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Topic Review
Role of Short-Chain Fatty Acids in COPD
Chronic obstructive pulmonary disease (COPD) is a widespread socially significant disease. The development of COPD involves the innate immune system. The regulation of the innate lung immune system is related to the gut microbiota. This connection is due to the production by gut microorganisms of short-chain fatty acids (SCFAs) such as acetate, propionate, and butyrate. Nutritional disturbances and changes in the structure of the intestinal microbiota lead to a decrease in SCFAs production and their effect on pulmonary immunity. The presence of a metabolic and immune axis linking the lungs and gut plays an important role in the pathogenesis of COPD. 
  • 1.5K
  • 27 Jul 2022
Topic Review
Aspiration Pneumonia and Dysphagia in the Elderly
Pneumonia in the elderly has been increasing on an annual basis. To a greater or lesser extent, aspiration is a major contributor to the development of pneumonia in the elderly. Antimicrobials alone are not sufficient for the treatment of pneumonia, and the condition may become intractable or even recur repeatedly. In addition, some patients with pneumonia may have no problems with eating, while others are unable to receive the necessary nutrition due to severe dysphagia. It has been found that pneumonia decreases both the muscle mass and strength of the swallowing and respiratory muscles, a condition named pneumonia-associated sarcopenia. This contributes to a pathophysiological time-axis of aspiration pneumonia and dysphagia in the elderly, in which silent aspiration leads to the development of pneumonia, and further to dysphagia, malnutrition, and low immunity. 
  • 1.5K
  • 09 Oct 2022
Topic Review
HRCT of Drug-Induced ILD
Interstitial Lung Diseases (ILDs) represent a heterogeneous group of pathologies, which may be related to different causes. A low percentage of these lung diseases may be secondary to the administration of drugs or substances. Several different high resolution computed tomography (HRCT) patterns related to pulmonary drug toxicity have been reported in literature, and the most frequent ILDs patterns reported include Nonspecific Interstitial Pneumonia (NSIP), Usual Interstitial Pneumonia (UIP), Hypersensitivity Pneumonitis (HP), Organizing Pneumonia (OP), Acute Respiratory Distress Syndrome (ARDS), and Diffuse Alveolar Damage (DAD). 
  • 1.5K
  • 14 Jul 2021
Topic Review
Diagnosing Primary Ciliary Dyskinesia
Primary Ciliary Dyskinesia (PCD) is a rare, under-recognized disease that affects respiratory ciliary function, resulting in chronic oto-sino-pulmonary disease. The PCD clinical phenotype overlaps with other common respiratory conditions and no single diagnostic test detects all forms of PCD. In 2018, PCD experts collaborated with the American Thoracic Society (ATS) to create a clinical diagnostic guideline for patients across North America, specifically considering the local resources and limitations for PCD diagnosis in the United States and Canada. Nasal nitric oxide (nNO) testing is recommended for first-line testing in patients ≥5 years old with a compatible clinical phenotype; however, all low nNO values require confirmation with genetic testing or ciliary electron micrograph (EM) analysis. Furthermore, these guidelines recognize that not all North American patients have access to nNO testing and isolated genetic testing is appropriate in cases with strong clinical PCD phenotypes. For unresolved diagnostic cases, referral to a PCD Foundation accredited center is recommended.
  • 1.5K
  • 26 Jul 2021
Topic Review
Congenital Lung Malformations
Congenital lung malformations arise during development and include numerous anatomical anomalies of the lung and respiratory tree. They are usually detected prenatally by ultrasonography and comprise congenital pulmonary airway malformation (CPAM), bronchopulmonary sequestration (BPS), bronchogenic cysts (BC), and more rarely bronchial atresia, congenital lobar emphysema (CLE), and congenital tracheal obstruction. This entry focuses on the molecular and genetic determinants of the most frequent anomalies: CPAM, BPS, and BC. Congenital diaphragmatic hernia (CDH) is not usually included in this group; however, since the lung is also highly affected in this condition, we have also incorporated evidence related to lung hypoplasia.
  • 1.5K
  • 30 Nov 2021
Topic Review
Treatment Drugs for Silicosis
Silicosis, characterized by irreversible pulmonary fibrosis, remains a major global public health problem. Cumulative studies are focusing on elucidating the pathogenesis of silicosis in order to identify preventive or therapeutic antifibrotic agents. However, the existing research on the mechanism of silica-dust-induced pulmonary fibrosis is only the tip of the iceberg and lags far behind clinical needs. Idiopathic pulmonary fibrosis (IPF), as a pulmonary fibrosis disease, also has the same problem.
