Retinoic Acid-Mediated Control of Energy Metabolism Is Essential for Lung Branching Morphogenesis

Lung branching morphogenesis relies on intricate epithelial-mesenchymal interactions and signaling networks. Still, the interplay between signaling and energy metabolism in shaping embryonic lung development remains unexplored. Retinoic acid (RA) signaling influences lung proximal-distal patterning and branching morphogenesis, but its role as a metabolic modulator is unknown. Hence, this study investigates how RA signaling affects the metabolic profile of lung branching. We performed ex vivo lung explant culture of embryonic chicken lungs treated with DMSO, 1 µM RA, or 10 µM BMS493. Extracellular metabolite consumption/production was evaluated by using 1H-NMR spectroscopy. Mitochondrial respiration and biogenesis were also analyzed. Proliferation was assessed using an EdU-based assay. The expression of crucial metabolic/signaling components was examined through Western blot, qPCR, and in situ hybridization. RA signaling stimulation redirects glucose towards pyruvate and succinate production rather than to alanine or lactate. Inhibition of RA signaling reduces lung branching, resulting in a cystic-like phenotype while promoting mitochondrial function. Here, RA signaling emerges as a regulator of tissue proliferation and lactate dehydrogenase expression. Furthermore, RA governs fatty acid metabolism through an AMPK-dependent mechanism. These findings underscore RA's pivotal role in shaping lung metabolism during branching morphogenesis, contributing to our understanding of lung development and cystic-related lung disorders.

Unraveling the Molecular Regulation of Ferroptosis in Respiratory Diseases

Ferroptosis, a type of programmed cell death that relies on iron, is distinct in terms of its morphological, biochemical and genetic features. Unlike other forms of cell death, such as autophagy, apoptosis, necrosis, and pyroptosis, ferroptosis is primarily caused by lipid peroxidation. Cells that die due to iron can potentially trigger an immune response which intensifies inflammation and causes severe inflammatory reactions that eventually lead to multiple organ failure. In recent years, ferroptosis has been identified in an increasing number of medical fields, including neurological pathologies, chronic liver diseases and sepsis. Ferroptosis has the potential to cause an inflammatory tempest, with many of the catalysts and pathological indications of respiratory ailments being linked to inflammatory reactions. The growing investigation into ferroptosis in respiratory disorders has also garnered significant interest to better understand the mechanism of ferroptosis in these diseases. In this review, the recent progress in understanding the molecular control of ferroptosis and its mechanism in different respiratory disorders is examined. In addition, this review discusses current challenges and prospects for understanding the link between respiratory diseases and ferroptosis.

Health Effects of Ionizing Radiation on the Human Body

Radioactivity is a process in which the nuclei of unstable atoms spontaneously decay, producing other nuclei and releasing energy in the form of ionizing radiation in the form of alpha (α) and beta (β) particles as well as the emission of gamma (γ) electromagnetic waves. People may be exposed to radiation in various forms, as casualties of nuclear accidents, workers in power plants, or while working and using different radiation sources in medicine and health care. Acute radiation syndrome (ARS) occurs in subjects exposed to a very high dose of radiation in a very short period of time. Each form of radiation has a unique pathophysiological effect. Unfortunately, higher organisms-human beings-in the course of evolution have not acquired receptors for the direct "capture" of radiation energy, which is transferred at the level of DNA, cells, tissues, and organs. Radiation in biological systems depends on the amount of absorbed energy and its spatial distribution, particularly depending on the linear energy transfer (LET). Photon radiation with low LET leads to homogeneous energy deposition in the entire tissue volume. On the other hand, radiation with a high LET produces a fast Bragg peak, which generates a low input dose, whereby the penetration depth into the tissue increases with the radiation energy. The consequences are mutations, apoptosis, the development of cancer, and cell death. The most sensitive cells are those that divide intensively-bone marrow cells, digestive tract cells, reproductive cells, and skin cells. The health care system and the public should raise awareness of the consequences of ionizing radiation. Therefore, our aim is to identify the consequences of ARS taking into account radiation damage to the respiratory system, nervous system, hematopoietic system, gastrointestinal tract, and skin.

Intertemporal Improvement in Physicians' Perceptions of the Short-Term Adverse Outcomes of Neonatal Pain: Results of a Two-Time-Point National Survey

Pain in early life may seriously impact neonatal outcomes. This study aimed to evaluate whether the perceptions of physicians working in neonatal intensive care units (NICUs) of the short-term adverse outcomes associated with neonatal pain have changed over a 20-year period. Self-administered questionnaires were distributed to 117 and 145 neonatologists, pediatricians, and fellows working in level III NICUs in 2000 (T1) and 2019 (T2), respectively. The questionnaire consisted of four domains, including the central nervous, cardiovascular, and respiratory systems, as well as "other systems" (metabolic/endocrine system, growth, and general condition), with 21 total items overall. Although the proportion of positive (correct) responses to the total and system-specific domain scores was significantly higher at T2 than T1, the knowledge of certain short-term adverse outcomes was suboptimal even at T2. Adjustment for cofactors confirmed the independent association of the survey time-point with the total and system-specific domain scores. Moreover, NICU type was an independent significant factor associated with the adjusted total and central nervous system scores, while young doctors had a better knowledge of adverse cardiovascular effects. Conclusions: The perceptions of NICU physicians concerning the short-term outcomes associated with neonatal pain have significantly improved over the past 20 years, although remaining knowledge gaps mandate ongoing efforts to achieve an improvement in neonatal care.

Darwin, Haeckel, and the "Mikluskan gas organ theory"

A previously unknown reference to the Russian ethnologist, biologist, and traveler Nikolai N. Miklucho-Maclay (1846-1888) was discovered in correspondence between Charles Darwin (1809-1882) and Ernst Haeckel (1834-1919). This reference has remained unknown to science, even to Miklucho-Maclay's biographers, probably because Darwin used the Russian nickname "Mikluska" when alluding to this young scientist. Here, we briefly outline the story behind the short discussion between Darwin and his German counterpart Haeckel, and highlight its importance for the history of science. Miklucho-Maclay's discovery of a putative swim bladder anlage in sharks, published in 1867, was discussed in four letters between the great biologists. Whereas, Haeckel showed enthusiasm for the finding because it supported (his view on) evolutionary theory, Darwin was less interested, which highlights the conceptual differences between the two authorities. We discuss the scientific treatment of Miklucho-Maclay's observation in the literature and discuss the homology, origin, and destiny of gas organs-swim bladders and lungs-in vertebrate evolution, from an ontogenetic point of view. We show that the conclusions reached by Miklucho-Maclay and Haeckel were rather exaggerated, although they gave rise to fundamental insights, and we illustrate how tree-thinking may lead to differences in the conceptualization of evolutionary change.

The origin of an invasive air sac system in sauropodomorph dinosaurs

One of the most remarkable features in sauropod dinosaurs relates to their pneumatized skeletons permeated by a bird-like air sac system. Many studies described the late evolution and diversification of this trait in mid to late Mesozoic forms but few focused on the origin of the invasive respiratory diverticula in sauropodomorphs. Fortunately, it is possible to solve this thanks to the boom of new species described in the last decade as well as the broad accessibility of new technologies. Here we analyze the unaysaurid sauropodomorph Macrocollum itaquii from the Late Triassic (early Norian) of southern Brazil using micro-computed tomography. We describe the chronologically oldest and phylogenetically earliest unambiguous evidence of an invasive air sac system in a dinosaur. Surprisingly, this species presented a unique pattern of pneumatization in non-sauropod sauropodomorphs, with pneumatic foramina in posterior cervical and anterior dorsal vertebrae. This suggests that patterns of pneumatization were not cladistically consistent prior to the arrival of Jurassic eusauropods. Additionally, we describe the protocamerae tissue, a new type of pneumatic tissue with properties of both camellae and camerae. This reverts the previous hypothesis which stated that the skeletal pneumatization first evolved into camarae, and derived into delicate trabecular arrangements. This tissue is evidence of thin camellate-like tissue developing into larger chambers. Finally, Macrocollum is an example of the gradual evolution of skeletal tissues responding to the fastly specializing Respiratory System of saurischian dinosaurs.

