A phase II, open-label clinical trial on the combination therapy with medium-chain triglycerides and ghrelin in patients with chronic obstructive pulmonary disease

Are Antimicrobial Peptides a 21st-Century Solution for Atopic Dermatitis?

Atopic dermatitis (AD) is a chronic inflammatory skin disorder that is the result of various environmental, bacterial and genetic stimuli, which culminate in the disruption of the skin's barrier function. Characterized by highly pruritic skin lesions, xerosis and an array of comorbidities among which skin infections are the most common, this condition results in both a significant loss of quality of life and in the need for life-long treatments (e.g., corticosteroids, monoclonal antibodies and regular antibiotic intake), all of which may have harmful secondary effects. This, in conjunction with AD's rising prevalence, made the development of alternative treatment strategies the focus of both the scientific community and the pharmaceutical industry. Given their potential to both manage the skin microbiome, fight infections and even modulate the local immune response, the use of antimicrobial peptides (AMPs) from more diverse origins has become one of the most promising alternative solutions for AD management, with some being already used with some success towards this end. However, their production and use also exhibit some limitations. The current work seeks to compile the available information and provide a better understanding of the state of the art in the understanding of AMPs' true potential in addressing AD.

Increased Oxygen Extraction by Pulmonary Rehabilitation Improves Exercise Tolerance and Ventilatory Efficiency in Advanced Chronic Obstructive Pulmonary Disease

Background: In cardiopulmonary exercise testing (CPET), oxygen uptake (V’_O2) is calculated using the product of minute ventilation (V’_E) and the difference between inspiratory and expiratory O₂ concentrations (ΔFO₂). However, little is known about the response of ΔFO₂ to pulmonary rehabilitation (PR). The aim of the present study was (1) to investigate whether PR increases peak V’_O2, based on whether ΔFO₂ or V’_E at peak exercise increase after PR, and (2) to investigate whether an improvement in ΔFO₂ correlates with an improvement in ventilatory efficiency. Methods: A total of 38 patients with severe and very severe COPD, whose PR responses were evaluated by CPET, were retrospectively analyzed. Results: After PR, peak V’_O2 was increased in 14 patients. The difference in ΔFO₂ at peak exercise following PR correlated with the difference in peak V’_O2 (r = 0.4884, p = 0.0019), the difference in V’_E/V’_CO2-nadir (r = −0.7057, p < 0.0001), and the difference in V’_E–V’_CO2 slope (r = −0.4578, p = 0.0039), but it did not correlate with the difference in peak V’_E. Conclusions: The increased O₂ extraction following PR correlated with improved exercise tolerance and ventilatory efficiency. In advanced COPD patients, a new strategy for improving O₂ extraction ability might be effective in those in whom ventilatory ability can be only minimally increased.

Managing COPD with expiratory or inspiratory pressure load training based on a prolonged expiration pattern

Background

Exertional prolonged expiration should be identified as a therapeutic target in COPD. The efficacy of expiratory or inspiratory pressure load training (EPT/IPT) based on the degree of prolonged expiration was investigated.

Methods

A total of 21 patients with COPD were divided into two groups according to the exertional change in the inspiratory duty cycle (T_I/Ttot). For 12 weeks, patients whose exertional T_I/Ttot decreased received EPT (EPT group, n=11, mean percentage forced expiratory volume in 1 s (%FEV₁), 32.8%) and those whose exertional T_I/Ttot increased received IPT (IPT group, n=10, mean %FEV₁, 45.1%).

Results

The therapeutic responses were as follows. In both groups, endurance time (EPT, +5.7 min, p<0.0001; IPT, +6.1 min, p=0.0004) on the constant work rate exercise test (WRET) and peak oxygen uptake increased (EPT, p=0.0028; IPT, p=0.0072). In the EPT group the following occurred: 1) soon after commencement of exercise with the constant WRET, the expiratory tidal volume (V_Tex) increased, reducing dyspnoea; 2) V_Tex and mean expiratory flow increased and then prolonged expiration (p=0.0001) improved at peak exercise with the incremental exercise test (ET); and 3) St. George's Respiratory Questionnaire total, activity and impact scores were improved. In the IPT group, on both the constant WRET and incremental ET, breathing frequency increased, which led to greater exercise performance with effort dyspnoea.

Conclusions

This study showed the benefits of EPT/IPT on exercise performance. If the choice of managing COPD with EPT/IPT is appropriate, inexpensive EPT/IPT may become widespread as home-based training.

Expiratory or inspiratory pressure load training (EPT/IPT) based on the degree of prolonged expiration improves exercise performance in COPD patients. If managing COPD with EPT/IPT is chosen appropriately, it could become widespread as home-based training.https://bit.ly/2ZWutWq