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Marcy F, Goettfried K, Enghard P, Piper SK, Kunz JV, Schroeder T. Impact of AKI on metabolic compensation for respiratory acidosis in ICU patients with AECOPD. J Crit Care 2024; 83:154846. [PMID: 38936337 DOI: 10.1016/j.jcrc.2024.154846] [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: 01/03/2024] [Revised: 05/28/2024] [Accepted: 06/08/2024] [Indexed: 06/29/2024]
Abstract
PURPOSE Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) can result in severe respiratory acidosis. Metabolic compensation is primarily achieved by renal retention of bicarbonate. The extent to which acute kidney injury (AKI) impairs the kidney's capacity to compensate for respiratory acidosis remains unclear. MATERIALS AND METHODS This retrospective analysis covers clinical data between January 2009 and December 2021 for 498 ICU patients with AECOPD and need for respiratory support. RESULTS 278 patients (55.8%) presented with or developed AKI. Patients with AKI exhibited higher 30-day-mortality rates (14.5% vs. 4.5% p = 0.001), longer duration of mechanical ventilation (median 90 h vs. 14 h; p = 0.001) and more severe hypercapnic acidosis (pH 7.23 vs. 7.28; pCO2 68.5 mmHg vs. 61.8 mmHg). Patients with higher AKI stages exhibited lower HCO3-/pCO2 ratios and did not reach expected HCO3- levels. In a mixed model analysis with random intercept per patient we analyzed the association of pCO2 (independent) and HCO3- (dependent variable). Lower estimates for averaged change in HCO3- were observed in patients with more severe AKI. CONCLUSION AKI leads to poor outcomes and compromises metabolic compensation of respiratory acidosis in ICU patients with AECOPD. While buffering agents may aid compensation for severe AKI, their use should be approached with caution.
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Affiliation(s)
- Florian Marcy
- Charité - Universitätsmedizin Berlin, Department of Nephrology and Medical Intensive Care Medicine, Berlin, Germany.
| | - Katharina Goettfried
- Charité - Universitätsmedizin Berlin, Department of Nephrology and Medical Intensive Care Medicine, Berlin, Germany
| | - Philipp Enghard
- Charité - Universitätsmedizin Berlin, Department of Nephrology and Medical Intensive Care Medicine, Berlin, Germany
| | - Sophie K Piper
- Charité - Universitätsmedizin Berlin, Institute of Biometry and Clinical Epidemiology, Berlin, Germany; Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Strasse 2, 10178 Berlin, Germany; Charité - Universitätsmedizin Berlin, Institute of Medical Informatics Berlin, Germany
| | - Julius Valentin Kunz
- Charité - Universitätsmedizin Berlin, Department of Nephrology and Medical Intensive Care Medicine, Berlin, Germany
| | - Tim Schroeder
- Charité - Universitätsmedizin Berlin, Department of Nephrology and Medical Intensive Care Medicine, Berlin, Germany
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Zeng J, Zhou C, Yi Q, Luo Y, Wei H, Ge H, Liu H, Zhang J, Li X, Pan P, Yi M, Cheng L, Liu L, Zhang J, Peng L, Pu J, Zhou H. Validation of the Rome Severity Classification of Chronic Obstructive Pulmonary Disease Exacerbation: A Multicenter Cohort Study. Int J Chron Obstruct Pulmon Dis 2024; 19:193-204. [PMID: 38249828 PMCID: PMC10800102 DOI: 10.2147/copd.s442382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 01/07/2024] [Indexed: 01/23/2024] Open
Abstract
Background The Rome severity classification is an objective assessment tool for the severity of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) based on readily measurable variables but has not been widely validated. The aim of this study is to evaluate the validity of the Rome classification in distinguishing the severity of AECOPD based on short-term mortality and other adverse outcomes. Methods The Rome severity classification was applied to a large multicenter cohort of inpatients with AECOPD. Differences in clinical features, in-hospital and 60-day mortality, intensive care unit (ICU) admission, mechanical ventilation (MV) and invasive mechanical ventilation (IMV) usage were compared among the mild, moderate and severe AECOPD according to the Rome proposal. Moreover, univariate logistic analysis and Kaplan Meier survival analysis were also performed to find the association between the Rome severity classification and those adverse outcomes. Results A total of 7712 patients hospitalized for AECOPD were included and classified into mild (41.88%), moderate (40.33%), or severe (17.79%) group according to the Rome proposal. The rate of ICU admission (6.4% vs 12.0% vs 14.9%, P <0.001), MV (11.7% vs 33.7% vs 45.3%, P <0.001) and IMV (1.4% vs 6.8% vs 8.9%, P <0.001) increased significantly with the increase of severity classification from mild to moderate to severe AECOPD. The 60-day mortality was higher in the moderate or severe group than in the mild group (3.5% vs 1.9%, 4.3% vs 1.9%, respectively, P <0.05) but showed no difference between the moderate and severe groups (2.6% vs 2.5%, P >0.05), results for in-hospital mortality showed the same trends. Similar findings were observed by univariate logistic analysis and survival analysis. Conclusion Rome severity classification demonstrated excellent performance in predicting ICU admission and the need for MV or IMV, but how it performs in differentiating short-term mortality still needs to be confirmed.
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Affiliation(s)
- Jiaxin Zeng
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Chen Zhou
- Center of Infectious Diseases, Division of Infectious Diseases in State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Qun Yi
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
- Sichuan Cancer Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, People’s Republic of China
| | - Yuanming Luo
- State Key Laboratory of Respiratory Disease, Guangzhou Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Hailong Wei
- Department of Respiratory and Critical Care Medicine, People’s Hospital of Leshan, Leshan, Sichuan Province, People’s Republic of China
| | - Huiqing Ge
- Department of Respiratory and Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Huiguo Liu
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People’s Republic of China
| | - Jianchu Zhang
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People’s Republic of China
| | - Xianhua Li
- Department of Respiratory and Critical Care Medicine, The First People’s Hospital of Neijiang City, Neijiang, Sichuan Province, People’s Republic of China
| | - Pinhua Pan
- Department of Respiratory and Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Mengqiu Yi
- Department of Emergency, First People’s Hospital of Jiujiang, Jiu jiang, Jiangxi Province, People’s Republic of China
| | - Lina Cheng
- Department of Emergency, First People’s Hospital of Jiujiang, Jiu jiang, Jiangxi Province, People’s Republic of China
| | - Liang Liu
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Chengdu University, Chengdu, Sichuan Province, People’s Republic of China
| | - Jiarui Zhang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Lige Peng
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Jiaqi Pu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Haixia Zhou
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - On behalf of the MAGNET AECOPD Registry Investigators
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
- Center of Infectious Diseases, Division of Infectious Diseases in State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
- Sichuan Cancer Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, People’s Republic of China
- State Key Laboratory of Respiratory Disease, Guangzhou Medical University, Guangzhou, Guangdong Province, People’s Republic of China
- Department of Respiratory and Critical Care Medicine, People’s Hospital of Leshan, Leshan, Sichuan Province, People’s Republic of China
- Department of Respiratory and Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People’s Republic of China
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People’s Republic of China
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People’s Republic of China
- Department of Respiratory and Critical Care Medicine, The First People’s Hospital of Neijiang City, Neijiang, Sichuan Province, People’s Republic of China
- Department of Respiratory and Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
- Department of Emergency, First People’s Hospital of Jiujiang, Jiu jiang, Jiangxi Province, People’s Republic of China
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Chengdu University, Chengdu, Sichuan Province, People’s Republic of China
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Samuel R. Application of Boston Compensation Rules in the Development of a Stepwise Approach for Novel Diagnostic Arterial Blood Gas Interpretation Method. Indian J Crit Care Med 2023; 27:717-723. [PMID: 37908425 PMCID: PMC10613873 DOI: 10.5005/jp-journals-10071-24552] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 09/13/2023] [Indexed: 11/02/2023] Open
Abstract
Background Arterial blood gas (ABG) interpretation plays an indispensable role in health care. The total changes in hydrogen ion concentration or actual pH are due to both the changes in respiratory and non-respiratory (metabolic) components affecting the hydrogen ion concentration or pH in the acid-base homeostasis. Using this concept, an innovative ABG interpretation method was developed and published by the current author. The aim of this study is to apply the compensation rules and to develop a stepwise approach in this novel method to interpret various acid-base disorders. Methods The total change in pH (ΔpH), non-respiratory hydrogen ion concentration (NRH+), changes in non-respiratory pH (ΔNRpH), and respiratory change in pH (ΔRpH) were calculated for 232 ABG samples. The expected pCO2 (Exp pCO2) or expected bicarbonate (Exp HCO3-) values were calculated using the compensation rules and compared with their actual given values. Results Few acid-base disorder cases were shown as examples comparing the physiological, standard base excess (Std BE) and parameters such as ΔpH, ΔRpH, and ΔNRpH values of novel ABG interpretation method which change in different acid-base disorders. Conclusion The stepwise approach in this novel method appears to be much user-friendly providing interpretation of various acid-base disorders easily and quickly. Clinical significance This innovative method may help to overcome the challenging task of ABG interpretation. How to cite this article Samuel R. Application of Boston Compensation Rules in the Development of a Stepwise Approach for Novel Diagnostic Arterial Blood Gas Interpretation Method. Indian J Crit Care Med 2023;27(10):717-723.
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Affiliation(s)
- Rajini Samuel
- Department of Biochemistry, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth Deemed to be University, Chennai, Tamil Nadu, India
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Maxouri O, Bodalal Z, Daal M, Rostami S, Rodriguez I, Akkari L, Srinivas M, Bernards R, Beets-Tan R. How to 19F MRI: applications, technique, and getting started. BJR Open 2023; 5:20230019. [PMID: 37953866 PMCID: PMC10636348 DOI: 10.1259/bjro.20230019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 07/26/2023] [Accepted: 08/01/2023] [Indexed: 11/14/2023] Open
Abstract
Magnetic resonance imaging (MRI) plays a significant role in the routine imaging workflow, providing both anatomical and functional information. 19F MRI is an evolving imaging modality where instead of 1H, 19F nuclei are excited. As the signal from endogenous 19F in the body is negligible, exogenous 19F signals obtained by 19F radiofrequency coils are exceptionally specific. Highly fluorinated agents targeting particular biological processes (i.e., the presence of immune cells) have been visualised using 19F MRI, highlighting its potential for non-invasive and longitudinal molecular imaging. This article aims to provide both a broad overview of the various applications of 19F MRI, with cancer imaging as a focus, as well as a practical guide to 19F imaging. We will discuss the essential elements of a 19F system and address common pitfalls during acquisition. Last but not least, we will highlight future perspectives that will enhance the role of this modality. While not an exhaustive exploration of all 19F literature, we endeavour to encapsulate the broad themes of the field and introduce the world of 19F molecular imaging to newcomers. 19F MRI bridges several domains, imaging, physics, chemistry, and biology, necessitating multidisciplinary teams to be able to harness this technology effectively. As further technical developments allow for greater sensitivity, we envision that 19F MRI can help unlock insight into biological processes non-invasively and longitudinally.
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Affiliation(s)
| | | | | | | | | | - Leila Akkari
- Division of Tumor Biology and Immunology, Oncode Institute, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - René Bernards
- Division of Molecular Carcinogenesis, Oncode Institute, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Tehrani FT, Roum JH. Non-invasive ventilation treatment for patients with chronic obstructive pulmonary disease. Healthc Technol Lett 2023; 10:80-86. [PMID: 37529410 PMCID: PMC10388227 DOI: 10.1049/htl2.12048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/12/2023] [Accepted: 05/24/2023] [Indexed: 08/03/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) affects the lives of millions of patients worldwide. Patients with advanced COPD may require non-invasive ventilation (NIV) to support the resultant deficiencies of the respiratory system. The purpose of this study was to evaluate the effects of varying the continuous positive airway pressure (CPAP) and oxygen supplementation components of NIV on simulated COPD patients by using an established and detailed model of the human respiratory system. The model used in the study simulates features of advanced COPD including the effects on the changes in ventilation control, increases in respiratory dead space and airway resistance, and the acid-base shifts in the blood seen in these patients over time. The results of the study have been compared with and found to be in general agreement with available clinical data. Our results demonstrate that under non-emergency conditions, low levels of oxygen supplementation combined with low levels of CPAP therapy seem to improve hypoxemia and hypercapnia in the model, whereas prolonged high-level CPAP and moderate-to-high levels of oxygen supplementation do not. The authors conclude that such modelling may be useful to help guide beneficial interventions for COPD patients using NIV.
