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The Journal of Physiology Dec 2023Carotid bodies are the principal sensory organs for detecting changes in arterial blood oxygen concentration, and the carotid body chemoreflex is a major regulator of... (Review)
Review
Carotid bodies are the principal sensory organs for detecting changes in arterial blood oxygen concentration, and the carotid body chemoreflex is a major regulator of the sympathetic tone, blood pressure and breathing. Intermittent hypoxia is a hallmark manifestation of obstructive sleep apnoea (OSA), which is a widespread respiratory disorder. In the first part of this review, we discuss the role of carotid bodies in heightened sympathetic tone and hypertension in rodents treated with intermittent hypoxia, and the underlying cellular, molecular and epigenetic mechanisms. We also present evidence for hitherto-uncharacterized role of carotid body afferents in triggering cellular and molecular changes induced by intermittent hypoxia. In the second part of the review, we present evidence for a contribution of a hypersensitive carotid body to OSA and potential therapeutic intervention to mitigate OSA in a murine model.
Topics: Animals; Mice; Carotid Body; Hypoxia; Sleep Apnea Syndromes; Hypertension; Sleep Apnea, Obstructive
PubMed: 37029496
DOI: 10.1113/JP284111 -
Lupus Aug 2023Systemic lupus erythematosus (SLE) is non-organ specific autoimmune disease with mainly skin, joint, and kidney involvement. SLE-related acute lung disease (ALD) is...
INTRODUCTION
Systemic lupus erythematosus (SLE) is non-organ specific autoimmune disease with mainly skin, joint, and kidney involvement. SLE-related acute lung disease (ALD) is rare, poorly investigated and can lead to acute respiratory failure. We conducted a retrospective study aiming to describe clinical features, treatments and outcome of SLE-related APD.
METHODS
We retrospectively included all patients with SLE and ALD admitted from November 1996 and September 2018 to La Pitié-Salpêtrière Hospital, after exclusion of viral or bacterial lung infection, cardiac failure or any other alternate diagnosis.
RESULTS
During the time of the study, 14 patients with 16 episodes were admitted to our center: female 79%, mean age ± SD at admission 24 ± 11 years. ALD was inaugural of the SLE in 70% cases. SLE main organ involvement were: arthritis 93%, skin 79%, serositis 79%, hematological 79%, kidney 64%, neuropsychiatric 36% and cardiac 21%. 11 episodes required ICU admission for a median time of 8 days. Chest CT-scan revealed mostly basal consolidation and ground-glass opacities. When available, bronchoalveolar lavage mostly revealed a neutrophilic alveolitis with alveolar hemorrhage in 67% cases. Symptomatic respiratory treatments were: oxygen 81%, high-flow nasal canula oxygen 27%, non-invasive ventilation 36%, mechanical ventilation 64% and venovenous extracorporeal membrane oxygenation 18%. SLE-specific treatments were: corticosteroids 100%, cyclophosphamide 56% and plasma exchange 25%. All patients but one survived to ICU and hospital discharge. Two patients had a relapse of SLE-related ALD but none had interstitial lung disease during follow-up.
CONCLUSION
Systemic lupus erythematosus-related acute respiratory failure is a severe event, mostly occurring at SLE onset, typical harboring a basal consolidation pattern on chest CT-scan and alveolar hemorrhage on BAL pathological examination. Mortality in our cohort is lower than previously reported but these results needs to be confirmed in further larger studies.
Topics: Humans; Female; Lupus Erythematosus, Systemic; Retrospective Studies; Lung Diseases; Hemorrhage; Respiratory Distress Syndrome; Lung; Respiratory Insufficiency
PubMed: 37395001
DOI: 10.1177/09612033231188034 -
Journal of Pediatric Nursing 2023High-flow nasal cannula (HFNC) has been widely used in paediatric medicine as a non-invasive ventilation mode for respiratory support. However, the differences in its... (Review)
Review
PROBLEM
High-flow nasal cannula (HFNC) has been widely used in paediatric medicine as a non-invasive ventilation mode for respiratory support. However, the differences in its efficacy across different diseases and intervention types remain poorly understood.
ELIGIBILITY CRITERIA
An extensive literature search was performed across multiple academic databases to investigate the systematic reviews and meta-analyses of HFNC.
SAMPLE
This study included 35 systematic reviews and meta-analyses, which collectively examined 355 randomised controlled trials and assessed 51 outcome indicators.
RESULTS
The findings suggest that the existing clinical research evidence predominantly supports the therapeutic efficacy of HFNC. Notably, there is a significant focus on treating acute lower respiratory infection, hypoxaemia, bronchiolitis, and respiratory distress syndrome following extubation. However, concerning the respiratory status, the existing clinical research evidence mainly demonstrates the therapeutic benefits in post-extubation respiratory support and primary respiratory support.
CONCLUSIONS
The research on HFNC has witnessed significant expansion, primarily focusing on respiratory disorders, post-extubation respiratory support, conscious sedation, and related fields. The evidence mapping provides a systematic and comprehensive overview of the available evidence on HFNC therapy in paediatric patients.
