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1
Shaikh, Zarrin F. "Patent foramen ovale in obstructive sleep apnoea and chronic obstructive pulmonary disease." Thesis, Imperial College London, 2011. http://hdl.handle.net/10044/1/9478.
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The objective of this thesis was to determine the impact of right to left shunting (RLS) through patent foramen ovale (PFO) on oxygen saturation in obstructive sleep apnoea (OSA) and chronic obstructive pulmonary disease (COPD). The first aim was to determine the prevalence of PFO in severe OSA and whether PFO closure improves nocturnal oxygen saturation. The data showed that PFO with large shunts were more prevalent, however overall prevalence was not statistically different when compared to healthy controls. PFO closure did not reduce nocturnal desaturation. The second aim was to determine whether severe COPD patients with PaO2 ≤ 7.3kPa had a higher prevalence of PFO compared to patients with PaO2 > 8kPa, additionally to compare the prevalence of PFO in COPD with healthy controls. The data showed no difference in PFO prevalence in patients with PaO2 ≤ 7.3kPa compared to patients with PaO2 > 8kPa, however, intrapulmonary shunts were more prevalent in hypoxaemic patients. Similar to OSA, PFO with large shunts were more prevalent in severe COPD, however overall prevalence was not statistically different to healthy controls. The final aim was to determine whether patients with COPD and PFO developed RLS during exercise and whether this was associated with reduced oxygen saturation, reduced exercise endurance and increased intrathoracic pressure swings. The data showed that RLS through PFO increased from baseline during exercise and this was associated with increased swings in intrathoracic pressure. There was no difference in desaturation or exercise endurance when compared to patients with no PFO. In summary, this thesis shows that PFO with large shunts are more prevalent in both OSA and COPD. PFO closure in OSA did not reduce nocturnal desaturation. Furthermore, the presence of a PFO in COPD did not influence resting or exercise oxygen saturation despite the observed increase in RLS with exercise.
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Derderian, Marc Gallinari Claude. "Bronchopneumopathie chronique obstructive (BPCO) du sujet âgé étude rétrospective /." Créteil : Université de Paris-Val-de-Marne, 2005. http://doxa.scd.univ-paris12.fr:80/theses/th0233033.pdf.
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Matsumoto, Takeshi. "Microalbuminuria in Patients with Obstructive Sleep Apnea-Chronic Obstructive Pulmonary Disease Overlap Syndrome." Kyoto University, 2018. http://hdl.handle.net/2433/232105.
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Turino, Cecilia. "A new approach to obstructive sleep apnoea management." Doctoral thesis, Universitat de Lleida, 2021. http://hdl.handle.net/10803/673267.
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L'aplicació de la pressió positiva contínua en la via aèria superior (CPAP) representa el mètode terapèutic de referència de la Síndrome d'Apnea Obstructiva del Son (SAOS). No obstant això, la SAOS es considera una malaltia amb múltiples fenotips i resposta al tractament variable. Per tant, el tractament amb CPAP hauria d'aconsellar-se segons el fenotip dels pacients. Així doncs, es necessiten noves estratègies per millorar el compliment del mateix tractament.
En el primer article hem identificat algunes variables relacionades amb la SAOS . En el segon article hem definit el perfil general dels pacients de Catalunya tractats amb CPAP i hem identificat sis clústers de pacients amb diferents patrons de comorbiditats, mortalitat i ús dels recursos sanitaris.
En el tercer article la telemedicina va demostrar més cost efectivitat que el maneig tradicional del tractament amb CPAP. En el quart article, el Sistema Intel•ligent de Monitoratge (MiSAOS) va demostrar més cost efectiu que el maneig tradicional del tractament amb CPAP.La aplicación de la presión positiva continua en la vía aérea superior (CPAP) representa el método terapéutico de referencia del Síndrome de Apneas Obstructivas del Sueño (SAOS) . Sin embargo, el SAOS se considera una enfermedad con múltiples fenotipos, por lo tanto, el tratamiento con CPAP debería aconsejarse según el fenotipo de los pacientes. Por otro lado, también se necesita nuevas estrategias para mejorar el cumplimento del mismo tratamiento. En el primer artículo hemos identificado algunas variables relacionadas con el SAOS . En el segundo artículo hemos definido el perfil general de los pacientes SAOS de Cataluña tratados con CPAP y hemos identificado seis clústers de pacientes con diferentes patrones de comorbilidades, mortalidad y uso de los recursos sanitarios. En el tercer artículo la telemonitorización demostró más coste efectividad que el manejo tradicional del tratamiento con CPAP. En el cuarto artículo, el Sistema Inteligente de Monitorización (MiSAOS) del cumplimiento con CPAP se demostró más coste efectivo que el manejo tradicional.
The application of continuous positive pressure (CPAP) represents the first line treatment for patients with Obstructive Sleep Apnoea (OSA) . However, OSA is now regarded as a disorder characterized by multiple phenotypes with variable response to treatment. Thus, CPAP treatment should be recommended according to phenotypes. On the other hand, new methods for improving CPAP compliance are required. In the first article we found some variables associated with OSA . In the second article, we defined a general profile of the entire CPAP-treated OSA population of Catalonia and identified six patient groups characterized by different patterns of comorbidities, mortality, and healthcare resource use. In the third article telemedicine did not improve CPAP compliance but was more cost effective than traditional follow-up. Finally, in the fourth article, the MiSAOS Intelligent Monitoring System for improving CPAP compliance resulted more cost effective than traditional management.