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Affiliation(s)
- Fleur T. Tehrani
- Department of Electrical and Computer EngineeringCalifornia State University FullertonCaliforniaUSA
| | - James H. Roum
- School of MedicineUniversity of CaliforniaIrvineCaliforniaUSA
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Abha Mishra KM, Podili R, Pathlavath TS, Sethi KK. A critical review on brain and heart axis response in COVID-19 patients: Molecular mechanisms, mediators, biomarkers, and therapeutics. J Biochem Mol Toxicol 2023; 37:e23409. [PMID: 37341157 DOI: 10.1002/jbt.23409] [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: 07/26/2022] [Revised: 06/01/2023] [Accepted: 06/08/2023] [Indexed: 06/22/2023]
Abstract
Since the outbreak of highly virulent coronaviruses, significant interest was assessed to the brain and heart axis (BHA) in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-affected patients. The majority of clinical reports accounted for unusual symptoms associated with SARS-CoV-2 infections which are of the neurological type, such as headache, nausea, dysgeusia, anosmia, and cerebral infarction. The SARS-CoV-2 enters the cells through the angiotensin-converting enzyme (ACE-2) receptor. Patients with prior cardiovascular disease (CVD) have a higher risk of COVID-19 infection and it has related to various cardiovascular (CV) complications. Infected patients with pre-existing CVDs are also particularly exposed to critical health outcomes. Overall, COVID-19 affected patients admitted to intensive care units (ICU) and exposed to stressful environmental constraints, featured with a cluster of neurological and CV complications. In this review, we summarized the main contributions in the literature on how SARS-CoV-2 could interfere with the BHA and its role in affecting multiorgan disorders. Specifically, the central nervous system involvement, mainly in relation to CV alterations in COVID-19-affected patients, is considered. This review also emphasizes the biomarkers and therapy options for COVID-19 patients presenting with CV problems.
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Affiliation(s)
- K M Abha Mishra
- Department of Medicinal Chemistry, National Institute of Pharmaceutical Education and Research Guwahati, Assam, India
| | - Runesh Podili
- Department of Medicinal Chemistry, National Institute of Pharmaceutical Education and Research Guwahati, Assam, India
| | - Teja S Pathlavath
- Department of Medicinal Chemistry, National Institute of Pharmaceutical Education and Research Guwahati, Assam, India
| | - Kalyan K Sethi
- Department of Medicinal Chemistry, National Institute of Pharmaceutical Education and Research Guwahati, Assam, India
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Reumkens C, Endres A, Simons SO, Savelkoul PH, Sprooten RT, Franssen FM. Application of the Rome severity classification of COPD exacerbations in a real-world cohort of hospitalised patients. ERJ Open Res 2023; 9:00569-2022. [PMID: 37228266 PMCID: PMC10204729 DOI: 10.1183/23120541.00569-2022] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/27/2023] [Indexed: 05/27/2023] Open
Abstract
Background Recently, the Rome classification was proposed in which objective and readily measurable variables were integrated to mark exacerbations of COPD (ECOPD) severity. The aim of this study is to investigate the distribution of a real-world patient population with hospitalised ECOPD according to the current classification across the newly proposed severity classification. We assume that a significant proportion of hospitalised patients will have a mild or moderate event. Methods The Rome classification was applied to a cohort of 364 COPD patients hospitalised at the Department of Respiratory Medicine of Maastricht University Medical Center (MUMC) with a severe ECOPD. Differences in in-hospital, 30- and 90-day mortality were compared between mild, moderate and severe ECOPD according to the new classification. Moreover, data were stratified by the different severity classes and compared regarding general disease characteristics and clinical parameters. Results According to the Rome proposal, 52 (14.3%) patients had a mild ECOPD, 204 (56.0%) a moderate and 108 (29.7%) a severe ECOPD. In-hospital mortality in mild, moderate and severe events was 3.8%, 6.9% and 13.9%, respectively. Most clinical parameters indicated a significantly worse condition in patients classified in the severe group, compared to those in mild or moderate groups. Conclusion Most of the events, traditionally all classified as severe because of the hospitalisation, were classified as moderate, while almost 15% were mild. The results of this study provide insight into the heterogeneity of hospitalised ECOPD and show that the newly proposed Rome criteria can differentiate between events with different short-term mortality rates.
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Affiliation(s)
- Carmen Reumkens
- Department of Medical Microbiology, Infectious Diseases and Infection Prevention, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Adrian Endres
- Department of Respiratory Medicine and Allergology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Sami O. Simons
- Department of Respiratory Medicine, NUTRIM, MUMC+, Maastricht, The Netherlands
| | - Paul H.M. Savelkoul
- Department of Medical Microbiology, Infectious Diseases and Infection Prevention, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Roy T.M. Sprooten
- Department of Respiratory Medicine, MUMC+, Maastricht, The Netherlands
- These authors contributed equally
| | - Frits M.E. Franssen
- Department of Respiratory Medicine, NUTRIM, MUMC+, Maastricht, The Netherlands
- Department of Research and Education, Ciro, Horn, The Netherlands
- These authors contributed equally
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Tariq S, Ismail D, Thapa M, Goriparthi L, Pradeep R, Khalid K, Cooper AC, Jean-Charles G. Chronic Obstructive Pulmonary Disease and Its Effect on Red Blood Cell Indices. Cureus 2023; 15:e36100. [PMID: 37065412 PMCID: PMC10097512 DOI: 10.7759/cureus.36100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 03/18/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) constitutes a set of heterogeneous symptoms affecting millions of people worldwide. The associated comorbidities developing in COPD involve dysregulation in physiological pathways resulting from systemic inflammation in respiratory airways. In addition to mentioning the pathophysiology, stages, and consequences of COPD, this paper also defines red blood cell (RBC) indices such as hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin concentration, red blood cell distribution width, and RBC count. It explains the role of RBC indices and RBC structural abnormalities with disease severity and exacerbations in COPD patients. Although many factors have been studied as a marker of morbidity and mortality for COPD patients, RBC indices have emerged as revolutionary evidence. Therefore, the effectiveness of evaluating RBC indices in COPD patients and their importance as a negative predictor of survival, mortality, and clinical outcomes have been debated through rigorous literature reviews. Furthermore, the prevalence, mechanisms of development, and prognosis of underlying anemia and polycythemia in COPD have also been evaluated, with anemia most significantly associated with COPD. Therefore, more studies should be conducted to address underlying anemia in COPD patients to lessen the severity and disease burden. Correcting the RBC indices in COPD patients remarkably impacts the quality of life and reduces in-patient admissions, healthcare resource utilization, and costs. Hence, it is noteworthy to understand the significance of considering RBC indices while dealing with COPD patients.
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Li XF, Wan CQ, Mao YM. Analysis of pathogenesis and drug treatment of chronic obstructive pulmonary disease complicated with cardiovascular disease. Front Med (Lausanne) 2022; 9:979959. [PMID: 36405582 PMCID: PMC9672343 DOI: 10.3389/fmed.2022.979959] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/05/2022] [Indexed: 09/19/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a disease characterized by persistent airflow limitation, and is associated with abnormal inflammatory responses in the lungs to cigarette smoke and toxic and harmful gases. Due to the existence of common risk factors, COPD is prone to multiple complications, among which cardiovascular disease (CVD) is the most common. It is currently established that cardiovascular comorbidities increase the risk of exacerbations and mortality from COPD. COPD is also an independent risk factor for CVD, and its specific mechanism is still unclear, which may be related to chronic systemic inflammation, oxidative stress, and vascular dysfunction. There is evidence that chronic inflammation of the airways can lead to destruction of the lung parenchyma and decreased lung function. Inflammatory cells in the airways also generate reactive oxygen species in the lungs, and reactive oxygen species further promote lung inflammation through signal transduction and other pathways. Inflammatory mediators circulate from the lungs to the whole body, causing intravascular dysfunction, promoting the formation and rupture of atherosclerotic plaques, and ultimately leading to the occurrence and development of CVD. This article reviews the pathophysiological mechanisms of COPD complicated by CVD and the effects of common cardiovascular drugs on COPD.
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Affiliation(s)
- Xiao-Fang Li
- Department of Respiratory Medicine, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, Henan, China
| | - Cheng-Quan Wan
- Department of Neonatology, Luoyang Maternal and Child Health Hospital,, Luoyang, Henan, China
| | - Yi-Min Mao
- Department of Respiratory Medicine, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, Henan, China
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Hebisz R, Hebisz P, Danek N, Michalik K, Zatoń M. Predicting Changes in Maximal Oxygen Uptake in Response to Polarized Training (Sprint Interval Training, High-Intensity Interval Training, and Endurance Training) in Mountain Bike Cyclists. J Strength Cond Res 2022; 36:1726-1730. [PMID: 32341248 DOI: 10.1519/jsc.0000000000003619] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Hebisz, R, Hebisz, P, Danek, N, Michalik, K, and Zatoń, M. Predicting changes in maximal oxygen uptake in response to polarized training (sprint interval training, high-intensity interval training, and endurance training) in mountain bike cyclists. J Strength Cond Res 36(6): 1726-1730, 2022-The aim of this study was to determine the predictors of change in maximal oxygen uptake (ΔV̇o2max) in response to a polarized training program. Twenty well-trained mountain bike cyclists completed an 8-week intervention of sprint interval training (SIT) (8-16 30-second maximal sprints), high-intensity interval training (4-6 bouts at 85-95% maximal aerobic power), and endurance training (2-3 hours cycling at 70-80% power at the ventilatory threshold). An incremental exercise test was performed to determine preintervention and postintervention maximal oxygen uptake (V̇o2max) and maximal pulmonary ventilation (VEmax) normalized to lean body mass (LBM). The frequency and time domain of heart rate variability (HRV) was also determined during recovery after moderate warm-up in the first and last SIT. Training status was quantified as the total distance cycled in the previous year. V̇o2max, VEmax, and the root mean square of the successive differences of normal-to-normal time interval between heartbeats (RMSSD), which is the time domain of HRV all increased significantly. Multiple significant correlations were observed between ΔV̇o2max and training status and baseline measures of VEmax·LBM-1, RMSSD, and V̇o2max·LBM-1 and a regression equation was developed (r = 0.87, r2 = 0.76; p = 0.0001). The change in V̇o2max in response to polarized training can be predicted with high accuracy based on several measurable variables.
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Affiliation(s)
- Rafał Hebisz
- Department of Physiology and Biochemistry, University School of Physical Education, Wroclaw, Poland
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Yan Y, Wu Q, Ren P, Liu Q, Zhang N, Ji Y, Liu J. Zinc ions coordinated carboxymethyl chitosan-hyaluronic acid microgel for pulmonary drug delivery. Int J Biol Macromol 2021; 193:1043-1049. [PMID: 34800517 DOI: 10.1016/j.ijbiomac.2021.11.088] [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: 09/24/2021] [Revised: 11/09/2021] [Accepted: 11/14/2021] [Indexed: 10/19/2022]
Abstract
Microgel affords a porous and swollen microstructure for the establishment of pulmonary delivery system with sustained released properties. Here, we report a microgel (with the diameter around 4 μm) prepared with a precipitation method, synthesized by coordinating Zn2+ to the Schiff base cross-linked carboxymethyl chitosan and glycol split hyaluronate. The microgel has shown well swollen and pH sensitive behaviors, high safety and biocompatibility in vitro. Besides, the biomaterial could escape from macrophage phagocytosis, a key factor contribute to quick drug clearance in the lung after co-incubated with RAW 264.7 cells. In consist with this, the bovine serum albumin loaded in the microgel showed sustained release behavior in 24 h in vitro; meanwhile, the drug had a retention time up to 36 h in the lung and followed by clearance in ICR mice through pulmonary administration. Thus, our microgel platform provides a promising candidate for pulmonary drug delivery systems with controlled release rate.
