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Houssin J, Meister L, Nicollas R, Médale M, Moreddu É. Assessment of high-flow nasal cannula efficacy in humidification of infant airways: A computational fluid dynamics approach. Comput Biol Med 2024; 176:108567. [PMID: 38763065 DOI: 10.1016/j.compbiomed.2024.108567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 04/18/2024] [Accepted: 05/05/2024] [Indexed: 05/21/2024]
Abstract
INTRODUCTION High-flow nasal cannula therapy has garnered significant interest for managing pathologies affecting infants' airways, particularly for humidifying areas inaccessible to local treatments. This therapy promotes mucosal healing during the postoperative period. However, further data are needed to optimize the use of these devices. In vivo measurement of pediatric airway humidification presents a challenge; thus, this study aimed to investigate the airflow dynamics and humidification effects of high-flow nasal cannulas on an infant's airway using computational fluid dynamics. METHODS Two detailed models of an infant's upper airway were reconstructed from CT scans, with high-flow nasal cannula devices inserted at the nasal inlets. The airflow was analyzed, and wall humidification was modeled using a film-fluid approach. RESULTS Air velocities and pressure were very high at the airway inlet but decreased rapidly towards the nasopharynx. Maximum relative humidity-close to 100%-was achieved in the nasopharynx. Fluid film development along the airway was heterogeneous, with condensation primarily occurring in the nasal vestibule and larynx. CONCLUSION This study provides comprehensive models of airway humidification, which pave the way for future studies to assess the impact of surgical interventions on humidification and drug deposition directly at operative sites, such as the nasopharynx or larynx, in infants.
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Affiliation(s)
- Juliette Houssin
- Aix-Marseille Univ, CNRS, IUSTI, Marseille, France; Department of Pediatric Otorhinolaryngology, Head & Neck Surgery, La Timone Children's Hospital, Aix-Marseille Univ, APHM, Marseille, France.
| | | | - Richard Nicollas
- Aix-Marseille Univ, CNRS, IUSTI, Marseille, France; Department of Pediatric Otorhinolaryngology, Head & Neck Surgery, La Timone Children's Hospital, Aix-Marseille Univ, APHM, Marseille, France.
| | - Marc Médale
- Aix-Marseille Univ, CNRS, IUSTI, Marseille, France.
| | - Éric Moreddu
- Aix-Marseille Univ, CNRS, IUSTI, Marseille, France; Department of Pediatric Otorhinolaryngology, Head & Neck Surgery, La Timone Children's Hospital, Aix-Marseille Univ, APHM, Marseille, France.
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Numata R, Sun S, Vaiyani D, Janson CM, Quartermain MD, Shah M, Banerjee A. Mushroom-Shaped Right Ventricular Outflow Tract Aneurysm May Provide an Early Clue in Pediatric Arrhythmogenic Right Ventricular Cardiomyopathy. CASE (PHILADELPHIA, PA.) 2024; 8:335-343. [PMID: 38947190 PMCID: PMC11213653 DOI: 10.1016/j.case.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
•ARVC is a life-threatening disease that requires early detection to prevent SCD. •ms-RVOT may serve as an early clue for diagnosis of ARVC. •ms-RVOT may help preempt adverse outcomes in asymptomatic ARVC cases.
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Affiliation(s)
- Ryusuke Numata
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Sarina Sun
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Danish Vaiyani
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Christopher M. Janson
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Michael D. Quartermain
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Maully Shah
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Anirban Banerjee
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
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Tian F, Zhong X, Ye Y, Liu X, He G, Wu C, Chen Z, Zhu Q, Yu S, Fan J, Yao H, Ma W, Dong X, Liu T. Mutual Associations of Exposure to Ambient Air Pollutants in the First 1000 Days of Life With Asthma/Wheezing in Children: Prospective Cohort Study in Guangzhou, China. JMIR Public Health Surveill 2024; 10:e52456. [PMID: 38631029 PMCID: PMC11063886 DOI: 10.2196/52456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/21/2023] [Accepted: 03/05/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND The first 1000 days of life, encompassing pregnancy and the first 2 years after birth, represent a critical period for human health development. Despite this significance, there has been limited research into the associations between mixed exposure to air pollutants during this period and the development of asthma/wheezing in children. Furthermore, the finer sensitivity window of exposure during this crucial developmental phase remains unclear. OBJECTIVE This study aims to assess the relationships between prenatal and postnatal exposures to various ambient air pollutants (particulate matter 2.5 [PM2.5], carbon monoxide [CO], sulfur dioxide [SO2], nitrogen dioxide [NO2], and ozone [O3]) and the incidence of childhood asthma/wheezing. In addition, we aimed to pinpoint the potential sensitivity window during which air pollution exerts its effects. METHODS We conducted a prospective birth cohort study wherein pregnant women were recruited during early pregnancy and followed up along with their children. Information regarding maternal and child characteristics was collected through questionnaires during each round of investigation. Diagnosis of asthma/wheezing was obtained from children's medical records. In addition, maternal and child exposures to air pollutants (PM2.5 CO, SO2, NO2, and O3) were evaluated using a spatiotemporal land use regression model. To estimate the mutual associations of exposure to mixed air pollutants with the risk of asthma/wheezing in children, we used the quantile g-computation model. RESULTS In our study cohort of 3725 children, 392 (10.52%) were diagnosed with asthma/wheezing. After the follow-up period, the mean age of the children was 3.2 (SD 0.8) years, and a total of 14,982 person-years were successfully followed up for all study participants. We found that each quartile increase in exposure to mixed air pollutants (PM2.5, CO, SO2, NO2, and O3) during the second trimester of pregnancy was associated with an adjusted hazard ratio (HR) of 1.24 (95% CI 1.04-1.47). Notably, CO made the largest positive contribution (64.28%) to the mutual effect. After categorizing the exposure according to the embryonic respiratory development stages, we observed that each additional quartile of mixed exposure to air pollutants during the pseudoglandular and canalicular stages was associated with HRs of 1.24 (95% CI 1.03-1.51) and 1.23 (95% CI 1.01-1.51), respectively. Moreover, for the first year and first 2 years after birth, each quartile increment of exposure to mixed air pollutants was associated with HRs of 1.65 (95% CI 1.30-2.10) and 2.53 (95% CI 2.16-2.97), respectively. Notably, SO2 made the largest positive contribution in both phases, accounting for 50.30% and 74.70% of the association, respectively. CONCLUSIONS Exposure to elevated levels of mixed air pollutants during the first 1000 days of life appears to elevate the risk of childhood asthma/wheezing. Specifically, the second trimester, especially during the pseudoglandular and canalicular stages, and the initial 2 years after birth emerge as crucial susceptibility windows. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR-ROC-17013496; https://tinyurl.com/2ctufw8n.
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Affiliation(s)
- Fenglin Tian
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou, China
| | - Xinqi Zhong
- Department of Neonatology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yufeng Ye
- Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Xiaohan Liu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou, China
| | - Guanhao He
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou, China
| | - Cuiling Wu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou, China
| | - Zhiqing Chen
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou, China
| | - Qijiong Zhu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou, China
| | - Siwen Yu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou, China
| | - Jingjie Fan
- Department of Prevention and Health Care, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Huan Yao
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou, China
| | - Wenjun Ma
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou, China
| | - Xiaomei Dong
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou, China
| | - Tao Liu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou, China
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Scheier E, Shoseyov D. Pleural line slope in point of care ultrasound assessment of paediatric wheeze may reflect respiratory effort. Acta Paediatr 2024; 113:795-801. [PMID: 38088477 DOI: 10.1111/apa.17057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/21/2023] [Accepted: 12/05/2023] [Indexed: 03/12/2024]
Abstract
AIM Asthma scoring systems rely on physical examination findings. Point of care ultrasound may provide an objective means to document improvement in the work of breathing in paediatric lower airway obstruction. METHODS Thirty children with wheeze on physical examination (cases) and 15 children presenting with abdominal pain (controls) were studied. Using point-of-care ultrasound, m-mode tracing of lung was recorded above the right hemidiaphragm at the midclavicular line. Pleural line slope and excursion were measured before and after treatment. RESULTS Twenty patients had a final slope measurement under 20°, and only three were admitted-one for hypoxia that resolved prior to ascending to the ward and another for poor compliance. Average decrease in pleural line slope after treatment was 43% and average decrease in pleural line excursion was 32%. Of the 10 children admitted, 8 had measurements over 25°. The correlation coefficient between pleural slope and pleural excursion was 0.67. All controls had a horizontal m-mode tracing at the pleural line. CONCLUSION Oscillation of the m-mode line at the pleura is seen in children with lower airway obstruction and is absent in controls. There appears to be a correlation between beta-agonist therapy and decreased pleural line slope and excursion.
