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International Journal of Chronic... 2018COPD is one of the leading causes of morbidity and mortality in the world; however, the most varied amounts of clinical and laboratory characteristics acts in different...
BACKGROUND
COPD is one of the leading causes of morbidity and mortality in the world; however, the most varied amounts of clinical and laboratory characteristics acts in different ways in the mortality among over time. Therefore, this study aimed to evaluate the predictors of mortality in patients with COPD after 9 years.
PATIENTS AND METHODS
One hundred and thirty-three patients with COPD were assessed at baseline by spirometry, pulse oximetry (SpO), body composition, intensity of dyspnea, distance walked in the 6-minute walk test (6MWT), and Charlson Comorbidity Index (CCI).
RESULTS
After 9 years, it was not possible to identify the lifetime of 4 patients who died and of 19 patients who stopped follow-up; thus, 110 patients were included in the analysis of predictors of mortality (67% male, 65±9 years old, and FEV: 52.5 [40%-73%]). Male sex, age, SpO, Body mass index, airway Obstruction, Dyspnea, and Exercise capacity (BODE) index, and frequency of exacerbations in the first 3 years of follow-up were considered in the model. Patients classified at baseline with BODE class 2 (HR: 2.62, 95% CI: 1.36-5.04; =0.004), BODE class 3 (HR: 2.54, 95% CI: 1.15-5.61; =0.02), and BODE class 4 (HR: 15.35, 95% CI: 3.11-75.75; =0.001) showed increased risk of death compared to those with BODE class 1. The CCI (HR: 1.29, 95% CI: 1.00-1.68; =0.04) and the number of exacerbations in the first 3 years (HR: 1.32, 95% CI: 1.00-1.76; =0.04) also showed increased risk of death. By replacing the BODE index for the variables that compose it, those with body mass index ≤21 kg/m showed increased risk of death compared to those with body mass index (BMI)>21 kg/m (HR: 2.70, 95% CI: 1.38-5.25; =0.003).
CONCLUSION
After 9 years, we identified that those with high BODE index, greater CCI, greater frequency of exacerbations in the first 3 years, and BMI ≤21 kg/m showed increased risk of death.
Topics: Aged; Airway Obstruction; Body Mass Index; Brazil; Dyspnea; Exercise Tolerance; Female; Forced Expiratory Volume; Humans; Male; Middle Aged; Mortality; Oximetry; Predictive Value of Tests; Prognosis; Pulmonary Disease, Chronic Obstructive; Severity of Illness Index; Spirometry; Walk Test
PubMed: 30410324
DOI: 10.2147/COPD.S174665 -
Dento Maxillo Facial Radiology Jul 2023The proportionality between anatomical characteristics and disease severity in children and adolescents with obstructive sleep apnea (OSA) has not been well...
OBJECTIVES
The proportionality between anatomical characteristics and disease severity in children and adolescents with obstructive sleep apnea (OSA) has not been well characterized. The present study investigated the relationship between the dentoskeletal and oropharyngeal features of young patients with OSA and either the apnea-hypopnea index (AHI) or the amount of upper airway obstruction.
METHODS
MRI of 25 patients (8- to 18-year-old) with OSA (mean AHI = 4.3 events/h) was retrospectively analyzed. Sleep kinetic MRI (kMRI) was used to assess airway obstruction, and static MRI (sMRI) was used to assess dentoskeletal, soft tissue, and airway parameters. Factors related to AHI and obstruction severity were identified with multiple linear regression (significance level = 0.05).
RESULTS
As evidenced by kMRI, circumferential obstruction was present in 44% of patients, while laterolateral and anteroposterior was present in 28%; as evidenced by kMRI, obstructions were retropalatal in 64% of cases and retroglossal in 36% (no nasopharyngeal obstructions); kMRI showed a higher prevalence of retroglossal obstructions compared to sMRI( = 0.037); the main obstruction airway area was not related to AHI; the maxillary skeletal width was related to AHI ( = -0.512, = 0.007) and obstruction severity ( = 0.625, = 0.002); and the retropalatal width was related to AHI ( = -0.384, = 0.024) and obstruction severity ( = 0.519, = 0.006).