  • 1.5K
  • 15 Jun 2023
Topic Review
COPD T-cells and Comorbidity Biomarkers
In smoking-induced chronic obstructive pulmonary disease (COPD), various comorbidities are linked to systemic inflammation and infection-induced exacerbations. The underlying mechanisms are unclear but might provide therapeutic targets. T-cell activity is central in systemic inflammation and for infection-defense mechanisms and might be influenced by comorbidities. Hypothesis: Circulating biomarkers of comorbidities modulate the activity of T-cells of the T-helper type 1 (Th1) and/or T-cytotoxic type 1 (Tc1). T-cells in peripheral blood mononuclear cells (PBMCs) from non-smokers (NS), current smokers without COPD (S), and COPD subjects (total n = 34) were ex vivo activated towards Th1/Tc1 and were then stimulated with biomarkers for metabolic and/or cardiovascular comorbidities (Brain Natriuretic Peptide, BNP; chemokine (C-C motif) ligand 18, CCL18; C-X3-C motif chemokine ligand 1, CX3CL1; interleukin-18, IL-18) or for asthma- and/or cancer-related comorbidities (CCL22; epidermal growth factor, EGF; IL-17; periostin) each at 10 or 50 ng/mL. The Th1/Tc1 activation markers interferon-γ (IFNγ), tumor necrosis factor-α (TNFα), and granulocyte-macrophage colony-stimulating factor (GM-CSF) were analyzed in culture supernatants by Enzyme-Linked Immunosorbent Assay (ELISA). Ex-vivo activation induced IFNγ and TNFα without differences between the groups but GM-CSF more in S vs. NS. At 10 ng/mL, the different biomarkers increased or reduced the T-cell activation markers without a clear trend for one direction in the different categories of comorbidities or for the different T-cell activation markers. At 50 ng/mL, there was a clear shift towards suppressive effects, particularly for the asthma— and cancer-related biomarkers and in cells of S and COPD. Comorbidities might suppress T-cell immunity in COPD. This could explain the association of comorbidities with frequent exacerbations.
  • 1.5K
  • 14 Jul 2021
Topic Review
Vitamin K in Chronic Obstructive Pulmonary Disease
Although defined by the presence of airflow obstruction and respiratory symptoms, patients with chronic obstructive pulmonary disease (COPD) are characterized by multimorbidity. Numerous co-occurring conditions and systemic manifestations contribute to the clinical presentation and progression of COPD. Vitamin A and vitamin D have been related to COPD pathogenesis. Another fat-soluble vitamin, vitamin K, has been put forward to exert protective roles in COPD. Vitamin K is an unequivocal cofactor for the carboxylation of coagulation factors, but also for extra-hepatic proteins including the soft tissue calcification inhibitor matrix Gla-protein and the bone protein osteocalcin.
  • 1.4K
  • 10 May 2023
Topic Review
The Mechanisms Underlying Vertical Artifacts in Lung Ultrasound
The recent advances in lung ultrasound for the diagnosis of cardiogenic pulmonary edema are outstanding; however, the mechanism of vertical artifacts known as B-lines used for the diagnosis has not yet been fully elucidated. The theory of “acoustic trap” is useful when considering the generation of vertical artifacts. Basic research in several studies supports the theory. Published studies with pilot experiments indicate that clarification of the relationship between the length and intensity of vertical artifacts and physical or acoustic composition of sources may be useful for differentiating cardiogenic pulmonary edema from lung diseases. There is no international consensus with regard to the optimal settings of ultrasound machines even though their contribution to the configuration of vertical artifacts is evident. In the clinical setting, the configuration is detrimentally affected by the use of spatial compound imaging, the placement of the focal point at a deep level, and the use of multiple focus. Simple educational materials using a glass microscope slide also show the non-negligible impact of the ultrasound machine settings on the morphology of vertical artifacts.
  • 1.4K
  • 29 Apr 2022
Topic Review
Connective Tissue Growth Factor in Idiopathic Pulmonary Fibrosis
Connective Tissue Growth Factor, also known as the cellular communication network 2 (CCN2), is a TGF-β-target gene and a member of the CCN family of secreted proteins that regulate matricellular protein. Matricellular proteins are expressed at higher levels during physiological and pathological processes, with distinct functions that bind to multiple receptors, other growth factors, and proteases, modulating their activity and mediating cross-talk between the ECM and cells. Idiopathic Pulmonary Fibrosis is a chronic, devastating, irreversible lung disease, characterized by injury-induced alveolar epithelial cell stress, progressive pathogenic myofibroblast differentiation, and imbalanced macrophage polarization, resulting in ECM deposition. 
  • 1.3K
  • 04 Jul 2022
Topic Review
Diagnosis and Treatment of Sleep Apnea in Children
Obstructive sleep apnea (OSA) in children is a prevalent, but still, today, underdiagnosed illness, which consists of repetitive episodes of upper airway obstruction during sleep with important repercussions for sleep quality. OSA has relevant consequences in the pediatric population, mainly in the metabolic, cardiovascular (CV), and neurological spheres. However, contrary to adults, advances in diagnostic and therapeutic management have been scarce in the last few years despite the increasing scientific evidence of the deleterious consequences of pediatric OSA. The problem of underdiagnosis and the lack of response to treatment in some groups make an update to the management of OSA in children necessary. Probably, the heterogeneity of OSA is not well represented by the classical clinical presentation and severity parameters (apnea/hypopnea index (AHI)), and new strategies are required. A specific and consensus definition should be established. Additionally, the role of simplified methods in the diagnosis algorithm should be considered. Finally, the search for new biomarkers for risk stratification is needed in this population. In conclusion, new paradigms based on personalized medicine should be implemented in this population. 
