Application of electronic inhaler monitoring for adherence of inhalational drug administration in patients with chronic respiratory diseases / 中华全科医师杂志

The adherence of inhalational drug administration is closely related the treatment effectiveness for patients with chronic respiratory diseases; on the other hand, poor adherence may increase healthcare costs or even lead to the death of patients. Electronic inhaler monitoring, currently considered the gold standard for assessing adherence, can provide clinicians with objectively accurate medication data, thereby assisting in clinical decision-making. This article provides a review of the significance of inhalation administration, the newly concept of medication adherence, the challenges faced in chronic respiratory diseases, and the current status of the application and value of electronic inhaler monitoring in improving adherence of inhalational drug administration for respiratory disease patients.

Clinical characteristics and drug resistance of Klebsiella pneumoniae infections at different systems / 中国基层医药

Objective:To investigate the clinical characteristics and drug resistance of Klebsiella pneumoniae infections at different systems, providing laboratory reference for the rational use of antibiotics in clinical practice.Methods:The clinical characteristics and drug resistance of patients with Klebsiella pneumoniae infections in respiratory, urinary, hematologic, and other systems who received treatment in Wuzhou Red Cross Hospital from January 2015 to December 2021 were analyzed.Results:From 2015 to 2021, there were 3 496 cases of Klebsiella pneumoniae infections in the hospital, among which the respiratory system was most affected with 2 250 strains (64.34%). The sex ratio of patients with Klebsiella pneumoniae infections at different systems was statistically significant ( χ2 = 266.77, P < 0.001). The respiratory system and hematological system were more commonly infected by Klebsiella pneumoniae in men, while the urinary system was more commonly infected in women. The sex ratio of patients with Klebsiella pneumoniae infections at other systems were similar. The age distribution of patients with Klebsiella pneumoniae infections at different systems was significantly different ( χ2 = 176.54, P < 0.001). Klebsiella pneumoniae infections of the respiratory, urinary, and hematological systems were the most common in people aged > 60-80 years, while Klebsiella pneumoniae infections in other systems were mainly found in people aged > 18-60 years. There were significant differences in the distribution of departments among different Klebsiella pneumoniae infection systems ( χ2 = 1 415.30, P < 0.001). The ICU had the highest incidence of Klebsiella pneumoniae infections in the respiratory system, while the department of internal medicine had the highest incidence of Klebsiella pneumoniae infections in the urinary and hematological systems, and the department of surgery had the highest incidence of Klebsiella pneumoniae infections in other parts of the body. The resistance rate of Klebsiella pneumoniae to common antibiotics for the hematologic system was lower than that of the other three infection systems. For infections in the respiratory system, urinary system, and other body parts, the resistance rates of Klebsiella pneumoniae to amikacin, meropenem, imipenem, and piperacillin/tazobactam were all below 10%, while the resistance rate to tobramycin was below 20%, and the resistance rate to cephalosporins was around 30%. Conclusion:The proportion of Klebsiella pneumoniae infections in different body parts varies by gender, age, and department. For Klebsiella pneumoniae infections in the hematological system, the resistance rate to commonly used antibiotics is lower than that for infections in the other three systems. In contrast, Klebsiella pneumoniae infections in the respiratory system, urinary system, and other systems have a particularly high resistance rate to third- and fourth-generation cephalosporins but are still sensitive to piperacillin/tazobactam and carbapenem antibiotics.

Applied research of the impact of air pollution on absenteeism in students with respiratory issues through machine learning analysis / 中国学校卫生

Objective@#To explore the performance of machine learning prediction models in forecasting student absenteeism due to respiratory symptoms caused by air pollution in short term, aiming to provide a methodological reference for early warning systems of school diseases.@*Methods@#Utilizing data from shortterm sequences of student absenteeism due to respiratory symptoms in Jiangsu Province from September 2019 to October 2022, the study integrated average concentrations of atmospheric pollutants. A univariate distributed lag nonlinear model was employed to select optimal lag variables for the pollutants. An extreme gradient boosting(XGBoost) algorithm model was developed to predict the frequency of absenteeism due to respiratory symptoms and compared with the seasonal autoregressive integrated moving average with exogenous factors(SARIMAX) model.@*Results@#Between 2019 and 2022, an average of 9 709 students per day in Jiangsu Province were absent due to respiratory symptoms. The daily average air quality index (AQI) was 76.96,with mass concentrations of PM2.5, PM10, NO2, and O3 averaging at 35.75, 61.13, 28.89, 104.81 μg/m3, respectively. Granger causality tests indicated that AQI, PM2.5, PM10, NO2, and O3 were significant predictors of absenteeism frequency due to respirutory symptoms(F=1.46,1.79,1.67,3.41,2.18,P<0.01). The singleday lag effects of PM2.5, PM10, NO2, and O3 reached their peak relative risk (RR) values at lag4, lag0, lag0, lag4 respectively. When integrating these optimal lag variables for the pollutants, the XGBoost model demonstrated superior predictive performance to the SARIMAX model, reducing the mean absolute error (MAE) from 2.251 to 0.475, mean absolute percentage error (MAPE) from 0.429 to 0.080, and root mean square error (RMSE) from 2.582 to 0.713; at the P75 percentile alert threshold, the sensitivity improved from 0.086 to 0.694 and specificity from 0.979 to 0.988, with the Youden index increasing from 0.065 to 0.682.@*Conclusions@#The XGBoost model exhibits robust predictive performance and effective early warning capabilities for shortterm sequences of student absenteeism due to respiratory symptoms caused by air pollution. Schools could timely adopt this model to preemptively detect and control disease outbreaks, thereby enhancing school health management.

