bluuebunny/crossref_metadata_2025 huggingface dataset:
Obtaining Food Flours through the Drying of Tamarind Fruits
Authors: de Queiroga A.X. Mesquita , da Silva O. Soares , da Costa F. Bezerra , Sales G.N. Barros , da Silva K. Gomes , Filho R. Bernadino , de Sousa B.A. Araújo
Published: January 2020

Tamarind is a fruit of foreign origin, more precisely African, but it has an excellent adaptation to the different types of climatic conditions in other continents. In Brazil, for example, it is possible to find it in several states. Although tamarind has a considerable yield on both its constituent parts, shell, pulp and seeds, and have a low purchasing power, the fruit is largely wasted and there are few in-depth studies on the same. As a way of reuse, the aim was to transform the fruit into new products, such as flours used in human food. The objective of this study was to make the drying of the tamarind fruits to obtain the ideal characteristics for the development of a food flour and to evaluate the physical-chemical quality and to determine the bioactive compounds of the tamarind flour. Drying was done at 60 °C in a greenhouse, during different drying periods, which varied according to each part of the fruit, after which the flours were elaborated and characterized for the physicochemical and bioactive parameters. In the physico-chemical characterization, a good presence of proteins in the seed flour (7.09%), low sugar content in the pulp flour (0.74%), good values ​​for lipids in the seed flour (3, 41%) and good ash values in the bark flour (2.69%). In general, the flour besides proteins had a good source of energy and minerals. Among the bioactive compounds present in the tamarind flour were the high contents of phenolic compounds (1564.9 mg/100g), vitamin C (80.95%), lycopene (89.62 mg/g), flavonoids (20.44 mg/100g) and anthocyanins (12.84mg / 10g) in the seed flour, carotenoids (20.80 mg/g) in the pulp flour. In general, flours produced from tamarind had excellent characteristics for the preparation of bakery products.
Foam-Mat Drying Process of Duck Egg White
Authors: Mangueira E. Rodrigues , de Assis Cavalcante J. , Costa N. Alves , Barbosa de Lima A.G.
Published: January 2020

The foam-mat dryingprocessof egg white, developed in the food industry, promotes a porous product, brittle and easy to grind. The powderedegg white has a good rehydration properties, safer consumption and storage conditions than fresh product, keeping the high level of proteins and vitamins contained in the egg. In this way, the objective of this work is to study, through numerical computational simulation, the physical aspects of the duck egg white foam-matdrying process. For this, the foam was characterized by its density, percentage of expansion, air over run, stability and moisture. Temperature (50, 60 and 70°C), stirring rate (levels 6, 7 and 8) and stirring time (4, 5 and 6 minutes) are taken as input conditions and the product final moisture and drying time are the output variables. Drying was performed based on the complete factorial 23 + 3 central point experimental design in this procedure. It has been observed that the time and stirring rate significantly influence the product final moisture and that the drying temperature is predominant for the total process time. From the foam moisturedata, adjustments of empirical mathematical models were made; evidencing that theModifiedPage and the Page models provided the best results, with a standard deviation lower than 0.01 and the coefficient of determination above 0.99. For this analysis, the case where the drying temperature, time and the stirring rate were, respectively, 70 °C, 6 minutes and 8 level, presented the best results.
Developing the Synergy Model Patient Acuity Tool for Admission, Discharge, and Transfer
Authors: Byrum Diane G. , Caulfield Eileen V. , Burgess Julia D. , Holshouser Tracy B. , Daniels Debra L. , Hunter Sandy
Published: January 2020

Background

The Admission Discharge Transfer–Synergy Model Acuity Tool (ADT-SMAT) was developed to quantify patient intervention intensity and patient response variability and to capture nurses’ critical thinking. The tool is based on the American Association of Critical-Care Nurses Synergy Model for Patient Care.

Objective

To determine whether the ADT-SMAT is reliable and valid for predicting the level of care for admission, discharge, and transfer of critically ill patients. Methods Reliability was examined by using interrater reliability, intraclass coefficient, and effect size analyses to evaluate physiological variables and total calculated ADT-SMAT score in 246 patients. Content validity was determined in consultation with critical care nurses, and construct validity was examined by assessing the correlation between ADT-SMAT scores and other convergent and divergent constructs.

Results

The ADT-SMAT showed strong reliability for measuring the physiological variables and total score, with an intraclass coefficient of 0.930. The value of Cohen d determining the effect size for each element of the ADT-SMAT was less than 0.20 for every element, indicating that substantial differences in scoring did not occur. The validity of the ADT-SMAT requires additional testing.

Conclusions

This is the first study attempting to correlate Synergy Model patient characteristics and acuity while integrating nurses’ critical decision-making process. With further testing, the ADT-SMAT could be a valuable tool to quantify and standardize patient characteristics in determining the appropriate level of care associated with admission, discharge, and transfer decisions.
Critical Update on the Third Edition of the Guidelines for Managing Severe Traumatic Brain Injury in Children
Authors: Reuter-Rice Karin , Christoferson Elise
Published: January 2020

Background

Severe traumatic brain injury (TBI) is associated with high rates of death and disability. As a result, the revised guidelines for the management of pediatric severe TBI address some of the previous gaps in pediatric TBI evidence and management strategies targeted to promote overall health outcomes.

Objectives

To provide highlights of the most important updates featured in the third edition of the guidelines for the management of pediatric severe TBI. These highlights can help critical care providers apply the most current and appropriate therapies for children with severe TBI.

