Impacto da técnica de expiração lenta e prolongada na mecânica respiratória de lactentes sibilantes

OBJECTIVE: To evaluate changes in respiratory mechanics and tidal volume (V T) in wheezing infants in spontaneous ventilation after performing the technique known as the prolonged, slow expiratory (PSE) maneuver. METHODS: We included infants with a history of recurrent wheezing and who had had no exacerbations in the previous 15 days. For the assessment of the pulmonary function, the infants were sedated and placed in the supine position, and a face mask was used and connected to a pneumotachograph. The variables of tidal breathing (V T and RR) as well as those of respiratory mechanics-respiratory system compliance (Crs), respiratory system resistance (Rrs), and the respiratory system time constant (prs)-were measured before and after three consecutive PSE maneuvers. RESULTS: We evaluated 18 infants. The mean age was 32 ± 11 weeks. After PSE, there was a significant increase in V T (79.3 ± 15.6 mL vs. 85.7 ± 17.2 mL; p = 0.009) and a significant decrease in RR (40.6 ± 6.9 breaths/min vs. 38.8 ± 0,9 breaths/min; p = 0.042). However, no significant differences were found in the variables of respiratory mechanics (Crs: 11.0 ± 3.1 mL/cmH2O vs. 11.3 ± 2.7 mL/cmH2O; Rrs: 29.9 ± 6.2 cmH2O mL-1 s-1 vs. 30.8 ± 7.1 cmH2O mL-1 s-1; and prs: 0.32 ± 0.11 s vs. 0.34 ±0.12 s; p > 0.05 for all). CONCLUSIONS: This respiratory therapy technique is able to induce significant changes in V T and RR in infants with recurrent wheezing, even in the absence of exacerbations. The fact that the variables related to respiratory mechanics remained unchanged indicates that the technique is safe to apply in this group of patients. Studies involving symptomatic infants are needed in order to quantify the functional effects of the technique.OBJETIVO: Avaliar as alterações da mecânica respiratória e do volume corrente (VC) em lactentes sibilantes em ventilação espontânea após a realização da técnica de expiração lenta e prolongada (ELPr). MÉTODOS: Foram incluídos no estudo lactentes com história de sibilância recorrente e sem exacerbações nos 15 dias anteriores. Para a avaliação da função pulmonar, os lactentes foram sedados e posicionados em decúbito dorsal com máscara facial acoplada a um pneumotacógrafo. As variáveis da respiração corrente - VC e FR - e da mecânica respiratória - complacência do sistema respiratório (Csr), resistência (Rsr) e constante de tempo (psr) - foram mensuradas antes e após a realização de três sequências consecutivas de ELPr. RESULTADOS: Foram avaliados 18 lactentes, com média de idade de 32 ± 11 semanas. Houve um aumento significante no VC após ELPr (79,3 ± 15,6 mL vs. 85,7 ± 17,2 mL; p = 0,009), assim como uma redução na FR (40,6 ± 6,9 ciclos/min vs. 38,8 ± 0,9 ciclos/min; p = 0,042). Entretanto, não houve alterações significantes nos valores da mecânica respiratória (Csr: 11,0 ± 3,1 mL/cmH2O vs. 11,3 ± 2,7 mL/cmH2O; Rsr: 29,9 ± 6,2 cmH2O mL-1 s-1 vs. 30,8 ± 7,1 cmH2O mL-1 s-1; e psr: 0,32 ± 0,11 s vs. 0,34 ± 0,12 s; p > 0,05 para todos). CONCLUSÕES: Essa técnica de fisioterapia respiratória é capaz de induzir alterações significativas no VC e na FR de lactentes com sibilância recorrente, mesmo na ausência de exacerbações. A manutenção das variáveis da mecânica respiratória indica que a técnica é segura para ser aplicada nesse grupo de pacientes. Estudos com lactentes sintomáticos são necessários para quantificar os efeitos funcionais da técnica.Universidade Nove de Julho Programa de Pós Graduação em Ciências da ReabilitaçãoUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de PediatriaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaHospital Israelita Albert Einstein Setor de Pediatria e NeonatologiaUNIFESP, EPM, Depto. de PediatriaUNIFESP, EPMSciEL

