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1.
J Cardiothorac Surg ; 19(1): 425, 2024 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-38978064

RESUMO

BACKGROUND: Postoperative pulmonary complications (PPCs) after one-lung ventilation (OLV) significantly impact patient prognosis and quality of life. OBJECTIVE: To study the impact of an optimal inspiratory flow rate on PPCs in thoracic surgery patients. METHODS: One hundred eight elective thoracic surgery patients were randomly assigned to 2 groups in this consort study (control group: n = 53 with a fixed inspiratory expiratory ratio of 1:2; and experimental group [flow rate optimization group]: n = 55). Measurements of Ppeak, Pplat, PETCO2, lung dynamic compliance (Cdyn), respiratory rate, and oxygen concentration were obtained at the following specific time points: immediately after intubation (T0); immediately after starting OLV (T1); 30 min after OLV (T2); and 10 min after 2-lung ventilation (T4). The PaO2:FiO2 ratio was measured using blood gas analysis 30 min after initiating one-lung breathing (T2) and immediately when OLV ended (T3). The lung ultrasound score (LUS) was assessed following anesthesia and resuscitation (T5). The occurrence of atelectasis was documented immediately after the surgery. PPCs occurrences were noted 3 days after surgery. RESULTS: The treatment group had a significantly lower total prevalence of PPCs compared to the control group (3.64% vs. 16.98%; P = 0.022). There were no notable variations in peak airway pressure, airway plateau pressure, dynamic lung compliance, PETCO2, respiratory rate, and oxygen concentration between the two groups during intubation (T0). Dynamic lung compliance and the oxygenation index were significantly increased at T1, T2, and T4 (P < 0.05), whereas the CRP level and number of inflammatory cells decreased dramatically (P < 0.05). CONCLUSION: Optimizing inspiratory flow rate and utilizing pressure control ventilation -volume guaranteed (PCV-VG) mode can decrease PPCs and enhance lung dynamic compliance in OLV patients.


Assuntos
Ventilação Monopulmonar , Complicações Pós-Operatórias , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Ventilação Monopulmonar/métodos , Idoso , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Procedimentos Cirúrgicos Torácicos/métodos , Pneumopatias/prevenção & controle , Pneumopatias/etiologia , Pneumopatias/fisiopatologia , Pulmão/fisiopatologia , Estudos Prospectivos
2.
Respir Res ; 25(1): 231, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38824592

RESUMO

Precision Cut Lung Slices (PCLS) have emerged as a sophisticated and physiologically relevant ex vivo model for studying the intricacies of lung diseases, including fibrosis, injury, repair, and host defense mechanisms. This innovative methodology presents a unique opportunity to bridge the gap between traditional in vitro cell cultures and in vivo animal models, offering researchers a more accurate representation of the intricate microenvironment of the lung. PCLS require the precise sectioning of lung tissue to maintain its structural and functional integrity. These thin slices serve as invaluable tools for various research endeavors, particularly in the realm of airway diseases. By providing a controlled microenvironment, precision-cut lung slices empower researchers to dissect and comprehend the multifaceted interactions and responses within lung tissue, thereby advancing our understanding of pulmonary pathophysiology.


Assuntos
Descoberta de Drogas , Pneumopatias , Pulmão , Animais , Pulmão/efeitos dos fármacos , Pulmão/fisiopatologia , Humanos , Pneumopatias/fisiopatologia , Pneumopatias/patologia , Descoberta de Drogas/métodos , Técnicas de Cultura de Órgãos
3.
Eur Respir Rev ; 33(172)2024 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-38719738

RESUMO

INTRODUCTION: The health effects of alcohol are well established but the influence on pulmonary function remains debated. Studies indicate that small amounts of alcohol are beneficial and heavy consumption is harmful, suggesting a U-shaped association. Our objective is to determine whether there is an association between alcohol intake and changes in pulmonary function parameters, exploring the potential protective effect of moderate alcohol consumption and the harm caused by heavy drinking. METHODS: A comprehensive search from PubMed, Embase, Cochrane and CINAHL was carried out, and studies were evaluated using the JBI methodological framework for scoping reviews. Two independent reviewers conducted parallel screening and data extraction. A data extraction form was utilised to organise key themes, with qualitative analysis and visual representation of the results. RESULTS: Among 4427 screened abstracts, 179 underwent full-text review, resulting in 30 eligible studies. Of these, 10 showed a negative effect, nine reported no impact, nine exhibited a positive effect and two indicated a nonlinear U-shaped association between alcohol consumption and pulmonary function parameters. CONCLUSION: While the U-shaped curve hypothesis remains unconfirmed by the current literature, there are notable associations. Heavy alcohol consumption appears to negatively affect pulmonary function, while low to moderate intake shows a positive influence in included studies. However, the diversity in study quality, the nonstandardised alcohol intake quantification and the confounding role of smoking challenge definitive conclusions. The need for consistent, long-term international studies is evident to further explore this relationship while addressing the complex interplay between alcohol and smoking.