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Affiliation(s)
- Yishu Yan
- Department of Pharmaceutics, School of Pharmaceutical Sciences, Jiangnan University, Wuxi 214122, People's Republic of China.
| | - Qingqing Wu
- Department of Pharmaceutics, School of Pharmaceutical Sciences, Jiangnan University, Wuxi 214122, People's Republic of China
| | - Panpan Ren
- Department of Pharmaceutics, School of Pharmaceutical Sciences, Jiangnan University, Wuxi 214122, People's Republic of China
| | - Qiuyi Liu
- Department of Pharmaceutics, School of Pharmaceutical Sciences, Jiangnan University, Wuxi 214122, People's Republic of China
| | - Na Zhang
- Department of Pharmaceutics, School of Pharmaceutical Sciences, Jiangnan University, Wuxi 214122, People's Republic of China
| | - Yang Ji
- Glycobiology Research and Training Center, Departments of Medicine and Cellular and Molecular Medicine, University of California, San Diego, CA 92093, United States
| | - Jingxian Liu
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing 210009, People's Republic of China
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12
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Chaudhary N, Khan UH, Shah TH, Shaheen F, Mantoo S, Qadri SM, Mehfooz N, Shabir A, Siraj F, Shah S, Koul PA, Jan RA. Prevalence and predictors of pulmonary embolism in patients with acute exacerbation of chronic obstructive pulmonary disease. Lung India 2021; 38:533-539. [PMID: 34747735 PMCID: PMC8614611 DOI: 10.4103/lungindia.lungindia_79_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background: The prevalence of pulmonary embolism (PE) in patients of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) varies over a wide range. Early detection and treatment of PE in AECOPD is a key to improve patient outcome. The purpose of the study was to investigate the prevalence and predictors of PE in patients of AECOPD in a high burden region of North India. Materials and Methods: This prospective study included patients of AECOPD with no obvious cause of exacerbation on initial evaluation. Apart from routine workup, the participants underwent assessment of D-dimer, compression ultrasound and venous Doppler ultrasound of the lower limbs and pelvic veins, and a multidetector computed tomography pulmonary angiography. Results: A total of 100 patients of AECOPD with unknown etiology were included. PE as a possible cause of AE-COPD was observed in 14% of patients. Among the participants with PE, 63% (n = 9) had a concomitant presence of lower extremity deep venous thrombosis. Hemoptysis and chest pain were significantly higher in patients of AECOPD with PE ([35.7% vs. 7%, P = 0.002] and [92.9% vs. 38.4%, P = 0.001]). Likelihood of PE was significantly higher in patients who presented with tachycardia, tachypnea, respiratory alkalosis (PaCO2 <45 mmHg and pH >7.45), and hypotension. No difference was observed between the two groups in terms of in-hospital mortality, age, sex distribution, and risk factors for embolism except for the previous history of venous thromboembolism (35.7% vs. 12.8% P = 0.03). Conclusion: PE was probably responsible for AECOPD in 14% of patients with no obvious cause on initial assessment. Patients who present with chest pain, hemoptysis, tachypnea, tachycardia, and respiratory alkalosis should be particularly screened for PE.
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Affiliation(s)
- Nasir Chaudhary
- Department of Cardiology, GMC, Jammu, Jammu and Kashmir, India
| | - Umar Hafiz Khan
- Department of Geriatric Medicine, Sher E Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Tajamul Hussain Shah
- Department of Pulmonary Medicine, Sher E Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Feroze Shaheen
- Department of Radiology, Sher E Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Suhail Mantoo
- Department of Internal Medicine, Sher E Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Syed Mudasir Qadri
- Department of Internal Medicine, Sher E Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Nazia Mehfooz
- Department of Pulmonary Medicine, Sher E Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Afshan Shabir
- Department of Geriatric Medicine, Sher E Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Farhana Siraj
- Department of Internal Medicine, Sher E Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Sonaullah Shah
- Department of Internal and Pulmonary Medicine, Sher E Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Parvaiz A Koul
- Department of Internal and Pulmonary Medicine, Sher E Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Rafi Ahmed Jan
- Department of Internal and Pulmonary Medicine, Sher E Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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13
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Genicio N, Bañobre-López M, Gröhn O, Gallo J. Ratiometric magnetic resonance imaging: Contrast agent design towards better specificity and quantification. Coord Chem Rev 2021. [DOI: 10.1016/j.ccr.2021.214150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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14
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Nechipurenko YD, Semyonov DA, Lavrinenko IA, Lagutkin DA, Generalov EA, Zaitceva AY, Matveeva OV, Yegorov YE. The Role of Acidosis in the Pathogenesis of Severe Forms of COVID-19. BIOLOGY 2021; 10:852. [PMID: 34571729 PMCID: PMC8469745 DOI: 10.3390/biology10090852] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/23/2021] [Accepted: 08/26/2021] [Indexed: 12/11/2022]
Abstract
COVID-19 has specific characteristics that distinguish this disease from many other infections. We suggest that the pathogenesis of severe forms of COVID-19 can be associated with acidosis. This review article discusses several mechanisms potentially linking the damaging effects of COVID-19 with acidosis and shows the existence of a vicious cycle between the development of hypoxia and acidosis in COVID-19 patients. At the early stages of the disease, inflammation, difficulty in gas exchange in the lungs and thrombosis collectively contribute to the onset of acidosis. In accordance with the Verigo-Bohr effect, a decrease in blood pH leads to a decrease in oxygen saturation, which contributes to the exacerbation of acidosis and results in a deterioration of the patient's condition. A decrease in pH can also cause conformational changes in the S-protein of the virus and thus lead to a decrease in the affinity and avidity of protective antibodies. Hypoxia and acidosis lead to dysregulation of the immune system and multidirectional pro- and anti-inflammatory reactions, resulting in the development of a "cytokine storm". In this review, we highlight the potential importance of supporting normal blood pH as an approach to COVID-19 therapy.
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Affiliation(s)
- Yury D. Nechipurenko
- Laboratory DNA-Protein Recognition, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow 119991, Russia
| | - Denis A. Semyonov
- Institute of Molecular Medicine and Pathobiochemistry, Voyno-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk 660022, Russia;
- Institute of Biophysics Siberian Branch of Russian Academy of Sciences, Krasnoyarsk 660036, Russia
| | - Igor A. Lavrinenko
- Department of Human and Animal Physiology, Faculty of Medicine and Biology, Voronezh State University, Voronezh 394018, Russia;
| | - Denis A. Lagutkin
- Department of Biological and Medical Physics, Moscow Institute of Physics and Technology, Dolgoprudny 141701, Russia;
| | - Evgenii A. Generalov
- Department of Biophysics, Faculty of Physics, Lomonosov Moscow State University, Moscow 119991, Russia;
| | - Anna Y. Zaitceva
- Laboratory of Medical Analytical Methods and Devices, Institute for Analytical Instrumentation of the Russian Academy of Sciences, St. Petersburg 198095, Russia;
| | | | - Yegor E. Yegorov
- Laboratory of Cellular Bases for the Development of Malignant Diseases, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow 119991, Russia
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15
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Cobre ADF, Stremel DP, Noleto GR, Fachi MM, Surek M, Wiens A, Tonin FS, Pontarolo R. Diagnosis and prediction of COVID-19 severity: can biochemical tests and machine learning be used as prognostic indicators? Comput Biol Med 2021; 134:104531. [PMID: 34091385 PMCID: PMC8164361 DOI: 10.1016/j.compbiomed.2021.104531] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/21/2021] [Accepted: 05/25/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE This study aimed to implement and evaluate machine learning based-models to predict COVID-19' diagnosis and disease severity. METHODS COVID-19 test samples (positive or negative results) from patients who attended a single hospital were evaluated. Patients diagnosed with COVID-19 were categorised according to the severity of the disease. Data were submitted to exploratory analysis (principal component analysis, PCA) to detect outlier samples, recognise patterns, and identify important variables. Based on patients' laboratory tests results, machine learning models were implemented to predict disease positivity and severity. Artificial neural networks (ANN), decision trees (DT), partial least squares discriminant analysis (PLS-DA), and K nearest neighbour algorithm (KNN) models were used. The four models were validated based on the accuracy (area under the ROC curve). RESULTS The first subset of data had 5,643 patient samples (5,086 negatives and 557 positives for COVID-19). The second subset included 557 COVID-19 positive patients. The ANN, DT, PLS-DA, and KNN models allowed the classification of negative and positive samples with >84% accuracy. It was also possible to classify patients with severe and non-severe disease with an accuracy >86%. The following were associated with the prediction of COVID-19 diagnosis and severity: hyperferritinaemia, hypocalcaemia, pulmonary hypoxia, hypoxemia, metabolic and respiratory acidosis, low urinary pH, and high levels of lactate dehydrogenase. CONCLUSION Our analysis shows that all the models could assist in the diagnosis and prediction of COVID-19 severity.
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Affiliation(s)
| | - Dile Pontarolo Stremel
- Department of Forest Engineering and Technology, Universidade Federal Do Paraná, Curitiba, Brazil
| | | | - Mariana Millan Fachi
- Pharmaceutical Sciences Postgraduate Programme, Universidade Federal Do Paraná, Curitiba, Brazil
| | - Monica Surek
- Pharmaceutical Sciences Postgraduate Programme, Universidade Federal Do Paraná, Curitiba, Brazil
| | - Astrid Wiens
- Department of Pharmacy, Universidade Federal Do Paraná, Curitiba, Brazil
| | - Fernanda Stumpf Tonin
- Pharmaceutical Sciences Postgraduate Programme, Universidade Federal Do Paraná, Curitiba, Brazil
| | - Roberto Pontarolo
- Department of Pharmacy, Universidade Federal Do Paraná, Curitiba, Brazil,Corresponding author
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16
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ABG Assistant-Towards an Understanding of Complex Acid-Base Disorders. J Clin Med 2021; 10:jcm10071516. [PMID: 33916476 PMCID: PMC8038584 DOI: 10.3390/jcm10071516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/30/2021] [Accepted: 04/02/2021] [Indexed: 11/30/2022] Open
Abstract
The ability to diagnose acid-base imbalances correctly is essential for physicians and other healthcare workers. Despite its importance, it is often considered too complex and confusing. Although most people dealing with arterial blood gases (ABGs) do not usually have problems with acid-base disorder assessment, such an analysis is also carried out by other healthcare workers for whom this can be a challenging task. Many aspects may be problematic, partly due to multiple data analysis methods and no definitive statement on which one is better. According to our survey, the correctness of arterial blood gas analysis is unsatisfactory, especially in mixed disorders, which do not always manifest an obvious set of symptoms. Therefore, ABG parameters can be used as an established biomarker panel, which is considered to be a powerful tool for personalized medicine. Moreover, using different approaches to analyze acid-base disorders can lead to varying diagnoses in some cases. Because of these problems, we developed a mobile application that can spot diagnostic differences by taking into account physiological and chemical approaches, including their variants, with a corrected anion gap. The proposed application is characterized by a high percentage of correct analyses and can be an essential aid for diagnosing acid-base disturbances.
