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Asma , Oscilometría , Humanos , Asma/diagnóstico , Asma/fisiopatología , Asma/epidemiología , Preescolar , Femenino , Masculino , Pulmón/fisiopatología , Pruebas de Función Respiratoria , NiñoRESUMEN
Background: Systemic immune-inflammation index (SII) is a novel comprehensive inflammatory marker. Inflammation is associated with impaired lung function. We aimed to explore the possible relationship between SII and lung function to examine the potential of SII in predicting lung function decline. Methods: A cross-sectional survey was conducted using the data of the NHANES from 2007 to 2012. Multiple linear regression models were used to analyze the linear relationship between SII and pulmonary functions. Sensitivity analyses, subgroup analyses, and interaction tests were used to examine the robustness of this relationship across populations. Fitted smooth curves and threshold effect analysis were used to describe the nonlinear relationships. Results: A total of 10,125 patients were included in this study. After adjusting for all covariates, multiple linear regression model analysis showed that high Log2-SII level was significantly associated with decreased FVC(ß, -23.4061; 95% CI, -42.2805- -4.5317), FEV1(ß, -46.7730; 95% CI, -63.3371- -30.2089), FEV1%(ß, -0.7923; 95% CI, -1.1635- -0.4211), FEV1/FVC(ß, -0.6366; 95% CI, -0.8328- -0.4404) and PEF(ß, -121.4468; 95% CI,-164.1939- -78.6998). The negative correlation between Log2-SII and pulmonary function indexes remained stable in trend test and stratified analysis. Inverted U-shaped relationships between Log2-SII and FVC, FEV1, FEV1%, and PEF were observed, while a negative linear correlation existed between FEV1/FVC and Log2-SII. The cutoff values of the nonlinear relationship between Log2-SII and FVC, FEV1, FEV1%, PEF were 8.3736, 8.0688, 8.3745, and 8.5255, respectively. When SII exceeded the critical value, the lung function decreased significantly. Conclusion: This study found a close correlation between SII and pulmonary function indicators. This study investigated the SII threshold when lung functions began to decline in the overall population. SII may become a promising serological indicator for predicting lung function decline. However, prospective studies were needed further to establish the causal relationship between these two factors.
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Mediadores de Inflamación , Inflamación , Pulmón , Encuestas Nutricionales , Valor Predictivo de las Pruebas , Humanos , Masculino , Estudios Transversales , Femenino , Persona de Mediana Edad , Pulmón/fisiopatología , Pulmón/inmunología , Volumen Espiratorio Forzado , Estados Unidos/epidemiología , Adulto , Capacidad Vital , Inflamación/fisiopatología , Inflamación/inmunología , Inflamación/diagnóstico , Inflamación/sangre , Mediadores de Inflamación/sangre , Anciano , Biomarcadores/sangre , Factores de Riesgo , Modelos LinealesRESUMEN
Background: The associations between gut microbiota and chronic obstructive pulmonary disease (COPD) have gained increasing attention and research interest among scholars. However, it remains unclear whether gut microbiota serves as a causal factor for COPD or if it is a consequence of the disease. Therefore, we investigated the causal relationship between COPD and gut microbiota, with intention of providing novel insights and references for clinical diagnosis and treatment. Methods: Based on the genome-wide association study (GWAS) data, we employed MR-Egger regression, random-effects inverse variance-weighted (IVW) method, and weighted median method for bidirectional Mendelian randomization (MR) analysis. We conducted Cochran's Q test for heterogeneity assessment and performed multivariable analysis, sensitivity analysis, and heterogeneity testing to validate the reliability and stability of results. Results: Utilizing MR analysis, mainly employing the IVW method, we detected a collective of 11 gut microbiota species that exhibited associations with COPD. Among them, Bacteroidia, family XIII, Clostridium innocuum group, Barnesiella, Collinsella, Lachnospiraceae NK4A136 group, Lachnospiraceae UCG004, Lachnospiraceae UCG010, and Bacteroidales were found to be protective factors for COPD. On the other hand, Holdemanella and Marvinbryantia were identified as risk factors for COPD. Individuals with elevated levels of Holdemanella exhibited a 1.141-fold higher risk of developing COPD compared to their healthy counterparts, and those with increased levels of Marvinbryantia had a 1.154-fold higher risk. Reverse MR analysis yielded no evidence indicating a causal relationship between gut microbiota and COPD occurrence. Conclusion: Our study established a causal link between 11 specific gut microbiota species and COPD, offering novel insights and valuable references for targeted therapies in the clinical management of COPD. However, our results were mainly based on the analysis of database, and further clinical studies are needed to clarify the effects of gut microbiota on COPD and its specific protective mechanism.