Assuntos
Consumo de Bebidas Alcoólicas , Pulmão , Testes de Função Respiratória , Humanos , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/epidemiologia , Pulmão/fisiopatologia , Pulmão/efeitos dos fármacos , Fatores de Risco , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Medição de Risco , Idoso , Adulto Jovem , Pneumopatias/fisiopatologia , Pneumopatias/epidemiologia , Pneumopatias/etiologia , Pneumopatias/diagnóstico , Adolescente
4.
Heart Lung ; 67: 62-69, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38703640

RESUMO

BACKGROUND: Four phenotypes relate metabolism and obesity: metabolically healthy (MHO) and unhealthy (MUO) people with obesity and metabolically healthy (MHNO) and unhealthy (MUNO) people without obesity. No studies have addressed the association between these categories and lung function in the working population. OBJECTIVES: The aim was to determine the relationship of phenotypes to lung ageing as measured by lung age and its relationship to lung dysfunction. METHODS: A descriptive cross-sectional study was conducted in a working population. The outcome variable was lung function assessed by lung age. The four phenotypes of obesity and metabolic health (MHNO, MHO, MUO and MUNO) were determined using NCEP-ATP III criteria. Lung dysfunctions were classified into restrictive, obstructive, and mixed patterns. RESULTS: The mean age of the participants was 43.7 years, ranging from 18 to 67 years. Of the 1860 workers, 51.3 % were women. The prevalences found were 71.4 %, 12 %, 10.6 % and 6 % for MHNO, MUO, MHO, and MUNO, respectively. MHO (ß = 0.66; p = 0.591) was not associated with increased lung ageing compared with MHNO, but MUO (ß = 7.1; p < 0.001) and MUNO (ß = 6.6; p < 0.001) were. Concerning pulmonary dysfunctions, MUNO (OR = 1.93; p < 0.001) and MUO (OR = 2.91; p < 0.001) were found to be related to the presence of a restrictive pattern, and MUNO (OR = 2.40; p = 0.028) to the mixed pattern. CONCLUSION: The results show that metabolic abnormalities, not obesity, are responsible for premature lung ageing and, therefore, lung function decline. In our study, having obesity without metabolic abnormality was not significantly associated with the presence of dysfunctional respiratory patterns.


Assuntos
Obesidade , Fenótipo , Testes de Função Respiratória , Humanos , Feminino , Estudos Transversais , Masculino , Pessoa de Meia-Idade , Adulto , Obesidade/epidemiologia , Obesidade/fisiopatologia , Obesidade/complicações , Idoso , Testes de Função Respiratória/métodos , Adulto Jovem , Adolescente , Pulmão/fisiopatologia , Pneumopatias/epidemiologia , Pneumopatias/fisiopatologia , Prevalência , Índice de Massa Corporal
5.
Sleep Med Clin ; 19(2): 211-218, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38692746

RESUMO

Obstructive sleep apnea (OSA) is a common disorder characterized by repetitive narrowing and collapse of the upper airways during sleep. It is caused by multiple anatomic and nonanatomic factors but end-expiratory lung volume (EELV) is an important factor as increased EELV can stabilize the upper airway via caudal traction forces. EELV is impacted by changes in sleep stages, body position, weight, and chronic lung diseases, and this article reviews the mechanical interactions between the lungs and upper airway that affect the propensity to OSA. In doing so, it highlights the need for additional research in this area.


