 (95%CI 0.73–0.87) vs. 0.69 (95%CI 0.62–0.76), respectively, p = 0.018. Eight eligible tracheal intubation‐related factors, that were selected by 100‐times repeated 10‐fold cross‐validated least absolute shrinkage selector operator regression, were used to develop the PeDiAC model. The PeDiAC model and score showed excellent diagnostic performance and model calibration. The PeDiAC score achieved significantly better diagnostic performance than the Cormack and Lehane classification, with an area under the receiver operating characteristic curve of 0.97 (95%CI 0.96–0.99) vs. 0.69 (95%CI 0.62–0.76), respectively, p < 0.001. Conclusion: We developed and validated a specifically tailored classification for paediatric videolaryngoscopic tracheal intubation with excellent diagnostic performance and calibration that outperformed the Cormack and Lehane classification. [ABSTRACT FROM AUTHOR]

Pyrethrin and pyrethroid are a relatively new class of pesticides with potent insecticidal properties. Pyrethrins are naturally occurring pesticides obtained from the Chrysanthemum cinerariaefolium flower, while pyrethroids are their synthetic derivatives. They are widely used as the insecticides of choice in agriculture, veterinary medicine, public health programs, and household activities. Pyrethrin, being a broad-spectrum insecticide kills a wide range of pests, while pyrethroids last longer in the environment owing to low susceptibility to sunlight, and greater stability and efficacy than parent molecules. Humans can be exposed through inhalation, ingestion, and dermal routes. Indoor usage of an insecticide poses a serious risk to human health, especially to women, children, and stay-at-home people. Although pyrethrin and pyrethroid are generally considered safe, sustained skin or inhalation exposure or direct contact with open wounds results in higher toxicity to mammals. There is a paucity of data on the impact of pyrethrin and pyrethroid on overall pulmonary health. The respiratory system, from the nose, nasal passages, airways, and bronchi to the pulmonary alveoli, is vulnerable to environmental contaminants such as pesticides because of its anatomical location as well as being a highly blood profused organ. Under and over-functioning of the respiratory system triggers diverse pathologies such as serious infections, allergies, asthma, metastatic malignancies, and auto-immune conditions. While the association between workplace-related pesticide exposures and respiratory diseases and symptoms is well documented, it is important to understand the adverse health impact of pyrethrin and pyrethroid on the general population for awareness and also for better regulation and implementation of the law. [ABSTRACT FROM AUTHOR]

BACKGROUND: PEEP is a cornerstone treatment for children with pediatric ARDS. Unfortunately, its titration is often performed solely by evaluating oxygen saturation, which can lead to inadequate PEEP level settings and consequent adverse effects. This study aimed to assess the impact of increasing PEEP on hemodynamics, respiratory system mechanics, and oxygenation in children with ARDS. METHODS: Children receiving mechanical ventilation and on pressure-controlled volume-guaranteed mode were prospectively assessed for inclusion. PEEP was sequentially changed to 5, 12, 10, 8 cm H2O, and again to 5 cm H2O. After 10 min at each PEEP level, hemodynamic, ventilatory, and oxygenation variables were collected. RESULTS: A total of 31 subjects were included, with median age and weight of 6 months and 6.3 kg, respectively. The main reasons for pediatric ICU admission were respiratory failure caused by acute viral bronchiolitis (45%) and community-acquired pneumonia (32%). Most subjects had mild or moderate ARDS (45% and 42%, respectively), with a median (interquartile range) oxygenation index of 8.4 (5.8-12.7). Oxygen saturation improved significantly when PEEP was increased. However, although no significant changes in blood pressure were observed, the median cardiac index at PEEP of 12 cm H2O was significantly lower than that observed at any other PEEP level (P = .001). Fourteen participants (45%) experienced a reduction in cardiac index of > 10% when PEEP was increased to 12 cm H2O. Also, the estimated oxygen delivery was significantly lower, at 12 cm H2O PEEP. Finally, respiratory system compliance significantly reduced when PEEP was increased. At a PEEP of 12 cm H2O, static compliance had a median reduction of 25% in relation to the initial assessment (PEEP of 5 cm H2O). CONCLUSIONS: Although it may improve arterial oxygen saturation, inappropriately high PEEP levels may reduce cardiac output, oxygen delivery, and respiratory system compliance in pediatric subjects with ARDS with low potential for lung recruitability. [ABSTRACT FROM AUTHOR]

Artificial ventilators are vital respiratory support systems in the field of medical care, especially for patients in critical condition. It is crucial to make sure the ventilator keeps the intended airway pressure because variations might be harmful to the brain and lungs. Thus, achieving accurate pressure tracking is a primary objective in designing optimal controllers for pressure‐controlled ventilators (PCVs). To address this need, a novel approach is proposed: a mixed integer tilted fractional order integral and integer order derivation controller (FOT1nIλ−D)$$ \left({\mathrm{FOT}}^{\frac{1}{n}}{I}^{\lambda }-D\right) $$ tailored for PCV systems. The gains of different parameters of the proposed controller are optimized using an adaptive chaotic search fractional order class topper optimization algorithm, augmented with a Gaussian‐based mutation operator. Moreover, the controller is designed to minimize oscillations in its output signal, thereby mitigating physical risks and reducing the size of actuators required. The efficacy of the optimized controller is further examined across various scenarios, including different lung resistances and compliances across different age groups of patients. Additionally, the impact of endotracheal tube resistance on air pressure is assessed as a potential disturbance in the PCV system. Through comprehensive testing, the proposed controller demonstrates superior performance in accurately tracking airway pressure to the desired levels. Across all evaluated cases, the proposed controller structure and accompanying algorithm outperform existing solutions. Notably, improvements are observed in system response time, overshoot, and settling time. This underscores the significance of employing advanced control strategies to enhancing the functionality and safety of PCV systems in medical settings. [ABSTRACT FROM AUTHOR]

