bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of a simplified oscillation technique for assessing airway obstruction in sleep apnoea
Authors: Farré R. , Rigau J. , Montserrat J.M. , Ballester E. , Navajas D. 
Published: July 2002

The forced oscillation technique (FOT) is a noninvasive method that is useful for assessing airway obstruction and for titrating continuous positive airway pressure (CPAP) in patients with sleep apnoea. The aim was to evaluate the routine applicability of a simplified FOT set-up based on recording pressure and flow at the level of the CPAP device,i.e.obviating the need for connecting the transducers to the nasal mask.A correction to account for the tubing and the exhaust port was applied. This simplified FOT was evaluated on nine patients with moderate or severe sleep apnoea during routine CPAP titration. Patient impedance measured by the simplified FOT (|Z|) was compared with actual patient impedance (|Zrs|) measured simultaneously with a reference FOT based on recording pressure and flow at the nasal mask.An excellent agreement was found between |Z| and |Zrs| over the wide range of airway obstruction explored (4.8–72.1 cmH2O·s·L−1): |Z|=|Zrs|×0.86+1.3 cmH2O·s·L−1(r= 0.99). Moreover, the simplified and the conventional FOT settings detected the same respiratory events during sleep.These results demonstrate that this simplified FOT is applicable for measuring airway obstruction during routine sleep studies in patients with sleep apnoea.
Pleural-fluid myeloperoxidase in complicated and noncomplicated parapneumonic pleural effusions
Authors: Alegre J. , Jufresa J. , Segura R. , Ferrer A. , Armadans L. , Aleman C. , Marti R. , Ruiz E. , Fernández de Sevilla T. 
Published: July 2002

The diagnostic accuracy of myeloperoxidase (MPO) in pleural fluid, for differentiating between complicated and noncomplicated parapneumonic pleural effusions (PPE) evaluated prospectively.Seventy patients aged >18 yrs with PPE (36 complicated and 34 noncomplicated) were studied after admission to a tertiary referral teaching hospital. MPO concentration was measured in plasma and pleural fluid using a double-antibody competitive radioimmunoassay.The concentrations of MPO in complicated and noncomplicated PPE were compared using a Mann-Whitney U-test and multiple logistic regression models were used to predict the odds that an effusion was complicated. MPO pleural-fluid concentrations were significantly higher in complicated than in noncomplicated PPE. After excluding purulent effusions, pleural-fluid MPO was the marker that best differentiated between the two types of PPE: the area under the receiver operating characteristic curve was 0.912, the sensitivity was 87.5% and the specificity was 85.1% at a cut-point limit of 3.000 µg·L−1.The authors concluded that the concentration of pleural-fluid myeloperoxidase helps to differentiate between nonpurulent complicated and noncomplicated parapneumonic pleural effusions.
Sleep quality and daytime function in adults with cystic fibrosis and severe lung disease
Authors: Dancey D.R. , Tullis E.D. , Heslegrave R. , Thornley K. , Hanly P.J. 
Published: July 2002

It was hypothesized that adult cystic fibrosis (CF) patients with severe lung disease have impaired daytime function related to nocturnal hypoxaemia and sleep disruption.Nineteen CF patients (forced expiratory volume in one second 28±7% predicted) and 10 healthy subjects completed sleep diaries, overnight polysomnography (PSG), and assessment of daytime sleepiness and neurocognitive function.CF patients tended to report more awakenings (0.7±0.5versus0.3±0.2·h−1, p=0.08), and PSG revealed reduced sleep efficiency (71±25versus93±4%, p=0.004) and a higher frequency of awakenings (4.2±2.7versus2.4±1.4·h−1, p=0.06). Mean arterial oxygen saturation during sleep was lower in CF patients (84.4±6.8versus94.3±1.5%, p<0.0001) and was associated with reduced sleep efficiency (regression coefficient (r)=0.57, p=0.014). CF patients had short sleep latency on the multiple sleep latency test (6.7±3 min). The CF group reported lower levels of activation and happiness and greater levels of fatigue (p<0.01), which correlated with indices of sleep loss, such as sleep efficiency (r=0.47, p=0.05). Objective neurocognitive performance was also impaired in CF patients, reflected by lower throughput for simple addition/subtraction, serial reaction and colour-word conflict.The authors concluded that adult cystic fibrosis patients with severe lung disease have impaired neurocognitive function and daytime sleepiness, which is partly related to chronic sleep loss and nocturnal hypoxaemia.
Tidal expiratory flow limitation and chronic dyspnoea in patients with cystic fibrosis
Authors: Goetghebeur D. , Sarni D. , Grossi Y. , Leroyer C. , Ghezzo H. , Milic-Emili J. , Bellet M. 
Published: July 2002