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17
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Buchholz KJ, Burgraff NJ, Neumueller SE, Hodges MR, Pan LG, Forster HV. Physiological and neurochemical adaptations following abrupt termination of chronic hypercapnia in goats. J Appl Physiol (1985) 2021; 130:1259-1273. [PMID: 33539265 PMCID: PMC8262788 DOI: 10.1152/japplphysiol.00909.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Chronic hypercapnia (CH) is a hallmark of respiratory diseases such as chronic obstructive pulmonary disease. In such patients, mechanical ventilation is often used to restore normal blood-gas homeostasis. However, little is known regarding physiological changes and neuroplasticity within physiological control networks after termination of CH. Utilizing our goat model of increased inspired CO2-induced CH, we determined whether termination of CH elicits time-dependent physiological and neurochemical changes within brain stem sites of physiological control. Thirty days of CH increased [Formula: see text] (+15 mmHg) and steady-state ventilation (SS V̇i; 283% of control). Within 24 h after terminating CH, SS V̇i, blood gases, arterial [H+], and most physiological measurements returned to control. However, the acute ventilatory chemoreflex (ΔV̇i/Δ[H+]) was greater than control, and measured SS V̇i exceeded ventilation predicted by arterial [H+] and ΔV̇i/Δ[H+]. Potentially contributing to these differences were increased excitatory neuromodulators serotonin and norepinephrine in the nucleus tractus solitarius, which contrasts with minimal changes observed at 24 h and 30 days of hypercapnia. Similarly, there were minimal changes found in markers of neuroinflammation and glutamate receptor-dependent neuroplasticity upon termination of CH, which were previously increased following 24 h of hypercapnia. Thus, following termination of CH: 1) ventilatory, renal, and other physiological functions rapidly return to control; 2) neuroplasticity within the ventilatory control network may contribute to the difference between measured vs. predicted ventilation and the elevation in the acute ventilatory [H+] chemoreflex; and 3) neuroplasticity is fundamentally distinct from acclimatization to CH.NEW & NOTEWORTHY In healthy adult goats, steady-state ventilation and most physiological measures return to control within 24 h after termination of chronic hypercapnia (CH). However, the acute [H+] chemoreflex is increased, and measured ventilation exceeds predicted ventilation. At 24 h of recovery, excitatory neuromodulators are above control, but other measured markers of neuroplasticity are unchanged from control. Our data suggest that CH elicits persistent physiological and neurochemical changes for up to 24 h after termination of CH.
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Affiliation(s)
- Kirstyn J. Buchholz
- 1Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nicholas J. Burgraff
- 5Center for Integrated Brain Research, Seattle Children’s Research Institute, Seattle, Washington
| | | | - Matthew Robert Hodges
- 1Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin,3Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lawrence G. Pan
- 2Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin
| | - Hubert V. Forster
- 1Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin,3Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, Wisconsin,4Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin
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18
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Shevel E. Conditions Favoring Increased COVID-19 Morbidity and Mortality: Their Common Denominator and its Early Treatment. MISSOURI MEDICINE 2021; 118:113-115. [PMID: 33840847 PMCID: PMC8029622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The factors contributing to increased morbidity and mortality in SARS-CoV-2 infection are diverse, and include diabetes, obesity, Chronic Obstructive Pulmonary Disease (COPD), advanced age, and male sex. Although there is no obvious connection between these, they do have one common denominator-they all have a tendency towards lower urine pH, which may indicate a lower-than-normal tissue pH. Furthermore, it has been shown that lower pH has two important negative influences: 1) it enhances viral fusion via the endosomal route, thereby facilitating viral multiplication; and 2) it facilitates increased production of inflammatory cytokines, thereby exacerbating the cytokine storm. This paper discusses published literature on lower tissue/interstitial pH in those diseases/co-morbidities that are known risk factors of severe COVID-19, and hypothesize that small doses of baking soda could be a simple, cost-effective, and rapid method of reducing both morbidity and mortality in COVID-19 patients.
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Affiliation(s)
- Eliot Shevel
- Head of the South African Headache Society, the South African affiliate of the International Headache Society. He is founder and practices at The Headache Clinic in Johannesburg, South Africa
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19
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Abstract
Metabolic alkalosis is an increase in blood pH to >7.45 due to a primary increase in serum bicarbonate (HCO3 -). Metabolic alkalosis results from alkali accumulation or acid loss, and it is associated with a secondary increase in carbon dioxide arterial pressure (PaCO2). Metabolic alkalosis is a common acid-base disorder, especially in critically ill patients. The pathogenesis of chronic metabolic alkalosis includes two derangements, generation of metabolic alkalosis via gain of alkali or loss of acid and maintenance of metabolic alkalosis by increased tubular HCO3 - reabsorption (failure of the kidneys to excrete excess alkali). Metabolic alkalosis is the most common acid-base disorder in hospitalized patients, particularly in the surgical critical care unit. Mortality increases as pH increases.
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Affiliation(s)
- Mohammad Tinawi
- Nephrology, Nephrology Specialists, P.C, Munster, USA
- Medicine, Indiana University School of Medicine Northwest, Gary, USA
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20
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Tehrani FT. Mathematical model of the human respiratory system in chronic obstructive pulmonary disease. Healthc Technol Lett 2020. [DOI: 10.1049/htl.2020.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Fleur T. Tehrani
- Department of Electrical Engineering California State University Fullerton California 92831 USA
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21
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Zolfaghari Emameh R, Falak R, Bahreini E. Application of System Biology to Explore the Association of Neprilysin, Angiotensin-Converting Enzyme 2 (ACE2), and Carbonic Anhydrase (CA) in Pathogenesis of SARS-CoV-2. Biol Proced Online 2020; 22:11. [PMID: 32572334 PMCID: PMC7302923 DOI: 10.1186/s12575-020-00124-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/01/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) appears with common symptoms including fever, dry cough, and fatigue, as well as some less common sysmptoms such as loss of taste and smell, diarrhea, skin rashes and discoloration of fingers. COVID-19 patients may also suffer from serious symptoms including shortness of breathing, chest pressure and pain, as well as loss of daily routine habits, pointing out to a sever reduction in the quality of life. COVID-19 has afftected almost all countries, however, the United States contains the highest number of infection (> 1,595,000 cases) and deaths cases (> 95,000 deaths) in the world until May 21, 2020. Finding an influential treatment strategy against COVID-19 can be facilitated through better understanding of the virus pathogenesis and consequently interrupting the biochemical pathways that the virus may play role in human body as the current reservoir of the virus. RESULTS In this study, we combined system biology and bioinformatic approaches to define the role of coexpression of angiotensin-converting enzyme 2 (ACE2), neprilysin or membrane metallo-endopeptidase (MME), and carbonic anhydrases (CAs) and their association in the pathogenesis of SARS-CoV-2. The results revealed that ACE2 as the cellular attachment site of SARS-CoV-2, neprilysin, and CAs have a great contribution together in the renin angiotensin system (RAS) and consequently in pathogenesis of SARS-CoV-2 in the vital organs such as respiratory, renal, and blood circulation systems. Any disorder in neprilysin, ACE2, and CAs can lead to increase of CO2 concentration in blood and respiratory acidosis, induction of pulmonary edema and heart and renal failures. CONCLUSIONS Due to the presence of ACE2-Neprilysin-CA complex in most of vital organs and as a receptor of COVID-19, it is expected that most organs are affected by SARS-CoV-2 such as inflammation and fibrosis of lungs, which may conversely affect their vital functions, temporary or permanently, sometimes leading to death. Therefore, ACE2-Neprilysin-CA complex could be the key factor of pathogenesis of SARS-CoV-2 and may provide us useful information to find better provocative and therapeutic strategies against COVID-19.
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Affiliation(s)
- Reza Zolfaghari Emameh
- Department of Energy and Environmental Biotechnology, National Institute of Genetic Engineering and Biotechnology (NIGEB), 14965/161, Tehran, Iran
| | - Reza Falak
- Immunology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Elham Bahreini
- Department of Biochemistry, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
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22
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Lu F, Yang H, Lin SD, Zhao L, Jiang C, Chen ZB, Liu YY, Kan YJ, Hu J, Pang WS. Cyclic Peptide Extracts Derived From Pseudostellaria heterophylla Ameliorates COPD via Regulation of the TLR4/MyD88 Pathway Proteins. Front Pharmacol 2020; 11:850. [PMID: 32581806 PMCID: PMC7296098 DOI: 10.3389/fphar.2020.00850] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 05/22/2020] [Indexed: 01/03/2023] Open
Abstract
We have explored the method of extraction and purification of cyclic-peptide extract (CPE) from Pseudostellaria heterophylla (Miq.) Pax. (Taizishen, TZS), characterized the structure about cyclic-peptide compounds and investigated the biological activity of CPE attenuating chronic obstructive pulmonary disease (COPD) in rats. The CPE from TZS was obtained by ethyl acetate, petroleum ether, hot water extraction, and alcohol-precipitation. Cyclic-peptide structures were distinguished using ultra-high performance liquid chromatography-quadrupole time-of-flight tandem mass spectrometry (UPLC-Q-TOF-MS/MS). Rats were induced by solid combustibles smoke (SCS) for the COPD model, and the anti-COPD activity of CPE was detected using lung airway resistance and dynamic lung compliance, as well as pulmonary tissue hematoxylin and eosin (HE) staining. The relevant inflammatory cytokines were assayed by enzyme-linked immunosorbent assay (ELISA). CPE obtained from TZS contained 12 cyclic-peptide constituents; the purity was up to 92.94%. CPE (200, 400, or 500 mg/kg/day) was given to SCS-induced COPD model rats orally for 15 days. The results showed that in rats given CPE (400 mg/kg/day) there was a sharp fall in lung airway resistance but a rise in dynamic lung compliance. The image analysis of lung tissue sections suggested that CPE could decrease the degree of alveolar destruction (p <0.05), alleviate lung inflammation, increase alveolar space, and improve the infiltration of inflammatory cells. CPE was found to reduce the levels of TNF-α, but increase IL-10, adjusting multiple cytokines in rat serum; the TLR4 mRNA, MyD88 mRNA and AP-1 mRNA levels, the expressing levels of p-JNK, p-p38 and p-TAK1 protein were significantly down regulated in rat alveolar macrophages. CPE intervention could improve the pulmonary ventilation function on COPD rats, which may be related to its effect in inhibiting the abnormal activation of the TLR4-MyD88-JNK/p38 pathway. This is the first report that the CPE of TZS lessens the severity of COPD episodes. The new preparation process of CPEs implements the anticipated goal, which is to refine CPE and actualize quality control.