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Objectives: To investigate the potential efficacy of a commercial continuous positive airway pressure (CPAP) ventilator to provide effective respiratory support in a simulated scenario of out-of-hospital cardiac arrest (OHCA). Methods: The study was conducted on a high-fidelity manikin (SimMan 3 GTM, Laerdal, NOR) connected to the ASL 5000TM Lung Simulator (IngMar Medical, USA). To simulate OHCA, we set no spontaneous respiratory acts and physiological respiratory system resistance (13 cmH2O/L.sec) and compliance (50 mL/cmH2O). The Respironics BiPAP A40 ventilatorI (Philips, NL) was used to provide ventilatory support while operating in CPAP mode. Tests were performed at different values of positive pressure of the CPAP ventilator (PCPAP: 5, 7.5, 10, 12.5 and 15 cmH2O) and the intrapulmonary volume (tidal volume, Vt) measured via the simulator software computer interface. A trained physician performed the tests. Our primary outcome was a VT of ≈500-600 mL with an intermittent maneuver simulating cardiopulmonary resuscitation (CPR)-like ventilatory support practice according to international guideline-based target (1-sec ventilation followed by 1-sec pause). Results: In intermittent ventilatory support tests, PCPAP levels of 12.5, and 15 cmH2O resulted in a VT equal to 508 ± 13 mL, and 557 ± 44 mL respectively (p = 0.04), thus approaching the VT target. Conclusions: We provide preliminary evidence of the potential efficacy of CPAP ventilators designed for home use to provide effective respiratory support to a simulated respiratory arrest patient. [ABSTRACT FROM AUTHOR]

The acute exacerbation of chronic obstructive pulmonary disease seriously affects the respiratory system function and quality of life of patients. This study employed 16S rRNA sequencing and metabolomics techniques to analyze the respiratory microbiota and serum metabolites of COPD and AECOPD patients. The results showed that the microbial diversity in the respiratory tract of AECOPD patients was significantly lower than that of COPD patients, and the relative abundance of Bacteroidetes, Prevotella and Neisseria in the respiratory tract of AECOPD patients was significantly lower than that of COPD patients. However, the relative abundance of Haemophilus_D, Veillonella_A and Pseudomonas_E, in AECOPD patients was significantly higher than that of COPD patients, and the ability of respiratory microbiota in AECOPD patients to participate in alanine metabolism was significantly lower than that of COPD patients. Metabolome results further revealed that the serum alanine levels in AECOPD patients were significantly lower than those in COPD patients, and these differential metabolites were mainly involved in linoleic acid metabolism, protein digestion and absorption and regulation of lipolysis in adipocytes. In summary, the structural characteristics of respiratory microbiota in COPD and AECOPD patients are different from those in healthy populations, and their microbiota diversity decreases and microbial community structure and function will also undergo changes when acute exacerbations occur. In addition, the predicted microbial community function and metabolomics results indicate that the onset of AECOPD is mainly related to energy and amino acid metabolism disorders, especially alanine metabolism. [ABSTRACT FROM AUTHOR]

The respiratory system, including the lungs, is essential for terrestrial life. While recent research has advanced our understanding of lung development, much still relies on animal models and transcriptome analyses. In this study conducted within the Human Developmental Cell Atlas (HDCA) initiative, we describe the protein-level spatiotemporal organization of the lung during the first trimester of human gestation. Using high-parametric tissue imaging with a 30-plex antibody panel, we analyzed human lung samples from 6 to 13 post-conception weeks, generating data from over 2 million cells across five developmental timepoints. We present a resource detailing spatially resolved cell type composition of the developing human lung, including proliferative states, immune cell patterns, spatial arrangement traits, and their temporal evolution. This represents an extensive single-cell resolved protein-level examination of the developing human lung and provides a valuable resource for further research into the developmental roots of human respiratory health and disease. Understanding the development of the lung will inform treatments for congenital diseases and approaches for preterm infant care. Here they map human lung development using high-parametric imaging at the single-cell level to track abundance, proliferation, and spatial organization of key cell types during early gestation. [ABSTRACT FROM AUTHOR]

Targeted plasticity therapy (TPT) utilizes vagus nerve stimulation (VNS) to promote improvements in function following neurological injury and disease. During TPT, a brief burst of VNS induces neuromodulator release, which when paired with relevant behavioral events can influence functionally relevant neuroplasticity. Functional improvements following TPT are therefore in part mediated by neuromodulator signaling. Unfortunately, comorbidities associated with neurological disease often result in altered cognitive states that can influence neuromodulator signaling, potentially impeding neuroplasticity induced by TPT. Aside from altered cognitive states, cardiorespiratory rhythms also affect neuromodulator signaling, due to the vagus nerve’s role in relaying visceral sensory information from the cardiovascular and respiratory systems. Moreover, precise VNS delivery during specific periods of the cardiorespiratory rhythms may further improve TPT. Ultimately, understanding the impact of patient-specific states on neuromodulator signaling may likely facilitate optimized VNS delivery, paving the way for personalized neuromodulation during TPT. Overall, this review explores challenges and considerations for developing advanced TPT paradigms, focusing on altered cognitive states and cardiorespiratory rhythms. We specifically discuss the possible impact of these cognitive states and autonomic rhythms on neuromodulator signaling and subsequent neuroplasticity. Altered cognitive states (arousal deficits or pain) could affect VNS intensity, while cardiorespiratory rhythmsmay further inform optimized timing of VNS. We propose that understanding these interactions will lead to the development of personalized state dependent VNS paradigms for TPT. [ABSTRACT FROM AUTHOR]

Antibiotic resistance in bacteria leads to high mortality rates and healthcare costs, a significant concern for public health. A colonizer of the human respiratory system, Stenotrophomonas maltophilia is frequently associated with hospital-acquired infections in individuals with cystic fibrosis, cancer, and other chronic illnesses. The importance of this study is underscored by its capacity to meet the critical demand for effective preventive strategies against this pathogen, particularly among susceptible groups of cystic fibrosis and those undergoing cancer treatment. In this study, we engineered a multi-epitope vaccine targeting S. maltophilia through genomic analysis, reverse vaccination strategies, and immunoinformatic techniques by examining a total of 81 complete genomes of S. maltophilia strains. Our investigation revealed 1945 core protein-coding genes alongside their corresponding proteomic sequences, with 191 of these genes predicted to exhibit virulence characteristics. Out of the filtered proteins, three best antigenic proteins were selected for epitope prediction while seven epitopes each from CTL, HTL, and B cell were chosen for vaccine development. The vaccine was refined and validated, showing highly antigenic and desirable physicochemical features. Molecular docking assessments revealed stable binding with TLR-4. Molecular dynamic simulation demonstrated stable dynamics with minor alterations. The originality of this investigation is rooted in the thorough techniques aimed at designing a vaccine that directly targets S. maltophilia, a microorganism of considerable clinical relevance that currently lacks an available vaccine. This study not only responds to a pressing public health crisis but also lays the groundwork for subsequent research endeavors focused on the prevention of S. maltophilia outbreaks. Further evidence from studies in mice models is needed to confirm immune protection against S. maltophilia. [ABSTRACT FROM AUTHOR]