Assuntos
Apneia Obstrutiva do Sono , Humanos , Apneia Obstrutiva do Sono/fisiopatologia , Apneia Obstrutiva do Sono/complicações , Pulmão/fisiopatologia , Pneumopatias/fisiopatologia , Doença Crônica
6.
Comput Med Imaging Graph ; 115: 102397, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38735104

RESUMO

We address the problem of lung CT image registration, which underpins various diagnoses and treatments for lung diseases. The main crux of the problem is the large deformation that the lungs undergo during respiration. This physiological process imposes several challenges from a learning point of view. In this paper, we propose a novel training scheme, called stochastic decomposition, which enables deep networks to effectively learn such a difficult deformation field during lung CT image registration. The key idea is to stochastically decompose the deformation field, and supervise the registration by synthetic data that have the corresponding appearance discrepancy. The stochastic decomposition allows for revealing all possible decompositions of the deformation field. At the learning level, these decompositions can be seen as a prior to reduce the ill-posedness of the registration yielding to boost the performance. We demonstrate the effectiveness of our framework on Lung CT data. We show, through extensive numerical and visual results, that our technique outperforms existing methods.


Assuntos
Processos Estocásticos , Tomografia Computadorizada por Raios X , Tomografia Computadorizada por Raios X/métodos , Humanos , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Pulmão/diagnóstico por imagem , Algoritmos , Pneumopatias/diagnóstico por imagem , Pneumopatias/fisiopatologia
7.
Respir Med ; 227: 107638, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38641121

RESUMO

RATIONALE: Exposure to burn pit smoke, desert and combat dust, and diesel exhaust during military deployment to Southwest Asia and Afghanistan (SWA) can cause deployment-related respiratory diseases (DRRDs) and may confer risk for worsening lung function after return. METHODS: Study subjects were SWA-deployed veterans who underwent occupational lung disease evaluation (n = 219). We assessed differences in lung function by deployment exposures and DRRD diagnoses. We used linear mixed models to assess changes in lung function over time. RESULTS: Most symptomatic veterans reported high intensity deployment exposure to diesel exhaust and burn pit particulates but had normal post-deployment spirometry. The most common DRRDs were deployment-related distal lung disease involving small airways (DDLD, 41%), deployment-related asthma (DRA, 13%), or both DRA/DDLD (24%). Those with both DDLD/DRA had the lowest estimated mean spirometry measurements five years following first deployment. Among those with DDLD alone, spirometry measurements declined annually, adjusting for age, sex, height, weight, family history of lung disease, and smoking. In this group, the forced expiratory volume in the first second/forced vital capacity (FEV1/FVC) ratio declined 0.2% per year. Those with more intense inhalational exposure had more abnormal lung function. We found significantly lower estimated FVC and total lung capacity five years following deployment among active duty participants (n = 173) compared to those in the reserves (n = 26). CONCLUSIONS: More intense inhalational exposures were linked with lower post-deployment lung function. Those with distal lung disease (DDLD) experienced significant longitudinal decline in FEV1/FVC ratio, but other DRRD diagnosis groups did not.


Assuntos
Campanha Afegã de 2001- , Espirometria , Veteranos , Humanos , Masculino , Feminino , Adulto , Estudos Longitudinais , Exposição Ocupacional/efeitos adversos , Volume Expiratório Forçado/fisiologia , Capacidade Vital/fisiologia , Pessoa de Meia-Idade , Pneumopatias/fisiopatologia , Pneumopatias/epidemiologia , Pneumopatias/etiologia , Destacamento Militar , Doenças Profissionais/fisiopatologia , Doenças Profissionais/epidemiologia , Doenças Profissionais/etiologia , Pulmão/fisiopatologia , Testes de Função Respiratória , Guerra do Iraque 2003-2011 , Ataques Terroristas de 11 de Setembro , Asma/fisiopatologia , Asma/epidemiologia , Estados Unidos/epidemiologia
8.
J Anesth ; 38(3): 386-397, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38546897