CONCLUSIONS
In children and adolescents, the severity of OSA and obstruction were inversely proportional to the maxillary basal width and retropalatal airway width. Further studies are needed to assess the benefits of targeted clinical treatments widening the transverse dimension of these structures.
Topics: Adolescent; Humans; Child; Retrospective Studies; Sleep Apnea, Obstructive; Airway Obstruction; Oropharynx; Magnetic Resonance Imaging
PubMed: 37192022
DOI: 10.1259/dmfr.20220422 -
Animals : An Open Access Journal From... May 2017Horses engaged in strenuous exercise display physiological responses that approach the upper functional limits of key organ systems, in particular their... (Review)
Review
Horses engaged in strenuous exercise display physiological responses that approach the upper functional limits of key organ systems, in particular their cardiorespiratory systems. Maximum athletic performance is therefore vulnerable to factors that diminish these functional capacities, and such impairment might also lead to horses experiencing unpleasant respiratory sensations, i.e., breathlessness. The aim of this review is to use existing literature on equine cardiorespiratory physiology and athletic performance to evaluate the potential for various types of breathlessness to occur in exercising horses. In addition, we investigate the influence of management factors such as rein and bit use and of respiratory pathology on the likelihood and intensity of equine breathlessness occurring during exercise. In ridden horses, rein use that reduces the jowl angle, sometimes markedly, and conditions that partially obstruct the nasopharynx and/or larynx, impair airflow in the upper respiratory tract and lead to increased flow resistance. The associated upper airway pressure changes, transmitted to the lower airways, may have pathophysiological sequelae in the alveolae, which, in their turn, may increase airflow resistance in the lower airways and impede respiratory gas exchange. Other sequelae include decreases in respiratory minute volume and worsening of the hypoxaemia, hypercapnia and acidaemia commonly observed in healthy horses during strenuous exercise. These and other factors are implicated in the potential for ridden horses to experience three forms of breathlessness-"unpleasant respiratory effort", "air hunger" and "chest tightness"-which arise when there is a mismatch between a heightened ventilatory drive and the adequacy of the respiratory response. It is not known to what extent, if at all, such mismatches would occur in strenuously exercising horses unhampered by low jowl angles or by pathophysiological changes at any level of the respiratory tract. However, different combinations of the three types of breathlessness seem much more likely to occur when pathophysiological conditions significantly reduce maximal athletic performance. Finally, most horses exhibit clear behavioural evidence of aversion to a bit in their mouths, varying from the bit being a mild irritant to very painful. This in itself is a significant animal welfare issue that should be addressed. A further major point is the potential for bits to disrupt the maintenance of negative pressure in the oropharynx, which apparently acts to prevent the soft palate from rising and obstructing the nasopharynx. The untoward respiratory outcomes and poor athletic performance due to this and other obstructions are well established, and suggest the potential for affected animals to experience significant intensities of breathlessness. Bitless bridle use may reduce or eliminate such effects. However, direct comparisons of the cardiorespiratory dynamics and the extent of any respiratory pathophysiology in horses wearing bitted and bitless bridles have not been conducted. Such studies would be helpful in confirming, or otherwise, the claimed potential benefits of bitless bridle use.
PubMed: 28587125
DOI: 10.3390/ani7060041 -
PloS One 2018The Air-Smart Spirometer is the first portable device accepted by the European Community (EC) that performs spirometric measurements by a turbine mechanism and displays...
BACKGROUND
The Air-Smart Spirometer is the first portable device accepted by the European Community (EC) that performs spirometric measurements by a turbine mechanism and displays the results on a smartphone or a tablet.
