bluuebunny/crossref_metadata_2025_split huggingface dataset:
Where current pharmacological therapies fall short in COPD: symptom control is not enough
Authors: Roche N. 
Published: September 2008

Chronic obstructive pulmonary disease (COPD) is a common and progressive condition that is currently the fourth leading cause of death worldwide. There is now a large body of evidence indicating that both pulmonary and systemic inflammation are present in patients with stable COPD and may underlie both respiratory symptoms and common comorbidities of this disease. Smoking cessation and long-term oxygen therapy have been shown to change the course of COPD and recent results obtained with the combination of fluticasone and salmeterol have indicated that it could decrease mortality and slow the decline in lung function in patients with this disease. However, some pharmacological treatments can significantly improve dyspnoea, exercise tolerance, limitations in activity, rate of exacerbations and quality of life (e.g.long-acting bronchodilators and inhaled corticosteroids combined with a long-acting β2-agonist). The ability of these agents to modify the rate of disease progression remains to be firmly established in large-scale, long-term trials.The concept of disease modification itself in COPD may need to be revisited and more precisely defined in terms of markers and clinical outcomes, including extrarespiratory manifestations: agents that durably affect symptoms, activities, exacerbations and quality of life should probably be considered as disease modifiers. It is also reasonable to suggest that early diagnosis and treatment of patients with COPD might be the first and potentially most important disease-modifying intervention.There is clearly a need for new therapies that directly target the specific inflammatory processes underlying chronic obstructive pulmonary disease and its pulmonary and extrapulmonary manifestations.
Ventilatory support and pharmacological treatment of patients with central apnoea or hypoventilation during sleep: FIGURE 1.
Authors: Pevernagie D. , Janssens J. P. , De Backer W. , Elliott M. , Pepperell J. , Andreas S. 
Published: September 2008

The concept of central sleep apnoea or hypoventilation encompasses hypercapnic central hypoventilation, such as obesity hypoventilation syndrome and eucapnic or hypocapnic central sleep apnoea.Among subjects with eucapnic or hypocapnic central sleep apnoea, several therapeutic options are available for those with Cheyne–Stokes respiration (CSR). CSR is frequent in patients with New York Heart Association stage III and IV chronic heart failure, and in various neurological disorders. In these patients, treatment modalities include optimising cardiac condition and drugs, such as theophylline, acetazolamide and/or oxygen. Ventilatory support, such as nasal continuous positive airway pressure (CPAP), bi-level pressure support, or adaptive servo-ventilation (ASV), has been shown to improve CSR in patients with cardiac failure; however, convincing evidence that nasal CPAP improves life expectancy in these patients is lacking. Nevertheless, the treatment of associated obstructive sleep-disordered breathing is indicatedper se, as it may improve cardiac function.There is currently no proof that bi-level ventilation is superior to nasal CPAP. The few available studies that have focused on ASV have shown satisfactory control of CSR in cardiac failure patients. While ASV is not a first-line treatment choice, it appears to be superior to oxygen, CPAP and bi-level pressure ventilation in controlling the apnoea/hypopnea index and probably sleep fragmentation. As yet there are no data on mortality and, as such, firm conclusions cannot be drawn as to the role of ASV in the management of cardiac failure patients suffering from CSR.Obesity-related hypoventilation has increased dramatically over recent decades due to the epidemic increase in obesity in the developed countries. Obesity hypoventilation syndrome predisposes to the development of pulmonary hypertension and cor pulmonale. Noninvasive home ventilation is increasingly applied in obese patients with hypercapnic respiratory failure, however, initial mechanical ventilatory support can be reduced to nasal continuous positive airway pressure in only a subset of these individuals.
Sleep apnoea, hypertension and vascular disease: where are we now?
Authors: Buyse B. , Hedner J. 
Published: September 2008

The objective of the present article was to explore the relationship between obstructive sleep apnoea (OSA) and hypertension (HT) and/or arterial vascular disease (VD), including stroke and ischaemic coronary disease.Epidemiological and interventional studies on these relationships provide compelling evidence that OSA is causally related to HT. The causal relationship between OSA and VD other than HT has not been firmly established.A number of pathophysiological mechanisms that could potentially provide a causal link between obstructive sleep apnoea and hypertension, as well as vascular disease, have been identified. Available data on such mechanisms include sustained daytime sympathetic activation, oxidative stress, promotion of vascular inflammation and endothelial dysfunction.
Sleep apnoea and driving: how can this be dealt with?
Authors: Krieger J. 
Published: September 2008

