Predictors of prolonged hospital stay in patients undergoing lung resection.

PURPOSE: To identify potential predictors of prolonged length of hospital stay in patients submitted to lung resection surgery. MATERIALS AND METHODS: This is a cohort study, carried out in 105 patients with lung cancer, submitted to posterolateral thoracotomy pulmonary resection. Data collection included preoperative assessment of demographic, clinical, pulmonary function, respiratory muscle function, physical fitness, and behavioral habits. After surgery, length of hospital stay was documented, and the sample was divided into two groups according to the length of hospital stay (LOS): the normal hospital stay group (NLOS) until 8 days, and the prolonged hospital stay group (PLOS) with more than 8 days of hospital stay. Multiple linear regressions were performed between length of hospital stay and the studied variables, for the total sample and, specifically, for the PLOS group. RESULTS: The multiple linear regression for the total sample, the most explanatory power variables were TLC, MIP, PEF, and BMI. When considering only the PLOS, the variables that mostly explained were the MIP%, MEP and TLC%. CONCLUSION: Besides the classic outcomes used to calculate surgical risk, the body mass index, respiratory muscle strength, peak expiratory flow, and total lung capacity are predictors of the variation on length of hospital stay in patients submitted to lung resection.

The addition of the respiratory muscles function in the preoperative assessment, might contribute to predict prolonged hospital stay in patients submitted to lung resection surgery.Respiratory muscle strength might be included in a prehabilitation program for patients selected to lung resection surgery.The preoperative respiratory muscle strength increment might contribute to reduce economic cost related to prolonged hospital stay after pulmonary resection surgery.

Development and Validation of an Analytical Method for Volatiles with Endogenous Production in Putrefaction and Submersion Situations.

A group of 16 volatile substances (ethyl acetate, 2-propanol, 1-propanol, methanol, acetone, ethanol, acetaldehyde, diethyl ether, methyl ethyl ketone, 1-butanol, 2-butanol, t-butanol, isobutanol, 2-methyl-1-butanol, 3-methyl-1-butanol and 1-pentanol) were qualitatively and quantitatively analyzed through a method developed for volatiles with endogenous production in putrefaction and submersion situations. The method was validated for blood, urine and vitreous humor, using a gas chromatograph (Varian 450-GC) with a flame ionization detector coupled to a headspace injector (HS-GC-FID). The vials were prepared by diluting 100 µL of the sample of interest in 1 mL of internal standard (acetonitrile 100 mg/L), using two capillary columns (VF-624ms and VF-5ms) with different polarities to ensure that all test compounds would be properly identified and undoubtedly distinguished from the rest. All volatiles were studied in a range of 50 to 2,000 mg/L in terms of selectivity/specificity, detection and quantification limits, linearity and calibration model, precision, accuracy, bias, robustness and stability according to the Scientific Working Group for Forensic Toxicology. Detection and quantification limits were between 1 to 8 mg/L and 4 to 24 mg/L, respectively, with coefficient of variation values under 10% in bias studies and in intermediate precision studies for most substances. The developed method was applied to real cases to test the method.

Sleep quality in times of Covid-19 pandemic.

BACKGROUND: Due to the 2019 novel coronavirus (COVID-19) disease outbreak, social distancing measures were imposed to control the spread of the pandemic. However, isolation may affect negatively the psychological well-being and impair sleep quality. Our aim was to evaluate the sleep quality of respiratory patients during the COVID-19 pandemic lockdown. METHODS: All patients who underwent a telemedicine appointment from March 30 to April 30 of 2020 were asked to participate in the survey. Sleep difficulties were measured using Jenkins Sleep Scale. RESULTS: The study population consisted of 365 patients (mean age 63.9 years, 55.6% male, 50.1% with sleep-disordered breathing [SDB]). During the lockdown, 78.9% of participants were confined at home without working. Most patients (69.6%) reported at least one sleep difficulty and frequent awakenings was the most prevalent problem. Reporting at least one sleep difficulty was associated with home confinement without working, female gender and diagnosed or suspected SDB, after adjustment for cohabitation status and use of anxiolytics. Home confinement without working was associated with difficulties falling asleep and waking up too early in the morning. Older age was a protective factor for difficulties falling asleep, waking up too early and non-restorative sleep. Notably, SDB patients with good compliance to positive airway pressure therapy were less likely to report sleep difficulties. CONCLUSIONS: Home confinement without working, female gender and SDB may predict a higher risk of reporting sleep difficulties. Medical support during major disasters should be strengthened and potentially delivered through telemedicine, as this comprehensive approach could reduce psychological distress and improve sleep quality.

Influence of Respiratory Muscle Training on Patients' Recovery after Lung Resection.

