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Scientific Reports Jun 2024Estimating the change rates in body size following the weight loss programs is very important in the compliance of those programs. Although, there is enough evidence on...
Estimating the change rates in body size following the weight loss programs is very important in the compliance of those programs. Although, there is enough evidence on the significant association of body weight change with the other anthropometric indices and/ or body composition, there is so limited studies that have depicted this relationship as mathematical formulas. Therefore, the present research designed to use a mathematical model to predict changes of anthropometric indices following a weight-loss diet in the overweight and obese women. In this longitudinal study, 212 overweight/obese women who received an individualized low-calorie diet (LCD) were selected and followed-up for five months. Anthropometric measurements such as weight, waist circumference (WC), hip circumference (HC), and body composition (lean mass and fat mass) were performed. Then, body mass index, waist to hip ratio (WHR), waist to height ratio (WHtR), a body shape index (ABSI), abdominal volume index (AVI), and body adiposity index (BAI) were calculated using the related formula. Following the LCD led to the substantial and consistent changes in various anthropometric indices over time. All of these anthropometric variations were significantly related with the percent change (PC) of body weight except than WHR. Moreover, according to the mathematical formulas, weight loss was closely related to the decrease of WC (PC-WC = - 0.120 + 0.703 × PC-WT), HC (PC-HC = - 0.350 + 0.510 × PC-WT), body fat percentage (PC-Body Fat = - 0.019 + 0.915 × PC-WT), WHtR (PC-WHtR = - 0.113 + 0.702 × PC-WT), and improvements in ABSI (PC-ABSI = - 0.112 + 0.034 × PC-WT) and AVI (PC-AVI = - 0.324 + 1.320 × PC-WT). The decreasing rates of WC, HC, body fat percentage, WHtR, ABSI, and AVI in relation to the weight loss were clinically and statistically significant. This means that a healthy weight lowering diet would be accompanied by decreasing the body fat, body size and also the risk of morbidities.
Topics: Humans; Female; Obesity; Adult; Weight Loss; Diet, Reducing; Middle Aged; Overweight; Anthropometry; Models, Theoretical; Longitudinal Studies; Body Mass Index; Waist Circumference; Waist-Hip Ratio; Body Composition; Caloric Restriction
PubMed: 38914732
DOI: 10.1038/s41598-024-65586-0 -
Scientific Reports Jun 2024Normally aerated lung tissue on computed tomography (CT) is correlated with static respiratory system compliance (C) at zero end-expiratory pressure. In clinical...
Normally aerated lung tissue on computed tomography (CT) is correlated with static respiratory system compliance (C) at zero end-expiratory pressure. In clinical practice, however, patients with acute respiratory failure are often managed using elevated PEEP levels. No study has validated the relationship between lung volume and tissue and C at the applied positive end-expiratory pressure (PEEP). Therefore, this study aimed to demonstrate the relationship between lung volume and tissue on CT and C during the application of PEEP for the clinical management of patients with acute respiratory distress syndrome due to COVID-19. Additionally, as a secondary outcome, the study aimed to evaluate the relationship between CT characteristics and C, considering recruitability using the recruitment-to-inflation ratio (R/I ratio). We analyzed the CT and respiratory mechanics data of 30 patients with COVID-19 who were mechanically ventilated. The CT images were acquired during mechanical ventilation at PEEP level of 15 cmHO and were quantitatively analyzed using Synapse Vincent system version 6.4 (Fujifilm Corporation, Tokyo, Japan). Recruitability was stratified into two groups, high and low recruitability, based on the median R/I ratio of our study population. Thirty patients were included in the analysis with the median R/I ratio of 0.71. A significant correlation was observed between C at the applied PEEP (median 15 [interquartile range (IQR) 12.2, 15.8]) and the normally aerated lung volume (r = 0.70 [95% CI 0.46-0.85], P < 0.001) and tissue (r = 0.70 [95% CI 0.46-0.85], P < 0.001). Multivariable linear regression revealed that recruitability (Coefficient = - 390.9 [95% CI - 725.0 to - 56.8], P = 0.024) and C (Coefficient = 48.9 [95% CI 32.6-65.2], P < 0.001) were significantly associated with normally aerated lung volume (R-squared: 0.58). In this study, C at the applied PEEP was significantly correlated with normally aerated lung volume and tissue on CT. Moreover, recruitability indicated by the R/I ratio and C were significantly associated with the normally aerated lung volume. This research underscores the significance of C at the applied PEEP as a bedside-measurable parameter and sheds new light on the link between recruitability and normally aerated lung.
