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Background: Emergency general surgery (EGS) patients require urgent surgical evaluation and intervention for various conditions, such as infectious or obstructive diseases of the gastrointestinal tract. We aimed to characterize the structures and processes that are relevant to the delivery of EGS care across Ontario hospitals and to evaluate the availability of critical resources at hospitals with formal EGS models. Methods: Between August 2019 and July 2020, we conducted a cross-sectional survey of Ontario hospitals that offered urgent general surgery (defined as the ability to provide nonelective surgical intervention within 24 to 48 hours of presentation) to adults. People with intimate knowledge of their hospital’s EGS program completed a Web-based or telephone survey characterizing the program’s organizational structure and staffing, operating room availability, interventional radiology and interventional endoscopy availability, intensive care unit availability and staffing, and regional participation. Their responses were compiled and comparisons were made between hospitals with and without formal EGS models of care, as well as between hospitals based on size and academic status. Results: Of the 114 Ontario hospitals identified, 109 responded (95.6% response rate). A third (34.6%; n = 37/107) of hospitals had EGS models of care. Thirty-four of these (91.9%) were large (> 100-bed) institutions that would be likely to have increased resources. However, even for hospitals of similar size, those with EGS models had increased staffing levels compared to those without (clinical associates 17.6% [n = 3/17] v. 10.0% [n = 2/20]; nurse practitioners or physician assistants 27.8% [n = 5/18] v. 14.3% [n = 3/21]). They also had better access to diagnostic and interventional equipment (24/7 access to computed tomography 94.1% [n = 16/17] v. 69.2% [n = 18/26]), interventional radiology (88.9% [n = 16/18] v. 42.3% [n = 11/26]), endoscopy (100% [n = 18/18] v. 69.2% [n = 18/26]) and endoscopic retrograde cholangiopancreatography (77.8% [n = 14/18] v. 42.3% [n = 11/26]), as well as dedicated operating room time (72.2% [n = 13/18] v. 0% [n = 0/25]). Interpretation: The structures and processes available to care for patients requiring EGS in Ontario were highly variable between hospitals. Hospitals with formal EGS models were more likely to have access to key resources.

As we know that, Asthma and chronic obstructive pulmonary diseases are well characterized diseases, they can co-exist as asthma-COPD overlap (ACO). The co-existence of asthma-chronic obstructive pulmonary disease overlap (ACO) in chronic obstructive pulmonary disease (COPD) patients is often unrecognized. In patients with a primary diagnosis of COPD or Asthma, the identification of ACO has got implication for better prognosis and treatment. Such patients experience frequent exacerbations, poor quality of life, rapid decline in lung function and high mortality than COPD or Asthma alone. Inhalational steroids provide significant alleviation of symptoms in such patients and some studies suggest that the most severe patients may respond to biological agents indicated for severe asthma. Patients who have asthma with a COPD component tend to present with severe hypoxia because of Irreversible/fixed airway obstruction and impairment of the alveolar diffusion capacity by emphysematous changes. In contrast, patients with COPD who have an asthma component not only have exertional dyspnoea but also develop paroxysmal wheezing or dyspnoea at night or in the early morning. The criteria to diagnose asthma-COPD overlap (ACO) include positive bronchodilator response, sputum eosinophilia or previous diagnosis of asthma, high IgE and/or history of atopy. There is scarcity of literature available in country like India. We highlight the importance of identification of Asthma COPD overlap as different phenotype from COPD or asthma alone as it is challenging to diagnose ACO in India. We report 3 cases having both the features of asthma and COPD, later diagnosed with Asthma-COPD overlap.

Aim. The paper aims to evaluate the effectiveness of respiratory training as part of a comprehensive spa and medical rehabilitation. Materials and methods. Studies were performed in 90 patients with bronchial asthma and 60 patients with chronic cerebral ischemia. During physical training, New Breath breathing simulators were used. The effectiveness of medical rehabilitation was evaluated according to the severity of impaired body functions related to the corresponding domains of the International Classification of Functioning, Disability and Health. Results. Under rehabilitation, the condition of patients in both groups improved significantly, systemic rehabilitation effects in the form of improved indicators of the blood system and its oxygen transport functions, as well as increased reserves for handling stress and other psychological demands were notified. Conclusion. The study suggests the inclusion of physical exercises with the New Breath simulator in the comprehensive rehabilitation of patients with chronic cerebral ischemia and obstructive diseases of the respiratory system.

