Changes in lung function in adolescents with substance use disorders: an exploratory study / Alterações da função pulmonar em adolescentes com transtornos relacionados ao uso de substâncias: estudo exploratório

ABSTRACT Objective: To compare lung function between adolescents with and without substance use disorder (SUD). Methods: This was an observational, cross-sectional exploratory study. The sample consisted of 16 adolescents with SUD and 24 age-matched healthy controls. The adolescents in the clinical group were recruited from a psychiatric inpatient unit for detoxification and rehabilitation; their primary diagnosis was SUD related to marijuana, cocaine, or polysubstance use. Questionnaires and pulmonary function tests were applied for clinical evaluation. Results: We found that FVC, FEV1, and their percentages of the predicted values were significantly lower in the adolescents with SUD than in those without. Those differences remained significant after adjustment for BMI and the effects of high levels of physical activity. The largest effect size (Cohen's d = 1.82) was found for FVC as a percentage of the predicted value (FVC%), which was, on average, 17.95% lower in the SUD group. In addition, the years of regular use of smoked substances (tobacco, marijuana, and crack cocaine) correlated negatively with the FVC%. Conclusions: This exploratory study is innovative in that it demonstrates the early consequences of smoked substance use for the lung health of adolescents with SUD.

RESUMO Objetivo: Comparar a função pulmonar de adolescentes com e sem transtornos relacionados ao uso de substâncias (TUS). Métodos: Trata-se de um estudo exploratório transversal observacional. A amostra foi composta por 16 adolescentes com TUS e 24 controles saudáveis emparelhados pela idade. Os adolescentes do grupo clínico foram recrutados em uma unidade de internação psiquiátrica para desintoxicação e reabilitação; seu diagnóstico primário era o de TUS (maconha, cocaína ou polissubstâncias). Foram aplicados questionários e testes de função pulmonar para a avaliação clínica. Resultados: A CVF, o VEF1 e seus valores em porcentagem do previsto foram significativamente mais baixos nos adolescentes com TUS do que naqueles sem TUS. Essas diferenças permaneceram significativas após os ajustes para levar em conta o IMC e os efeitos de altos níveis de atividade física. O maior tamanho de efeito (d de Cohen = 1,82) foi o observado em relação à CVF em porcentagem do previsto (CVF%), que foi, em média, 17,95% menor no grupo TUS. Além disso, os anos de uso regular de substâncias fumadas (tabaco, maconha e crack) correlacionaram-se negativamente com a CVF%. Conclusões: Este estudo exploratório é inovador na medida em que demonstra as consequências precoces do uso de substâncias fumadas para a saúde pulmonar de adolescentes com TUS.

Lipoabdominoplasty: repercussions for diaphragmatic mobility and lung function in healthy women / Lipoabdominoplastia: repercussão na mobilidade diafragmática e função pulmonar em mulheres saudáveis

ABSTRACT Objective: To evaluate the impact of lipoabdominoplasty on diaphragmatic mobility (DM) and lung function in healthy women. Methods: This was a prospective cohort study using high-resolution ultrasound and forced spirometry to assess DM and lung function, respectively, prior to lipoabdominoplasty, as well as on postoperative day (POD) 10 and POD 30. DM was measured under two conditions: during tidal volume breathing and during a VC maneuver. Results: The sample consisted of 20 women, with a mean age of 39.85 ± 7.52 years and a mean body mass index of 26.21 ± 2.0 kg/m2. Comparing the preoperative and postoperative periods, we found that DM and lung function values were significantly lower after lipoabdominoplasty, the mean DM on POD 10 being 17% and 15% lower during tidal volume breathing and during the VC maneuver, respectively, in comparison with the preoperative mean (p = 0.009 and p < 0.001, respectively). In addition, FEV1, FVC, and PEF were significantly lower on POD 10 than in the preoperative period (p = 0.046, p = 0.002, and p < 0.001, respectively), returning to preoperative values by POD 30. Conclusions: Lipoabdominoplasty appears to have negative short-term repercussions for DM and lung function in healthy women. However, lung function and DM are both apparently restored to preoperative conditions by POD 30. (ClinicalTrials.gov identifier: NCT02762526 [http://www.clinicaltrials.gov/])