Whipple's disease of the respiratory system: A case report

Whipple's disease (WD) is a multiple-system chronic disease caused by Tropheryma whipplei (T. whipplei) infection. The present study describes 3 cases of WD with clinical manifestations of cough, chest pain, headache, dyspnea, sputum, joint pain, abdominal pain, diarrhea and weight loss. Chest computed tomography (CT) showed signs of plaques, nodules and pleural thickening; and bronchoscopic alveolar lavage fluid metagenomic-sequencing indicated that it was T. whipplei. One patient was treated with meropenem as the starting regimen and two patients were treated with ceftriaxone as the starting regimen. Furthermore, two patients were provided with a maintenance regimen of cotrimoxazole and one was given a maintenance regimen of minocycline, which was combined with meropenem and ceftriaxone in order to improve their cough, chest pain, headache and dyspnea symptoms. To the best of our knowledge, there are few reports on WD of the respiratory system caused by T. whipplei, and differential diagnosis is the key to clinical diagnosis. When WD of the respiratory system is difficult to diagnose, metagenomic second-generation sequencing (mNGS) may be a better choice, which can achieve early diagnosis and early treatment. However, its clinical value is still limited; therefore, more research needs to be conducted in the future.

Enhancing respiratory physiology education: innovative wet spirometer modifications for hands-on learning

The use of wet spirometers, although once common, has greatly declined because these devices measure only static lung volumes and students often face technical issues in their use. In this study, the wet spirometer has been modified to investigate the fundamental laws of flow and different types of lung disease. This modification was achieved by changing the dimensions of the device, printing a scale on the bell, and attaching an airflow control system (ACS) between the corrugated tube and hollow tube of the inner cylinder. The ACS allowed for flow control during the exercises. Two exercises were performed: exercise I compared the parameters measured by the wet spirometer, modified spirometer, and computerized spirometer to determine the suitability of the modification, while exercise II tested the variables affecting flow. These exercises introduce students to data collection, analysis, and the use of statistical tests as they compare various spirometers. Additionally, students gain valuable experience in experimental design by conducting diverse experiments that investigate factors influencing flow dynamics. By plotting the results and participating in small group discussions, students can apply flow principles in respiratory and circulatory systems, offering a hands-on experience that integrates physics and physiology. The modified spirometer facilitated multifaceted topic exploration, surpassing the traditional wet spirometer's capabilities.NEW & NOTEWORTHY This activity involves cost-effective modifications to the wet spirometer, broadening its applicability. These modifications effectively address student challenges associated with wet spirometer handling and enhance comprehension of fluid dynamics, all without the need for costly simulations, wet experiments, or fragile instruments. By offering a hands-on experience without traditional limitations, our modified spirometer provides an accessible and engaging approach to respiratory physiology education.

Amphiregulin in lung diseases: A review

Amphiregulin is a member of the EGFR family, which is involved in many physiological and pathological processes through its binding with EGFR. Studies have found that amphiregulin plays an important role in the occurrence and development of lung diseases. This paper mainly reviews the structure and function of amphiregulin and focuses on the important role of amphiregulin in lung diseases.

Opportunities and Challenges for Inhalable Nanomedicine Formulations in Respiratory Diseases: A Review

Lungs experience frequent interactions with the external environment and have an abundant supply of blood; therefore, they are susceptible to invasion by pathogenic microorganisms and tumor cells. However, the limited pharmacokinetics of conventional drugs in the lungs poses a clinical challenge. The emergence of different nano-formulations has been facilitated by advancements in nanotechnology. Inhaled nanomedicines exhibit better targeting and prolonged therapeutic effects. Although nano-formulations have great potential, they still present several unknown risks. Herein, we review the (1) physiological anatomy of the lungs and their biological barriers, (2) pharmacokinetics and toxicology of nanomaterial formulations in the lungs; (3) current nanomaterials that can be applied to the respiratory system and related design strategies, and (4) current applications of inhaled nanomaterials in treating respiratory disorders, vaccine design, and imaging detection based on the characteristics of different nanomaterials. Finally, (5) we analyze and summarize the challenges and prospects of nanomaterials for respiratory disease applications. We believe that nanomaterials, particularly inhaled nano-formulations, have excellent prospects for application in respiratory diseases. However, we emphasize that the simultaneous toxic side effects of biological nanomaterials must be considered during the application of these emerging medicines. This study aims to offer comprehensive guidelines and valuable insights for conducting research on nanomaterials in the domain of the respiratory system.

Flap of the sternocephalicus muscle in the repair of a partial defect in the trachea of a rabbit (Oryctolagus cuniculus)

PURPOSE

The current study aimed at evaluating the repair of a partial defect of the trachea with a muscle flap, an advanced technique that employs combined suture patterns.

METHODS

Sixteen healthy male New Zealand white rabbits were used as an experimental model. A partial defect in the trachea within the ventral region of the fourth to eighth tracheal ring was created. Subsequently, repair was initiated with a flap of the sternocephalicus muscle. The animals were divided into four groups for postoperative evaluation using clinical, tracheoscopic, and histopathological analyses. Each group was separated according to the time of euthanasia, programmed at interval of seven (G7), 15 (G15), 30 (G30), and 60 days (G60).

RESULTS

One animal from the G60 group died, whereas the other animals had good surgical recovery without serious changes in the breathing pattern. The major clinical signs observed were stridor and coughing. Tracheoscopy revealed secretions in the tracheal lumen, exuberant granulation, and stenosis. Histopathological analysis showed growth of the ciliary respiratory epithelium at the flap site 30 days after implantation.

CONCLUSIONS

Partial repair showed satisfactory results owing to the anatomical location of the muscle, adequate vascular support, and structural and physiological maintenance without serious changes in the respiratory system.

Chronic respiratory symptoms following deployment-related occupational and environmental exposures among US veterans

OBJECTIVES

Characterise inhalational exposures during deployment to Afghanistan and Southwest Asia and associations with postdeployment respiratory symptoms.

METHODS

Participants (n=1960) in this cross-sectional study of US Veterans (Veterans Affairs Cooperative Study 'Service and Health Among Deployed Veterans') completed an interviewer-administered questionnaire regarding 32 deployment exposures, grouped a priori into six categories: burn pit smoke; other combustion sources; engine exhaust; mechanical and desert dusts; toxicants; and military job-related vapours gas, dusts or fumes (VGDF). Responses were scored ordinally (0, 1, 2) according to exposure frequency. Factor analysis supported item reduction and category consolidation yielding 28 exposure items in 5 categories. Generalised linear models with a logit link tested associations with symptoms (by respiratory health questionnaire) adjusting for other covariates. OR were scaled per 20-point score increment (normalised maximum=100).

RESULTS

The cohort mean age was 40.7 years with a median deployment duration of 11.7 months. Heavy exposures to multiple inhalational exposures were commonly reported, including burn pit smoke (72.7%) and VGDF (72.0%). The prevalence of dyspnoea, chronic bronchitis and wheeze in the past 12 months was 7.3%, 8.2% and 15.6%, respectively. Burn pit smoke exposure was associated with dyspnoea (OR 1.22; 95% CI 1.06 to 1.47) and chronic bronchitis (OR 1.22; 95% CI 1.13 to 1.44). Exposure to VGDF was associated with dyspnoea (OR 1.29; 95% CI 1.14 to 1.58) and wheeze (OR 1.18; 95% CI 1.02 to 1.35).

CONCLUSION

Exposures to burn pit smoke and military occupational VGDF during deployment were associated with an increased odds of chronic respiratory symptoms among US Veterans.