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Affiliation(s)
- Feng Lu
- School of Pharmacy, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Respiratory Department, The Second Affiliated Hospital of Fujian Traditional Chinese Medical University, Fuzhou, China
| | - Han Yang
- School of Pharmacy, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Si-Ding Lin
- School of Pharmacy, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Li Zhao
- Institute of Materia Medica, Fujian Academy of Traditional Chinese Medicine, Fuzhou, China
| | - Chang Jiang
- Institute of Materia Medica, Fujian Academy of Traditional Chinese Medicine, Fuzhou, China
| | - Zhi-Bin Chen
- Respiratory Department, The Second Affiliated Hospital of Fujian Traditional Chinese Medical University, Fuzhou, China
| | - Ying-Ying Liu
- Respiratory Department, The Second Affiliated Hospital of Fujian Traditional Chinese Medical University, Fuzhou, China
| | - Yong-Jun Kan
- Institute of Materia Medica, Fujian Academy of Traditional Chinese Medicine, Fuzhou, China
| | - Juan Hu
- School of Pharmacy, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Respiratory Department, The Second Affiliated Hospital of Fujian Traditional Chinese Medical University, Fuzhou, China
| | - Wen-Sheng Pang
- School of Pharmacy, Fujian University of Traditional Chinese Medicine, Fuzhou, China
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23
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Cole JL. Acetazolamide Causes Worsening Acidosis in Uncompensated COPD Exacerbations: Increased Awareness Needed for Patient Safety. J Emerg Med 2020; 58:953-958. [PMID: 32241707 DOI: 10.1016/j.jemermed.2020.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 11/25/2019] [Accepted: 01/20/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Acetazolamide has been studied extensively in post-hypercapnic alkalosis as a tool to facilitate ventilator weaning in chronic obstructive pulmonary disease (COPD). It has also been utilized to facilitate respiratory drive in nonmechanically ventilated patients with COPD. Although this is generally a forgiving intervention, providers must carefully select patients for this medication, as it can cause severe acidosis and deterioration of clinical status in severe COPD cases. The present report describes two cases of patients who developed worsening acidosis and hypercapnia after receiving acetazolamide in acute respiratory failure. CASE REPORT Case 1 was a 72-year-old obese male with COPD who was dependent on supplemental oxygen and presented to the emergency department (ED) with acute on chronic hypercapnic respiratory failure. He was given a one-time dose of acetazolamide in the ED for "respiratory failure made worse by severe metabolic alkalosis." His arterial blood gas (ABG) worsened overnight, accompanied by decreased mental status: pH 7.32, paCO2 82 mm Hg, paO2 50 mm Hg, HCO3 41.7 mmol/L, FiO2 32% to pH 7.21, paCO2 91.7 mm Hg, paO2 59 mm Hg, HCO3 36.6 mmol/L, and FiO2 32%. Case 2 was a 62-year-old male with COPD who was dependent on supplemental oxygen and presented to the ED with acute on chronic hypercapnic respiratory failure. He was given acetazolamide in the ED with similar results: ABG on presentation pH 7.37, paCO2 79.3 mm Hg, paO2 77.6 mm Hg, HCO3 45.5 mmol/L, and FiO2 32%. The next morning, ABG was pH 7.29, paCO2 79 mm Hg, paO2 77 mm Hg, HCO3 45.5 mmol/L, and FiO2 32%. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Acetazolamide given early in the uncompensated setting can worsen acidosis and potentiate clinical deterioration.
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Affiliation(s)
- Jennifer L Cole
- Veterans Healthcare System of the Ozarks, Fayetteville, Arkansas
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24
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van der Kleij LA, De Vis JB, de Bresser J, Hendrikse J, Siero JCW. Arterial CO 2 pressure changes during hypercapnia are associated with changes in brain parenchymal volume. Eur Radiol Exp 2020; 4:17. [PMID: 32147754 PMCID: PMC7061094 DOI: 10.1186/s41747-020-0144-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 01/23/2020] [Indexed: 11/10/2022] Open
Abstract
The Monro-Kellie hypothesis (MKH) states that volume changes in any intracranial component (blood, brain tissue, cerebrospinal fluid) should be counterbalanced by a co-occurring opposite change to maintain intracranial pressure within the fixed volume of the cranium. In this feasibility study, we investigate the MKH application to structural magnetic resonance imaging (MRI) in observing compensating intracranial volume changes during hypercapnia, which causes an increase in cerebral blood volume. Seven healthy subjects aged from 24 to 64 years (median 32), 4 males and 3 females, underwent a 3-T three-dimensional T1-weighted MRI under normocapnia and under hypercapnia. Intracranial tissue volumes were computed. According to the MKH, the significant increase in measured brain parenchymal volume (median 6.0 mL; interquartile range 4.5, 8.5; p = 0.016) during hypercapnia co-occurred with a decrease in intracranial cerebrospinal fluid (median -10.0 mL; interquartile range -13.5, -6.5; p = 0.034). These results convey several implications: (i) blood volume changes either caused by disorders, anaesthesia, or medication can affect outcome of brain volumetric studies; (ii) besides probing tissue displacement, this approach may assess the brain cerebrovascular reactivity. Future studies should explore the use of alternative sequences, such as three-dimensional T2-weighted imaging, for improved quantification of hypercapnia-induced volume changes.
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Affiliation(s)
- Lisa A van der Kleij
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
| | - Jill B De Vis
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Jeroen de Bresser
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
| | - Jeroen C W Siero
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
- Spinoza Center for Neuroimaging, Amsterdam, The Netherlands
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25
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Mendez Y, Ochoa-Martinez FE, Ambrosii T. Chronic Obstructive Pulmonary Disease and Respiratory Acidosis in the Intensive Care Unit. CURRENT RESPIRATORY MEDICINE REVIEWS 2019. [DOI: 10.2174/1573398x15666181127141410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Chronic obstructive lung disease is a common and preventable disease. One of its
pathophysiological consequences is the presence of carbon dioxide retention due to hypoventilation
and ventilation/perfusion mismatch, which in consequence will cause a decrease in the acid/base
status of the patient. Whenever a patient develops an acute exacerbation, acute respiratory
hypercapnic failure will appear and the necessity of a hospital ward is a must. However, current
guidelines exist to better identify these patients and make an accurate diagnosis by using clinical
skills and laboratory data such as arterial blood gases. Once the patient is identified, rapid treatment
will help to diminish the hospital length and the avoidance of intensive care unit. On the other hand,
if there is the existence of comorbidities such as cardiac failure, gastroesophageal reflux disease,
pulmonary embolism or depression, it is likely that the patient will be admitted to the intensive care
unit with the requirement of intubation and mechanical ventilation.
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Affiliation(s)
- Yamely Mendez
- Faculty of Medicine “Dr. Alberto Romo Caballero”, Universidad Autonoma de Tamaulipas, Tampico, Mexico
| | - Francisco E. Ochoa-Martinez
- Faculty of Medicine, Universidad Autonoma de Nuevo Leon, University Hospital “Dr. Jose Eleuterio Gonzalez”, Monterrey, Mexico
| | - Tatiana Ambrosii
- Chair of Anesthesiology and Reanimatology “Valeriu Ghereg”, State University of Medicine and Pharmacy “Nicolae Testemitanu”, Chisinau, Moldova, Republic of
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Abdulnour‐Nakhoul S, Hering‐Smith K, Hamm LL, Nakhoul NL. Effects of chronic hypercapnia on ammonium transport in the mouse kidney. Physiol Rep 2019; 7:e14221. [PMID: 31456326 PMCID: PMC6712239 DOI: 10.14814/phy2.14221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 11/24/2022] Open
Abstract
Hypercapnia and subsequent respiratory acidosis are serious complications in many patients with respiratory disorders. The acute response to hypercapnia is buffering of H+ by hemoglobin and cellular proteins but this effect is limited. The chronic response is renal compensation that increases HCO3- reabsorption, and stimulates urinary excretion of titratable acids (TA) and NH4+ . However, the main effective pathway is the excretion of NH4+ in the collecting duct. Our hypothesis is that, the renal NH3 /NH4+ transporters, Rhbg and Rhcg, in the collecting duct mediate this response. The effect of hypercapnia on these transporters is unknown. We conducted in vivo experiments on mice subjected to chronic hypercapnia. One group breathed 8% CO2 and the other breathed normal air as control (0.04% CO2 ). After 3 days, the mice were euthanized and kidneys, blood, and urine samples were collected. We used immunohistochemistry and Western blot analysis to determine the effects of high CO2 on localization and expression of the Rh proteins, carbonic anhydrase IV, and pendrin. In hypercapnic animals, there was a significant increase in urinary NH4+ excretion but no change in TA. Western blot analysis showed a significant increase in cortical expression of Rhbg (43%) but not of Rhcg. Expression of CA-IV was increased but pendrin was reduced. These data suggest that hypercapnia leads to compensatory upregulation of Rhbg that contributes to excretion of NH3 /NH4+ in the kidney. These studies are the first to show a link among hypercapnia, NH4+ excretion, and Rh expression.
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Affiliation(s)
- Solange Abdulnour‐Nakhoul
- Section of Nephrology, Departments of Medicine and PhysiologyTulane University School of MedicineNew OrleansLouisiana
| | - Kathleen Hering‐Smith
- Section of Nephrology, Departments of Medicine and PhysiologyTulane University School of MedicineNew OrleansLouisiana
| | - L. Lee Hamm
- Section of Nephrology, Departments of Medicine and PhysiologyTulane University School of MedicineNew OrleansLouisiana
| | - Nazih L. Nakhoul
- Section of Nephrology, Departments of Medicine and PhysiologyTulane University School of MedicineNew OrleansLouisiana
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27
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Trudzinski FC, Kahnert K, Vogelmeier CF, Alter P, Seiler F, Fähndrich S, Watz H, Welte T, Speer T, Zewinger S, Biertz F, Kauczor HU, Jörres RA, Bals R. Combined effects of lung function, blood gases and kidney function on the exacerbation risk in stable COPD: Results from the COSYCONET cohort. Respir Med 2019; 154:18-26. [PMID: 31203096 DOI: 10.1016/j.rmed.2019.06.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/26/2019] [Accepted: 06/10/2019] [Indexed: 11/15/2022]
Abstract
RATIONALE Alterations of acid-base metabolism are an important outcome predictor in acute exacerbations of COPD, whereas sufficient metabolic compensation and adequate renal function are associated with decreased mortality. In stable COPD there is, however, only limited information on the combined role of acid-base balance, blood gases, renal and respiratory function on exacerbation risk grading. METHODS We used baseline data of the COPD cohort COSYCONET, applying linear and logistic regression analyses, the results of which were implemented into a comprehensive structural equation model. As most informative parameters it comprised the estimated glomerular filtration rate (eGFR), lung function defined via forced expiratory volume in 1 s (FEV1), intrathoracic gas volume (ITGV) and (diffusing capacity for carbon monoxide (DLCO), moreover arterial oxygen content (CaO2), partial pressure of oxygen (PaCO2), base exess (BE) and exacerbation risk according to GOLD criteria. All measures were adjusted for age, gender, body-mass index, the current smoking status and pack years. RESULTS 1506 patients with stable COPD (GOLD grade 1-4; mean age 64.5 ± 8.1 y; mean FEV1 54 ± 18 %predicted, mean eGFR 82.3 ± 16.9 mL/min/1.73 m2) were included. BE was linked to eGFR, lung function and PaCO2 and played a role as indirect predictor of exacerbation risk via these measures; moreover, eGFR was directly linked to exacerbation risk. These associations remained significant after taking into account medication (diuretics, oral and inhaled corticosteroids), whereby corticosteroids had effects on exacerbation risk and lung function, diuretics on eGFR, BE and lung function. CONCLUSION Even in stable COPD acid-base metabolism plays a key integrative role in COPD risk assessment despite rather small deviations from normality. It partially mediates the effects of impairments in kidney function, which are also directly linked to exacerbation risk.
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Affiliation(s)
- F C Trudzinski
- Department of Internal Medicine V - Pulmonology, Allergology, Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany.
| | - K Kahnert
- Department of Internal Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research, Munich, Germany
| | - C F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - P Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - F Seiler
- Department of Internal Medicine V - Pulmonology, Allergology, Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany
| | - S Fähndrich
- Department of Pneumology, University Hospital Freiburg, Freiburg, Germany
| | - H Watz
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North, Member of the German Center for Lung Research, Grosshansdorf, Germany
| | - T Welte
- Clinic for Pneumology, Hannover Medical School, Member of the German Center for Lung Research, Hannover, Germany
| | - T Speer
- Department of Internal Medicine IV - Nephrology, Saarland University Hospital, Homburg, Germany
| | - S Zewinger
- Department of Internal Medicine IV - Nephrology, Saarland University Hospital, Homburg, Germany
| | - F Biertz
- Institute for Biostatistics, Hannover Medical School, Hannover, Germany
| | - H-U Kauczor
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Member of the German Center of Lung Research, Heidelberg, Germany
| | - R A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig Maximilians University (LMU), Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - R Bals
- Department of Internal Medicine V - Pulmonology, Allergology, Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany
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28
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Liao KM, Tseng CJ, Chen YC, Wang JJ, Ho CH. Outcomes of laparoscopic cholecystectomy in patients with and without COPD. Int J Chron Obstruct Pulmon Dis 2019; 14:1159-1165. [PMID: 31213795 PMCID: PMC6549428 DOI: 10.2147/copd.s201866] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 04/30/2019] [Indexed: 12/20/2022] Open
Abstract
Objective: The aim of this study was to investigate the outcomes of patients with COPD after laparoscopic cholecystectomy (LC). Patients and methods: All COPD patients who underwent LC from 2000 to 2010 were identified from the Taiwanese National Health Insurance Research Database. The outcomes of hospital stay, intensive care unit (ICU) stay, and use of mechanical ventilation and life support measures in COPD and non-COPD populations were compared. Results: A total of 3,954 COPD patients who underwent LC were enrolled in our study. There were significant differences in the hospitalization period, ICU stay, and use of mechanical ventilation and life support measures between the COPD and non-COPD populations. The mean hospital stay, ICU stay and number of mechanical ventilation days in the COPD and non-COPD groups were 7.81 vs 6.01 days, 5.5 vs 4.5 days and 6.40 vs 4.74 days, respectively. The use of life support measures, including vasopressors and hemodialysis, and the rates of hospital mortality, acute respiratory failure and pneumonia were also increased in COPD patients compared with those in non-COPD patients. Conclusion: COPD increased the risk of mortality, lengths of hospital and ICU stays, ventilator days and poor outcomes after LC in this study.