Methods and Results

After a brief overview of the process behind identifying the evidence to support the third edition guidelines, both relevant and new recommendations from the guidelines are outlined to provide critical care providers with the most current management approaches needed for children with severe TBI. Recommendations for neuroimaging, hyperosmolar therapy, analgesics and sedatives, seizure prophylaxis, ventilation therapies, temperature control/hypothermia, nutrition, and corticosteroids are provided. In addition, the complete guideline document and its accompanying algorithm for recommended therapies are available electronically and are referenced within this article.

Conclusions

The evidence base for treating pediatric TBI is increasing and provides the basis for high-quality care. This article provides critical care providers with a quick reference to the current evidence when caring for a child with a severe TBI. In addition, it provides direct access links to the comprehensive guideline document and algorithms developed to support critical care providers.
Motivators and Stressors for Canadian Research Coordinators in Critical Care: The MOTIVATE Survey
Authors: McDonald Ellen , Zytaruk Nicole , Heels-Ansdell Diane , Smith Orla , Borges Debbie , Hand Lori , Clarke France , Nassar Aussama , Bennardo Michael , Cook Deborah ,   for the Canadian Critical Care Research Coordinators’ Group
Published: January 2020

Background

Critical care research coordinators implement study protocols in intensive care units, yet little is known about their experiences.

Objective

To identify the responsibilities, stressors, motivators, and job satisfaction of critical care research coordinators in Canada.

Methods

Responses to a self-administered survey were collected in order to identify and understand factors that motivate and stress research coordinators and enhance their job satisfaction. Items were generated in 5 domains (demographics, job responsibilities, stressors, motivators, and satisfaction). Face validity pretesting was conducted and clinical sensibility was evaluated. Items were rated on 5-point Likert scales. Descriptive analyses were used to report results.

Results

The response rate was 78% (66 of 85). Most critical care research coordinators (71%) were employed full time; they were engaged in 9 studies (7 academic, 2 industry); and 49% were nurses. Of 30 work responsibilities, the most frequently cited were submitting ethics applications (89%), performing data entry (89%), and attending meetings (87%). Highest-rated stressors were unrealistic workload and weekend/holiday screening; highest-rated motivators were a positive work environment and team spirit. Overall, 26% were “very satisfied” and 53% were “satisfied” with their jobs.

Conclusions

Critical care research coordinators in Canada indicate that, despite significant work responsibilities, they are satisfied with their jobs thanks to positive work environments and team spirit.
Magnitude and Functional Profile of the Human CD4+ T Cell Response throughout Primary Immunization with Tick-Borne Encephalitis Virus Vaccine
Authors: Varnaitė Renata , Blom Kim , Lampen Margit H. , Vene Sirkka , Thunberg Sarah , Lindquist Lars , Ljunggren Hans-Gustaf , Rombo Lars , Askling Helena H. , Gredmark-Russ Sara
Published: January 2020

Tick-borne encephalitis (TBE) is a viral infection of the CNS caused by TBE virus. With no specific treatment available, the only protection is a formalin-inactivated whole virus vaccine. Primary immunization with European TBE vaccines, as recommended by the manufacturers, consists of three vaccine doses administered within a 1-y period. Protection from vaccination is believed to be mediated by Abs, yet T cells may also have a protective role. We set out to characterize the human CD4+ T cell response throughout primary TBE immunization. The responses were evaluated before vaccination and 1 mo after each vaccine dose. A heterogeneous magnitude of CD4+ T cell–mediated memory responses was observed in regard to lymphoblast expansion and cytokine production (IFN-γ, IL-2, and TNF), with the highest median magnitude detected after the second dose of vaccine. Stimulation with an overlapping peptide library based on structural TBE virus proteins E and C revealed that CD4+ T cells concomitantly producing IL-2 and TNF dominated the responses from vaccinees after each vaccine dose, whereas a control cohort of TBE patients responded mainly with all three cytokines. CD107a expression was not upregulated upon peptide stimulation in the vaccinees. However, CD154 (CD40L) expression on cytokine-positive memory CD4+ T cells significantly increased after the second vaccine dose. Taken together, TBE vaccination induced CD4+ T cell responses dominated by IL-2 and TNF production together with CD154 upregulation and a lower IFN-γ response compared with TBE patients. This response pattern was consistent after all three doses of TBE vaccine.
Editorial
Authors: Orellana Urtubia Luis , Vélez C. Constanza
Published: January 2020

Presentación al Volumen XIII, N°1 de 2019
La Iglesia Católica Cubana: entre el Vaticano II y la Revolución marxista (1959 - 1966)
Authors: Pérez-Valencia Felipe
Published: January 2020

El presente trabajo analiza cómo la Iglesia católica cubana vivió la convocatoria, la preparación y la celebración del concilio Vaticano II. En Cuba, estas primeras fases del Vaticano II serán vividas en paralelo con la instauración del sistema socialista, como etapa previa a la construcción de la sociedad comunista. La construcción del socialismo, que asume el marxismo como ideología y metodología para la transformación social, supone la destrucción del sistema capitalista y de todas las instituciones que lo sustentan. Dado que para el marxismo la religión, como cosmovisión, y la Iglesia, como institución, han sido instrumentos de la clase dominante para ejercer su control sobre las clases explotadas, el aniquilamiento del capitalismo debe pasar inexorablemente por la desarticulación de la religión. Este principio, axial para la construcción del comunismo, creó una situación de enfrentamiento Estado-Iglesia Católica en Cuba. Así, mientras la Iglesia Católica Latinoamericana, bajo la influencia del Vaticano II, vivió la expansión más importante de su historia, el catolicismo cubano, bajo el sistema marxista, hubo de experimentar la peor retracción de su historia.
DE ÁNGEL MÉNDEZ: Festín del deseo. Hacia una teología alimentaria
Authors: Granados Valdéz Juan
Published: January 2020