Topics: Humans; COVID-19; Positive-Pressure Respiration; Male; Female; Aged; Lung; Middle Aged; Tomography, X-Ray Computed; SARS-CoV-2; Respiratory Mechanics; Respiratory Distress Syndrome; Lung Compliance; Aged, 80 and over
PubMed: 38914620
DOI: 10.1038/s41598-024-64622-3 -
Allergy, Asthma & Immunology Research May 2024Concerns regarding the safety of beta-2 agonists have led to revisions of the major asthma guidelines to better address these issues. Although these updates allow for a... (Review)
Review
Concerns regarding the safety of beta-2 agonists have led to revisions of the major asthma guidelines to better address these issues. Although these updates allow for a combination of previous and current strategies, they may confuse clinical practitioners. Beta-2 agonists are vital for alleviating asthma symptoms by relaxing smooth muscles; however, they also pose significant risks by inducing pro-inflammatory mediators both and . In addition to the risks of overuse and symptom masking, the use of beta-agonists alone at therapeutic doses can worsen airway inflammation and enhance virus-induced inflammation during asthma exacerbation. Inhaled corticosteroids (ICS) can effectively prevent these adverse effects. With new insights into the mechanisms of these adverse events, reserving short-acting beta-agonists for acute symptom relief during exacerbations and only for those who are already on ICS or oral steroids represents a careful approach to using beta-agonists with least adverse effects in patients with asthma. However, a major drawback of this approach is the potential non-compliance with ICS, leading to beta-agonist use without the necessary counteraction by ICS. An optimal strategy, both during and outside exacerbations, would integrate beta-agonists into an anti-inflammatory regimen that includes ICS, ideally combined with the same inhaler to ensure their concurrent use where finances allow. This would maintain the beneficial effects of beta-agonists, such as bronchodilation, while preventing the adverse effects from the induction of inflammatory mediators. This method is aligned with diverse clinical settings, maximizes the safe use of beta-agonists, and supports a comprehensive guideline-compliant management strategy.
PubMed: 38910281
DOI: 10.4168/aair.2024.16.3.217 -
Medicine Jun 2024Although medical emergency teams (METs) have been widely introduced, studies on the importance of a dedicated intensivist staffing to METs are lacking. A single-center... (Observational Study)
Observational Study
Although medical emergency teams (METs) have been widely introduced, studies on the importance of a dedicated intensivist staffing to METs are lacking. A single-center retrospective before-and-after study was performed. Deteriorating patients who required emergency airway management in general wards by MET were included in this study. We divided the study period according to the presence of a dedicated intensivist staff in MET: (1) non-staffed period (from January 2016 to February 2018, n = 971) and (2) staffed period (from March 2018 to December 2019, n = 651), and compared emergency airway management-related variables and outcomes between the periods. Among 1622 patients included, mean age was 63.0 years and male patients were 64.2% (n = 1042). The first-pass success rate was significantly increased in the staffed period (85.9% in the non-staffed vs 89.2% in the staffed; P = .047). Compliance to rapid sequence intubation was increased (9.4% vs 34.4%; P < .001) and vocal cords were more clearly open (P < .001) in the staffed period. The SpO2/FiO2 ratio (median [interquartile range], 125 [113-218] vs 136 [116-234]; P = .007) and the ROX index (4.6 [3.4-7.6] vs 5.1 [3.6-8.5]; P = .013) at the time of intubation was higher in the staffed period, suggesting the decision on intubation was made earlier. The post-intubation hypoxemia was less commonly occurred in the staffed period (7.2% vs 4.2%, P = .018). In multivariate analysis, the rank of operator was a strong predictor of the first-pass success (adjusted OR [95% CI], 2.280 [1.639-3.172]; P < .001 for fellow and 5.066 [1.740-14.747]; P < .001 for staff, relative to resident). In our hospital, a dedicated intensivist staffing to MET was associated with improved emergency airway management in general wards. Staffing an intensivist to MET needs to be encouraged to improve the performance of MET and the patient safety.