Excessive daytime sleepiness has long been known to be associated with an increased risk of often particularly severe traffic accidents. Obstructive sleep apnoea (OSA) is among the most prevalent conditions leading to excessive daytime sleepiness, in addition to impaired cognitive function, both of which are likely to impair driving ability.An increased risk of traffic accidents has been demonstrated repeatedly, in association with OSA, as well its normalisation with effective treatment. However, it seems that not all patients are at equal risk, but it is not clear how to identify when and how at-risk patients can be identified.Nevertheless, some European countries have made specific regulations concerning OSA and/or excessive daytime sleepiness and the capacity to obtain or to keep a driving license. Most countries have the general rule that “a driving license should not be given or renewed to any candidate or license holder suffering from a disorder … likely to compromise safety on the road”, without a specific mention of sleepiness and/or sleep apnoea. However, the way in which such a statement is applied and the measures taken to identify unfit drivers vary greatly from country to country. In addition, in those countries that have made specific regulations, no evaluation of their efficacy in reducing sleepiness-related accidents is available.In practice, it is the physician's responsibility to inform the untreated obstructive sleep apnoea patient about the risk associated with their condition, and about the regulations that prevail in their country, if relevant; only in a few countries, is the physician allowed (or compelled) to report the unfit patient to the licensing authorities. Although it is generally accepted that the treated patient may be allowed to drive, the specific treatment conditions that eliminate the risk are not clearly established.
Mortality in sleep apnoea syndrome: a review of the evidence
Authors: Lavie P. 
Published: September 2008

Sleep apnoea syndrome is associated with cardiovascular morbidity, but it is less clear if it is also associated with increased mortality.Studies investigating mortality in sleep apnoea have 1) compared mortality rates of patients with different levels of severity of the syndrome relying on sleep laboratory populations, 2) compared treated and untreated patients, 3) examined the effect of co-existing cardiovascular diseases on survival and 4) investigated the effect of sleep-disordered breathing on mortality in the elderly.In spite of methodological limitations, the accumulated data generally support an increased risk of mortality in patients with severe sleep apnoea in comparison with mild or no sleep apnoea, and indicate that efficient treatment decreases mortality. Surprisingly, several studies have shown that the highest risk of mortality in sleep apnoea occurs in patients younger than 50 yrs of age, that risk tends to decline with age and that the occurrence of disordered breathing in sleep in the elderly does not affect mortality. It is as yet unclear if this finding represents a selection bias, differences in apnoea severity or in compliance with treatment between young and old patients, or an adaptation to the syndrome with age.There is conflicting evidence as to whether the occurrence of sleep apnoea in patients with existing cardiovascular diseases increases the risk of mortality beyond that associated with the cardiovascular diseases themselves.
Results of endoscopic surgery and intralesional steroid therapy for airway compromise due to tracheobronchial Wegener's granulomatosis
Authors: Nouraei S. A. R. , Obholzer R. , Ind P. W. , Salama A. D. , Pusey C. D. , Porter F. , Howard D. J. , Sandhu G. S. 
Published: September 2008