Reseña del Libro de Ángel Méndez, El Festín del deseo.
Anastomotic healing in a rat model of peritonitis after non-steroidal anti-inflammatory drug administration
Authors: Ghiselli Roberto , Lucarini Guendalina , Ortenzi Monica , Salvolini Eleonora , Saccomanno Stefania , Orlando Fiorenza , Provinciali Mauro , Casciani Fabio , Guerrieri Mario
Published: January 2020

The tissue inflammatory response can influence the outcome of anastomotic healing. Anastomotic leakage represents a dreadful complication after gastrointestinal surgery, in particular sepsis and intra-abdominal infections impair the restorative process of colic anastomoses. It has been debated whether the administration of non-steroidal anti-inflammatory drugs (NSAIDs) is a risk factor for dehiscence, since many patients receive NSAIDs in the early postoperative period. Our aim was, for the first time, to analyze the morpho-functional effects of postoperative administration of two commonly used NSAIDs, Diclofenac and Ketorolac, on the healing process of colo-colic anastomoses constructed under condition of fecal peritonitis in a rat model. Sixty adult male rats underwent two surgical procedures: peritonitis induction and colo-colic anastomosis, and were divided into three groups: 20 rats received saline; 20 rats 4 mg/kg Diclofenac and 20 rats 5 mg/kg Ketorolac. We assessed anastomosis strength, morphological features of tissue wound healing, immunohistochemical metalloproteinase 9 (MMP9) expression and collagen deposition and content by Sirius red staining and hydroxyproline level. We found no significant difference in bursting pressure, collagen content and organization and morphological features between the groups, except a significantly reduced presence of inflammatory cells and MMP9 expression in the groups treated with NSAIDs. Our findings showed that Diclofenac and Ketorolac administration did not affect post-surgical healing and did not increase the leakage risk of colo-colic anastomoses during peritonitis.
Spontaneous pneumothorax
Authors: Matthys Heinrich
Published: January 2020

Pneumothorax is defined as the presence of air in the pleural space due to: a) communication be- tween alveolar spaces and pleura; b) direct or indi- rect exchange of air between the atmosphere and the pleural space; or c) the presence of gas produc- ing organisms in the pleural space. From the clinical and etiological standpoint the pneumothorax [...]
The lung at high altitude
Authors: Cogo Annalisa
Published: January 2020

The lung is the interface between the environment and the metabolic mechanisms of the body, and plays a pivotal role in exposure to high altitude. In fact, high altitude is a challenge for [...]
When to perform a bronchial challenge with mannitol?
Authors: Sanguinetti Claudio M.
Published: January 2020

Variable airflow limitation can be diagnosed by spirometry in asthmatic patients or provoked in a lung function laboratory by getting patients to in- hale substances that induce bronchoconstriction, so making it possible to detect and measure the airway hyperresponsiveness (AHR) frequently associated with the diagnosis of asthma [...]
COPD, smoking behaviour, and the importance of teachers as role-models for adolescents
Authors: Maio Sara , Baldacci Sandra , Viegi Giovanni
Published: January 2020

Chronic obstructive pulmonary disease (COPD) has been described by the ATS (American Thoracic Society)/ERS (European Respiratory Society) guidelines as a disease “characterized by airflow lim- itation that is not fully reversible”. The diagnosis of COPD should be considered in any patient who ex- periences cough, sputum production, or dyspnea in association with specific risk factors [...]
Anxiety and depression in COPD
Authors: Salerno Francesco G. , Carone Mauro
Published: January 2020

Chronic obstructive pulmonary disease (COPD) is a lung disease associated with chronic systemic in- flammatory syndrome. COPD is often associat- ed with comorbidities that need to be evaluated be- cause they affect the severity of the disease. [...]
Ultrasound guided fine-needle aspiration biopsy of metastases in nonpalpable supraclavicular lymph nodes in lung cancer patients
Authors: Kendirlinan Resat , Özkan Gülcihan , Bayram Mehmet , Bakan Nur Dilek , Tutar Mehmet , Gür Aygün , Camsari Güngör
Published: January 2020

Background and objectives: To assess frequency and signifi- cance of enlarged nonpalpable supraclavicular lymph nodes with routine ultrasound (US) evaluation and US-guided fine- needle aspiration biopsy (FNAB) for the diagnosis and staging of patients with lung cancer.

Materials and methods: 106 consecutive patients with lung cancer and nonpalpable supraclavicular lymph nodes were evaluated with cervical US for the presence of pathological lymph nodes. FNAB was performed in patients with nodes with short-axis > 5 mm, rounded shape and missing echogenic hilum.