Association of Physical Fitness and Anthropometric Parameters With Lung Function in 7-Year-Old Children

PURPOSE

Associations between health-related parameters and lung function remain unclear in childhood. The study aims to evaluate the relationship between physical fitness and anthropometric parameters with the lung function of healthy scholar-aged children.

METHOD

A total of 418 children aged 7 years old participated in this study. The associations of physical fitness (handgrip strength, standing broad jump, and 800-m run) and anthropometric (waist circumference and body mass index) parameters with lung function (forced vital capacity and forced expiratory volume in 1 s) were analyzed using a mixed-linear regression model.

RESULTS

Girls had significantly lower forced vital capacity values (P = .006) and physical fitness (P < .030) compared to boys. On mixed-linear regression analyses, waist circumference (P = .003) was independently associated with forced vital capacity, explaining 34.6% of its variance, while handgrip strength (P = .042) and waist circumference (P = .010) were independently associated with forced expiratory volume in 1 second, accounting together for 26.5% of its variance in 7-year-old healthy children.

CONCLUSIONS

Handgrip strength and waist circumference were associated with lung function in healthy children highlighting the influence of upper body muscular strength and trunk dimension on lung function. Our results corroborate the need to promote physical fitness during childhood to protect against lung complications in later on in life.

[Viral co-infections targeting the porcine respiratory system: Consequences and limits of the experimental systems]

Coinfections affecting the porcine respiratory system have often been overlooked, in favor of mono-infections, even though they are significantly more common in the field. In pigs, the term 'porcine respiratory complex' is used to describe coinfections involving both viruses, such as, for example, the swine influenza type A virus (swIAV), the porcine respiratory and reproductive syndrome virus (PRRSV), and the porcine circovirus type 2 (PCV-2), as well as bacteria. Until recently, most studies were primarily focused on clinical aspects and paid little attention to the molecular consequences of coinfections. This narrative review addresses the consequences of coinfections in the porcine respiratory system involving viruses. When possible, interactions that can occur between viruses are briefly presented. Conversely, research involving bacteria, protozoa, and fungi has not been considered at all. Finally, the main limitations complicating the interpretation of results from coinfection/superinfection studies are considered, and prospects in this exciting field of health research are presented.

Rapid Detection of Antimicrobial Resistance Genes in Critically Ill Children Using a Custom TaqMan Array Card

Bacteria are identified in only 22% of critically ill children with respiratory infections treated with antimicrobial therapy. Once an organism is isolated, antimicrobial susceptibility results (phenotypic testing) can take another day. A rapid diagnostic test identifying antimicrobial resistance (AMR) genes could help clinicians make earlier, informed antimicrobial decisions. Here we aimed to validate a custom AMR gene TaqMan Array Card (AMR-TAC) for the first time and assess its feasibility as a screening tool in critically ill children. An AMR-TAC was developed using a combination of commercial and bespoke targets capable of detecting 23 AMR genes. This was validated using isolates with known phenotypic resistance. The card was then tested on lower respiratory tract and faecal samples obtained from mechanically ventilated children in a single-centre observational study of respiratory infection. There were 82 children with samples available, with a median age of 1.2 years. Major comorbidity was present in 29 (35%) children. A bacterial respiratory pathogen was identified in 13/82 (16%) of children, of which 4/13 (31%) had phenotypic AMR. One AMR gene was detected in 49/82 (60%), and multiple AMR genes were detected in 14/82 (17%) children. Most AMR gene detections were not associated with the identification of phenotypic AMR. AMR genes are commonly detected in samples collected from mechanically ventilated children with suspected respiratory infections. AMR-TAC may have a role as an adjunct test in selected children in whom there is a high suspicion of antimicrobial treatment failure.

Barriers and Facilitators in Pricing and Funding Policies of European Countries That Impact the Use of Point-of-Care Diagnostics for Acute Respiratory Tract Infections in Outpatient Practices

Antimicrobial resistance is a major global health threat, which is increased by the irrational use of antibiotics, for example, in the treatment of respiratory tract infections in community care. By using rapid point-of-care diagnostics, overuse can be avoided. However, the diagnostic tests are rarely used in most European countries. We mapped potential barriers and facilitators in health technology assessment (HTA), pricing, and funding policies related to the use of rapid diagnostics in patients with community-acquired acute respiratory tract infections. Expert interviews were conducted with representatives of public authorities from five European case study countries: Austria, Estonia, France, Poland, and Sweden. Barriers to the HTA process include the lack of evidence and limited transferability of methods established for medicines to diagnostics. There was no price regulation for the studied diagnostics in the case study countries, but prices were usually indirectly determined via procurement. The lack of price regulation and weak purchasing power due to regional procurement processes were mentioned as pricing-related barriers. Regarding funding, coverage (reimbursement) of the diagnostic tests and the optimized remuneration of physicians in their use were mentioned as facilitators. There is potential to strengthen peri-launch policies, as optimized policies may promote the uptake of POCT.

Morphological variations of the lung: Accessory fissures and lobes

Anatomical variability in the human body is not as rare as was previously hypothesised. Indeed, as recently reviewed, the term 'norm' in anatomy can be considered an approximation. Thus, anatomical variations occur quite often, as largely demonstrated during non-invasive diagnosis, surgical intervention, or post mortem investigations. In the present study, we describe different anatomical variations in both the right and left lungs derived from cadavers of different ethnicities. The analysed organs were collected during dissection, and accessory lobes and fissures were observed in both the right and left lungs. Moreover, a horizontal fissure was missing from the right lung, resulting in only two lobes. Since lung anatomical variability is common in clinical practice and preclinical imaging studies can miss different morphologies, a deep and accurate knowledge of the anatomical variations of the lung is of extreme importance to avoid difficulties or changes during the surgical procedure.

The Effect of the Toxic Dose of Baclofen on Selected Parameters of the Cardiovascular and Respiratory Systems

The effect of the toxic dose of the muscle relaxant baclofen on the parameters of the cardiovascular and respiratory systems was studied in adult male Wistar rats (n=20). Systolic and diastolic BP, HR, and respiratory rate were measured; histological changes in the lungs 3, 4.5, and 24 h after drug administration. Baclofen was administered orally in a sublethal toxic dose of 85 mg/kg under anesthesia. Cardiac activity was analyzed using RSM physiological indicators monitoring system with MouseMonitor S (Indus Instruments) software. Histological examination was performed by light microscopy. Baclofen significantly decreased the respiratory rate and increased HR and BP. Histological examination of the lungs revealed a complex of general pathological processes, such as local circulatory disorders (venular and capillary fullness, sludge), leukocyte infiltration of the interalveolar septa and their thickening due to edema. These findings can be used to estimate the time elapsed after baclofen treatment.

Increasing Rates of RSV Hospitalization among Preterm Infants: A Decade of Data

OBJECTIVE

In 2014, the American Academy of Pediatrics (AAP) changed its policy on the use of respiratory syncytial virus immunoprophylaxis (RSV-IP) so that RSV-IP was no longer recommended for use among infants without other medical conditions born >29 weeks of gestational age (wGA). This study examines 10-year trends in RSV-IP and RSV hospitalizations among term infants and preterm infants born at 29 to 34 wGA, including the 5 RSV seasons before and 5 RSV seasons after the AAP guidance change.

STUDY DESIGN

A retrospective observational cohort study of a convenience sample of infants less than 6 months of age during RSV season (November-March) born between July 1, 2008, and June 30, 2019, who were born at 29 to 34 wGA (preterm) or >37 wGA (term) in the IBM MarketScan Commercial and Multi-State Medicaid databases. We excluded infants with medical conditions that would independently qualify them for RSV-IP. We identified RSV-IP utilization along with RSV and all-cause bronchiolitis hospitalizations during each RSV season. A difference-in-difference model was used to determine if there was a significant change in the relative rate of RSV hospitalizations following the 2014 policy change.