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Microbioma Gastrointestinal , Estudio de Asociación del Genoma Completo , Análisis de la Aleatorización Mendeliana , Enfermedad Pulmonar Obstructiva Crónica , Enfermedad Pulmonar Obstructiva Crónica/microbiología , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/genética , Humanos , Factores de Riesgo , Disbiosis , Medición de Riesgo , Bacterias/genética , Bacterias/aislamiento & purificación , Bacterias/clasificación , Predisposición Genética a la Enfermedad , Fenotipo , Pulmón/microbiología , Pulmón/fisiopatología , Factores ProtectoresRESUMEN
BACKGROUND: Acute exacerbation (AE) refers to rapidly progressive respiratory deterioration in the clinical course of interstitial lung disease (ILD). Progressive pulmonary fibrosis (PPF) is the chronic progressive phenotype of ILD. No study has investigated the relationship between AE and PPF in ILD. OBJECTIVES: We aimed to determine the association between AE and PPF in ILD patients. DESIGN: A retrospective cohort study. METHODS: A total of 414 patients hospitalised for ILD were included in our study. The clinical presentations, radiographic features and laboratory findings of the patients were reviewed. RESULTS: AE was present in 120 (29.0%) ILD patients and was associated with a higher risk of death than non-AE patients in the whole cohort (HR 2.893; 95% CI, 1.847-4.529; p < 0.001). However, the significant difference disappeared when stratified by PPF (HR 1.192; 95% CI, 0.633-2.247; p = 0.586) and non-PPF (HR 1.113; 95% CI, 0.384-3.223; p = 0.844). In addition, the adverse effect of PPF on prognosis remained consistent in both AE and non-AE patients. Multivariable logistic regression analysis showed that compared with non-PPF patients, only age was a risk factor for PPF in AE-ILD, while the risk factors for PPF in the non-AE group were age, definite usual interstitial pneumonia and mediastinal lymph node enlargement. CONCLUSION: In the context of ILD, both AE and PPF were found to be associated with poor prognosis. However, the adverse effect of AE on prognosis disappeared when PPF was considered as a stratification feature, whereas the adverse effect of PPF on prognosis persisted in both AE and non-AE individuals. Therefore, it is important to investigate effective strategies to prevent disease progression after AE. Increased recognition and attention to PPF and early antifibrotic therapy at the appropriate time is also warranted.
Association between acute exacerbation and progressive pulmonary fibrosis in interstitial lung diseaseWhy was the study done? Acute exacerbation (AE) is an acute respiratory worsening of interstitial lung disease (ILD). Progressive pulmonary fibrosis (PPF) is a chronic progressive-fibrosing form of ILD. The relationship between AE and PPF in ILD remained unclear. We aimed to determine the association between AE and PPF in ILD patients.What did the researchers do? The researchers studied 414 patients with ILD to see how AE and PPF affect the outcome of ILD and explored the risk factors for PPF in ILD.What did the researchers find? AE was present in 120 (29.0%) ILD patients and was associated with higher risk of death than non-AE patients in the whole cohort. However, the significant difference disappeared when stratified by PPF and non-PPF. In addition, the adverse effect of PPF on prognosis remained consistent in both AE and non-AE patients. In AE-ILD patients, age was the only risk factor for PPF. In the non-AE group, age, definite usual interstitial pneumonia and mediastinal lymph node enlargement were risk factors for PPF.What do the findings mean? The findings suggest that it is important to investigate effective strategies to prevent disease progression after AE. Increased recognition and attention to PPF and early antifibrotic therapy at the appropriate time is also necessary.
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Progresión de la Enfermedad , Enfermedades Pulmonares Intersticiales , Fibrosis Pulmonar , Humanos , Estudios Retrospectivos , Masculino , Femenino , Enfermedades Pulmonares Intersticiales/fisiopatología , Enfermedades Pulmonares Intersticiales/mortalidad , Enfermedades Pulmonares Intersticiales/diagnóstico , Anciano , Persona de Mediana Edad , Fibrosis Pulmonar/fisiopatología , Fibrosis Pulmonar/mortalidad , Factores de Riesgo , Pronóstico , Factores de Tiempo , Anciano de 80 o más Años , Pulmón/fisiopatología , Pulmón/diagnóstico por imagenRESUMEN
Objective: To observe the changes of lung function and inflammatory factors in rat models of coal workers' pneumoconiosis at different time points. Methods: In June 2021, 96 healthy male SD rats with SPF grade were divided into 1, 3, and 6-month control group and dust staining group (coal dust group, coal silica dust group, quartz group) according to random number table method, with 8 rats in each group. After one week of adaptive feeding, a one-time non-exposed tracheal perfusion method (1 ml/ piece) was used. The dust dyeing group was given 50 g/L coal dust, coal silica mixed dust and quartz dust suspension, respectively, and the control group was given 0.9% normal saline solution. At 1, 3 and 6 months after perfusion, lung function was detected by animal lung function apparatus, then all lung tissues and alveolar lavage fluid were killed, and lung histopathological morphological changes were observed by HE staining, and the contents of interleukin (IL-1ß), IL-18, IL-4 and IL-10 in alveolar lavage fluid were detected by ELISA. One-way analysis of variance was used to compare groups. Two factors (inter-group treatment factor (4 levels) and observation time factor (3 levels) ) were used in the analysis of the effects of inter-group treatment and treatment time on related indicators. Results: HE staining results showed that coal spot appeared in the lung tissue of coal dust group, coal spot and coal silicon nodule appeared in the lung tissue of coal dust group, and silicon nodule appeared in the lung tissue of quartz group. Compared with the control group, the forced vital capacity (FVC) and forced expiratory volume at 0.2 second (FEV(0.2)) of rats in the dust staining group had interaction between the treatment and treatment time (P<0.05). With the increase of dust dyeing time, FVC and FEV(0.2) decreased significantly at 3-6 months of dust dyeing, and the maximum gas volume per minute (MVV) decreased significantly at 1-3 months of dust dyeing (P<0.05). The lowest lung function index was in quartz group, followed by coal-silica group and coal-dust group. There were statistically significant differences in the main effect and interaction effect of the pro-inflammatory factor IL-18 among all groups in treatment and treatment time (IL-18: F=70.79, 45.97, 5.90, P<0.001), and interaction existed. The highest content of inflammatory factors in alveolar lavage fluid of all dust groups was quartz group, followed by coal silica group and coal dust group. There were significant differences in the main effect and interaction effect of anti-inflammatory factors between groups and treatment time (IL-4: F=41.55, 33.01, 5.23, P<0.001, <0.001, <0.001; IL-10: F=7.46, 20.80, 2.91, P=0.002, <0.001, 0.024), and there was interaction. The highest content of anti-inflammatory factor was in quartz group, followed by coal silica group and coal dust group. Conclusion: Lung function decreased and levels of inflammatory fators increased in rat models of coal workers' pneumoconiosis, with the quartz group being the most severely damaged. Lung function is mainly impaired in thrid-six months, and the content of inflammatory factors begins to change in first-thrid months. MVV are the earliest and most obvious in lung function. IL-18 is suitable for monitoring changes in the pro-inflammatory response of coal workers' pneumoconiosis, and IL-10 is suitable for monitoring changes in anti-inflammatory response.