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Murat, Sandrine. "Débit cardiaque : Influence dans le pronostic de la bronchopneumopathie chronique obstructive." Bordeaux 2, 2000. http://www.theses.fr/2000BOR2M035.
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Brousse, Christophe. "L'inflammation éosinophilique dans la bronchopneumopathie chronique obstructive et sa reversibilité aux corticoi͏̈des." Montpellier 1, 1994. http://www.theses.fr/1994MON11146.
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McPherson, G. A. D. "Biliary drainage in obstructive jaundice." Thesis, University of Oxford, 1986. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.375172.
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Bemelmans, Marcus Henricus Adrianus. "Inflammatory cytokines in obstructive jaundice." Maastricht : Maastricht : Universitaire Pers Maastricht ; University Library, Maastricht University [Host], 1994. http://arno.unimaas.nl/show.cgi?fid=6812.
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Gunaratnam, Kogulan. "OBSTRUCTIVE SLEEP APNOEA AND PERIODONTITIS." Thesis, Faculty of Dentistry, 2008. http://hdl.handle.net/2123/4057.
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Obstructive sleep apnoea (OSA) and its associated daytime symptoms form a syndrome, obstructive sleep apnoea-hypopnoea syndrome (OSAHS) that affects about 5% of the population worldwide (Young et al 2002a, Pack 2006). OSA is characterized by repeated episodes of upper airway obstruction during sleep, resulting in recurrent hypoxemia and sleep fragmentation (Hensley & Ray 2005). These in turn are associated with neurocognitive disorders, hypertension and cardiovascular complications (Pack 2006). Current therapies for this condition include surgical interventions, oral appliances and continuous positive airways pressure (CPAP). Systemic and local airway inflammation has recently been linked to OSA and is hypothesized to increase the risk of cardiovascular complications (Lavie 2005). While the exact mechanism is not certain, it is believed that the underlying systemic inflammation from OSA is due to the hypoxia/reperfusion injury from intermittent hypoxia that occurs with OSA (Lavie 2005). Specifically, the episodic hypoxia in OSA leads to increased production of reactive oxidative species (ROS) and, via various pathways, in the formation of systemic inflammatory mediators. The resultant inflammatory response is then responsible for the increased cardiovascular morbidity and mortality by potentiating disease in those that already have inflammatory disease or triggering inflammatory diseases in people with existing genetic, behavioural and environmental exposure. Periodontitis involves the supporting structures of the tooth and is a disease caused by specific bacteria that triggers an inflammatory response (Kinane 2001). Tissue damage and destruction, including loss of the connective tissue attachment between the tooth and the jaw, together with resorption of supporting bone, is initiated by the micro-organisms and mediated by the host response. Periodontitis, which is a severe form of periodontal disease, is one of the most common chronic infections in the world. The prevalence of moderate to severe periodontitis across the globe is in the range of 5 to 20 % (Burt 2005). Recent studies have speculated on an association between periodontitis and systemic inflammation in, for example, diabetes (Soskolne & Klinger 2001), rheumatoid arthritis (Mercado et al. 2000) and cardiovascular disease (CVD) (Beck & Offenbacher 2005), but no research has been undertaken on the link between OSA and periodontitis. This review will focus on features of OSA, inflammation and periodontitis to examine if there is a possible link between OSA and periodontitis by means of systemic inflammation.
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Noell, Guillaume. "Multi-Level Integrated Analysis of Chronic Obstructive Pulmonary Disease (COPD) heterogeneity." Doctoral thesis, Universitat de Barcelona, 2019. http://hdl.handle.net/10803/667980.
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Non-Communicable Diseases (NCDs), including cancer, cardiovascular (heart diseases or stroke), respiratory (COPD or asthma) and metabolic diseases (diabetes) are chronic conditions that represent a major global health problem of the 21st century. All of them, however, are the end-result of a complex set of gene-environment interactions that develop over years and often lead to several NCDs co-existing in the same individual (multi-morbidity).
Multi-level integrated analysis has the potential to uncover the heterogeneity of NCDs by conceptualizing them as emergent properties of a complex, non-linear, dynamic and multilevel biological system, or network of biological and environmental interactions.
Chronic Obstructive Pulmonary Disease (COPD) is a NCD of increasing prevalence worldwide that is projected to be by 2020 the third leading cause of death worldwide. It is currently viewed as a broad diagnostic term that encompass a continuum of subtypes each characterized by distinct functional or pathobiological mechanisms (endotypes) and is characterized by persistent respiratory symptoms and airflow limitation.
The underlying hypothesis of this PhD Thesis is that multi-level integrated analysis can help us understand highly heterogeneous respiratory diseases such as COPD. Specifically, the following two aspects of COPD heterogeneity will be addressed:
1) Exacerbations of COPD (ECOPD): ECOPD are episodes of worsening of the symptoms whose pathogenesis and biology are not entirely understood. They are heterogeneous events of non-specific diagnosis. Biomarkers analysis and networks medicine were used to uncover novel pathobiological information from the comparison of the multi-level (i.e., clinical, physiological, biological, imaging and microbiological) correlation networks determined during ECOPD and clinical recover. We concluded that ECOPD are characterised by disruption of network homeokinesis that exists during convalescence and can be identified objectively by using a panel of three biomarkers (dyspnoea, circulating neutrophils and CRP levels) frequently determined in clinical practice.