IMPLICATIONS
This study systematically and comprehensively assessed the clinical subjects and populations involved in HFNC therapy. Notably, this study analyzed the trends, current status, and evidence gaps of research, and furnished decision-makers and relevant researchers with a more comprehensive reference basis.
Topics: Infant, Newborn; Humans; Child; Cannula; Oxygen Inhalation Therapy; Respiration, Artificial; Respiratory Distress Syndrome, Newborn; Continuous Positive Airway Pressure; Randomized Controlled Trials as Topic
PubMed: 37838549
DOI: 10.1016/j.pedn.2023.10.001 -
Chest Sep 2023A 71-year-old woman sought treatment for a nonproductive cough. The patient had experienced no episodes of hemoptysis or shortness of breath. Her illness history...
A 71-year-old woman sought treatment for a nonproductive cough. The patient had experienced no episodes of hemoptysis or shortness of breath. Her illness history included lumbago and dry mouth. The patient did not smoke and had no significant family medical history or medication use. She had no allergies to any food or drugs. Blood test results, including a CBC count, biochemical examination, and coagulation, were unremarkable. Autoantibody screening revealed positive antinuclear antibody findings with a titer of speckled and nucleolar, and anti-Ro/SSA antibodies were elevated at 240 U/mL (normal range, < 7.0 U/mL). Chest CT scan imaging showed a slight infiltrative shadow of the bilateral lower lobes. Because the patient was suspected to have interstitial pneumonia resulting from Sjögren disease, we decided to perform fiber optic bronchoscopy with BAL for evaluation of interstitial lung disease.
Topics: Humans; Female; Aged; Bronchoscopy; Hemoptysis; Cough; Dyspnea; Autoantibodies
PubMed: 37689476
DOI: 10.1016/j.chest.2023.04.027 -
Biomolecules Aug 2023Autophagy is the key process by which the cell degrades parts of itself within the lysosomes. It maintains cell survival and homeostasis by removing molecules... (Review)
Review
Autophagy is the key process by which the cell degrades parts of itself within the lysosomes. It maintains cell survival and homeostasis by removing molecules (particularly proteins), subcellular organelles, damaged cytoplasmic macromolecules, and by recycling the degradation products. The selective removal or degradation of mitochondria is a particular type of autophagy called mitophagy. Various forms of cellular stress (oxidative stress (OS), hypoxia, pathogen infections) affect autophagy by inducing free radicals and reactive oxygen species (ROS) formation to promote the antioxidant response. Dysfunctional mechanisms of autophagy have been found in different respiratory diseases such as chronic obstructive lung disease (COPD) and asthma, involving epithelial cells. Several existing clinically approved drugs may modulate autophagy to varying extents. However, these drugs are nonspecific and not currently utilized to manipulate autophagy in airway diseases. In this review, we provide an overview of different autophagic pathways with particular attention on the dysfunctional mechanisms of autophagy in the epithelial cells during asthma and COPD. Our aim is to further deepen and disclose the research in this direction to stimulate the develop of new and selective drugs to regulate autophagy for asthma and COPD treatment.
Topics: Humans; Mitophagy; Autophagy; Respiration Disorders; Oxidative Stress; Asthma; Pulmonary Disease, Chronic Obstructive; Epithelial Cells; Lysosomes
PubMed: 37627282
DOI: 10.3390/biom13081217 -
Allergy and Asthma Proceedings Nov 2023Allergy immunotherapy (AIT) with fungal extracts is not as straight forward as that with other inhalants. The complexities relate to the number of airborne fungal... (Review)
Review
Allergy immunotherapy (AIT) with fungal extracts is not as straight forward as that with other inhalants. The complexities relate to the number of airborne fungal spores, the limited data on the exposure to the spores of individual species of fungi and their clinical importance, the poor quality of the fungal allergen extracts that are available for the diagnosis and treatment, and the lack of controlled studies establishing dosing and efficacy of AIT with fungal extracts except for Alternaria. The objective was to review what is known with regard to the role of fungi in causing allergic respiratory diseases as well as the evidence that exists for the role of AIT as a treatment for these conditions. A search was conducted of PubMed, textbooks, known articles on immunotherapy with fungal extracts, and references derived from these primary sources. Nine immunotherapy studies that used Alternaria or its major allergen Alt a 1 and two studies that used Cladosporium herbarum were identified. When a good quality extract was administered in adequate doses, immunotherapy with Alternaria was as effective as that with other inhalant allergens. There was a suggestion of efficacy with a specially prepared Cladosporium extract, but systemic reactions were common and limited the tolerated dose. The use of immunotherapy as an adjunct treatment for allergic fungal sinusitis is briefly reviewed, but controlled trials are lacking. Fungal immunotherapy should largely be limited to Alternaria alternata and perhaps C. herbarum. Under conditions of demonstrated exposure to a particular species of fungus and with symptoms that correlate with that exposure as well as availability of an apparently potent extract of that fungus to which the patient is sensitive that fungus may be considered for immunotherapy. Fungal (mold) mixes should not be used for diagnosis or therapy.