This prospective experimental study aimed to compare effects of 3 different home-based postoperative respiratory muscle training protocols - inspiratory, expiratory and combined, in the patients' postoperative recovery, regarding safety and respiratory muscle function, pulmonary function, physical fitness, physical activity (PA), dyspnoea and quality of life (QoL). Patients were divided in four groups Usual Care (UCare), inspiratory (IMT), expiratory (EMT) or combined muscle training (CombT) according to group allocation. Significant treatment*time interactions were found for maximal inspiratory pressure (MIP) (p=0.014), sedentary PA (SEDPA) (p=0.003), light PA (LIGPA) (p=0.045) and total PA (p=0.035). Improvements were observed for MIP in CombT (p=0.001), IMT (p=0.001), EMT (p=0.050). SEDPA reduced in EMT (p=0.001) and IMT (p=0.006), while LIGPA increased in both groups (p=0.001), as well as Total PA (p=0.005 and p=0.001, respectively). In UCare, CombT, and EMT, QoL improved only for Usual Activities. In conclusion, the addition of respiratory muscle training to physiotherapy usual care is safe and effective to increase MIP and contribute to improve physical activity. The CombT showed greater improvement on MIP, while IMT compared to EMT, was more effective to improve physical activity.

Evaluation of adherence to ambulatory liquid oxygen treatment: are commercialized dual-pressure transducers helpful?

BACKGROUND: Treatment adherence is widely recognized as a critical problem in long-term oxygen therapy, particularly in ambulatory liquid oxygen (LOX) systems. Adherence-monitoring strategies may be helpful in managing patients. We evaluated subjects' adherence to LOX using VisionOx and compared these results with the subjects' own adherence diaries and self-reported perceptions of use. METHODS: Patients using LOX were recruited for a clinical interview; the number of days/week and the mean time of use according to subjects' perceptions were recorded. A 14-day diary was provided for every subject while VisionOx was attached to the LOX. VisionOx is a small device that uses pressure transducers to detect oxygen flow and the subject's breathing frequency. Information is stored and downloaded using dedicated software. RESULTS: Nineteen subjects were included (57.9% male with a median age of 63 years). When asked about the perception of LOX use, subjects self-reported using the device for a median of 100.0% of days (78.9% reported to have used it every day) for a median time of 180 min/day. According to data from VisionOx and subjects' diaries during the 14-day evaluation period, the median use was 92.8% of days for 210 min/day. No difference was found between the diaries and VisionOx data. Regarding subjects' perceptions of use, the declared use of LOX percent was significantly higher than reported in the diaries (P = .045) and VisionOx monitoring (P = .045) even though both underestimated the median use per day. CONCLUSIONS: Subjects overestimated adherence to LOX therapy (when measuring percent of days of use) compared to adherence diary and objective adherence monitoring. Because no significant difference was found comparing the diaries and VisionOx use, either may be helpful in clinical practice.

On the pyrolysis mechanism of 2-pyranones and 2-pyranthiones: thermally induced ground electronic state chemistry of pyran-2-thione.

[reaction: see text] This work reports studies of thermochemistry of pyran-2-thione (PT), a sulfur derivative of alpha-pyrone (AP). Moderate heating of PT results in scrambling of sulfur and oxygen atoms in the molecule and formation of isomeric thiapyran-2-one (TP). The products of pyrolysis of PT were studied experimentally by a combined use low temperature matrix isolation and Fourier transform infrared spectroscopy. The infrared spectrum of the TP monomer isolated in solid argon at 10 K was completely assigned based on comparison with theoretical calculations undertaken at the DFT(B3LYP)/6-311++G(d,p) level. The upper limit of thermal stability of PT was investigated using the differential scanning calorimetry technique. It was found that pyrolysis of PT is already initiated at temperatures below 130 degrees C. The mechanism of the observed pyrolytical conversion has been studied theoretically at the MP2/6-311++G(d,p) level, in the ground electronic state. The primary step of the pyrolytical reaction in PT is the alpha-cleavage of the C-O single bond. It proceeds via an open-ring thioketene-aldehyde structure, TK1. According to the calculations, the ring-opening reaction from PT to TK1 requires an activation energy less than 80 kJ mol(-1), at 130 degrees C, being the rate-determining step. Further steps of the pyrolytical reaction involve internal rotations around single bonds and [1,5] sigmatropic shift of the aldehydic hydrogen. Pyrolytical ring-opening reactions were studied theoretically also for AP and TP and compared to the pyrolysis of PT. It is suggested that the relative ease of the pyrolytical transformation in PT can be explained in terms of existence of the additional minimum TK1 in the reaction path. No counterparts for this structure could be theoretically located for AP and TP.