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Comparative Biochemistry and... Apr 2021Anurans have an exceptional capacity for maintaining vascular volume compared with other groups of vertebrates. They can mobilize interstitial fluids via lymphatic... (Comparative Study)
Comparative Study Review
Anurans have an exceptional capacity for maintaining vascular volume compared with other groups of vertebrates. They can mobilize interstitial fluids via lymphatic return at rates that are ten-fold higher than mammals. This extraordinary capacity is the result of coordination of specialized skeletal muscles and pulmonary ventilation that vary volume and pressure of subcutaneous lymph sacs, thus moving lymph to dorsally located lymph hearts that return lymph to the vascular space. Variation in the capacity to mobilize lymph within anurans varies with the degree of terrestriality, development of skeletal muscles, lung volume and lung compliance, and lymph heart pressure development. This ability enable anurans, which have the highest rates of evaporative water loss among terrestrial vertebrates, to withstand levels of dehydration far exceeding that of other vertebrates, and to successfully occupy virtually all terrestrial environments during their evolution. Maintenance of vascular fluid volume for all vertebrates can be achieved primarily by moving fluid from the interstitial space to the vascular space by transcapillary uptake and mobilization of interstitial (lymphatic) fluid. Transcapillary fluid uptake at the capillary level has been analyzed historically by Krogh and others from a Starling perspective and involves a balance of hydrostatic and oncotic forces. A complete evaluation of blood volume homeostasis also incorporates pressures and compliances of the vascular and interstitial spaces, but has been applied to only a few species. In this review we outline the current understanding of how anurans and other vertebrates maintain blood volume during hypovolemic challenges such as dehydration and hemorrhage which is crucial for maintaining cardiac output.
Topics: Amphibians; Animals; Anura; Biological Transport; Blood Volume; Capillaries; Fishes; Hemorrhage; Humans; Hypovolemia; Lung; Lymph; Lymphatic System; Muscle, Skeletal; Pulmonary Ventilation; Ranidae; Species Specificity; Vertebrates; Viscosity
PubMed: 33358925
DOI: 10.1016/j.cbpa.2020.110878 -
Nitric Oxide : Biology and Chemistry May 2024Cardiopulmonary bypass (CPB) is associated with intravascular hemolysis which depletes endogenous nitric oxide (NO). The impact of hemolysis on pulmonary arterial... (Observational Study)
Observational Study
BACKGROUND
Cardiopulmonary bypass (CPB) is associated with intravascular hemolysis which depletes endogenous nitric oxide (NO). The impact of hemolysis on pulmonary arterial compliance (PAC) and right ventricular systolic function has not been explored yet. We hypothesized that decreased NO availability is associated with worse PAC and right ventricular systolic function after CPB.
METHODS
This is a secondary analysis of an observational cohort study in patients undergoing cardiac surgery with CPB at Massachusetts General Hospital, USA (2014-2015). We assessed PAC (stroke volume/pulmonary artery pulse pressure ratio), and right ventricular function index (RVFI) (systolic pulmonary arterial pressure/cardiac output), as well as NO consumption at 15 min, 4 h and 12 h after CPB. Patients were stratified by CPB duration. Further, we assessed the association between changes in NO consumption with PAC and RVFI between 15min and 4 h after CPB.
RESULTS
PAC was lowest at 15min after CPB and improved over time (n = 50). RVFI was highest -worse right ventricular function- at CPB end and gradually decreased. Changes in hemolysis, PAC and RVFI differed over time by CPB duration. PAC inversely correlated with total pulmonary resistance (TPR). TPR and PAC positively and negatively correlated with RVFI, respectively. NO consumption between 15min and 4 h after CPB correlated with changes in PAC (-0.28 ml/mmHg, 95%CI -0.49 to -0.01, p = 0.012) and RVFI (0.14 mmHg*L*min, 95%CI 0.10 to 0.18, p < 0.001) after multivariable adjustments.
CONCLUSION
PAC and RVFI are worse at CPB end and improve over time. Depletion of endogenous NO may contribute to explain changes in PAC and RVFI after CPB.