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

Purpose: The current study aimed at evaluating the repair of a partial defect of the trachea with a muscle flap, an advanced technique that employs combined suture patterns. Methods: Sixteen healthy male New Zealand white rabbits were used as an experimental model. A partial defect in the trachea within the ventral region of the fourth to eighth tracheal ring was created. Subsequently, repair was initiated with a flap of the sternocephalicus muscle. The animals were divided into four groups for postoperative evaluation using clinical, tracheoscopic, and histopathological analyses. Each group was separated according to the time of euthanasia, programmed at interval of seven (G7), 15 (G15), 30 (G30), and 60 days (G60). Results: One animal from the G60 group died, whereas the other animals had good surgical recovery without serious changes in the breathing pattern. The major clinical signs observed were stridor and coughing. Tracheoscopy revealed secretions in the tracheal lumen, exuberant granulation, and stenosis. Histopathological analysis showed growth of the ciliary respiratory epithelium at the flap site 30 days after implantation. Conclusions: Partial repair showed satisfactory results owing to the anatomical location of the muscle, adequate vascular support, and structural and physiological maintenance without serious changes in the respiratory system.

Relationship between Bacteria in the Lower Respiratory Tract/Lung Cancer and the Development of Lung Cancer as well as Its Clinical Application / 中国肺癌杂志

Due to the advancement of 16S rRNA sequencing technology, the lower respiratory tract microbiota, which was considered non-existent, has been revealed. The correlation between these microorganisms and diseases such as tumor has been a hot topic in recent years. As the bacteria in the surrounding can infiltrate the tumors, researchers have also begun to pay attention to the biological behavior of tumor bacteria and their interaction with tumors. In this review, we present the characteristic of the lower respiratory tract bacteria and summarize recent research findings on the relationship between these microbiota and lung cancer. On top of that, we also summarize the basic feature of bacteria in tumors and focus on the characteristic of the bacteria in lung cancer. The relationship between bacteria in lung cancer and tumor development is also been discussed. Finally, we review the potential clinical applications of bacterial communities in the lower respiratory tract and lung cancer, and summarize key points of sample collection, sequencing, and contamination control, hoping to provide new ideas for the screening and treatment of tumors.
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Relevance of the correlation between tomography findings and laboratory test results in the accuracy of the diagnosis of pulmonary tuberculosis / Relevância da correlação entre achados tomográficos e laboratoriais na precisão diagnóstica da tuberculose pulmonar

Abstract Objective: To evaluate the correlation between multidetector computed tomography (MDCT) findings and laboratory test results in patients with pulmonary tuberculosis (PTB). Materials and Methods: A total of 57 patients were evaluated. Patients with suspected PTB were divided into groups according to the final diagnosis (confirmed or excluded), and the groups were compared in terms of sociodemographic variables, clinical symptoms, tomography findings, and laboratory test results. Results: Among the patients with a confirmed diagnosis of PTB, small pulmonary nodules with a peribronchovascular distribution were significantly more common in the patients with a positive sputum smear microscopy result (47.4% vs. 8.3%; p = 0.046), as were a miliary pattern (36.8% vs. 0.0%; p = 0.026), septal thickening (84.2% vs. 41.7%; p = 0.021), and lymph node enlargement (52.6% vs. 8.3%; p = 0.020). Small pulmonary nodules with a centrilobular distribution were significantly more common among the culture-positive patients (75.0% vs. 35.7%; p = 0.045), as was a tree-in-bud pattern (91.7% vs. 42.9%; p = 0.014). A tree-in-bud pattern, one of the main tomography findings characteristic of PTB, had a sensitivity, specificity, positive predictive value, and negative predictive value of 71.0%, 73.1%, 75.9%, and 67.9%, respectively. Conclusion: MDCT presented reliable predictive values for the main tomography findings in the diagnosis of PTB, being a safe tool for the diagnosis of PTB in patients with clinical suspicion of the disease. It also appears to be a suitable tool for the selection of patients who are candidates for more complex, invasive examinations from among those with high clinical suspicion of PTB and a negative sputum smear microscopy result.