METHODS
In this multicenter, descriptive and cross-sectional prospective study carried out in 2 hospital centers, we compare FEV1, FVC, FEV1/FVC ratio measured with the Air Smart-Spirometer device and a conventional spirometer, and analyze the ability of this new portable device to detect obstructions. Patients were included for 2 consecutive months. We calculate sensitivity, specificity, positive and negative predictive value (PPV and NPV) and likelihood ratio (LR +, LR-) as well as the Kappa Index to evaluate the concordance between the two devices for the detection of obstruction. The agreement and relation between the values of FEV1 and FVC in absolute value and the FEV1/FVC ratio measured by both devices were analyzed by calculating the intraclass correlation coefficient (ICC) and the Pearson correlation coefficient (r) respectively.
RESULTS
200 patients (100 from each center) were included with a mean age of 57 (± 14) years, 110 were men (55%). Obstruction was detected by conventional spirometry in 73 patients (40.1%). Using a FEV1/FVC ratio smaller than 0.7 to detect obstruction with the Air Smart-Spirometer, the kappa index was 0.88, sensitivity (90.4%), specificity (97.2%), PPV (95.7%), NPV (93.7%), positive likelihood ratio (32.29), and negative likelihood ratio (0.10). The ICC and r between FEV1, FVC, and FEV1 / FVC ratio measured by the Air Smart Spirometer and the conventional spirometer were all higher than 0.94.
CONCLUSION
The Air-Smart Spirometer is a simple and very precise instrument for detecting obstructive airway diseases. It is easy to use, which could make it especially useful non-specialized care and in other areas.
Topics: Adult; Aged; Female; Forced Expiratory Volume; Humans; Lung Diseases, Obstructive; Male; Middle Aged; Spirometry; Vital Capacity
PubMed: 29474502
DOI: 10.1371/journal.pone.0192789 -
International Journal of Chronic... 2018The purpose of this study was to examine differences between patients clinically diagnosed with COPD with and without obstruction by spirometry and to identify risk... (Comparative Study)
Comparative Study
PURPOSE
The purpose of this study was to examine differences between patients clinically diagnosed with COPD with and without obstruction by spirometry and to identify risk factors for respiratory hospitalizations.
MATERIALS AND METHODS
This is a retrospective analysis of all patients diagnosed with COPD at a large academic Internal Medicine Clinic in 2014, who had spirometry performed during the period 2013-2014. Two groups existed: one with obstruction termed classical COPD and another without obstruction. Demographics, comorbidities, prescribed medications, spirometry, respiratory hospitalization, and eosinophilia among other variables were compared between patients with and without obstruction. Risk factors for two or more respiratory hospitalizations during the period 2014-2015 were sought for both populations by both univariate and multivariate analyses. Subsequently, we studied the population without obstruction for risk factors for one or more respiratory hospitalizations first by univariate analysis and then by multivariate analysis.
RESULTS
Among 657 patients, 210 met inclusion criteria, with 157 having obstruction on spirometry and 53 without obstruction. There was no difference between those with and without obstruction on the rate of respiratory hospitalization when using two or more respiratory hospitalizations (=0.397) or one or more respiratory hospitalizations (=0.467). Nontreatment risk factors associated with two or more respiratory hospitalizations by multivariate analysis included a maximum eosinophil count above the threshold of 0.5 K/µL (maximum eosinophil number threshold [MENT]; =0.001, OR =3.792, 95% CI =1.676-8.582) and % predicted forced expiratory volume in the first second (=0.031, OR =0.978, 95% CI =0.959-0.998). In patients without obstruction, MENT above the threshold of 0.5 K/µL (=0.032, OR =5.087, 95% CI =1.147-22.557) was the only risk factor associated with one or more respiratory hospitalizations.
CONCLUSION
In a clinically diagnosed COPD population who had spirometry performed, the presence of airflow obstruction was not a risk factor for respiratory hospitalizations. The most significantly associated nontreatment factor associated with respiratory hospitalization, both in the study population as a whole and in the cohort without obstruction, was MENT above the threshold of 0.5 K/µL.
