Search Results (192)

Obstructive sleep apnea (OSA) is a sleep-related respiratory disorder characterized by partial or complete obstruction of the upper airway, typically resulting in a decrease in arterial oxygen saturation and repeated awakenings from sleep. It is the most common sleep-related respiratory disorder, affecting 9% to 38% of adults. OSA is associated with loss of tone, improper contraction of the tongue, and pharyngeal dilator muscles of the upper airway during sleep. The gold-standard treatment for moderate-to-severe OSA is continuous positive airway pressure (CPAP). However, many patients have poor long-term compliance with CPAP. Stimulation of the upper airway with electrical activation of the hypoglossal nerve has emerged as a promising treatment for patients with moderate-to-severe OSA who have failed CPAP therapy. Objectives: The present paper aims to review the literature regarding neurostimulation for the treatment of OSA. Conclusions: Hypoglossal nerve stimulation (HNS) has shown favorable success and low morbidity in the management of moderate-to-severe OSA. Full article

This study explored the effects of cannabidiol (CBD) on clinically relevant parameters, including sedation, compliance, and temperament, as well as mechanical nociceptive thresholds in healthy cats. Nine client-owned cats (3.44 ± 2.35 years, mean ± standard deviation) were assessed prior to (baseline) and 30 min, 1, 2, 4, 8, 12, and 24 h after oral administration of 8 mg/kg CBD oil via capsule. Sedation scores increased significantly 2, 4, and 8 h post administration compared to baseline (all medians = 1 vs. 0 at baseline; p < 0.001). Compliance and temperament scores were significantly reduced 2 and 4 h post dosing, with median scores decreasing from 1 at baseline to 0 after 2 and 4 h for both parameters (p < 0.001 and p = 0.012, respectively). Mechanical nociceptive thresholds and sensitivity, assessed using an algometer and von Frey filaments, respectively, along with physiological parameters (heart rate, respiratory rate, and body temperature), remained unchanged across timepoints. These results indicate that 8 mg/kg CBD induces mild sedation and reduces handling resistance in healthy cats without affecting nociceptive thresholds or physiological stability. Therefore, CBD may facilitate non-painful procedures requiring animal cooperation; further controlled studies are warranted to confirm these findings. Full article

Background/Objectives: Lung-protective ventilation (LPV) reduces postoperative pulmonary complications (PPCs) in obese patients. While the roles of low tidal volume and positive end-expiratory pressure (PEEP) in LPV have been established in patients with healthy lungs, the protective effect of alveolar recruitment strategies (ARSs) remains a subject of debate. This study aims to evaluate the benefit of ARSs in patients with low-to-moderate risk according to the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score undergoing gynecologic cancer surgery with LPV and low tidal volume intraoperatively. Methods: A total of 88 obese patients were evaluated in this study. They were divided into two groups as the non-ARS group (non-ARS) and the ARS group (ARS). Intraoperative hemodynamics, blood gas analyses, respiratory mechanics, mechanical ventilator parameters, and postoperative outcomes were compared in these obese patients. Results: A total of 40 obese patients undergoing major gynecological cancer surgery were included in this study. Although the non-ARS group presented with higher weight (p < 0.05), body mass indexes were similar to the ARS group. Intraoperative blood gas analysis revealed higher end-tidal carbon dioxide (etCO₂) levels in the non-ARS group during the T2 and T3 time intervals (p < 0.05). In the ARS group, peak inspiratory pressure (PIP) at T3 was lower, while drive pressures at T1 and T2 and dynamic compliance at T3 were higher (p < 0.05). Radiologic atelectasis scores were higher in the non-ARS group, indicating more atelectatic lung images (p < 0.05). PPC rates were similar across both groups. Conclusions: Although the ARS demonstrated positive effects on lung mechanics and radiologic atelectasis scores in major open gynecologic cancer surgeries, it did not effectively reduce postoperative pulmonary complications. Full article