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Affiliation(s)
- Eric Scheier
- Pediatric Emergency, Kaplan Medical Center, Rehovot, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - David Shoseyov
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Pediatric Pulmonology, Kaplan Medical Center, Rehovot, Israel
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Cai W, Köndgen S, Tolksdorf K, Dürrwald R, Schuler E, Biere B, Schweiger B, Goerlitz L, Haas W, Wolff T, Buda S, Reiche J. Atypical age distribution and high disease severity in children with RSV infections during two irregular epidemic seasons throughout the COVID-19 pandemic, Germany, 2021 to 2023. Euro Surveill 2024; 29:2300465. [PMID: 38551098 PMCID: PMC10979527 DOI: 10.2807/1560-7917.es.2024.29.13.2300465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 02/01/2024] [Indexed: 04/01/2024] Open
Abstract
BackgroundNon-pharmaceutical interventions (NPIs) during the COVID-19 pandemic affected respiratory syncytial virus (RSV) circulation worldwide.AimTo describe, for children aged < 5 years, the 2021 and 2022/23 RSV seasons in Germany.MethodsThrough data and 16,754 specimens from outpatient sentinel surveillance, we investigated RSV seasonality, circulating lineages, and affected children's age distributions in 2021 and 2022/23. Available information about disease severity from hospital surveillance was analysed for patients with RSV-specific diagnosis codes (n = 13,104). Differences between RSV seasons were assessed by chi-squared test and age distributions trends by Mann-Kendall test.ResultsRSV seasonality was irregular in 2021 (weeks 35-50) and 2022/23 (weeks 41-3) compared to pre-COVID-19 2011/12-2019/20 seasons (median weeks 51-12). RSV positivity rates (RSV-PR) were higher in 2021 (40% (522/1,291); p < 0.001) and 2022/23 (30% (299/990); p = 0.005) than in prior seasons (26% (1,430/5,511)). Known globally circulating RSV-A (lineages GA2.3.5 and GA2.3.6b) and RSV-B (lineage GB5.0.5a) strains, respectively, dominated in 2021 and 2022/23. In 2021, RSV-PRs were similar in 1 - < 2, 2 - < 3, 3 - < 4, and 4 - < 5-year-olds. RSV hospitalisation incidence in 2021 (1,114/100,000, p < 0.001) and in 2022/23 (1,034/100,000, p < 0.001) was approximately double that of previous seasons' average (2014/15-2019/20: 584/100,000). In 2022/23, proportions of RSV patients admitted to intensive care units rose (8.5% (206/2,413)) relative to pre-COVID-19 seasons (6.8% (551/8,114); p = 0.004), as did those needing ventilator support (6.1% (146/2,413) vs 3.8% (310/8,114); p < 0.001).ConclusionsHigh RSV-infection risk in 2-4-year-olds in 2021 and increased disease severity in 2022/23 possibly result from lower baseline population immunity, after NPIs diminished exposure to RSV.
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Affiliation(s)
- Wei Cai
- Unit 36, Respiratory Infections, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Sophie Köndgen
- Unit 17, Influenza and Other Respiratory Viruses, Department of Infectious Diseases, National Influenza Centre, Robert Koch Institute, Berlin, Germany
- Unit 17, Influenza and Other Respiratory Viruses, Department of Infectious Diseases, Consultant Laboratory for RSV, PIV and HMPV, Robert Koch Institute, Berlin, Germany
| | - Kristin Tolksdorf
- Unit 36, Respiratory Infections, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Ralf Dürrwald
- Unit 17, Influenza and Other Respiratory Viruses, Department of Infectious Diseases, National Influenza Centre, Robert Koch Institute, Berlin, Germany
- Unit 17, Influenza and Other Respiratory Viruses, Department of Infectious Diseases, Consultant Laboratory for RSV, PIV and HMPV, Robert Koch Institute, Berlin, Germany
| | | | - Barbara Biere
- Unit 17, Influenza and Other Respiratory Viruses, Department of Infectious Diseases, National Influenza Centre, Robert Koch Institute, Berlin, Germany
| | - Brunhilde Schweiger
- Unit 17, Influenza and Other Respiratory Viruses, Department of Infectious Diseases, National Influenza Centre, Robert Koch Institute, Berlin, Germany
| | - Luise Goerlitz
- Unit 36, Respiratory Infections, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Walter Haas
- Unit 36, Respiratory Infections, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Thorsten Wolff
- Unit 17, Influenza and Other Respiratory Viruses, Department of Infectious Diseases, National Influenza Centre, Robert Koch Institute, Berlin, Germany
- Unit 17, Influenza and Other Respiratory Viruses, Department of Infectious Diseases, Consultant Laboratory for RSV, PIV and HMPV, Robert Koch Institute, Berlin, Germany
| | - Silke Buda
- Unit 36, Respiratory Infections, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Janine Reiche
- Unit 17, Influenza and Other Respiratory Viruses, Department of Infectious Diseases, National Influenza Centre, Robert Koch Institute, Berlin, Germany
- Unit 17, Influenza and Other Respiratory Viruses, Department of Infectious Diseases, Consultant Laboratory for RSV, PIV and HMPV, Robert Koch Institute, Berlin, Germany
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Prinz F, Pokorný J, Elcner J, Lízal F, Mišík O, Malý M, Bělka M, Hafen N, Kummerländer A, Krause MJ, Jedelský J, Jícha M. Comprehensive experimental and numerical validation of Lattice Boltzmann fluid flow and particle simulations in a child respiratory tract. Comput Biol Med 2024; 170:107994. [PMID: 38308867 DOI: 10.1016/j.compbiomed.2024.107994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 01/03/2024] [Accepted: 01/13/2024] [Indexed: 02/05/2024]
Abstract
The numerical simulation of inhaled aerosols in medical research starts to play a crucial role in understanding local deposition within the respiratory tract, a feat often unattainable experimentally. Research on children is particularly challenging due to the limited availability of in vivo data and the inherent morphological intricacies. CFD solvers based on Finite Volume Methods (FVM) have been widely employed to solve the flow field in such studies. Recently, Lattice Boltzmann Methods (LBM), a mesoscopic approach, have gained prominence, especially for their scalability on High-Performance Computers. This study endeavours to compare the effectiveness of LBM and FVM in simulating particulate flows within a child's respiratory tract, supporting research related to particle deposition and medication delivery using LBM. Considering a 5-year-old child's airway model at a steady inspiratory flow, the results are compared with in vitro experiments. Notably, both LBM and FVM exhibit favourable agreement with experimental data for the mean velocity field and the turbulence intensity. For particle deposition, both numerical methods yield comparable results, aligning well with in vitro experiments across a particle size range of 0.1-20 µm. Discrepancies are identified in the upper airways and trachea, indicating a lower deposition fraction than in the experiment. Nonetheless, both LBM and FVM offer invaluable insights into particle behaviour for different sizes, which are not easily achievable experimentally. In terms of practical implications, the findings of this study hold significance for respiratory medicine and drug delivery systems - potential health impacts, targeted drug delivery strategies or optimisation of respiratory therapies.