Topics: Humans; Cardiopulmonary Bypass; Male; Hemolysis; Female; Middle Aged; Ventricular Function, Right; Aged; Pulmonary Artery; Nitric Oxide; Systole; Cohort Studies; Compliance
PubMed: 38521488
DOI: 10.1016/j.niox.2024.03.003 -
Journal of Thoracic Oncology : Official... Apr 2022
Topics: Humans; Lung; Lung Neoplasms; Patient Compliance; Thorax; Tomography, X-Ray Computed; United States
PubMed: 35307109
DOI: 10.1016/j.jtho.2022.01.014 -
Journal of Thoracic Oncology : Official... Mar 2022
Topics: Humans; Lung; Lung Neoplasms; Patient Compliance; Thorax; Tomography, X-Ray Computed; United States
PubMed: 35216733
DOI: 10.1016/j.jtho.2021.12.013 -
JMIR MHealth and UHealth Mar 2020In recent years, mobile health (mHealth)-related apps have been developed to help manage chronic diseases. Apps may allow patients with a chronic disease characterized...
BACKGROUND
In recent years, mobile health (mHealth)-related apps have been developed to help manage chronic diseases. Apps may allow patients with a chronic disease characterized by exacerbations, such as chronic obstructive pulmonary disease (COPD), to track and even suspect disease exacerbations, thereby facilitating self-management and prompt intervention. Nevertheless, there is insufficient evidence regarding patient compliance in the daily use of mHealth apps for chronic disease monitoring.
OBJECTIVE
This study aimed to provide further evidence in support of prospectively recording daily symptoms as a useful strategy to detect COPD exacerbations through the smartphone app, Prevexair. It also aimed to analyze daily compliance and the frequency and characteristics of acute exacerbations of COPD recorded using Prevexair.
METHODS
This is a multicenter cohort study with prospective case recruitment including 116 patients with COPD who had a documented history of frequent exacerbations and were monitored over the course of 6 months. At recruitment, the Prevexair app was installed on their smartphones, and patients were instructed on how to use the app. The information recorded in the app included symptom changes, use of medication, and use of health care resources. The patients received messages on healthy lifestyle behaviors and a record of their cumulative symptoms in the app. There was no regular contact with the research team and no mentoring process. An exacerbation was considered reported if medical attention was sought and considered unreported if it was not reported to a health care professional.
RESULTS
Overall, compliance with daily records in the app was 66.6% (120/180), with a duration compliance of 78.8%, which was similar across disease severity, age, and comorbidity variables. However, patients who were active smokers, with greater dyspnea and a diagnosis of depression and obesity had lower compliance (P<.05). During the study, the patients experienced a total of 262 exacerbations according to daily records in the app, 99 (37.8%) of which were reported exacerbations and 163 (62.2%) were unreported exacerbations. None of the subject-related variables were found to be significantly associated with reporting. The duration of the event and number of symptoms present during the first day were strongly associated with reporting. Despite substantial variations in the COPD Assessment Test (CAT), there was improvement only among patients with no exacerbation and those with reported exacerbations. Nevertheless, CAT scores deteriorated among patients with unreported exacerbations.
CONCLUSIONS
The daily use of the Prevexair app is feasible and acceptable for patients with COPD who are motivated in their self-care because of frequent exacerbations of their disease. Monitoring through the Prevexair app showed great potential for the implementation of self-care plans and offered a better diagnosis of their chronic condition.
Topics: Female; Humans; Male; Mobile Applications; Patient Compliance; Prospective Studies; Pulmonary Disease, Chronic Obstructive; Smartphone
PubMed: 32191213
DOI: 10.2196/15699 -
Pediatric Research Jun 2020Supplemental oxygen exposure administered to premature infants is associated with chronic lung disease and abnormal pulmonary function. This study used mild (40%),...
BACKGROUND
Supplemental oxygen exposure administered to premature infants is associated with chronic lung disease and abnormal pulmonary function. This study used mild (40%), moderate (60%), and severe (80%) oxygen to determine how hyperoxia-induced changes in lung structure impact pulmonary mechanics in mice.
METHODS
C57BL/6J mice were exposed to room air or hyperoxia from birth through postnatal day 8. Baseline pulmonary function and methacholine challenge was assessed at 4 and 8 weeks of age, accompanied by immunohistochemical assessments of both airway (smooth muscle, tethering) and alveolar (simplification, elastin deposition) structure.