Background/Objectives: Patients recovering from COVID-19 often experience persistent respiratory symptoms, necessitating pulmonary function monitoring. While clinical spirometry is the gold standard, home spirometry offers a remote alternative. This study evaluated the validity of an ultrasonic home-based spirometer for monitoring lung function in post-COVID-19 pneumonia patients over 12 weeks. Methods: This prospective study included 30 post-COVID pneumonia patients who underwent clinical spirometry at weeks 4, 8 and 12. Participants performed weekly home spirometry using the SpiroHome Personal^® device. Agreement between home and clinical spirometry was assessed using a Bland–Altman analysis, intraclass correlation coefficients (ICCs), and Pearson correlation coefficients. Pulmonary function changes over time were analyzed using repeated measures ANOVA. Results: Home spirometry showed strong agreement with clinical spirometry for forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1), with ICC values exceeding 0.92. The Bland–Altman analysis demonstrated minimal bias, though limits of agreement exceeded the clinically accepted threshold of ±150 mL. FEV1/FVC ratios showed greater variability. Pulmonary function improved significantly over 12 weeks for both methods (p < 0.002). Patient adherence to home spirometry remained high, with a median of 18.50 sessions [IQR: 15.00–26.00] and an overall compliance rate of 98.33% ± 9.13%. Conclusions: Home spirometry provides reliable pulmonary function measurements, particularly for FVC and FEV1, supporting its role as a remote monitoring tool. Despite minor variability in FEV1/FVC, home spirometry enables frequent assessment of lung function recovery, potentially reducing hospital visits and improving patient management. Full article

The COVID-19 pandemic raised global concerns about the shortage of ventilators and revealed the challenges of rapidly scaling up production to meet emergency needs. In response, numerous teams worldwide attempted to develop emergency and simple mechanical ventilators. Among these, the CoroVent ventilator was developed to meet the urgent need for ventilatory support in the Czech Republic. The aim of this study was to describe the innovative and simple design of the CoroVent emergency ventilator, evaluate its compliance with international safety and performance standards, verify its reliability under simulated clinical conditions, and demonstrate its suitability for use in crisis scenarios. CoroVent was designed with a focus on the clinical needs of patients with COVID-19 respiratory failure and to ensure safe ventilation while maintaining a simplified design. It features volume-controlled, pressure-limited mandatory ventilation and supports key adjustable parameters such as tidal volume, respiratory rate, inspiratory-to-expiratory time ratio, inspired oxygen fraction, and positive end-expiratory pressure (PEEP). The ventilator incorporates robust safety mechanisms, including alarms and a safety relief valve, to protect against excessive airway pressures. Results confirmed the ability to maintain consistent tidal volumes, stable PEEP, and precise pressure limitation over extended periods of use. The results showed that CoroVent met the essential international standards for accuracy, including those set by the UK Medicines and Healthcare products Regulatory Agency, U.S. Food and Drug Administration, and ISO 80601-2-12. Although production of these ventilators was stopped in 2021 as the Czech Republic managed the crisis and shortage of ventilators, the results validate their reliability as emergency ventilators and indicate their potential to support critical care needs in crisis situations. Full article

Automated ventilator controllers have the potential to simplify oxygen and carbon dioxide management for trauma. In the pre-hospital or military medicine environment, trauma care can be required for prolonged periods by personnel with limited ventilator management training. As such, there is a need for closed-loop control systems that can adapt ventilator management to a complex, ever-changing medical environment. Here, we present a novel hardware-in-loop test platform for the independent troubleshooting and evaluation of oxygen and carbon dioxide automated ventilator management capabilities. The oxygen management system provides an analogue blood oxygen signal that is responsive to the fraction of inspired oxygen and the peak inspiratory pressure ventilator settings. A tested oxygenation controller successfully reached the target oxygen saturation within 5 min. The carbon dioxide removal system integrates with commercial ventilator technology and mimics carbon dioxide generation, lung compliance, and airway resistance while providing an end-tidal carbon dioxide level that is responsive to changes in the tidal volume and respiratory rate settings. A test mechanical ventilator controller was able to regulate EtCO₂ regardless of the starting value within 10 min. This highlights the system’s functionality and provides proof-of-concept demonstrations for how the hardware-in-loop test platforms can be used for evaluating closed-loop controller technologies. Full article