2) Early low lung function and health in later life: In 2015 Lange P. et al. showed that low peak lung function in early adulthood is associated with the diagnosis of COPD later in life. We assessed in three general population cohorts the prevalence of low peak lung function and its association with other clinical or biological parameters - specifically respiratory, cardiovascular, and metabolic abnormalities – as well as incidence of comorbid diseases during follow-up. We concluded that low peak lung function in early adulthood is common in the general population and could identify a group of individuals at risk of early (cardiovascular, metabolic and systemic) comorbidities and premature death.
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Le, Quément Catherine. "Implication de l'élastase du macrophage (MMP-12) dans l'inflammation pulmonaire associée à la Broncho Pneumopathie Chronique Obstructive." Rennes 1, 2008. http://www.theses.fr/2008REN1B113.
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La Broncho-pneumopathie chronique obstructive (BPCO) est une pathologie pulmonaire caractérisée par une irréversible obstruction des voies aériennes et principalement provoquée par une consommation de tabac. Chez les patients atteints de BPCO se développe une réaction inflammatoire intense, et la métalloélastase du macrophage (MMP-12) semble y jouer un rôle préponderant. Dans un premier temps, nous avons montré que la MMP-12 est impliquée spécifiquement dans l'inflammation pulmonaire provoquée par la fumée de cigarette, car l'utilisateur d'un inhibiteur de MMP-12 (AS111792) permet de freiner l'inflammation induite par la fumée de cigarette chez la souris mais n'empêche pas celle induite par le LPS. Dans un deuxième temps, nous avons mis en évidence le fait que la MMP-12 possède la capacité d'activer les MAP kinases ERK 1/2 via une transactivation du récepteur à l'EGF provocant une libération d'IL-8/CXCL8 par des cellules épithéliales alvéolaires humaines en culture.
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Damera, Gautam V. "Molecular mechanisms of mucus hypersecretion in chronic airway obstructive diseases." Oklahoma City : [s.n.], 2006.
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Bourdin, Arnaud. "Mécanismes inflammatoires et cicatriciels bronchiques : conséquences fonctionnelles et immunopathologiques, et rôle des glucocorticoïdes." Montpellier 1, 2006. http://www.theses.fr/2006MON1T027.
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L'asthme et la BPCO sont des maladies bronchiques chroniques obstructives qui partagent des caractéristiques cliniques et fonctionnelles mais le pronostic et la prise en charge sont différents. L'étude des biopsies bronchiques nous a permis de mieux connaître la physiopathologie de ces affections ; nous avons cependant démontré qu'elles ne pouvaient différencier ces maladies en routine. En améliorant le phénotypage des patients et l'analyse de ces biopsies, nous avons pu montrer qu'il existait des spécificités de l'asthme sévère dans le remodelage bronchique. Le rôle des corticoïdes est discuté. Pour l'exploration des voies aériennes distales, siège initial et persistant des lésions dans ces deux affections, nous avons utilisé un test fonctionnel (test de rinçage à l'azote) et le dosage de la protéine CC10 sécrétée par les cellules de Clara dans l'expectoration induite. Ces pistes permettraient d'intervenir précocement dans l'histoire naturelle de ces maladies.
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Murphy, Nicola. "Chronic obstructive pulmonary disease and anxiety." Thesis, Coventry University, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.368862.
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Mason, Rebecca Helen. "Vascular complications of obstructive sleep apnoea." Thesis, University of Bristol, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.619138.
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Obstructive sleep apnoea (OSA) is the third commonest respiratory condition after Asthma and COPD and has been increasingly linked to cardiovascular consequences. This thesis examines how OSA might affect different vascular beds; large (the aorta), medium (the carotid artery) and small (retinal and cerebral blood vessels) through five different studies. Each study will be reported as a separate chapter and a final discussion will assess the overall conclusions. Methodology Study one examines the prevalence of OSA in individuals with an abdominal aortic aneurysm and demonstrates the increased prevalence and rate of aneurysm expansion in those with severe OSA. Study two demonstrates the increased prevalence of OSA in individuals with type two diabetes and clinically significant diabetic macular oedema (CS MO). Study three examines the clinical benefit of continuous positive airway pressure (CPAP) in individuals with OSA and CS MO and demonstrates an improvement in visual acuity when CPAP is used for >2.5hrs per night. Study four is a retrospective examination of the effect of snoring on carotid vessel disease and shows no significant difference between the severity of snoring and degree of carotid artery stenosis. Study five describes the effect of minimally symptomatic obstructive sleep apnoea on cerebrovascular disease and shows no association between OSA and small white matter change but, does confirm the association of increasing age and hypertension. Discussion This thesis adds to our understanding of the association of OSA and vascular disease and the potential therapeutic benefits of CPAP in these individuals.
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Papaioannou, Ioannis. "Glucose intolerance in obstructive sleep apnoea." Thesis, Imperial College London, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.516557.
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Lam, Chung-mei Jamie, and 林頌眉. "Obstructive sleep apnea and cardiometabolic complications." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B43085854.
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Parks, Rowan Wesley. "Gut barrier function in obstructive jaundice." Thesis, Queen's University Belfast, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.361292.
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Davies, David Paul. "Snoring, obstructive sleep apnoea and stroke." Thesis, University of Newcastle Upon Tyne, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.364858.
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McMillan, Alison. "Obstructive sleep apnoea in older people." Thesis, Imperial College London, 2014. http://hdl.handle.net/10044/1/28969.