RESULTS
Mild/moderate hyperoxia increased baseline airway resistance (40% only) and airway hyperreactivity (40 and 60%) at 4 weeks accompanied by increased airway smooth muscle deposition, which resolved at 8 weeks. Severe hyperoxia increased baseline compliance, baseline resistance, and total elastin/surface area ratio without increasing airway hyperreactivity, and was accompanied by increased alveolar simplification, decreased airway tethering, and changes in elastin distribution at both time points.
CONCLUSIONS
Mild to moderate hyperoxia causes changes in airway function and airway hyperreactivity with minimal parenchymal response. Severe hyperoxia drives its functional changes through alveolar simplification, airway tethering, and elastin redistribution. These differential responses can be leveraged to further develop hyperoxia mouse models.
Topics: Animals; Animals, Newborn; Dose-Response Relationship, Drug; Female; Hyperoxia; Lung; Lung Compliance; Male; Methacholine Chloride; Mice; Mice, Inbred C57BL; Muscarinic Agonists; Muscle, Smooth; Pulmonary Alveoli; Respiratory Function Tests; Respiratory Mechanics; Sex Factors
PubMed: 31835269
DOI: 10.1038/s41390-019-0723-y -
Revue Des Maladies Respiratoires Nov 2019The respiratory impact of obesity can be both symptomatic (resting and exertional breathlessness) and functional (pulmonary function at rest and on exercise). The... (Review)
Review
The respiratory impact of obesity can be both symptomatic (resting and exertional breathlessness) and functional (pulmonary function at rest and on exercise). The prevalence of breathlessness is increased in adult obese individuals, ∼50% at rest and ∼75% on exertion (mMRC score>0). Pulmonary function abnormalities in obese adults include reduced functional residual capacity (FRC) and expiratory residual volume (ERV), and less frequently reduced total lung capacity (a restrictive defect, with TLC below the 5th percentile of predicted is present in around 15% in severe obese adults), with normal residual volume (RV). Airflows are barely affected by obesity, but bronchial hyperresponsiveness (BHR) is very prevalent, which may be due to the loss of bronchoprotective effect of deep inspiration in obesity (mechanical pathophysiology of BHR). In children, the modifications of lung volumes seen are quite different: TLC is normal while FRC and RV are reduced, explaining the increase in FVC. FEV1/FVC is therefore reduced by obesity, without true airflow obstruction (dysanaptic growth). Resting oxygen consumption (V'O) is increased due to obesity and normally increases with exercise. Maximum V'O is normal or weakly reduced in obese patients; on the other hand, the increase in respiratory load increases the oxygen cost of ventilation, which tends to be rapid, both at rest and during exertion. Finally, it should be noted that there is only limited statistical correlation between exercise dyspnoea and respiratory function abnormalities in obesity.
Topics: Dyspnea; Humans; Lung; Obesity; Respiration
PubMed: 31522948
DOI: 10.1016/j.rmr.2019.07.009 -
JMIR MHealth and UHealth Dec 2023Digital health technologies are widely used for disease management, with their computing platforms, software, and sensors being used for health care. These technologies... (Review)
Review
BACKGROUND
Digital health technologies are widely used for disease management, with their computing platforms, software, and sensors being used for health care. These technologies are developed to manage chronic diseases and infectious bacterial diseases, including tuberculosis (TB).
OBJECTIVE
This study aims to comprehensively review the literature on the use of digital health interventions (DHIs) for enhancing TB treatment adherence and identify major strategies for their adoption.
METHODS
We conducted a literature search in the PubMed, Cochrane Library, Ovid Embase, and Scopus databases for relevant studies published between January 2012 and March 2022. Studies that focused on web-based or mobile phone-based interventions, medication adherence, digital health, randomized controlled trials, digital interventions, or mobile health and ubiquitous health technology for TB treatment and related health outcomes were included.
RESULTS
We identified 27 relevant studies and classified them according to the intervention method, a significant difference in treatment success, and health outcomes. The following interventions were emphasized: SMS text messaging interventions (8/27, 30%), medicine reminders (6/27, 22%), and web-based direct observation therapy (9/27, 33%). Digital health technology significantly promoted disease management among individuals and health care professionals. However, only a few studies addressed 2-way communication therapies, such as interactive SMS text messaging and feedback systems.
