Search Results (11)

Study Objectives: This review aims to explore the epidemiology, pathophysiology, risk factors, and diagnostic approaches of obstructive sleep apnea syndrome and small airway disease, emphasizing their interrelationship and implications for clinical management. Methods: A comprehensive analysis of the literature was conducted to examine shared and distinct characteristics of obstructive sleep apnea syndrome and small airway disease. Risk factors, clinical presentations, diagnostic tools, and management strategies were reviewed to identify potential areas for improvement in care. Results: Obstructive sleep apnea syndrome, characterized by intermittent upper airway obstruction during sleep, contributes to fragmented sleep and systemic diseases. Small airway disease involves inflammation and obstruction of the small airways, impairing airflow and gas exchange. Shared risk factors, such as obesity, smoking, and age, were identified as contributors to the development and progression of both conditions. The co-occurrence of obstructive sleep apnea syndrome and small airway disease exacerbates respiratory symptoms and increases the risk of comorbidities, such as pulmonary hypertension, heart failure, and respiratory failure. Recognition of their interplay highlights the need for integrated diagnostic and therapeutic strategies. Conclusions: The interrelationship between obstructive sleep apnea syndrome and small airway disease underscores the importance of integrated management approaches to improve patient outcomes. Addressing shared risk factors and understanding the interplay between these conditions are crucial for optimizing care. This review identifies key knowledge gaps, including the need for precise diagnostic tools and targeted therapies, which are essential for advancing personalized treatment strategies for individuals with obstructive sleep apnea syndrome and small airway disease. Full article

COVID-19 affects the respiratory system, reducing the oxygen saturation level, leading to hypoxemia and increasing the metabolic oxygenation need. Objective: To describe the nursing interventions related to the need for oxygenation in hospitalized adults with severe COVID-19 disease in the Intensive Care Unit. Method: This was an observational, retrospective and descriptive study in a population of 2205 patients with a convenience sample of n = 430 and based on the North American Nursing Diagnosis Association (NANDA), the Nursing Interventions Classification (NIC) and the Nursing Outcomes Classification (NOC). The analysis was performed with a non-parametric test to determine the association between the nursing interventions and the need for oxygenation. Results: The findings are aimed at improving nursing interventions with statistical associations as follow: oxygen therapy (p < 0.000), airway suctioning (p < 0.000), airway management (p = 0.029), invasive mechanical ventilation (p < 0.000) and non-invasive mechanical ventilation (p = 0.022). NOC taxonomy expected outcomes in ventilation, 34% (146), alteration in gas exchange, 33.7% (145), and respiratory status, 558.9% (253), were severely compromised. Conclusions: The nursing interventions to maintain the respiratory status are focused on airway care and oxygen therapy in order to increase the oxygen saturation level and decrease the severity of the need for oxygenation. Full article

Acute respiratory failure (ARF) is a sudden failure of the respiratory system to ensure adequate gas exchanges. Numerous clinical conditions may cause ARF, including pneumonia, obstructive lung diseases (e.g., asthma), restrictive diseases such as neuromuscular diseases (e.g., spinal muscular atrophy and muscular dystrophy), and albeit rarely, interstitial lung diseases. Children, especially infants, may be more vulnerable to ARF than adults due to anatomical and physiological features of the respiratory system. Assessing respiratory impairment in the pediatric population is particularly challenging as children frequently present difficulties in reporting symptoms and due to compliance and cooperation in diagnostic tests. The evaluation of clinical and anamnestic aspects represents the cornerstone of ARF diagnosis: first level exams (e.g., arterial blood gas analysis) confirm and evaluate the severity of the ARF and second level exams help to uncover the underlying cause. Prompt management is critical, with supplemental oxygen, mechanical ventilation, and the treatment of the underlying problem. The aim of this review is to provide a comprehensive summary of the current state of the art in diagnosing pediatric ARF, with a focus on pathophysiology, novel imaging applications, and new perspectives, such as biomarkers and artificial intelligence. Full article

This paper presents a novel technique for extracting the alveolar part of human breath. Gas exchange occurs between blood and inhaled air in the alveoli, which is helpful in medical diagnostics based on breath analysis. Consequently, the alveolar portion of the exhaled air contains specific concentrations of endogenous EVOC (exogenous volatile organic compound), which, among other factors, depend on the person’s health condition. As this part of the breath enables the screening for diseases, accurate sample collection for testing is crucial. Inaccurate sampling can significantly alter the composition of the specimen, alter the concentration of EVOC (biomarkers) and adversely affect the diagnosis. Furthermore, the volume of alveolar air is minimal (usually <350 mL), especially in the case of people affected by respiratory system problems. For these reasons, precise sampling is a key factor in the effectiveness of medical diagnostic systems. A new technique ensuring high accuracy and repeatability is presented in the article. It is based on analyzing the changes in carbon dioxide concentration in human breath using a fast and compensated non-dispersive infrared (NDIR) sensor and the simple moving adjacent average (SMAA) algorithm. Research has shown that this method accurately identifies exhalation phases with an uncertainty as low as 20 ms. This provides around 350 ms of breath duration for carrying out additional stages of the diagnostic process using various types of analyzers. Full article