Results: 27 (25.5%) patients had enlarged supraclavicular lymph nodes on US. Fourteen patients (13.2%) had cytologically proven lymph node involvement. Supraclavicular lymph node metastasis was more frequent in patients with medi- astinal invasion (p = 0.0001) and patients with enlarged lymph nodes on upper paratracheal stations on thorax CT (p = 0.0001). No relation was found between supraclavicular lymph node involvement and T stage (p = 0.27), distant metastasis (p = 0.50) or histological type (p = 0.80). Three patients were upstaged from IIIA to IIIB status. US-guided FNAB was the only diagnostic method in 2 patients.

Conclusion: US-guided FNAB is a simple and safe procedure which can document N3 stage of disease in lung cancer patients. Thereby more invasive and expensive diagnostic procedures can be avoided in selected lung cancer patients.
JAK2 V617F mutation negative erythrocytosis (or how to more simply perform diagnosis and treat a patient with increased hematocrit)
Authors: Zito Luca , Torchio Roberto , Bannout Kassem , Ulisciani Stefano , Guglielmo Marco , Ciacco CLAUDIO , Lodico Donatella
Published: January 2020

This case report focuses on a 71-year old patient affected by unknown dyspnea and erythrocytosis referred by his general practitioner to our center for specialist advice after a hematological examination had excluded polycythemia vera on grounds of negative test for JAK2 V617F / exon 12 mutation. An accurate clinical history and physical examination accompanied by respiratory function tests resulted in diagnosis of JAK2 V617F mutation negative erythrocytosis, and treatment could be started. The discussion examines decisional algorithms when a polyglobulic patient is referred for diagnosis.
Chronic pulmonary aspergilloses: do they exist?
Authors: Schiraldi Gianfranco , Minniti Lucia
Published: January 2020

In an editorial of this journal in 2006, Professor de Marinis made a heartfelt appeal to Italian pulmonologists to become more active and involved in the field of lung tumors [1]; today we find ourselves in the same situation regarding pulmonary mycoses with, we fervently hope, more chance of success. Recently, within the span of one month two eminent clinicians as well as a biologist
Efficacy of hormonal suppression in a patient with chyluria due to lymphangioleiomyomatosis
Authors: Contini Paola , Schiavina Mario , Schiavina Riccardo , Tavalazzi Francesco , Fabiani Andrea , Di Scioscio Valerio , Spagnolo Paolo , Richeldi Luca
Published: January 2020

Lymphangioleiomyomatosis (LAM) is a rare lung disease affecting almost exclusively young women, characterised by abnormal proliferation of atypical smooth muscle cells. We describe a young woman presenting with chyluria secondary to the presence of a large retroperitoneal lymph - angioleiomyoma. Immunohistochemical analysis revealed HMB45-negative LAM cells (HMB45 staining is absent only in rare cases) expressing low levels of estrogen receptors. Estrogen suppressive treatment with triptoreline, a synthetic analogue of Gn-RH, resulted in dramatic reduction of the retroperitoneal mass size. The role of estrogens in the pathogenesis of LAM remains poorly understood, and hormonal therapy is still debated, but this case suggests that at least in some LAM patients, possibly those with HMB45-negative disease and estrogen receptor expression, hormonal therapy may be effective in controlling the disease process.
Prevalence of allergen sensitization among patients with allergic diseases in Guangzhou, Southern China: a four-year observational study
Authors: Sun Bao-qing , Zheng Pei-yan , Zhang Xiao-wen , Huang Hui-min , Chen De-hui , Zeng Guang-qiao
Published: January 2020

Background: The distribution of allergens may vary with different geographic areas, suggesting the importance of local epidemiological data to support evidence-based prevention and management of allergic diseases. We investigated the distribution of common allergens in allergic patients in Guangzhou, southern China.

Methods: 7,047 patients with allergic symptoms were examined for serum sIgE to 15 common allergens in thisregion, based on the protocol of reversed enzyme allergosorbent test.

Results: 4,869 (69.09%) of the subjects tested positive for sIgE to at least one of the 15 common allergens. There was no statistical difference in the overall rate of positive sIgE detection between males (3128/4523, 69.16%) and females (1741/2524, 68.98%). Der pteronyssinus and Der farinae were the most common aeroallergens, while eggs and cow’s milk the most common food allergens, responsible for higher positive rates of sIgE responses. A good correlation in positive sIgE response was found between Der pteronyssinus and Der farinae. By age-group analysis, we noted several peaks of sensitization to certain allergens: Der pteronyssinus, Der farinae, and Blomiatropicalis at age between 9 and 12; Blattellagermanica and mosquito at age between 15 and 18, cow’s milk before age 3; eggs and flour at age between 3 and 6; crabs and shrimps at age between 12 and 15. Along with older age, there was an ascending tendency in the overall positive rate of sIgE response to house dust mites among subjects who tested positive for sIgE to eggs or cow’s milk.

Conclusions: Der pteronyssinus, Der farinae, cow’s milk, and eggs are major allergens in Guangzhou. Sensitization to eggs and cow’s milk is more common at younger age, and then gives place to the increasing prevalence of sensitization to Der pteronyssinus and Der farinae at older age. Such a sequence of events may be a result of allergy march. Knowledge on the prevalence of allergen sensitization in different age groups would help early diagnosis and intervention of allergic diseases in this large geographical region.
Reviewer acknowledgement 2013
Authors: De Benedetto Fernando , Donner Claudio F. , Sanguinetti Claudio M.
Published: January 2020

The editors of Multidisciplinary Respiratory Medicine would like to thank all of our reviewers who have contributed to the journal in Volume 8 (2013).
Effectiveness of pharmacologic therapies on smoking cessation success: three years results of a smoking cessation clinic
Authors: Ucar Elif Yilmazel , Araz Omer , Yilmaz Nafiye , Akgun Metin , Meral Mehmet , Kaynar Hasan , Saglam Leyla
Published: January 2020

Background: Pharmacologic therapies have an important role in the success of interventions for smoking cessation. This study aims to determine the efficacy of several pharmacologic treatments in patients who applied to a smoking cessation clinic.