RESULTS

There were 53,535 commercially insured and 85,099 Medicaid-insured qualifying preterm infants and 1,111,670 commercially insured and 1,492,943 Medicaid-insured qualifying term infants. Following the 2014 policy change, RSV-IP utilization decreased for all infants, while hospitalization rates tended to increase for preterm infants. Rate ratios comparing preterm to term infants also increased. The relative rate for RSV hospitalization for infants born at 29 to 34 wGA increased significantly for both commercially and Medicaid-insured infants (1.95, 95% CI: 1.67-2.27, p <0.001; 1.70, 95% CI: 1.55-1.86, p <0.001, respectively). Findings were similar for all-cause bronchiolitis hospitalizations.

CONCLUSION

We found that the previously identified increase in RSV hospitalization rates among infants born at 29 to 34 wGA persisted for at least 5 years following the policy change.

KEY POINTS

· Immunoprophylaxis rates decreased after the 2014 American Academy of Pediatrics guidelines update.. · Rate of RSV hospitalization increased among preterm infants after the 2014 AAP guidelines update.. · Increase in RSV hospitalization persisted for at least 5 years after AAP guidelines update..

A variable heart rate multi-compartmental coupled model of the cardiovascular and respiratory systems

Current mathematical models of the cardiovascular system that are based on systems of ordinary differential equations are limited in their ability to mimic important features of measured patient data, such as variable heart rates (HR). Such limitations present a significant obstacle in the use of such models for clinical decision-making, as it is the variations in vital signs such as HR and systolic and diastolic blood pressure that are monitored and recorded in typical critical care bedside monitoring systems. In this paper, novel extensions to well-established multi-compartmental models of the cardiovascular and respiratory systems are proposed that permit the simulation of variable HR. Furthermore, a correction to current models is also proposed to stabilize the respiratory behaviour and enable realistic simulation of vital signs over the longer time scales required for clinical management. The results of the extended model developed here show better agreement with measured bio-signals, and these extensions provide an important first step towards estimating model parameters from patient data, using methods such as neural ordinary differential equations. The approach presented is generalizable to many other similar multi-compartmental models of the cardiovascular and respiratory systems.

Lady Windermere syndrome with haemoptysis: suspected pulmonary aspergilloma and MAC pulmonary disease

We present a case of a woman in her 70s, with a history of Mycobacterium avium complex (MAC) pulmonary disease, pectus excavatum, s-shaped thoracolumbar scoliosis, bronchiectasis of the right middle lobe, lingula of left upper lobe, and malnutrition with low body mass index of 14 kg/m2, who presented to the hospital due to worsening shortness of breath and small volume haemoptysis over 2 weeks. The patient was diagnosed with pulmonary MAC infection for the first time in 1999 without known history of pulmonary disease. Later on, it was complicated by massive haemoptysis requiring bronchial artery embolisation; however, she was unable to complete an oral antibiotic regimen due to gastrointestinal adverse reactions. Chest CT identified a newly found mass in the left upper lobe bulla, consistent with a radiological finding of aspergilloma. We present a rare symptoms constellation, described as 'Lady Windermere syndrome' and chronic untreated MAC infection progressing from reticulonodular changes to fibrocavitary lung disease and suspected aspergilloma formation.

Vie Scope® versus videolaryngoscopy in expected difficult airways: a randomized controlled trial

PURPOSE

The management of patients with an anticipated difficult airway remains challenging. We evaluated laryngeal visualization with the recently introduced Vie Scope® as a straight blade laryngoscope consisting of an illuminated tube necessitating bougie-facilitated intubation vs Macintosh videolaryngoscopy.

METHODS

We conducted a prospective randomized controlled noninferiority trial. Patients undergoing elective ear, nose, and throat or oral and maxillofacial surgery with an anticipated difficult airway were randomized 1:1 to receive tracheal intubation with the Vie Scope or Macintosh videolaryngoscope (C-MAC®). The primary outcome measure was laryngeal visualization by the percentage of glottis opening (POGO) scale. Secondary outcome measures were the time to successful intubation (TTI) and first-attempt and overall success rates.

RESULTS

We included two sets of 29 patients in our analysis. For visualization, the Vie Scope was noninferior to videolaryngoscopy (VL) with mean (standard deviation [SD]) POGO scores of 71 (31)% vs 64 (30)% in the VL group [difference in means, 7 (8)%; 95% confidence interval, -9 to 23; P = 0.38]. Mean (SD) TTI was 125 (129) sec in the Vie Scope and 51 (36) sec in the VL group (difference in means, 75 sec; 95% confidence interval, 25 to 124; P = 0.005). The first-attempt and overall success rates were 22/29 (76%) and 27/29 (93%) in both groups. Two patients per group were switched to a different device. Four accidental esophageal intubations occurred in the Vie Scope group, these were presumably due to bougie misplacement.

CONCLUSION

Visualization with the Vie Scope was noninferior to VL in patients with an anticipated difficult airway, but TTI was longer in the Vie Scope group.

STUDY REGISTRATION

ClinicalTrials.gov (NCT05044416); registered 5 September 2021.

Classifier for the functional state of the respiratory system via descriptors determined by using multimodal technology

Currently, intelligent systems built on a multimodal basis are used to study the functional state of living objects. Its essence lies in the fact that a decision is made through several independent information channels with the subsequent aggregation of these decisions. The method of forming descriptors for classifiers of the functional state of the respiratory system includes the study of the spectral range of the respiratory rhythm and the construction of the wavelet plane of the monitoring electrocardiosignal overlapping this range. Then, variations in the breathing rhythm are determined along the corresponding lines of the wavelet plane. Its analysis makes it possible to select slow waves corresponding to the breathing rhythm and systemic waves of the second order. Analysis of the spectral characteristics of these waves makes it possible to form a space of informative features for classifiers of the functional state of the respiratory system. To construct classifiers of the functional state of the respiratory system, hierarchical classifiers were used. As an example, we took a group of patients with pneumonia with a well-defined diagnosis (radiography, X-ray tomography, laboratory data) and a group of volunteers without pulmonary pathology. The diagnostic sensitivity of the obtained classifier was 76% specificity with a diagnostic specificity of 82%, which is comparable to the results of X-ray studies. It is shown that the corresponding lines of the wavelet planes are correlated with the respiratory system and, using their Fourier analysis, descriptors can be obtained for training neural network classifiers of the functional state of the respiratory system.

Macroscopic and histological aspects of the pharynx and larynx of the giant anteater (Myrmecophaga tridactyla Linnaeus, 1758)

Giant anteater (Myrmecophaga tridactyla) is an endangered species that resides in much of Latin America, but it has been losing its habitat, especially in the Cerrado biome, where it constantly suffers traumas resulting from fires and roadkill. The anatomical knowledge of structures of the respiratory system is important for a better morphophysiological understanding of the species. Thus, this study aimed to perform the macroscopic and histomorphological description of the pharynx and larynx of the giant anteater. Twelve adult giant anteaters were used, three of them fixed in buffered formalin for further dissection and pharynx and larynx macroscopic analysis of structures. From the other animals, samples of the pharynx and larynx were collected and prepared for histological evaluation under optical microscope. Macroscopically, their pharynx and soft palate are extensive, and the anatomical location of these structures and the larynx differs greatly from that described in other species. The larynx, although more caudal, was similar to that of other animals. Histologically, the epithelium of these regions varied between the pseudostratified ciliated columnar and the non-keratinized stratified squamous epithelium. Laryngeal cartilages were composed of elastic (epiglotti) and hyaline cartilages (arytenoid, cricoid and thyroid cartilage), with an ossification process and glandular clusters around the hyaline cartilage. The distinct anatomical location of the pharynx and larynx of Myrmecophaga tridactyla is the main macroscopic finding of this study, besides the length of the pharynx and soft palate of these animals.