ABSTRACT Deep lung delivery is crucial for respiratory disease treatment. Although nano and submicron particles exhibited a good deposition efficiency in deep regions of the lung, powder nonuniformity and particle agglomeration reduce their efficiency. Inhalation of porous particles (PPs) can overcome the mentioned challenges due to their larger size and low‐density. The present study numerically investigates the deposition and penetration efficiency of orally inhaled PPs. A revised drag coefficient was implemented for PP transport. A realistic mouth–throat to the fifth generation of the lung was reconstructed from CT‐scan images. A dilute suspension of uniformly distributed particles was considered at three inhalation flow rates (15, 30, and 45 L/min). Governing equations of the flow field and particle transport are solved using an Eulerian–Lagrangian approach. The results demonstrate that inhaling PPs significantly reduces the total and regional deposition of particles. There was also a critical porosity value under moderate and high inhalation flow rates for large PPs. Below this critical value, PP deposition efficiency substantially decreases. Additionally, it was also found that under low inhalation flow rates, the impact of porosity value is negligible. Almost 95% of the PPs penetrate the lower branches. These findings provide particle engineers and pharmaceutics with profound insight into developing novel inhalation techniques and drug delivery methods for deep lung delivery. [ABSTRACT FROM AUTHOR]

Background: Plastics are the most flexible products developed with a wide range of applications. They have been incorporated into almost every aspect of daily life due to their strength and low weight. However, widespread use and inadequate waste management have resulted in the accumulation of tiny plastic particles throughout the environment. Main text: Microplastics are found in oceans, rivers, sediments, sewers, soil, and agricultural products, even in table salts. Human beings are affected by microplastics through food ingestion and inhalation. Incorporated microplastics may accrue within the body and affect gastrointestinal, immune, endocrine, brain, and respiratory systems. It also interferes with the functions of major organs and causes chromosomal abnormalities. Conclusion: Addressing the issue of micro and nanoplastics requires interdisciplinary research, sustainable solutions, and improved waste management systems. The main focus of this review is to cover the harmful effects and impact of microplastics on human health and stress the need for combating strategies. [ABSTRACT FROM AUTHOR]

Objective: To explore the relationship between dietary flavonoids and bronchitis, emphysema and asthma. Method: A total of 11743 United States adults were extracted from the National Health and Nutrition Examination Survey (NHANES) in 2007–2008, 2009–2010 and 2017–2018. Of these, 47.7% were male and 52.3% female. Dietary flavonoid intake assessed using FDNNS and 24-hour dietary recall data. Inclusion of demographics (gender, age, education, family income), behavioral factors (BMI, smoking, drinking status, diet), chronic disease information (diabetes, hypertension) as covariates to eliminate confounding. Stepwise logistic regression was used to analyze the association between total dietary flavonoid intake and the risk of chronic respiratory disease. Weighted quantile sum regression (WQS) was used to analyze the association between 29 dietary flavonoids and the risk of chronic respiratory disease. Restricted cubic spline was used to analyze the dose-response relationship between dietary flavonoid intake and risk of chronic respiratory disease. Results: Stepwise logistic regression results showed that higher flavonoid intake in men was associated with a lower risk of CB and asthma (OR of CB: 0.55(0.31–0.97); OR of asthma: 0.72(0.52–0.99)), and WQS results showed a mixed health effect for total flavonoids and chronic respiratory tract in response to the 29 flavonoid fractions (OR of asthma: 0.97(0.94–0.99); OR of emphysema: 0.95(0.90–0.99)). Glycitein had the highest health contribution of 26.2% for emphysema; Eriodictyol had the highest health contribution of 32.13% for asthma, respectively. The RCS showed a dose-response relationship between flavonoids and respiratory tract health. The maximum dose for ingesting flavonoids to gain respiratory health benefits is 1500 mg/d. Conclusion: Higher dietary flavonoid intake was associated with lower chronic respiratory risk in adult U.S. men. Also 29 dietary flavonoid components have an overall health effect on respiratory health. Glycitein and Eriodictyol may have potential health effects on the respiratory system. 1500 mg/day may be the Tolerable Upper Intake Level of dietary flavonoids for respiratory health in U.S. adults. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic has triggered a renewed interest in indoor air sampling for infectious disease surveillance. However, scalability is currently limited, as samples are usually collected in a single indoor space. An alternative is to place the device within a heating, ventilation, and air conditioning system (HVAC), but this approach has not been tested against room air sampling. Methods: In this observational study, we sampled the air in an indoor fitness centre for 2 or 6 h, simultaneously in three locations of the main exercise hall and in the return plenum of the HVAC system. Samples were collected twice weekly for 11 weeks. All samples were tested for 29 respiratory pathogens using PCR. We compared the ventilation system and exercise hall air with regard to the presence and quantity of pathogens. Findings: Samples collected in two locations in the exercise hall had a similar overall sensitivity to the HVAC sampler for detecting pathogens, while a third sampling location was associated with significantly lower sensitivity. Overall, the pathogen concentration was similar in the ventilation system and the exercise hall air (ratio: 1.0; 95% CI: 0.8–1.3). Interpretation: Our results show that air sampling within a ventilation system can have equal sensitivity for detecting respiratory pathogens, compared to room‐based sampling. Thus, placing samplers within central ventilation systems could increase the scalability of air sampling for infectious disease surveillance. [ABSTRACT FROM AUTHOR]

Positive expiratory pressure (PEP) is a technique used in respiratory physiotherapy to treat diseases related to the respiratory system through spontaneous breathing. This equipment consists of an oronasal mask coupled to a T connector with a unidirectional valve. Studies that evaluate whether the pressure level in the one-way valve corresponds to the actual pressure level provided are scarce in the scientific literature. In order to investigate the failures, bench tests were carried out on the spring-loaded valves, using a U-tube manometer. This pressure was exerted on the valve using a syringe that generated air flow inside the U-tube, allowing analysis numerical value of the measured pressure and the specified values of the valve, thus verifying the disparity of these measured values in relation to the PEP values operated by valves (0 to 20 cmH2O) from the three manufacturers under study. PEPs generated by spring-loaded valves from all three manufacturers were higher than pressures in the range of 2.5 to 20 cmH2O, with significant differences between manufacturers. This bench study showed inaccurate operation of all spring-loaded PEP valves of the three manufactures. The results obtained and the performance of the valves require a reevaluation of manufacturing procedures to preserve product quality and efficacy in clinical application. [ABSTRACT FROM AUTHOR]

