Related Articles

Hepatopulmonary syndrome: What we know and what we would like to know.

World J Gastroenterol. 2016 Jul 7;22(25):5728-41

Authors: Grilo-Bensusan I, Pascasio-Acevedo JM

Abstract
Hepatopulmonary syndrome (HPS) is characterized by abnormalities in blood oxygenation caused by the presence of intrapulmonary vascular dilations (IPVD) in the context of liver disease, generally at a cirrhotic stage. Knowledge about the subject is still only partial. The majority of the information about the etiopathogenesis of HPS has been obtained through experiments on animals. Reported prevalence in patients who are candidates for a liver transplantation (LT) varies between 4% and 32%, with a predominance of mild or moderate cases. Although it is generally asymptomatic it does have an impact on their quality of life and survival. The diagnosis requires taking an arterial blood gas sample of a seated patient with alveolar-arterial oxygen gradient (AaO2) ≥ 15 mm Hg, or ≥ 20 mm Hg in those over 64 years of age. The IPVD are identified through a transthoracic contrast echocardiography or a macroaggregated albumin lung perfusion scan ((99m)Tc-MAA). There is currently no effective medical treatment. LT has been shown to reverse the syndrome and improve survival rates, even in severe cases. Therefore the policy of prioritizing LT would appear to increase survival rates. This paper takes a critical and clinical look at the current understanding of HPS, as well as the controversies surrounding it and possible future research.

PMID: 27433086 [PubMed - in process]

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Clinical Presentation and Outcomes of Middle East Respiratory Syndrome in the Republic of Korea.

Infect Chemother. 2016 Jun;48(2):118-26

Authors: Choi WS, Kang CI, Kim Y, Choi JP, Joh JS, Shin HS, Kim G, Peck KR, Chung DR, Kim HO, Song SH, Kim YR, Sohn KM, Jung Y, Bang JH, Kim NJ, Lee KS, Jeong HW, Rhee JY, Kim ES, Woo H, Oh WS, Huh K, Lee YH, Song JY, Lee J, Lee CS, Kim BN, Choi YH, Jeong SJ, Lee JS, Yoon JH, Wi YM, Joung MK, Park SY, Lee SH, Jung SI, Kim SW, Lee JH, Lee H, Ki HK, Kim YS, Korean Society of Infectious Diseases

Abstract
BACKGROUND: From May to July 2015, the Republic of Korea experienced the largest outbreak of Middle East respiratory syndrome (MERS) outside the Arabian Peninsula. A total of 186 patients, including 36 deaths, had been diagnosed with MERS-coronavirus (MERS-CoV) infection as of September 30th, 2015.
MATERIALS AND METHODS: We obtained information of patients who were confirmed to have MERS-CoV infection. MERS-CoV infection was diagnosed using real-time reverse-transcriptase polymerase chain reaction assay.
RESULTS: The median age of the patients was 55 years (range, 16 to 86). A total of 55.4% of the patients had one or more coexisting medical conditions. The most common symptom was fever (95.2%). At admission, leukopenia (42.6%), thrombocytopenia (46.6%), and elevation of aspartate aminotransferase (42.7%) were observed. Pneumonia was detected in 68.3% of patients at admission and developed in 80.8% during the disease course. Antiviral agents were used for 74.7% of patients. Mechanical ventilation, extracorporeal membrane oxygenation, and convalescent serum were employed for 24.5%, 7.1%, and 3.8% of patients, respectively. Older age, presence of coexisting medical conditions including diabetes or chronic lung disease, presence of dyspnea, hypotension, and leukocytosis at admission, and the use of mechanical ventilation were revealed to be independent predictors of death.
CONCLUSION: The clinical features of MERS-CoV infection in the Republic of Korea were similar to those of previous outbreaks in the Middle East. However, the overall mortality rate (20.4%) was lower than that in previous reports. Enhanced surveillance and active management of patients during the outbreak may have resulted in improved outcomes.

PMID: 27433382 [PubMed]

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Cardiorespiratory Response to Different Exercise Tests in Interstitial Lung Disease.

Med Sci Sports Exerc. 2016 Jul 18;

Authors: Chéhère B, Bougault V, Gicquello A, Wallaert B

Abstract
INTRODUCTION: The 6-minute stepper test (6MST) has been used as an alternative to the 6-minute walk test (6MWT) to assess exercise tolerance in patients with interstitial lung disease (ILD). Recent data suggest that the tests may involve different energy pathways and cardiorespiratory responses. We thus aimed to compare the cardiorespiratory responses of ILD patients during the 6MWT and the 6MST.
METHODS: Thirty-one patients with ILD were randomised to perform both tests in the order 6MST→6MWT (n=16) or 6MWT→6MST (n=15). Gas exchange, heart rate, and pulse O2 saturation (SpO2) were measured continuously, and dyspnoea, leg discomfort, and blood lactate concentration were assessed before and immediately after each test.
RESULTS: Oxygen uptake (VO2) was lower (p=0.002) and respiratory equivalent ratio for O2 (VE/VO2) and respiratory exchange ratios were higher (both p<0.001) during the 6MST compared with the 6MWT. The 6MST was also associated with higher blood lactate concentrations (6MST 4.16±1.95 mmol·L, 6MWT 2.84±1.17 mmol·L; p=0.01), higher leg discomfort scores (6MST 5±3 points, 6MWT 3±2 points; p<0.001), and smaller decreases in SpO2 (6MST -5±5%, 6MWT -9±6%; p<0.001).
CONCLUSIONS: ILD patients exhibited greater ventilatory responses and lower arterial O2 desaturation during the 6MST compared with the 6MWT. The higher lactate concentrations and perceived muscle fatigue observed during the 6MST may indicate the presence of inter-test differences in active muscle metabolism that could contribute to the distinct cardiorespiratory responses.

PMID: 27434081 [PubMed - as supplied by publisher]

The advent of biodegradable polymer-encapsulated drug nanoparticles has made the pulmonary route of administration an exciting area of drug delivery research.

Chitosan, a natural biodegradable and biocompatible polysaccharide has received enormous attention as a carrier for drug delivery. Recently, nanoparticles of chitosan (CS) and its synthetic derivatives have been investigated for the encapsulation and delivery of many drugs with improved targeting and controlled release. Herein, recent advances in the preparation and use of micro-/nanoparticles of chitosan and its derivatives for pulmonary delivery of various therapeutic agents (drugs, genes, vaccines) are reviewed.

Although chitosan has wide applications in terms of formulations and routes of drug delivery, this review is focused on pulmonary delivery of drug-encapsulated nanoparticles of chitosan and its derivatives. In addition, the controversial toxicological effects of chitosan nanoparticles for lung delivery will also be discussed.