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Affiliation(s)
- Kuang-Ming Liao
- Department of Internal Medicine, Chi Mei Medical Center, Chiali, Taiwan
| | - Chien-Jen Tseng
- Department of Surgery, Chi Mei Medical Center, Chiali, Taiwan
| | - Yi-Chen Chen
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.,Allied AI Biomed Center, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.,Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
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29
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Batley KC, Sandoval‐Castillo J, Kemper CM, Attard CRM, Zanardo N, Tomo I, Beheregaray LB, Möller LM. Genome-wide association study of an unusual dolphin mortality event reveals candidate genes for susceptibility and resistance to cetacean morbillivirus. Evol Appl 2019; 12:718-732. [PMID: 30976305 PMCID: PMC6439501 DOI: 10.1111/eva.12747] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 11/25/2018] [Accepted: 11/27/2018] [Indexed: 12/28/2022] Open
Abstract
Infectious diseases are significant demographic and evolutionary drivers of populations, but studies about the genetic basis of disease resistance and susceptibility are scarce in wildlife populations. Cetacean morbillivirus (CeMV) is a highly contagious disease that is increasing in both geographic distribution and incidence, causing unusual mortality events (UME) and killing tens of thousands of individuals across multiple cetacean species worldwide since the late 1980s. The largest CeMV outbreak in the Southern Hemisphere reported to date occurred in Australia in 2013, where it was a major factor in a UME, killing mainly young Indo-Pacific bottlenose dolphins (Tursiops aduncus). Using cases (nonsurvivors) and controls (putative survivors) from the most affected population, we carried out a genome-wide association study to identify candidate genes for resistance and susceptibility to CeMV. The genomic data set consisted of 278,147,988 sequence reads and 35,493 high-quality SNPs genotyped across 38 individuals. Association analyses found highly significant differences in allele and genotype frequencies among cases and controls at 65 SNPs, and Random Forests conservatively identified eight as candidates. Annotation of these SNPs identified five candidate genes (MAPK8, FBXW11, INADL, ANK3 and ACOX3) with functions associated with stress, pain and immune responses. Our findings provide the first insights into the genetic basis of host defence to this highly contagious disease, enabling the development of an applied evolutionary framework to monitor CeMV resistance across cetacean species. Biomarkers could now be established to assess potential risk factors associated with these genes in other CeMV-affected cetacean populations and species. These results could also possibly aid in the advancement of vaccines against morbilliviruses.
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Affiliation(s)
- Kimberley C. Batley
- Molecular Ecology Laboratory, College of Science and EngineeringFlinders UniversityAdelaideSouth AustraliaAustralia
- Cetacean Ecology, Behaviour, and Evolution Laboratory, College of Science and EngineeringFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Jonathan Sandoval‐Castillo
- Molecular Ecology Laboratory, College of Science and EngineeringFlinders UniversityAdelaideSouth AustraliaAustralia
| | | | - Catherine R. M. Attard
- Molecular Ecology Laboratory, College of Science and EngineeringFlinders UniversityAdelaideSouth AustraliaAustralia
- Cetacean Ecology, Behaviour, and Evolution Laboratory, College of Science and EngineeringFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Nikki Zanardo
- Molecular Ecology Laboratory, College of Science and EngineeringFlinders UniversityAdelaideSouth AustraliaAustralia
- Cetacean Ecology, Behaviour, and Evolution Laboratory, College of Science and EngineeringFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Ikuko Tomo
- South Australian MuseumAdelaideSouth AustraliaAustralia
| | - Luciano B. Beheregaray
- Molecular Ecology Laboratory, College of Science and EngineeringFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Luciana M. Möller
- Molecular Ecology Laboratory, College of Science and EngineeringFlinders UniversityAdelaideSouth AustraliaAustralia
- Cetacean Ecology, Behaviour, and Evolution Laboratory, College of Science and EngineeringFlinders UniversityAdelaideSouth AustraliaAustralia
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30
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Leite MR, Ramos EMC, Kalva-Filho CA, De Alencar Silva BS, Freire APCF, Campos EZ, Ramos D. Analysis of the heart rate deflection point as a tool for exercise prescription in subjects with COPD - a cross-sectional study. Physiother Theory Pract 2019; 36:1322-1328. [PMID: 30821563 DOI: 10.1080/09593985.2019.1579282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Prescription of exercise training in subjects with chronic obstructive pulmonary disease (COPD) remains a challenge in clinical practice. The heart rate deflection point (HRDP) is an option to reduce costs, reflects the anaerobic threshold and it is noninvasive; however its applicability in COPD is still unknown. Aim: To compare HRDP with gas exchange threshold values (GET) in subjects with COPD. Methods: Thirty-one subjects were evaluated in this cross-sectional study, diagnosed with COPD. The subjects performed an incremental exercise test on a treadmill to determine the GET, peak oxygen consumption (VO2PEAK), speed corresponding to VO2PEAK (sVO2PEAK), and peak values of heart rate (HRPEAK). To determine HRDP the heart rate values observed were plotted as a function of intensity. Results: The HRDP was visible in 96.77% of subjects. There was no difference between HRDP and GET (p = 0.07) and a moderate intraclass correlation coefficient (ICC): 0.74 [0.52-0.87] and high limits of agreements were presented (±1.1 km·h-1). Conclusion: The HRDP cannot be used to determine the limits between the physiological domains of these subjects. Thus, although significant correlation was found between HRDP and GET, their application for training prescription and monitoring in subjects with COPD proved to be limited.
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Affiliation(s)
- Marceli Rocha Leite
- Department of Physical Therapy, Universidade Estadual Paulista (UNESP) , Presidente Prudente, São Paulo, Brazil
| | - Ercy Mara Cipulo Ramos
- Department of Physical Therapy, Universidade Estadual Paulista (UNESP) , Presidente Prudente, São Paulo, Brazil
| | - Carlos Augusto Kalva-Filho
- Department of Rehabilitation and Functional Performance, University of São Paulo , Ribeirão Preto, São Paulo, Brazil
| | | | | | | | - Dionei Ramos
- Department of Physical Therapy, Universidade Estadual Paulista (UNESP) , Presidente Prudente, São Paulo, Brazil
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31
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Ward-Based Non-Invasive Ventilation in Acute Exacerbations of COPD: A Narrative Review of Current Practice and Outcomes in the UK. Healthcare (Basel) 2018; 6:healthcare6040145. [PMID: 30544857 PMCID: PMC6315392 DOI: 10.3390/healthcare6040145] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/05/2018] [Accepted: 12/07/2018] [Indexed: 12/30/2022] Open
Abstract
Non-invasive ventilation (NIV) is frequently used as a treatment for acute hypercapnic respiratory failure (AHRF) in hospitalised patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). In the UK, many patients with AHRF secondary to AECOPD are treated with ward-based NIV, rather than being treated in critical care. NIV has been increasingly used as an alternative to invasive ventilation and as a ceiling of treatment in patients with a ‘do not intubate’ order. This narrative review describes the evidence base for ward-based NIV in the context of AECOPD and summarises current practice and clinical outcomes in the UK.
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32
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Abstract
A significant interaction between kidneys and lungs has been shown in physiological and pathological conditions. The two organs can both be targets of the same systemic disease (eg., some vasculitides). Moreover, loss of normal function of either of them can induce direct and indirect dysregulation of the other one. Subjects suffering from COPD may have systemic inflammation, hypoxemia, endothelial dysfunction, increased sympathetic activation and increased aortic stiffness. As well as the exposure to nicotine, all the foresaid factors can induce a microvascular damage, albuminuria, and a worsening of renal function. Renal failure in COPD can be unrecognized since elderly and frail patients may have normal serum creatinine concentration. Lungs and kidneys participate in maintaining the acid-base balance. Compensatory role of the lungs rapidly expresses through an increase or reduction of ventilation. Renal compensation usually requires a few days as it is achieved through changes in bicarbonate reabsorption. Chronic kidney disease and end-stage renal diseases increase the risk of pneumonia. Vaccination against Streptococcus pneumonia and seasonal influenza is recommended for these patients. Vaccines against the last very virulent H1N1 influenza A strain are also available and effective. Acute lung injury and acute kidney injury are frequent complications in critical illnesses, associated with high morbidity and mortality. The concomitant failure of kidneys and lungs implies a multidisciplinary approach, both in terms of diagnostic processes and therapeutic management.
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33
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Zouboules SM, Lafave HC, O'Halloran KD, Brutsaert TD, Nysten HE, Nysten CE, Steinback CD, Sherpa MT, Day TA. Renal reactivity: acid-base compensation during incremental ascent to high altitude. J Physiol 2018; 596:6191-6203. [PMID: 30267579 DOI: 10.1113/jp276973] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 09/19/2018] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Ascent to high altitude imposes an acid-base challenge in which renal compensation is integral for maintaining pH homeostasis, facilitating acclimatization and helping prevent mountain sicknesses. The time-course and extent of plasticity of this important renal response during incremental ascent to altitude is unclear. We created a novel index that accurately quantifies renal acid-base compensation, which may have laboratory, fieldwork and clinical applications. Using this index, we found that renal compensation increased and plateaued after 5 days of incremental altitude exposure, suggesting plasticity in renal acid-base compensation mechanisms. The time-course and extent of plasticity in renal responsiveness may predict severity of altitude illness or acclimatization at higher or more prolonged stays at altitude. ABSTRACT Ascent to high altitude, and the associated hypoxic ventilatory response, imposes an acid-base challenge, namely chronic hypocapnia and respiratory alkalosis. The kidneys impart a relative compensatory metabolic acidosis through the elimination of bicarbonate (HCO3 - ) in urine. The time-course and extent of plasticity of the renal response during incremental ascent is unclear. We developed an index of renal reactivity (RR), indexing the relative change in arterial bicarbonate concentration ([HCO3 - ]a ) (i.e. renal response) against the relative change in arterial pressure of CO2 ( P aC O 2 ) (i.e. renal stimulus) during incremental ascent to altitude ( Δ [ HC O 3 - ] a / Δ P aC O 2 ). We aimed to assess whether: (i) RR magnitude was inversely correlated with relative changes in arterial pH (ΔpHa ) with ascent and (ii) RR increased over time and altitude exposure (i.e. plasticity). During ascent to 5160 m over 10 days in the Nepal Himalaya, arterial blood was drawn from the radial artery for measurement of blood gas/acid-base variables in lowlanders at 1045/1400 m and after 1 night of sleep at 3440 m (day 3), 3820 m (day 5), 4240 m (day 7) and 5160 m (day 10) during ascent. At 3820 m and higher, RR significantly increased and plateaued compared to 3440 m (P < 0.04), suggesting plasticity in renal acid-base compensations. At all altitudes, we observed a strong negative correlation (r ≤ -0.71; P < 0.001) between RR and ΔpHa from baseline. Renal compensation plateaued after 5 days of altitude exposure, despite subsequent exposure to higher altitudes. The time-course, extent of plasticity and plateau in renal responsiveness may predict severity of altitude illness or acclimatization at higher or more prolonged stays at altitude.