Topics: Academic Medical Centers; Aged; Chi-Square Distribution; Comorbidity; Eosinophilia; Eosinophils; Female; Forced Expiratory Volume; Hospitalization; Humans; Lung; Male; Michigan; Middle Aged; Multivariate Analysis; Odds Ratio; Pulmonary Disease, Chronic Obstructive; Retrospective Studies; Risk Factors; Spirometry; Vital Capacity
PubMed: 29681729
DOI: 10.2147/COPD.S157230 -
Journal of Plastic, Reconstructive &... Jul 2016In microsurgery, there is a demand for more reliable methods of post-operative monitoring of free flaps, especially with regard to tissue-threatening obstructions of the...
BACKGROUND
In microsurgery, there is a demand for more reliable methods of post-operative monitoring of free flaps, especially with regard to tissue-threatening obstructions of the feeding arteries and draining veins. In this study, we evaluated laser speckle contrast imaging (LSCI) and laser Doppler flowmetry (LDF) to assess their possibilities to detect partial and full venous outflow obstruction, as well as full arterial occlusion, in a porcine flap model.
METHODS
Cranial gluteal artery perforator flaps (CGAPs) were raised, and arterial and venous blood flow to and from the flaps was monitored using ultrasonic flow probes. The venous flow was altered with an inflatable cuff to simulate partial and full (50% and 100%) venous obstruction, and arterial flow was completely obstructed using clamps. The flap microcirculation was monitored using LSCI and LDF.
RESULTS
Both LDF and the LSCI detected significant changes in flap perfusion. After partial (50%) venous occlusion, perfusion decreased from baseline, LSCI: 63.5 ± 12.9 PU (p = 0.01), LDF 31.3 ± 15.7 (p = 0.64). After 100% venous occlusion, a further decrease in perfusion was observed: LSCI 54.6 ± 14.2 PU (p < 0.001) and LDF 16.7 ± 12.8 PU (p < 0.001). After release of the venous cuff, LSCI detected a return of the perfusion to a level slightly, but not significantly, below the baseline level 70.1 ± 11.5 PU (p = 0.39), while the LDF signal returned to a level not significant from the baseline 36.1 ± 17.9 PU (p > 0.99). Perfusion during 100% arterial occlusion decreased significantly as measured with both methods, LSCI: 48.3 ± 7.7 (PU, p < 0.001) and LDF: 8.5 ± 4.0 PU (p < 0.001). During 50% and 100% venous occlusion, LSCI showed a 20% and 26% intersubject variability (CV%), respectively, compared to 50% and 77% for LDF.
CONCLUSIONS
LSCI offers sensitive and reproducible measurements of flap microcirculation and seems more reliable in detecting decreases in blood perfusion caused by venous obstruction. It also allows for perfusion measurements in a relatively large area of flap tissue. This may be useful in identifying areas of the flap with compromised microcirculation during and after surgery.
Topics: Animals; Arterial Occlusive Diseases; Arteries; Blood Flow Velocity; Free Tissue Flaps; Hemodynamics; Laser-Doppler Flowmetry; Microsurgery; Models, Anatomic; Postoperative Complications; Plastic Surgery Procedures; Regional Blood Flow; Reproducibility of Results; Swine; Vascular Patency; Veins
PubMed: 27026039
DOI: 10.1016/j.bjps.2016.02.015 -
International Journal of Chronic... 2021Depression is a prevalent comorbidity of chronic obstructive pulmonary disease (COPD) that, along with COPD, has been associated with inflammation. An association...
RATIONALE
Depression is a prevalent comorbidity of chronic obstructive pulmonary disease (COPD) that, along with COPD, has been associated with inflammation. An association between inflammation and depression in COPD has not been validated in a large COPD cohort.