RESUMO

PURPOSE: We aimed to quantify perioperative changes in diaphragmatic function and phrenic nerve conduction in patients undergoing routine thoracic surgery. METHODS: A prospective observational study was performed in patients undergoing esophageal resection or pulmonary lobectomy. Examinations were carried out the day prior to surgery, 3 days and 10-14 days after surgery. Endpoints for diaphragmatic function included ultrasonographic measurements of diaphragmatic excursion and thickening fraction. Endpoints for phrenic nerve conduction included baseline-to-peak amplitude, peak-to-peak amplitude, and transmission delay. Measurements were assessed on both the surgical side and the non-surgical side of the thorax. RESULTS: Forty patients were included in the study. Significant reductions in diaphragmatic excursion were seen on the surgical side of the thorax for all excursion measures (posterior part of the right hemidiaphragm, p < 0.001; hemidiaphragmatic top point, p < 0.001; change in intrathoracic area, p < 0.001). Significant changes were seen for all phrenic nerve measures (baseline-to-peak amplitude, p < 0.001; peak-to-peak amplitude, p < 0.001; transmission delay, p = 0.041) on the surgical side. However, significant changes were also seen on the non-surgical side for all phrenic nerve measures (baseline-to-peak amplitude, p < 0.001; peak-to-peak amplitude, p < 0.001; transmission delay, p = 0.022). A postoperative reduction in posterior diaphragmatic excursion of more than 50% was significantly associated with postoperative pulmonary complications (coefficient: 2.69 (95% CI [1.38, 4.01], p < 0.001). CONCLUSION: Thoracic surgery caused a significant unilateral reduction in diaphragmatic excursion on the surgical side of the thorax, which was accompanied by significant changes in phrenic nerve conduction. However, phrenic nerve conduction was also significantly affected on the non-surgical side to a lesser extent, which was not mirrored in diaphragmatic excursion. Our findings suggest that phrenic nerve paresis plays a role in postoperative diaphragmatic dysfunction, which may be a contributing factor in the pathogenesis of postoperative pulmonary complications. CLINICAL TRIALS REGISTRATION NUMBER: NCT04507594.


Assuntos
Diafragma , Nervo Frênico , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Torácicos , Humanos , Nervo Frênico/fisiopatologia , Diafragma/fisiopatologia , Masculino , Feminino , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Estudos Prospectivos , Pessoa de Meia-Idade , Idoso , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Procedimentos Cirúrgicos Torácicos/métodos , Paresia/etiologia , Paresia/fisiopatologia , Pneumopatias/fisiopatologia , Pneumopatias/etiologia , Ultrassonografia/métodos
9.
J Infect Chemother ; 30(8): 780-784, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38182008

RESUMO

Patients with Mycobacterium avium complex pulmonary disease (MAC-PD) often suffer from chronic symptoms such as sputum production, which reduces quality of life. Oscillatory positive expiratory pressure (OPEP) devices are used in physiotherapy to promote the clearance of respiratory secretions. We report two cases of improved lung function and improved scores on the Leicester Cough Questionnaire (LCQ) and the Breathlessness, Cough and Sputum Scale (BCSS) after the use of OPEP in patients with MAC-PD where treatment with guideline-based therapy, including amikacin liposome inhalation suspension, had proved ineffective for symptoms. Use of OPEP might maximize the efficacy of therapy and thereby improves outcomes in patients with MAC-PD. It is important to use both guideline-based therapy and OPEP, especially in patients whose health-related quality of life is affected by sputum symptoms. Further prospective studies are warranted to assess the benefit of adding OPEP to guidelines concerning therapy for patients with MAC-PD and sputum symptoms.


Assuntos
Complexo Mycobacterium avium , Infecção por Mycobacterium avium-intracellulare , Qualidade de Vida , Humanos , Infecção por Mycobacterium avium-intracellulare/terapia , Infecção por Mycobacterium avium-intracellulare/microbiologia , Masculino , Idoso , Escarro/microbiologia , Feminino , Respiração com Pressão Positiva/instrumentação , Respiração com Pressão Positiva/métodos , Pessoa de Meia-Idade , Antibacterianos/uso terapêutico , Antibacterianos/administração & dosagem , Resultado do Tratamento , Pneumopatias/microbiologia , Pneumopatias/terapia , Pneumopatias/fisiopatologia
10.
Work ; 78(2): 381-392, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38160382