CONCLUSIONS
This scoping review classified studies on DHIs for patients with TB and demonstrated their potential for the self-management of TB. DHIs are still being developed, and evidence on the impact of digital technologies on enhancing TB treatment adherence remains limited. However, it is necessary to encourage patients' participation in TB treatment and self-management through bidirectional communication. We emphasize the importance of developing a communication system.
Topics: Humans; Cell Phone; Text Messaging; Tuberculosis; Medication Adherence; Telemedicine
PubMed: 38054471
DOI: 10.2196/49741 -
Advances in Experimental Medicine and... 2020Chronic obstructive pulmonary disease (COPD) is one of the most severe public health problems and a leading cause of death worldwide. One of the main reasons for poor...
Chronic obstructive pulmonary disease (COPD) is one of the most severe public health problems and a leading cause of death worldwide. One of the main reasons for poor control of the disease is low patient compliance with treatment plan. The aim of the study was to investigate sociodemographic and health status factors that may have an influence on adherence to treatment. There were 106 inpatients (F/M, 42/64; mean age 70 ± 6 years) with COPD enrolled into this retrospective study. Patients completed the Adherence to Refills and Medications Scale (ARMS) to assess adherence to therapy. We found that the mean ARMS score was 23.1 ± 6.8. About 86% of patients had low adherence, and 14% had good adherence (mean score 3.2 ± 2.4). The low-adherence patients were more likely to be older (p = 0.020), female (p = 0.011), single (p = 0.019), not professionally active (p = 0.049), hospitalized more often (p = 0.005) and for a longer time (p = 0.046), feel worse (p = 0.023), experience a greater impact of the disease on sleep quality (p = 0.008) and daily activities (p = 0.001), and had a higher GOLD stage of COPD when compared to patients with good adherence patients (p = 0.012). Multiple factor analysis demonstrates that independent adverse predictors of the ARMS score included the following: being single (OR = 3.18), having had more than eight hospitalizations (OR = 1.18), and experiencing dysfunction in daily activities (OR = 1.79). Male gender (OR = 0.77) and longer than 21-day hospitalizations (OR = 0.93) were independent positive predictors of adherence. In conclusion, COPD patients demonstrate a low level of adherence to pharmacotherapy. Adherence is adversely affected by sociodemographic (older age, female gender, being single, and professionally inactive) and clinical factors (more frequent hospitalizations, perception of poor well-being, disordered sleep and daily functioning, and a higher GOLD stage).
Topics: Aged; Female; Health Status; Hospitalization; Humans; Male; Medication Adherence; Pulmonary Disease, Chronic Obstructive; Retrospective Studies
PubMed: 32239444
DOI: 10.1007/5584_2020_508 -
Current Medicinal Chemistry 2023Nowadays, lungs are the most common organs affected by diseases due to climate change, tobacco smoking, pollution and genetic factors. Conventional pharmacotherapy (oral... (Review)
Review
Nowadays, lungs are the most common organs affected by diseases due to climate change, tobacco smoking, pollution and genetic factors. Conventional pharmacotherapy (oral medication or injection) is poorly selective; this causes toxicity problems and numerous systemic side effects. Furthermore, although pulmonary administration is an interesting drug administration route for treating lung diseases, inhalation therapy is complex mainly due to the lung defense mechanisms leading to rapid drug elimination. Pulmonary drug delivery using nanocarriers appears to be the best therapeutic strategy to overcome these issues. In fact, these nanosystems can reduce both drug therapeutic dose and side effects, improving patient compliance, avoiding alveolar macrophage clearance, protecting the drug from degradation processes, and providing a controlled and targeted drug release. Therefore, this review aims to analyze the scientific literature regarding the use of nanocarriers to treat the main lung diseases (cancer, asthma, infections). In particular, attention was devoted to liposomes and polymer- and lipid-based nanoparticles, being the topic of most published articles in the last decade.
Topics: Humans; Drug Delivery Systems; Lung; Lung Diseases; Nanoparticles; Asthma; Neoplasms; Drug Carriers; Administration, Inhalation
PubMed: 36043745
DOI: 10.2174/0929867329666220829092323