Rare but life-threatening cause of massive haemoptysis in an adolscent with tuberculosis: Rasmussen's aneurysm

Rasmussen's aneurysm is a rare yet fatal cause of massive haemoptysis in pulmonary tuberculosis. Early identification and timely intervention are of utmost importance to reduce the associated mortality. A girl in early adolescence presented with persistent fever and massive haemoptysis who required intubation and was subsequently confirmed to have tuberculosis. CT pulmonary angiogram showed the presence of pseudoaneurysms in the left upper and lower lobes. The haemoptysis resolved following the embolisation of the culprit's vessel. Residual lung destruction was evident on CT after a 12-month course of antituberculosis therapy. Rasmussen's aneurysm is a significant vascular complication of cavitary tuberculosis and needs to be considered in patients presenting with massive haemoptysis.

Pulmonary nodular lymphoid hyperplasia presenting as cavitating lung mass

Pulmonary nodular lymphoid hyperplasia (PNLH) is a rare non-neoplastic disorder, which can mimic malignancy due to its indolent yet progressive nature. Here, we report a case of surgically proven PNLH that progressed over many years from a ground glass opacity to a solid cavitating lesion mimicking a slow growing primary lung carcinoma.

Effects of Smoking Marijuana on the Respiratory System: A Systematic Review

BACKGROUND

The prevalence of marijuana use and its derivatives has surged over the past century, largely due to increasing legalization globally. Despite arguments advocating its benefits, marijuana smoking exposes the lungs to harmful combustion byproducts, leading to various respiratory issues such as asthma, pneumonia, emphysema, and chronic obstructive pulmonary disease.

METHODS

We embarked on an extensive literature search, utilizing PubMed/Medline, Scopus, Web of Science, and Google Scholar databases, identifying 200 studies. After the elimination of duplicates, and meticulous review of abstracts and full texts, 55 studies were included in our analysis.

RESULTS

Current literature demonstrates that marijuana use negatively impacts lung function, triggering symptoms like chronic cough, sputum production, and wheezing, and diminishing FEV1/FVC ratio in spirometry tests. Moreover, prolonged or chronic marijuana use augments the risk of respiratory function impairment. While the carcinogenic effects of marijuana are still contested, a weak correlation between marijuana use and lung cancer has been observed in some studies. Additionally, instances of other pathologies linked to marijuana use have been reported, including the development of COPD, pulmonary bullae, spontaneous pneumothorax, pleuritic pain, chronic pulmonary aspergillosis, hemoptysis, and pulmonary Langerhans cell histiocytosis.

CONCLUSIONS

The evidence underscores that marijuana use is detrimental to respiratory health. In light of the escalating trend of marijuana use, particularly among the youth, it is imperative to advocate public health messages discouraging its consumption.

Rapid maxillary expansion and nasal patency in mouth breathing children with maxillary atresia due to or not due to allergic rhinitis

AIM

To evaluate the effects of rapid maxillary expansion (RME) on nasal patency in mouth breathing (MB) children with maxillary atresia due to or not due to allergic rhinitis (AR) associated with asthma.

METHODS

Fifty-three MB children/adolescents (aged 7-14 years) with mixed or permanent dentition and maxillary atresia participated, with or without unilateral or bilateral crossbite. They formed the groups: RAD (AR + asthma; clinical treatment, RME); RAC (AR + asthma; clinical treatment, no RME); and D (mouth breathers; RME only). RAD and RAC patients received topical nasal corticosteroid and/or systemic H1 antihistamine (continuous use) and environmental exposure control. All were evaluated before RME (T1) and 6 months after (T2) with the CARATkids score, acoustic rhinometry, and nasal cavity computed tomography (CT). Patients RAD and D underwent RME (Hyrax® orthopedic appliance).

RESULTS

A significant reduction in the CARATkids score occurred in the RAD (-4.06; p < 0.05), similarly when patient and parent/guardian scores were evaluated (-3.28 and -3.16, respectively). Acoustic rhinometry (V5) showed increased nasal volume in all groups, significantly higher in RAD patients than in RAC and D (0.99 × 0.71 × 0.69 cm³, respectively). CT of the nasal cavity documented increased volume in all three groups, with no significant differences between them.

CONCLUSION

In MB patients with AR, asthma, and maxillary atresia, RME increased nasal cavity volume and improved respiratory symptoms. However, it should not be used as the only treatment for managing patients with respiratory allergies.

Dynamic expression of mucins and the genes controlling mucin-type O-glycosylation within the mouse respiratory system

The COVID-19 global pandemic has underscored the need to understand how viruses and other pathogens are able to infect and replicate within the respiratory system. Recent studies have highlighted the role of highly O-glycosylated mucins in the protection of the respiratory system as well as how mucin-type O-glycosylation may be able to modify viral infectivity. Therefore, we set out to identify the specific genes controlling mucin-type O-glycosylation throughout the mouse respiratory system as well as determine how their expression and the expression of respiratory mucins is influenced by infection or injury. Here, we show that certain mucins and members of the Galnt family are abundantly expressed in specific respiratory tissues/cells and demonstrate unique patterns of O-glycosylation across diverse respiratory tissues. Moreover, we find that the expression of certain Galnts and mucins is altered during lung infection and injury in experimental mice challenged with infectious agents, toxins, and allergens. Finally, we examine gene expression changes of Galnts and mucins in a mouse model of SARS-CoV-2 infection. Our work provides foundational knowledge regarding the specific expression of Galnt enzyme family members and mucins throughout the respiratory system, and how their expression is altered upon lung infection and injury.

The Effects of Endogenous Cannabinoids on the Mammalian Respiratory System: A Scoping Review of Cyclooxygenase-Dependent Pathways

Introduction: The endogenous cannabinoid (endocannabinoid) system is an emerging target for the treatment of chronic inflammatory disease with the potential to advance treatment for many respiratory illnesses. The varied effects of endocannabinoids across tissue types makes it imperative that we explore their physiologic impact within unique tissue targets. The aim of this scoping review is to explore the impact of endocannabinoid activity on eicosanoid production as a measure of human airway inflammation. Methods: A scoping literature review was conducted according to PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Search strategies using MeSH terms related to cannabinoids, eicosanoids, cyclooxygenase (COX), and the respiratory system were used to query Medline, Embase, Cochrane, CINAHL, Web of Science, and Biosis Previews in December 2021. Only studies that investigated the relationship between endocannabinoids and the eicosanoid system in mammalian respiratory tissue after 1992 were included. Results: Sixteen studies were incorporated in the final qualitative review. Endocannabinoid activation increases COX-2 expression, potentially through ceramide-dependent or p38 and p42/44 Mitogen-Activated Protein Kinase pathways and is associated with a concentration-dependent increase in prostaglandin (PG)E2. Inhibitors of endocannabinoid hydrolysis found either an increase or no change in levels of PGE2 and PGD2 and decreased levels of leukotriene (LT)B4, PGI2, and thromboxane A2 (TXA2). Endocannabinoids increase bronchial epithelial cell permeability and have vasorelaxant effects in human pulmonary arteries and cause contraction of bronchi and decreased gas trapping in guinea pigs. Inhibitors of endocannabinoid hydrolysis were found to have anti-inflammatory effects on pulmonary tissue and are primarily mediated by COX-2 and activation of eicosanoid receptors. Direct agonism of endocannabinoid receptors appears to play a minor role. Conclusion: The endocannabinoid system has diverse effects on the mammalian airway. While endocannabinoid-derived PGs can have anti-inflammatory effects, endocannabinoids also produce proinflammatory conditions, such as increased epithelial permeability and bronchial contraction. These conflicting findings suggest that endocannabinoids produce a variety of effects depending on their local metabolism and receptor agonism. Elucidation of the complex interplay between the endocannabinoid and eicosanoid pathways is key to leveraging the endocannabinoid system as a potential therapeutic target for human airway disease.