Inhalation therapy has revolutionized the care of patients with asthma and chronic obstructive pulmonary disease. The choice of the inhaler is based on the cooperation of the doctor and the patient, it is not only the selection of the drug and dose, but a complex process based on the individual assessment of the patient – symptoms, manual abilities and compliance. An important aspect is the quality of the inhaler, good experience with it, but also ease of use. It seems that for the benefit of the patient and to respect the choice of the physician, the pharmacist should not suggest replacing medications in inhaled formulas.

Background: Ultrasound is established as a diagnostic tool in salivary glands for obstructive diseases such as sialolithiasis and tumors. Concerning inflammatory diseases and in non-sialolithiasis-caused obstruction, much fewer data are available. In recent years, technical development has allowed a better assessment of the gland parenchyma, and knowledge about intraductal pathologies has increased considerably, which has provided new insights and a new interpretation of ultrasound findings. Objectives: To provide a comprehensive review of the literature that includes our own experiences and to point out the state of the art in ultrasound in the diagnostics of inflammatory and obstructive salivary gland diseases, taking adequate techniques and recent technical developments into consideration. Data sources and study eligibility criteria: A systematic literature search was performed in Pubmed using various specific key words. Results: According to the literature results, including our own experiences, ultrasound is of value in up to >90% of cases presenting with inflammatory and/or obstructive diseases. Technical developments (e.g., elastography) and the application of modified ultrasound techniques (e.g., transoral ultrasound) have contributed to these results. Today, ultrasound is considered a first-line diagnostic tool in these diseases. However, in some inflammatory diseases, the final diagnosis can be made only after inclusion of the anamnesis, clinical symptoms, serologic blood tests, or histopathologic investigation. Conclusions: Ultrasound can be considered as a first-line diagnostic tool in obstructive and inflammatory salivary gland diseases. In obstructive diseases, it may be sufficient for diagnostics in >90% of cases. In inflammatory diseases, ultrasound is at least an excellent screening method and can be used to establish the diagnosis in cases of an early suspicion. In all diseases ultrasound can contribute to better management and can be used for monitoring during follow-up.

We have refactored the Pulse Physiology Engine respiratory software with enhanced parameterization for improved simulation functionality and results. Realistic patient variability can be applied using discretized lumped-parameters that define lung volumes, compliances, and resistances. A new sigmoid compliance waveform helps meet validation of compartment pressures, flows, volumes, and substance values. Further parameterization and enhanced logic for the application of pathophysiology allows for more accurate modeling of both restrictive and obstructive diseases for mild, moderate, and severe cases.Clinical Relevance— This free and open model provides a well-validated respiratory system for integration with medical simulations and research. It improves the Pulse modeling software and allows for new, low-cost training and in silico testing use-cases. Applications include virtual/augmented environments, manikin-based simulations, and clinical explorations.

We showed the present data about the efficacy and safety of inhaled short-acting β2-agonists (SABA), such as salbutamol and fenoterol, in the management of obstructive diseases in children and adults. Our work discusses major mechanisms of action, clinical effects, possible side effects and indications of inhaled SABA. We presented current recommendations for the position of SABA in the therapy of obstructive diseases in children and adults, particularly in asthma and chronic obstructive pulmonary disease.

The article presents the experience of surgical treatment of 12 patients with pancreatic cancer who were treated at the clinic of the Department of Surgery No. 2 of the ONMEDU during 2017. As a preoperative diagnosis, an MRI scan was performed in these patients. In general, the intraoperative size of the tumor was not significantly different from MRI - sizes: the medians of their differences were only + 5.5 mm and + 3.5 mm for the average and maximum MRT sizes. The calculated sensitivity and specificity of the method of MRTand CT in the assessment of artery invasion was 83.3% and 71.4% respectively, in the assessment of vein invasion - up to 50.0% and 42.9%, respectively. The combination of MRI and CT with intravenous contrast is the best option for planning surgical tactics today.