Cystic fibrosis (CF) eventually leads to hyperinflation linked to tidal expiratory flow limitation (FL) and ventilatory failure.Presence of FL was assessed at rest in 22 seated children and adults with CF (forced expiratory volume in one second (FEV1) range: 16–92% predicted), using both the negative expiratory pressure (NEP) technique and the “conventional” method based on comparison of tidal and maximal expiratory flow/volume curves. In addition, chronic dyspnoea was scored with the modified Medical Research Council (MRC) scale. Measurements were made before and 15 min after inhalation of salbutamol.With NEP, FL was present in only three malnourished patients, who had the lowest FEV1values (16–27% pred) and claimed very severe dyspnoea (MRC score 5). By contrast, an additional seven patients were classified as FL with the conventional method. Six of these patients had little or no dyspnoea (MRC scores 0–1). Salbutamol administration had no effect on the extent of FL, and the concomitant decrease in functional residual capacity (FRC) was too small to play any clinically significant role.This study concluded that in seated patients with cystic fibrosis, expiratory flow limitation is absent at rest, unless the forced expiratory volume in one second is <30% predicted. If present, expiratory flow limitation is associated with severe chronic dyspnoea. The conventional method for assessing expiratory flow limitation is not reliable and bronchodilator administration has little effect on expiratory flow limitation.
Nocturnal periodic breathing in primary pulmonary hypertension
Authors: Schulz R. , Baseler G. , Ghofrani H.A. , Grimminger F. , Olschewski H. , Seeger W. 
Published: July 2002

Cheyne-Stokes respiration is frequently observed in congestive heart failure. Among other factors, prolongation of circulation time, hypocapnia and hypoxia are thought to underlie this sleep-related breathing disorder. Primary pulmonary hypertension (PPH) is also characterized by reduced cardiac output and blood gas alterations. Therefore, the aim of the present study was to determine whether a nocturnal periodic breathing (PB) occurs in PPH.A total of 20 consecutive patients with PPH who had been admitted for pharmacological investigation of pulmonary vasoreactivity were investigated by lung function testing, right heart catheterization and full-night attended polysomnography.PB was detected in six patients (30%) (mean±SEM: apnoea/hypopnoea index 37±5 h−1; arterial oxygen saturation was <90% during 56±6.5% of total sleep time). The patients with PB had more severe haemodynamic impairment than those without. They also had a more marked reduction in the pulmonary diffusion capacity and greater arterial hypoxia. PB was markedly improved or even eradicated by nasal oxygen during the night.Periodic breathing occurs in patients with advanced primary pulmonary hypertension and can be reversed by nocturnal nasal oxygen. The clinical and prognostic significance of periodic breathing in primary pulmonary hypertension needs to be determined by further studies.
Recording flow in the first second of a maximal forced expiratory manoeuvre: influence of frequency content
Authors: Miller M.R. , Lloyd J. , Bright P. 
Published: July 2002

The frequency content of the first second of the maximum forced expiratory manoeuvre (MFEM) was measured to determine if the currently accepted frequency limit of 20 Hz for MFEM is adequate for recording peak expiratory flow (PEF).The frequency response of a Fleisch pneumotachograph (PT) was measured and used to record MFEM from 24 patients attending a lung-function laboratory and 26 normal volunteers. The first 1.024 s of the signal recorded at 1,000 Hz for that blow with maximum PEF, underwent fast Fourier transformation using a triangular window function, applied after 0.75 s to reduce flow linearly to zero. All the frequencies above a set limit were removed, followed by inverse transformation to reconstitute the blow. The limits for this frequency cut-off were progressively varied from 100 Hz down to 15 Hz, with the resulting PEF being compared with the PEF from the reconstituted blow with no frequency reduction.The average±sd age for the group was 47±18 yrs and the average PEF was 450±187 L·min−1, which, when expressed as a standardized residual, was 0.1±2.1, with a range from −4.5–3.9 indicating a good spread around normal values. Average rise time to PEF was 83±38 ms and dwell time >90% PEF was 45±25 ms. Cut-off >20 Hz reduced the mean PEF of the group by 8.5 L·min−1(95% confidence limit 5.5–11.4 L·min−1), whereas cut-off >30 Hz reduced mean PEF by 4.4 L·min−1(2.6–6.2). In the present study subjects, 30 Hz was on the 95th percentile of frequencies for defining the upper limit for 98% of the power spectrum for the first second of the blow.It has been shown that there are frequencies >20 Hz that contribute to peak expiratory flow enough to influence readings made using conventional hand-held peak expiratory flow meters, such as the mini-Wright. Devices used for recording flow from a maximum forced expiratory manoeuvre should therefore have an adequate frequency response of up to 30 Hz.
Interactions between respiratory tract infections and atopy in the aetiology of asthma: Fig. 1.—
Authors: Holt P.G. , Sly P.D. 
Published: July 2002