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Obstructive sleep apnoea (OSA) is common and the prevalence increases with age. When OSA leads to sleep disruption and excessive daytime sleepiness, it is referred to as obstructive sleep apnoea syndrome (OSAS). The aim of this thesis was to investigate the consequences of OSAS in older people (˃ 65 years) and the effect of continuous positive airway pressure (CPAP) therapy. CPAP is the treatment of choice in moderate to severe OSAS in middle aged people. However, there is a paucity of evidence on the therapeutic and economic benefits of CPAP in older people with OSAS. The two studies in this thesis aimed to address this by comparing outcomes in older people with OSAS before and after treatment with CPAP. The first study presented is the thesis is the PREDICT trial; a multicentre randomised controlled trial of CPAP in older people with OSAS. The trial studied the clinical efficacy of CPAP after 3 months, while determining the cost effectiveness of treatment over 12 months. The results of the trial showed that CPAP was an effective treatment for reducing excessive daytime sleepiness by -2.1 (95%CI -3.0 to -1.3); p < 0.001 points as measured by the Epworth sleepiness scale. CPAP also improved quality of life, with a statistically significant increase in the quality adjusted life years calculated with the SF-6D, equating to one week. The CPAP group also accrued marginally lower health care costs over 12 months compared to the group treated with best supportive care alone. Overall the economic benefit of CPAP was linked to the reduced healthcare usage offsetting the cost of the equipment. The second study presented in the thesis was a single centre randomised controlled trial to investigate the impact of CPAP on cognitive function and brain morphology in older people with minimally symptomatic OSAS after 6 months of treatment. In this study I tested the hypothesis that older patients with OSAS have cognitive impairment and corresponding brain changes which would be modifiable with treatment. The results of this study suggested older people with minimally symptomatic OSAS had normal cognitive function but impaired attention and executive function. CPAP treatment improved one aspect of attention, although memory and overall cognitive function were unchanged. The results of the brain MRI scans are not presented, and are in the process of being analysed. In conclusion the data presented in this thesis support the use of CPAP therapy in older people with excessive daytime sleepiness due to OSAS.
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Holme, Jayne. "Clinical studies in obstructive airways disease." Thesis, University of Birmingham, 2011. http://etheses.bham.ac.uk//id/eprint/2874/.
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Four clinical studies in subjects with alpha-1 antitrypsin deficiency were undertaken. The first examined CT densitometry and health status in 4 groups with discordant pulmonary physiology. It demonstrated that subjects with an isolated gas transfer abnormality had more emphysema, the least basal predominant emphysema and a worse health status than those with normal physiology. Subjects with an isolated spirometry abnormality had the most basal emphysema. The second study examined the age at which radiological, physiological and health status measures started to deviate from values expected for a normal population, and concluded that CT densitometry and gas transfers measures were the first to deviate from normal, while spirometry was the last. The third study examined the relationship of γ-glutamyl transferase to physiology, symptoms, mortality and liver disease in alpha-1 antitrypsin deficiency, and demonstrated associations between γ-glutamyl transferase and spirometry, mortality and cirrhosis after correction for associated factors. The final study described subjects with the PiSZ phenotype compared to matched PiZ subjects. CT revealed emphysema (mainly panacinar) in 46% of PiSZ index and 15% of non-index subjects. Health status was impaired in PiSZ subjects, who had less lower zone emphysema, better health status, pulmonary physiology and symptom profile compared with PiZ subjects.
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Mariscal, Norma Linda, and Norma Linda Mariscal. "Management of Postoperative Obstructive Sleep Apnea." Diss., The University of Arizona, 2017. http://hdl.handle.net/10150/624558.
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Background: Obstructive sleep apnea (OSA) is a sleep disorder characterized by episodes of cessation of breathing (apnea) during sleep. Unfortunately, a significant number of surgical patients are unaware they are afflicted with this disorder increasing the risks of postoperative complications. The lingering effect of general anesthesia causes an increase in frequency of airway collapse, leading to longer periods of apnea. This increasingly common sleep disorder is concerning for many anesthesia providers.
Purpose: The purpose of this study was to evaluate the anesthesia provider's knowledge and postoperative management of patients with suspected or diagnosed OSA.
Setting: The study setting was a local urban hospital Mountain Vista Medical Center (MVMC) in Gilbert, AZ. The study included (N=7) participants, who were predominantly male (85%) and a majority of the participants were Master’s prepared (85%) anesthesia providers.
Method: An online survey was disseminated to participants via email. The survey included questions regarding the anesthesia provider's knowledge and postoperative practice habits of patients with suspected or diagnosed OSA at MVMC.
Results: The response rate was (24%). All the respondents acknowledged that OSA was a risk factor for postoperative complications. Over half of the respondents (85%) reported encountering postoperative complications such as desaturation and apnea in their patients with OSA. The main complication that was encountered was postoperative apnea (50%), followed by decreased in saturations (33.33%), and one respondent (16.67%) encountered re-intubation during the postoperative period. However, the most important finding of the study is that over half of the providers did not routinely include continued positive airway pressure (CPAP)/noninvasive positive pressure ventilation (NIPPV) in their postoperative management of patients with suspected or known OSA due to the time needed to initiate the therapy.
Conclusion: The study illustrates that a majority of anesthesia providers at MVMC agreed OSA is a significant risk factor for postoperative complications, but time constraints limited the implementation of noninvasive ventilation (NIV) therapies. Recommended strategies would be to establish a task force to examine this barrier to therapy and develop plans to address it.
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Lam, Chung-mei Jamie. "Obstructive sleep apnea and cardiometabolic complications." Click to view the E-thesis via HKUTO, 2009. http://sunzi.lib.hku.hk/hkuto/record/B43085854.