The article presents modern standards for the diagnosis of intracranial hemorrhages (ICH) in premature and premature newborns. Possible causes of ICH, including premature newborns, are highlighted. The emphasis is placed on the role of electronic sources, social networks in shaping the opinion of parents or authorized representatives of the child on the causes of ICH, the correct use of diagnostic interventions, determining the correctness of treatment.It is stressed that the causes of the ICH, apart from the "modern" delivery trauma, play a significant role in coagulopathy due to aloimmune thrombocytopenic purpura, DIC, ECMO, vascular obstructive diseases - thrombophilia with venous thrombosis or idiopathic origin - aloimmune thrombocytopenic purpura found in 25 -50% antenatal, and 10-30% after birth. The infection of simple herpes type ІІ plays an important role in the provocation of the hepatocellular carcinoma. It is described that in urgent situations, NSG or CT remain the primary choice of visual diagnosis of the ICH, and MRI is an indisputable method of not only diagnosis, but also a detailed refinement of changes in the brain that can predict short-term and long-term consequences. Three protocols of NSG neonatal examination are presented, which allow not only to detect, but also to evaluate the resolution of the ICH in dynamics.It is recommended in order to prevent the development of conflict situations, parents or persons responsible for the child should be informed about the existing risks of the occurrence of ICH in the fetus and newborn. Talk with parents on the basis of analysis of information about the ICH, available to parents from Internet resources. In the work of the maternity hospitals I, II levels of provision of medical care, to introduce prenatal parent counseling on the prediction of the presence of potential abnormalities in the fetus and the newborn, caused by the influence of factors associated with the ICH. With the screening and the purpose of early diagnosis of ICH in each department of newborns, it is necessary to carry out US of brain, using a portable ultrasound apparatus, using one of the following protocols of examination. Clarification of the suspicion of the ICH performed in the NICU, which should be provided with the possibility of CT, MRI.

AIM To evaluate feasibility of establishing a clinically applicable reference value through those unaffected salivary gland on sialoscintigraphic data obtained from patients presented with obstructive sialadenitis affected a single gland. MATERIALS AND METHODS Ninety-one patients suffered from single salivary gland swelling, pain/tenderness and received sialoscintigraphic examinations were retrospectively enrolled. The quantitative data parameters, including the uptake ratio, maximal accumulation, maximal excretion, time to maximal (Tmax) and time to minimal (Tmin) activity of the affected and unaffected glands, were calculated for analysis. Data were also obtained and recorded for comparison from 50 patients who fulfill the American-European criteria for the diagnosis of Sjogren's syndrome. RESULTS The maximal excretion appeared to be the best indicator for distinguishing affected and unaffected glands of obstructive diseases, for parotid and submandibular glands (P = 0.0002 and P

Background: Obese-related asthma (OBA) is an asthma sub-phenotype that often is severe. Inflamed adipose tissue may release pro (leptin) and anti-inflammatory (adiponectin) adipokines implicated in OBA. The effects of treatment with oral corticosteroids (OCS) on systemic levels of adipokines remains unknown. Subjects and Methods: Patients with mild to moderate asthma (MMA, n=55), severe asthma (SA= 72) and COPD (n=41) were from BIOAIR, a European multicenter study. After recruitment (visit 1), patients were optimized with medium doses of inhaled glucocorticosteroids (ICS) and LABA for four weeks (visit 2), then included in a double blind placebo-controlled OCS intervention trial (visit 3A), followed by an open OCS treatment in the placebo group (visit 3B). Blood samples were collected for measurement of leptin and adiponectin. Results: At visit 1, leptin was higher in SA compared with MMA (p = 0.0085) and COPD (p = 0.0006). Both leptin and adiponectin were significantly higher in women than in men. A positive correlation between leptin and higher BMI was found for both sexes in all groups and a negative correlation between adiponectin and BMI in COPD and male SA. No correlation was found in female SA and MMA. Optimization did not significantly change neither leptin nor adiponectin. OCS intervention resulted in increases in leptin (MMA p = 0.029; SA p = 0.0010; COPD p = 0.0004) and adiponectin (MMA p = Conclusions: OCS increased systemic levels of leptin and adiponectin in patients with asthma and COPD.

Information and telecommunications infrastructure is based upon to play an essential part in the changes that must be made to health centres to cope with chronic conditions. This article discusses telemedicine’s perspective in residential treatment for chronic patients with chronic obstructive pulmonary disease (COPD) & an advanced framework developed to do so. The chronic care telemedicine method to assess the effect on wellbeing. The paper proposed a method to this unaddressed requirement by modelling & structurally constructing a model mobile device that constantly monitors the airflow rate, respiratory rate, physical exercise, nap quality, the likelihood of respiratory problems, & the degree of distress & exhaustion in a protected central server that can be accessed from a mobile globally.