Topics: Humans; Male; Middle Aged; Retrospective Studies; Female; Airway Management; Aged; Intubation, Intratracheal; Personnel Staffing and Scheduling
PubMed: 38905417
DOI: 10.1097/MD.0000000000038571 -
BioRxiv : the Preprint Server For... Feb 2024Septic shock, in humans and in our well-established animal model, is associated with increases in biventricular end diastolic volume (EDV) and decreases in ejection...
BACKGROUND
Septic shock, in humans and in our well-established animal model, is associated with increases in biventricular end diastolic volume (EDV) and decreases in ejection fraction (EF). These abnormalities occur over 2 days and reverse within 10 days. Septic non-survivors do not develop an increase in EDV. The mechanism for this cardiac dysfunction and EDV differences is unknown.
METHODS
Purpose-bred beagles randomized to receive intrabronchial (n=27) or saline (n=6) were provided standard ICU care including sedation, mechanical ventilation, and fluid resuscitation to a pulmonary arterial occlusion pressure of over 10mmHg. No catecholamines were administered. Over 96h, cardiac magnetic resonance imaging, echocardiograms, and invasive hemodynamics were serially performed, and laboratory data was collected. Tissue was obtained at 66h from six septic animals.
RESULTS
From 0-96h after bacterial challenge, septic animals controls had significantly increased left ventricular wall edema (6%) and wall thinning with loss of mass (15%) which was more pronounced at 48h in non-survivors than survivors. On histology, edema was located predominantly in myocytes, the interstitium, and endothelial cells. Edema was associated with significantly worse biventricular function (lower EFs), ventricular-arterial coupling, and circumferential strain. In septic animals, from 0-24h, the EDV decreased from baseline and, despite cardiac filling pressures being similar, decreased significantly more in non-survivors. From 24-48h, all septic animals had increases in biventricular chamber sizes. Survivors biventricular EDVs were significantly greater than baseline and in non-survivors, where biventricular EDVs were not different from baseline. Preload, afterload, or HR differences did not explain these differential serial changes in chamber size.
CONCLUSION
Systolic and diastolic cardiac dysfunction during sepsis is associated with ventricular wall edema. Rather than differences in preload, afterload, or heart rate, structural alterations to the ventricular wall best account for the volume changes associated with outcome during sepsis. In non-survivors, from 0-24h, sepsis induces a more severe diastolic dysfunction, further decreasing chamber size. The loss of left ventricular mass with wall thinning in septic survivors may, in part explain, the EDV increases from 24-48h. However, these changes continued and even accelerated into the recovery phase consistent with a reparative process rather than ongoing injury.
CLINICAL PERSPECTIVE
Utilizing multimodal imaging and hemodynamics, we demonstrate the cardiac changes of sepsis have injury and reparative phases.The injury phase (0-24h) has EDV decreases more profound in non-survivors and is associated with worse ventricular compliance, myocardial edema, and diastolic dysfunction.The recovery phase has left ventricular mass loss with wall thinning in survivors that explains the EDV increases (24-96h). These progressed into the EF recovery phase consistent with a reparative process removing damaged tissue.This is the first controlled CMR sepsis study supporting ventricular wall edema is a fundamental aspect of sepsis pathophysiology and dry mass loss a reparative mechanism. Despite optimizing filling pressures, the cardiac changes in ventricular wall structure and function associated with survival and non-survival in sepsis still occurred, thereby discounting fluid resuscitation as the major factor of therapeutic importance for cardiac function and survival.The changes reported here have potential implications for sepsis treatment especially in the field of fluid resuscitation. These findings yield new understanding into the pathophysiology of sepsis cardiac dysfunction and allow for novel phenotyping and prognosticating of the syndrome with ventricular compliance and EDVs. This also offers potentially high yielding targets for research for new therapeutic approaches for sepsis and heart failure.
PubMed: 38903100
DOI: 10.1101/2024.02.05.578971 -
Chronic Respiratory Disease 2024Previous studies have focused on demographic factors that might predict non-completion of pulmonary rehabilitation (PR). We aimed to identify key modifiable factors...
Previous studies have focused on demographic factors that might predict non-completion of pulmonary rehabilitation (PR). We aimed to identify key modifiable factors that promote completion of PR. A mixed methods survey was offered to participants completing a discharge assessment following PR. Descriptive statistics and inductive thematic analysis were used to analyse the survey responses, with investigator triangulation. 62 of 187 (33%) patients attending a PR discharge assessment between November 2022 and April 2023 returned the anonymised survey. Desire to improve health and wellbeing was the main reason for both initially committing to a course and for continuing with PR past transient thoughts of leaving. The positive impact of staff was the second most common reason. The enjoyment of the PR programme, being held accountable to attend classes, and the importance of other group members were other key themes identified. In conclusion, our findings suggest PR services need to implement strategies which ensure regular promotion and reinforcement of the health benefits of PR as well as implementation of PR modalities which best monopolise on the positive impact skilled staff have on motivating patients to complete PR.