Background: Upper airway compromise due to tracheobronchial stenosis commonly occurs in patients with Wegener's Granulomatosis (WG). There is at present no consensus on the optimal management of this life-threatening condition.Objective: To assess the results of laryngo-tracheo-bronchoscopy, intralesional steroid therapy, laser surgery, and dilatation in managing obstructive tracheobronchial WG.Methods: Records of eighteen previously-untreated stridulous patients with obstructive tracheobronchial WG, treated between 2004 and 2006 were prospectively recorded on an airway database and retrospectively reviewed. Information about patient and lesion characteristics and treatment details were recorded. Treatment progress was illustrated using a timeline plot, and intervention-free intervals were calculated with actuarial analysis.Results: There were nine males and the average age at presentation was 40 (16) years [range 13–74]. There were thirteen patients with tracheal, and five patients with tracheal and bronchial lesions. The average tracheal lesion height was 8 (3) mm, located 23 (9) mm below the glottis. There were 1, 10 and 7 Myer-Cotton grade I, II and III lesions respectively. Mean intervention-free interval following minimally-invasive treatment was 26 (2.8) months. Following endobronchial therapy the median intervention-free interval was 22 months (p>0.8 vs. tracheal lesions). No patient required a tracheostomy or endoluminal stenting.Conclusions: Intralesional steroid therapy and conservative endoluminal surgery is an effective strategy for treating airway compromise due to active tracheal and bronchial WG, obviating the need for airway bypass or stenting. We recommend the combination of endotracheal dilatation, conservative laser surgery and steroid therapy as the standard of care for treating airway compromise due to obstructive tracheobronchial WG.
Objective evaluation of patient–ventilator interactions during noninvasive ventilation (NIV)
Authors: Rabarimanantsoa Herinaina , Achour Linda , Letellier Christophe , Muir Jean-Francois , Cuvelier Antoine 
Published: September 2008

The success of NIV depends on patient–ventilator interactions. These interactions are evaluated with the subjective comfort score which is not always reliable. An objective evaluation is thus required. To evaluate these interactions, we use a statistical measure of the variability of a physiological signal, i.e the Shannon entropy. Our purpose is to show whether estimating Shannon entropy from airway pressure (SP) and from the total duration of ventilatory cycles (ST) may evaluate objectively the patient–ventilator interactions during NIV.Pressure support NIV was applied to 4 COPD patients, 4 OHS patients in stable state and 4 healthy subjects during six successive 10-min periods with various inspiratory pressure. The flow and the airway pressure signals were recorded with sensors located near the mask. Good patient–ventilator interactions were assumed to correspond to patient well synchronized (low ineffective efforts) and with low ventilatory variability. All the subjects were awaked and both Shannon entropies SPand STwere computed for each ventilatory tracing.The incidence of ineffective efforts (IE) varied from 0 to 64.7 %. SPappeared to be strongly correlated to this incidence (r = 0.91). STquantified precisely the ventilatory variability. When SPwas plotted versus ST, 4 distinct groups of patients were distinguished as follows:SP<1 and ST<1: IE<10% but no ventilatory variabilitySP<1 and ST>1: IE <10% with high ventilatory variabilitySP>1 and ST<1: IE >10% but no ventilatory variabilitySP>1 and ST>1: IE > 10% with high ventilatory variabilityShannon entropies objectively evaluate the patient–ventilator interactions in terms of ineffective efforts and ventilatory variability. Good patient–ventilator interactions occur when there is only few ineffective efforts (SP<1) and a low ventilatory variability (ST<1).
Virtual respiratory system for interactive e-learning of spirometry
Authors: Tomalak W. , Gólczewski T. , Michnikowski M. , Darowski M. 
Published: September 2008

Progress in computer simulation technology offers new possibilities for modern medicine. On one hand – virtual organs can help to create animal or human models for research, on the other hand – e-learning or distant learning through Internet is now possible. The aim of our work was to create a system for interactive learning of spirometry (SILS), enabling students or physicians to observe spirometric measurements (flow-volume) modified by setting level and kind of abnormalities within the respiratory system. SILS is based on a virtual respiratory system presented previously in several papers. Its main features are: separation of the lungs and chest; anatomical division of the lungs; division of airway resistance into transmural pressure dependent (Rp) and lung volume dependent (Rv) parts. The one mathematical formula that represents Rpdescribes both flow limitation (forced expiration) and dependence of Raw on lungs volume (small airflows). The output of system are spirometric parameters (as FEV1, FVC, FEV1%FVC) and a flow–volume loop constructed according to results of simulation of forced expiration for the chosen abnormality kind and level.As a result – this system may be used in teaching process in medical schools and postgraduate education. We offer access to a basic version of SILS for students and physicians at:www.spirometry.ibib.waw.plandwww.zpigichp.edu.pl. As we expect feedback from users, it is possible to modify user interface or model features to comply with users' requests.
Relationship between respiratory muscle strength, functional capacity and quality of life in pre-operative cardiac surgery patients
Authors: Saglam Melda , Arikan Hulya , Savci Sema , Inal-Ince Deniz , Bosnak-Guclu Meral , Degirmence Betul , Nur Turan Hatice , Demircin Metin 
Published: September 2008