ABSTRACT Asafoetida is an oleo–gum‐resin mainly obtained from Ferula foetida in eastern Iran, which is employed for the treatment of stomachaches, acid reflux, nervous system disorders and respiratory diseases. Asafoetida has attracted the attention of researchers due to its sulfide compounds and their proven effects on respiratory illnesses. In this study, the shelf stability of supplement of F. foetida's oleo–gum‐resin by quantifying two key sulfide compounds including E/Z‐sec‐butyl propenyl disulfane and E/Z‐(methylthio)propyl 1‐propenyl disulfane was evaluated by 1H NMR (qH NMR) and gas chromatography–mass spectrometry (GC–MS). The similar results were obtained in both qH NMR and GC–MS methods. The qH NMR method showed good linearity in the ranges of 2–12 mg/mL for E/Z‐sec‐butyl propenyl disulfane and 2.2–17 mg/mL for E/Z‐(methylthio) propyl 1‐propenyl disulfane with a correlation coefficient of 0.99 and acceptable stability (RSD% ≤ 2.72%) for the quantification of the compounds. Therefore, despite the volatility of disulfide compounds and according to the results, the qH NMR method could be considered adequate method for quantifying these compounds in supplements containing the volatile components that requires extra extraction steps before analyses by other method. [ABSTRACT FROM AUTHOR]

Dynamic covalent organic frameworks (COFs) offer a promising platform for bioinspired soft actuators, yet transitioning their typical microcrystalline or single crystalline morphology to a flexible film suitable for wearable technology applications still remains a grand challenge. Herein, aiming at this issue, this work synthesizes an innovative class of hygrosensitive COF films, denoted as JNU‐hygroCOF, with superior mechanical strength, chemical stability and tunable thickness from nanometer to micrometer scales through solution‐processable sol‐gel method. These JNU‐hygroCOF films display exceptional moisture‐driven actuation capabilities through modulating the intramolecular hydrogen bonds, which act as specific locks that open and close the molecular rotor of N─N bond responding to guest molecules, within the unique azine‐pyridine molecular skeleton. By integrating these new JNU‐hygroCOF films into a portable respiratory monitoring system, a proactive and preventive solution for diagnosing and managing respiratory disorders such as sleep apnea and asthma has been provided. [ABSTRACT FROM AUTHOR]

Background: Cardiopulmonary resuscitation-associated lung edema (CRALE) is a phenomenon that has been recently reported in both experimental and out-of-hospital cardiac arrest patients. We aimed to explore the respiratory and cardiovascular pathophysiology of CRALE in an experimental model of cardiac arrest undergoing prolonged manual and mechanical chest compression (CC). Oxygen delivery achieved during mechanical or manual CC were also investigated as a secondary aim, to describe CRALE evolution under different hemodynamic supports generated during CPR. Methods: Ventricular fibrillation (VF) was induced and left untreated for 5 min prior to begin cardiopulmonary resuscitation (CPR), including CC, ventilation with oxygen, epinephrine administration and defibrillation. Continuous mechanical and manual CC was performed alternating one of the two strategies every 5 min for a total of 25 min. Unsynchronized mechanical ventilation was resumed simultaneously to CC. A lung computed tomography (CT) was performed at baseline and 1 h after return of spontaneous circulation (ROSC) in surviving animals. Partitioned respiratory mechanics, gas exchange, hemodynamics, and oxygen delivery were evaluated during the experimental study at different timepoints. Lung histopathology was performed. Results: After 25 min of CPR, a marked decrease of the respiratory system compliance with reduced oxygenation and CO2 elimination were observed in all animals. The worsening of the respiratory system compliance was driven by a significant decrease in lung compliance. The presence of CRALE was confirmed by an increased lung weight and a reduced lung aeration at the lung CT, together with a high lung wet-to-dry ratio and reduced airspace at histology. The average change in esophageal pressure during the 25-min CPR highly correlated with the severity of CRALE, i.e., lung weight increase. Conclusions: In this porcine model of cardiac arrest followed by a 25-min interval of CPR with mechanical and manual CC, CRALE was consistently present and was characterized by lung inhomogeneity with alveolar tissue and hemorrhage replacing alveolar airspace. Despite mechanical CPR is associated with a more severe CRALE, the higher cardiac output generated by the mechanical compression ultimately accounted for a greater oxygen delivery. Whether specific ventilation strategies might prevent CRALE while preserving hemodynamics remains to be proved. [ABSTRACT FROM AUTHOR]

Background: Large variations in respiratory system compliance and resistance may cause the accuracy of tidal volume (VT) delivery beyond the declared range. This study aimed at evaluating the accuracy of VT delivery using a test lung model to simulate pulmonary mechanics under normal or disease conditions. Methods: In vitro assessment of the VT delivery accuracy was carried out on two commercial ventilators. Measurements of the inspired and expired VT from the ventilator and FlowAnalyser were compared to evaluate the separated and combined influences of compliance and resistance on the delivered VT accuracy. To do this, the errors of five delivered volumes (30 ml, 50 ml, 100 ml, 300 ml, and 500 ml) were checked under 29 test conditions involving a total of 27 combinations of resistance and compliance. Results: For the tested ventilator S1 with a flow sensor near the expiratory valve, the average of expired VT errors (ΔVTexp) in three measurements (4 test conditions for each measurement) correlated to test lung compliance (r=-0.96, p = 0.044), and the average of inspired VT errors (ΔVTins) correlated to compliance (r = 0.89, p = 0.106); for the tested ventilator S2 with a flow sensor located at the Y piece, no clear relationship between compliance and ΔVTexp or ΔVTins was found. Furthermore, on two ventilators tested, the current measurements revealed a poor correlation between test lung resistance and ΔVTins or ΔVTexp, and the maximum values of ΔVTexp and ΔVTins correspond to the maximum resistance of 200 cmH2O/(L/s), at which the phenomenon of the flap fluttering in the variable orifice flow senor was observed, and the recorded peak inspiratory pressure (Ppeak) was much higher than the Ppeak estimated by the classical equation of motion. In contrast, at the lower resistance values of 5, 20, 50 and 100 cmH2O/(L/s), the recorded Ppeak was very close to the estimated Ppeak. Overall, the delivered VT errors were in the range of ± 14% on two ventilators studied. Conclusions: Depending on the placement site of the flow sensor in the ventilator circuit, the compliance and resistance of the test lung have different influences on the accuracy of VT delivery, which is further attributed to different fluid dynamics effects of the compliance and resistance. The main influence of compliance is to raise the peak inspiratory pressure Ppeak, thereby increasing the compression volume within the ventilator circuit; whereas a high resistance not only contributes to elevating Ppeak, but more importantly, it governs the gas flow conditions. Ppeak is a critical predictive indicator for the accuracy of the VT delivered by a ventilator. [ABSTRACT FROM AUTHOR]