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Affiliation(s)
- František Prinz
- Brno University of Technology, Technicka 2896, Brno, 616 69, Czech Republic.
| | - Jan Pokorný
- Brno University of Technology, Technicka 2896, Brno, 616 69, Czech Republic
| | - Jakub Elcner
- Brno University of Technology, Technicka 2896, Brno, 616 69, Czech Republic
| | - František Lízal
- Brno University of Technology, Technicka 2896, Brno, 616 69, Czech Republic
| | - Ondrej Mišík
- Brno University of Technology, Technicka 2896, Brno, 616 69, Czech Republic
| | - Milan Malý
- Brno University of Technology, Technicka 2896, Brno, 616 69, Czech Republic
| | - Miloslav Bělka
- Brno University of Technology, Technicka 2896, Brno, 616 69, Czech Republic
| | - Nicolas Hafen
- Karlsruhe Institute of Technology, Kaiserstraße 12, Karlsruhe, 76131, Germany
| | - Adrian Kummerländer
- Karlsruhe Institute of Technology, Kaiserstraße 12, Karlsruhe, 76131, Germany
| | - Mathias J Krause
- Karlsruhe Institute of Technology, Kaiserstraße 12, Karlsruhe, 76131, Germany
| | - Jan Jedelský
- Brno University of Technology, Technicka 2896, Brno, 616 69, Czech Republic
| | - Miroslav Jícha
- Brno University of Technology, Technicka 2896, Brno, 616 69, Czech Republic
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Valerian Corda J, Shenoy BS, Ahmad KA, Lewis L, K P, Rao A, Zuber M. Comparison of microparticle transport and deposition in nasal cavity of three different age groups. Inhal Toxicol 2024; 36:44-56. [PMID: 38343121 DOI: 10.1080/08958378.2024.2312801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 01/23/2024] [Indexed: 02/22/2024]
Abstract
Objective: The nasal cavity effectively captures the particles present in inhaled air, thereby preventing harmful and toxic pollutants from reaching the lungs. This filtering ability of the nasal cavity can be effectively utilized for targeted nasal drug delivery applications. This study aims to understand the particle deposition patterns in three age groups: neonate, infant, and adult.Materials and methods: The CT scans are built using MIMICS 21.0, followed by CATIA V6 to generate a patient-specific airway model. Fluid flow is simulated using ANSYS FLUENT 2021 R2. Spherical monodisperse microparticles ranging from 2 to 60 µm and a density of 1100 kg/m3 are simulated at steady-state and sedentary inspiration conditions.Results: The highest nasal valve depositions for the neonate are 25% for 20 µm, for infants, 10% for 50 µm, 15% for adults, and 15% for 15 µm. At mid nasal region, deposition of 15% for 20 µm is observed for infant and 8% for neonate and adult nasal cavities at a particle size of 10 and 20 µm, respectively. The highest particle deposition at the olfactory region is about 2.7% for the adult nasal cavity for 20 µm, and it is <1% for neonate and infant nasal cavities.Discussion and conclusions: The study of preferred nasal depositions during natural sedentary breathing conditions is utilized to determine the size that allows medication particles to be targeted to specific nose regions.
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Affiliation(s)
- John Valerian Corda
- Department of Aeronautical & Automobile Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal-576104, Karnataka, India
| | - B Satish Shenoy
- Department of Aeronautical & Automobile Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal-576104, Karnataka, India
| | - Kamarul Arifin Ahmad
- Department of Aerospace Engineering, Universiti Putra Malaysia, Seri Kembangan, Malaysia
| | - Leslie Lewis
- Department of Paediatrics, Kasturba Medical College & Hospital, Manipal Academy of Higher Education, Manipal-576104, Karnataka, India
| | - Prakashini K
- Department of Radio Diagnosis, Kasturba Medical College & Hospital, Manipal Academy of Higher Education, Manipal-576104, Karnataka, India
| | - Anoop Rao
- Department of Pediatrics, Neonatology, Stanford University, Palo Alto, CA, USA
| | - Mohammad Zuber
- Department of Aeronautical & Automobile Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal-576104, Karnataka, India
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Wu W, Ruan X, Gu C, Dan Luo, Ye J, Diao F, Wu L, Luo M. Blood-cerebrospinal fluid barrier permeability of metals/metalloids and its determinants in pediatric patients. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 266:115599. [PMID: 37866033 DOI: 10.1016/j.ecoenv.2023.115599] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/08/2023] [Accepted: 10/14/2023] [Indexed: 10/24/2023]
Abstract
Concerns regarding adverse effects of metal/metalloids exposure on brain development and neurological disorders among children are increasing. However, the transport patterns of metals/metalloids across the blood-cerebrospinal fluid barrier (BCSFB) need to be clarified in children. A total of 99 Chinese pediatric patients were enrolled from February 2020 to August 2021, with a median age of 6.76 months. We detected 16 metal/metalloid levels in matched serum and cerebrospinal fluid (CSF) samples using inductively coupled plasma mass spectrometry. The BCSFB permeability of metals/metalloids were estimated and the potential effects of biomedical parameters were explored. Most metals/metalloids were detectable among > 80.0% of CSF samples. Significant correlations were observed between strontium (Sr, r = 0.46), molybdenum (Mo, r = 0.50), and cadmium (Cd, r = 0.24) concentrations in serum and CSF (P < 0.05). Ratios of metal/metalloid levels in CSF to serum (Rmetal) ranged from 0.02 to 0.74, and hazardous metals/metalloids including arsenic (As), Cd, lead (Pb), thallium (Tl), and manganese (Mn) showed high transfer efficiencies across the BCSFB (Rmetals > 0.5). With the adjustment of age and sex, albumin, β2-microglobulin, and total protein levels in CSF were positively associated with copper (Cu) permeability (FDR-adjusted P < 0.05), while glucose in CSF was negatively correlated with calcium (Ca), Cu, Sr, and Mo BCSFB permeability (FDR-adjusted P < 0.05). Q-Alb promoted Cu permeability across the BCSFB (FDR-adjusted P < 0.001), while C-reactive protein levels in serum were positively associated with selenium (Se) permeability (FDR-adjusted P = 0.046). For the first time, our findings provided data for the BCSFB permeability of 16 metals/metalloids in children, and indicated that some biomedical parameters could influence the transformation of metals/metalloids from serum to CSF. Metals/metalloids with strong BCSFB permeability warrant attention for their potential neurotoxicity.
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Affiliation(s)
- Weixiang Wu
- Department of Clinical Laboratory, Guangdong Women and Children Hospital, Guangzhou, China
| | - Xiaolin Ruan
- Department of Clinical Laboratory, Guangdong Women and Children Hospital, Guangzhou, China
| | - Chunming Gu
- Department of Clinical Laboratory, Guangdong Women and Children Hospital, Guangzhou, China
| | - Dan Luo
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Jinfeng Ye
- Department of Clinical Laboratory, Guangdong Women and Children Hospital, Guangzhou, China
| | - Fuqiang Diao
- Department of Clinical Laboratory, Guangdong Women and Children Hospital, Guangzhou, China
| | - Lihong Wu
- Department of Clinical Laboratory, Guangdong Women and Children Hospital, Guangzhou, China
| | - Mingyong Luo
- Department of Clinical Laboratory, Guangdong Women and Children Hospital, Guangzhou, China.