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Antracosis , Carbón Mineral , Modelos Animales de Enfermedad , Polvo , Pulmón , Ratas Sprague-Dawley , Animales , Ratas , Masculino , Pulmón/fisiopatología , Pulmón/patología , Antracosis/fisiopatología , Interleucina-18/metabolismo , Interleucina-4/metabolismo , Interleucina-10/metabolismo , Interleucina-1beta/metabolismo , Líquido del Lavado Bronquioalveolar/citología , Cuarzo , Inflamación , Pruebas de Función RespiratoriaRESUMEN
OBJECTIVES: Inspiratory muscle training is used in rehabilitation to exercise respiratory muscles in various conditions associated with limited ventilatory reserve. In this review, we investigated inspiratory muscle training in lung transplant candidates and recipients. MATERIALS AND METHODS: We searched 5 primary databases from inception through April 2024. Two key word entries, "lung transplantation" and "inspiratory muscle training," were matched using the Boolean operator AND. No filters were applied for document type, age, sex, publication date, language, and subject. RESULTS AND CONCLUSIONS: The searched databases returned 119 citations. Seven articles that considered 64 patients (47% female) were included in the final analysis, with 1 study involving a pediatric patient. Lung transplant recipients used a threshold trainer at 15% to 60% of maximal inspiratory pressure and mostly exercised twice daily for 10 to 15 minutes per session. Lung transplant candidates exercised at 30% to >50% of maximal inspiratory pressure twice daily, performing 30 to 60 inspirations or for 15 minutes. The highest inspiratory muscle strength was observed in a series of adult lung transplant recipients whose mean value improved by 31.8 ± 14.6 cmH2O versus baseline after treatment. To the same extent, the highest value of maximal inspiratory pressure was detected in a pediatric patient who scored 180 cmH2O after training. Overall, participants obtained improvements in lung function (forced expiratory volume in 1 second, forced vital capacity), functional performance, dyspnea intensity, and exercise tolerance. Inspiratory muscle training is easy to perform and can be done at home without specific supervision (in adults) before or after a lung transplant. Nevertheless, additional rigorous investigations should aim to replicate the positive effects reported in the present review.
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Ejercicios Respiratorios , Trasplante de Pulmón , Pulmón , Fuerza Muscular , Recuperación de la Función , Músculos Respiratorios , Humanos , Músculos Respiratorios/fisiopatología , Femenino , Resultado del Tratamiento , Masculino , Pulmón/fisiopatología , Adulto , Niño , Persona de Mediana Edad , Adolescente , Adulto Joven , Inhalación , Factores de Tiempo , Tolerancia al Ejercicio , AncianoRESUMEN
Introduction: Lung function constraints and comorbidities such as coronary heart disease, sarcopenia, and mood disorders make chronic obstructive pulmonary disease (COPD) patients avoid physical activity (PA). However, PA represents an important pillar of COPD management and is explicitly recommended by professional associations to enhance physical functioning and positively modulate disease progression. Methods: In this monocentric, prospective, observational feasibility study, it was our primary objective to investigate the association between PA and the evolution of the COPD assessment test (CAT) and the occurrence of acute exacerbations of COPD (AECOPD), respectively. To this end, we equipped 42 COPD patients with an activity tracking wearable and telemonitored their daily PA levels over one year using a dedicated web-based interface. Patients additionally provided weekly CAT scores using the same telehealth platform and came in for 3 study visits to assess functional parameters and biochemical markers related to nutrition and inflammation. Results: A principal study finding was that PA was inversely associated with CAT score (drop of 0.21 points associated with an increase of 1000 daily steps, p = 0.004), and that the 50% of patients with higher PA levels showed less CAT score progression over time (0.42 points per year) than the 50% of patients with lower PA levels (3.26 points per year) (p < 0.001). In addition, higher PA levels were significantly associated with a lower likelihood of experiencing a moderate-to-severe AECOPD (31% risk reduction associated with an increase of 1000 daily steps, p = 0.0097). Discussion: Our study demonstrates the relevance of PA for key COPD outcome metrics in a real-world setting and underpins the importance of PA for COPD self-management in everyday life. Our study paves the way for future intervention trials to prospectively identify medically relevant PA thresholds and establish training recommendations for different patient subgroups.