AbstractPseudomonas aeruginosa is a versatile Gram-negative pathogen known for its ability to invade the respiratory tract, particularly in cystic fibrosis patients. This review provides a comprehensive analysis of the multifaceted strategies for colonization, virulence, and immune evasion used by P. aeruginosa to infect the host. We explore the extensive protein arsenal of P. aeruginosa, including adhesins, exotoxins, secreted proteases, and type III and VI secretion effectors, detailing their roles in the infective process. We also address the unique challenge of treating diverse lung conditions that provide a natural niche for P. aeruginosa on the airway surface, with a particular focus in cystic fibrosis. The review also discusses the current limitations in treatment options due to antibiotic resistance and highlights promising future approaches that target host-pathogen protein-protein interactions. These approaches include the development of new antimicrobials, anti-attachment therapies, and quorum-sensing inhibition molecules. In summary, this review aims to provide a holistic understanding of the pathogenesis of P. aeruginosa in the respiratory system, offering insights into the underlying molecular mechanisms and potential therapeutic interventions. [ABSTRACT FROM AUTHOR]

The anatomy of the avian lower respiratory system includes a complex interaction between air‐filled pulmonary tissues, pulmonary air sacs, and much of the postcranial skeleton. Hypotheses related to the function and phylogenetic provenance of these respiratory structures have been posed based on extensive interspecific descriptions for an array of taxa. By contrast, intraspecific descriptions of anatomical variation for these features are much more limited, particularly for skeletal pneumatization, and are essential to establish a baseline for evaluating interspecific variation. To address this issue, we collected micro‐computed tomography (μCT) scans of live and deceased African grey parrots (Psittacus erithacus) to assess variation in the arrangement of the lungs, the air sacs, and their respective invasion of the postcranial skeleton via pneumatic foramina. Analysis reveals that the two pairs of caudalmost air sacs vary in size and arrangement, often exhibiting an asymmetric morphology. Further, locations of the pneumatic foramina are more variable for midline, non‐costal skeletal elements when compared to other pneumatized bones. These findings indicate a need to better understand contributing factors to variation in avian postcranial respiratory anatomy that can inform future intraspecific and interspecific comparisons. [ABSTRACT FROM AUTHOR]

Objective: In our investigation, we aimed to assess the efficacy of employing lidocaine spray application around endotracheal tube cuff (ETTC) prior to intubation, alongside and the use of intracuff lidocaine application following intubation. Our primary objective encompassed an examination of the resultant effects on the cardiovascular and respiratory systems leading up to the extubation phase. Methods: Two hundred patients scheduled for gynecologic operations, with an ASA physical status of I or II and aged between 18 and 65 years, undergoing general anesthesia lasting over one hour, were recruited for the study. Patients were allocated into four groups. Group I involved the inflation of the endotracheal tube cuff with air following intubation. In Group II, 10% lidocaine was sprayed around the ETTC prior to intubation. Group III entailed the inflation of the ETTC with 2% lidocaine after intubation. Lastly, Group IV received both the pre-intubation application of 10% lidocaine spray around the ETTC and the inflation of the cuff with 2% lidocaine following intubation. Cardiovascular parameters in the early post-extubation period and occurrences of postoperative sore throat, cough, and hoarseness up to 48 hours post-operation were documented for analysis. Results: Increases were observed at cardiovasvular system parameters after extubation in all groups continued for 5 or 15 minutes. Postoperative data for sore throat, cough and hoarseness were smilar in all groups. Conclusion: The study revealed that the administration of 10% lidocaine spray around the ETTC, as well as the use of 2% lidocaine within the cuff alone or in combination, did not result in a reduction of cardiovascular system responses during the early post-extubation period. However, these interventions did lead to a decrease in postoperative respiratory system side effects, albeit not providing complete prevention of such occurrences. [ABSTRACT FROM AUTHOR]

Background: Respiratory infections refer to any disease of airways and lungs which affects the respiratory system of humans. The nasal cavities, pharynx, larynx, trachea, bronchi and bronchioles, the tissues of the lungs and the respiratory muscles of chest cage are all susceptible to respiratory system diseases. To evaluate cost-benefit and cost-effective analysis of medications used in respiratory tract diseases, an observational prospective study was conducted for 120 patients. Materials and Methods: The patient data and other socioeconomic details were collected. The current index of medical specialists, updated version in March 2022, was used for Cost benefit and Cost effectiveness study. Regression analysis was used for the statistical analysis. Results: Among the 120 participants studied, 74 (61.66%) were male and 46 (38.34%) were female. Out of these participants, 89 had a C/B ratio of less than 1,30 had a C/B ratio greater than 1 and 1 had a C/B ratio equal to 1. The Cost-Effectiveness Analysis (CEA) of various drugs indicated that among bronchodilators, Asthalin is more cost-effective than Duolin; among corticosteroids, Budecort is more cost-effective than Hydrocort; and among anti-tuberculosis medications, AKT-4 is more cost-effective than Ethambutol. Conclusion: The common medications prescribed in our study were Asthalin (bronchodilators). Out of 120 study participants 89 patients were cost benefited from the treatment. The CEA results showed that Asthalin, Budecort and AKT-4 are more cost-effective than Duolin, Hydrocort and Ethambutol. The study found that Asthalin is the most effective treatment for respiratory tract diseases among participants, according to CBA and CEA. [ABSTRACT FROM AUTHOR]