Background: Chronic obstructive pulmonary disease (COPD) attribute to systemic inflammation which is responsible for microalbuminuria reflecting endothelial dysfunction, could be a significant surrogate marker of potential cardiovascular morbidity. Objective: The aim of our study was to find out the possible association of COPD with early cardiovascular changes in the form of renal endothelial dysfunction. Settings and Design: Case–control, multi-group, cross-sectional hospital-based study was designed and conducted in the Department of Respiratory Medicine of BPS Government Medical College for Women, Khanpur Kalan, Sonipat, Haryana. Subjects and Methods: The study included 150 subjects, comprising of three groups with each having 50 subjects: Group 1 – acute exacerbation of COPD, Group 2 – stable COPD patients, Group 3 – asymptomatic smokers. Pulmonary function test, urine albumin creatinine ratio (UACR) and brachio-ankle pulse wave velocity were measured in all the subjects. Statistical Analysis: Data were analyzed using SPSS ver 20 (IBM, USA) software. Continuous variables were compared by unpaired Student's t-test while correlation was measured by Pearson correlation test, P < 0.05 was considered statistically significant. Results: The mean urine albumin creatinine ratio UACR value in acute exacerbation of COPD (283.30 mg/g; standard deviation [SD] ±871.98) was found significantly higher compare to control subjects (24.17 mg/g; SD ± 32.105;) P = 0.038. Besides this COPD patients with Type 2 respiratory failure having robust positive correlation in between UACR and arterial blood pH (r = 0.559; P = 0.030) while it was inverse and moderate with partial pressure of arterial oxygen (r = −0.470; P = 0.077). Conclusions: Acute state of COPD with or without Type 2 respiratory failure is having a significant impact on cardiovascular system in the form of early microvascular changes.

We present the results of treatment of sialolithiasis of the submandibular and parotid glands using sialendoscopy and sialendoscopy-assisted surgery. Between 2009-2013, 397 consecutive patients (mean (range) age 48 (18-76) years) were treated for obstructive diseases of the major salivary glands (sialolithiasis n=239, 175 submandibular and 64 parotid). In a total of 175 patients with 191 stones in the submandibular gland treated by endoscopic retrieval or surgical release, 149 patients (85%) were rendered free of stones (by sialendoscopy alone n=82, and sialendoscopy with operation n=67) Twenty patients (11%) had residual stones and 6 patients (4%) required excisionof the gland. Sixty-four patients had 71 stones removed from the parotid gland by endoscopic retrieval or surgical release and 43 (67%) were free of stones (by sialendoscopy alone n=25, and sialendoscopy with operation n=18). Twenty patients (31%) had residual stones and one (2%) required removal of the gland. In the group of patients whose stones were removed endoscopically, the effectiveness of sialendoscopy was 87% and 85%, respectively. We confirm that sialendoscopy and sialendoscopy-assisted removal is the current treatment of choice for stones in the submandibular and parotid glands. The indications for excision of the gland are becoming less common as first-line treatment, although it is still indispensable in some cases.

Summary Objective: Children are especially vulnerable to respiratory injury induced by exposure to air pollutants. In the present study, we investigate periods of up to 7 days, and evaluate the lagged effects of exposure to air pollutants on the daily number of children and adolescents visiting the emergency room (ER) for the treatment of lower respiratory obstructive diseases (LROD), in the city of Sao Paulo, Brazil. Methods: Daily records of LROD-related ER visits by children and adolescents under the age of 19, from January 2000 to December 2007 (2,922 days) were included in the study. Time-series regression models (generalized linear Poisson) were used to control for short- and long-term trends, as well as for temperature and relative humidity. Third-degree polynomial lag models were used to estimate both lag structures and the cumulative effects of air pollutants. Effects of air pollutants were expressed as the percentage increase in LROD-related ER visits. Results: We observed an acute effect at the same day of exposure to air pollutants; however, the cumulative effects of air pollutants on the number of LROD-related ER visits was almost threefold greater than the one observed at the same day of exposure to PM10, SO2, and NO2 mainly in children aged 5 years and under. The 7-day cumulative effect of SO2 reached 11.0% (95% CI: 5.0–16.7) increase in visits. Conclusion and Relevance: This study highlights the effects of intermediate-term exposure to air pollutants on LROD in children. Pediatr Pulmonol. 2016; 9999:XX–XX. © 2016 Wiley Periodicals, Inc.

• Transoral ultrasound is a simple technique, very helpful for the evaluation of obstructive diseases of the salivary glands. • It overcomes most of the limitations of transcutaneous ultrasound.