RESUMO

BACKGROUND: Mine workers face various health risks from occupational hazards, notably dust-related pulmonary dysfunction. This dysfunction is also attributed to diverse risk factors and health conditions. Despite the variety of underlying mechanisms, conflicting evidence persists regarding hypertension as a potential risk factor for such dysfunction. OBJECTIVE: To determine the predictors of pulmonary dysfunction vis-à-vis the hypertension status of mine workers. METHODS: We conducted a cross-sectional study among 444 mine workers from ten open-cast mines in Gujarat state (western part of India) from November 2020 to February 2022. We collected data on demographics, occupation, addiction, and comorbidities, including measurements like anthropometry, blood pressure, blood sugar, haemoglobin, and lipid levels. Hypertension was confirmed based on self-reported history and/or onsite blood pressure measurement, while pulmonary functions were assessed using a spirometer (expressed as forced expiratory volume in the first second FEV1 and forced vital capacity FVC). Multiple linear regression analysis was performed to determine the significant predictor of FEV1 or FVC vis-à-vis the hypertension status after adjusting for confounding variables. In addition, we assessed the effect of anti-hypertensive medications on pulmonary dysfunction. RESULTS: A total of 41% (95% CI: 36-45%) of mine workers were suffering from hypertension. On multiple linear regression, only being a male and work experience duration were the significant predictors of FEV1 [0.900 (0.475-1.092), p=<0.001; -0.029 (-0.034 - -0.021, p=<0.001] and FVC [1.088 (0.771-1.404), p=<0.001; -0.031 (-0.038 - -0.024, p = 0.001] respectively. While unadjusted analysis indicated hypertension led to FEV1 and FVC reduction, this effect lost significance after adjusting for confounders. Nevertheless, subgroup analysis revealed those on antihypertensive medications had reductions in FEV1 and FVC by -0.263 (95% CI: -0.449 - -0.078, p = 0.006) L and -0.271 (95% CI: -0.476 - -0.067, p = 0.009) L respectively. CONCLUSION: In our study among mine workers, alterations in lung function (FEV1 and FVC) on spirometry were predicted by gender and duration of work experience, while hypertension did not serve as a predictor. It is noteworthy that antihypertensive drugs were found to reduce lung functions on spirometry, highlighting the need for further research.


Assuntos
Anti-Hipertensivos , Hipertensão , Humanos , Estudos Transversais , Masculino , Índia/epidemiologia , Feminino , Adulto , Hipertensão/epidemiologia , Hipertensão/tratamento farmacológico , Anti-Hipertensivos/efeitos adversos , Anti-Hipertensivos/uso terapêutico , Pessoa de Meia-Idade , Mineradores/estatística & dados numéricos , Mineração/estatística & dados numéricos , Fatores de Risco , Pneumopatias/epidemiologia , Pneumopatias/fisiopatologia , Pneumopatias/induzido quimicamente , Pneumopatias/etiologia , Capacidade Vital/efeitos dos fármacos , Exposição Ocupacional/efeitos adversos , Exposição Ocupacional/estatística & dados numéricos , Testes de Função Respiratória
11.
JAMA ; 330(5): 442-453, 2023 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-37526720

RESUMO

Importance: People who smoked cigarettes may experience respiratory symptoms without spirometric airflow obstruction. These individuals are typically excluded from chronic obstructive pulmonary disease (COPD) trials and lack evidence-based therapies. Objective: To define the natural history of persons with tobacco exposure and preserved spirometry (TEPS) and symptoms (symptomatic TEPS). Design, Setting, and Participants: SPIROMICS II was an extension of SPIROMICS I, a multicenter study of persons aged 40 to 80 years who smoked cigarettes (>20 pack-years) with or without COPD and controls without tobacco exposure or airflow obstruction. Participants were enrolled in SPIROMICS I and II from November 10, 2010, through July 31, 2015, and followed up through July 31, 2021. Exposures: Participants in SPIROMICS I underwent spirometry, 6-minute walk distance testing, assessment of respiratory symptoms, and computed tomography of the chest at yearly visits for 3 to 4 years. Participants in SPIROMICS II had 1 additional in-person visit 5 to 7 years after enrollment in SPIROMICS I. Respiratory symptoms were assessed with the COPD Assessment Test (range, 0 to 40; higher scores indicate more severe symptoms). Participants with symptomatic TEPS had normal spirometry (postbronchodilator ratio of forced expiratory volume in the first second [FEV1] to forced vital capacity >0.70) and COPD Assessment Test scores of 10 or greater. Participants with asymptomatic TEPS had normal spirometry and COPD Assessment Test scores of less than 10. Patient-reported respiratory symptoms and exacerbations were assessed every 4 months via phone calls. Main Outcomes and Measures: The primary outcome was assessment for accelerated decline in lung function (FEV1) in participants with symptomatic TEPS vs asymptomatic TEPS. Secondary outcomes included development of COPD defined by spirometry, respiratory symptoms, rates of respiratory exacerbations, and progression of computed tomographic-defined airway wall thickening or emphysema. Results: Of 1397 study participants, 226 had symptomatic TEPS (mean age, 60.1 [SD, 9.8] years; 134 were women [59%]) and 269 had asymptomatic TEPS (mean age, 63.1 [SD, 9.1] years; 134 were women [50%]). At a median follow-up of 5.76 years, the decline in FEV1 was -31.3 mL/y for participants with symptomatic TEPS vs -38.8 mL/y for those with asymptomatic TEPS (between-group difference, -7.5 mL/y [95% CI, -16.6 to 1.6 mL/y]). The cumulative incidence of COPD was 33.0% among participants with symptomatic TEPS vs 31.6% among those with asymptomatic TEPS (hazard ratio, 1.05 [95% CI, 0.76 to 1.46]). Participants with symptomatic TEPS had significantly more respiratory exacerbations than those with asymptomatic TEPS (0.23 vs 0.08 exacerbations per person-year, respectively; rate ratio, 2.38 [95% CI, 1.71 to 3.31], P < .001). Conclusions and Relevance: Participants with symptomatic TEPS did not have accelerated rates of decline in FEV1 or increased incidence of COPD vs those with asymptomatic TEPS, but participants with symptomatic TEPS did experience significantly more respiratory exacerbations over a median follow-up of 5.8 years.