Resumo Objetivo: Avaliar a correlação entre os achados na tomografia computadorizada multidetectores (TCMD) comparativamente aos resultados laboratoriais em pacientes com tuberculose pulmonar (TBP). Materiais e Métodos: Amostra de 57 pacientes foi avaliada. Pacientes com suspeita clínica de TBP foram divididos de acordo com a positividade do diagnóstico, e as variáveis sociodemográficas, sintomas clínicos e achados tomográficos e laboratoriais foram comparados. Resultados: Nos pacientes com TBP e baciloscopia positiva, foram verificadas frequências significativas para pequenos nódulos pulmonares com distribuição peribroncovascular (47,4% vs. 8,3%; p = 0,046) e miliar (36,8% vs. 0,0%; p = 0,026), espessamento septal (84,2% vs. 41,7%; p = 0,021) e linfonodomegalias (52,6% vs. 8,3%; p = 0,020). Em relação à cultura, os pequenos nódulos pulmonares com distribuição centrolobular (75,0% vs. 35,7%; p = 0,045) e opacidades em árvore em brotamento (91,7% vs. 42,9%; p = 0,014) apresentaram frequências significativamente superiores. Medidas de sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo para árvore em brotamento, um dos principais achados tomográficos característicos da TBP, foram, respectivamente, 71.0%, 73,1%, 75,9% e 67,9%. Conclusão: A TCMD apresentou medidas preditivas confiáveis para os principais achados tomográficos no diagnóstico de TBP, sendo uma ferramenta segura para o diagnóstico da doença em pacientes com suspeita clínica. Também se mostrou adequada para selecionar os pacientes para exames mais complexos e invasivos entre os com alta suspeita clínica de TBP e baciloscopia negativa.

Afectación en nariz o garganta en población del área de influencia de una obra de infraestructura vial en la Comuna 14 de Medellín, Colombia / Irritation of the nose or throat in the population of the area of influence of a road infrastructure project in Comuna 14 in Medellín, Colombia / Afetação no nariz ou na garganta da população na área de influência de um projeto de infraestrutura rodoviária na Comuna 14 de Medellín, Colômbia

Resumen Objetivo: identificar condiciones sociodemográficas, ambientales, de vivienda y entorno, relacionadas con afectación en nariz o garganta de población que habitaba el área de influencia de una obra de infraestructura vial urbana. Medellín, Colombia, 2017. Metodología: estudio transversal, con fuente primaria de información. Se aplicó encuesta asistida a 170 adultos, en viviendas seleccionadas mediante muestreo tipo bola de nieve, que habitaran en un perímetro hasta de 1,5 kilómetros del centro de la obra, que aceptaran participar y firmaran el consentimiento informado. Análisis: exploratorios cualitativos y cuantitativos. Cálculo de Razones de prevalencias (RP) y estadístico Chi2 de asociación. Proyecto aprobado por el Comité Institucional de Ética en Humanos de la Universidad CES. Resultados: la prevalencia de afectación en nariz y/o garganta fue del 35,88 %. Se identificó asociación (p<0,05) entre esta afectación, tener menor edad, y ser hombre (RP=0,50. IC=0,29; 0,84). También se asoció a mayor prevalencia de esta afectación, tener mala percepción de calidad del aire durante la obra, realizar actividad física al aire libre, tener hábito tabáquico y una mayor cercanía de la vivienda con la obra. Conclusiones: esta obra de infraestructura vial tuvo una repercusión negativa en la percepción de salud física de los habitantes de su área de influencia, sería necesaria la implementación de estrategias incidir positivamente en la salud pública.