The use of commercialised forced oscillation (FOT) devices to assess impedance in obstructive diseases such as asthma has gained popularity. However, it has yet to be fully established whether resistance and reactance measurements are comparable across different FOT devices, particularly in disease. We compared two commercially available FOT devices: Impulse Oscillometry (IOS) and TremoFlo FOT (Thorasys) in a) clinical adult population of healthy controls (n = 14), asymptomatic smokers (n = 17) and individuals with asthma (n = 73) and b) a 3D printed CT-derived airway tree model resistance, as well as a 3 L standardised volume reactance. Bland-Altman Plots and linear regressions were used to evaluate bias between the devices. Resistance measurements at both 5 and 20 Hz were numerically higher with IOS compared to FOT, with evidence of small and statistically significant proportional systematic bias and a positive Bland-Altman regression slope at both 5 and 20 Hz. In contrast, the IOS device recorded reactances that were less negative at both 5 Hz and 20 Hz and significantly smaller reactance areas when compared to TremoFlo. Larger statistically significant proportional systematic biases were demonstrated with both reactance at 5 Hz and reactance area (AX) between the devices with a negative Bland-Altman regression slope. The printed airway resistance and standardised volume reactance confirmed the observations seen in patients. We have demonstrated that the impulse oscillation system and TremoFlo FOT demonstrate comparative bias, particularly when comparing airway reactance in patients. Our results highlight the need for further standardisation across FOT measurement devices, specifically using variable test loads for reactance standardisation.

The automatic analysis of respiratory sound is of enormous challenge. The success of the Automatic Classification of pulmonary obstructive diseases can carry a radical change in the medical field. The extracted features of adventitious respiratory sound are classified; the ability of classifier provides the best results. Neural Networks have come out to be a promising classifier for respiratory disorders. The paper reviews works of classification of adventitious and vascular sounds by methods like Neural Networks, KNN, ANN, SNN, CNN, and others. CNN technique recently applied to classification of respiratory sound is analyzed. Due to a large number of ongoing researches in the field of classification of respiratory diseases by signal processing techniques, there is a great need to summaries results at a place. It is concluded that CNN has emerged out as one of the better technique for the classification of respiratory sounds.

Background Exhaled aerosols from lungs have unique patterns, and their variation can be correlated to the underlying lung structure and associated abnormities. However, it is challenging to characterize such aerosol patterns and differentiate their difference because of their complexity. This challenge is even greater for small airway diseases, where the disturbance signals are weak. Objectives and methods The objective of this study is exploiting different feature extraction algorithms to develop a practical classifier to diagnose obstructive lung diseases using exhaled aerosol images. These include proper orthogonal decomposition (POD), principal component analysis (PCA), dynamic mode decomposition (DMD), and DMD with control (DMDC). Aerosol images were generated via physiology-based simulations in one normal and four diseased airway models in G7-9 bronchioles. The image data were classified using both the support vector machine (SVM) and random forest (RF) algorithms. The effectiveness of different features was evaluated by classification accuracy and misclassification rate. Findings Results show a significantly higher performance using dynamic feature extractions (DMD and DMDC) than static algorithms (POD and PCA). Adding the control variables to DMD further improved classification accuracy. Comparing the classification methods, RF persistently outperformed SVM for all types of features considered. While the performance of RF constantly increased with the number of features retained, the performance of SVM peaked at 50 and decreased thereafter. The 5-class classification accuracy was 94.8% using the DMDC-RF model and 93.0% using the DMD-RF model, both of which were higher than 87.0% in the previous study that used fractal dimension features. Conclusion Considering that disease progression is inherently a dynamic process, DMD(C)-based feature extraction preserves temporal information and is preferred over POD and PCA. Compared with hand-crafted features like fractals, feature extraction by DMD and DMDC is automatic and more accurate.

Supplemental Digital Content is available in the text, Background: Volatile organic compounds (VOC) are end products of human metabolism (normal and disease-associated) that can be mainly excreted in breath, urine, and feces. Therefore, VOC can be very useful as markers of diseases and helpful for clinicians since its sampling is noninvasive, inexpensive, and painless. Electronic noses, or eNoses, provide an easy and inexpensive way to analyze gas samples. Thus, this device may be used for diagnosis, monitoring or phenotyping diseases according to specific breathprints (breath profile). Objective: In this review, we summarize data showing the ability of eNose to be used as a noninvasive tool to improve diagnosis in clinical settings. Methods: A PRISMA-oriented search was performed in PubMed and Cochrane Library. Only studies performed in humans and published since 2000 were included. Results: A total of 48 original articles, 21 reviews, and 7 other documents were eligible and fully analyzed. The quality assessment of the selected studies was conducted according to the Standards for Reporting of Diagnostic Accuracy. Airway obstructive diseases were the most studied and Cyranose 320 was the most used eNose. Conclusions: Several case–control studies were performed to test this technology in diverse fields. More than a half of the selected studies showed good accuracy. However, there are some limitations regarding sampling methodology, analysis, reproducibility, and external validation that need to be standardized. Additionally, it is urgent to test this technology in intend-to-treat populations. Thus, it is possible to think in the contribution of VOC analysis by eNoses in a clinical setting.