The aim of this study was to investigate the relationship between respiratory muscle strength, functional capacity, physical activity, and quality of life in preoperative cardiac surgery patients.Forty eight preoperative cardiac surgery patients (mean age 59.79±10.29 years, 40 M, 8 F, FEV1: 79.52±17.02%) participated in this study. Pulmonary function tests and respiratory muscle strength (MIP and MEP) were performed. Physical activity level was measured using International Physical Activity Questionnaire (IPAQ). Quality of life was determined using Nottingham Health Profile (NHP). Functional capacity was assessed using six-minute walk test (6MWT).The MIP was significantly correlated with 6MWT distance (r = 0.31, p<0.05). Respiratory muscle strength was not significantly correlated with quality of life and physical activity level (p>0.05). Total physical activity level was significantly related with NHP total score (r =  -0.35, p<0.05), NHP emotional stress dimension (r =  -0.32, p<0.05), NHP pain dimension (r =  -0.35, p<0.05), NHP energy dimension (r =  -0.29, p<0.05), NHP physical activity dimension (r =  -0.37, p<0.05). The NHP physical activity dimension was significantly correlated with 6MWT distance (r =  -0.29, p<0.05).Inspiratory muscle strength is related to functional capacity in preoperative cardiac surgery patients. Quality of life is related with physical activity level and functional capacity in these patients.
Towards new antituberculotic targets: biochemical characterisation of mycobacterial RNase E/G
Authors: Csanadi Agnes , Zeller Mirijam-Elisabeth , Miczak Andras , Rose Thierry , Bizebard Thierry , Kaberdin Vladimir R. 
Published: September 2008

The World Health Organization estimates that each year 3 million people die from tuberculosis (TB) and 8 million people become infected. No new anti-TB drugs have been introduced in the past 30 years, even though their development becomes increasingly important to face new challenges posed by multidrug-resistant and extensively drug-resistant strains and by acute infection withM. tuberculosisof HIV positive patients. Owing to its apparently important role in RNA metabolism, the RNase E/G family of endoribonucleases can be considered as a promising target for antimicrobial drugs. This consideration promted us to characterise biochemical properties of theM. tuberculosisRNase E/G homologue.To learn more about specific properties of RNase E/G homologues aM. tuberculosisRNase E/G (MycRne) was overexpressed inE. coliand purified as a 6His-tagged polypeptide.To characterise MycRne,we usedin vitrocleavage assays and primer extension analysis of total RNA extracted from mycobacteria.We show that affinity purified MycRne has an endoribonucleolytic activity, which is dependent on the 5′-phosphorylation status of RNA. We could also show that RNase E/G has Mg2+dependent activity and similar toE. coliRNase E, MycRne was able to cleave in an intercistronic region of the putative 9S precursor of 5S rRNA.Although, similar toE. coliRNase E, the mycobacterial RNase E/G homologue plays a role in rRNA processing, the substrate specificities of these enzymes show differences. This suggests that RNase E/G can be used as a promising target for antimicrobial drugs that can be optimized to specifically target pathogenic species.
The epithelial integrity is preserved during particle exchange across the epithelium by macrophages and dendritic cells
Authors: Blank F. , Wehrli M. , Baum O. , Gehr P. , Rothen-Rutishauser B. 
Published: September 2008