Topics: Humans; Allergens; Antigens, Fungal; Hypersensitivity; Immunotherapy; Plant Extracts; Respiration Disorders
PubMed: 37919848
DOI: 10.2500/aap.2023.44.230058 -
Molecular Genetics and Metabolism Nov 2023At any age, respiratory manifestations are a major cause of increased morbidity and mortality of inherited metabolic diseases (IMDs). Type and severity are extremely... (Review)
Review
At any age, respiratory manifestations are a major cause of increased morbidity and mortality of inherited metabolic diseases (IMDs). Type and severity are extremely variable, this depending on the type of the underlying disorder. Symptoms and signs originating from upper or lower airways and/or thoracic wall and/or respiratory muscles involvement can occur either at presentation or in the late clinical course. Acute respiratory symptoms can trigger metabolic decompensation which, in turn, makes airway symptoms worse, creating a vicious circle. We have identified 181 IMDs associated with various types of respiratory symptoms which were classified into seven groups according to the type of clinical manifestations affecting the respiratory system: (i) respiratory failure, (ii) restrictive lung disease, (iii) interstitial lung disease, (iv) lower airway disease, (v) upper airway obstruction, (vi) apnea, and (vii) other. We also provided a list of investigations to be performed based on the respiratory phenotypes and indicated the therapeutic strategies currently available for IMD-associated airway disease. This represents the thirteenth issue in a series of educational summaries providing a comprehensive and updated list of metabolic differential diagnoses according to system involvement.
Topics: Humans; Metabolic Diseases; Respiratory Tract Diseases; Diagnosis, Differential
PubMed: 37517329
DOI: 10.1016/j.ymgme.2023.107655 -
Critical Care Clinics Apr 2024Acute hypoxemic respiratory failure is defined by Pao less than 60 mm Hg or SaO less than 88% and may result from V/Q mismatch, shunt, hypoventilation, diffusion... (Review)
Review
Acute hypoxemic respiratory failure is defined by Pao less than 60 mm Hg or SaO less than 88% and may result from V/Q mismatch, shunt, hypoventilation, diffusion limitation, or low inspired oxygen tension. Acute hypercapnic respiratory failure is defined by Paco ≥ 45 mm Hg and pH less than 7.35 and may result from alveolar hypoventilation, increased fraction of dead space, or increased production of carbon dioxide. Early diagnostic maneuvers, such as measurement of SpO and arterial blood gas, can differentiate the type of respiratory failure and guide next steps in evaluation and management.
Topics: Humans; Hypoventilation; Respiratory Distress Syndrome
PubMed: 38432694
DOI: 10.1016/j.ccc.2024.01.002 -
Pulmonology 2024
Topics: Humans; Chronic Cough; Cough
PubMed: 37210335
DOI: 10.1016/j.pulmoe.2023.04.004 -
Scientific Reports Dec 2023The existence of causal relationship between dietary factors and respiratory diseases is uncertain. We comprehensively investigated the association between dietary...
The existence of causal relationship between dietary factors and respiratory diseases is uncertain. We comprehensively investigated the association between dietary factors and respiratory diseases by using Mendelian randomization (MR). Genetic variants linked to dietary factors were selected as instrumental variables with genome-wide significance. These instrumental variables were obtained from large GWAS databases. These databases include Biobank, the FinnGen study, and other large consortia. We used multivariate MR analyses to control the effects of smoking and education. Median analysis was conducted to evaluate whether body mass index (BMI) played a role in dietary factors in respiratory diseases. Dried fruit intake was found to be associated with a decreased risk of chronic obstructive pulmonary disease (COPD) (OR: 0.211; 95% CI 0.117-0.378; P < 0.001) and asthma (OR: 0.539; 95% CI 0.357-0.815; P = 0.003). Conversely, pork intake was associated with an increased risk of international pharmaceutical federation (IPF) (OR: 1.051*10, 95% CI 4.354-2.56*10, P = 0.004). However, no significant associations were observed between the 20 dietary factors and obstructive sleep apnea (OSA). In addition, multivariate MR analyses showed that the above results were unchanged in smoking and nonsmoking populations, while the effect of dried fruit intake on asthma was significantly attenuated after corrective education. The results of the mediator variable analysis indicated that BMI could serve as a mediator of the above results. This study found that dried fruits slowed the progression of COPD and asthma, while pork promoted IPF. However, no effect of dietary factors on OSA was found. Meanwhile, we showed that the above results were unchanged in smoking and non-smoking populations. In contrast, education could influence the role of diet on asthma, and BMI could be used as a mediating variable to influence the above results.
Topics: Humans; Mendelian Randomization Analysis; Smoking; Respiratory Tract Diseases; Asthma; Pulmonary Disease, Chronic Obstructive; Sleep Apnea, Obstructive; Genome-Wide Association Study
PubMed: 38114639
DOI: 10.1038/s41598-023-50055-x