Rationale: Airways obstruction with thick, adherent mucus is a pathophysiologic and clinical feature of muco-obstructive respiratory diseases, including chronic obstructive pulmonary disease, asthma, and cystic fibrosis (CF). Mucins, the dominant biopolymer in mucus, organize into complex polymeric networks via the formation of covalent disulfide bonds, which govern the viscoelastic properties of the mucus gel. For decades, inhaled N-acetylcysteine (NAC) has been used as a mucolytic to reduce mucin disulfide bonds with little, if any, therapeutic effects. Improvement of mucolytic therapy requires the identification of NAC deficiencies and the development of compounds that overcome them. Objectives: Elucidate the pharmacological limitations of NAC and test a novel mucin-reducing agent, P3001, in preclinical settings. Methods: The study used biochemical (e.g., Western blotting, mass spectrometry) and biophysical assays (e.g., microrheology/macrorheology, spinnability, mucus velocity measurements) to test compound efficacy and toxicity in in vitro and in vivo models and patient sputa. Measurements and Main Results: Dithiothreitol and P3001 were directly compared with NAC in vitro and both exhibited superior reducing activities. In vivo, P3001 significantly decreased lung mucus burden in βENaC-overexpressing mice, whereas NAC did not (n = 6–24 mice per group). In NAC-treated CF subjects (n = 5), aerosolized NAC was rapidly cleared from the lungs and did not alter sputum biophysical properties. In contrast, P3001 acted faster and at lower concentrations than did NAC, and it was more effective than DNase in CF sputum ex vivo. Conclusions: These results suggest that reducing the viscoelasticity of airway mucus is an achievable therapeutic goal with P3001 class mucolytic agents.

Mucociliary clearance (MCC) plays an essential role in maintaining airway sterility and health. Conversely, mucociliary dysfunction is implicated across many airway obstructive diseases. Understanding the necessary requirements for successful MCC is imperative to establish the pathology of disease, as well as to develop therapeutic strategies. Although postural, that is, gravitational, drainage is used clinically to aid mucus clearance, it is ignored in both animal and cell culture models of MCC. In this study, we develop a novel mucus clearance assay that enables the first particle image velocimetry of human bronchial epithelial cell cultures tilted relative to the gravitational field. This tilting system makes it possible to observe drainage of the airway surface liquid and, thus, reveals the effect gravity has on mucociliary clearance. First, we use this assay to demonstrate that beating cilia alone cannot transport buffer upward against gravity. Next, we show the same cilia successfully transporting mucus upward. These results indicate that the biophysical and biochemical properties of mucus enable vertical clearance and that current assay systems are not equipped to determine which properties are required for physiologically relevant vertical mucociliary clearance.

Spirometry is the most popular test of lung function. Its status arises from the effort-independence of the maximal expiratory flow-volume (MEFV) curve, its reproducibility for a given subject and simultaneous sensitivity to respiratory disorders. Previous trials have shown that the morphology-based, quasi-static models cannot reproduce characteristic swings in the MEFV curve, sometimes visible in the case of obstructive diseases. The aim of this work was to test the hypothesis that the aforementioned details in the MEFV curve are caused by dynamic phenomena occurring during forced expiration, and that they manifest particularly in obstructive diseases. To this end, the computational model for forced expiration including the fundamental physical phenomena in quasi-static conditions was further developed by including the dynamic phenomena: additional flows from narrowing airways, and gas compressibility and inertia. The MEFV curves simulated using the quasi-dynamic and quasi-static models were then compared for a variety of respiratory system states. For most simulated cases, the differences between forced expiratory curves computed with the models were negligible. Only implementing some specific conditions causing flow limitation in small airways yielded a visible alteration and the characteristic swing after the peak expiratory flow (PEF). Concluding, the dynamic effects of airway narrowing and gas compressibility and inertia modify the MEFV curve near the PEF slightly and only in specific cases. This finding justifies the general use of the quasi-static models as an adequate tool for forced expiration simulations.

The diagnosis and therapy of obstructive inflammatory disorders of the salivary glands have changed in the past decades following the introduction of sialoendoscopy. The aims of the present study were to analyze the relevance of sialoendoscopy using our own data and to compare the results to those of other studies. A retrospective analysis of 70 patients was performed, who were treated for obstructive disorders of the parotid and/or submandibular gland in whom sialoendoscopy was indicated. Two categories of interventions were considered: diagnostic interventional sialoendoscopy and endoscope-assisted interventions. Interventional sialoendoscopy procedures requiring extirpation of the gland were included in the analysis, as were abnormal intraductal processes that were detected during endoscopy. Treatment was successful in 58 of 67 (86.6 %) procedures (sialoendoscopy without surgical intervention n = 59; endoscope-assisted surgical intervention n = 8). Based on the underlying disease, the success rate was 88.6 % (n = 39) in patients with obstructive sialadenitis without sialolithiasis and 86.6 % (n = 19) in patients with sialolithiasis. It was not possible to draw definitive conclusions on the underlying disease from the observed pathological intraductal changes. Sialoendoscopy is an effective and safe diagnostic and therapeutic option with low complication rate. However, limiting factors such as the size or the position of potentially removable obstacles must be taken into consideration. The rate of gland extirpations can be reduced using sialoendoscopy.