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Shen Y, Li X, Feng X, Yu L, Weng L, Zhang C, Shang Y, Lin J. Differences in the effects of orthodontic treatment on airway-craniocervical functional environment in adult and adolescent patients with skeletal class II high-angle: a retrospective pilot study. BMC Oral Health 2023; 23:605. [PMID: 37644470 PMCID: PMC10464110 DOI: 10.1186/s12903-023-03328-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION This retrospective cohort study aimed to compare the change in upper airway and craniocervical posture after orthodontic treatment between adolescent and adult patients with Class II high-angle malocclusion. METHODS A total of 12 adolescent (mean ± standard deviation age = 13.0 ± 2.0 years) and 12 adult patients with Class II high-angle malocclusion (mean ± standard deviation age = 23.7 ± 6.4 years) were selected in this study. The lateral cephalograms and cone beam computed tomography images of adolescent and adult patients were taken before and after treatment, which can be employed to evaluate the variables of craniofacial morphology, upper airway, and craniocervical posture through paired t tests, respectively. An independent sample t test was performed to observe the differences between two groups after orthodontic intervention. For adults and adolescents, the correlation between craniofacial morphology, upper airway, and craniocervical posture was determined through Pearson correlation analysis. RESULTS In all subjects, the improvements in vertical and sagittal facial morphology after treatment were observed. Anterior and inferior movements of the hyoid bone, an increase of upper airway dimension, posterior tipping of the head and a reduction of cervical inclination in the lower and middle segments post-treatment were identified in adolescence (P < 0.05). Adults displayed anterior movements of the hyoid bone, whereas no significant difference was observed in upper airway dimension and craniocervical posture (P < 0.05). Notable differences were identified in the change of hyoid position and airway volume between two groups (P > 0.05). Mandibular plane inclination, growth pattern, occlusal plane inclination, and chin position were all significantly correlated with craniocervical posture in adolescent patients. Besides, the mandibular growth pattern and chin position in adult patients were significantly correlated with craniocervical posture (P < 0.05). CONCLUSIONS Orthodontic treatment is capable of enhancing the facial profile of patients with skeletal class II high-angle while improving their upper airway morphology and craniocervical posture, where adolescents and adults differ substantially in that the former exhibit a more favorable alteration in the airway-craniocervical functional environment.
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Affiliation(s)
- Yiyang Shen
- Department of Stomatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, Zhejiang University School of Stomatology, Hangzhou, Zhejiang, China
| | - Xin Li
- Department of Stomatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, Zhejiang University School of Stomatology, Hangzhou, Zhejiang, China
| | - Xiaoyan Feng
- Department of Stomatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, Zhejiang University School of Stomatology, Hangzhou, Zhejiang, China
| | - Lan Yu
- The Affiliated Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Luxi Weng
- Department of Stomatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, Zhejiang University School of Stomatology, Hangzhou, Zhejiang, China
| | - Chenxing Zhang
- Department of Stomatology, Hangzhou Geriatric Hospital, Hangzhou, Zhejiang, China
| | - Yufeng Shang
- Department of Stomatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, Zhejiang University School of Stomatology, Hangzhou, Zhejiang, China
| | - Jun Lin
- Department of Stomatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, Zhejiang University School of Stomatology, Hangzhou, Zhejiang, China.
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10
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Kolewe EL, Padhye S, Woodward IR, Feng Y, Briddell JW, Fromen CA. A Pediatric Upper Airway Library to Evaluate Interpatient Variability of In Silico Aerosol Deposition. AAPS PharmSciTech 2023; 24:162. [PMID: 37523076 PMCID: PMC10660588 DOI: 10.1208/s12249-023-02619-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 07/11/2023] [Indexed: 08/01/2023] Open
Abstract
The airway of pediatric patients' changes through development, presenting a challenge in developing pediatric-specific aerosol therapeutics. Our work aims to quantify geometric variations and aerosol deposition patterns during upper airway development in subjects between 3.5 months-6.9 years old using a library of 24 pediatric models and 4 adult models. Computational fluid-particle dynamics was performed with varying particle size (0.1-10 μm) and flow rate (10-120 Lpm), which was rigorously analyzed to compare anatomical metrics (epiglottis angle (θE), glottis to cricoid ring ratio (GC-ratio), and pediatric to adult trachea ratio (H-ratio)), inhaler metrics (particle diameter, [Formula: see text], and flow rate, Q), and clinical metrics (age, sex, height, and weight) against aerosol deposition. Multivariate non-linear regression indicated that all metrics were all significantly influential on resultant deposition, with varying influence of individual parameters. Additionally, principal component analysis was employed, indicating that [Formula: see text], Q, GC-ratio, θE, and sex accounted for 90% of variability between subject-specific deposition. Notably, age was not statistically significant among pediatric subjects but was influential in comparing adult subjects. Inhaler design metrics were hugely influential, thus supporting the critical need for pediatric-specific inhalable approaches. This work not only improves accuracy in prescribing inhalable therapeutics and informing pediatric aerosol optimization, but also provides a framework for future aerosol studies to continue to strive toward optimized and personalized pediatric medicine.
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Affiliation(s)
- Emily L Kolewe
- Department of Chemical and Biomolecular Engineering, University of Delaware, 150 Academy St., Newark, Delaware, 19716, USA
| | - Saurav Padhye
- Department of Chemical and Biomolecular Engineering, University of Delaware, 150 Academy St., Newark, Delaware, 19716, USA
| | - Ian R Woodward
- Department of Chemical and Biomolecular Engineering, University of Delaware, 150 Academy St., Newark, Delaware, 19716, USA
| | - Yu Feng
- Department of Chemical Engineering, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Jenna W Briddell
- Division of Otorhinolaryngology, Department of Surgery, Nemours Children's Hospital, Wilmington, Delaware, USA
| | - Catherine A Fromen
- Department of Chemical and Biomolecular Engineering, University of Delaware, 150 Academy St., Newark, Delaware, 19716, USA.
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11
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He Q, Liu Y, Dou Z, Ma K, Li S. Congenital heart diseases with airway stenosis: a predictive nomogram to risk-stratify patients without airway intervention. BMC Pediatr 2023; 23:351. [PMID: 37438689 DOI: 10.1186/s12887-023-04160-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/26/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND This study focused on congenital heart disease (CHD) patients complicated with airway stenosis (AS) without airway intervention and aimed to identify the patients with potential risks. METHODS Patients diagnosed with CHD and AS were enrolled in this retrospective study. The primary outcome was defined as a postoperative mechanical ventilation duration of more than two weeks. We constructed a prediction model to predict the risk of prolonged mechanical ventilation (PMV). RESULTS A total of 185 patients diagnosed with CHD and AS in Fuwai Hospital from July 2009 to December 2022 were included in the study. Weight at CHD surgery, cardiopulmonary bypass (CPB) duration, complex CHD and comorbid tracheobronchomalacia were identified as risk factors and included in the model. The ROC curve showed a good distinguishing ability, with an AUC of 0.847 (95% CI: 0.786-0.908). According to the optimal cut-off value of the ROC curve, patients were divided into high- and low-risk groups, and the subsequent analysis showed significant differences in peri-operative characteristics and in-hospital deaths. CONCLUSIONS With the predictive model, several factors could be used to assess the risky patients with PMV. More attention should be paid to these patients by early identification and routine surveillance.
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Affiliation(s)
- Qiyu He
- Pediatric Cardiac Surgery Centre, National Centre for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100037, China
| | - Yuze Liu
- Pediatric Cardiac Surgery Centre, National Centre for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100037, China
| | - Zheng Dou
- Pediatric Cardiac Surgery Centre, National Centre for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100037, China
| | - Kai Ma
- Pediatric Cardiac Surgery Centre, National Centre for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100037, China
| | - Shoujun Li
- Pediatric Cardiac Surgery Centre, National Centre for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100037, China.
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12
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Kurihara C, Kuniyoshi KM, Rehan VK. Preterm Birth, Developmental Smoke/Nicotine Exposure, and Life-Long Pulmonary Sequelae. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040608. [PMID: 37189857 DOI: 10.3390/children10040608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 05/17/2023]
Abstract
This review delineates the main pulmonary issues related to preterm birth, perinatal tobacco/nicotine exposure, and its effects on offspring, focusing on respiratory health and its possible transmission to subsequent generations. We review the extent of the problem of preterm birth, prematurity-related pulmonary effects, and the associated increased risk of asthma later in life. We then review the impact of developmental tobacco/nicotine exposure on offspring asthma and the significance of transgenerational pulmonary effects following perinatal tobacco/nicotine exposure, possibly via its effects on germline epigenetics.