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Actigrafía , Progresión de la Enfermedad , Ejercicio Físico , Estudios de Factibilidad , Monitores de Ejercicio , Pulmón , Enfermedad Pulmonar Obstructiva Crónica , Humanos , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/terapia , Estudios Prospectivos , Femenino , Masculino , Anciano , Persona de Mediana Edad , Factores de Tiempo , Pulmón/fisiopatología , Actigrafía/instrumentación , Telemedicina , Valor Predictivo de las PruebasRESUMEN
Purpose: COPD affects more than 300 million people worldwide, requiring inhalation treatment. Novel triple formulations of ICS, LABAs and LAMAs are becoming the mainstay of treatment, however there is still a lack of clinical evidence for personalized therapy. Patients and Methods: RATIONALE was a non-interventional, prospective, 52 week study, assessing the effectiveness of beclometasone/formoterol/glycopyrronium-bromide (BDP/FF/G), in symptomatic COPD patients, with moderate airflow obstruction. The study included 4 visits, where data on demographic parameters, exacerbations, symptoms, quality of life (based on the EQ-5D-3L questionnaire) and lung function were collected. Data on adherence to treatment, based on prescriptions filled was collected from the database of the National Health Insurance Fund, with the patients' consent. The primary objective was the change of adherence to treatment during the study, compared to baseline. Results: Altogether 613 patients had been enrolled. Their average age was 64.56 years and 50.5% were female. The average CAT score was 20.86, and most patients had suffered minimum one exacerbation (82.2%). Average FEV1 was 59.6%. Most patients had some limitation in one or more dimensions of EQ-5D-3L, with an average visual analogue scale score (VAS) of 60.31. After 12 months of treatment, adherence improved significantly - proportion of patients in the highest adherence group increased from 29.8% to 69.7% (p<0.001). The average CAT score improved by 7.02 points (95% CI 5.82-8.21, p<0.001). There was a significant improvement in all dimensions of EQ-5D-3L, with an average increase of 17.91 (95% CI 16.51-19.31, p< 0.001) points in the VAS score. Exacerbation frequency also decreased significantly. Conclusion: Although limitations of observational studies are present, we observed that early introduction of fixed triple combination results in a marked improvement in adherence to treatment, symptom scores, exacerbation frequency and quality of life. The optimal choice of treatment is crucial for reaching the highest possible adherence.
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Agonistas de Receptores Adrenérgicos beta 2 , Beclometasona , Broncodilatadores , Combinación de Medicamentos , Fumarato de Formoterol , Glicopirrolato , Pulmón , Cumplimiento de la Medicación , Antagonistas Muscarínicos , Enfermedad Pulmonar Obstructiva Crónica , Calidad de Vida , Humanos , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Femenino , Masculino , Persona de Mediana Edad , Administración por Inhalación , Estudios Prospectivos , Anciano , Resultado del Tratamiento , Broncodilatadores/administración & dosificación , Glicopirrolato/administración & dosificación , Agonistas de Receptores Adrenérgicos beta 2/administración & dosificación , Pulmón/fisiopatología , Pulmón/efectos de los fármacos , Antagonistas Muscarínicos/administración & dosificación , Antagonistas Muscarínicos/efectos adversos , Beclometasona/administración & dosificación , Factores de Tiempo , Fumarato de Formoterol/administración & dosificación , Volumen Espiratorio Forzado , Índice de Severidad de la Enfermedad , Recuperación de la Función , Progresión de la Enfermedad , Glucocorticoides/administración & dosificaciónRESUMEN
Purpose: Sedentary time (ST) is associated with mortality independent of moderate-to-vigorous physical activity in patients with COPD. The proper processing methods for the measurement data and factors related to ST are still unknown. We investigated several conditions for determining the proper processing of ST accelerometric data and created a reference equation for ST using ST-related factors. Patients and Methods: In Study 1, we evaluated the minimum required number of days to obtain repeatability at different measurement times and assessed the effects of rainy days or weekend days on ST in patients with COPD. In Study 2, we detected the ST-related factors among 28 parameters and created a reference equation for ST using the detected factors. Results: In Study 1, 38 patients with stable COPD were analyzed. The minimum number of days required for repeatability was 3 for 8-h wearing and 2 for 10-h wearing. The ST was significantly prolonged on rainy days, but not on weekends. In Study 2, 216 patients with stable COPD were analyzed. BMI, FEV1%pred, 6MWD, and mMRC were detected as ST-related factors, and a reference equation could be created using these four factors. The equation was validated for patients whose ST was ≥ 6 h. Conclusion: By using properly processed measurement data of ST, we created a reference equation for assessing ST that is expected to be useful for providing individual guidance on the shortening of ST to patients with COPD.
When measuring sedentary time (ST) objectively, we should recognize that the minimum required number of days is three and that ST is prolonged on rainy days. The reference equation for ST could be created using four ST-related factors. It might serve as a guide for shortening ST in COPD.
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Pulmón , Valor Predictivo de las Pruebas , Enfermedad Pulmonar Obstructiva Crónica , Conducta Sedentaria , Humanos , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Masculino , Femenino , Anciano , Factores de Tiempo , Reproducibilidad de los Resultados , Persona de Mediana Edad , Pulmón/fisiopatología , Volumen Espiratorio Forzado , Actigrafía/instrumentación , Monitores de Ejercicio , Ejercicio Físico , Prueba de Paso , Índice de Masa CorporalRESUMEN
Two cystic fibrosis (CF) rat models, one carrying the common Phe508del mutation and the other a nonsense cystic fibrosis transmembrane conductance regulator (CFTR) mutation (knockout) were previously characterised. Although relevant CFTR mRNA reductions were present in the lung, no overt CF lung disease was observed. This study used flexiVent lung mechanic assessment and regional ventilation assessment via X-ray velocimetry (XV) functional imaging to assess the lung phenotype in both models. To determine the sensitivity of XV regional ventilation imaging, the effect of a localised physical obstruction (delivery of agar beads to part of the lungs) on lung ventilation was examined. At baseline, Phe508del and knockout CF rats had a lower inspiratory capacity, total respiratory system compliance, and static compliance than wildtype rats. Following agar bead delivery all XV ventilation parameters were altered, with substantial increases in poorly ventilated regions and ventilation heterogeneity. XV ventilation maps accurately identified locations of bead-induced airflow changes. Despite unremarkable lung histopathology, this study indicated that CF rats display altered respiratory mechanics, with CF rats needing to exert additional effort to expand and deflate their lungs due to increased stiffness. This study demonstrated the utility of XV imaging providing spatial lung ventilation information.