Assuntos
Fumar Cigarros , Pneumopatias , Espirometria , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Progressão da Doença , Seguimentos , Volume Expiratório Forçado , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Doença Pulmonar Obstrutiva Crônica/etiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Capacidade Vital , Estudos Longitudinais , Fumar Cigarros/efeitos adversos , Fumar Cigarros/fisiopatologia , Pneumopatias/diagnóstico por imagem , Pneumopatias/etiologia , Pneumopatias/fisiopatologia , Testes de Função Respiratória
12.
Clin Sci (Lond) ; 137(11): 895-912, 2023 06 14.
Artigo em Inglês | MEDLINE | ID: mdl-37314017

RESUMO

Circadian regulation causes the activity of biological processes to vary over a 24-h cycle. The pathological effects of this variation are predominantly studied using two different approaches: pre-clinical models or observational clinical studies. Both these approaches have provided useful insights into how underlying circadian mechanisms operate and specifically which are regulated by the molecular oscillator, a key time-keeping mechanism in the body. This review compares and contrasts findings from these two approaches in the context of four common respiratory diseases (asthma, chronic obstructive pulmonary disease, pulmonary fibrosis, and respiratory infection). Potential methods used to identify and measure human circadian oscillations are also discussed as these will be useful outcome measures in future interventional human trials that target circadian mechanisms.


Assuntos
Relógios Circadianos , Pneumopatias , Humanos , Asma/fisiopatologia , Relógios Circadianos/fisiologia , Pneumopatias/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Fibrose Pulmonar/fisiopatologia , Infecções Respiratórias/fisiopatologia , Fatores de Tempo , Ensaios Clínicos como Assunto , Projetos de Pesquisa
13.
Rev. chil. enferm. respir ; 39(1): 108-113, 2023. ilus
Artigo em Espanhol | LILACS | ID: biblio-1515102

RESUMO

Las calcificaciones pulmonares metastásicas, hacen referencia a una enfermedad metabólica, caracterizada por depósitos de calcio en tejido pulmonar sano. La etiología es amplia e incluye enfermedades malignas y benignas, siendo la falla renal la causa más frecuente. Es una condición, que, a pesar de ser frecuente, suele ser subdiagnosticada, por presentar pocos o ningún síntoma. Presentamos tres casos clínicos asociados a enfermedad renal crónica, pre y post trasplante.


Metastatic pulmonary calcifications refer to a metabolic disease, characterized by calcium deposits in healthy lung tissue. The etiology is broad and includes malignant and benign diseases, the kidney failure being the most frequent cause. It is a condition, which, despite being frequent, is usually underdiagnosed, because it presents few or no symptoms. We present three clinical cases associated with pre- and post-transplant kidney disease.


Assuntos
Humanos , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Calcinose/etiologia , Insuficiência Renal Crônica/complicações , Pneumopatias/etiologia , Testes de Função Respiratória , Calcinose/diagnóstico por imagem , Radiografia Torácica , Tomografia Computadorizada por Raios X , Pneumopatias/fisiopatologia , Pneumopatias/diagnóstico por imagem
14.
Nutrients ; 14(19)2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-36235741

RESUMO

In the modern diet, excessive fructose intake (>50 g/day) had been driven by the increase, in recent decades, of the consumption of sugar-sweetened beverages. This phenomenon has dramatically increased within the Caribbean and Latin American regions. Epidemiological studies show that chronic high intake of fructose related to sugar-sweetened beverages increases the risk of developing several non-communicable diseases, such as chronic obstructive pulmonary disease and asthma, and may also contribute to the exacerbation of lung diseases, such as COVID-19. Evidence supports several mechanisms­such as dysregulation of the renin−angiotensin system, increased uric acid production, induction of aldose reductase activity, production of advanced glycation end-products, and activation of the mTORC1 pathway­that can be implicated in lung damage. This review addresses how these pathophysiologic and molecular mechanisms may explain the lung damage resulting from high intake of fructose.