Choledocholithiasis is a common surgical pathology and main cause of nonmalignant obstructive diseases of biliary system. Estimation of the safest method of diagnostics allows reducing the frequency of complications, accuracy of diagnostics andunnecessary economic expenses.The aim of the study – to determine the most optimal methods for diagnosing choledocholithiasis on the basis of the analysis of literature data.Materials and Methods. According to the data of literature for 5-year period, the experience of diagnostics of choledocholithiasis has been analyzed. Comparative analysis of different instrumental methods of diagnostics of choledocholithiasis has been performed.Results and Discussion. For now there is no final decision about certain method of choledocholithiasis diagnostics. Different researches show ambiguous data of sensitivity and specificity of both invasive and non-invasive techniques.Conclusions. Scientific experience shows, that non-invasive diagnostic methods of choledocholithiasis and more perspective due to the absence of surgical intervention, complications and wide spectrum of possibilities of their improving. It is noteworthy, that prevalent are magnetic-resonance cholangiopancreatography and endoscopic ultrasound diagnostics, which are the most informative and highly specific diagnostic methods with less quantity of complications.

Purpose Strip meniscometry (SM) is a new technique for evaluating tear film volume. The aim of the present study was to evaluate the efficacy of SM in detecting lacrimal obstructive diseases (LODs) in patients with epiphora retrospectively. Methods One-hundred sixty-six patients (53 men, 113 women; mean age: 72.4 ± 8.0 years) who were referred to Saitama Medical University Hospital with epiphora as their chief complaint were enrolled; finally, 72 patients with and 89 patients without LOD were examined. We assessed tear volume using SM, tear meniscus height (TMH), tear meniscus area (TMA), and Schirmer-1 test values. Patients with LOD underwent lacrimal intubation surgery to treat their epiphora; their SM scores were assessed before and 8 weeks after surgery. Results SM, TMH, TMA, and Schirmer-1 values were significantly higher in the LOD group (10.80 ± 3.63 mm, 0.49 ± 0.24 mm, 0.06 ± 0.06 mm2, 18.46 ± 8.00 mm, respectively) than in the non-LOD group (5.44 ± 3.20 mm, 0.30 ± 0.18 mm, 0.03 ± 0.04 mm2, 11.84 ± 7.16 mm). The area under the receiver operating characteristic curve (AUC) for SM was 0.88, the sensitivity and specificity were 82% and 84%. The AUC was significantly larger for SM than for the Schirmer-1 test and TMA. The SM scores significantly improved after surgery (5.30 ± 2.20 mm) compared with those before (10.69 ± 3.20 mm). Conclusions SM was significantly better than the Schirmer-1 test, TMH, and TMA for detecting LOD and evaluating the effect of lacrimal surgery. Translational relevance SM, widely used for dry eye, is also useful for using epiphora.

ResumenLos síntomas urinarios bajos en el hombre han sido tradicionalmente interpretados como secundarios a obstrucción del tracto urinario inferior originada en crecimiento de la próstata y llamados “prostatismo”. Esto es una simplificación inexacta, ya que existen otras patologías obstructivas y otras alteraciones no obstructivas del ciclo vesical que pueden presentar los mismos síntomas, pero que difieren en su fisiopatología y en su manejo terapéutico. Un diagnóstico preciso, permitirá no solo evitar el deterioro de la calidad de vida de estos pacientes sino evitar complicaciones derivadas de un manejo inadecuado. El objetivo de este artículo es entregar herramientas para interpretar los síntomas urinarios bajos en el hombre en relación a la fisiología y fisiopatología del complejo vesico esfinteriano, representada en el ciclo vesical, diagnosticar sus principales causas y delinear sus opciones terapéuticas de un modo racional.SummaryThe lower urinary tract symptoms in men have traditionally been interpreted as secondary to lower urinary tract obstrution caused by prostate enlargement and called “prostatism”. This is an inaccurate simplification since there are other obstructive diseases and non-obstructive urinary disturbances, that may have the same symptoms, but differ in their physiopathology and therapeutic management. An accurate diagnosis, will not only prevent deterioration of the quality of life of these patients but also avoid complications arising from inadequate management. The aim of this article is to provide tools to interpret the lower urinary tract symptoms in men in relation to the physiology and physiopathology of the vesico sphincter complex, diagnose their main causes and outline treatment options in a rational way.