Abstract Objective: To identify sociodemographic, environmental, housing and environmental conditions related to nose or throat involvement of the population that lived in the area of influence of an urban road infrastructure project in Medellín, Colombia, 2017. Methodology: Cross-sectional study, with primary source of information. An assisted survey was applied to 170 adults, in homes selected through snowball sampling, who lived in a perimeter of up to 1.5 kilometers from the center of the work and who agreed to participate and signed informed consent. Analysis: qualitative and quantitative exploratory. Prevalence ratio (PR) calculation and Chi2 statistic association. Project approved by the Institutional Committee for Human Ethics of Universidad CES. Results: Prevalence of irritation of nose and/or throat was of 35.88%. An association (p<0.05) was identified between this condition, being younger, and being male (RP=0.50, CI=0.29; 0.84). Higher prevalence of this condition was also associated with having poor perception of air quality during the construction work, doing physical activity outdoors, having a smoking habit, and the proximity of the home to the construction site. Conclusions: This road infrastructure project had a negative impact on the perception of physical health of the inhabitants of this area of influence. The implementation of strategies to positively impact public health would be necessary.

Resumo Objetivo: Identificar condições sócio-demográficas, ambientais, habitacionais e do ambiente, relacionadas com afetação no nariz ou na garganta da população que habitava na área de influência de um projeto de infraestrutura de estradas urbanas. Medellín, Colômbia, 2017. Metodologia: Estudo transversal, com fonte primária de informação. Uma pesquisa assistida foi aplicada a 170 adultos, em domicílios selecionados por amostragem de tipo de bolas de neve, que residiam em um perímetro de até 1,5 km do centro da obra, que concordaram em participar e assinaram o termo de consentimento informado. Análise: qualitativa e quantitativa exploratória. Cálculo da razão de prevalência (RP) e estatística de associação de Chi2. Projeto aprovado pelo Comitê Institucional de Ética Humana da Universidade CES. Resultados: Prevalência de afetação no nariz ou na garganta de 35,88%. Foi identificada uma associação (p<0,05) entre a variável estudada, ser mais jovem e ser homem (RP=0,50. IC=0,29; 0,84). Também foram associados à maior afetação no nariz ou na garganta, ter uma baixa percepção da qualidade do ar durante o trabalho, fazer atividade física ao ar livre, tabagismo e proximidade da casa com o trabalho. Conclusões: Este trabalho de infraestrutura viária teve um impacto negativo na percepção de saúde dos habitantes de sua área de influência; será necessária a implementação de estratégias para impactar positivamente a Saúde Pública.

Mecánica Tusígena / Cough Mechanics

El control neurológico de la tos o la neurofisiología de la tos, implica una serie de eventos complejos en el sistema nervioso que coordinan y desencadenan este reflejo protector pulmonar. Esta intrincada red de señales nerviosas y coordinación muscular se origina en los receptores de la tos, pasa por el centro de la tos en el bulbo raquídeo y finalmente activa los músculos necesarios para la adecuada eliminación del agente irritante. Este mecanismo involucra, la detección del estímulo por receptores especializados, transducción de señales que viajan a lo largo de fibras nerviosas aferentes hacia el sistema nervioso central, centro integrador a nivel del bulbo raquídeo, en el centro de la tos es donde se procesa las señales de los receptores y se coordina la respuesta. La integración de las señales y la respuesta radica en este centro de la tos y en la corteza cerebral quien regula y modula la tos. El control neuronal cortical de la tos implica la participación consciente y voluntaria de la corteza cerebral en la percepción, regulación y adaptación de la tos. La coordinación muscular requiere que la señal viaje por vías nerviosas eferentes motoras hacia los músculos involucrados, la contracción muscular se integra en una secuencia específica que desencadena las fases de la tos, inspiración máxima, compresión y expulsiva.

The neurological control of cough, or the neurophysiology of cough, involves a series of complex events in the nervous system that coordinate and trigger this lung protective reflex. This intricate network of nerve signals and muscle coordination originates from the cough receptors, passes through the cough center in the medulla oblongata, and finally activates the muscles necessary for proper elimination of the irritant. This mechanism involves the detection of the stimulus by specialized receptors, transduction of signals that travel along afferent nerve fibers towards the central nervous system, integrating center at the level of the medulla oblongata, in the cough center is where the signals are processed. receptors and the response is coordinated. The integration of signals and response resides in this cough center and in the cerebral cortex, which regulates and modulates coughing. Cortical neural control of cough involves the conscious and voluntary participation of the cerebral cortex in the perception, regulation, and adaptation of cough. Muscle coordination requires that the signal travel through efferent motor nerve pathways to the muscles involved; muscle contraction is integrated into a specific sequence that triggers the cough, maximum inspiration, compression, and expulsive phases.