The prevalence of asthma, in particular atopic asthma, has markedly increased in recent years. Accumulating evidence suggests that environmental factors associated with allergic sensitization and exposure to microbial stimuli during infancy and early childhood, are associated with these changes in prevalence. However, considerable controversy surrounds the role of microbial agents, as evidence has been presented for both positive and negative effects in this context.The review below focuses upon interactions between immune competence during infancy, the development of T‐helper (Th)1-polarizedversusTh2-polarized memory against inhalant allergens, and susceptibility to virus infection. In particular, recent finding are highlighted which suggest that delayed postnatal maturation of Th1 function is associated with increased risk for early postnatal sensitization to inhalant allergens, and also with risk for viral bronchiolitis during infancy.Variations in the kinetics of postnatal maturation of T‐helper 1 function may in part be attributable to polymorphisms in the CD14 gene, which influence host responsiveness both to bacterial as well as viral stimuli.
Fluticasone induces apoptosis in peripheral T-lymphocytes: a comparison between asthmatic and normal subjects
Authors: Melis M. , Siena L. , Pace E. , Gjomarkaj M. , Profita M. , Pirazzoli A. , Todaro M. , Stassi G. , Bonsignore G. , Vignola A.M. 
Published: July 2002

Apoptosis is an important mechanism allowing inflammation to be limited. Glucocorticoids are the most effective anti-inflammatory agents in asthma therapy and induce cell apoptosis.Since T-lymphocytes are critically involved in airway inflammation in asthma, the effects of fluticasone propionate (FP) on apoptosis in unstimulated and in interleukin (IL)-2 stimulated peripheral blood T-lymphocytes (PBTs) isolated from 14 normal and 19 mild-to-moderate asthmatic subjects were evaluated. Apoptosis was evaluated by: deoxyribonucleic acid (DNA) fragmentation electrophoresis, DNA content, annexin V binding, apoptosis related markers (Fas, B-cell lymphona leukaemia-2 (Bcl-2), Bax, and CD25), and by electron microscopy.FP induced apoptosis in unstimulated PBTs of normal and asthmatic subjects in a time-dependent fashion. In asthma, this effect was associated with a significant decrease of Bcl-2 expression, and with an increase of Bax/Bcl-2 ratio. In PBTs of asthmatics, FP also reduced Fas and CD25 expression. Moreover, in IL-2-stimulated PBTs from both asthmatics and normal subjects, FP was able to induce apoptosis and to reduce Bcl-2, Fas and CD25 expression, whereas negligible effects were detected on Bax expression.This study shows that the glucocorticosteroid, fluticasone, increases apoptosis and modulates expression of apoptosis-related markers in unstimulated and in interleukin-2 stimulated T-lymphocytes. This points towards a potential mechanism by which fluticasone exerts its anti-inflammatory effects.
Inhibition of granulocyte activation by surfactant in a 2‐yr-old female with meningococcus-induced ARDS
Authors: Tegtmeyer F.K. , Möller J. , Zabel P. 
Published: July 2002