Many pulmonary disorders like respiratory obstructive diseases, systemic diseases with pulmonary involvement, lung cancer, cystic fibrosis or tuberculosis all have clinical and/ or therapeutic involvement of the oral cavity, which underlines the necessity of regular dental services and careful oral cavity exam, as well as an active collaboration between dental practitioners and pulmonologists. The main objective of this review is to create awareness among the dental professionals about the various oral manifestations of respiratory disorders, so that they diagnose it in a much earlier stages, for patient’s ultimate benefit

To investigate the etiopathogenic role of sinus inflammatory disease in primary acquired dacryocystitis and other chronic obstructive diseases of the lachrymal drainage system.Noninterventional controlled study.Tertiary care center.Sixty consecutive patients with primary acquired dacryocystitis and other chronic obstructive diseases of the lachrymal drainage system, selected for endoscopic endonasal dacryocystorhinostomy (DCR) and who had been ordered a preoperative sinus CT scan, had their sinus scans assessed for inflammatory naso-sinusal disease extension, using the modified Lund-Mackay system. A control group of 40 subjects was simultaneously enrolled, as a way to assess the prevalence of sinus disease in the general population.Chronic inflammatory sinus disease was found to be no more frequent or more extensive in DCR patients than in controls.Chronic sinusitis alone does not seem to be a causative factor to primary acquired chronic obstructive diseases of the lachrymal drainage system.

OBJECTIVES/HYOTHESIS: Parotid obstruction is one of the most common problems affecting the parotid gland. We aimed to investigate the blockage ratio (BR) and the intraductal pressure change of Stensen's duct using computational fluid dynamics.Retrospective review of 16 patients who had undergone interventional sialendoscopy for parotid obstruction from 2009 to 2011.The three-dimensional configurations of Stensen's duct were reconstructed from computed tomography (CT) sialographic images. Finite volume modeling in fluid dynamics of parotid obstruction was used to analyze the pressure distribution under conditions of rest and stimulation.Intraductal pressure increased with increasing distance from the orifice. The upstream pressure was higher than that of downstream pressure in the same BR (P.05). The upstream pressure increased as the BR increased. Statistically, the pressure turning point was indicated when BR = 60%. Only when the BR was much greater than 90% did the pressure reach 811.64 Pa, at which point patients could feel the painful swelling under the rest condition. Under the stimulated condition, the upstream pressure increased from 1.3- to 2.9-fold of that of the no blocking state when the BR increased from 80% to 90%, which may aggravate the obstructive symptoms. There was no significant difference observed for downstream pressure under the same condition (P.05).CT sialography was effectively used for analysis of the intraductal pressure distribution in patients with parotid obstruction. Analysis of salivary fluid dynamics in Stensen's duct may provide a further pathophysiological mechanism for obstructive diseases.

Obstructive diseases of the salivary glands are a common problem of the salivary glands; often based on Sialolithiasis, duct stenosis, or other rarer reasons. There exist several diagnostic features to classify the disease; however, ultrasound or conventional radiological imaging does not provide a diagnosis in 5-10% of all cases. The intraductal applied contrast-enhanced ultrasound (IA-CEUS) improves the visualization of obstructive diseases of the salivary glands; simultaneously an evaluation of the parenchyma of the glands is possible. We think IA-CEUS is a promising tool, which improved the diagnostic assessment capabilities of ultrasound and results in a better treatment for patients with obstructive salivary gland diseases.

The treatment of stenoses and non-stone-related obstructive diseases of the major salivary glands has undergone significant changes due to the development of minimally invasive treatment modalities. Correct diagnosis can often not be established in detail with all diagnostic tools except sialendoscopy, which is necessary for gland-preserving therapy. Over the last 10 years a range of minimally invasive treatment approaches aimed at preserving gland function have been developed. In addition to sialography-controlled therapy, interventional sialendoscopy plays a central role, representing the treatment of first choice in all stenoses and non-stone-related obstructions of the salivary duct system and with a success rate of about 85%-90%. By combining sialendoscopy with other minimally invasive surgical procedures, the function of the gland can be preserved in more than 95%. Thus sialendoscopy plays a crucial role in the treatment of non-stone-related obstructive diseases of the major salivary glands. In stenoses of the salivary gland ducts extirpation of the gland should be considered only as a last step.