RESUMO Objetivo: Avaliar o impacto da lipoabdominoplastia na mobilidade diafragmática (MD) e na função pulmonar de mulheres saudáveis. Métodos: Estudo prospectivo de coorte com ultrassonografia de alta resolução e espirometria forçada para a avaliação da MD e da função pulmonar, respectivamente, antes da lipoabdominoplastia, no 10º dia do pós-operatório e no 30º dia do pós-operatório. A MD foi medida durante a respiração em volume corrente e durante uma manobra de CV. Resultados: A amostra foi composta por 20 mulheres, com média de idade de 39,85 ± 7,52 anos e média de índice de massa corporal de 26,21 ± 2,0 kg/m2. Ao compararmos os períodos pré e pós-operatório, observamos que a MD e a função pulmonar foram significativamente menores após a lipoabdominoplastia; a média de MD no 10º dia do pós-operatório foi 17% menor durante a respiração em volume corrente e 15% menor durante a manobra de CV do que a média pré-operatória (p = 0,009 e p < 0,001, respectivamente). Além disso, o VEF1, a CVF e o PFE foram significativamente menores no 10º dia do pós-operatório que no pré-operatório (p = 0,046, p = 0,002 e p < 0,001, respectivamente), retornando aos valores pré-operatórios até o 30º dia do pós-operatório. Conclusões: A lipoabdominoplastia parece ter repercussões negativas em curto prazo na MD e função pulmonar de mulheres saudáveis. No entanto, tanto a função pulmonar como a MD aparentemente retornam ao estado pré-operatório até o 30º dia do pós-operatório. (ClinicalTrials.gov identifier: NCT02762526 [http://www.clinicaltrials.gov/])

Inflammatory lung injury in rabbits: effects of high-frequency oscillatory ventilation in the prone position / Lesão inflamatória pulmonar em coelhos: efeitos da ventilação oscilatória de alta frequência em posição prona

ABSTRACT Objective: To compare the effects that prone and supine positioning during high-frequency oscillatory ventilation (HFOV) have on oxygenation and lung inflammation, histological injury, and oxidative stress in a rabbit model of acute lung injury (ALI). Methods: Thirty male Norfolk white rabbits were induced to ALI by tracheal saline lavage (30 mL/kg, 38°C). The injury was induced during conventional mechanical ventilation, and ALI was considered confirmed when a PaO2/FiO2 ratio < 100 mmHg was reached. Rabbits were randomly divided into two groups: HFOV in the supine position (SP group, n = 15); and HFOV with prone positioning (PP group, n = 15). For HFOV, the mean airway pressure was initially set at 16 cmH2O. At 30, 60, and 90 min after the start of the HFOV protocol, the mean airway pressure was reduced to 14, 12, and 10 cmH2O, respectively. At 120 min, the animals were returned to or remained in the supine position for an extra 30 min. We evaluated oxygenation indices and histological lung injury scores, as well as TNF-α levels in BAL fluid and lung tissue. Results: After ALI induction, all of the animals showed significant hypoxemia, decreased respiratory system compliance, decreased oxygenation, and increased mean airway pressure in comparison with the baseline values. There were no statistically significant differences between the two groups, at any of the time points evaluated, in terms of the PaO2 or oxygenation index. However, TNF-α levels in BAL fluid were significantly lower in the PP group than in the SP group, as were histological lung injury scores. Conclusions: Prone positioning appears to attenuate inflammatory and histological lung injury during HFOV in rabbits with ALI.

RESUMO Objetivo: Comparar os efeitos das posições prona e supina durante ventilação oscilatória de alta frequência (VOAF) sobre oxigenação e inflamação pulmonar, lesão histológica e estresse oxidativo em um modelo de lesão pulmonar aguda (LPA) em coelhos. Métodos: Trinta coelhos Norfolk machos brancos foram submetidos à LPA por meio de lavagem traqueal com salina (30 ml/kg, 38°C). A lesão foi induzida durante a ventilação mecânica convencional, e a LPA foi considerada confirmada na presença de relação PaO2/FiO2 < 100 mmHg. Os coelhos foram aleatoriamente divididos em dois grupos: VOAF em posição supina (grupo PS, n = 15); e VOAF em posição prona (grupo PP, n = 15). Para a VOAF, a pressão média das vias aéreas foi inicialmente estabelecida em 16 cmH2O. No 30º, 60º e 90º min após o início do protocolo de VOAF, a pressão média das vias aéreas foi reduzida para 14, 12 e 10 cmH2O, respectivamente. No 120º min, os animais foram recolocados ou permaneceram na posição supina por mais 30 min. Foram avaliados os índices de oxigenação e escores histológicos de lesão pulmonar, bem como os níveis de TNF-α em lavado broncoalveolar e tecido pulmonar. Resultados: Após a indução da LPA, todos os animais apresentaram hipoxemia significativa, diminuição da complacência do sistema respiratório, diminuição da oxigenação e aumento da pressão média das vias aéreas em comparação aos valores basais. Não houve diferenças estatisticamente significativas entre os dois grupos, em nenhum dos momentos avaliados, quanto a PaO2 e índice de oxigenação. Entretanto, os níveis de TNF-α no lavado broncoalveolar foram significativamente menores no grupo PP que no grupo PS, assim como os escores histológicos de lesão pulmonar. Conclusões: A posição prona parece atenuar a lesão pulmonar inflamatória e histológica durante a VOAF em coelhos com LPA.