Definition, Composition, and Harmonization of Core Datasets Within the German Center for Lung Research

Core datasets are the composition of essential data items for a certain research scope. As they state commonalities between heterogeneous data collections, they serve as a basis for cross-site and cross-disease research. Therefore, researchers at the national and international levels have addressed the problem of missing core datasets. The German Center for Lung Research (DZL) comprises five sites and eight disease areas and aims to gain further scientific knowledge by continuously promoting collaborations. In this study, we elaborated a methodology for defining core datasets in the field of lung health science. Additionally, through support of domain experts, we have utilized our method and compiled core datasets for each DZL disease area and a general core dataset for lung research. All included data items were annotated with metadata and where possible they were assigned references to international classification systems. Our findings will support future scientific collaborations and meaningful data collections.

Acoustic-Based Deep Learning Architectures for Lung Disease Diagnosis: A Comprehensive Overview

Lung auscultation has long been used as a valuable medical tool to assess respiratory health and has gotten a lot of attention in recent years, notably following the coronavirus epidemic. Lung auscultation is used to assess a patient's respiratory role. Modern technological progress has guided the growth of computer-based respiratory speech investigation, a valuable tool for detecting lung abnormalities and diseases. Several recent studies have reviewed this important area, but none are specific to lung sound-based analysis with deep-learning architectures from one side and the provided information was not sufficient for a good understanding of these techniques. This paper gives a complete review of prior deep-learning-based architecture lung sound analysis. Deep-learning-based respiratory sound analysis articles are found in different databases including the Plos, ACM Digital Libraries, Elsevier, PubMed, MDPI, Springer, and IEEE. More than 160 publications were extracted and submitted for assessment. This paper discusses different trends in pathology/lung sound, the common features for classifying lung sounds, several considered datasets, classification methods, signal processing techniques, and some statistical information based on previous study findings. Finally, the assessment concludes with a discussion of potential future improvements and recommendations.

Artificial-Intelligence-Driven Algorithms for Predicting Response to Corticosteroid Treatment in Patients with Post-Acute COVID-19

Pulmonary fibrosis is one of the most severe long-term consequences of COVID-19. Corticosteroid treatment increases the chances of recovery; unfortunately, it can also have side effects. Therefore, we aimed to develop prediction models for a personalized selection of patients benefiting from corticotherapy. The experiment utilized various algorithms, including Logistic Regression, k-NN, Decision Tree, XGBoost, Random Forest, SVM, MLP, AdaBoost, and LGBM. In addition easily human-interpretable model is presented. All algorithms were trained on a dataset consisting of a total of 281 patients. Every patient conducted an examination at the start and three months after the post-COVID treatment. The examination comprised a physical examination, blood tests, functional lung tests, and an assessment of health state based on X-ray and HRCT. The Decision tree algorithm achieved balanced accuracy (BA) of 73.52%, ROC-AUC of 74.69%, and 71.70% F1 score. Other algorithms achieving high accuracy included Random Forest (BA 70.00%, ROC-AUC 70.62%, 67.92% F1 score) and AdaBoost (BA 70.37%, ROC-AUC 63.58%, 70.18% F1 score). The experiments prove that information obtained during the initiation of the post-COVID-19 treatment can be used to predict whether the patient will benefit from corticotherapy. The presented predictive models can be used by clinicians to make personalized treatment decisions.

The Application of New Approach Methodologies in Respiratory Disease Research: Their Role in Improving Translational Medicine from Bench to Bedside

The SARS-CoV-2 outbreak focused global attention on the shortcomings of the drug discovery process. It led to its acceleration in several areas, particularly in the processes associated with the development and approval of COVID-19 vaccines. This situation contrasts with the low approval rates of new drugs for respiratory system diseases (e.g. asthma, chronic obstructive pulmonary disease, cancer, tuberculosis), which are leading causes of morbidity and mortality worldwide. In this context, innovation in respiratory system drug discovery is surely needed, and it is most likely to succeed through the use of preclinical models that are cost-effective, high-throughput and generate predictive human-relevant outcomes. Here, we highlight several non-animal new approach methodologies (NAMs) and their applications in respiratory research. We describe their potential uses for efficacy and toxicity assessments, to optimise the drug development process and reduce the high failure rates in clinical trials.

Climate change and public health: The effects of global warming on the risk of allergies and autoimmune diseases: The effects of global warming on the risk of allergies and autoimmune diseases

Global climate change and extreme weather events are associated with epigenetic modifications in immune cells, leading to the possible increased risk and prevalence of allergies and autoimmune diseases.

Foreign Body Accidents in a Pediatric Emergency Department

Introduction  Foreign body accidents (FBAs) are frequent in children and can be severe, being a common cause of morbidity and mortality and a public health problem. As these accidents are multifactorial, their cause can only be determined by analyzing the clinical details and characteristics of the object. Knowing the associated mechanisms and factors is essential to determine a risk profile and have a preventive, therapeutic, and diagnostic purpose. Objective  The present study aimed to describe the incidence of FBAs in otorhinolaryngology according to their anatomical location, focusing on the aerodigestive system. Methods  This is a retrospective study performed by reviewing the medical records of 668 cases seen in the emergency department of a tertiary pediatric hospital in São Paulo, state of São Paulo, Brazil, between 2014 and 2017. Results  Foreign bodies (FBs) were found in the digestive system (238/668), in the nasal cavities (206/668), in the ears (182/668), in the oropharynx (34/668), and in the respiratory system (8/668). A total of 91.77% of the patients were treated in the emergency room. The main age group affected was < 5 years old, with no difference between genders. The most frequent complications affected the digestive system and the most serious occurred in cases involving the respiratory system. Conclusion  Multidisciplinary teams should be ready in the emergency room to provide adequate care in FBAs. Early diagnosis, FB removal in the emergency room or the surgical center and follow-up are essential. Developing prevention campaigns including a risk profile for certain products and/or materials, helping to ensure safety for consumers, is necessary. For this, a national database with compulsory notification containing relevant information on FBAs in the pediatric population should be created.

Inspiratory Muscle Training Improves Maximal Inspiratory Pressure Without Increasing Performance in Elite Swimmers

PURPOSE

To analyze the effect of inspiratory muscle training (IMT) on the maximal inspiratory mouth pressure (MIP) and performance of elite swimmers.

METHODS

Eight participants performed a 3000-m swimming test (T-3000), followed by blood lactate measurements at 1 and 5 minutes postexercise.. The testing protocol was carried out before and after 6 weeks of IMT, in which a high-volume IMT group (HV-IMT) (n = 4) performed IMT twice a day-in the morning in a seated position and in the afternoon in a concurrent session of IMT and core muscle training. Also, a low-volume IMT group (LV-IMT) (n = 4) performed IMT in the morning session only.

RESULTS

After the intervention, both groups improved their MIP, HV-IMT (132.75 [27.42] to 156.75 [21.88] cmH2O; P = .010; d = 0.967) and LV-IMT (149.25 [22.82] to 171.50 [23.74] cmH2O; P = .013; d = 0.955), without a significant difference between groups (P = .855). Regarding swimming performance, there were no changes between groups in the T-3000 (P = .472) or lactate removal rate (P = .104).

CONCLUSION

IMT increased inspiratory muscle strength in elite swimmers, but there was no association or meaningful impact on swimming performance.