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Regulador de Conductancia de Transmembrana de Fibrosis Quística , Fibrosis Quística , Modelos Animales de Enfermedad , Pulmón , Mecánica Respiratoria , Animales , Fibrosis Quística/diagnóstico por imagen , Fibrosis Quística/genética , Fibrosis Quística/fisiopatología , Ratas , Regulador de Conductancia de Transmembrana de Fibrosis Quística/genética , Regulador de Conductancia de Transmembrana de Fibrosis Quística/metabolismo , Pulmón/diagnóstico por imagen , Pulmón/metabolismo , Pulmón/patología , Pulmón/fisiopatología , Reología , Masculino , Ratas Sprague-DawleyRESUMEN
OBJECTIVE: To investigate the correlation between serum Rac1 enzyme (Rac1) level with asthma control, airway inflammatory response and lung function in asthmatic children. METHODS: A retrospective analysis was performed on 79 children with asthma who were diagnosed and treated in our hospital from June 2020 to January 2023. According to the severity of the disease, the children were divided into mild group (25 cases), moderate group (30 cases) and severe group (24 cases). 36 healthy children who underwent physical examination at the same period in our hospital were selected as the control group. The state of an illness, control level, serum mRNA Rac1, inflammatory factors, and lung function of the children in two groups were compared between the control group and the observation group. RESULTS: The Rac1 mRNA levels, forced vital capacity (FVC), forced expiratory volume in one second/FVC (FEV1/FVC), peak expiratory flow (PEF), and maximum mid-expiratory flow (MMEF) in the observation group were significantly lower than these in the control group (P < 0.05). The tumor necrosis factor-alpha (TNF-α), interleukin-5 (IL-5), IL-6, and IL-33 in the observation group were markedly higher than these in the control group (P < 0.05). As the state of an illness worsened, the Rac1 mRNA levels, FVC, FEV1/FVC, PEF, and MMEF gradually reduced (P < 0.05), while the levels of TNF-α, IL-5, IL-6, and IL-33 increased (P < 0.05). As the degree of disease control improved, the Rac1 mRNA levels, FVC, FEV1/FVC, PEF, and MMEF gradually elevated (P < 0.05), and the levels of TNF- α, IL-5, IL-6, and IL-33 showed the opposite trend (P < 0.05). Rac1 was negatively related to the levels of TNF-α, IL-5, IL-6 and IL-33 (P < 0.05), and positively to the levels of FVC, FEV1/FVC, PEF and MMEF (P < 0.001). Rac1 mRNA levels, FVC, FEV1/FVC, PEF and MMEF were protective factors, while TNF-α, IL-5, IL-6 and IL-33 were risk factors for the prognosis of children with asthma (P < 0.05). CONCLUSION: Children with asthma have obviously lower serum Rac1 mRNA levels, higher inflammatory factor levels and lower lung function. Serum Rac1 mRNA level may be associated with better asthma control, lower airway inflammatory response, better lung function and lower disease severity. It has important reference value for the evaluation of the state of an illness, efficacy and prognosis of children with bronchial asthma.
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Asma , Proteína de Unión al GTP rac1 , Humanos , Asma/fisiopatología , Asma/genética , Asma/sangre , Proteína de Unión al GTP rac1/metabolismo , Proteína de Unión al GTP rac1/genética , Femenino , Masculino , Niño , Estudios Retrospectivos , Capacidad Vital , Volumen Espiratorio Forzado , Pulmón/fisiopatología , Pruebas de Función Respiratoria , Factor de Necrosis Tumoral alfa/sangre , Estudios de Casos y Controles , Interleucina-33/sangre , Interleucina-33/genética , Preescolar , Interleucina-6/sangre , Adolescente , Índice de Severidad de la Enfermedad , Interleucina-5/sangre , ARN Mensajero/metabolismoRESUMEN
BACKGROUND: Postoperative hypoxemia and pulmonary complications remain a frequent event after on-pump cardiac surgery and mostly characterized by pulmonary atelectasis. Surfactant dysfunction or hyposecretion happens prior to atelectasis formation, and sigh represents the strongest stimulus for surfactant secretion. The role of sigh breaths added to conventional lung protective ventilation in reducing postoperative hypoxemia and pulmonary complications among cardiac surgery is unknown. METHODS: The perioperative sigh ventilation in cardiac surgery (E-SIGHT) trial is a single-center, two-arm, randomized controlled trial. In total, 192 patients scheduled for elective cardiac surgery with cardiopulmonary bypass (CPB) and aortic cross-clamp will be randomized into one of the two treatment arms. In the experimental group, besides conventional lung protective ventilation, sigh volumes producing plateau pressures of 35 cmH2O (or 40 cmH2O for patients with body mass index > 35 kg/m2) delivered once every 6 min from intubation to extubation. In the control group, conventional lung protective ventilation without preplanned recruitment maneuvers is used. Lung protective ventilation (LPV) consists of low tidal volumes (6-8 mL/kg of predicted body weight) and positive end-expiratory pressure (PEEP) setting according to low PEEP/FiO2 table for acute respiratory distress syndrome (ARDS). The primary endpoint is time-weighted average SpO2/FiO2 ratio during the initial post-extubation hour. Main secondary endpoint is the severity of postoperative pulmonary complications (PPCs) computed by postoperative day 7. DISCUSSION: The E-SIGHT trial will be the first randomized controlled trial to evaluate the impact of perioperative sigh ventilation on the postoperative outcomes after on-pump cardiac surgery. The trial will introduce and assess a novel perioperative ventilation approach to mitigate the risk of postoperative hypoxemia and PPCs in patients undergoing cardiac surgery. Also provide the basis for a future larger trial aiming at verifying the impact of sigh ventilation on postoperative pulmonary complications. TRIAL REGISTRATION: ClinicalTrials.gov NCT06248320. Registered on January 30, 2024. Last updated February 26, 2024.