  • 1.3K
  • 21 Jun 2023
Topic Review
Chest Imaging in Viral Pneumonia
Viral pneumonia is one the most frequent respiratory diseases among very young people and the elderly, contributing to an increase in the number of hospitalizations and deaths, mainly in subjects over 60 years of age. To assess the presence of pulmonary involvement and extension of disease, diagnostic imaging techniques are traditional chest radiographs (CXR) and computed tomography (CT). CXR may show a negative radiological pattern or otherwise areas of monolateral or bilateral consolidations, in association with nodular opacities, bronchial wall thickening, and small pleural effusions.
  • 1.3K
  • 02 Jul 2021
Topic Review
Asthma Pathogenesis
Asthma is a widespread chronic disease of the bronchopulmonary system with a heterogeneous course due to the complex etiopathogenesis. Natural-climatic and anthropogenic factors play an important role in the development and progression of this pathology. 
  • 1.3K
  • 28 Jul 2021
Topic Review
Non-Invasive Drug Delivery through Respiratory Routes
With rapid and non-invasive characteristics, the respiratory route of administration has drawn significant attention compared with the limitations of conventional routes. Respiratory delivery can bypass the physiological barrier to achieve local and systemic disease treatment.
  • 1.3K
  • 28 Sep 2022
Topic Review
Idiopathic Pulmonary Fibrosis and Lipid Metabolism
It has become evident that lipid metabolism is involved in the fibrosis of lungs, and various reports have been made at the cellular level as well as at the organic level. The balance among eicosanoids, sphingolipids, and lipid composition has been reported to be involved in fibrosis, with particularly close attention being paid to a bioactive lipid “lysophosphatidic acid (LPA)” and its pathway.
  • 1.3K
  • 20 Feb 2023
Topic Review
Helicobacter pylori and Respiratory Diseases
Helicobacter pylori (H. pylori) is a Gram-negative bacterium involved in the development of gastritis, peptic ulcer disease, gastric adenocarcinoma, and gastric mucosa-associated lymphoid tissue. Unexplained iron deficiency anemia, idiopathic thrombocytopenic purpura and vitamin B12 deficiency have also been related to H. pylori infection, whereas for other extra-gastric diseases, the debate is still open. In this entry, we evaluate and discuss the potential involvement of H. pylori infection in the pathogenesis of several respiratory diseases.
  • 1.2K
  • 28 Sep 2021
Topic Review
Management of Obstructive Sleep Apnea in Adults
Obstructive sleep apnea (OSA) is a common disease that is often under-diagnosed and under-treated in all ages. The conventional diagnostic and therapeutic approaches for adults with OSA are usually based on clinical assessments, followed by polysomnography (PSG) or respiratory polygraphy (RPG) in a sleep lab or at home (HSAT: home sleep apnea testing), and treatment decisions. With this approach, it could be unadvisable for physicians to decide the treatment approach for OSA without evaluating AHI.
  • 1.2K
  • 21 Dec 2022
Topic Review
Biomarkers of Allergic Asthma
Allergic asthma is the most common asthma phenotype and is characterized by IgE sensitization to airborne allergens and subsequent typical asthmatic symptoms after exposure. A form of type 2 (T2) airway inflammation underlies allergic asthma. It usually arises in childhood and is accompanied by multimorbidity presenting with the occurrence of other atopic diseases, such as atopic dermatitis and allergic rhinitis. Biomarkers identifying patients with allergic asthma include total immunoglobulin E (IgE) levels, fractional exhaled nitric oxide (FeNO) and serum eosinophil counts. 
  • 1.2K
  • 28 Jul 2022
Topic Review
Latent Tuberculosis Infection
Latent tuberculosis infection (LTBI) represents a subclinical, asymptomatic mycobacterial state affecting approximately 25% of the global population. The substantial prevalence of LTBI, combined with the risk of progressing to active tuberculosis, underscores its central role in the increasing incidence of tuberculosis (TB). Accurate identification and timely treatment are vital to contain and reduce the spread of the disease, forming a critical component of the global strategy known as “End TB.”
  • 1.2K
  • 04 Oct 2023
Topic Review
Melatonin in Disease and Health
Melatonin is a derivative of tryptophan, synthesized mainly in the pineal gland. Its synthesis is characterized by a regular circadian rhythm, with a peak concentration in plasma reached in the night hours. The intensity of melatonin production is related to exposure to light, with an increase of its synthesis in the dark part of the day.
  • 1.2K
  • 25 Aug 2021
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