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Affiliation(s)
- Chie Kurihara
- Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Katherine M Kuniyoshi
- Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Virender K Rehan
- Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
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13
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Kumar H, Green R, Cornfeld DM, Condron P, Emsden T, Elsayed A, Zhao D, Gilbert K, Nash MP, Clark AR, Tawhai MH, Burrowes K, Murphy R, Tayebi M, McGeown J, Kwon E, Shim V, Wang A, Choisne J, Carman L, Besier T, Handsfield G, Babarenda Gamage TP, Shen J, Maso Talou G, Safaei S, Maller JJ, Taylor D, Potter L, Holdsworth SJ, Wilson GA. Roadmap for an imaging and modelling paediatric study in rural NZ. Front Physiol 2023; 14:1104838. [PMID: 36969588 PMCID: PMC10036853 DOI: 10.3389/fphys.2023.1104838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/30/2023] [Indexed: 03/12/2023] Open
Abstract
Our study methodology is motivated from three disparate needs: one, imaging studies have existed in silo and study organs but not across organ systems; two, there are gaps in our understanding of paediatric structure and function; three, lack of representative data in New Zealand. Our research aims to address these issues in part, through the combination of magnetic resonance imaging, advanced image processing algorithms and computational modelling. Our study demonstrated the need to take an organ-system approach and scan multiple organs on the same child. We have pilot tested an imaging protocol to be minimally disruptive to the children and demonstrated state-of-the-art image processing and personalized computational models using the imaging data. Our imaging protocol spans brain, lungs, heart, muscle, bones, abdominal and vascular systems. Our initial set of results demonstrated child-specific measurements on one dataset. This work is novel and interesting as we have run multiple computational physiology workflows to generate personalized computational models. Our proposed work is the first step towards achieving the integration of imaging and modelling improving our understanding of the human body in paediatric health and disease.
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Affiliation(s)
- Haribalan Kumar
- Mātai Medical Research Institute, Gisborne, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- GE Healthcare (Australia & New Zealand), Auckland, New Zealand
| | - Robby Green
- Mātai Medical Research Institute, Gisborne, New Zealand
| | - Daniel M. Cornfeld
- Mātai Medical Research Institute, Gisborne, New Zealand
- Faculty of Medical and Health Sciences, Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Paul Condron
- Mātai Medical Research Institute, Gisborne, New Zealand
- Faculty of Medical and Health Sciences, Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Taylor Emsden
- Mātai Medical Research Institute, Gisborne, New Zealand
- Faculty of Medical and Health Sciences, Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Ayah Elsayed
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- Auckland University of Technology, Auckland, New Zealand
| | - Debbie Zhao
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Kat Gilbert
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Martyn P. Nash
- Mātai Medical Research Institute, Gisborne, New Zealand
- Department of Engineering Science, University of Auckland, Auckland, New Zealand
| | - Alys R. Clark
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Merryn H. Tawhai
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Kelly Burrowes
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Rinki Murphy
- Faculty of Medical and Health Sciences, Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Maryam Tayebi
- Mātai Medical Research Institute, Gisborne, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Josh McGeown
- Mātai Medical Research Institute, Gisborne, New Zealand
| | - Eryn Kwon
- Mātai Medical Research Institute, Gisborne, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- Faculty of Medical and Health Sciences, Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Vickie Shim
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Alan Wang
- Mātai Medical Research Institute, Gisborne, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- Faculty of Medical and Health Sciences, Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Julie Choisne
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Laura Carman
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Thor Besier
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Geoffrey Handsfield
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | | | - Jiantao Shen
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Gonzalo Maso Talou
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Soroush Safaei
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Jerome J. Maller
- GE Healthcare (Australia & New Zealand), Auckland, New Zealand
- Monash Alfred Psychiatry Research Centre, Melbourne, VIC, Australia
| | | | - Leigh Potter
- Mātai Medical Research Institute, Gisborne, New Zealand
| | - Samantha J. Holdsworth
- Mātai Medical Research Institute, Gisborne, New Zealand
- Faculty of Medical and Health Sciences, Centre for Brain Research, University of Auckland, Auckland, New Zealand
- *Correspondence: Samantha J. Holdsworth,
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14
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Naidoo RN. Environmental plastics and lung health: Increasing evidence for concern. Respirology 2023; 28:206-207. [PMID: 36411227 DOI: 10.1111/resp.14411] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/07/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Rajen N Naidoo
- Discipline of Occupational and Environmental Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
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15
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Miller CK, Reynolds J, Kelchner LN, Scarborough D, Langmore S, Gosa M. Tutorial on Clinical Practice for Use of the Fiberoptic Endoscopic Evaluation of Swallowing Procedure With Pediatric Populations: Part 2. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:55-82. [PMID: 36538506 DOI: 10.1044/2022_ajslp-22-00057] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE This is Part 2 of a two-part tutorial series establishing clinical guidelines pertaining to the administration of fiberoptic endoscopic evaluation of swallowing (FEES) developed by representatives of the American Board of Swallowing and Swallowing Disorders, all of whom are members of Special Interest Group 13. Whereas Part 1 focused on use of FEES with adults and included general information common to using FEES in any population, the purpose of this tutorial is to provide clinicians with updated best practice clinical guidelines for performing, interpreting, and documenting outcomes when using FEES with the pediatric population. This document has two main sections. The first section discusses the history of pediatric FEES, needed knowledge and skill pertaining to all elements of performing and interpreting the examination including detailed information related to indications and contraindications, developmental anatomical and physiological changes across childhood, preparing for and conducting the examination, medical collaboration, and patient safety. The second section provides detailed guidelines for clinicians who require training for use of FEES with the pediatric population. CONCLUSIONS This first of its kind tutorial offers guidelines for clinicians who perform, interpret, and/or want to train to perform FEES in the pediatric population. Important clinical distinctions exist when using FEES with the pediatric population versus with the adult population. Developmental changes, pediatric medical frailty, provider-parent/caregiver interaction, collaboration with physician colleagues, and patient safety are representative of key areas highlighted in this document.
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Affiliation(s)
- Claire Kane Miller
- Aerodigestive and Esophageal Center, Division of Speech-Language Pathology, Cincinnati Children's Hospital Medical Center, OH
| | - Jenny Reynolds
- Neonatal Intensive Care Unit, Baylor University Medical Center, Dallas, TX
| | - Lisa N Kelchner
- Department of Communication Sciences and Disorders, University of Cincinnati, OH
| | - Donna Scarborough
- Department of Speech Pathology and Audiology, Miami University, Oxford, OH
| | - Susan Langmore
- Department of Otolaryngology-Head & Neck Surgery, Boston University School of Medicine, MA
| | - Memorie Gosa
- Department of Communicative Disorders, The University of Alabama, Tuscaloosa
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16
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Mendez-Rebolledo G, Guzman-Muñoz E, Valdés-Badilla P, Ramirez-Campillo R, Cruz-Montecinos C, Núñez-Cortés R, Cabrera-Aguilera I, Calatayud J. Influence of lower limb muscle isometric strength and cardiovascular parameters on locomotor capacity in children and adolescents. J Back Musculoskelet Rehabil 2023; 36:1435-1446. [PMID: 37545211 DOI: 10.3233/bmr-230049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
BACKGROUND Although measures of exercise performance and physical activity are known to be related to 6-minute walk test (6mWT), the role of the strength of each muscle group of the lower limb in the locomotor capacity during the development period is unknown. OBJECTIVE To identify the role of the isometric strength of lower limb muscles and cardiovascular parameters on the locomotor capacity in children and adolescents, controlling for participants sex, age, and height. METHODS Participants (7 to 15 years old; female, n= 113; male, n= 128) were assessed for isometric strength (seven lower limb muscles), cardiovascular parameters (diastolic pressure, oxygen saturation, resting heart rate, respiratory rate), and 6mWT. Participants were split into nine age groups and separated by 1-year intervals. RESULTS Hip flexors-controlled for sex, age, and height-explained a meaningful percentage of the variance (R=2 0.45; p< 0.001) for 6mWT distance, and the resting heart rate explained a change in R2 of only 2% (p= 0.008). CONCLUSIONS Isometric strength of hip flexors explained ∼ 50% of the 6mWT distance, suggesting the importance of strength from an early age. Other factors, such as cardiovascular parameters, while relevant, may exert a secondary role on youth's capacity.