Background: In recent years, enzootic nasal tumor virus 2 (ENTV-2) has become prevalent in China, resulting in substantial economic losses for the goat industry. In order to enrich the availability of detection methods for ENTV-2, this study developed an expedited and accurate reverse-transcription quantitative real-time polymerase chain reaction (RT-qPCR) assay to facilitate the detection and quantification of ENTV-2. Methods: Specifically, a pair of primers and a TaqMan probe targeting conserved regions of the pro gene were designed to allow the specific amplification and detection of viral RNA in clinical samples. Moreover, modifying the method for use in a quantitative real-time PCR (qPCR) assay enables the detection of proviral DNA in tumor specimens. Results: Both methods exhibited a detection limit for the ENTV-2 standard plasmid at 10⁰ copies/µL. The detection methods we established exhibited high specificity and sensitivity to ENTV-2, without cross-reactivity with other pathogens causing respiratory diseases or endogenous retroviruses (EBRVs). We performed an ENTV-2 analysis of clinical samples in goats via RT-qPCR using nasal swab samples (n = 558) collected from three geographically distinct flocks in Lingyou County, Baoji City, Shaanxi Province, China, and 58 positive samples were detected for a positivity rate of 10.4%. After euthanasia, the autopsy report showed nasal cavity masses. Histopathological analysis demonstrated an epithelial neoplasm, in compliance with the features of enzootic nasal adenocarcinoma (ENA). Three full-length genomes were sequenced to assess genomic sequence conservation and variation. Multiple-sequence alignment demonstrated the existence of sequence variations among strains. Phylogenetic analysis of the nucleotide sequences revealed that the ENTV-2 SX1~3 isolates were phylogenetically related to the Chinese ENTV-2 isolates, especially the JY strain. Furthermore, recombination analysis suggested that both ENTV-2 SX1 and ENTV-2 SX2 might be recombinant variants. Conclusions: In conclusion, both methods are highly specific for the pro gene of ENTV-2, and the development of this assay has been deemed crucial to the early identification and subsequent control of this viral infection. Our results provide valuable information for further research on the genetic variation and evolution of ENTV-2 in China. Full article

Background: Influenza virus is one of the major respiratory virus infections that is a global health concern. Although there are already approved vaccines, most are administered via the intramuscular route, which is usually painful, leading to vaccine hesitancy. To this end, exploring the non-invasive, transdermal vaccination route using dissolving microneedles would significantly improve vaccine compliance. Research on innovative vaccine delivery systems, such as antigen-loaded PLGA microparticles, has the potential to pave the way for a broader range of vaccine candidates. Methods: In this proof-of-concept study, a combination of the inactivated influenza A H1N1 virus and inactivated influenza A H3N2 virus were encapsulated in a biodegradable poly (lactic-co-glycolic acid) (PLGA) polymeric matrix within microparticles, which enhanced antigen presentation. The antigen PLGA microparticles were prepared separately using a double emulsion (w/o/w), lyophilized, and characterized. Next, the vaccine microparticles were assessed in vitro in dendritic cells (DC 2.4) for immunogenicity. To explore pain-free transdermal vaccination, the vaccine microparticles were loaded into dissolving microneedles and administered in mice (n = 5). Results: Our vaccination study demonstrated that the microneedle-based vaccine elicited strong humoral responses as demonstrated by high antigen-specific IgA, IgG, IgG1, and IgG2a antibodies in serum samples and IgA in lung supernatant. Further, the vaccine also elicited a strong cellular response as evidenced by high levels of CD4+ and CD8a+ T cells in lymphoid organs such as the lymph nodes and spleen. Conclusion: The delivery of influenza vaccine-loaded PLGA microparticles using microneedles would be beneficial to individuals experiencing needle-phobia, as well as the geriatric and pediatric population. Full article

Chronic respiratory diseases (CRDs) are a significantly major cause of mortality in Saudi Arabia, with their progression frequently involving comorbidities and exacerbations that extend beyond the lungs. This review considers the current state of pulmonary rehabilitation (PR) in Saudi Arabia, this being a well-known non-pharmacological intervention to help control and reduce the burden of CRDs, highlighting the intervention’s availability, multidisciplinary approach, and integration within the healthcare system, as well as examining the diseases’ contribution to overall symptom severity, impairing daily activities and significantly worsening the patient’s quality of life. Although PR is strongly recommended for managing CRDs, its utilization in Saudi Arabia remains limited or unavailable in many regions. Key barriers to PR access include inadequate awareness among healthcare providers and patients, logistical challenges, and an insufficient number of specialized facilities and trained professionals. Expanding PR programs in Saudi Arabia requires addressing geographical barriers, ensuring adequate space, resources, and trained personnel, and raising awareness among healthcare providers through education and training. Integrating PR principles into medical education and offering incentives for specialization can help overcome personnel shortages. Additionally, promoting telerehabilitation can enhance patient compliance and ensure the long-term success of PR programs. These initiatives aim to optimize PR services and improve patient outcomes across the nation. Full article