Analysis of pulmonary manifestations in patient infected with plasmodium vivax / Análise das manifestações pulmonares em pacientes infectados por plasmodium vivax

Objective: To evaluate pulmonary manifestations in patients infected with Plasmodium vivax. MethOds: This was a cross- sectional, retrospective study of 50 patients diagnosed in 2006 to 2008 with vivax malaria at the Evandro Chagas Institute and referred to the University Hospital João de Barros Barreto to examine the pulmonary manifestations. Results: 72% of the patients were men, 28% were 21 to 30 years of age, 30% had parasitaemia 50 to 2000 p/mm3, 88%, 94% and 92% of the patients presented respectively with fever, chills and headache respectively, 56% of the patients had cough, 62% felt breathlessness, 28% presented dyspnea and 86% experienced chest pain. COnClusiOn: The majority of patients surveyed had parasitaemia in the range 50 to 2000 p/mm3. The classic triad fever, chills and headache was present in most patients. Among pulmonary manifestations, cough, chest pain and shortness of breath were reported by the majority of patients.(AU)

Objetivo: Analisar as manifestações pulmonares em pacien- tes infectados por Plasmodium vivax. Métodos: Estudo transversal realizado por meio da análise de 50 prontuários de pacientes diagnosticados com malária vivax entre 2006 a 2008, no Instituto Evandro Chagas, e encaminhados para o Hospital Universitário João de Barros Barreto para análise das manifes- tações pulmonares. ResultadOs: Observou-se que 72% dos pacientes eram homens, 28% possuíam de 21 a 30 anos de idade, 30% apresentaram parasitemia de 50 a 2000 p/mm3. Entre as manifestações clínicas, 88%, 94% e 92% dos pacientes apresentaram, respectivamente, febre, calafrio e cefaleia, 56% apresentaram tosse, 62% sentiram falta de ar, 28% dispneia e 86% dor torácica. COnClusãO: A maioria dos pacientes pesquisados apresentou parasitemia no intervalo de 50 a 2000 p/mm3. A tríade clássica da malária esteve presente na maioria, já dentre as manifestações pulmonares pesquisadas, a tosse, a dor torácica e a falta de ar corresponderam aos sintomas mais relatados pelos pacientes.(AU)

Blood-gas and morphology study of functional pulmonary lobectomy on dogs / 中华胸心血管外科杂志

Objective To investigate the feasibility of the functional pulmonary lobectomy (FPLT) by studying the blood-gas and morphology of the FPLT model. Methods 18 healthy dogs were divided into three groups randomly: Group A (n=6): the target bronchus and lung bubbles were filled with emulsion of iodine oil and pingyangmycin(PYM)and then target bronchus was occluded with polymethylmethacrylate(PMMA).Group B (n=6): the target bronchus was only occluded with PMMA and Group C (n=6): the target pulmonary lobe was resected. Artery blood gas were measured at the time of pre-operation and post-operation immediately and then 1st, 2nd, 3rd and 4th week after operation respectively. Chest radiolography and histology and bacterial culture of tissue of target lung lobe were made after 4 weeks. Results There was a significant difference in artery blood-gas among 3 groups pre-operation compared with post-operation immediately (P0.05) compared with 1st, 2nd, 3rd and 4th week after operation. It showed atelectasis radiologically and fibrosis of target lung lobe histologically and no bacterium grew in target tissue the 4th week after operation. There were 3 cases of lung atelectasises but no pulmonary fibrosis in group B. Conclusion FPLT may be obtained after the target bronchus and lung bubbles were filled with emulsion of iodine oil and PYM and then target bronchus were occluded.FPLT is a minimal invasive, safe and effective procedure and might partially replace the surgical pulmonary lobectomy in future.

Lung protection by pulmonary perfusion with oxygenated blood in children with congenital heart defects / 中华胸心血管外科杂志

Objective To evaluate the effects of continuous pulmonary artery Perfusion with hypothermic oxygenated blood on lung function in children with congenital heart defects (CHD) and pulmonary hypertension(PH). Methods 20 patients diagnosed with CHD and PH were divided into group 1( perfused with oxygenated blood) and group 2 (conventional CPB). A canula was inserted into the main pulmonary artery for the perfusion with a rate of 15～30 ml?kg -1 ?min -1 . CPB was established as usual. The data of two groups including the oxygen concentration, airway pressure, blood gas analysis were recorded. At fixed times, blood sample was taken out for the measurement of the sICAM-1 and MDA. Results The concentration of sICAM-1 and MDA in group 1 was much lower than that in group 2 on 12 and 24 hours after surgery. Issues of the lung function including OI?A-aDOa_2 and airway pressure was significantly different between the two groups. Conclusion The study showed that the continuous pulmonary perfusion with oxygenated blood could preserve lung function in patients with CHD and PH.