Comparative study of evaluation techniques in physiology clinical practicals by objective structured practical examination verses traditional practical examination

Background: Objective structural practical examination assesses students by evaluating their knowledge, attitude, communication skills, interpersonal skills, ethical issues and professional judgement. Objectives were to compare the traditional practical clinical examination with objective structured practical examination. To establish the relation between the TCE and OSPE. To take the feedback from students about the study. Methods: This interventional longitudinal study was conducted on 100 first-year medical students. They were divided into 4 practical batches each consisting of about 25 students. In TCE each student performed a clinical skill, followed by viva voce on the RS. Assessment of each student were done on the bases of overall performance. In OSPE, students were provided an OSPE map and a written instruction list before the start of the examinations, and they move from one station to another following the audible ring by the timekeeper. Three observation station, six unobserved stations with questions relates to the procedural stations arrange in physiology practical laboratory. An examiner was provided with prevalidated checklist to mark according to the observed procedure. Results: Marks obtained during OSPE mean was 11.07 was more effective than marks obtained during TCE mean was 8.34. Most of students strongly agreed that OSPE was well structured, performance based, more objective as compared to TCE. Conclusions: OSPE is a good tool for practical assessment as compared to TCE to improve students’ learning process.

Foreign Body Accidents in a Pediatric Emergency Department

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

Hipoplasia tímica en pacientes pediátricos con enfermedad respiratoria / Thymic hypoplasia in pediatric patients with respiratory illnesses

Objetivos : Determinar las características clínicas y epidemiológicas de niños con hipoplasia del timo y enfermedad respiratoria en Cuba. Material y Métodos : Estudio descriptivo retrospectivo en niños con edades comprendidas entre 1 y 6 años, de ambos sexos, atendidos en la consulta de Inmunología Pediátrica del Programa de Proyección Comunitaria del Municipio Arroyo Naranjo de La Habana o en la consulta de Inmunología Pediátrica del Hospital Materno Infantil Ángel Arturo Aballí Arellano del Municipio Arroyo Naranjo La Habana, entre los meses de septiembre 2019 y agosto 2022. Se incluyeron los niños con hipoplasia tímica y con antecedentes personales de enfermedad respiratoria infecciosa o no infecciosa diagnosticadas durante el período de estudio. Resultados : No se encontró relación entre la hipoplasia tímica y la edad o el sexo; se encontró mayor frecuencia de la hipoplasia tímica leve y moderada en niños con desarrollo de enfermedad respiratoria grave. Los factores con mayor frecuencia descritos en la enfermedad respiratoria complicada fueron la lactancia materna inefectiva, los antecedentes patológicos personales de atopia, el embarazo de riesgo, la prematuridad, el humo de tabaco en el ambiente y la asistencia a círculo infantil o a casa de cuidado infantil. Conclusiones : El desarrollo de hipoplasia tímica no mostró relación con la edad y el sexo. Se describieron varias condiciones con mayor frecuencia en niños con hipoplasia tímica y con enfermedad respiratoria complicada. La frecuencia de la hipoplasia tímica leve y moderada fue mayor en los pacientes con enfermedad respiratoria grave.

SUMMARY Objective : To determine the clinical and epidemiologic features of children with thymic hypoplasia and respiratory illnesses in Cuba. Methods : A retrospective study was conducted among children of 1-6 years of age of both sexes attended at a Pediatric Immunology Program of Hospital Materno Infantil Ángel Arturo Aballí Arellano in Habana, Cuba from September 2019 to August 2022. Children with thymic hypoplasia with and without a history of a respiratory illness either infectious or non-infectious were included. Results : No association between age and sex with thymic hypoplasia but an association was found with children with a severe respiratory illness. Factors associated with a severe respiratory illness were ineffective breastfeeding, history of an atopic condition, pregnancy of high risk, prematurity and exposure to tobacco smoke. Conclusions : Thymic hypoplasia was not associated with age or sex. An association with mild-moderate thymic hypoplasia was found with a severe respiratory illness.

Morphological Effects of Cigarette Smoking on Respiratory System and Related Functions Based on AQPs Expression

SUMMARY: A great deal of attention of air pollution on respiratory health is increasing, particularly in relation to haze days. It is that exposure to cigarette smoke augments the toxicity of common air contaminants, thereby increasing the complexity of respiratory diseases. Although there are various mechanisms involved to respiratory diseases caused or worsen by cigarette smoking, in which the role of AQPs in the lung with regard to fluid homeostasis still remains elusive. In this paper, we copied the rat models based on smoke generator, and investigated the morphological changes of mucosa and related functions depending on the balance of lining liquid of alveoli via AQPs expression. Compared with normal group, weak labelling of AQP1 and AQP5 protein abundance were clearly detected in the corresponding part of smoke exposure groups compared with normal group. Hence, it is suggested that the contribution of AQPs in the lung is diminished, thereby causing perturbed balancing between resorptive and secretory fluid homeostasis under cigarette smoking.