Topics: Humans; Motivation; Male; Female; Middle Aged; Aged; Qualitative Research; Surveys and Questionnaires; Pulmonary Disease, Chronic Obstructive; Patient Compliance
PubMed: 38901833
DOI: 10.1177/14799731241264789 -
American Journal of Veterinary Research Jun 2024To investigate the effects of FLow-controlled EXpiration (FLEX) ventilation expiration time and speed on respiratory and pulmonary mechanics in anesthetized horses in...
Flow-controlled expiration ventilation using a piston ventilator: effects of expiration time and speed on respiratory and pulmonary mechanics with focus on hysteresis and compliance in healthy horses.
OBJECTIVE
To investigate the effects of FLow-controlled EXpiration (FLEX) ventilation expiration time and speed on respiratory and pulmonary mechanics in anesthetized horses in dorsal recumbency.
ANIMALS
6 healthy adult research horses.
METHODS
In this randomized crossover experimental study, horses were anesthetized 3 times and were ventilated each time for 60 minutes using conventional volume-controlled ventilation (VCV), linear emptying of the lung over 50% of the expiratory time (FLEX50), or linear emptying of the lung over 100% of the expiratory time (FLEX100) in a randomized order. The primary outcome variables were dynamic compliance (Cdyn), hysteresis, and alveolar dead space. The data was analyzed using two-factor ANOVA. Significance was set to P < .05.
RESULTS
Horses ventilated using FLEX50 and FLEX100 showed significantly higher Cdyn and significantly lower hysteresis values compared to horses ventilated using VCV. Horses ventilated using FLEX50 had significantly lower alveolar dead space compared to horses ventilated using FLEX100 or VCV. Horses ventilated using FLEX100 had significantly lower alveolar dead space compared to VCV horses.
CLINICAL RELEVANCE
Our results demonstrate improved Cdyn, hysteresis, and alveolar dead space in horses ventilated with either FLEX50 or FLEX100 relative to traditional VCV. The use of FLEX with a faster exhalation speed (FLEX50) offers additional respiratory advantages.
PubMed: 38901463
DOI: 10.2460/ajvr.24.02.0036 -
BioRxiv : the Preprint Server For... Jun 2024The role of MUC5B mucin expression in IPF pathogenesis is unknown. Bleomycin-exposed rodent models do not exhibit sustained fibrosis or airway remodeling. Unlike mice,...
RATIONALE
The role of MUC5B mucin expression in IPF pathogenesis is unknown. Bleomycin-exposed rodent models do not exhibit sustained fibrosis or airway remodeling. Unlike mice, ferrets have human-like distribution of MUC5B expressing cell types and natively express the risk-conferring variant that induces high MUC5B expression in humans. We hypothesized that ferrets would consequently exhibit aberrant repair to propagate fibrosis similar to human IPF.
METHODS
Bleomycin (5U/kg) or saline-control was micro-sprayed intratracheally then wild-type ferrets were evaluated through 22 wks. Clinical phenotype was assessed with lung function. Fibrosis was assessed with µCT imaging and comparative histology with Ashcroft scoring. Airway remodeling was assessed with histology and quantitative immunofluorescence.
RESULTS
Bleomycin ferrets exhibited sustained restrictive physiology including decreased inspiratory capacity, decreased compliance, and shifted Pressure-Volume loops through 22 wks. Volumetric µCT analysis revealed increased opacification of the lung bleomycin-ferrets. Histology showed extensive fibrotic injury that matured over time and MUC5B-positive cystic structures in the distal lung suggestive of honeycombing. Bleomycin ferrets had increased proportion of small airways that were double-positive for CCSP and alpha-tubulin compared to controls, indicating an aberrant 'proximalization' repair phenotype. Notably, this aberrant repair was associated with extent of fibrotic injury at the airway level.