Assuntos
Frutose , Pneumopatias , Aldeído Redutase , Frutose/efeitos adversos , Humanos , Pneumopatias/epidemiologia , Pneumopatias/fisiopatologia , Alvo Mecanístico do Complexo 1 de Rapamicina , Edulcorantes/efeitos adversos , Ácido Úrico
15.
Artigo em Português | LILACS | ID: biblio-1402295

RESUMO

Objetivo: Avaliar a associação entre o grau de comprometimento pulmonar (CP) na TC de tórax dos pacientes com COVID-19 com fatores de risco e desfechos. Métodos: Estudo observacional e retrospectivo com 284 pacientes com COVID-19. Avaliou-se idade, sexo, quadro clínico, saturação na admissão, fatores de risco, tempo de sinto-mas, porcentagem de CP, tempo de internação em enfermaria, UTI e de IOT, e óbito. Foram divididos três grupos conforme o grau de CP. Resultados: 167 pacientes possuíam comprometimento <25%; 80, 25-50%; e 37, >50%. O grupo com maior comprometimento pulmonar possuía maior idade, mais homens e maior presença de tosse, dispneia e alguma comorbidade. Também apresentou menor saturação à admissão, maior necessidade de IOT, in-ternação em enfermaria ou UTI e maior mortalidade. O CP, IOT e idade foram fatores preditores de mortalidade.Conclusões: O grau de CP aparenta estar significativamente associado a alguns parâmetros clínicos, necessidade de internação, intubação e óbito (AU)


Objective: To assess the association between the degree of lung involvement (LI) on chest CT scans of COVID-19 patients, risk factors and outcomes. Methods: Observational and retrospective study of 284 COVID-19 patients. Age, sex, clinical presentation, oxygen saturation on admission, risk factors, time after symptom onset, percentage of LI, length of stay in ward and ICU, duration of ETI, and death were assessed. 3 groups were created according to the LI. Results: 167 patients had an involvement of <25%; 80, 25-50%; and 37, >50%. The group with gre-ater LI was older, had more males and a higher incidence of cough, dyspnea and some comorbidity. Moreover, the group with greater LI had lower saturation on admission, more ETI, more admissions to the ward or ICU, and higher mortality. LI, ETI and age were predictors of mortality. Conclusion: The degree of LI appears to be significantly associated with some clinical parameters, need for hospitalization, intubation, and death (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Estudos Retrospectivos , Fatores de Risco , COVID-19/complicações , Unidades de Terapia Intensiva , Tempo de Internação , Pneumopatias/fisiopatologia
16.
Elife ; 112022 02 08.
Artigo em Inglês | MEDLINE | ID: mdl-35131031

RESUMO

Background: The optimal procedures to prevent, identify, monitor, and treat long-term pulmonary sequelae of COVID-19 are elusive. Here, we characterized the kinetics of respiratory and symptom recovery following COVID-19. Methods: We conducted a longitudinal, multicenter observational study in ambulatory and hospitalized COVID-19 patients recruited in early 2020 (n = 145). Pulmonary computed tomography (CT) and lung function (LF) readouts, symptom prevalence, and clinical and laboratory parameters were collected during acute COVID-19 and at 60, 100, and 180 days follow-up visits. Recovery kinetics and risk factors were investigated by logistic regression. Classification of clinical features and participants was accomplished by unsupervised and semi-supervised multiparameter clustering and machine learning. Results: At the 6-month follow-up, 49% of participants reported persistent symptoms. The frequency of structural lung CT abnormalities ranged from 18% in the mild outpatient cases to 76% in the intensive care unit (ICU) convalescents. Prevalence of impaired LF ranged from 14% in the mild outpatient cases to 50% in the ICU survivors. Incomplete radiological lung recovery was associated with increased anti-S1/S2 antibody titer, IL-6, and CRP levels at the early follow-up. We demonstrated that the risk of perturbed pulmonary recovery could be robustly estimated at early follow-up by clustering and machine learning classifiers employing solely non-CT and non-LF parameters. Conclusions: The severity of acute COVID-19 and protracted systemic inflammation is strongly linked to persistent structural and functional lung abnormality. Automated screening of multiparameter health record data may assist in the prediction of incomplete pulmonary recovery and optimize COVID-19 follow-up management. Funding: The State of Tyrol (GZ 71934), Boehringer Ingelheim/Investigator initiated study (IIS 1199-0424). Clinical trial number: ClinicalTrials.gov: NCT04416100.