Methods: This retrospective study includes 422 patients who presented to our smoking cessation clinic between January 2010 and June 2013, used the pharmacologic treatment as prescribed and completed the one-year follow-up period. All patients were assessed using the Fagerström Test for Nicotine Dependence (FTND) and received both behavioral therapy and pharmacotherapy. Patients’ smoking status at one year was assessed by telephone interview.

Results: The patients were 24.3% female (103/422) and 75.7% male (319/422) with a mean age of 38 ± 10 years. Patients were divided into three groups: varenicline (166 patients), bupropion (148 patients) and nicotine replacement therapy (108 patients).  The smoking cessation rates of these groups were 32.5%, 23% and 52.8%, respectively, and were statistically significant (p < 0.001). The overall success rate was 35%. Further analysis revealed that pharmacologic therapy (p < 0.001) and gender (p = 0.01) were factors that showed statistically significant effects on smoking cessation rates. Males had higher success rates than females. The overall relapse rate was 21.6% and the bupropion group showed the highest relapse rate among treatment groups. Lack of determination emerged as the most important factor leading to relapse.

Conclusion: Nicotine replacement therapy was found to be more effective at promoting abstinence from smoking than other pharmacologic therapies.
Diagnostic utility of serum and pleural levels of adenosine deaminase 1–2, and interferon-γ in the diagnosis of pleural tuberculosis
Authors: Yurt Sibel , Küçükergin Canan , Yigitbas Burcu Arpinar , Seçkin Şule , Tigin Hüseyin Cem , Koşar Ayşe Filiz
Published: January 2020

Background: To evaluate and compare the diagnostic efficiency of serum (s) and pleural (p) levels of adenosine deaminase (ADA)-1, ADA-2, total ADA, and interferon-gamma (IFN-γ) for the differential diagnosis of pleural tuberculosis (TB).

Methods: Clinical and analytic data of 93 consecutive patients with pleural effusions from May 2012 to February 2013 were prospectively evaluated. The study population included 43 pleural TB, 23 malignancies, and 27 other exudates. The median and interquartile range of ADA-1, ADA-2, total ADA, and IFN-γ were evaluated according to their underlying diseases.

Results: There were no significant differences in sADA-1 and sIFN-γ values among each group. pADA-1, pADA-2, total pADA, and pIFN-γ levels were significantly higher in patients with pleural TB than in other patients (p < 0.0001). As for pleural TB receiving operating characteristic (ROC) curves identified the following results. The best cut-off value for pADA-2 was 20.37 U/L and it yielded a sensitivity and specificity of 95.35% and 86%, respectively. Taking a cut-off value of 40.68 U/L for total pADA, the sensitivity and the specificity were found to be 88.37% and 88%, respectively. ROC curve identified 110 U/L as the best cut-off value for pμg/ml, while the sensitivity and the specificity were 74.42% and 68%, respectively. Finally, the best cut-off value for pADA-1 was 16.8 U/L and yielded a sensitivity and specificity of 69.77% and 68%, respectively.

Conclusions: To distinguish pleural TB, pleural levels of ADA-2 have the highest sensitivity among the different diagnostic parameters and may find a place as routine investigation for early detection of TB in the future.
Sedation and weaning from mechanical ventilation: time for ‘best practice’ to catch up with new realities?
Authors: Conti Giorgio , Mantz Jean , Longrois Dan , Tonner Peter
Published: January 2020

Delivery of sedation in anticipation of weaning of adult patients from prolonged mechanical ventilation is an arena of critical care medicine where opinion-based practice is currently hard to avoid because robust evidence is lacking. We offer some views on this subject, hoping to stimulate debate among colleagues.
Patient reported experiences of CT guided lung biopsy: a prospective cohort study
Authors: Winn Naomi , Spratt Jonathan , Wright Enid , Cox Julie
Published: January 2020

Background: CT guided lung biopsy is a commonly performed procedure to obtain tissue for a histological diagnosis in cases of suspected lung cancer.

Methods: This is a prospective cohort study to obtain information directly from patients about their experiences of the biopsy procedure, thus obtaining a more accurate picture of complications compared with previously performed retrospective reviews. Patients participated in a post-procedure telephone interview and information was gathered about any procedural complications and personal experiences. We also compared the patient reported complications with those obtained from a retrospective review of hospital databases, analogous to previously performed retrospective studies.

Results: In our patient group, reported procedural complication rates were 10% pneumothorax rate (4% requiring a chest drain) and 10% haemoptysis. Post-procedural pain and shortness of breath showed positive correlation, with one patient experiencing prolonged pain. No statistical difference was found between the patient reported complication rates and those obtained from retrospective review of the hospital database.