At present, the management of patients with acute respiratory distress syndrome (ARDS) largely focuses on ventilator settings to limit intrathoracic pressures by using low tidal volumes and on FiO₂/PEEP relationships to maintain optimal gas exchange. Acute respiratory distress syndrome is a complex medical disorder that can develop in several primary acute disorders, has a rapid time course, and has several classifications that can reflect either the degree of hypoxemia, the extent of radiographic involvement, or the underlying pathogenesis. The identification of subtypes of patients with ARDS would potentially make precision medicine possible in these patients. This is a very difficult challenge given the heterogeneity in the clinical presentation, pathogenesis, and treatment responses in these patients. The analysis of large databases of patients with acute respiratory failure using statistical methods such as cluster analysis could identify phenotypes that have different outcomes or treatment strategies. However, clinical information available on presentation is unlikely to separate patients into groups that allow for secure treatment decisions or outcome predictions. In some patients, non-invasive positive pressure ventilation provides adequate support through episodes of acute respiratory failure, and the development of specialized units to manage patients with this support might lead to the better use of hospital resources. Patients with ARDS have capillary leak, which results in interstitial and alveolar edema. Early attention to fluid balance in these patients might improve gas exchange and alter the pathophysiology underlying the development of severe ARDS. Finally, more attention to the interaction of patients with ventilators through complex monitoring systems has the potential to identify ventilator dyssynchrony, leading to ventilator adjustments and potentially better outcomes. Recent studies with COVID-19 patients provide tentative answers to some of these questions. In addition, expert clinical investigators have analyzed the promise and difficulties associated with the development of precision medicine in patients with ARDS. Full article

Crotalus venom has broad biological activity, including neurotoxic, myotoxic, hematologic, and cytotoxic compounds that induce severe systemic repercussions. We evaluated the pathophysiological and clinical significance of Crotalus durissus cascavella (Cdc) venom-induced pulmonary impairment in mice. We conducted a randomized experimental study, involving 72 animals intraperitoneally inoculated with saline solution in the control group (CG), as well as venom in the experimental group (EG). The animals were euthanized at predetermined intervals (1 h, 3 h, 6 h, 12 h, 24 h, and 48 h), and lung fragments were collected for H&E and Masson histological analysis. The CG did not present inflammatory alterations in pulmonary parenchyma. In the EG, interstitial and alveolar swelling, necrosis, septal losses followed by alveolar distensions, and areas of atelectasis in the pulmonary parenchyma were observed after three hours. The EG morphometric analysis presented pulmonary inflammatory infiltrates at all time intervals, being more significant at three and six (p = 0.035) and six and 12 h (p = 0.006). The necrosis zones were significant at intervals of one and 24 h (p = 0.001), one and 48 h (p = 0.001), and three and 48 h (p = 0.035). Crotalus durissus cascavella venom induces a diffuse, heterogeneous, and acute inflammatory injury in the pulmonary parenchyma, with potential clinical implications for respiratory mechanics and gas exchange. The early recognition and prompt treatment of this condition are essential to prevent further lung injury and to improve outcomes. Full article

Monitoring of the physiologic metric, respiratory frequency (RF), has been shown to be of value in health, disease, and exercise science. Both heart rate (HR) and variability (HRV), as represented by variation in RR interval timing, as well as analysis of ECG waveform variability, have shown potential in its measurement. Validation of RF accuracy using newer consumer hardware and software applications have been sparse. The intent of this report is to assess the precision of the RF derived using Kubios HRV Premium software version 3.5 with the Movesense Medical sensor single-channel ECG (MS ECG) and the Polar H10 (H10) HR monitor. Gas exchange data (GE), RR intervals (H10), and continuous ECG (MS ECG) were recorded from 21 participants performing an incremental cycling ramp to failure. Results showed high correlations between the reference GE and both the H10 (r = 0.85, SEE = 4.2) and MS ECG (r = 0.95, SEE = 2.6). Although median values were statistically different via Wilcoxon testing, adjusted median differences were clinically small for the H10 (RF about 1 breaths/min) and trivial for the MS ECG (RF about 0.1 breaths/min). ECG based measurement with the MS ECG showed reduced bias, limits of agreement (maximal bias, −2.0 breaths/min, maximal LoA, 6.1 to −10.0 breaths/min) compared to the H10 (maximal bias, −3.9 breaths/min, maximal LoA, 8.2 to −16.0 breaths/min). In conclusion, RF derived from the combination of the MS ECG sensor with Kubios HRV Premium software, tracked closely to the reference device through an exercise ramp, illustrates the potential for this system to be of practical usage during endurance exercise. Full article