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Wimms, Alison Jane. "Gender Differences in Obstructive Sleep Apnea." Thesis, The University of Sydney, 2019. https://hdl.handle.net/2123/21632.
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The overall aim of this thesis was to understand gender differences in obstructive sleep apnea (OSA) and use this information to develop a tailored therapy for female patients. Specific aims were to determine whether gender differences commonly reported in the literature are present in mild OSA and upper airway resistance syndrome (UARS) patient groups, and whether symptoms could be linked to respiratory parameters in these groups. The final aim was to develop, test and validate a new AutoSet treatment for female OSA patients. CHAPTER 1 of this thesis provides a detailed review of gender differences in the prevalence, symptoms, clinical experience, and health outcomes of OSA and UARS patients, with a focus on the implications of different scoring rules. CHAPTER 2 reviews of quality of life questionnaires from 259 untreated patients with mild OSA. Females reported statistically significantly higher levels of sleepiness, fatigue, insomnia, and anxiety/depression compared to males. CHAPTER 3 of this thesis reviews polygraphy data from patients with mild OSA. Male patients were found to have significantly more breathing disturbances than females, however many of these difference disappeared when updated scoring criteria were used. Some weak correlations were found between respiratory parameters and symptoms; however, no clear conclusions could be drawn. CHAPTER 4 outlines the development of a new AutoSet device designed for female- specific breathing patterns. The remaining chapters (CHAPTER 5, and CHAPTER 6) of this thesis describe the testing and validation activities undertaken on the AutoSet F, including a clinical trial to test efficacy; a bench test to compare performance against other commercially available devices; a controlled product launch to validate the features of the algorithm; and finally a clinical trial which demonstrated improvements in sleep efficacy and quality of life over a three-month usage period. In summary, this thesis has shown that at the mild end of the OSA spectrum females are more symptomatic than males, even though respiratory differences in the genders are less pronounced than those described in moderate-to-severe patients. An AutoSet designed specifically for female OSA patients was successful in demonstrating efficacy and clinical effectiveness.
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Jansson, Sven-Arne. "Health economic epidemiology of obstructive airway diseases : the obstructive lung disease in northern Sweden studies - thesis VII /." Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-805-3/.
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Bissoonauth, Veena Devi. "L'oxygénothérapie de longue durée chez les sujets atteints de bronchopneumopathie chronique obstructive/par Veena Devi Bissoonauth, épouse Sabatier." Montpellier 1, 1991. http://www.theses.fr/1991MON11235.
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McGown, Anne Dora. "Assessment of cerebral oxygenation using near infra-red spectroscopy in obstructive sleep apnoea and chronic obstructive pulmonary disease." Thesis, University College London (University of London), 2006. http://discovery.ucl.ac.uk/1445942/.
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This thesis describes a set of studies of the use of near infrared spectroscopy to measure cerebral oxygenation in obstructive sleep apnea (OSA) and chronic hypoxia. Cerebral oxygenation depends on cerebral blood flow and arterial oxygen saturation. The hypothesis underlying these studies was whether measurement of cerebral oxygenation using near infra-red spectroscopy (MRS) gives additional valid information compared to measuring arterial oxygen saturation alone. We also hypothesized that this technique could be used to assess overnight cerebral oxygenation in sleep studies. Our first validation study in 13 subjects with significant OS A showed that the fall in cerebral tissue saturation (measured as tissue oxygenation index, TO I) during sleep apnoea is related to arterial saturation (Sa02) (p=0.012), apnoea duration (p=0.001) and sleep stage (p<0.001) in a multiple regression in 1036 apnoeas. We also demonstrated changes in cerebral blood volume (range 0.41 - 0.09 ml/lOOg) and cytochrome oxidase oxidation state (range 0.48 - 0.13uM) occurring during apnoeas in 8 of these subjects. In a second validation study in 8 subjects we demonstrated correlations between changes in TOI and both arterial saturation (p=0.001), apnoea duration (p=0.001) and cerebral blood flow velocity (p=0.012) measured using carotid Doppler. We derived area under the curve (AUC) measures and dip rates for TOI and Sa02 during overnight studies and compared them to conventional polysomnographic measures, showing significant correlations of pretreatment apnoea hypopnoea index (AHI) with dip rates for both TOI and Sa02. AUC TOI correlations with pretreatment AHI were weak. Mean AUC for TOI was 339.4 (161-675) and mean AUC for Sa02 was 308.5 (89-944). Mean 4% Sa02 dip rate was 32.6 (1.5-90.6) and mean 4% TOI dip rate was 24 (0.1-95.7). Pilot studies were also carried out on 11 subjects with chronic obstructive pulmonary disease (COPD) during oxygen challenge. Calculated cerebral blood volume measurements varied from 1.51 ml/lOOg to 3.65 ml/lOOg. Changes in TOI in response to supplementary oxygen in patients with COPD and chronic hypoxia are related to both cerebral blood volume (p=0.001) and arterial saturation (p=0.001). The most important new findings in these studies are that cerebral blood flow changes appear to exacerbate rather than compensate for arterial hypoxia during sleep apnoea, and so it is plausible that TOI measurement (which picks up both Sa02 and cerebral blood flow velocity (CBFV) changes) may be more closely related to changes in neuropsychological function than pulse oximetry. The changes in cerebral oxygenation are profound enough to affect intracerebral redox state measured as cytochrome oxidase oxidation. Pilot work in COPD patients suggests that changes in cerebral blood volume affecting cerebral oxygenation occur during supplementary oxygen administration. NIRS provides a non-invasive method of measuring cerebral oxygenation suitable for use in sleep studies, and during oxygen administration.
