Respiratory muscle endurance training with normocapnic hyperpnoea for patients with chronic spinal cord injury: A pilot short-term randomized controlled trial.

OBJECTIVE: To investigate the effects of normocapnic hyperpnoea training on pulmonary function and patient-reported outcomes in chronic spinal cord injury. DESIGN: Single-centre randomized controlled trial. PATIENTS: Eighteen patients with spinal cord injury > 24 months post-injury and without regular respiratory muscle training prior to the study were included prospectively. METHODS: Patients were randomly assigned to either normocapnic hyperpnoea or control groups. The normocapnic hyperpnoea group patients performed training 15-20 min per day, 5 times a week for 4 weeks. The patients hyperventilated through partial re-breathing of ventilated air. The control group received no respiratory muscle training. Other rehabilitative programmes were performed identically in both groups. Lung function testing was performed in the sitting position prior to and after the study. Patient-reported outcomes were assessed using the Patient Health Questionnaire-9, St George's Respiratory Questionnaire, Chronic Obstructive Pulmonary Disease Assessment Test and Borg scores. RESULTS: Significant differences were found in the improvement ratio between the normocapnic hyperpnoea and control groups for all investigated parameters, except total lung capacity and diffusing capacity of the lung for carbon monoxide. CONCLUSION: Normocapnic hyperpnoea training may reduce the incidence of respiratory symptoms, improve pulmonary function and quality of life, and reduce depression in patients with chronic spinal cord injury, regardless of their neurological level of injury, even at more than 24 months after injury.

COPD care delivery pathways in five European Union countries: mapping and health care professionals' perceptions.

BACKGROUND: COPD is among the leading causes of chronic morbidity and mortality in the European Union with an estimated annual economic burden of €25.1 billion. Various care pathways for COPD exist across Europe leading to different responses to similar problems. Determining these differences and the similarities may improve health and the functioning of health services. OBJECTIVE: The aim of this study was to compare COPD patients' care pathway in five European Union countries including England, Ireland, the Netherlands, Greece, and Germany and to explore health care professionals' (HCPs) perceptions about the current pathways. METHODS: HCPs were interviewed in two stages using a qualitative, semistructured email interview and a face-to-face semistructured interview. RESULTS: Lack of communication among different health care providers managing COPD and comorbidities was a common feature of the studied care pathways. General practitioners/family doctors are responsible for liaising between different teams/services, except in Greece where this is done through pulmonologists. Ireland and the UK are the only countries with services for patients at home to shorten unnecessary hospital stay. HCPs emphasized lack of communication, limited resources, and poor patient engagement as issues in the current pathways. Furthermore, no specified role exists for pharmacists and informal carers. CONCLUSION: Service and professional integration between care settings using a unified system targeting COPD and comorbidities is a priority. Better communication between health care providers, establishing a clear role for informal carers, and enhancing patients' engagement could optimize current care pathways resulting in a better integrated system.

Ingestion of (n-3) fatty acids augments basal and platelet activating factor-induced permeability to dextran in the rat mesenteric vascular bed.

Loss of intestinal barrier function and subsequent edema formation remains a serious clinical problem leading to hypoperfusion, anastomotic leakage, bacterial translocation, and inflammatory mediator liberation. The inflammatory mediator platelet activating factor (PAF) promotes eicosanoid-mediated edema formation and vasoconstriction. Fish oil-derived (n-3) fatty acids (FA) favor the production of less injurious eicosanoids but may also increase intestinal paracellular permeability. We hypothesized that dietary (n-3) FA would ameliorate PAF-induced vasoconstriction and enhance vascular leakage of dextran tracers. Rats were fed either an (n-3) FA-rich diet (EPA-rich diet; 4.0 g/kg EPA, 2.8 g/kg DHA) or a control diet (CON diet; 0.0 g/kg EPA and DHA) for 3 wk. Subsequently, isolated and perfused small intestines were stimulated with PAF and arterial pressure and the translocation of fluid and macromolecules from the vasculature to lumen and lymphatics were analyzed. In intestines of rats fed the EPA-rich diet, intestinal phospholipids contained up to 470% more EPA and DHA at the expense of arachidonic acid (AA). The PAF-induced increase in arterial pressure was not affected by the EPA-rich diet. However, PAF-induced fluid loss from the vascular perfusate was higher in intestines of rats fed the EPA-rich diet. This was accompanied by a greater basal loss of dextran from the vascular perfusate and a higher PAF-induced transfer of dextran from the vasculature to the lumen (P = 0.058) and lymphatics. Our data suggest that augmented intestinal barrier permeability to fluid and macromolecules is a possible side effect of (n-3) FA-rich diet supplementation.