METHODS
Individuals from the University of Pittsburgh SCCOR cohort and the COPDGene cohort with tobacco use history and airway obstruction (FEV/FVC <0.7) were evaluated using the Beck Depression Inventory II (BDI-II) and the Hospital Anxiety and Depression Scale (HADS), respectively. Participants completed symptom-related questionnaires and plasma IL-6 measurements. -test, Fisher's Exact tests and logistic regression were used for statistical analysis.
RESULTS
The SCCOR cohort included 220 obstructed participants: 44% female and 21.4% with elevated depressive symptoms. GOLD staging distribution was predominantly stage I and II. The COPDGene cohort included 745 obstructed participants: 44% female and 13.0% with elevated depressive symptoms. GOLD distribution was predominantly stage II and III. In the SCCOR cohort, correlation between IL-6 and depressive symptoms trended toward significance (p= 0.08). Multivariable modeling adjusted for FEV, age, gender and medical comorbidities showed a significant association (OR = 1.70, 95% CI = 1.08-2.69). IL-6 was significantly associated with elevated depressive symptoms in COPDGene in both univariate (p=0.001) and multivariable modeling (OR = 1.52, 95% CI =1.13-2.04).
CONCLUSION
Elevated plasma IL-6 levels are associated with depressive symptoms in individuals with COPD independent of airflow limitation and comorbid risk factors for depression. Our results suggest that systemic inflammation may play a significant and possibly bidirectional role in depression associated with COPD.
Topics: Cohort Studies; Comorbidity; Depression; Female; Humans; Inflammation; Male; Pulmonary Disease, Chronic Obstructive
PubMed: 34511896
DOI: 10.2147/COPD.S322144 -
Cureus Jan 2022Bowel obstruction is a surgical emergency that leads to a high rate of admissions. Twenty percent of patients with acute abdominal pain will be diagnosed with bowel...
Bowel obstruction is a surgical emergency that leads to a high rate of admissions. Twenty percent of patients with acute abdominal pain will be diagnosed with bowel obstruction; eighty percent of them are of small origin. It is classified based on etiology to either mechanical or functional. Mechanical obstruction is a physical barrier that obstructs the passage of bowel content; it could be caused by adhesion, tumors, volvulus, hernias, strictures, and gallstone ileus. Functional obstruction is usually due to impaired peristalsis or metabolic disorders. In this article, we report a case of an 80-year-old gentleman with no previous surgical history who was found to have a bowel obstruction. Diagnostic imaging and colonoscopy showed that his clinical presentation was due to gallstone ileus with cholecysto-enteric fistula and sigmoid mass. He underwent exploratory laparotomy with small bowel resection and sigmoidectomy with primary anastomosis and diverting ileostomy. The final pathology showed early moderately differentiated polyp adenocarcinoma T1N0 and was kept on surveillance. The novelty of this case is the presentation of two different abdominal pathologies, which lead to large and small bowel obstruction. Thus, the management decision was challenging, and a thorough workup is advisable in such cases.
PubMed: 35198291
DOI: 10.7759/cureus.21379 -
Journal of Visualized Experiments : JoVE Apr 2017Partial bladder outlet obstruction (pBOO) has a high prevalence, causes significant patient burden, and immense health care costs. The most common animal model to...
Partial bladder outlet obstruction (pBOO) has a high prevalence, causes significant patient burden, and immense health care costs. The most common animal model to investigate bladder remodeling in pBOO are female rodents undergoing partial obstruction at the proximal urethra. Variability in the degree of obstruction and animal mortality are major concerns with proximal obstruction. Furthermore, dissecting around the proximal urethra and bladder neck jeopardizes bladder innervation. We developed a nerve-sparing mid-urethral obstruction (NeMO) model for pBOO avoiding the disadvantages of the traditional model. We approached the urethra just inferior to the pubic symphysis, which obviated the need for laparotomy as well as for dissection in this area; also, the striated urethral sphincter remained untouched. We performed NeMO in female Sprague-Dawley rats (12 obstructions, 6 sham animals) as well as in female C57/bl6 mice (20 obstructions, 18 sham animals). After two weeks, we evaluated bladder function, bladder mass, and body mass. We had no mortalities among obstructed- or sham-operated female rats; as described for the traditional proximal pBOO-method, we tied the suture around the proximal urethra and a temporarily placed 0.9 mm metal rod. NeMO induced an 85% increase in bladder mass after two weeks, average residual urine volume was 0.4 mL in partially obstructed rats while only 0.03 mL in sham animals. In mice, we tested 3 sizes of cannulas that we placed along the urethra when tying the suture. We found that using a 27-gauge cannula resulted in over 50% animal mortality; placing the 25-gauge cannula did not yield the desired response in increasing bladder mass; utilizing a 26-gauge cannula yielded favorable results with minimal animal mortality (1/8) yet a significant 2-fold increase in bladder mass.