Cada vez se presta más atención a la contaminación del aire en la salud respiratoria, particularmente, en relación con los días de neblina. En consecuencia la exposición al humo del cigarrillo aumenta la toxicidad de los contaminantes comunes del aire, lo que además aumenta la complejidad de las enfermedades respiratorias. Aunque existen varios mecanismos involucrados en las enfermedades respiratorias causadas o empeoradas por el tabaquismo, en las que el papel de las AQP en el pulmón respecto a la homeostasis de líquidos sigue siendo difícil de alcanzar. En este artículo, copiamos los modelos de rata basados en el generador de humo e investigamos los cambios morfológicos de la mucosa y las funciones relacionadas según el equilibrio del líquido de revestimiento de los alvéolos a través de la expresión de AQP. En comparación con el grupo normal, se detectó claramente un etiquetado débil de la abundancia de proteínas AQP1 y AQP5 en la parte correspondiente de los grupos de exposición al humo en comparación con el grupo control. Por lo tanto, se sugiere que la contribución de las AQP en el pulmón está disminuida, provocando así un equilibrio perturbado entre la homeostasis del líquido secretor y de reabsorción bajo el hábito de fumar cigarrillos.

A correlation of the spirometric outcomes of follow up patients of COVID-19 pneumonia with their admission time computed tomography severity score on high resolution computed tomography thorax

Background: Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus. Most people who fall sick with COVID-19 experience mild to moderate symptoms and recover without any special treatment. However, some become seriously ill and require serious medical attention. The respiratory system has been the main organ affected by COVID-19 along with other organs such as heart, kidneys and liver. Spirometry is the most common of the pulmonary function tests. Spirometry is helpful in assessing respiratory outcomes that identify conditions such as asthma, pulmonary fibrosis, cystic fibrosis, and COPD. Methods: A total of 100 COVID-19 pneumonia patients coming for follow-up 6-10 weeks post-discharge in OPD at Department of General Medicine, Dr. D. Y. Patil Medical College Hospital and Research Institute, Kolhapur, Maharashtra, satisfying the inclusion criteria and exclusion criteria were enrolled. High resolution computed tomography (HRCT) thorax reports during their admission were collected and Computed tomography severity score (CTSS) was noted. Their spirometry was done and pattern of spirometric outcome noted. Admission-time CTSS and spirometric outcome were correlated. Results: In majority of the patients, CT severity score during course of illness had strong correlation with spirometric outcome after 6 weeks of follow up and the association was statistically significant. Conclusions: CT severity score during course of illness had strong correlation with spirometry findings after 6 weeks of follow up. Higher age and higher HRCT score are good predictors for impaired pulmonary function after discharge.

The Association between Exposure to Second-Hand Smoke and Disease in the Chinese Population: A Systematic Review and Meta-Analysis / 生物医学与环境科学（英文）

OBJECTIVE@#To analyze the association between exposure to second-hand smoke (SHS) and 23 diseases, categorized into four classifications, among the Chinese population.@*METHODS@#We searched the literature up to June 30, 2021, and eligible studies were identified according to the PECOS format: Participants and Competitors (Chinese population), Exposure (SHS), Outcomes (Disease or Death), and Study design (Case-control or Cohort).@*RESULTS@#In total, 53 studies were selected. The odds ratio (OR) for all types of cancer was 1.79 (1.56-2.05), and for individual cancers was 1.92 (1.42-2.59) for lung cancer, 1.57 (1.40-1.76) for breast cancer, 1.52 (1.12-2.05) for bladder cancer, and 1.37 (1.08-1.73) for liver cancer. The OR for circulatory system diseases was 1.92 (1.29-2.85), with a value of 2.29 (1.26-4.159) for stroke. The OR of respiratory system diseases was 1.76 (1.13-2.74), with a value of 1.82 (1.07-3.11) for childhood asthma. The original ORs were also shown for other diseases. Subgroup analyses were performed for lung and breast cancer. The ORs varied according to time period and were significant during exposure in the household; For lung cancer, the OR was significant in women.@*CONCLUSION@#The effect of SHS exposure in China was similar to that in Western countries, but its definition and characterization require further clarification. Studies on the association between SHS exposure and certain diseases with high incidence rates are insufficient.