Conclusions: Our study demonstrates CT guided lung biopsy is a safe procedure and is generally well tolerated. Some patients may experience significant and lasting pain and therefore should be counselled about this pre-procedure.
Enhancing the diagnosis and management of COPD in Primary care
Authors: Partridge Martyn R.
Published: January 2020

Achieving the optimal management of Chronic Ob- structive Pulmonary Disease (COPD) is a major chal- lenge facing all countries where smoking is and has been highly prevalent. [...]
The influence of active and passive smoking on the cardiorespiratory fitness of adults
Authors: Thier de Borba Andresa , Trevisan Jost Renan , Gass Ricardo , Borges Nedel Fúlvio , Machado Cardoso Dannuy , Hedwig Pohl Hildegard , Reckziegel Miriam Beatris , Corbellini Valeriano Antonio , Nunes Paiva Dulciane
Published: January 2020

Background: The aim of this study was to analyze the influence of active and passive smoking on cardiorespiratory responses in asymptomatic adults during a sub-maximal-exertion incremental test.

Methods: The participants (n = 43) were divided into three different groups: active smokers (n = 14; aged 36.5 ± 8 years), passive smokers (n = 14; aged 34.6 ± 11.9 years) and non-smokers (n = 15; aged 30 ± 8.1 years). They all answered the Test for Nicotine Dependence and underwent anthropometric evaluation, spirometry and ergospirometry according to the Bruce Treadmill Protocol.

Results: VO2max differed statistically between active and non-smokers groups (p < 0.001) and between non-smokers and passive group (p=0.022). However, there was no difference between the passive and active smokers groups (p=0.053). Negative and significant correlations occurred between VO2max and age (r = − 0.401, p = 0.044), percentage of body fat (r = − 0.429, p = 0.011), and waist circumference (WC) (r = − 0.382, p = 0.025).

Conclusion: VO2max was significantly higher in non-smokers compared to active smokers and passive smokers. However, the VO2max of passive smokers did not differ from active smokers.
Look at the lung: can chest ultrasonography be useful in pregnancy?
Authors: Inchingolo Riccardo , Smargiassi Andrea , Mormile Flaminio , Marra Roberta , De  Carolis Sara , Lanzone Antonio , Valente Salvatore , Corbo Giuseppe M.
Published: January 2020

Background: This study aimed to evaluate the clinical value of chest ultrasound (US) in the detection, diagnosis and follow-up of pathologic processes of both peripheral lung parenchyma and pleural space in pregnant women.

Findings: Pregnant women admitted to Obstetric Pathology Hospital Department for respiratory diseases were enrolled. Chest US examination was performed when there was a respiratory disease highly suggestive of pneumonia and/or pleural effusion and chest X-ray (CXR) should have been obtained. Three chest US patterns were identified: lung consolidation (LC), pleural effusion (PE) and focal sonographic interstitial syndromes (SIS). When chest US pathologic signs were reported, one or more subsequent chest US examinations were performed to follow-up the patient until their complete resolution. Sixteen inpatients underwent 54 chest US evaluations. We identified: 9 LCs, 6 PEs and 11 SISs. Total number of CXRs was 7 (10 females avoided X-rays exposure and one underwent 2 CXR evaluations on the advice of Gynecologist). Chest US follow-up, during and after therapy, showed complete resolution of echographic patterns previously described.

Conclusions: Chest US evaluation during pregnancy is a useful diagnostic tool to detect and monitor respiratory diseases, avoiding excessive X-rays exposure.
Does zafirlukast reduce future risk of asthma exacerbations in adults? Systematic review and meta-analysis
Authors: Chen Chao Feng , Lv Yan , Zhang Hong Ping , Wang Gang
Published: January 2020

Background and objective: The purpose of asthma management is to achieve a total asthma control that involves current control and future risk. It has proven efficacy in reducing asthma exacerbations, but the effect size of zafirlukast for asthma exacerbations of various severity is not systematically explored.

Methods: Randomized controlled trials were searched in PubMed Central, Web of Science, and Embase, where zafirlukast prevented asthma exacerbations in adults. The primary outcome was asthma exacerbations, the secondary outcomes were asthma exacerbations requiring systemic corticosteroids and emergency visits, respectively. Odds ratio (OR) with 95% confidence intervals (CI) were pooled.

Results: Twelve trials were identified. As first-line therapy, compared to those having placebo, the patients with chronic asthma receiving zafirlukast experienced statistically lower asthma exacerbations (OR = 0.68, 95% CI = [0.45, 1.00]), but it was not found that zafirlukast was superior to placebo in asthma exacerbations requiring systemic corticosteroids (OR = 0.76, 95% CI = [0.45, 1.29]). Furthermore, zafirlukast was inferior to ICs in asthma exacerbations (OR = 2.11, 95% CI = [1.35, 3.30]) and requiring systemic corticosteroids (OR = 3.71, 95% CI = [1.82, 7.59]). As add-on therapy, zafirlukast was not superior to placebo in asthma exacerbations (OR =0.99, 95% CI = [0.54, 1.81] and requiring emergency visits (OR = 0.72, 95% CI = [0.18, 2.99]). Intriguingly, there was not a significant difference in asthma exacerbations between zafirlukast and ICs (OR = 1.12, 95% CI = [0.53, 2.34]).