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Procedimientos Quirúrgicos Cardíacos , Puente Cardiopulmonar , Hipoxia , Respiración con Presión Positiva , Complicaciones Posoperatorias , Ensayos Clínicos Controlados Aleatorios como Asunto , Humanos , Hipoxia/etiología , Hipoxia/prevención & control , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Respiración con Presión Positiva/métodos , Puente Cardiopulmonar/efectos adversos , Resultado del Tratamiento , Atelectasia Pulmonar/etiología , Atelectasia Pulmonar/prevención & control , Factores de Tiempo , Atención Perioperativa/métodos , Persona de Mediana Edad , Femenino , Masculino , Adulto , Pulmón/fisiopatología , Pulmón/cirugía , Anciano , Respiración Artificial/efectos adversos , Enfermedades Pulmonares/etiología , Enfermedades Pulmonares/prevención & control , Enfermedades Pulmonares/diagnósticoRESUMEN
Cardiopulmonary exercise testing (CPET) is a comprehensive and invaluable assessment used to identify the mechanisms that limit exercise capacity. However, its interpretation remains poorly standardised. This scoping review aims to investigate which limitations to exercise are differentiated by the use of incremental CPET in literature and which criteria are used to identify them. We performed a systematic, electronic literature search of PubMed, Embase, Cochrane CENTRAL, Web of Science and Scopus. All types of publications that reported identification criteria for at least one limitation to exercise based on clinical parameters and CPET variables were eligible for inclusion. 86 publications were included, of which 57 were primary literature and 29 were secondary literature. In general, at the level of the cardiovascular system, a distinction was often made between a normal physiological limitation and a pathological one. Within the respiratory system, ventilatory limitation, commonly identified by a low breathing reserve, and gas exchange limitation, mostly identified by a high minute ventilation/carbon dioxide production slope and/or oxygen desaturation, were often described. Multiple terms were used to describe a limitation in the peripheral muscle, but all variables used to identify this limitation lacked specificity. Deconditioning was a frequently mentioned exercise limiting factor, but there was no consensus on how to identify it through CPET. There is large heterogeneity in the terminology, the classification and the identification criteria of limitations to exercise that are distinguished using incremental CPET. Standardising the interpretation of CPET is essential to establish an objective and consistent framework.
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Prueba de Esfuerzo , Tolerancia al Ejercicio , Valor Predictivo de las Pruebas , Humanos , Consumo de Oxígeno , Pulmón/fisiopatología , Capacidad Cardiovascular , Reproducibilidad de los ResultadosRESUMEN
This study aimed to evaluate the impact of time-restricted eating (TRE) on neuro-physiological parameters, objective and subjective sleep, pulmonary capacity, and postural balance among women with excess body weight. METHODS: Thirty-one participants were assigned to either a TRE group (n = 15, 28.74 ± 9.25 years, 88.32 ± 13.38 kg, and 32.71 ± 5.15 kg/m2), engaging in ad libitum 16 h fasting over a 12-week period, or a control group (CG, n = 16, 36.25 ± 11.52 years, 90.88 ± 19.01 kg, and 33.66 ± 6.18 kg/m2). The assessment of heart rate variability (HRV), spirometric parameters (forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1/ FVC ratio, objective and subjective sleep assessments employing actigraphy and the Epworth Sleepiness Scale, and postural balance using the Y balance test (YBT) were conducted before and after the intervention. RESULTS: No significant negative effects of TRE were observed for HRV and objective sleep parameters. Only the TRE group improved FEV1 in both sitting (p < 0.0005) and supine positions (p = 0.001). Furthermore, the TRE group showed improvement in postural balance performance compared to the CG in anterior (p = 0.03), postero-medial (p = 0.04), and postero-lateral directions (p = 0.003). CONCLUSION: This study highlights TRE as a feasible and safe dietary intervention with significant improvements in postural balance and pulmonary function, without any negative impact on HRV or objective sleep assessments among overweight or obese women.