Application progress of air-liquid interface exposure technology in respiratory system toxicity induced by diesel exhaust in vitro / 环境与职业医学

Diesel exhaust (DE) is an important pollution source widely existing in the living and production environment, which is closely related to the health of the public and occupational groups. The International Agency for Research on Cancer has classified DE as a Group 1 carcinogen. Considering the negative health impacts on the respiratory system due to DE exposure in vitro, it is crucial to apply reliable test systems allowing accurate assessment of the biological effects of DE. The exposure technology of respiratory system in vitro is considered as one of the feasible measures to implement the 3R (reduce, refine, and replace) principle in animal experiments. Compared with the traditional submerged culture in vitro models, the air-liquid interface (ALI) exposure technology has the advantages including fewer influencing factors, easier exposure condition control, and shorter exposure cycle. ALI has become an important tool to study molecular events associated with physiology and pathology of respiratory system, and action modes and interactions of different cell types. Also, ALI has been increasingly widely used because it can simulate the actual processes of human respiratory system cells and/or tissues to DE exposure. This review was intended to introduce the development and advantages of ALI exposure technology, and further summarized the application progress of ALI exposure technology in studying the respiratory toxicity induced by DE exposure in vitro, so as to provide new ideas and pathways for the use of ALI exposure technology in the study of biomarkers and mechanisms of respiratory toxicity associated with DE exposure, and provide basic data to screen and promote biomarkers for exposed populations.

Role of interleukin-6 signaling pathway in adverse health effects induced by air pollution / 环境与职业医学

Air pollution is one of the most important environmental issues in China and worldwide, as well as a critical public health problem affecting human health. With the implementation of emission reduction and other programs, the air quality in China has been improved dramatically in recent years, but is still worse than the WHO guideline recommended levels. Numerous epidemiological and toxicological studies have shown that short-term or long-term exposure to air pollution is strongly associated with respiratory diseases, cardiovascular diseases, diabetes, and so forth, in which interleukin-6 (IL-6), a well-known inflammatory factor, may play an important role. Studies have found that IL-6 can bind to interleukin-6 receptor (IL-6R) , which leads to the recruiting and activation of glycoprotein 130, and then the formed IL-6/IL-6R/gp130 complex triggers the janus kinase/signal transducer and activator of transcription, Src homology-2 domain-containing protein tyrosine phosphatase-2/mitogen-activated protein kinase, and phosphatidylinositol 3-kinase/protein kinase B signaling pathways. All of these signaling pathways are found to be involved in a variety of physiopathological processes. In the present review, information about the IL-6 signaling pathway and its role in air pollution-induced adverse health effects was systematically reviewed, hoping to provide insights for the future prevention and control policies.

Formation, reconstruction and prospect of pulmonary and critical care medicine in China / 中华医院管理杂志

The development of respiratory and critical care medicine from a combination and binding approach to a cross-integrated reconstruction of pulmonary and critical care medicine (PCCM) has become an inevitable trend and basic strategy for the high-quality development of respiratory medicine and actively responding to the prevention and control of major disease risks in China. The author analyzed the dilemmas and bottlenecks in the long-term development of traditional respiratory medicine in China and their causes, summarized the international experience in the establishment of modern respiratory disciplines, and systematically reviewed the development process of traditional respiratory disciplines in China to PCCM department.Finally, the author pointedly put forward some thoughts and prospects on leading the development of disciplines from personnel training, department construction and industry development, promoting the new business form of " integrated vertical and horizontal" disciplines with intelligent information construction, and practicing the concept of population medicine to improve the high-quality development of PCCM.

The Use of Casemix System to Estimate Providers' Inpatients' Cost of Influenza Related Sari Diseases in Malaysia

Introduction: @#Influenza is an upper respiratory infection is caused by the influenza virus. It occurs throughout the whole year in Malaysia with occasional outbreaks. Influenza-like illnesses (ILI) are generally treated as outpatient care while the more severe (SARI) is managed in patient care. The Casemix system, used in healthcare professionals' practices, may help in estimating the cost of influenza management. @*Methods: @#This cross-sectional study extracts the cost of influenza management from different public hospitals in years 2016, 2017 and 2018. Data used selected ICD-10 codes, and the cost was abstracted from Malaysian Diagnostic Related Groups (MyDRG) software. The secondary data are from 2 sources, an urban teaching hospital Hospital Cancellor Tuanku Muhriz (HCTM) and Ministry of Health (MoH) inpatient hospitals database. The sample size of the study was 586, while a structured datasheet collating patients' sociodemographic data and cost of admission, per case, was obtained from the MyDRG software. Microsoft Excel and SPSS software were used in the analysis. @*Results: @#Most influenza cases (61.8%) are between the ages of 0 and 10, Malays, and have similar gender proportions. Overall, the influenza treatment cost for inpatient care, totalled to RM 294,017,112. In 2018, the GDP for health consumed 3.76% of Malaysia's GDP income of RM 1.4 trillion, with an estimated RM 60,339 million used for health. Thus, the three-year public cost consumed 0.5% of 2018 GDP.@*Conclusion: @#Influenza screening at the primary healthcare setting, health education and treatment compliance should be scale-up to minimize the cost of influenza management of the public providers.