Assuntos
COVID-19/terapia , Pneumopatias/epidemiologia , Pneumopatias/fisiopatologia , Adulto , Idoso , COVID-19/epidemiologia , COVID-19/reabilitação , Feminino , Seguimentos , Humanos , Unidades de Terapia Intensiva , Modelos Logísticos , Estudos Longitudinais , Pneumopatias/diagnóstico , Masculino , Pessoa de Meia-Idade , Fenótipo , Estudos Prospectivos , Fatores de Risco , SARS-CoV-2 , Tomografia Computadorizada por Raios X/métodos
17.
Chest ; 161(2): e97-e101, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35131080

RESUMO

CASE PRESENTATION: An 84-year-old man with an active smoking habit presented to the ED with dyspnea, hemoptysis, and thick phlegm that was difficult to clear. He reported no weight loss, no fever, and no chest pain or dysphonia. He denied both international travel and previous contact with confirmed cases of TB or SARS-CoV-2. He had no known occupational exposures. The patient's personal history included a resolved complete atrioventricular block that required a permanent pacemaker, moderate-to-severe COPD, rheumatoid arthritis (treated with oral prednisone, 2.5 mg/d) and B-chronic lymphocytic leukemia (treated with methotrexate and prophylactic oral supplements of ferrous sulfate). Moreover, he was in medical follow up because of a peptic ulcer, atrophic gastritis, and colonic diverticulosis. The patient also had a history of thoracic surgery after an episode of acute mediastinitis from an odontogenic infection, which required ICU management and temporal tracheostomy.


Assuntos
Broncoscopia/métodos , COVID-19/diagnóstico , Compostos Ferrosos , Pneumopatias , Múltiplas Afecções Crônicas/terapia , Aspiração Respiratória , Idoso de 80 Anos ou mais , Biópsia/métodos , Lavagem Broncoalveolar/métodos , COVID-19/epidemiologia , Diagnóstico Diferencial , Compostos Ferrosos/administração & dosagem , Compostos Ferrosos/efeitos adversos , Hematínicos/administração & dosagem , Hematínicos/efeitos adversos , Hemoptise/diagnóstico , Hemoptise/etiologia , Humanos , Pneumopatias/induzido quimicamente , Pneumopatias/diagnóstico por imagem , Pneumopatias/fisiopatologia , Pneumopatias/terapia , Masculino , Aspiração Respiratória/complicações , Aspiração Respiratória/diagnóstico , Aspiração Respiratória/fisiopatologia , SARS-CoV-2 , Tomografia Computadorizada por Raios X/métodos , Suspensão de Tratamento
18.
Am J Physiol Lung Cell Mol Physiol ; 322(1): L84-L101, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34850650

RESUMO

An often overlooked element of pulmonary vascular disease is time. Cellular responses to time, which are regulated directly by the core circadian clock, have only recently been elucidated. Despite an extensive collection of data regarding the role of rhythmic contribution to disease pathogenesis (such as systemic hypertension, coronary artery, and renal disease), the roles of key circadian transcription factors in pulmonary hypertension remain understudied. This is despite a large degree of overlap in the pulmonary hypertension and circadian rhythm fields, not only including shared signaling pathways, but also cell-specific effects of the core clock that are known to result in both protective and adverse lung vessel changes. Therefore, the goal of this review is to summarize the current dialogue regarding common pathways in circadian biology, with a specific emphasis on its implications in the progression of pulmonary hypertension. In this work, we emphasize specific proteins involved in the regulation of the core molecular clock while noting the circadian cell-specific changes relevant to vascular remodeling. Finally, we apply this knowledge to the optimization of medical therapy, with a focus on sleep hygiene and the role of chronopharmacology in patients with this disease. In dissecting the unique relationship between time and cellular biology, we aim to provide valuable insight into the practical implications of considering time as a therapeutic variable. Armed with this information, physicians will be positioned to more efficiently use the full four dimensions of patient care, resulting in improved morbidity and mortality of pulmonary hypertension patients.


Assuntos
Ritmo Circadiano/fisiologia , Saúde , Pneumopatias/fisiopatologia , Pulmão/irrigação sanguínea , Animais , Restrição Calórica , Relógios Circadianos , Humanos
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