Topics: Animals; Disease Models, Animal; Female; Rats; Rats, Sprague-Dawley; Urethra; Urethral Obstruction; Urinary Bladder; Urinary Bladder Neck Obstruction
PubMed: 28518071
DOI: 10.3791/55288 -
Fluids and Barriers of the CNS Jan 2021Approximately 30% of cerebrospinal fluid (CSF) shunt systems for hydrocephalus fail within the first year and 98% of all patients will have shunt failure in their...
BACKGROUND
Approximately 30% of cerebrospinal fluid (CSF) shunt systems for hydrocephalus fail within the first year and 98% of all patients will have shunt failure in their lifetime. Obstruction remains the most common reason for shunt failure. Previous evidence suggests elevated pro-inflammatory cytokines in CSF are associated with worsening clinical outcomes in neuroinflammatory diseases. The aim of this study was to determine whether cytokines and matrix metalloproteinases (MMPs) contribute towards shunt failure in hydrocephalus.
METHODS
Using multiplex ELISA, this study examined shunt failure through the CSF protein concentration profiles of select pro-inflammatory and anti-inflammatory cytokines, as well as select MMPs. Interdependencies such as the past number of previous revisions, length of time implanted, patient age, and obstruction or non-obstruction revision were examined. The pro-inflammatory cytokines were IL-1β, IL-2, IL-5, IL-6, IL-8, IL-12, IL-17, TNF-α, GM-CSF, IFN-γ. The anti-inflammatory cytokines were IL-4 and IL-10, and the MMPs were MMP-2, MMP-3, MMP-7, MMP-9. Protein concentration is reported as pg/mL for each analyte.
RESULTS
Patient CSF was obtained at the time of shunt revision operation; all pediatric (< 18), totaling n = 38. IL-10, IL-6, IL-8 and MMP-7 demonstrated significantly increased concentrations in patient CSF for the non-obstructed subgroup. Etiological examination revealed IL-6 was increased in both obstructed and non-obstructed cases for PHH and congenital hydrocephalic patients, while IL-8 was higher only in PHH patients. In terms of number of past revisions, IL-10, IL-6, IL-8, MMP-7 and MMP-9 progressively increased from zero to two past revisions and then remained low for subsequent revisions. This presentation was notably absent in the obstruction subgroup. Shunts implanted for three months or less showed significantly increased concentrations of IL-6, IL-8, and MMP-7 in the obstruction subgroup. Lastly, only patients aged six months or less presented with significantly increased concentration of IL-8 and MMP-7.
CONCLUSION
Non-obstructive cases are reported here to accompany significantly higher CSF cytokine and MMP protein levels compared to obstructive cases for IL-10, IL-6, IL-8, MMP-7 and MMP-9. A closer examination of the definition of obstruction and the role neuroinflammation plays in creating shunt obstruction in hydrocephalic patients is suggested.
Topics: Adolescent; Biomarkers; Cerebrospinal Fluid Shunts; Child; Child, Preschool; Cytokines; Equipment Failure; Female; Humans; Hydrocephalus; Infant; Inflammation; Male; Matrix Metalloproteinases; Outcome Assessment, Health Care
PubMed: 33514409
DOI: 10.1186/s12987-021-00237-4