CONCLUSIONS
Bleomycin-exposed ferrets exhibit sustained fibrosis through 22 wks and have pathologic features of IPF not found in rodents. Ferrets exhibited proximalization of the distal airways and other pathologic features characteristic of human IPF. MUC5B expression through native cell types may play a key role in promoting airway remodeling and lung injury in IPF.
PubMed: 38895273
DOI: 10.1101/2024.06.04.597198 -
Animals : An Open Access Journal From... May 2024Respiratory diseases significantly affect intensive pig finishing farms, causing production losses and increased antimicrobial use (AMU). Lesion scoring at slaughter has...
Respiratory diseases significantly affect intensive pig finishing farms, causing production losses and increased antimicrobial use (AMU). Lesion scoring at slaughter has been recognized as a beneficial practice to evaluate herd management. The integrated analysis of abattoir lesion scores and AMU data could improve decision-making by providing feedback to veterinarians and farmers on the effectiveness of antimicrobial treatments, thus rationalizing their use. This study compared lung and pleural lesion scores collected at Italian pig slaughterhouses with on-farm AMU, estimated through a treatment index per 100 days (TI100). Overall, 24,752 pig carcasses, belonging to 236 batches from 113 finishing farms, were inspected. Bronchopneumonia and chronic pleuritis were detected in 55% and 48% of the examined pigs, respectively. Antimicrobials were administered in 97% of the farms during the six months prior to slaughter (median TI100 = 5.2), notwithstanding compliance with the mandatory withdrawal period. EMA category B (critical) antimicrobials were administered in 15.2% of cases (median TI100 = 0.06). The lung score was not associated with the total AMU, but significant, positive associations were found with the past use of critical antimicrobials ( = 0.041) and macrolides ( = 0.044). This result highlights the potential of abattoir lung lesion monitoring to rationalize antimicrobial stewardship efforts, contributing to AMU reduction.
PubMed: 38891668
DOI: 10.3390/ani14111621 -
Respiratory Research Jun 2024Sleep-disordered breathing (SDB) is a major comorbidity in idiopathic pulmonary fibrosis (IPF) and is associated with a poor outcome. There is a lack of knowledge...
Treating sleep-disordered breathing of idiopathic pulmonary fibrosis patients with CPAP and nocturnal oxygen treatment. A pilot study : Sleep-disordered breathing treatment in IPF.
INTRODUCTION
Sleep-disordered breathing (SDB) is a major comorbidity in idiopathic pulmonary fibrosis (IPF) and is associated with a poor outcome. There is a lack of knowledge regarding the impact of SDB treatment on IPF. We assessed at one year: (1) the effect of CPAP and/or nocturnal oxygen therapy on IPF regarding lung function, blood mediators, and quality of life; (2) adherence to SDB treatment and SDB changes.
METHODOLOGY
This is a prospective study of consecutive newly diagnosed IPF patients initiating anti-fibrotic treatment. Lung function, polysomnography, blood tests and quality of life questionnaires were performed at inclusion and after one year. Patients were classified as obstructive sleep apnoea (OSA), central sleep apnoea (CSA), and sleep-sustained hypoxemia (SSH). SDB therapy (CPAP and/or nocturnal oxygen therapy) was initiated if needed.
RESULTS
Fifty patients were enrolled (36% had OSA, 22% CSA, and 12% SSH). CPAP was started in 54% of patients and nocturnal oxygen therapy in 16%. At one-year, polysomnography found improved parameters, though 17% of patients had to add nocturnal oxygen therapy or CPAP, while 33% presented SDB onset at this second polysomnography. CPAP compliance at one year was 6.74 h/night (SD 0.74). After one year, matrix metalloproteinase-1 decreased in OSA and CSA (p = 0.029; p = 0.027), C-reactive protein in OSA (p = 0.045), and surfactant protein D in CSA group (p = 0.074). There was no significant change in lung function.
CONCLUSIONS
Treatment of SBD with CPAP and NOT can be well tolerated with a high compliance. IPF patients may exhibit SDB progression and require periodic re-assessment. Further studies to evaluate the impact of SDB treatment on lung function and serological mediators are needed.
Topics: Humans; Continuous Positive Airway Pressure; Female; Male; Idiopathic Pulmonary Fibrosis; Pilot Projects; Aged; Prospective Studies; Sleep Apnea Syndromes; Oxygen Inhalation Therapy; Middle Aged; Treatment Outcome; Polysomnography; Quality of Life
PubMed: 38890648
DOI: 10.1186/s12931-024-02871-6