Objectives: This study aims to assess the potential role of the ultrasound (US) monochromatic Superb Microvascular Index (mSMI) to predict malignancy of solid focal lesions, correlating the vascular index (VI) with bioptic histological results. Methods: In this single-center retrospective analysis, patients undergoing percutaneous US-guided biopsy of solid lesions were considered. Biopsy indication was given by a multidisciplinary team evaluation based on clinical radiological data. Exclusion criteria were: unfeasible SMI evaluations due to poor respiratory compliance, locations not appreciable with the SMI, previous antiangiogenetic chemo/immunotherapies, and inconclusive histological reports. The mSMI examination was conducted in order to visualize extremely low-velocity flows with a high resolution and high frame rate; the VI was semi-automatically calculated. All bioptic procedures were performed under sole US guidance using 16G or 18G needles, immediately after mSMI assessment. Results: Forty-four patients were included (mean age: 64 years; 27 males, 17 females). Liver (15/43), kidneys (9/43), and lymph nodes (6/43) were the most frequent targets. At histopathological analysis, 7 lesions were benign and 37 malignant, metastasis being the most represented. The VI calculated in malignant lesions was statistically higher compared to benign lesions (35.45% and 11% in malignant and benign, respectively; p-value 0.013). A threshold VI value of 15.4% was identified to differentiate malignant lesions. The overall diagnostic accuracy of the VI with the mSMI was 0.878, demonstrating a high level of diagnostic accuracy. Conclusions: In this study, the mSMI analysis of solid focal lesions undergoing percutaneous biopsy significantly correlated with histological findings in terms of malignant/benign predictive value, reflecting histological vascular changes in malignant lesions. Full article

Background/Objectives: Surgical procedures in chronic obstructive pulmonary disease (COPD) patients carry a high risk of postoperative respiratory failure, often causing the need for mechanical ventilation and prolonged intensive care unit (ICU) stays. Accompanying COPD with heart failure further increases the risk of complications. This study aimed to identify predictors of mortality, prolonged ICU and hospital stays, the need for mechanical ventilation, and vasoactive drug usage in ICU patients with moderate to severe COPD undergoing elective non-cardiac surgery. Methods: This retrospective cohort study analyzed eICU-CRD data, including adult patients with moderate to severe COPD admitted to the ICU from the operating room following elective non-cardiac surgery. Spearman’s correlation analysis was performed to assess associations between intraoperative ventilation parameters and ICU/hospital length of stay, postoperative laboratory parameters, and their perioperative dynamics. Results: This study included 680 patients (21% with severe COPD). Hospital and ICU mortality were 8.6% and 4.4%, respectively. Median ICU and hospital stays were 1.9 and 6.6 days, respectively. Intraoperative tidal volume, expired minute ventilation, positive end-expiratory pressure, mean airway pressure, peak inspiratory pressure, and compliance had no statistically significant association with mortality, postoperative mechanical ventilation, its duration, or the use of vasopressors/inotropes. Tidal volume correlated positively with changes in monocyte count (R = 0.611; p = 0.016), postoperative lymphocytes (R = 0.327; p = 0.017), and neutrophil count (R = 0.332; p = 0.02). Plateau pressure showed a strong positive association with the neutrophil-to-lymphocyte ratio (R = 0.708; p = 0.001). Conclusions: Intraoperative ventilation modes and parameters in COPD patients appear to have no significant impact on the outcomes or laboratory markers, except possibly for the neutrophil-to-lymphocyte ratio, although its elevation cause remains unclear. Full article