[The regional aspects of social economic factors effect on morphophysiological status and somatic health of young women]

The analysis of various social, economic, and demographic factors demonstrates different degrees and directions of their impact on human body systems and human health in general. The examination of residents of several cities of Russia and neighboring countries provides an opportunity to assess strength and direction of relationship between socioeconomic factors and morphofunctional health. The comprehensive morphofunctional examination was applied to 722 young females aged 18.8±0.05 years from six cities: Moscow, Samara, Saransk, Arkhangelsk (the Russian Federation), Tiraspol (the Transdniestria Moldavian Republic), and Baku (the Republic of Azerbaijan). The economic, demographic, social and ecological indicators of the city and relevant region were considered as factors of urban environment. The Spearman's rank correlation coefficient (RS). was used as measure of relation between attributes. The variability of morphophysiological characteristics is hardly related to the population density (RS -0.18-0.15). At the same time the greatest contribution was demonstrated by complex of economic factors and environmental pollution (RS up to -0.29 for both). The relationships between functional indicators of cardiovascular system and economic status of the region, associated demographic factors, and indicators of air pollution were established in the surveyed cities. In overall, the results suggest that cardiovascular system is the most susceptible area to influence of city-level social economic factors and demonstrates deterioration of functional indicators under economic decline at the regional level. In other morphophysiological systems, adaptive changes were established only as tendencies. The deterioration conditions of human body systems under impact of urban environment factors is evident in some cities. The observed deterioration potentially can adversely affect health during growth and will further be aggravated by ongoing negative environmental influences. In this regard, it is necessary to enhance knowledge about impact of external influences on human health and body systems to develop directed preventive measures improving quality of life.

The β1 Adrenergic Blocker Nebivolol Ameliorates Development of Endotoxic Acute Lung Injury

Acute lung injury (ALI) is a disease, with no effective treatment, which might result in death. Formations of excessive inflammation and oxidative stress are responsible for the pathophysiology of ALI. Nebivolol (NBL), a third-generation selective β1 adrenoceptor antagonist, has protective pharmacological properties, such as anti-inflammatory, anti-apoptotic, and antioxidant functions. Consequently, we sought to assess the efficacy of NBL on a lipopolysaccharide (LPS)-induced ALI model via intercellular adhesion molecule-1 (ICAM-1) expression and the tissue inhibitor of metalloproteinases-1 (TIMP-1)/matrix metalloproteinases-2 (MMP-2) signaling. Thirty-two rats were split into four categories: control, LPS (5 mg/kg, intraperitoneally [IP], single dose), LPS (5 mg/kg, IP, one dosage 30 min after last NBL treatment), + NBL (10 mg/kg oral gavage for three days), and NBL (10 mg/kg oral gavage for three days). Six hours after the administration of LPS, the lung tissues of the rats were removed for histopathological, biochemical, gene expression, and immunohistochemical analyses. Oxidative stress markers such as total oxidant status and oxidative stress index levels, leukocyte transendothelial migration markers such as MMP-2, TIMP-1, and ICAM-1 expressions in the case of inflammation, and caspase-3 as an apoptotic marker, significantly increased in the LPS group. NBL therapy reversed all these changes. The results of this study suggest that NBL has utility as a potential therapeutic agent to dampen inflammation in other lung and tissue injury models.

Accuracy of the nursing diagnosis of ineffective airway clearance in intensive care unit patients

OBJECTIVES

to analyze the accuracy of the clinical indicators of ineffective airway clearance in adult intensive care unit patients.

METHODS

diagnostic accuracy study, performed in the intensive care unit of a university hospital in northeastern Brazil. The sample consisted of 104 patients hospitalized between June and October 2019.

RESULTS

the prevalence of ineffective airway clearance was 36.54%. The indicators with high specificity included absence of cough (0.8326), orthopnea (0.6817), adventitious breath sounds (0.8175), and diminished breath sounds (0.8326). The clinical indicators with high sensitivity and specificity were alteration in respiratory rate (0.9999) and alteration in respiratory pattern (0.9999).

CONCLUSIONS

six clinical indicators provided an accurate identification of ineffective airway clearance. The clinical indicators alteration in respiratory rate and alteration in respiratory pattern were the most accurate for critical adult patients. The findings of this study contribute to accurate diagnostic inferences and to prevention of respiratory complications in these patients.

Temporal and geographical variation in low carbon inhaler dispensing in England, 2016 to 2021: an ecological study

OBJECTIVES

In 2019-2020, four national recommendations were published in the United Kingdom to encourage use of low carbon inhalers. This study aimed to investigate whether these were associated with a change in primary care dispensing in England and to explore associations between geographical variation and clinical commissioning group (CCG) characteristics.

DESIGN

Ecological study using aggregated publicly available data.

SETTING

All CCGs in England (March 2016 to February 2021).

PARTICIPANTS

not applicable.

MAIN OUTCOME MEASURES

Percentage of low carbon inhalers dispensed.

RESULTS

The percentage of low carbon inhalers dispensed was 26.3% in 2020-2021 (of 8.8 million inhalers). This decreased over the study period for short-acting beta-agonist (SABA), inhaled corticosteroid (ICS) and ICS+long-acting beta-agonist (LABA) inhalers. The same trend was seen for LABA and ICS+LABA+long-acting muscarinic antagonist inhalers from 2019. The SABA and ICS classes were less often dispensed as low carbon inhalers (⁓6% versus 35-45%). Interrupted time series analyses found slight increases in low carbon inhaler percentage in the SABA, LABA and ICS classes after April 2019, which were soon erased by the long-term trend. There was also geographical variation, with the north-west, Birmingham and London consistently dispensing more low carbon inhalers. The presence of advice on climate change in CCG formularies/guidelines, the prevalence of asthma and population age profile were associated with significant variation in low carbon inhaler percentage for some classes.

CONCLUSIONS

The percentage of low carbon inhalers dispensed in England remains low and continues to decrease. Greater use of low carbon inhalers is achievable, but is more likely with locally implemented initiatives.

The study of trends in mortality of respiratory system cancers in Babol, North of Iran (2013-2021)

Background

In Iran, cancers are known as the second leading cause of death, among which respiratory system cancers are particularly important because lung cancer is the second most common cause of death in this country. This study aimed to estimate the crude and age-standardized mortality and its trends during 9 years in the Northern city of Iran, Babol.

Methods

In this cross-sectional study, all the recorded deaths due to respiratory system cancers in Babol during the years 2013-2021 on the Classification of Causes of Deaths and Death Registration System of Babol University of Medical Sciences were taken into consideration, and the population estimate was based on the latest census. Finally, the crude and age-standardized rates of mortality and trends of cancer incidents were calculated.

Results

In general, 393 deaths with an overall mean age of 67.8±3.9 years have happened due to respiratory system cancers. The crude and standardized rates of respiratory system cancers increased from 6.5 and 5.5 per hundred thousand people in 2013 to 9.1 and 7.8 per hundred thousand people in 2021, respectively. With each decade in age, their trends increased significantly in men (p=0.024) and remained constant in women (p=0.262). In examining the trend of respiratory system cancers, we found an increasing trend for lung cancer and a constant trend for larynx and oropharynx cancers. There was also a decreasing trend for hypopharyngeal cancer.

Conclusions

The age-standardized rate and trend of respiratory system cancers are increasing. Therefore, it is important to prevent their prevalence by reducing the risk factors and increasing the general awareness of risks and timely diagnosis.

Silica associated systemic sclerosis: an occupational health hazard

A middle-aged male working in the sandblasting and stone-cutting industry was brought to the medicine department with skin tightness, dysphagia and discolouration of the skin for the last 1 year. On examination, he had skin thickening over the face and the extremities with restricted mouth opening. His hands were cold and showed peripheral cyanosis. Systemic examination was suggestive of diffuse cutaneous systemic sclerosis, further confirmed by the antinuclear antibody testing. Further, CT of the chest showed mediastinal lymphadenopathy with eggshell calcification and interstitial fibrosis consistent with silicosis and fibrotic non-specific interstitial pneumonitis. The patient was started on pulse monthly cyclophosphamide for six cycles, and steroids were given for 4 weeks and tapered. Tadalafil and amlodipine were given for his pulmonary artery hypertension and Raynaud's phenomenon, respectively. This case also highlights the importance of periodic screening of the workers exposed to silica dust to prevent silicosis.