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Affiliation(s)
- Guillermo Mendez-Rebolledo
- Laboratorio de Investigación Somatosensorial y Motora, Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Chile
| | - Eduardo Guzman-Muñoz
- Laboratorio de Investigación Somatosensorial y Motora, Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Chile
| | - Pablo Valdés-Badilla
- Department of Physical Activity Sciences, Faculty of Education Sciences Universidad Católica del Maule, Talca, Chile
- Sports Coach Career, School of Education, Universidad Viña del Mar, Valparaíso, Chile
| | - Rodrigo Ramirez-Campillo
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Carlos Cruz-Montecinos
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Rodrigo Núñez-Cortés
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Ignacio Cabrera-Aguilera
- Escuela de Kinesiología, Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Concepción, Chile
| | - Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
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17
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Kolewe EL, Padhye S, Woodward IR, Wee J, Rahman T, Feng Y, Briddell JW, Fromen CA. Spatial aerosol deposition correlated to anatomic feature development in 6-year-old upper airway computational models. Comput Biol Med 2022; 149:106058. [PMID: 36103743 PMCID: PMC10167792 DOI: 10.1016/j.compbiomed.2022.106058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/03/2022] [Accepted: 08/27/2022] [Indexed: 02/01/2023]
Abstract
The upper airways of children undergo developmental changes around age 6, yielding differences between adult and pediatric anatomies. These differences include the cricoid ring area shape, the location of narrowest constriction, and the angle of the epiglottis, all of which are expected to alter local fluid dynamic profiles and subsequent upper airway deposition and downstream aerosol delivery of inhaled therapeutics. In this work, we quantify "pediatric"-like and "adult"-like geometric and fluid dynamic features of two computed tomography (CT)-scan derived models of 6-year-old upper airways in healthy subjects and compare to an idealized model. The two CT-scan models had a mixture of "adult"- and "pediatric"-like anatomic features, with Subject B exhibiting more "pediatric"-like features than Subject A, while the idealized model exhibited entirely "adult"-like features. By computational fluid-particle dynamics, these differences in anatomical features yielded distinct local fluid profiles with altered aerosol deposition between models. Notably, the idealized model better predicted deposition characteristics of Subject A, the more "adult"-like model, including the relationship between the impaction parameter, dp2Q and the fraction of deposition across a range of flow rates and particle diameters, as well as deposition of an approximate pharmaceutical particle size distribution model. Our results with even this limited dataset suggest that there are key personalized metrics that are influenced by anatomical development, which should be considered when developing pediatric inhalable therapeutics. Quantifying anatomical development and correlating to aerosol deposition has the potential for high-throughput developmental characterization and informing desired aerosol characteristics for pediatric applications.
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Affiliation(s)
- Emily L Kolewe
- Department of Chemical and Biomolecular Engineering, University of Delaware, Newark, DE, USA
| | - Saurav Padhye
- Department of Chemical and Biomolecular Engineering, University of Delaware, Newark, DE, USA
| | - Ian R Woodward
- Department of Chemical and Biomolecular Engineering, University of Delaware, Newark, DE, USA
| | - Jinyong Wee
- Department of Biomedical Research, Nemours Children's Hospital, Wilmington, DE, USA
| | - Tariq Rahman
- Department of Biomedical Research, Nemours Children's Hospital, Wilmington, DE, USA
| | - Yu Feng
- Department of Chemical Engineering, Oklahoma State University, Stillwater, OK, USA
| | - Jenna W Briddell
- Division of Otorhinolaryngology, Department of Surgery, Nemours Children's Hospital, Wilmington, DE, USA
| | - Catherine A Fromen
- Department of Chemical and Biomolecular Engineering, University of Delaware, Newark, DE, USA.
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18
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de Souza Xavier Costa N, Mirtes Teles A, de Brito JM, de Barros Mendes Lopes T, Calciolari Rossi R, Magalhães Arantes Costa F, Mangueira Saraiva-Romanholo B, Perini A, Furuya TK, Germán Murillo Carrasco A, Matera Veras M, Nascimento Saldiva PH, Chammas R, Mauad T. Allergic sensitization and exposure to ambient air pollution beginning early in life lead to a COPD-like phenotype in young adult mice. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2022; 241:113821. [PMID: 36068749 DOI: 10.1016/j.ecoenv.2022.113821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/10/2022] [Accepted: 06/26/2022] [Indexed: 06/15/2023]
Abstract
The perinatal period and early infancy are considered critical periods for lung development. During this period, adversities such as environmental exposures, allergic sensitization, and asthma are believed to impact lung health in adulthood. Therefore, we hypothesized that concomitant exposure to allergic sensitization and urban-derived fine particulate matter (PM2.5) in the early postnatal period of mice would cause more profound alterations in lung alveolarization and growth and differently modulate lung inflammation and gene expression than either insult alone in adult life. BALB/c mice were sensitized with ovalbumin (OVA) and exposed to PM2.5 from the fifth day of life. Then, we assessed lung responsiveness, inflammation in BALF, lung tissue, and alveolarization by stereology. In addition, we performed a transcriptomic analysis of lung tissue on the 40th day of life. Our results showed that young adult mice submitted to allergic sensitization and exposure to ambient PM2.5 since early life presented decreased lung growth with impaired alveolarization, a mixed neutrophilic-eosinophilic pattern of lung inflammation, increased airway responsiveness, and increased expression of genes linked to neutrophil recruitment when compared to animals that were OVA-sensitized or PM2.5 exposed only. Both, early life allergic sensitization and PM2.5 exposure, induced inflammation and impaired lung growth, but concomitant exposure was associated with worsened inflammation parameters and caused alveolar enlargement. Our experimental data provide pathological support for the hypothesis that allergic or environmental insults in early life have permanent adverse consequences for lung growth. In addition, combined insults were associated with the development of a COPD-like phenotype in young adult mice. Together with our data, current evidence points to the urgent need for healthier environments with fewer childhood disadvantage factors during the critical windows of lung development and growth.
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Affiliation(s)
- Natália de Souza Xavier Costa
- Laboratório de Patologia Ambiental e Experimental (LIM05), Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Aila Mirtes Teles
- Laboratório de Patologia Ambiental e Experimental (LIM05), Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Jôse Mára de Brito
- Laboratório de Patologia Ambiental e Experimental (LIM05), Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Thaís de Barros Mendes Lopes
- Laboratório de Patologia Ambiental e Experimental (LIM05), Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Renata Calciolari Rossi
- Department of Pathology, Universidade do Oeste Paulista UNOESTE, Presidente Prudente, SP, Brazil
| | - Fernanda Magalhães Arantes Costa
- Laboratory of Experimental Therapeutics (LIM20), Department of Medicine, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Beatriz Mangueira Saraiva-Romanholo
- Laboratory of Experimental Therapeutics (LIM20), Department of Medicine, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Adenir Perini
- Laboratory of Experimental Therapeutics (LIM20), Department of Medicine, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Tatiane Katsue Furuya
- Center of Translational Research in Oncology (LIM24), Instituto do Cancer do Estado de Sao Paulo (ICESP), Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Alexis Germán Murillo Carrasco
- Center of Translational Research in Oncology (LIM24), Instituto do Cancer do Estado de Sao Paulo (ICESP), Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Mariana Matera Veras
- Laboratório de Patologia Ambiental e Experimental (LIM05), Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Paulo Hilário Nascimento Saldiva
- Laboratório de Patologia Ambiental e Experimental (LIM05), Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Roger Chammas
- Center of Translational Research in Oncology (LIM24), Instituto do Cancer do Estado de Sao Paulo (ICESP), Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Thais Mauad
- Laboratório de Patologia Ambiental e Experimental (LIM05), Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil.