Background/Objectives: Managing ventilatory strategies in patients with obesity under general anesthesia presents significant challenges due to obesity-related pathophysiological changes. Inverse ratio ventilation (IRV) has emerged as a potential strategy to optimize respiratory mechanics during laparoscopic surgery in this population. The primary outcomes were changes in respiratory mechanics, including peak inspiratory pressure (P_Peak), plateau pressure (P_Plat), mean airway pressure (P_Mean), and dynamic compliance (C_Dyn). Secondary outcomes included gas exchange parameters, hemodynamic measures, inflammatory cytokines, and postoperative complications. Methods: A systematic review and meta-analysis were conducted, searching PubMed, Scopus, EMBASE, and PMC Central. Only English-language randomized controlled trials (RCTs) evaluating the impact of IRV in adult surgical patients with obesity were included. The quality and certainty of evidence were assessed using the Risk of Bias 2 (RoB 2) tool and the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) framework, respectively. Results: Three RCTs including 172 patients met the inclusion criteria. Compared to conventional ventilation without prolonged inspiratory time or IRV, IRV significantly reduced P_Peak (MD [95%CI]: −3.15 [−3.88; −2.42] cmH₂O, p < 0.001) and P_Plat (MD [95%CI]: −3.13 [−3.80; −2.47] cmH₂O, p < 0.001) while increasing P_Mean (MD [95%CI]: 4.17 [3.11; 5.24] cmH₂O, p < 0.001) and C_Dyn (MD [95%CI]: 2.64 [0.95; 4.22] mL/cmH₂O, p = 0.002) during laparoscopy, without significantly affecting gas exchange. IRV significantly reduced mean arterial pressure (MD [95%CI]: −2.93 [−3.95; −1.91] mmHg, p < 0.001) and TNF-α levels (MD [95%CI]: −9.65 [−17.89; −1.40] pg/mL, p = 0.021). Conclusions: IRV optimizes intraoperative respiratory mechanics but has no significant impact on postoperative outcomes, necessitating further research to determine its clinical role. Full article

Background/Objectives: A common reason for a pediatrician’s visit is acute tonsillopharyngitis (ATR), which is usually caused by viruses. A dietary supplement comprising Pelargonium sidoides extract, honey, propolis, and zinc was proposed as an effective adjuvant for the management of respiratory tract infections. The study aimed to determine the efficacy of this dietary supplement in conjunction with standard of care (SoC) compared to SoC alone, in a pediatric population affected by ATR. Methods: This open randomized study (registered on ClinicalTrials.gov: NCT 04899401) involved three Romanian sites specialized in pediatric care. The primary endpoints were changes in Tonsillitis Severity Score and the number of patients failing to respond (evaluating the use of ibuprofen or high-dose paracetamol as a rescue medication). One hundred and thirty children, distributed into two groups, were enrolled and treated for six days. Results: The results showed an overall better performance in terms of efficacy of dietary supplement + SoC, compared to SoC alone, with lower total Tonsillitis Severity Score ratings on day 6 (p = 0.002) and lower sub-scores related to erythema and throat pain on day 6. No adverse events were reported. Investigators found compliance to be optimal. Conclusions: The administration of the dietary supplement + SoC in pediatric patients with ATR was found to be safe and superior to the administration of SoC alone in terms of efficacy. The results confirmed that the tested dietary supplement is an optimum effective adjuvant in the treatment of respiratory tract infections and is suitable for the daily clinical practice of pediatricians. Full article

Respiratory compliance reflects the ability of the lungs and chest wall to expand in response to increases in pressure. In this review, relevant studies were selected through a comprehensive literature search with the aim of summarizing and generalizing them to describe the relevant factors that may be present in veterinary clinical practice and affect respiratory compliance in dogs. Individual factors, including breeds, disease background, drugs administered, and especially surgical procedures, can result in alterations to respiratory compliance due to their impact on the respiratory system in dogs. Despite its potential clinical utility, such as in anesthesia monitoring, respiratory compliance remains underutilized in veterinary medicine, and further research is necessary to support its future clinical applications. Full article

Traffic-related air pollution significantly affects air quality. Many cities have introduced low emission zones (LEZs) to restrict urban transport. Nitrogen dioxide (NO₂) is a dangerous pollutant associated with adverse health effects, such as respiratory diseases, cancer, and death. This research aimed to evaluate the impact of implementing an LEZ during an informative period in which no fines were imposed on vehicles. The methodology consisted of several phases. Firstly, the legal levels to guarantee compliance with air quality standards of the Directive 2008/50/EC were studied. Secondly, this study analyzed the temperature and wind speed patterns of the city under investigation. Finally, an in-depth statistical study evaluated the impact of the LEZ at each air quality monitoring station throughout the municipality. The case study focused on Seville, Spain, using data from 2022, 2023, and the first quarter of 2024, the latter corresponding to the reporting period without fines. The results reveal a wide dispersion and periodicity in NO₂ concentrations at the monitoring stations. Seville complied with NO₂ air quality regulations before the implementation of the LEZ, with similar seasonal patterns observed. A low overall impact was observed in the first three months after implementation. This methodology can be used universally. Full article