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Faria, Cindy. "A Síndrome da Apneia/Hipopneia Obstrutiva do Sono (SAHOS) e seu tratamento com cirurgia ortognática." Master's thesis, [s.n.], 2013. http://hdl.handle.net/10284/4146.
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Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Medicina DentáriaA Síndrome da Apneia/Hipopneia Obstrutiva do Sono (SAHOS) é uma síndrome com grande prevalência na sociedade actual, constituíndo um grande problema de saúde pública. A SAHOS ocorre pelo repetido estreitamento ou colapso das vias aéreas superiores (VAS) durante o sono provocando como principal síntoma uma hipersonolência diurna exessiva. Os factores de riscos mais comuns incluem o sexo masculino, a obesidade, um palato mole alongado e uma retrognatia maxilar e/ou mandibular. A fisiopatologia da síndrome é multifactorial decorrente, em parte, de alterações das estruturas craniofaciais e dos tecidos moles das VAS associadas a alterações neuromusculares da faringe e a uma maior complacência da faringe. Relativamente ao tratamento, existem actualmente várias modalidades, tanto comportamentais, clínicas e cirúrgicas que devem ser individualizadas e criteriosamente seleccionadas para a situação clínica de cada paciente. Acredita-se que a SAHOS resulta na maioria das vezes de um estreitamento difuso da faringe. Para o seu tratamento é importante detectar os diferentes padrões de obstrução das VAS que parecem determinar o sucesso ou a falha do tratamento cirúrgico. As novas tecnologias permitem a criação de imagems tridimensionais a partir de imagems obtidas por ressonância magnética e tomografia computorizada juntamente com programas de reconstrução em 3 dimensões. Estas imagems tridimensionais possibilitam a avaliação dos locais de obstrução bem como proporcionam medições volumétricas das VAS. A cirurgia de avanço maxilo-mandibular (AMM) é um movimento em cirurgia ortognática que permite o avanço bi-maxilar, aumentando o volume das VAS a nível da velo-oro-hipofaringe. Tem sido descrita como sendo o tratamento cirúrgico mais efetivo para a SAHOS (excluíndo a traqueostomia) com índices de sucesso acima dos 80%. Vários autores comprovaram a eficiência da cirurgia de AMM no aumento do espaço faríngeo, diminuindo ou mesmo eliminando os episódios de colapsos respiratórios e melhorando significativemente a qualidade do sono e de vida dos pacientes. As palavras chaves utilizadas foram: “obstructive sleep apnea syndrome”, “maxillomandibular advancement” e “upper airway obstruction” que foram associados de múltiplas formas. Obstructive Sleep Apnea/Hipopnea Syndrome (OSAH) is a highly prevalent syndrome in the society, characterized as a public health burden. OSAH occurs by recurrent episodes of upper airway (UA) obstruction or collapse during sleep with daytime somnolence as the major symptom. The principal risks factors are : male, obesity, elongated soft palate and maxillary and/or mandibular retrognathia. Pathophysiology of OSAH is multifactorial, due partly to abnormalities of craniofacial stuctures and UA soft tissue associated with neuromuscular alterations of the pharynx and increased UA compliance. Behavioral, clinical and surgical options are available for the treatment of OSAH, which must be individualized and carefully selected for the clinical situation of each patient. Over the time, OSAH has been recognized as an obstructive process with a diffuse narrowing of the pharynx. For its treatment it is important te detect the different patterns of UA obstruction that seems to determine the sucess or failure of surgical treatment. New technologies allow the creation of tridimensional images achieved from magnetic resonance and computed tomography with reconstruction program. This tridimensional images enable the evaluation of obstruction sites and provide volumetric measurments of UA. Maxillomandibular advancement (MMA) is a movement on orthognatic surgery which allows bi-maxillary advancement, increasing the volume of UA at the level of velo-oro-hypopharynx. It has been described as the most effective surgical treatment for OSAH (excluding tracheostomy) with success rates above 80%. Several authors have demonstrated the effectiveness of AMM surgery on increasing the AMM pharyngeal space, reducing or eliminating episodes of respiratory collapse and improving sleep quality and life of patients. The keys words were : “obstructive sleep apnea syndrome”, “maxillomandibular advancement” e “upper airway obstruction” which have been associated in multiple ways.
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Vallet, Gilles. "Evaluation et optimisation d'un programme de réentraînement à l'effort individualisé chez des bronchopneumopathes chroniques obstructifs." Montpellier 1, 1996. http://www.theses.fr/1996MON14002.
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Roos-Engstrand, Ester. "T cells in chronic obstructive pulmonary disease." Doctoral thesis, Umeå : Umeå university, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-33677.
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Stevenson, Nicola Jane. "Lung mechanics in chronic obstructive pulmonary disease." Thesis, University of Liverpool, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.432977.
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Kelly, M. G. "Air way inflammation in obstructive airway diseases." Thesis, Queen's University Belfast, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.273059.
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West, Sophie Diana. "Obstructive sleep apnoea and type 2 diabetes." Thesis, University of Leicester, 2007. http://hdl.handle.net/2381/29539.