The Respiratory System of the Arctocephalus australis in Comparison to the Dog as a Land-Carnivore: Are There Adaptations to Marine Life?

Marine mammals are divided into three groups, with similar adaptations resulting from their aquatic lifestyle: sirenians, pinnipeds, and cetaceans. The present work focused on the South American fur seal, or Arctocephalus australis, a carnivore included in the pinnipeds group. We assessed whether the anatomical features of the Arctocephalus australis' respiratory system are comparable to those of other land-carnivores or whether these individuals show anatomical adaptations related to their ability to dive or their breath-holding capacities. We studied 11 cadavers of Arctocephalus australis, which included adult (n = 2) and juvenile (n = 9) individuals, by anatomically dissecting their isolated entire respiratory system. Although it is generally similar to that in land-carnivores, we demonstrated that the Arctocephalus australis's respiratory apparatus shows several specific characteristics. Therefore, our results are of great importance for clinical diagnostic and wildlife conservation purposes.

Lung abscess due to Streptococcus intermedius associated with SARS CoV-2 infection in pregnancy: Unusual presentation and complication of a commensal bacteria during pregnancy

Streptococcus intermedius is a commensal bacterium reported in a few cases as the causative agent of brain and lung abscesses, pneumonia, and endocarditis. Lung abscesses due to Streptococcus intermedius are rare, especially in pregnancy. We describe the first case of lung abscess due to Streptococcus intermedius in a pregnant woman.

Development and validation of a mathematical model to simulate human cardiovascular and respiratory responses to battlefield trauma

Mathematical models of human cardiovascular and respiratory systems provide a viable alternative to generate synthetic data to train artificial intelligence (AI) clinical decision-support systems and assess closed-loop control technologies, for military medical applications. However, existing models are either complex, standalone systems that lack the interface to other applications or fail to capture the essential features of the physiological responses to the major causes of battlefield trauma (i.e., hemorrhage and airway compromise). To address these limitations, we developed the cardio-respiratory (CR) model by expanding and integrating two previously published models of the cardiovascular and respiratory systems. We compared the vital signs predicted by the CR model with those from three models, using experimental data from 27 subjects in five studies, involving hemorrhage, fluid resuscitation, and respiratory perturbations. Overall, the CR model yielded relatively small root mean square errors (RMSEs) for mean arterial pressure (MAP; 20.88 mm Hg), end-tidal CO₂ (ETCO₂ ; 3.50 mm Hg), O₂ saturation (SpO₂ ; 3.40%), and arterial O₂ pressure (PaO₂ ; 10.06 mm Hg), but a relatively large RMSE for heart rate (HR; 70.23 beats/min). In addition, the RMSEs for the CR model were 3% to 10% smaller than the three other models for HR, 11% to 15% for ETCO₂ , 0% to 33% for SpO₂ , and 10% to 64% for PaO₂ , while they were similar for MAP. In conclusion, the CR model balances simplicity and accuracy, while qualitatively and quantitatively capturing human physiological responses to battlefield trauma, supporting its use to train and assess emerging AI and control systems.

Reducing the time delay of oxygen transport to the neonate on continuous positive airway pressure support: A bench study

Background

Premature newborns often require oxygen support as part of their therapy. Systems for oxygen administration are developed to assure adequate oxygenation of newborns. Several factors were identified in the systems that contribute to the time delay between the change in the set inspiratory oxygen fraction and its actual delivery to tissues. In this study, we aimed to reduce the physical delay in oxygen delivery to newborns.

Methods

We developed an O₂ Flush System (O₂-FS) that brings the source of oxygen as close to a patient as possible to make oxygen available for rapid delivery that compensates for the physical delay in the ventilator circuit. The O₂-FS system is built around an electromechanical on/off valve. We validated the O₂-FS concept in experiments with non-invasive Continuous Positive Airways Pressure (CPAP) ventilators.

Results

The O₂-FS accelerated oxygen delivery with all the tested systems and arrangements, typically by 5-15 s. We also observed that the application of supplemental oxygen increased the pressure in the ventilator circuit by 3-4 cmH₂O which may mitigate the apneic pauses that are common in premature newborns.

Conclusions

The O₂-FS system may work as a universal accessory of the CPAP lung ventilator and shorten the distribution of oxygen to the patient during oxygen desaturation events, possibly eliminating or interrupting apneic pauses in neonates, for whom oxygen therapy is an essential treatment. In clinical practice, the O₂-FS could help maintain normoxemic saturation values through adequate oxygen dosing in preterm neonates, thus reducing morbidity and mortality.

The endocannabinoid system and breathing

Recent changes in cannabis accessibility have provided adjunct therapies for patients across numerous disease states and highlights the urgency in understanding how cannabinoids and the endocannabinoid (EC) system interact with other physiological structures. The EC system plays a critical and modulatory role in respiratory homeostasis and pulmonary functionality. Respiratory control begins in the brainstem without peripheral input, and coordinates the preBötzinger complex, a component of the ventral respiratory group that interacts with the dorsal respiratory group to synchronize burstlet activity and drive inspiration. An additional rhythm generator: the retrotrapezoid nucleus/parafacial respiratory group drives active expiration during conditions of exercise or high CO₂. Combined with the feedback information from the periphery: through chemo- and baroreceptors including the carotid bodies, the cranial nerves, stretch of the diaphragm and intercostal muscles, lung tissue, and immune cells, and the cranial nerves, our respiratory system can fine tune motor outputs that ensure we have the oxygen necessary to survive and can expel the CO₂ waste we produce, and every aspect of this process can be influenced by the EC system. The expansion in cannabis access and potential therapeutic benefits, it is essential that investigations continue to uncover the underpinnings and mechanistic workings of the EC system. It is imperative to understand the impact cannabis, and exogenous cannabinoids have on these physiological systems, and how some of these compounds can mitigate respiratory depression when combined with opioids or other medicinal therapies. This review highlights the respiratory system from the perspective of central versus peripheral respiratory functionality and how these behaviors can be influenced by the EC system. This review will summarize the literature available on organic and synthetic cannabinoids in breathing and how that has shaped our understanding of the role of the EC system in respiratory homeostasis. Finally, we look at some potential future therapeutic applications the EC system has to offer for the treatment of respiratory diseases and a possible role in expanding the safety profile of opioid therapies while preventing future opioid overdose fatalities that result from respiratory arrest or persistent apnea.

Aging affects the number and morphological heterogeneity of rat phrenic motor neurons and phrenic motor axons

Diaphragm muscle (DIAm) motor units comprise a phrenic motor neuron (PhMN), the phrenic nerve and the muscle fibers innervated, with the size of PhMNs and axons characteristic of motor unit type. Smaller PhMNs and their axons comprise slow (type S) and fatigue-resistant (type FR) DIAm motor units, while larger PhMNs and their axons comprise more fatigable (type FF) motor units. With aging, we have shown a loss of larger PhMNs, consistent with selective atrophy of type IIx/IIb DIAm fibers and reduced maximum DIAm force. In the present study, we hypothesized that with aging there is a loss of larger myelinated phrenic α motor axons. Female and male young (6 months) and old (24 months) Fischer 344 rats were studied. PhMNs were retrogradely labeled by intrapleural injection of 488-conjugated CTB. The phrenic nerves were excised ~1 cm from the DIAm insertion and mounted in resin, and phrenic α motor axons were delineated based on size (i.e., >4 μm diameters). In older rats, the number of larger PhMNs and larger phrenic α motor axons were reduced. There were no differences in non-α axons. In addition, there was evidence of demyelination of larger phrenic α motor axons in older rats. Together, these findings are consistent with the selective age-related vulnerability of larger PhMNs and denervation of type FF motor units, which may underlie DIAm sarcopenia.