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Frecuencia Cardíaca , Obesidad , Sobrepeso , Equilibrio Postural , Sueño , Humanos , Femenino , Adulto , Sobrepeso/fisiopatología , Obesidad/fisiopatología , Equilibrio Postural/fisiología , Sueño/fisiología , Frecuencia Cardíaca/fisiología , Capacidad Vital , Pulmón/fisiopatología , Pulmón/fisiología , Ayuno , Volumen Espiratorio Forzado , Adulto Joven , Persona de Mediana EdadRESUMEN
BACKGROUND: The objective is to assess lung compliance and identify the optimal positive end-expiratory pressure (PEEP) levels in patients with tuberculosis-associated Acute Respiratory Distress Syndrome (TB-ARDS) compared to non-TB-ARDS patients. METHODS: This observational case-control study utilized electrical impedance tomography to evaluate lung mechanics in 20 TB-ARDS and 20 non-TB-ARDS patients. Participants underwent PEEP titration from 23 to 5 cm H2O in 2 cm H2O decrements. Lung compliance and the rates of hyperdistention and collapse were assessed at each PEEP level. RESULTS: Delta impedance values showed higher amounts in a PEEP range of 11-17 cm H2O and in patients with TB-ARDS (P > 0.05). In addition, both hyperdistention and collapse rates were nonsignificantly higher in TB-ARDS patients (P > 0.05), and the compromised levels of hyperdistention and collapse rates were at 15-17 cm H2O, indicating the most favorable PEEP level. CONCLUSIONS: The observed patterns of hyperdistention and collapse rates across various PEEP levels provide valuable insights into the susceptibility of TB-ARDS patients to barotrauma. Notably, the identified optimal PEEP range between 15 and 17 cm H2O may guide ventilator management strategies in mitigating both hyperdistention and collapse; nonetheless, due to the high variability of lung compliances within groups, we strongly recommend individualized consideration for tailored respiratory support and evaluation.
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Respiración con Presión Positiva , Síndrome de Dificultad Respiratoria , Humanos , Síndrome de Dificultad Respiratoria/terapia , Síndrome de Dificultad Respiratoria/fisiopatología , Masculino , Estudios de Casos y Controles , Femenino , Persona de Mediana Edad , Adulto , Impedancia Eléctrica , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/fisiopatología , Tuberculosis/complicaciones , Anciano , Pulmón/fisiopatología , Rendimiento PulmonarRESUMEN
Pulmonary fibrosis is a complex and intractable disease characterized by extracellular matrix accumulation and altered mechanical properties of lung tissue. Biomechanical properties are closely related to the development, progression, and treatment of tissue fibrosis. In this review, we summarized the changes in the pulmonary biomechanical microenvironment, highlight the role of mechanotransduction in pulmonary fibrosis, and describe recent clinical advances targeting mechanical signals to alleviate pulmonary fibrosis.
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Matriz Extracelular , Mecanotransducción Celular , Fibrosis Pulmonar , Humanos , Fibrosis Pulmonar/metabolismo , Fibrosis Pulmonar/fisiopatología , Matriz Extracelular/metabolismo , Pulmón/metabolismo , Pulmón/patología , Pulmón/fisiopatología , Transducción de Señal , AnimalesRESUMEN
Left atrial (LA) physiology and hemodynamics are intimately connected to cardiac and lung function in health and disease. This study examined the relationship between MRI-based left atrial (LA) size and function with MRI-based lung volume and pulmonary function testing (PFT) parameters in the population-based KORA study cohort of 400 participants without overt cardiovascular disease. MRI quantification assessed LA size/function in sequences with and without ECG synchronization, alongside lung volume. Regression analysis explored the relationship of LA with MRI lung volume and PFT parameters. Among 378 participants (average age 56.3 ± 9.2 years; 42.3% women), non-gated LA size averaged 16.8 cm2, while maximal and minimal LA size from gated measurements were 19.6 cm2 and 11.9 cm2 respectively. The average MRI-derived lung volume was 4.0 L, with PFT showing a total lung capacity of 6.2 L, residual lung volume of 2.1 L, and forced vital capacity of 4.1 L. Multivariate regression analysis, adjusted for age, gender, and cardiovascular risk factors, revealed an inverse association between maximum LA size, non-gated LA, and LA area fraction with lung volume (ß = - 0.03, p = 0.006; ß = - 0.03, p = 0.021; ß = - 0.01, p = 0.012), with no significant association with PFT parameters. This suggests that MRI-based assessment may offer greater sensitivity in detecting subclinical LA impairment than PFT.
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Atrios Cardíacos , Imagen por Resonancia Magnética , Pruebas de Función Respiratoria , Humanos , Femenino , Masculino , Persona de Mediana Edad , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/fisiopatología , Imagen por Resonancia Magnética/métodos , Anciano , Pulmón/diagnóstico por imagen , Pulmón/fisiopatología , Mediciones del Volumen Pulmonar , Función del Atrio Izquierdo/fisiologíaRESUMEN
BACKGROUND: Understanding the characteristics of pulmonary resistance and elastance in relation to the location of airway narrowing, e.g., tracheal stenosis vs. intrapulmonary airway obstruction, will help us understand lung function characteristics and mechanisms related to different airway diseases. METHODS: In this study, we used ex vivo sheep lungs as a model to measure lung resistance and elastance across a range of transpulmonary pressures (5-30 cmH2O) and ventilation frequencies (0.125-2 Hz). We established two tracheal stenosis models by inserting plastic tubes into the tracheas, representing mild (71.8% lumen area reduction) and severe (92.1%) obstructions. For intrapulmonary airway obstruction, we induced airway narrowing by challenging the lung with acetylcholine (ACh). RESULTS: We found a pattern change in the lung resistance and apparent lung elastance as functions of ventilation frequency that depended on the transpulmonary pressure (or lung volume). At a transpulmonary pressure of 10 cmH2O, lung resistance increased with ventilation frequency in severe tracheal stenosis, whereas in ACh-induced airway narrowing the opposite occurred. Furthermore, apparent lung elastance at 10 cmH2O decreased with increasing ventilation frequency in severe tracheal stenosis whereas in ACh-induced airway narrowing the opposite occurred. Flow-volume analysis revealed that the flow amplitude was much sensitive to ventilation frequency in tracheal stenosis than it was in ACh induced airway constriction. CONCLUSIONS: Results from this study suggest that lung resistance and apparent elastance measured at 10 cmH2O over the frequency range of 0.125-2 Hz can differentiate tracheal stenosis vs. intrapulmonary airway narrowing in ex vivo sheep lungs.