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Aims: To establish the prevalence of OSA in individuals with type 2 diabetes, and whether treatment with CPAP improves glycaemic control and insulin resistance. Methods and Results: A questionnaire was sent to 1682 men with type 2 diabetes from hospital and primary care databases. Fifty-six percent replied; 57% scored as 'high' and 39% as 'low' risk for OSA; 4% had known OSA. Overnight oximetry in 240 respondents from the 'high' and 'low' risk groups showed 31% and 13% respectively had significant OSA, verified by sleep studies. Exploration and oximetry data to the questionnaire respondent population suggests 23% have OSA. Comparison with a general population showed OSA prevalence to be significantly higher in the diabetes population (p<0.001). Multiple linear regression revealed diabetes was a significant independent OSA predictor after correction for BMI, explaining 8% of OSA variance (p<0.001). There was no correlation of OSA with HbA1c. A double blind randomized controlled trial of CPAP in men with type 2 diabetes and newly diagnosed OSA was performed. Forty-two men attended for baseline investigations and then received either therapeutic or placebo CPAP for 3 months; baseline tests were then repeated. In the therapeutic group, significantly improved subjective and objective sleepiness were noted, however no significant improvement in HbA1c, euglycaemic clamp, adiponectin or HOMA-%S were found. Conclusions: OSA is highly prevalent in men with type 2 diabetes; most individuals are undiagnosed. Diabetes may be a significant independent contributor to OSA risk. CPAP treatment of OSA does not improve insulin resistance or HbA1c in men with type 2 diabetes.
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Gadler, Fredrik. "Atrioventricular synchronous pacing in hypertrophic obstructive cardiomyopathy /." Stockholm, 1997. http://diss.kib.ki.se/1997/91-628-2748-0.
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Ulander, Martin. "Psychometric aspects of obstructive sleep apnea syndrome." Doctoral thesis, Linköpings universitet, Avdelningen för neurovetenskap, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-97475.
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Introduction: Obstructive sleep apnea (OSA) is a common chronic disorder consisting of episodes with impaired breathing due to obstruction of the upper airways. Treatment with Continuous Positive Airway Pressure (CPAP) is a potentially effective treatment, but adherence is low. Several potential factors affecting adherence, e.g., subjective sleepiness and personality, are only quantifiable through questionnaires. Better knowledge about psychometric properties of such questionnaires might improve future research on CPAP adherence and thus lead to better treatment options. Aim: Study I: To describe the devlopment and initial testing of the Side Effects of CPAP treatment Inventory (SECI) questionnaire. Study II: To describe the prevalence of Type D personality in OSAS patients with CPAP treatment longer than 6 months and the association with self-reported side effects and adherence. Study III: To study whether any of the items in the Epworth Sleepiness Scale (ESS) exhibit differential item functioning and, if so, to which degree. Study IV: To examine the evolution of CPAP side effects over time; and prospectively assess correlations between early CPAP side effects and treatment adherence. Patients and Methods: In study I, SECI items were based on a literature review, an expert panel and interviews with patients. It was then mailed to 329 CPAP-treated OSAS patients. Based on this, a principal component analysis was performed, and SECI results were compared between adherent and non-adherent patients. In study II, the population consisted of 247 OSAS patients with ongoing CPAP treatment. The DS14 was used to assess the prevalence of type D personality, and SECI and adherence data from medical records were used to correlate Type D personality to side effects and adherence. In study III, the population consisted of pooled data from 1,167 subjects who had completed the ESS in five other studies. Ordinal regression and Rasch analysis were used to assess the existence of differential item functioning for age and gender. The cutoff for age was 65 years in the Rasch analysis. In study IV, SECI was sent to 186 subjects with newly diagnosed OSAS three times during the first year on CPAP. SECI results were followed over time within subjects, and were correlated to treatment dropout during the first year and machine usage time after 6 months. Results: SECI provides a valid and reliable instrument to measure side effects, and non-adherent patients have higher scores (i.e., were more bothered by side effects) than adherent patients (study I). Type D personality was prevalent in approximately 30 % of CPAP treated OSAS patients, and was associated to poorer objective and subjective adherence as well as more side effects (study II). Differential item functioning was present in items 3, 4 and 8 for age in both DIF analyses, and to gender in item 8 the Rasch analysis (study III). Dry mouth and increased number of awakenings were consistently associated to poorer adherence in CPAP treated patients. Side effects both emerged and resolved over time (study IV). Conclusions: Differences in previous research regarding side effects and CPAP adherence might be explained by differences in how side effects and adherence are defined. While some side effects are related to adherence, others are not. Side effects are furthermore not stable over time, and might be related to personality. ESS scores are also related to CPAP adherence according to previous research, but might be affected by other factors than sleepiness, such as age and possibly gender.
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Filtness, Ashleigh J. "Obstructive sleep apnoea and daytime driver sleepiness." Thesis, Loughborough University, 2011. https://dspace.lboro.ac.uk/2134/8338.
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Driver sleepiness is known to be a major contributor to road traffic incidents (RTIs). An initial literature review identified many studies reporting untreated obstructive sleep apnoea (OSA) sufferers as having impaired driving performance and increased RTI risk. It is consistently reported that treatment with continuous positive air pressure (CPAP) improves driving performance and decreases RTI risk, although most of these studies are conducted less than one year after starting treatment. UK law allows treated OSA patients to continue driving if their doctor states that treatment has been successful. Despite the wealth of publications surrounding OSA and driving, 6 key areas were identified from the literature review as not fully investigated, the: (i) prevalence of undiagnosed OSA in heavy goods vehicle (HGV) drivers in the UK; (ii) impact of sleep restriction on long term CPAP treated OSA compared with healthy controls; (iii) ability of treated OSA participants to identify sleepiness when driving; (iv) impact of one night CPAP withdrawal on driving performance; (v) individual difference in driving performance of long term CPAP treated OSA participants; (vi) choice of countermeasures to driver sleepiness by two groups susceptible to driver sleepiness, OSA and HGV drivers. Key areas (i) and (vi) were assessed using questionnaires. 148 HGV drivers were surveyed to assess OSA symptoms and preference of countermeasures to driver sleepiness. All participants completing the driving simulator study were also surveyed. 9.5% of HGV drivers were found to have symptoms of suspected undiagnosed OSA. Additionally the OSA risk factors were more prevalent for HGV drivers than reported in national statistics reports for the general population. The most effective countermeasures to driver sleepiness (caffeine and a nap) were not the most popular. Being part of a susceptible group (OSA or HGV driver) and prior experience of driver sleepiness did not promote effective choice of countermeasure. Key areas (ii) to (v) were assessed using a driving simulator. Driving simulators present a safe environment to test participants in a scenario where they may experience sleepiness without endangering other road users.
