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Preoperative evaluation of the patient with pulmonary disease.

BACKGROUND AND OBJECTIVES: In daily clinical practice, pulmonary complications related to surgical procedure are common, increasing the morbidity and mortality of patients. Assessment of the risk of pulmonary complications is an important step in the preoperative evaluation. Thus, we review the most relevant aspects of preoperative assessment of the patient with lung disease.

CONTENT: Pulmonary risk stratification depends on clinical symptoms and patient's physical status. Age, preexisting respiratory diseases, nutritional status, and continued medical treatment are usually more important than additional tests. Pulmonary function tests are of great relevance when high abdominal or thoracic procedures are scheduled, particularly when lung resection are considered.

CONCLUSION: Understanding the perioperative evaluation of the potential risk for developing pulmonary complication allows the medical team to choose the adequate anesthetic technique and surgical and clinical care required by each patient, thereby reducing adverse respiratory outcomes.

A steroid-mimicking nanomaterial that mediates inhibition of human lung mast cell responses.

Water-soluble fullerenes can be engineered to regulate activation of mast cells (MC) and control MC-driven diseases in vivo. To further understand their anti-inflammatory mechanisms a C70-based fullerene conjugated to four myo-inositol molecules (C70-I) was examined in vitro for its effects on the signaling pathways leading to mediator release from human lung MC.

The C70-I fullerene stabilize MC and act synergistically with long-acting β2-adrenergic receptor agonists (LABA) to enhance inhibition of MC mediator release through FcεRI-simulation. The inhibition was paralleled by the upregulation of dual-specificity phosphatase one (DUSP1) gene and protein levels. Concomitantly, increases in MAPK were blunted in C70-I treated cells. The increase in DUSP1 expression was due to the ability of C70-I to prevent the ubiquitination and degradation of DUSP1.

These findings identify a mechanism of how fullerenes inhibit inflammatory mediator release from MC and suggest they could potentially be an alternative therapy for steroid resistant asthmatics.

Polymer nanoparticle-based controlled pulmonary drug delivery.

The development of novel formulations for controlled pulmonary drug delivery purposes has gained remarkable interest in medicine. Although nanomedicine represents attractive concepts for the treatment of numerous systemic diseases, scant information is available on the controlled drug release characteristics of colloidal formulations following lung administration, which might be attributed to the lack of methods to follow their absorption and distribution behavior in the pulmonary environment.

In this chapter, we describe the methods of preparation and characterization of drug-loaded polymeric nanoparticles prepared from biodegradable charge-modified branched polyesters, aerosolization of the nanosuspensions using a vibrating-mesh nebulizer, and evaluation of the pulmonary pharmacokinetics (i.e., absorption and distribution characteristics) of the nanoscale drug delivery vehicles following aerosol delivery to the airspace of an isolated lung model.

The disclosed methodology may contribute to the design of advanced colloids for the treatment of respiratory disorders.

Pulmonary rehabilitation: A regional perspective evidenced-based review.

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Pulmonary rehabilitation: A regional perspective evidenced-based review.

Ann Thorac Med. 2014 Jan;9(1):3-7

Authors: Al Moamary MS, Alorainy H, Al-Hajjaj MS

Abstract
Pulmonary rehabilitation (PR) is an integral component of the comprehensive management plan of patients with chronic lung diseases by addressing their functional and psychological deficits. PR is generally recommended to symptomatic patients with chronic lung diseases who develop shortness of breath on their own pace at level ground while receiving optimum therapy. From a regional perspective, this review covers the description of a PR program, its establishment and outcome assessment.

PMID: 24551010 [PubMed]

DNA nanoparticle-mediated thymulin gene therapy prevents airway remodeling in experimental allergic asthma.

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DNA nanoparticle-mediated thymulin gene therapy prevents airway remodeling in experimental allergic asthma.

J Control Release. 2014 Feb 17;

Authors: da Silva AL, Martini SV, Abreu SC, Samary CD, Diaz BL, Fernezlian S, de Sá VK, Capelozzi VL, Boylan NJ, Goya RG, Suk JS, Rocco PR, Hanes J, Morales MM

Abstract
Thymulin has been shown to present anti-inflammatory and anti-fibrotic properties in experimental lung diseases. We hypothesized that a biologically active thymulin analog gene, methionine serum thymus factor, delivered by highly compacted DNA nanoparticles composed of single molecule of plasmid DNA compacted with block copolymers of poly-l-lysine and polyethylene glycol (CK30PEG) that have been found safe in a human phase I clinical trial, may prevent lung inflammation and remodeling in a mouse model of allergic asthma. Thymulin plasmids were detected in the lungs of ovalbumin-challenged asthmatic mice up to 27days after administration of DNA nanoparticles carrying thymulin plasmids. A single dose of DNA nanoparticles carrying thymulin plasmids prevented lung inflammation, collagen deposition and smooth muscle hypertrophy in the lungs of a murine model of ovalbumin-challenged allergic asthma, leading to improved lung mechanics. In the present model of chronic allergic asthma, highly compacted DNA nanoparticles using thymulin analog gene modulated the inflammatory and remodeling processes improving lung mechanics.

PMID: 24556417 [PubMed - as supplied by publisher]

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