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Resistencia de las Vías Respiratorias , Pulmón , Estenosis Traqueal , Animales , Resistencia de las Vías Respiratorias/fisiología , Ovinos , Pulmón/fisiopatología , Estenosis Traqueal/fisiopatología , Elasticidad , Modelos Animales de Enfermedad , Técnicas In VitroRESUMEN
BACKGROUND: Some pulmonary tuberculosis patients may require lung resection surgery. Postoperative pulmonary rehabilitation is essential to restore the lung function and maintain quality of life. We aimed to study the pulmonary rehabilitation outcomes and complications of step-by-step Baduanjin exercise under a doctor-nurse-patient integration mode in patients after lobectomy due to pulmonary tuberculosis. METHODS: We performed a randomized controlled clinical trial in patients undergoing lobectomy due to pulmonary tuberculosis between September 2017 and August 2021. Eligible patients were randomly assigned into the control group or interventional group. The control group received routine postoperative care. The interventional group received step-by-step Baduanjin exercise based on the doctor-nurse-patient integration mode in addition to the routine care. The primary outcomes were the pulmonary functions, including forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC. The secondary outcomes were the maximum walking distance in a 6-min walk test and postoperative pulmonary complications, including atelectasis, pneumonia, and respiratory failure. RESULTS: A total of 100 patients were enrolled into the study, with 50 patients in the control and interventional groups. There were 60 female patients (60%). The mean patient age was 37.9 (± 2.8) years old. At the one- and two-month postoperative follow-ups, pulmonary function tests showed statistically significantly better performances in FEV1/prediction, FVC/prediction, and FEV1/FVC in the interventional group than the control group. The 6-min walk test also revealed longer walking distances in the interventional group than the control group. There were no statistically significant differences in postoperative complications between the two groups. CONCLUSIONS: A step-by-step Baduanjin exercise regimen under the doctor-nurse-patient integration mode could safely improve pulmonary rehabilitation in patients after lobectomy due to pulmonary tuberculosis.
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Neumonectomía , Tuberculosis Pulmonar , Humanos , Femenino , Masculino , Tuberculosis Pulmonar/cirugía , Neumonectomía/efectos adversos , Adulto , Persona de Mediana Edad , Resultado del Tratamiento , Terapia por Ejercicio/métodos , Complicaciones Posoperatorias/prevención & control , Qigong/métodos , Pruebas de Función Respiratoria , Calidad de Vida , Volumen Espiratorio Forzado , Pulmón/cirugía , Pulmón/fisiopatología , Capacidad VitalRESUMEN
BACKGROUND: Asthma is a chronic inflammatory condition, and choline may alleviate airway inflammation and oxidative stress but studies on the association between dietary choline and asthma remain limited. The purpose of this study is to investigate the associations between dietary choline intake and asthma, as well as pulmonary inflammation and lung function in children and adults. METHODS: In our research, we employed the data of the National Health and Nutrition Examination Survey (NHANES) from 2009 to 2018, including 7,104 children and 16,580 adults. We used fractional exhaled nitric oxide (FENO) to assess pulmonary inflammation and forced expiratory volume in one second (FEV1), forced vital capacity (FVC), the FEV1/FVC ratio, peak expiratory flow rate (PEF), predicted FEV1% and predicted FVC% to assess lung function. Binary logistic regression, linear regression, and the restricted cubic splines were used to analyze the associations between dietary choline intake and asthma and pulmonary inflammation and lung function. RESULTS: In children, we observed the positive associations between the natural logarithmic transformation of choline (ln-choline) and ln-FEV1 [ ß:0.011; 95%CI: (0.004,0.018)] and ln-FVC [ ß:0.009; 95%CI: (0.002,0.016)]. In adult males, the ln-choline was positively associated with ln-FEV1[ ß:0.018; 95%CI: (0.011,0.024)], ln-FVC [ ß:0.020; 95%CI: (0.014,0.026)], ln-PEF [ ß:0.014; 95%CI: (0.007,0.022)], ln-predicted FEV1% [ ß: 0.007; 95%CI: (0.001, 0.013)] and ln-predicted FVC%[ ß: 0.010; 95%CI: (0.005, 0.015)] and negatively associated with FENO [ ß: -0.029; 95%CI: (-0.049, -0.009)]. In unadjusted and partially adjusted models, adult females with ln-choline in the highest quartile had 25.2% (95%CI:9.4-38.3%) and 23.8% (95%CI:7.6-37.1%) decreased odds of asthma compared to those with the lowest quartile group. In the dose-response relationships of dietary choline and pulmonary inflammation and lung function indicators in adults, there existed threshold and saturation effects. CONCLUSION: The associations between dietary choline and lung function indicators such as FEV1 and FVC are positive in children and adults. The association between dietary choline and pulmonary inflammation is negative only in adults.