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Affiliation(s)
- Shaelynn M Zouboules
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Alberta, Canada
| | - Hailey C Lafave
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Alberta, Canada
| | | | | | | | - Cassandra E Nysten
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Alberta, Canada
| | - Craig D Steinback
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | | | - Trevor A Day
- Department of Biology, Faculty of Science and Technology, Mount Royal University, Calgary, Alberta, Canada
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34
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Rabe KF, Hurst JR, Suissa S. Cardiovascular disease and COPD: dangerous liaisons? Eur Respir Rev 2018; 27:27/149/180057. [PMID: 30282634 DOI: 10.1183/16000617.0057-2018] [Citation(s) in RCA: 191] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 08/20/2018] [Indexed: 12/12/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) frequently occur together and their coexistence is associated with worse outcomes than either condition alone. Pathophysiological links between COPD and CVD include lung hyperinflation, systemic inflammation and COPD exacerbations. COPD treatments may produce beneficial cardiovascular (CV) effects, such as long-acting bronchodilators, which are associated with improvements in arterial stiffness, pulmonary vasoconstriction, and cardiac function. However, data are limited regarding whether these translate into benefits in CV outcomes. Some studies have suggested that treatment with long-acting β2-agonists and long-acting muscarinic antagonists leads to an increase in the risk of CV events, particularly at treatment initiation, although the safety profile of these agents with prolonged use appears reassuring. Some CV medications may have a beneficial impact on COPD outcomes, but there have been concerns about β-blocker use leading to bronchospasm in COPD, which may result in patients not receiving guideline-recommended treatment. However, there are few data suggesting harm with these agents and patients should not be denied β-blockers if required. Clearer recommendations are necessary regarding the identification and management of comorbid CVD in patients with COPD in order to facilitate early intervention and appropriate treatment.
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Affiliation(s)
- Klaus F Rabe
- Dept of Medicine, University of Kiel, Kiel, Germany .,Lung Clinic Großhansdorf, Airway Research Center North (ARCN), Groβhansdorf, Germany
| | - John R Hurst
- Centre for Inflammation and Tissue Repair, Division of Medicine, University College London, London, UK
| | - Samy Suissa
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada.,Dept of Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada
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35
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Gungor S, Kargin F, Irmak I, Ciyiltepe F, Acartürk Tunçay E, Atagun Guney P, Aksoy E, Ocakli B, Adiguzel N, Karakurt Z. Severity of acidosis affects long-term survival in COPD patients with hypoxemia after intensive care unit discharge. Int J Chron Obstruct Pulmon Dis 2018; 13:1495-1506. [PMID: 29780244 PMCID: PMC5951127 DOI: 10.2147/copd.s159504] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Patients admitted to the intensive care unit (ICU) with acute respiratory failure (ARF) due to COPD have high mortality and morbidity. Acidosis has several harmful effects on hemodynamics and metabolism, and the current knowledge regarding the relationship between respiratory acidosis severity on the short- and long-term survival of COPD patients is limited. We hypothesized that COPD patients with severe acidosis would have a poorer short- and long-term prognosis compared with COPD patients with mild-to-moderate acidosis. Patients and methods This retrospective observational cohort study was conducted in a level III respiratory ICU of a tertiary teaching hospital for chest diseases between December 1, 2013, and December 30, 2014. Subject characteristics, comorbidities, ICU parameters, duration of mechanical ventilation, length of ICU stay, ICU mortality, use of domiciliary noninvasive mechanical ventilation (NIMV) and long-term oxygen therapy (LTOT), and short- and long-term mortality were recorded. Patients were grouped according to their arterial blood gas (ABG) values during ICU admission: severe acidotic (pH≤7.20) and mild-to-moderate acidotic (pH 7.21–7.35). These groups were compared with the recorded data. The mortality predictors were analyzed by logistic regression test in the ICU and the Cox regression test for long-term mortality predictors. Results During the study period, a total of 312 COPD patients admitted to the ICU with ARF, 69 (72.5% male) in the severe acidosis group and 243 (79% male) in the mild-to-moderate acidosis group, were enrolled. Group demographics, comorbidities, duration of mechanical ventilation, and length of ICU stay were similar in the two groups. The severe acidosis group had a significantly higher rate of NIMV failure (60.7% vs 40%) in the ICU. Mild-to-moderate acidotic COPD patients using LTOT had longer survival after ICU discharge than those without LTOT. On the other hand, severely acidotic COPD patients without LTOT showed shorter survival than those with LTOT. Kaplan–Meier cumulative survival analysis showed that the 28-day and 1-, 2-, and 3-year mortality rates were 12.2%, 36.2%, 52.6%, 63.3%, respectively (p=0.09). The Cox regression analyses showed that older age, PaO2/FiO2 <300 mmHg, and body mass index ≤20 kg/m2 was associated with mortality of all patients after 3 years. Conclusion Severely acidotic COPD patients had a poorer short- and long-term prognosis compared with mild-to-moderate acidotic COPD patients if acute and chronic hypoxemia was predominant.
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Affiliation(s)
- Sinem Gungor
- Respiratory Intensive Care Unit Clinic, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, Istanbul, Turkey
| | - Feyza Kargin
- Respiratory Intensive Care Unit Clinic, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, Istanbul, Turkey
| | - Ilim Irmak
- Respiratory Intensive Care Unit Clinic, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, Istanbul, Turkey
| | - Fulya Ciyiltepe
- Respiratory Intensive Care Unit Clinic, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, Istanbul, Turkey
| | - Eylem Acartürk Tunçay
- Respiratory Intensive Care Unit Clinic, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, Istanbul, Turkey
| | - Pinar Atagun Guney
- Respiratory Intensive Care Unit Clinic, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, Istanbul, Turkey
| | - Emine Aksoy
- Respiratory Intensive Care Unit Clinic, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, Istanbul, Turkey
| | - Birsen Ocakli
- Respiratory Intensive Care Unit Clinic, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, Istanbul, Turkey
| | - Nalan Adiguzel
- Respiratory Intensive Care Unit Clinic, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, Istanbul, Turkey
| | - Zuhal Karakurt
- Respiratory Intensive Care Unit Clinic, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, Istanbul, Turkey
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Adkar SS, Turner MC, Leraas HJ, Gilmore BF, Nag U, Turley RS, Shortell CK, Mureebe L. Low mortality rates after endovascular aortic repair expand use to high-risk patients. J Vasc Surg 2018; 67:424-432.e1. [PMID: 28951155 PMCID: PMC7243615 DOI: 10.1016/j.jvs.2017.06.107] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 06/22/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The 2010 endovascular aneurysm repair (EVAR) trial 2 (EVAR 2) reported that patients with comorbidity profiles rendering them unfit for open aneurysm repair who underwent EVAR did not experience a survival advantage compared with those who did not undergo intervention. These patients experienced a 30-day mortality of 7.3%, whereas reports from similar cohorts reported far lower mortality rates. The primary objective of our study was to compare the incidence of 30-day mortality in low- and high-risk patients undergoing EVAR in a contemporary data set, using patient risk stratification criteria from EVAR 2. Secondarily, we sought to identify risk factors associated with a disproportionate contribution to 30-day mortality risk. METHODS Data were obtained from the 2005 to 2013 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Participant Use Data Files (N = 24,813). Patients were included in the high-risk cohort with the presence of renal, respiratory, or cardiac preoperative criteria alone or in combination. Renal impairment criteria were defined as dialysis and creatinine concentration >2.26 mg/dL. Respiratory impairment criteria included history of chronic obstructive pulmonary disease and preoperative ventilator support. Cardiac impairment criteria included history of myocardial infarction, congestive heart failure, angina, and prior coronary intervention. Patient and procedural characteristics and 30-day postoperative outcomes were compared using Pearson χ2 tests for categorical variables and Wilcoxon rank sum tests for continuous variables. RESULTS Among 24,813 patients undergoing EVAR, 12,043 (48%) patients were characterized as high risk (at least one impairment criterion); 12,770 (52%) patients were stratified as low risk. The 30-day mortality rate was 1.9% in the high-risk cohort compared with the 7.3% reported by EVAR 2, and it was higher in the high-risk cohort compared with the low-risk cohort (1.9% vs 0.9%; P < .001). Whereas the presence of each comorbidity increased the odds of 30-day mortality (respiratory odds ratio [OR], 1.62; 95% confidence interval [CI], 1.16-2.26; P = .005; cardiac OR, 1.55; 95% CI, 1.14-2.10; P = .005), the presence of renal criteria disproportionately increased the odds of mortality threefold (OR, 3.42; 95% CI, 2.31-5.09; P < .001). CONCLUSIONS Contemporary 30-day mortality after EVAR in high-risk patients is substantially lower than that reported in the EVAR 2 trial. Whereas low- and high-risk stratification by current comorbidity criteria is appropriate, attention needs to be paid to disproportionate risk contribution from renal disease to mortality compared with cardiac and pulmonary comorbidities. Given the lower mortality risk than previously described, patients stratified as high risk should be thoughtfully considered for definitive EVAR.
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Affiliation(s)
- Shaunak S Adkar
- Duke University School of Medicine, Duke University Medical Center, Durham, NC.
| | - Megan C Turner
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Harold J Leraas
- Duke University School of Medicine, Duke University Medical Center, Durham, NC
| | - Brian F Gilmore
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Uttara Nag
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Ryan S Turley
- Department of Surgery, Duke University Medical Center, Durham, NC; Cardiothoracic Vascular Surgeons, Austin, Tex
| | | | - Leila Mureebe
- Department of Surgery, Duke University Medical Center, Durham, NC
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Corsonello A, Aucella F, Pedone C, Antonelli-Incalzi R. Chronic kidney disease: A likely underestimated component of multimorbidity in older patients with chronic obstructive pulmonary disease. Geriatr Gerontol Int 2017; 17:1770-1788. [DOI: 10.1111/ggi.13054] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 01/28/2017] [Accepted: 02/20/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Andrea Corsonello
- Unit of Geriatric Pharmacoepidemiology; Italian National Research Center on Aging (INRCA); Cosenza Italy
| | - Filippo Aucella
- Department of Nephrology and Dialysis; Scientific Institute for Research and Health Care "Casa Sollievo della Sofferenza" IRCCS; San Giovanni Rotondo Foggia Italy
| | - Claudio Pedone
- Unit of Geriatric and Respiratory Medicine; University Campus BioMedico; Rome Italy
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Jonker R, Deutz NE, Erbland ML, Anderson PJ, Engelen MP. Effectiveness of essential amino acid supplementation in stimulating whole body net protein anabolism is comparable between COPD patients and healthy older adults. Metabolism 2017; 69:120-129. [PMID: 28285641 PMCID: PMC5351771 DOI: 10.1016/j.metabol.2016.12.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 11/22/2016] [Accepted: 12/14/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The development of effective nutritional strategies in support of muscle growth for patients with chronic obstructive pulmonary disease (COPD) remains challenging. Dietary essential amino acids (EAAs) are the main driver of postprandial net protein anabolism. In agreement, EAA supplements in healthy older adults are more effective than supplements with the composition of complete proteins. In patients with COPD it is still unknown whether complete protein supplements can be substituted with only EAAs, and whether they are as effective as in healthy older adults. METHODS According to a double-blind randomized crossover design, we examined in 23 patients with moderate to very severe COPD (age: 65±2 years, FEV1: 40±2% of predicted) and 19 healthy age-matched subjects (age: 64±2 years), whether a free EAA mixture with a high proportion (40%) of leucine (EAA mixture) stimulated whole body net protein gain more than a similar mixture of balanced free EAAs and non-EAAs as present in whey protein (TAA mixture). Whole body net protein gain and splanchnic extraction of phenylalanine (PHE) were assessed by continuous IV infusion of L-[ring-2H5]-PHE and L-[ring-2H2]-tyrosine, and enteral intake of L-[15N]-PHE (added to the mixtures). RESULTS Besides an excellent positive linear relationship between PHE intake and net protein gain in both groups (r=0.84-0.91, P<0.001), net protein gain was 42% higher in healthy controls and 49% higher in COPD patients after intake of the EAA mixture compared to the TAA mixture (P<0.0001). These findings could not be attributed to the high LEU content, as in both groups net protein gain per gram EAA intake was lower for the EAA mixture (P<0.0001). Net protein gain was higher in COPD patients for both mixtures due to a 40% lower splanchnic extraction (P<0.0001), but was similarly related to dietary PHE (i.e. EAA) plasma appearance. CONCLUSIONS In COPD patients, similarly to healthy older adults, free EAA supplements stimulate whole body protein anabolism more than free amino acid supplements with the composition of complete proteins. Therefore, free EAA supplements may aid in the prevention and treatment of muscle wasting in this patient population.