Activated polymorphonuclear neutrophils (PMNs) play a crucial role in acute respiratory distress syndrome (ARDS)viaextracellular release of reactive cell products such as elastase. Surfactant has proved valuable in restoring lung function in ARDS. The significance of its immunomodulatory properties with respect to this effect has not yet been clarified. The aim of the present study was to determine the anti-inflammatory effects of surfactant administration in an infant with ARDS.During the acute phase of ARDS in a 2‐yr-old female, levels of PMN-derived elastase complexed with α1‐protease inhibitor (E‐α1PI) were measured in both arterial and central venous blood samples obtained simultaneously. The results were correlated with oxygen demand and plasma concentrations of tumour necrosis factor‐α (TNF‐α) and interleukin‐6 (IL‐6) after endotracheal administration of surfactant (Alveofact® 60 mg·kg·body weight−1).In the present case, for the first time, a higher E‐α1PI concentration was detected in arterial blood (4.51 mg·L−1) than in central venous blood (2.28 mg·L−1). After administration of surfactant, these concentrations and the arteriovenous difference decreased, indicating that during ARDS, most PMN degranulation takes place in the pulmonary vascular bed and is inhibited by surfactant administration. Simultaneously, TNF‐α and IL‐6 plasma concentrations decreased within hours and lung function was restored.This local inhibition of polymorphonuclear neutrophil activation by exogenous surfactant may play a key role in the early improvement in lung function after surfactant administration.
Noninvasive ventilation for acute respiratory failure
Authors: Brochard L. , Mancebo J. , Elliott M.W. 
Published: July 2002

Noninvasive ventilation (NIV) has emerged as a significant advance in the management of respiratory failure. There is now a wide body of prospective randomized-controlled trial data to support its use, particularly in the management of patients with acute or respiratory failure due to exacerbations of chronic obstructive pulmonary disease (COPD). Its successful application results in a more rapid resolution of the physiological derangements, reduces the need for intubation and, in larger studies, improves survival. A reduction in the number of infectious complications is a particular advantage.In patients with acute exacerbations of COPD there is evidence of benefit when NIV is introduced earlier in the course of the illness than would be the case for invasive ventilation and it should now be considered even with mild acidosis (pH<7.35) and tachypnoea (respiratory rate >23 breaths·min−1) after initial medical therapy.There is less clinical-trial data in patients with hypoxaemic respiratory failure, but again as with COPD those with less severe physiological disturbance are more likely to benefit. By contrast noninvasive continuous positive airways pressure, while being widely used has not been shown to reduce the need for intubation or to improve survival in patients with hypoxaemic respiratory failure, with the exception of acute cardiogenic pulmonary oedema.Noninvasive ventilation has been a real advance in the treatment of the critically ill. Most of the studies published to date, have excluded patients needing immediate intubation and it should be viewed as a complimentary technique rather than an alternative to invasive ventilation. It is best viewed as a means of preventing the need for endotracheal intubation and as a result should be introduced earlier than would be the case for invasive ventilation.
A national study of medical care expenditures for respiratory conditions
Authors: Yelin E. , Trupin L. , Cisternas M. , Eisner M. , Katz P. , Blanc P. 
Published: July 2002

This study was undertaken to estimate the magnitude of medical care expenditures among persons with respiratory conditions in the USA in 1996, and the increment in expenditures attributable to these conditions.The study data were derived from the 1996 Medical Expenditure Panel Survey, a national sample of 21,571 persons. Of the 21,571, 1,027 reported one or more respiratory condition. After weighting, the individuals may represent about 12.1 million persons in the USA. All medical care expenditures of these individuals were tabulated, stratified by comorbidity status, and then compared to those among persons with nonrespiratory conditions or with no conditions. Regression techniques were then used to estimate the increment of healthcare expenditures attributable to the respiratory conditions.From a national total of $45.3 billion, medical care expenditures averaged $3,753 among persons with respiratory conditions. Hospital stays comprised the largest component (45%). The per capita increment in total expenditures attributable to respiratory conditions ranged from $1,003–2,588, from a national total ranging from $12.1–31.3 billion.The total medical care expenditure of persons with respiratory conditions was estimated to be $45.3 billion, of which $12.1–31.3 billion represents an increment in expenditures associated with the conditions themselves.
Outgrown asthma does not mean no airways inflammation
Authors: Warke T.J. , Fitch P.S. , Brown V. , Taylor R. , Lyons J.D.M. , Ennis M. , Shields M.D. 
Published: July 2002