The damaging effect of ozone in the respiratory system / 中国职业医学

The global issue of ozone pollution is becoming increasingly prominent. Previous epidemiological studies suggested that ozone might cause respiratory system damage and increase the risk of mortality from all causes, as well as respiratory diseases such as chronic obstructive pulmonary disease and pneumonia. It results in severe illness and economic burden. Ozone can also lead to lung inflammation, asthma, and chronic obstructive pulmonary disease, increasing susceptibility to pathogen infections and affecting lung development. Some studies have observed upregulated of serum amyloid-like protein A and neutrophil chemotactic keratinocyte chemoattractant in mice exposed to ozone, along with increased percentage of polymorphonuclear leukocytes, total protein, oxidative proteins, lactate, and phospholipids in bronchoalveolar lavage fluid. Ozone exposure could cause enlarged alveolar spaces, granulocyte infiltration, type 2 inflammation, mucus obstruction, and metaplasia of mucus cells in the lungs of mice. When mass concentration of ozone was 1.962 mg/m3, rats showed necrosis and detachment of bronchial ciliated cells, swelling of type 1 alveolar epithelial cells, disruption of endothelium in capillaries, and increased emptying of type 2 alveolar epithelial cells. At a mass concentration of 5.886 mg/m3, monkeys showed degeneration or complete loss of the inner layers of alveolar epithelium, partial pulmonary interstitial edema, and thickening of the blood-air barrier. Ozone could induce oxidative stress, leading to increased oxidative stress response in cells. Particular attention should be paid to personal protection for workers exposed to ozone, researches on the mechanisms related to ozone, as well as the development of corresponding treatments, preventive drugs, and medical devices.

Infecciones respiratorias recurrentes en paciente escolar, asociadas a Síndrome de Mounier-Khün: reporte de caso / Recurrent respiratory infections associated with Mounier-Khün Syndrome in a school patient: clinical case report / Infecções respiratórias recorrentes associadas à Síndrome de Mounier-Khün num paciente escolar: relato do caso

El síndrome de Mounier Kühn es una patología infrecuente de la vía aérea, caracterizada por una dilatación anormal de tráquea y bronquios. Se debe sospechar ante la presencia de infecciones broncopulmonares recurrentes e irritación traqueobronquial. El diagnóstico se lleva a cabo a través de la medición del diámetro traqueal en tres segmentos de su anatomía, a través de tomografía torácica. Se presenta el caso de un paciente masculino escolar de 10 años de edad, con antecedentes de infecciones respiratorias recurrentes, hospitalizado por un cuadro neumónico; los hallazgos reportados en la tomografía de tórax corresponden a traqueobroncomegalia además de incremento del diámetro esofágico. El tratamiento de esta entidad es sintomático con medidas de sostén y fisioterapia pulmonar.

Mounier Kühn syndrome is a rare airway pathology characterized by abnormal dilatation of the trachea and bronchi. It should be suspected in the presence of recurrent bronchopulmonary infections and tracheobronchial irritation. The diagnosis is made by measuring the tracheal diameter in three segments of its anatomy, through thoracic tomography. We present the case of a 10 year-old male school boy with a history of recurrent respiratory infections, hospitalized for a pneumonic condition; the findings reported in the thoracic tomography correspond to a tracheobronchomegaly in addition to an increase of the esophageal diameter. The treatment of this entity is symptomatic with supportive measures and pulmonary physical therapy.

A síndrome de Mounier Kühn é uma patologia incomumdas vias aéreas, caracterizada por dilatação anormal da traqueia e brônquios. Devese suspeitar na presença de infecções broncopulmonares recorrentes e irritação traqueobrônquica. O diagnóstico é realizado através da medida do diâmetro traqueal em três segmentos de sua anatomia, através da tomografia de tórax. Apresentamos o caso de um paciente escolar de 10 anos de idade, do sexo masculino, com história de infecções respiratórias de repetição, internado por sintomas pneumônicos; os achados relatados na tomografia de tórax correspondem a uma traqueobroncomegalia, além de aumento do diâmetro esofágico. O tratamento dessa entidade é sintomático com medidas de suporte e fisioterapia pulmonar.