A 36-year-old female patient diagnosed with asthma at an external center was referred to us after her complaints did not improve, at which point, hoarseness was added to the complaints. Stridor was identified in a respiratory system examination. Tracheal stenosis was seen in a postero-anterior chest X-ray and a fixed airway obstruction in a respiratory function test, upon which, the patient was referred to the ear, nose and throat department. Subglottic stenosis was detected on a neck computerized tomography and a bronchoscopy evaluation. The etiology of subglottic stenosis was evaluated, collagen tissue markers were positive, and the patient was asked to undergo a rheumatology consultation. The patient was subsequently diagnosed with Sjögren syndrome based on a salivary gland biopsy result. This rare case is presented to underline the need to keep Sjögren syndrome in mind as an etiology of subglottic stenosis. [ABSTRACT FROM AUTHOR]

Bacterial Lysates are immunostimulants clinically prescribed for the prevention of respiratory tract infections (RTIs). It has been shown that Bacterial Lysates upregulate the immune system, acting both on innate and adaptive reactions. In fact, there are demonstrations of their efficacy in restoring the integrity and immune function of epithelial barriers, activating ILC3 and dendritic cells with an enhanced Th1 response, and producing serum IgG and serum and salivary IgA specific to the administered bacterial antigens. The activated immune system also protects against other bacteria and viruses due to a trained immunity effect. Most studies show that the number of RTIs and their severity decrease in Bacterial Lysates-pretreated patients, without relevant side effects. The Bacterial Lysates treatment, in addition to reducing the number of RTIs, also prevents the deterioration of the underlying disease (i.e., COPD) induced by repeated infections. Despite these positive data, the most recent meta-analyses evidence the weakness of the studies performed, which are of low quality and have an inadequate number of patients, some of which were non-randomized while others were without a control group or were performed contemporarily in different clinical conditions or with different ages. The high heterogeneity of the studies does not allow us to state Bacterial Lysates' effectiveness in preventing RTIs with sufficient certainty. To completely define their indications, double-blind, placebo-controlled, multicenter, randomized clinical trials should be performed for each product and for each indication. The study population should be adequate for each indication. For this purpose, an adequate run-in phase will be necessary. [ABSTRACT FROM AUTHOR]

Background: Some orthodontic devices used in children share similar design principles to appliances used to treat obstructive sleep apnoea in adults. As well as treating malocclusion, orthodontic appliances used in children may therefore also have effects on the upper airway. Objective: A review of the literature to assess the effects of orthodontic treatment on the upper airway dimensions in children assessed on CBCT. Materials and Methods: Following registration of the protocol (PROSPERO CRD42023439056), a systematic electronic search of published studies was performed using several databases (PubMed; Scopus, Web of Science and Science Direct) in accordance with the PRISMA guidelines. Inclusion criteria were as follows: age under 18 years, orthodontic treatment with any appliance, a control group who received no treatment or a non‐active alternative treatment and airway measurement using CBCT. RoB‐2 and ROBINS‐I tools were used to assess risk of bias and quality of the evidence. Results: In total, 341 studies were identified following the initial search. Title and abstract screening resulted in 45 studies for further full‐text analysis. On completion of the screening process, a total of 23 studies met the inclusion criteria. Study interventions included functional appliances (10 studies), rapid maxillary expansion (RME) (9 studies), reverse‐pull headgear (1 study) and 4 premolar dental extractions (3 studies). The included studies had moderate to high risk of bias, and the quality of evidence was low. Conclusion: The scientific evidence shows that functional appliances are associated with significant improvements in both upper airway volume and constriction when used in children however, the effects on the nasal cavity are limited. RME was associated with a significant increase in nasal cavity and nasopharyngeal dimensions, but not the upper pharyngeal airway. Neither reverse‐pull headgear nor dental extractions were associated with any change in airway dimensions; however, the evidence is limited. Functional appliances may reduce the severity of obstructive sleep apnoea (OSA) in children. [ABSTRACT FROM AUTHOR]

Carbonic anhydrase (CA) activity is ubiquitously found in all vertebrate species, tissues and cellular compartments. Most species have plasma-accessible CA (paCA) isoforms at the respiratory surfaces, where the enzyme catalyzes the conversion of plasma bicarbonate to carbon dioxide (CO2) that can be excreted by diffusion. A notable exception are the teleost fishes that appear to lack paCA at their gills. The present review: (i) recapitulates the significance of CA activity and distribution in vertebrates; (ii) summarizes the current evidence for the presence or absence of paCA at the gills of fishes, from the basal cyclostomes to the derived teleosts and extremophiles such as the Antarctic icefishes; (iii) explores the contribution of paCA to organismal CO2 excretion in fishes; and (iv) the functional significance of its absence at the gills, for the specialized system of O2 transport in most teleosts; (v) outlines the multiplicity and isoform distribution of membrane-associated CAs in fishes and methodologies to determine their plasma-accessible orientation; and (vi) sketches a tentative time line for the evolutionary dynamics of branchial paCA distribution in the major groups of fishes. Finally, this review highlights current gaps in the knowledge on branchial paCA function and provides recommendations for future work. [ABSTRACT FROM AUTHOR]

This paper presents a novel technique for extracting the alveolar part of human breath. Gas exchange occurs between blood and inhaled air in the alveoli, which is helpful in medical diagnostics based on breath analysis. Consequently, the alveolar portion of the exhaled air contains specific concentrations of endogenous EVOC (exogenous volatile organic compound), which, among other factors, depend on the person's health condition. As this part of the breath enables the screening for diseases, accurate sample collection for testing is crucial. Inaccurate sampling can significantly alter the composition of the specimen, alter the concentration of EVOC (biomarkers) and adversely affect the diagnosis. Furthermore, the volume of alveolar air is minimal (usually <350 mL), especially in the case of people affected by respiratory system problems. For these reasons, precise sampling is a key factor in the effectiveness of medical diagnostic systems. A new technique ensuring high accuracy and repeatability is presented in the article. It is based on analyzing the changes in carbon dioxide concentration in human breath using a fast and compensated non-dispersive infrared (NDIR) sensor and the simple moving adjacent average (SMAA) algorithm. Research has shown that this method accurately identifies exhalation phases with an uncertainty as low as 20 ms. This provides around 350 ms of breath duration for carrying out additional stages of the diagnostic process using various types of analyzers. [ABSTRACT FROM AUTHOR]