⁶⁸Ga-radionuclide has gained importance due to its availability via ⁶⁸Ge/⁶⁸Ga generator or cyclotron production, therefore increasing the number of ⁶⁸Ga-based PET radiopharmaceuticals available in clinical practice. [⁶⁸Ga]Ga-citrate PET has been shown to be prominent for detection of inflammation/infection of the musculoskeletal, gastrointestinal, respiratory, and cardiovascular systems. Automation and comparison between conventional and microfluidic production of [⁶⁸Ga]Ga-citrate was performed using miniAllInOne^® (Trasis) and iMiDEV™ (PMB-Alcen) synthetic modules. Fully automated procedures were elaborated for cGMP production of tracer. In order to facilitate the tracer approval as a radiopharmaceutical for clinical use, a new method for radiochemical identity determination by HPLC analysis to complement standard TLC radiochemical purity measurement was developed. The results showed higher radiochemical yields when using MCX cartridge on the conventional module mAIO^®, while a PS-H+ cation exchanger was shown to be preferred for integration into the microfluidic cassette of iMiDEV™ module. In this study, the fully automated radiosynthesis of [⁶⁸Ga]Ga-citrate using different synthesizers demonstrated reliable and reproducible radiochemical yields. In order to demonstrate the applicability of [⁶⁸Ga]Ga-citrate, in vitro and in vivo studies were performed showing similar characteristics of the tracer obtained using macro- and microfluidic ways of production. Full article

Monitoring physical activity, e.g., training load and energy expenditure (EE), is important to optimize the training process in various sports. Especially in team handball, where there is little information about EE in training and competition. The objective of the study was to compare EE in team handball derived from a respiratory gas exchange analysis (spiroergometry) and a local position measurement (LPM) system. Eleven participants completed a validated, team handball game-based performance test and wore a portable spiroergometry system (K5 Cosmed) and an LPM transponder (Catapult ClearSky T6). EE was determined via indirect calorimetry for spiroergometry data and via the metabolic power model for EE for LPM data. EE estimated via the metabolic power model was −66 to −63 ± 12% lower than via indirect calorimetry (p < 0.001, _pη² = 0.97). No correlation was found for the overall test (r = 0.32, p = 0.34), nor for every single heat (r ≤ 0.44, 0.18 ≤ p ≤ 0.99). Therefore, regression analyses predicting spiroergometry data based on LPM data were not feasible. In line with previous studies, the metabolic power model for EE in team handball (including short-distance movements, great accelerations, and non-locomotive actions) is not suitable. Full article

The present work simulates the transport of oxygen, carbon dioxide, and carbon monoxide between a fetus’s circulatory system and the mother’s. The organ responsible for this exchange is the placenta. Carbon monoxide is a common air pollutant, and it impacts the physiological conditions even in low concentration. The impacts of carbon monoxide are especially dangerous for pregnant women, fetuses, and newborn babies. A model of carbon monoxide transport, from the literature, is modified to simulate a pregnant woman (original model was a male), therefore changing some parameters to express the adjusted respiratory system. It was considered the gas exchange in the placenta, to evaluate the concentration of these different gases in the fetus arterial and venous blood. Three methods of the exergy analysis are implemented for both mother and fetus respiratory systems, aiming at the comparison with the respiratory system of a male adult. The destroyed exergy of the literature did not have the same trend as the models proposed in this article, taking into consideration the hemoglobin reactions. In contrast, the entropy generation associated only with the diffusion transport phenomena was one order of magnitude lower than the other methods. The placenta destroyed exergy rate is significantly higher compared to the irreversibilities of the mother’s respiratory system. One possible explanation is the fact that the placenta has other physiological functions than gas transportation. Full article

Lung tissue plays an important role in the respiratory system of mammals after birth. Early lung development includes six key stages, of which the saccular stage spans the pre- and neonatal periods and prepares the distal lung for alveolarization and gas-exchange. However, little is known about the changes in gene expression between fetal and neonatal lungs. In this study, we performed transcriptomic analysis of messenger RNA (mRNA) and long noncoding RNA (lncRNA) expressed in the lung tissue of fetal and neonatal piglets. A total of 19,310 lncRNAs and 14,579 mRNAs were identified and substantially expressed. Furthermore, 3248 mRNAs were significantly (FDR-adjusted p value ≤ 0.05, FDR: False Discovery Rate) differentially expressed and were mainly enriched in categories related to cell proliferation, immune response, hypoxia response, and mitochondrial activation. For example, CCNA2, an important gene involved in the cell cycle and DNA replication, was upregulated in neonatal lungs. We also identified 452 significantly (FDR-adjusted p value ≤ 0.05) differentially expressed lncRNAs, which might function in cell proliferation, mitochondrial activation, and immune response, similar to the differentially expressed mRNAs. These results suggest that differentially expressed mRNAs and lncRNAs might co-regulate lung development in early postnatal pigs. Notably, the TU64359 lncRNA might promote distal lung development by up-regulating the heparin-binding epidermal growth factor-like (HB-EGF) expression. Our research provides basic lung development datasets and will accelerate clinical researches of newborn lung diseases with pig models. Full article