Conclusions: Our study suggests that zafirlukast, as the first-line therapy, significantly reduces mild to moderate but not severe asthma exacerbations. In the add-on regimen, zafirlukast could not reduce asthma exacerbations, which would perhaps result from small sample size and needs to be further studied.
ISMAR-study presentation: in-hospital epidemiology and clinical management of respiratory and cardiac comorbidities in cardiac and respiratory disease units
Authors: Tramarin Roberto , Polverino Mario , Volterrani Maurizio , Girardi Bruna , Chimini Claudio , Ambrosino Nicolino , De Benedetto Fernando , Proto Cesare , The ISMAR Investigators And on behalf of
Published: January 2020

Background: Cardiovascular and respiratory diseases are leading causes of morbidity and their co-occurrence has important implications in mortality and other outcomes. Even the most recent guidelines do not reliably address clinical, prognostic, and therapeutic concerns due to the overlap of respiratory and cardiac diseases.

Study objectives and design: In order to evaluate in the reality of clinical practice the epidemiology and the reciprocal impact of cardio-pulmonary comorbidity on the clinical management, diagnostic workup and treatment, 1,500 cardiac and 1,500 respiratory inpatients, admitted in acute and rehabilitation units, will be enrolled in a multicenter, nationwide, prospective observational study. For this purpose, each center will enroll at least 50 consecutive patients. At discharge, data analysis will be aimed at the definition of cardiac and pulmonary inpatient comorbidity prevalence, demographic characteristics, length of hospital stay, and risk factors, taking into account also procedures, pharmacological and non-pharmacological treatment, and follow up in patients with cardio-respiratory comorbidity.

Conclusions: The purely observational design of the study aims to give new relevant information on the assessment and management of overlapping patients in real life clinical practice, and new insight for improvement and implementation of current guidelines on the management of individual diseases.
Treating severe allergic asthma with anti-IgE monoclonal antibody (omalizumab): a review
Authors: D'Amato Gennaro , Stanziola Anna , Sanduzzi Alessandro , Liccardi Gennaro , Salzillo Antonello , Vitale Carolina , Molino Antonio , Vatrella Alessandro , D'Amato Maria
Published: January 2020

Increased asthma severity is not only associated with enhanced recurrent hospitalization and mortality but also with higher social costs.Several cases of asthma are atopic in nature, with the trigger for acute asthma attacks and chronic worsening of inflammation being allergens inducing an immune, IgE mediated response.

Anti-inflammatory treatments are effective for most of asthma patients, but there are subjects whose disease is incompletely controlled by inhaled or systemic corticosteroids and these patients account for about 50% of the healthcare costs of asthma.Omalizumab is a biological engineered, humanized recombinant monoclonal anti-IgE antibody developed for the treatment of allergic diseases and with clear efficacy in adolescent and adult patients with severe allergic asthma. The anti-IgE antibody inhibits IgE functions blocking free serum IgE and inhibiting their binding to cellular receptors. By reducing serum IgE levels and IgE receptor expression on inflammatory cells in the context of allergic cascade, omalizumab has demonstrated to be a very useful treatment of atopic asthma, improving quality of life of patients with severe persistent allergic asthma that is inadequately controlled by currently available asthma medications. Several trials have demonstrated that this therapy is well tolerated and significantly improves symptoms and disease control, reducing asthma exacerbations and the need to use high dosage of inhaled corticosteroids.
Sedation options for the morbidly obese intensive care unit patient: a concise survey and an agenda for development
Authors: Aantaa Riku , Tonner Peter , Conti Giorgio , Longrois Dan , Mantz Jean , Mulier Jan P.
Published: January 2020

Background: We offer some perspectives and commentary on the sedation of obese patients in the intensive care unit (ICU).

Discussion: Sedation in morbidly obese patients should conform to the same broad principles now current in ICU practice. These include a general presumption against benzodiazepines as first-line agents. Opioids should be avoided in any situation where spontaneous breathing is required. Remifentanil is the preferred agent where continuous stable opioid levels using an infusion are required, because of its lack of context-sensitive accumulation. Volatile anaesthetics may be an option for the same reason but there are no substantial, controlled demonstrations of effectiveness/safety in short-term use in the ICU setting. Propofol is a valuable resource in the morbidly obese patients but the duration of continuous sedation should not exceed 6 days, in order to avoid propofol infusion syndrome. Alpha-2 agonists offer a range of theoretically positive features for the sedation of morbidly obese patients, but at present there is a lack of pharmacokinetic data and a critical mass of high-grade clinical data. Dexmedetomidine has the attraction of not causing respiratory depression or obstructive breathing during sedation and its sympatholytic effects should help deliver stable blood pressure and heart rate. Ketamine has a poor tolerability profile in adults so its use in the ICU context is largely confined to paediatrics.

Conclusion: None of the agents currently available is ideal for every situation encountered in the management of morbidly obese patients. This article identifies additional research needed to place sedation practice of obese patients on a more systematic footing.
Association between inflammatory airway disease of horses and exposure to respiratory viruses: a case control study
Authors: Houtsma Ashley , Bedenice Daniela , Pusterla Nicola , Pugliese Brenna , Mapes Samantha , Hoffman Andrew M. , Paxson Julia , Rozanski Elizabeth , Mukherjee Jean , Wigley Margaret , Mazan Melissa R.
Published: January 2020

Background: Inflammatory airway disease (IAD) in horses, similar to asthma in humans, is a common cause of chronic poor respiratory health and exercise intolerance due to airway inflammation and exaggerated airway constrictive responses. Human rhinovirus is an important trigger for the development of asthma; a similar role for viral respiratory disease in equine IAD has not been established yet.