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19
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Relationships between diaphragm ultrasound, spirometry, and respiratory mouth pressures in children. Respir Physiol Neurobiol 2022; 305:103950. [PMID: 35905862 DOI: 10.1016/j.resp.2022.103950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/12/2022] [Accepted: 07/24/2022] [Indexed: 11/22/2022]
Abstract
Diaphragm ultrasound (DUS) is a noninvasive method of evaluating the diaphragm's structure and function. This study explored the relationships between DUS, spirometry, and respiratory mouth pressures in 10 healthy children (median age: 11 [range: 7-14 years]; 5 females, 5 males). Thickening fraction correlated with maximal inspiratory pressure (MIP) (Spearman's rho [rs] = 0.64, p = 0.05). During quiet breaths, excursion time correlated with MIP (rs = 0.78, p = 0.01) while velocity correlated with maximal expiratory pressure (rs = -0.82, p = 0.01). During deep breaths, MIP correlated with excursion (rs = 0.64, p = 0.05) and time (rs = 0.87, p = 0.01). Excursion time during deep breaths also correlated with forced vital capacity (rs = 0.65, p = 0.04). Our findings suggest that DUS parameters are closely related to spirometry and respiratory mouth pressures in healthy children and further support the use of DUS as a noninvasive method of respiratory assessment.
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20
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Lifelong Lung Sequelae of Prematurity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095273. [PMID: 35564667 PMCID: PMC9104309 DOI: 10.3390/ijerph19095273] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 04/22/2022] [Accepted: 04/24/2022] [Indexed: 11/29/2022]
Abstract
The clinical, functional, and structural pattern of chronic lung disease of prematurity has changed enormously in last years, mirroring a better perinatal management and an increasing lung immaturity with the survival of increasingly premature infants. Respiratory symptoms and lung function impairment related to prematurity seem to improve over time, but premature birth increases the likelihood of lung function impairment in late childhood, predisposing to chronic obstructive pulmonary disease (COPD). It is mandatory to identify those individuals born premature who are at risk for developing long-term lung disease through a better awareness of physicians, the use of standardized CT imaging scores, and a more comprehensive periodic lung function evaluation. The aim of this narrative review was to provide a systematic approach to lifelong respiratory symptoms, lung function impairment, and lung structural anomalies in order to better understand the specific role of prematurity on lung health.
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21
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Di Cicco M, Del Tufo E, Fasola S, Gracci S, Marchi MG, Fibbi L, Cilluffo G, Ferrante G, Peroni DG, La Grutta S. The Effect of Outdoor Aeroallergens on Asthma Hospitalizations in Children in North-Western Tuscany, Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063586. [PMID: 35329272 PMCID: PMC8949088 DOI: 10.3390/ijerph19063586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/04/2022] [Accepted: 03/15/2022] [Indexed: 02/01/2023]
Abstract
Few data are currently available on the effects of aeroallergens in triggering respiratory symptoms in children. To evaluate the potential effects of daily outdoor aeroallergens loads on childhood admissions, in this case-crossover study, we analyzed data from 85 children hospitalized at the University Hospital of Pisa, Italy, for asthma or asthma-like symptoms without respiratory infection, between 2010 and 2019. Data were linked to outdoor allergens, temperature, nitrogen dioxide, and relative humidity observed during the same period. A 10-grains/m3 increase in the total aeroallergen concentration was associated with an increased risk of admission at lag 0 (OR = 1.054, 95% CI: 1.011–1.098), with a smaller effect at lag 1 (OR = 1.037, 95% CI: 1.008–1.067) and lag 2 (OR = 1.021, 95% CI: 1.003–1.039). Trends to larger effects were observed in children with sensitization to one or more aeroallergens (OR = 1.085, 95% CI: 1.004–1.173 at lag 0), in males (OR = 1.069, 95% CI: 1.009–1.132 at lag 0) and in older children (OR = 1.065, 95% CI: 1.007–1.127 at lag 0). Our study shows an association between increased outdoor allergens loads and asthma or asthma-like symptoms in children up to at least two days prior to hospitalization, suggesting that tracking aeroallergen counts may be useful to improve the management of respiratory allergic diseases.
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Affiliation(s)
- Maria Di Cicco
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma n. 55, 56126 Pisa, Italy; (E.D.T.); (S.G.); (D.G.P.)
- Allergology Section, Pediatrics Unit, Pisa University Hospital, Via Roma n. 67, 56126 Pisa, Italy
- Correspondence: ; Tel.: +39-050-992-797
| | - Ester Del Tufo
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma n. 55, 56126 Pisa, Italy; (E.D.T.); (S.G.); (D.G.P.)
- Allergology Section, Pediatrics Unit, Pisa University Hospital, Via Roma n. 67, 56126 Pisa, Italy
| | - Salvatore Fasola
- Institute of Translational Pharmacology, IFT, National Research Council, 90146 Palermo, Italy; (S.F.); (S.L.G.)
| | - Serena Gracci
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma n. 55, 56126 Pisa, Italy; (E.D.T.); (S.G.); (D.G.P.)
- Allergology Section, Pediatrics Unit, Pisa University Hospital, Via Roma n. 67, 56126 Pisa, Italy
| | - Maria Giovanna Marchi
- Regional Agency for Environmental Protection of Tuscany (ARPAT), 50144 Florence, Italy;
| | - Luca Fibbi
- Laboratory for Meteorology and Environmental Modelling (LaMMA Consortium), 50019 Sesto Fiorentino, Italy;
- Institute of Bioeconomy, IBE, National Research Council, 50019 Sesto Fiorentino, Italy
| | - Giovanna Cilluffo
- Department of Earth and Marine Sciences, University of Palermo, 90123 Palermo, Italy;
| | - Giuliana Ferrante
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, 37126 Verona, Italy;
| | - Diego G. Peroni
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma n. 55, 56126 Pisa, Italy; (E.D.T.); (S.G.); (D.G.P.)
- Allergology Section, Pediatrics Unit, Pisa University Hospital, Via Roma n. 67, 56126 Pisa, Italy
| | - Stefania La Grutta
- Institute of Translational Pharmacology, IFT, National Research Council, 90146 Palermo, Italy; (S.F.); (S.L.G.)
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22
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Jarvis JL, Lyng JW, Miller BL, Perlmutter MC, Abraham H, Sahni R. Prehospital Drug Assisted Airway Management: An NAEMSP Position Statement and Resource Document. PREHOSP EMERG CARE 2022; 26:42-53. [PMID: 35001829 DOI: 10.1080/10903127.2021.1990447] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Airway management is a critical intervention for patients with airway compromise, respiratory failure, and cardiac arrest. Many EMS agencies use drug-assisted airway management (DAAM) - the administration of sedatives alone or in combination with neuromuscular blockers - to facilitate advanced airway placement in patients with airway compromise or impending respiratory failure who also have altered mental status, agitation, or intact protective airway reflexes. While DAAM provides several benefits including improving laryngoscopy and making insertion of endotracheal tubes and supraglottic airways easier, DAAM also carries important risks. NAEMSP recommends:DAAM is an appropriate tool for EMS clinicians in systems with clear guidelines, sufficient training, and close EMS physician oversight. DAAM should not be used in settings without adequate resources.EMS physicians should develop clinical guidelines informed by evidence and oversee the training and credentialing for safe and effective DAAM.DAAM programs should include best practices of airway management including patient selection, assessmenct and positioning, preoxygenation strategies including apneic oxygenation, monitoring and management of physiologic abnormalities, selection of medications, post-intubation analgesia and sedation, equipment selection, airway confirmation and monitoring, and rescue airway techniques.Post-DAAM airway placement must be confirmed and continually monitored with waveform capnography.EMS clinicians must have the necessary equipment and training to manage patients with failed DAAM, including bag mask ventilation, supraglottic airway devices and surgical airway approaches.Continuous quality improvement for DAAM must include assessment of individual and aggregate performance metrics. Where available for review, continuous physiologic recordings (vital signs, pulse oximetry, and capnography), audio and video recordings, and assessment of patient outcomes should be part of DAAM continuous quality improvement.