Despite numerous scientific reports on the negative impact of vitamin D3 deficiency on many respiratory diseases, little is known about the influence of this phenomenon on the development and progression of hypersensitivity pneumonitis (HP). The presented study is an attempt to shed light on this occurrence. The research was performed on mouse strain C57BL/6J exposed to the antigen of Pantoea agglomerans (etiological factor of HP). To induce vitamin D3 deficiency, mice received a diet with a 10 times lower amount of cholecalciferol than the main control group. VD3-deficient mice inhaled 25(OH)-VD3 or 1,25(OH)2-VD3 used separately or with SE-PA. At the beginning of the experiment and after 14 and 28 days of inhalation, respiratory function was examined using whole-body plethysmography. Moreover, at indicated time points, mice were sacrificed and samples collected for histological examination, flow cytometry, and ELISA. The performed study revealed that inhalations with 25(OH)-VD3 and 1,25(OH)2-VD3 effectively eliminated most of the negative changes in the respiratory system caused by vitamin D3 deficiency by restoring the physiological concentration of 1,25(OH)2-VD3 in the body. VD3-deficient mice which inhaled P. agglomerans antigen and vitamin D3 metabolites also demonstrated the ability of the tested compounds to eliminate, or at least weaken, the negative effects of the HP causative factor and desired effect, including improvement of respiratory functions and attenuation of inflammation and signs of fibrosis. The obtained results suggested that the beneficial influence of inhaled vitamin D3 metabolites on HP development was associated with the restoration of the physiological concentration of 1,25(OH)2-VD3 in the pulmonary compartments in VD3-deficient mice. [ABSTRACT FROM AUTHOR]

Inhalable particulate drug carriers—nano- and micro-particles, liposomes, and micelles—should be designed to promote drug deposition in the lung and engineered to exhibit the desired drug release property. To deposit at the desired site of action, inhaled particles must evade various lines of lung defense, including mucociliary clearance, entrapment by mucus layer, and phagocytosis by alveolar macrophages. Various physiological, mechanical, and chemical barriers of the respiratory system reduce particle residence time in the lungs, prevent particle deposition in the deep lung, remove drug-filled particles from the lung, and thus diminish the therapeutic efficacy of inhaled drugs. To develop inhalable drug carriers with efficient deposition properties and optimal retention in the lungs, particle engineers should have a thorough understanding of the barriers that particles confront and appreciate the lung defenses that remove the particles from the respiratory system. Thus, this section summarizes the mechanical, chemical, and immunological barriers of the lungs that inhaled particles must overcome and discusses the influence of these barriers on the fate of inhaled particles. [ABSTRACT FROM AUTHOR]

Background: Asthmatic children present variable degrees of airway inflammation, remodeling, and resistance, which correlate with disease control and severity. The chronic inflammatory process of the airway triggers airway remodeling, which reflects the degree of airway resistance. Pro-inflammatory and pro-fibrotic mediators are centrally involved in this process. Objective: To investigate whether the levels of pulmonary and systemic pro-inflammatory and pro-fibrotic mediators present a correlation with the resistance of the respiratory system and of the proximal and distal airways. Methods: 39 Asthmatic children (persistent mild and moderate) and 39 non-asthmatic children (both between 6 and 13 years old) were evaluated for anthropometric characteristics, lung function and mechanics, and pulmonary and systemic immune responses. Results: Asthmatic children showed an increased number of blood eosinophils (p < 0.04), basophils (p < 0.04), monocytes (p < 0.002) and lymphocytes (p < 0.03). In addition, asthmatic children showed impaired lung function, as demonstrated by FEV1 (p < 0.0005) and FEV1/FVC (p < 0.004), decreased total resistance of the respiratory system (R5Hz; p < 0.009), increased resistance of the proximal airways (R20Hz; p < 0.02), increased elastance (Z5Hz; p < 0.02) and increased reactance (X5Hz; p < 0.002) compared to non-asthmatic children. Moreover, the following inflammatory factors were significantly higher in asthmatic than non-asthmatic children: GM-CSF in the breath condensate (BC) (p < 0.0001) and in the serum (p < 0.0001); TGF-beta in the BC (p < 0.0001) and in the serum (p < 0.004); IL-5 in the BC (p < 0.02) and in the serum (p < 0.01); IL-4 in the serum (p < 0.0002). Conclusions: Impulse oscillometry is a sensitive method to detect airway resistance in persistent mild and moderate asthmatic children, an event followed by increased levels of pro-inflammatory and pro-fibrotic mediators. [ABSTRACT FROM AUTHOR]

Summary: Background: Although videolaryngoscopy has been proposed as a default technique for tracheal intubation in children, published evidence on universal videolaryngoscopy implementation programmes is scarce. We aimed to determine if universal, first‐choice videolaryngoscopy reduces the incidence of restricted glottic views and to determine the diagnostic performance of the Cormack and Lehane classification to discriminate between easy and difficult videolaryngoscopic tracheal intubations in children. Methods: We conducted a prospective observational study within a structured universal videolaryngoscopy implementation programme. We used C‐MAC™ (Karl Storz, Tuttlingen, Germany) videolaryngoscopes in all anaesthetised children undergoing elective tracheal intubation for surgical procedures. The direct and videolaryngoscopic glottic views were classified using a six‐stage grading system. Results: There were 904 tracheal intubations in 809 children over a 16‐month period. First attempt and overall success occurred in 607 (67%) and 903 (> 99%) tracheal intubations, respectively. Difficult videolaryngoscopic tracheal intubation occurred in 47 (5%) and airway‐related adverse events in 42 (5%) tracheal intubations. Direct glottic view during laryngoscopy was restricted in 117 (13%) and the videolaryngoscopic view in 32 (4%) tracheal intubations (p < 0.001). Videolaryngoscopy improved the glottic view in 57/69 (83%) tracheal intubations where the vocal cords were only just visible, and in 44/48 (92%) where the vocal cords were not visible by direct view. The Cormack and Lehane classification discriminated poorly between easy and difficult videolaryngoscopic tracheal intubations with a mean area under the receiver operating characteristic curve of 0.68 (95%CI 0.59–0.78) for the videolaryngoscopic view compared with 0.80 (95%CI 0.73–0.87) for the direct glottic view during laryngoscopy (p = 0.005). Conclusions: Universal, first‐choice videolaryngoscopy reduced substantially the incidence of restricted glottic views. The Cormack and Lehane classification was not a useful tool for grading videolaryngoscopic tracheal intubation in children. [ABSTRACT FROM AUTHOR]