Methods: In a case–control study, horses with IAD (n = 24) were compared to control animals from comparable stabling environments (n = 14). Horses were classified using pulmonary function testing and bronchoalveolar lavage. PCR for equine rhinitis virus A and B (ERAV, ERBV), influenza virus (EIV), and herpesviruses 2, 4, and 5 (EHV-2, EHV-4, EHV-5) was performed on nasal swab, buffy coat from whole blood, and cells from BAL fluid (BALF), and serology were performed. Categorical variables were compared between IAD and control using Fisher’s exact test; continuous variables were compared with an independent t-test. For all analyses, a value of P <0.05 was considered significant.

Results: There was a significant association between diagnosis of IAD and history of cough (P = 0.001) and exercise intolerance (P = 0.003) but not between nasal discharge and IAD. Horses with IAD were significantly more likely to have a positive titer to ERAV (68 %) vs. control horses (32 %). Horses with IAD had higher log-transformed titers to ERAV than did controls (2.28 ± 0.18 v.1.50 ± 0.25, P = 0.038). There was a significant association between nasal shedding (positive PCR) of EHV-2 and diagnosis of IAD (P = 0.002).

Conclusions: IAD remains a persistent problem in the equine population and has strong similarities to the human disease, asthma, for which viral infection is an important trigger. The association between viral respiratory infection and development or exacerbation of IAD in this study suggests that viral infection may contribute to IAD susceptibility; there is, therefore, merit in further investigation into the relationship between respiratory virus exposure and development of IAD.
Supplemental oxygen users with pulmonary fibrosis perceive greater dyspnea than oxygen non-users
Authors: Cao Mengshu , Wamboldt Frederick S. , Brown Kevin K. , Hickman Jonathon , Olson Amy L. , Solomon Joshua J. , Swigris Jeffrey J.
Published: January 2020

Background: Exertional dyspnea is a hallmark symptom of fibrosing interstitial lung disease (fILD), and oxygen (O2) desaturation is common among patients with fILD. Supplemental O2 is prescribed to maintain normoxia and alleviate dyspnea. We sought to better understand the associations between O2 and dyspnea in fILD during the 6-min walk test (6MWT).

Methods: 1326 fILD patients compose the sample group. Borg dyspnea and other 6MWT variables were compared between subjects who performed the test without (non-users) versus with O2 (users).

Results: There were 812 users and 514 non-users; users were older, more likely to have smoked, had greater body mass index, and had more severe fILD. Despite a similar 6-min SpO2, users perceived greater dyspnea than non-users (Borg 3.9 ± 2.0 vs 2.9 ± 1.7, p < 0.0001). Whether subjects became hypoxemic (6-min SpO2 < 89 %) or not during the walk, the results were the same: users perceived greater dyspnea than non-users (hypoxemic: users 3.5 ± 2.1 vs non-users 2.7 ± 1.8, p < 0.0001; non-hypoxemic: users 3.4 ± 1.9 vs non-users 2.4 ± 1.6, p < 0.0001). Among subjects who did not desaturate (SpO2 drop < 4 %), users walked a shorter distance (944.9 ± 367.0 vs 1385.3 ± 322.4 feet, p < 0.0001) but perceived greater dyspnea than non-users (3.3 ± 1.6 vs 2.3 ± 1.7, p = 0.005). No combination of potentially influential predictor variables entered in multivariate models explained more than 11 % of the variance in dyspnea ratings.

Conclusion: Dyspnea is a complex perception, and in patients with fILD, O2 may lessen, but does not resolve, it. Further research is needed to clarify why fILD patients who use O2 perceive greater levels of dyspnea with activity than O2 non-users.
Effects on asthma and respiratory allergy of Climate change and air pollution
Authors: D’Amato Gennaro , Vitale Carolina , De Martino Annamaria , Viegi Giovanni , Lanza Maurizia , Molino Antonio , Sanduzzi Alessandro , Vatrella Alessandro , Annesi-Maesano Isabella , D'Amato Maria
Published: January 2020

The major changes to our world are those involving the atmosphere and the climate, including global warming induced by anthropogenic factors, with impact on the biosphere and human environment. Studies on the effects of climate changes on respiratory allergy are still lacking and current knowledge is provided by epidemiological and experimental studies on the relationship between allergic respiratory diseases, asthma and environmental factors, like meteorological variables, airborne allergens and air pollution. Epidemiologic studies have demonstrated that urbanization, high levels of vehicle emissions and westernized lifestyle are correlated with an increased frequency of respiratory allergy, mainly in people who live in urban areas in comparison with people living in rural areas. However, it is not easy to evaluate the impact of climate changes and air pollution on the prevalence of asthma in general and on the timing of asthma exacerbations, although the global rise in asthma prevalence and severity could be also considered an effect of air pollution and climate changes. Since airborne allergens and air pollutants are frequently increased contemporaneously in the atmosphere, enhanced IgE-mediated response to aeroallergens and enhanced airway inflammation could account for the increasing frequency of respiratory allergy and asthma in atopic subjects in the last five decades. Pollen allergy is frequently used to study the interrelationship between air pollution and respiratory allergic diseases such as rhinitis and bronchial asthma. Climatic factors (temperature, wind speed, humidity, thunderstorms, etc) can affect both components (biological and chemical) of this interaction. Scientific societies should be involved in advocacy activities, such as those realized by the Global Alliance against chronic Respiratory Diseases (GARD).