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Affiliation(s)
- Renate Jonker
- Center for Translational Research in Aging & Longevity, Dept. of Health and Kinesiology, Texas A&M University, College Station, TX, U.S.A.; Dept. of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, AR, U.S.A..
| | - Nicolaas Ep Deutz
- Center for Translational Research in Aging & Longevity, Dept. of Health and Kinesiology, Texas A&M University, College Station, TX, U.S.A.; Dept. of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, AR, U.S.A
| | - Marcia L Erbland
- Dept. of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, U.S.A
| | - Paula J Anderson
- Dept. of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, U.S.A
| | - Mariëlle Pkj Engelen
- Center for Translational Research in Aging & Longevity, Dept. of Health and Kinesiology, Texas A&M University, College Station, TX, U.S.A.; Dept. of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, AR, U.S.A
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Altinoz H, Adiguzel N, Salturk C, Gungor G, Mocin O, Berk Takir H, Kargin F, Balci M, Dikensoy O, Karakurt Z. Obesity might be a good prognosis factor for COPD patients using domiciliary noninvasive mechanical ventilation. Int J Chron Obstruct Pulmon Dis 2016; 11:1895-901. [PMID: 27578969 PMCID: PMC4998020 DOI: 10.2147/copd.s108813] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Cachexia is known to be a deteriorating factor for survival of patients with chronic obstructive pulmonary disease (COPD), but data related to obesity are limited. We observed that obese patients with COPD prescribed long-term noninvasive mechanical ventilation (NIMV) had better survival rate compared to nonobese patients. Therefore, we conducted a retrospective observational cohort study. Archives of Thoracic Diseases Training Hospital were sought between 2008 and 2013. All the subjects were prescribed domiciliary NIMV for chronic respiratory failure secondary to COPD. Subjects were grouped according to their body mass index (BMI). The first group consisted of subjects with BMI between 20 and 30 kg/m2, and the second group consisted of subjects with BMI >30 kg/m2. Data obtained at the first month’s visit for the following parameters were recorded: age, sex, comorbid diseases, smoking history, pulmonary function test, 6-minute walk test (6-MWT), and arterial blood gas analysis. Hospital admissions were recorded before and after the domiciliary NIMV usage. Mortality rate was searched from the electronic database. Overall, 118 subjects were enrolled. Thirty-eight subjects had BMI between 20 and 30 kg/m2, while 80 subjects had BMI >30 kg/m2. The mean age was 65.8±9.4 years, and 81% were male. The median follow-up time was 26 months and mortality rates were 32% and 34% for obese and nonobese subjects (P=0.67). Improvement in 6-MWT was protective against mortality. In conclusion, survival of obese patients with COPD using domiciliary NIMV was found to be better than those of nonobese patients, and the improvement in 6-MWT in such patients was found to be related to a better survival.
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Affiliation(s)
- Hilal Altinoz
- Pulmonary Division, Acibadem University School of Medicine
| | - Nalan Adiguzel
- Sureyyapasa Thoracic Diseases and Thoracic Surgery Training Hospital, Istanbul, Turkey
| | - Cuneyt Salturk
- Sureyyapasa Thoracic Diseases and Thoracic Surgery Training Hospital, Istanbul, Turkey
| | - Gokay Gungor
- Sureyyapasa Thoracic Diseases and Thoracic Surgery Training Hospital, Istanbul, Turkey
| | - Ozlem Mocin
- Sureyyapasa Thoracic Diseases and Thoracic Surgery Training Hospital, Istanbul, Turkey
| | - Huriye Berk Takir
- Sureyyapasa Thoracic Diseases and Thoracic Surgery Training Hospital, Istanbul, Turkey
| | - Feyza Kargin
- Sureyyapasa Thoracic Diseases and Thoracic Surgery Training Hospital, Istanbul, Turkey
| | - Merih Balci
- Sureyyapasa Thoracic Diseases and Thoracic Surgery Training Hospital, Istanbul, Turkey
| | - Oner Dikensoy
- Pulmonary Division, Acibadem University School of Medicine
| | - Zuhal Karakurt
- Sureyyapasa Thoracic Diseases and Thoracic Surgery Training Hospital, Istanbul, Turkey
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Sharma AS, Weerwind PW, Strauch U, van Belle A, Maessen JG, Wouters EFM. Applying a low-flow CO2 removal device in severe acute hypercapnic respiratory failure. Perfusion 2015; 31:149-55. [PMID: 26040584 DOI: 10.1177/0267659115589401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A novel and portable extracorporeal CO2-removal device was evaluated to provide additional gas transfer, auxiliary to standard therapy in severe acute hypercapnic respiratory failure. A dual-lumen catheter was inserted percutaneously in five subjects (mean age 55 ± 0.4 years) and, subsequently, connected to the CO2-removal device. The median duration on support was 45 hours (interquartile range 26-156), with a blood flow rate of approximately 500 mL/min. The mean PaCO2 decreased from 95.8 ± 21.9 mmHg to 63.9 ± 19.6 mmHg with the pH improving from 7.11 ± 0.1 to 7.26 ± 0.1 in the initial 4 hours of support. Three subjects were directly weaned from the CO2-removal device and mechanical ventilation, one subject was converted to ECMO and one subject died following withdrawal of support. No systemic bleeding or device complications were observed. Low-flow CO2 removal adjuvant to standard therapy was effective in steadily removing CO2, limiting the progression of acidosis in subjects with severe acute hypercapnic respiratory failure.
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Affiliation(s)
- Ajay S Sharma
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Patrick W Weerwind
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Uli Strauch
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Arne van Belle
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Emiel F M Wouters
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
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Labonté L, Coulombe P, Zago M, Bourbeau J, Baglole CJ. Alterations in the expression of the NF-κB family member RelB as a novel marker of cardiovascular outcomes during acute exacerbations of chronic obstructive pulmonary disease. PLoS One 2014; 9:e112965. [PMID: 25409035 PMCID: PMC4237338 DOI: 10.1371/journal.pone.0112965] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 10/16/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) exacerbations are acute events of worsened respiratory symptoms and enhanced inflammation partly mediated by NF-κB activation. RelB, an NF-κB family member, suppresses cigarette smoke-induced inflammation but its expression in COPD is unknown. Moreover, there is no information on its association with clinical features of COPD. The objectives of this study were to assess RelB expression relative to markers of inflammation as well as its association with cardiovascular and pulmonary features of COPD patients at stable-state and exacerbation. METHODS Data from 48 COPD patients were analyzed. Blood samples were collected from stable-state and exacerbating patients. After RNA isolation, quantitative real-time polymerase chain reaction (qRT-PCR) was performed to assess RelB, Cox-2, IL-8 and IL-1β mRNA expression and their associations with measured clinical variables. RESULTS Of the 48 COPD subjects, 18 were in stable-state and 30 were in exacerbation. RelB mRNA expression was lower than that of Cox-2, IL-8, and IL-1β in all cases (all p<0.001, except for IL-8 at exacerbation (p = 0.22)). Cox-2, IL-8 and IL-1β were significantly associated with clinical features of patients in both stable-state and at exacerbation. There was no association with RelB expression and any clinical features in COPD subjects at stable-state. RelB mRNA levels were significantly associated with cardiovascular events such as systolic blood pressure during exacerbation. CONCLUSIONS RelB mRNA expression is lower than that of the other inflammatory mediators. Expression of Cox-2, IL-8 and IL-1β were related to clinical features in both stable-state and at exacerbation. However, RelB expression was associated with clinical features of patients only during exacerbation, suggesting that RelB may represent a novel marker of health outcomes, in particular cardiovascular, during exacerbation in COPD.
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Affiliation(s)
- Laura Labonté
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Respiratory Epidemiology and Clinical Research Unit (RECRU), Montreal Chest Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Patrick Coulombe
- Respiratory Epidemiology and Clinical Research Unit (RECRU), Montreal Chest Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Michela Zago
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Meakins-Christie Laboratories, McGill University, Montreal, Quebec, Canada
| | - Jean Bourbeau
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Respiratory Epidemiology and Clinical Research Unit (RECRU), Montreal Chest Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Carolyn J. Baglole
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Meakins-Christie Laboratories, McGill University, Montreal, Quebec, Canada
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Development of poly(lactic-co-glycolic acid) microparticles with pH-sensitive drug release behaviors. JOURNAL OF PHARMACEUTICAL INVESTIGATION 2014. [DOI: 10.1007/s40005-014-0157-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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43
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Everything you need to know about distal renal tubular acidosis in autoimmune disease. Rheumatol Int 2014; 34:1037-45. [PMID: 24682397 PMCID: PMC4107275 DOI: 10.1007/s00296-014-2993-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 03/14/2014] [Indexed: 11/24/2022]
Abstract
Renal acid–base homeostasis is a complex process, effectuated by bicarbonate reabsorption and acid secretion. Impairment of urinary acidification is called renal tubular acidosis (RTA). Distal renal tubular acidosis (dRTA) is the most common form of the RTA syndromes. Multiple pathophysiologic mechanisms, each associated with various etiologies, can lead to dRTA. The most important consequence of dRTA is (recurrent) nephrolithiasis. The diagnosis is based on a urinary acidification test. Potassium citrate is the treatment of choice.
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de Laurentiis G, Paris D, Melck D, Montuschi P, Maniscalco M, Bianco A, Sofia M, Motta A. Separating Smoking-Related Diseases Using NMR-Based Metabolomics of Exhaled Breath Condensate. J Proteome Res 2013; 12:1502-11. [DOI: 10.1021/pr301171p] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Guglielmo de Laurentiis
- Department of Respiratory Medicine,
AO Monaldi, Faculty of Medicine, University of Naples “Federico II”, Naples, Italy
- Rehabilitation Center “Santa Maria del Pozzo”, Somma
Vesuviana (Naples), Italy
| | - Debora Paris
- Institute of Biomolecular Chemistry, National Research Council, Pozzuoli (Naples), Italy
| | - Dominique Melck
- Institute of Biomolecular Chemistry, National Research Council, Pozzuoli (Naples), Italy
| | - Paolo Montuschi
- Department of Pharmacology,
Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Mauro Maniscalco
- Department of Respiratory Medicine,
AO Monaldi, Faculty of Medicine, University of Naples “Federico II”, Naples, Italy
| | - Andrea Bianco
- Department of Health Sciences,
Faculty of Medicine and Surgery, University of Molise, Campobasso, Italy
| | - Matteo Sofia
- Department of Respiratory Medicine,
AO Monaldi, Faculty of Medicine, University of Naples “Federico II”, Naples, Italy
| | - Andrea Motta
- Institute of Biomolecular Chemistry, National Research Council, Pozzuoli (Naples), Italy
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El-Korashy R, Amin Y, Moussa H, Badawy I, Bakr S. Study the relationship of erythropoietin and chronic obstructive pulmonary disease. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2012. [DOI: 10.1016/j.ejcdt.2012.10.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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