The epithelium of the human airway wall serves as structural and functional barrier against inhaled and deposited particulate antigen. Recently we have shown that human blood monocyte-derived dendritic cells (MDDC) and human blood monocytes derived macrophages (MDM) collaborate as sentinels against foreign particulate antigen by building a transepithelial interacting cellular network. Although the tight junction belt was penetrated by processes of MDDC and MDM to transfer particles across the epithelium, the monolayer integrity of the epithelial cells was not affected. These results brought up two main questions: (1) How is the epithelial integrity preserved? (2) If MDM and MDDC make a direct contact by their processes can they exchange particles?The presence of tight junction and adherens junction mRNA and proteins in MDM and MDDC monocultures was determined by RT-PCR, and immunofluorescence. Living co-cultures of MDM and MDDC exposed to particles (1 mm in diameter) were investigated by laser scanning microscopy.We found that MDDC as well as MDM express adherens junction and tight junction mRNA and proteins as shown by RT-PCR and SDS-Page. Furthermore, performing live cell experiments we have seen that MDDC and MDM moved towards each other and that particles were transferred from MDM to MDDC. Interestingly, MDDC also made contacts with other MDDC and we observed particle exchange between them as well.We may conclude from these findings that MDM and MDDC can form tight junction and adherens junction-like structures with epithelial cells to preserve the epithelial integrity during particle translocation across the epithelium. In addition, we demonstrate an exchange of particles from MDM to MDDC and MDDC to MDDC which supports our hypothesis that MDM and MDDC collaborate as sentinels.
Sleep-disordered breathing: a new risk factor of suspected fatty liver disease in overweight children and adolescents?
Authors: Verhulst S. L. , Schrauwen N. , Haentjens D. , Rooman R. P. , Van Gaal L. , De Backer W. A. , Desager K. N. 
Published: September 2008

Sleep-disordered breathing (SDB) in childhood obesity is associated with hyperinsulinemia, dyslipidemia and inflammation and by these mechanisms, SDB could contribute to development of non-alcoholic fatty liver disease. We, therefore, investigated if SDB was an independent predictor of suspected fatty liver disease in a clinical sample of overweight and obese children and adolescents.Retrospective case study of consecutive overweight or obese children and adolescents attending a paediatric obesity clinic. Suggestive fatty liver disease was defined as a serum alanine aminotransferase >40 U·L−1and/or a hyperechoic liver on abdominal ultrasound.Subjects with suggestive fatty liver disease presented with higher waist circumference, more circulating peripheral leukocytes and a lower % of total sleep time with SaO2 ≥95% than their peers with a normal liver evaluation. Multiple logistic regression (stepwise forward) selected waist circumference (odds ratio = 1.05; 95% confidence interval = 1.00–1.10; p = 0.06) and SaO2nadir (odds ratio = 0.87; 95% confidence interval = 0.76–0.99; p = 0.03) as predictors of suggestive fatty liver disease.This study suggests an association between the severity of SDB and suspected fatty liver disease in a clinical sample of overweight and obese children and adolescents. We strongly recommend more and carefully designed research on the influence of SDB on the development of fatty liver disease and on the effect of treating sleep apnoea on liver function parameters.
CPAP increases bronchial reactivity in OSAS patients
Authors: Korczyński P. , Górska K. , Bielicki P. , Byśkiniewicz K. , Zieliński J. , Chazan R. 
Published: September 2008

Continuous positive airways pressure (CPAP) is a well known and safe method of treatment patients with obstructive sleep apnoea syndrome (OSAS). The effects of CPAP administration on the upper respiratory tract are known. However its effects on the lower respiratory tract still needs to be determined. Studies on bronchial hyperreactivity in patients treated by CPAP are contradictory.The aim of the study was to assess the influence of a 3-week CPAP treatment in patients with OSAS and to evaluate associations between changes in bronchial reactivity and clinical features of OSAS and lung function tests (LFT).Patients with newly diagnosed OSAS and lack of infection or chronic illness of the respiratory tract or other conditions which could influence bronchial hyperreactivity (BHR) were included.Investigations were performed in 101 patients. There were 88 males and 13 females, mean age 51.5±11.2 years and BMI 32.6±5.4 kg·m−2. Qualified patients were randomly divided into 2 groups: 76 patients to CPAP treatment group, 25 control group. Both groups did not differ in anthropometrics features, severity of OSAS and LFT. Metacholine challenge test (MchCT) was performed at baseline and repeated after 3 weeks. Analysis of the individual results showed that in 11 patients the MchCT was positive (6 in the CPAP and 5 in the control groups). After 3 weeks in the group of CPAP treated patients an increase of BHR was noted. Log PC20M decreased from 1.38±0.3 to 1.26±0.5 (p<0.05). The number of patients with a positive result in the MchCT increased from 6 to 16 patients. There was no significant change in BHR in the control group.It was found that CPAP treated patients with BHR were older, had less severe OSAS and lower FEV1 (p<0.05). In none of the patients positive result of BHR did no affect compliance to CPAP treatment.Conclusions: CPAP therapy increases bronchial reactivity, but does not affect compliance to treatment.