Although some asthmatic children seem to recover from their asthma, 30–80% develop asthma again in later life. The underlying risk factors are unknown. The hypothesis for this study was that children with apparently outgrown asthma would have underlying airway inflammation.Nonbronchoscopic bronchoalveolar lavage was performed on normal children (n=35) and children who had wheezed previously (n=35).Eosinophils were raised in the lavage fluid of atopic children who had apparently outgrown asthma (median (interquartile range) 0.36 (0.05–0.74) compared to controls 0.10 (0–0.18), p=0.002). There was no relationship between length of remission and degree of airways eosinophilia.Thus, there is persistent airways inflammation in some children with outgrown asthma and this may be a risk factor for future relapse.
Traffic-related air pollution and respiratory health during the first 2 yrs of life
Authors: Gehring U. , Cyrys J. , Sedlmeir G. , Brunekreef B. , Bellander T. , Fischer P. , Bauer C.P. , Reinhardt D. , Wichmann H.E. , Heinrich J. 
Published: July 2002

As part of an international collaborative study on the impact of Traffic-Related Air Pollution on Childhood Asthma (TRAPCA), the health effects associated with long-term exposure to particles with a 50% cut-off aerodynamic diameter of 2.5 µm (PM2.5), PM2.5absorbance, and nitrogen dioxide (NO2) were analysed.The German part of the TRAPCA study used data from subpopulations of two ongoing birth cohort studies (German Infant Nutrition Intervention Programme (GINI) and Influences of Lifestyle Related Factors on the Human Immune System and Development of Allergies in Children (LISA)) based in the city of Munich. Geographic information systems (GIS)-based exposure modelling was used to estimate traffic-related air pollutants at the birth addresses of 1,756 infants. Logistic regression was used to analyse possible health effects and potential confounding factors were adjusted for.The ranges in estimated exposures to PM2.5, PM2.5absorbance, and NO2were 11.9–21.9 µg·m−3, 1.38–4.39×10−5 m−1, and 19.5–66.9 µg·m3, respectively. Significant associations between these pollutants and cough without infection (odds ratio (OR) (95% confidence interval (CI)): 1.34 (1.11–1.61), 1.32 (1.10–1.59), and 1.40 (1.12–1.75), respectively) and dry cough at night (OR (95% CI): 1.31 (1.07–1.60), 1.27 (1.04–1.55), and 1.36 (1.07–1.74), respectively) in the first year of life were found. In the second year of life, these effects were attenuated.There was some indication of an association between traffic-related air pollution and symptoms of cough. Due to the very young age of the infants, it was too early to draw definitive conclusions from this for the development of asthma.
Pulmonary hypertension in collagen vascular disease: Table 1—
Authors: Hoeper M.M. 
Published: July 2002

Pulmonary hypertension is a serious but often overlooked complication in collagen vascular disease. The understanding of the development of pulmonary hypertension has increased substantially during the last years.Abnormal proliferation of pulmonary vascular cells is now being regarded as a predominant process leading to pulmonary vascular obliteration. Medical therapy focuses on prostacyclin treatment, which has been shown to improve exercise capacity and haemodynamic variables in patients with several collagen vascular diseases and pulmonary arterial hypertension.Continuous intravenous prostacyclin remains the standard treatment of associated pulmonary hypertension but less invasive alternatives such as subcutaneous treprostinil, oral beraprost or aerosolized iloprost, as well as, novel substances such as endothelin receptor antagonists may be appropriate for selected patients.
Beyond disability: perceived participation in people with a chronic disabling condition
Authors: Cardol Mieke , de Jong Bareld A , van den Bos Geertrudis AM , Beelen Anita , de Groot Imelda J M , de Haan Rob J 
Published: July 2002

Objective: To describe the impact of a chronic disabling condition on participation and to identify variables that may explain perceived restrictions in participation. Study design: Cross-sectional. Setting: People were recruited from the outpatient clinics of two rehabilitation centres and the rehabilitation department of an academic hospital. Subjects: One hundred and twenty-six people from five diagnostic groups (neuromuscular disease, rheumatoid arthritis, spinal cord injury, stroke, fibromyalgia) participated in the study. Method: The IPA (Impact on Participation and Autonomy) questionnaire was used to describe perceived participation. Explanatory variables were studied in terms of sociodemographic factors and health status variables. Results: Some restrictions in participation seem comparable among diagnostic groups, others are specific to one or two groups. People with stroke, rheumatoid arthritis or fibromyalgia perceived more restrictions in participation than people with spinal cord injury or neuromuscular disorders. Emotional distress was the most important factor contributing to restrictions in participation. Conclusions: Perceived participation remains a complex concept in which many factors are involved. To make a contribution to meaningful participation of people with a chronic disabling condition, rehabilitation treatment should address physical, social, emotional and environmental aspects.