Un indicateur de pollution à mémoire. L'analyse des métaux dans les sédiments de rivière

La présente note rappelle brièvement qu'à l'aval d'un rejet de métaux en rivière, ceux-ci s'adsorbent rapidement sur les particules en suspension et si les conditions de vitesse du courant le permettent, celles-ci sédimentent au fond de la rivière constituant ainsi un témoin des rejets. Les principaux résultats d'une expérience de mise en évidence de ce phénomène dans le cas du mercure sont décrits. A partir de deux séries de résultats de campagnes d'analyses de métaux les sédiments de deux bassins : l'Oise et l'Yerres aval, on a montré que ceux-ci étaient parfaitement cohérents avec la localisation des principaux rejets polluants répertoriés dans ces bassins, illustrant ainsi l'intérêt de cette méthode comme indicateur de pollution

Monitoring of therapy for mucopolysaccharidosis Type I Using dysmorphometric facial phenotypic signatures

There is a pattern of progressive facial dysmorphology in mucopolysaccharidosis type I (MPS I). Advances in 3D facial imaging have facilitated the development of tools, including dysmorphometrics, to objectively and precisely detect these facial phenotypes. Therefore, we investigated the application of dysmorphometrics as a noninvasive therapy-monitoring tool, by longitudinally scoring facial dysmorphology in a child with MPS I receiving enzyme replacement therapy (ERT) and bone marrow transplantation (BMT). Both dysmorphometric measures showed a decreasing trend, and the greatest differences were found in the severity of facial discordance (Z-RMSE), displaying scores >3 SD higher than the mean at their peak, in comparison to Z-RSD scores that mostly fell within the normative range (maximum; 1.5 SD from the mean). In addition to the general trend of reduced facial dysmorphology with treatment, initial fluctuations were also evident that may have related to transient subcutaneous facial fluctuations, in the context of conditioning for bone marrow transplant. These findings support the potential of our approach as a sensitive, noninvasive, and rapid means of assessing treatment response or failure in clinical trials, and for established therapies, and would be applicable for other inherited disorders of metabolism

LPS binding protein and activation signatures are upregulated during asthma exacerbations in children

Asthma exacerbations in children are associated with respiratory viral infection and atopy, resulting in systemic immune activation and infiltration of immune cells into the airways. The gene networks driving the immune activation and subsequent migration of immune cells into the airways remains incompletely understood. Cellular and molecular profiling of PBMC was employed on paired samples obtained from atopic asthmatic children (n = 19) during acute virus-associated exacerbations and later during convalescence. Systems level analyses were employed to identify coexpression networks and infer the drivers of these networks, and validation was subsequently obtained via independent samples from asthmatic children. During exacerbations, PBMC exhibited significant changes in immune cell abundance and upregulation of complex interlinked networks of coexpressed genes. These were associated with priming of innate immunity, inflammatory and remodelling functions. We identified activation signatures downstream of bacterial LPS, glucocorticoids and TGFB1. We also confirmed that LPS binding protein was upregulated at the protein-level in plasma. Multiple gene networks known to be involved positively or negatively in asthma pathogenesis, are upregulated in circulating PBMC during acute exacerbations, supporting the hypothesis that systemic pre-programming of potentially pathogenic as well as protective functions of circulating immune cells preceeds migration into the airways. Enhanced sensitivity to LPS is likely to modulate the severity of acute asthma exacerbations through exposure to environmental LPS. © 2023, The Author(s).Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

CD14 C-159T and early infection with Pseudomonas aeruginosa in children with cystic fibrosis

Early acquisition of Pseudomonas aeruginosa is associated with a poorer prognosis in patients with cystic fibrosis. We investigated whether polymorphisms in CD14, the lipopolysaccharide receptor, increase the risk of early infection. Forty-five children with cystic fibrosis were investigated with annual bronchoalveolar lavage (BAL) and plasma sCD14 levels. Plasma sCD14 levels were significantly lower in children from whom P. aeruginosa was subsequently isolated (492.75 mu g/ml vs. 1339.43 mu g/ml, p = 0.018). Those with the CD14 - 159CC genotype had a significantly increased risk of early infection with P. aeruginosa suggesting that CD14 C-159T plays a role in determining the risk of early infection with P. aeruginosa