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Lyng J, Harris M, Mandt M, Moore B, Gross T, Gausche-Hill M, Donofrio-Odmann JJ. Prehospital Pediatric Respiratory Distress and Airway Management Training and Education: An NAEMSP Position Statement and Resource Document. PREHOSP EMERG CARE 2022; 26:102-110. [PMID: 35001818 DOI: 10.1080/10903127.2021.1992551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Although pediatric airway and respiratory emergencies represent high-acuity situations, the ability of EMS clinicians to effectively manage these patients is hampered by infrequent clinical exposure and shortcomings in pediatric-specific education. Cognitive gaps in EMS clinicians' understanding of the differences between pediatric and adult airway anatomy and respiratory physiology and pathology, variability in the training provided to EMS clinicians, and decay of the psychomotor skills necessary to safely and effectively manage pediatric patients experiencing respiratory emergencies collectively pose significant threats to the quality and safety of care delivered to pediatric patients. NAEMSP recommends:Pediatric airway education should include discussion of the factors that make pediatric airway management challenging.EMS agencies should provide pediatric-specific education that addresses recognition and treatment of pediatric respiratory distress based upon pathophysiology affecting upper airways, lower airways, cardiovascular systems, or extrinsic causes of disordered breathing. Pediatric airway training should also differentiate between hypoxic and hypercapnic respiratory failure. Education should emphasize that the cognitive and psychomotor skills requisite in management of pediatric respiratory emergencies will differ across patient age groups.EMS clinicians should be provided education and training in technology-dependent children and children and youth with special health care needs.EMS clinicians should receive initial and ongoing education and training in pediatric airway and respiratory conditions that emphasizes the principle of using the least invasive most effective strategies to achieve oxygenation and ventilation.Initial and continuing pediatric-focused education should be structured to maintain EMS clinician competency in the assessment and management of pediatric airway and respiratory emergencies and should be provided on a recurring basis to mitigate the decay of EMS clinicians' knowledge and skills that occurs due to infrequent field-based clinical exposure.Integration of clinician education programs with quality management programs is essential for the development and delivery of initial and continuing education intended to help EMS clinicians attain and maintain proficiency in pediatric airway and respiratory management.
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24
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The maturational gradient of infant vocalizations: Developmental stages and functional modules. Infant Behav Dev 2021; 66:101682. [PMID: 34920296 DOI: 10.1016/j.infbeh.2021.101682] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 12/29/2022]
Abstract
Stage models have been influential in characterizing infant vocalizations in the first year of life. These models are basically descriptive and do not explain why certain types of vocal behaviors occur within a particular stage or why successive patterns of vocalization occur. This review paper summarizes and elaborates a theory of Developmental Functional Modules (DFMs) and discusses how maturational gradients in the DFMs explain age typical vocalizations as well as the transitions between successive stages or other static forms. Maturational gradients are based on biological processes that effect the reconfiguration and remodeling of the respiratory, laryngeal, and craniofacial systems during infancy. From a dynamic systems perspective, DFMs are part of a complex system with multiple degrees of freedom that can achieve stable performance with relatively few control variables by relying on principles such as synergies, self-organization, nonlinear performance, and movement variability.
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Di Cicco ME, Bizzoco F, Morelli E, Seccia V, Ragazzo V, Peroni DG, Comberiati P. Nasal Polyps in Children: The Early Origins of a Challenging Adulthood Condition. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8110997. [PMID: 34828710 PMCID: PMC8620101 DOI: 10.3390/children8110997] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/28/2021] [Accepted: 10/30/2021] [Indexed: 12/03/2022]
Abstract
Nasal polyps (NPs) are benign inflammatory masses causing chronic nasal obstruction, usually associated with underlying chronic rhinosinusitis (CRS), which are rarely reported in childhood. The interest in NPs has recently increased due to new therapeutic options, namely biological agents, such as dupilumab, and an update of the European position paper on this topic was released in 2020, providing a detailed classification for these lesions and also discussing diagnostic and therapeutic approaches also in children. In childhood, NPs usually represent red flags for systemic diseases, such as cystic fibrosis and immunodeficiencies. This review outlines the recent data on NPs in childhood, focusing on predisposing factors for CRS as well as on the potential endotypes in this particular age group, for which further studies are required in order to better clarify their pathogenesis and to identify molecular biomarkers that could help achieve more personalized treatments.
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Affiliation(s)
- Maria E. Di Cicco
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma n. 55, 56126 Pisa, Italy; (F.B.); (E.M.); (D.G.P.); (P.C.)
- Allergology Section, Pediatrics Unit, Pisa University Hospital, Via Roma n. 67, 56126 Pisa, Italy
- Correspondence: ; Tel.: +39-050-992797
| | - Francesca Bizzoco
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma n. 55, 56126 Pisa, Italy; (F.B.); (E.M.); (D.G.P.); (P.C.)
- Allergology Section, Pediatrics Unit, Pisa University Hospital, Via Roma n. 67, 56126 Pisa, Italy
| | - Elena Morelli
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma n. 55, 56126 Pisa, Italy; (F.B.); (E.M.); (D.G.P.); (P.C.)
- Allergology Section, Pediatrics Unit, Pisa University Hospital, Via Roma n. 67, 56126 Pisa, Italy
| | - Veronica Seccia
- Otolaryngology, Audiology, and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology, and Critical Care Medicine, Pisa University Hospital, Via Trivella, 56124 Pisa, Italy;
| | - Vincenzo Ragazzo
- Paediatrics and Neonatology Division, Women’s and Children’s Health Department, Versilia Hospital, Via Aurelia n. 335, 55049 Lido di Camaiore, Italy;
| | - Diego G. Peroni
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma n. 55, 56126 Pisa, Italy; (F.B.); (E.M.); (D.G.P.); (P.C.)
- Allergology Section, Pediatrics Unit, Pisa University Hospital, Via Roma n. 67, 56126 Pisa, Italy
| | - Pasquale Comberiati
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma n. 55, 56126 Pisa, Italy; (F.B.); (E.M.); (D.G.P.); (P.C.)
- Allergology Section, Pediatrics Unit, Pisa University Hospital, Via Roma n. 67, 56126 Pisa, Italy
- Department of Clinical Immunology and Allergology, I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia
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26
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Fayon M, Beaufils F. The lower respiratory airway wall in children in health and disease. ERJ Open Res 2021; 7:00874-2020. [PMID: 34322550 PMCID: PMC8311136 DOI: 10.1183/23120541.00874-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 03/24/2021] [Indexed: 02/06/2023] Open
Abstract
Alone or in association with other lung or thorax component disorders, the airway wall (AWW) remains one of the most frequently involved elements in paediatric lung diseases. A myriad of AWW disorders will present with similar symptomatology. It is thus important for the clinician to reappraise the normal development and structure of the AWW to better understand the underlying disease patterns. We herein provide an overview of the structure of the AWW and a description of its development from the fetal period to adulthood. We also detail the most common AWW changes observed in several acute and chronic respiratory disorders as well as after cigarette smoke or chronic pollution exposure. We then describe the relationship between the AWW structure and lung function. In addition, we present the different ways of investigating the AWW structure, from biopsies and histological analyses to the most recent noninvasive airway (AW) imaging techniques. Understanding the pathophysiological processes involved in an individual patient will lead to the judicious choice of nonspecific or specific personalised treatments, in order to prevent irreversible AW damage.
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Affiliation(s)
- Michael Fayon
- Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM U1045, Bordeaux Imaging Center, Bordeaux, France
- CHU de Bordeaux, Département de Pédiatrie, Service d'Exploration Fonctionnelle Respiratoire, Bordeaux, France
- INSERM, Centre d'Investigation Clinique (CIC1401), Bordeaux, France
| | - Fabien Beaufils
- Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM U1045, Bordeaux Imaging Center, Bordeaux, France
- CHU de Bordeaux, Département de Pédiatrie, Service d'Exploration Fonctionnelle Respiratoire, Bordeaux, France
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