Fluid resuscitation reduces mortality and morbidity in acute pancreatitis (AP); however, whether glucose-containing fluids negatively impact AP remains uncertain. We aimed to examine the association between glucose-containing fluids and AP outcomes. This multicenter retrospective cohort study included patients diagnosed with AP between January 2015 and December 2018. Glucose density was defined as total glucose content divided by total fluid volume (g/dl) on day 1, and was considered high if the level exceeded the median. Endpoints were early organ failure (OF), including cardiovascular, renal, or respiratory system failure within 7 days; 30-day OF; ICU admission; and AP-related 90-day mortality. Logistic regression models, restricted cubic spline curves, and Cox proportional hazards models were used for statistical analysis. From the database, 1,146 patients with AP were included. Early OF occurred in 8.8% of patients within 7 days. The high glucose-density group (>5 g/dl) had increased risk of early OF (9.7% vs. 8.2%; adjusted odds ratio [aOR], 1.69; 95% confidence interval [CI], 1.03–2.80; P = 0.039), respiratory failure (8.0% vs. 6.2%; aOR, 1.88; 95% CI, 1.09–3.24; P = 0.024), cardiovascular failure (3.4% vs. 2.4%; aOR, 3.59; 95% CI, 1.28–10.0; P = 0.015), and ICU admission (6.8% vs. 5.8%; aOR, 2.06; 95% CI, 1.08–3.94; P = 0.029), with a dose-response effect observed for cardiovascular failure and ICU admission. A significant increase 30-day OF risk (adjusted hazard ratio [aHR], 1.70; 95% CI, 1.19–2.45) was also noted. Excess glucose-containing fluid was associated with increased risks of overall, respiratory, and cardiovascular OF and ICU admission in AP. [ABSTRACT FROM AUTHOR]

In the last ten years, lung cancer and chronic pulmonary diseases have become prominent respiratory diseases that require significant attention. This increase in prominence underscores their widespread impact on public health and the urgent need for better understanding, detection, and management strategies. Accurate identification of lung cancer and Chronic Obstructive Pulmonary Disease (COPD) is crucial for preserving human life. Accurate differentiation between the two disorders and the administration of the necessary treatment are very important. This study focuses on effectively discriminating between two of the deadliest chest diseases using chest X-ray images. Recurrent neural networks help to classify diseases accurately by improving feature extraction from radiographs. The proposed algorithm performs more effectively when analyzing chest X-ray image datasets showing alterations in a patient's chest, including the development of tiny lobes or thicker capillaries in the respiratory system among other details, compared to standard lung imaging. [ABSTRACT FROM AUTHOR]

Successful medical treatment for patients with COVID-19 requires rapid and accurate diagnosis. Fighting the COVID-19 pandemic requires an automated system to diagnose the virus on Chest X-Ray (CXR) images. CXR images are frequently used in healthcare as they offer the potential for rapid and accurate disease diagnosis. SARS-CoV-2 targets the respiratory system, resulting in pneumonia with additional symptoms, such as dry cough, fatigue, and fever, which could be misdiagnosed as pneumonia, TB, or lung cancer. There is difficulty in differentiating the features of COVID-19 from other diseases that have similarities in CXR images. Automated Computer-Aided Diagnosis (CAD) systems incorporate machine or deep learning methods to improve efficiency and accuracy. CNNs are among the most widely used methods, as they have shown encouraging accuracy in identifying COVID-19 in CXR images. This study presents a hybrid deep learning model to provide faster diagnosis of COVID-19 infection using CXR images. The Densenet201 model was used for feature extraction and a Multi-Layer Perceptron (MLP) was used for classification. The proposed method achieved 98.82 % accuracy and similar sensitivity, specificity, precision, recall, and F1 score. These results are promising when compared to other DL models trained in similar datasets. [ABSTRACT FROM AUTHOR]

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Environmental pollution continues to increase with industrial development and has become a threat to human health. Atmospheric particulate matter (PM) was designated as a Group 1 carcinogen by the International Agency for Research on Cancer in 2013 and is an emerging global environmental risk factor that is a major cause of death related to cardiovascular and respiratory diseases. PM is a complex composed of highly reactive organic matter, chemicals, and metal components, which mainly cause excessive production of reactive oxygen species (ROS) that can lead to DNA and cell damage, endoplasmic reticulum stress, inflammatory responses, atherosclerosis, and airway remodeling, contributing to an increased susceptibility to and the exacerbation of various diseases and infections. PM has various effects on human health depending on the particle size, physical and chemical characteristics, source, and exposure period. PM smaller than 5 μm can penetrate and accumulate in the alveoli and circulatory system, causing harmful effects on the respiratory system, cardiovascular system, skin, and brain. In this review, we describe the relationship and mechanism of ROS-mediated cell damage, oxidative stress, and inflammatory responses caused by PM and the health effects on major organs, as well as comprehensively discuss the harmfulness of PM. [ABSTRACT FROM AUTHOR]

Asian sand dust (ASD), generated from the deserts of China and Mongolia, affects Korea and Japan during spring and autumn, causing harmful effects on various bio-organs, including the respiratory system, due to its irritants such as fine dust, chemicals, and toxic materials. Here, we investigated the therapeutic effects of silibinin against ASD-induced airway inflammation using mouse macrophage-like cell line RAW264.7 and a murine model. ASD was intranasally administered to mice three times a week and silibinin was administered for 6 days by oral gavage. In ASD-stimulated RAW264.7 cells, silibinin treatment decreased tumor necrosis factor-α production and reduced the expression of p-p65NF-κB, p-p38, and cyclooxygenase (COX)-2, while increasing heme oxygenase (HO)-1 expression. In ASD-exposed mice, silibinin administration reduced inflammatory cell count and cytokines in bronchoalveolar lavage fluid and decreased inflammatory cell infiltration in lung tissue. Additionally, silibinin lowered oxidative stress, as evidenced by decreased 8-hydroxy-2'-deoxyguanosin (8-OHdG) expression and increased HO-1 expression. The expression of inflammatory-related proteins, including p-p65NF-κB, COX-2, and p-p38, was markedly reduced by silibinin administration. Overall, silibinin treatment reduced the expression of p-p65NF-κB, COX-2, and p-p38 in response to ASD exposure, while increasing HO-1 expression both in vitro and in vivo. These findings suggest that silibinin mitigates pulmonary inflammation caused by ASD exposure by reducing inflammatory signaling and oxidative stress, indicating its potential as a therapeutic agent for ASD-induced pulmonary inflammation. [ABSTRACT FROM AUTHOR]