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Al-shair, Khaled. "Systemic Manifestations of Chronic Obstructive Pulmonary Disease." Thesis, University of Manchester, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.509061.
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Coughlin, Steven Robert. "The cardiovascular consequences of obstructive sleep apnoea." Thesis, University of Liverpool, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.403099.
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Obstructive sleep apnoea (OSA) is associated with increased cardiovascular morbidity and mortality, possibly because it clusters with a number of cardiovascular risk factors that comprise and underpin the metabolic syndrome. These include, obesity, high blood pressure, insulin resistance, impaired glucose tolerance and dyslipidaemia, and an increased sympathetic activity, altered cardiac autonomic tone and reduced baroreceptor sensitivity. However, it is currently unclear whether OSA clusters with these risk factors independently of obesity as studies investigating these relationships generally used BMI as a surrogate marker of adiposity. Likewise, a lack of intervention studies for the majority of these risk factors makes it difficult to assess whether OSA directly influences their development. The first aim of this thesis was to determine whether OSA was associated with the cardiovascular risk factors that comprise the metabolic syndrome independently of obesity. This was accomplished by measuring these cardiovascular risk factors in two groups of subjects with and without OSA whom were closely matched for a range of obesity related variables. The second aim of this thesis was to determine whether these risk factors resolved with the application of nasal continuous positive airways pressure (CPAP) treatment. This was investigated by randomising subjects to either CPAP or a sub-therapeutic alternative for a six week period and then crossed-over to the alternative treatment for a further six weeks. The cardiovascular risk factors were compared following CPAP and sub-therapeutic therapy. The methodologies used to measure these cardiovascular risk factors included; blood pressure measurements, a HOMA analysis of fasting glucose and insulin values to estimate insulin resistance, a full lipid profile, a urine catecholamine analysis, and spectral analyses of baroreceptor sensitivity and heart rate variability, the latter being an indirect measure of cardiac autonomic tone. The results of these studies demonstrated that whilst OSA was independently associated with a reduced HDL cholesterol, an increased incidence of the metabolic syndrome and values of cardiac autonomic tone that have previously been demonstrated to confer an increased cardiovascular risk following myocardial infarction, only systolic, diastolic and mean arterial blood pressures were significantly reduced by CPAP. Whilst the associations of OSA with these known cardiovascular risk factors may help explain the increased cardiovascular morbidity and mortality associated with this condition, the results of the intervention study suggest that OSA clusters with the majority of these risk factors because of a common cause rather than any direct effect. Whether this common cause is a shared genetic mechanism or because subjects with OSA exhibit a sedentary lifestyle, a known risk factor for the metabolic syndrome which develops as a consequence of their daytime sleepiness, remains unclear. Further intervention using a structured physical activity programme in subjects with OSA is needed to clarify this.
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Revill, Susan M. "Endurance exercise in chronic obstructive pulmonary disease." Thesis, Loughborough University, 1997. https://dspace.lboro.ac.uk/2134/15388.
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Diamond, Thomas. "Experimental aspects of endotoxaemia in obstructive jaundice." Thesis, Queen's University Belfast, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.334469.
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Polkey, Michael Iain. "Diaphragm function in chronic obstructive pulmonary disease." Thesis, King's College London (University of London), 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.286262.
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Donaldson, Anna. "Circulating microRNA in Chronic Obstructive Pulmonary Disease." Thesis, Imperial College London, 2014. http://hdl.handle.net/10044/1/24776.
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Skeletal muscle dysfunction in COPD is associated with increased morbidity. Novel agents might reverse skeletal muscle dysfunction through different mechanisms since the biopsy picture in COPD patients is heterogenous. Thus there is a need for a biomarker of skeletal muscle dysfunction which could both be measured in blood and obviate the need for a biopsy. Previous work has found that muscle-specific microRNA (miR-1, miR-499, miR-206 and miR-133) are down-regulated in the quadriceps of COPD patients. Tissue specific miRNA circulate in the blood at detectable levels and are currently under investigation as biomarkers of other diseases. I therefore hypothesised that muscle-specific microRNA might be clinically viable biomarkers of skeletal muscle dysfunction. The studies in this thesis found that: 1. Levels of circulating muscle-specific microRNA (miR-1, miR-133, miR-206 and miR-499) were increased in stable COPD patients. The increase in muscle-specific microRNA in the stable COPD patients suggests that continual muscle turnover occurs outside of times of disease exacerbation. 2. Plasma levels of muscle-specific miRNA were not different in COPD patients admitted to hospital for an exacerbation of their disease compared to stable COPD patients. 3. Most muscle-specific microRNA did not change in muscle with acute exercise. I demonstrated an increase in miR-181 (an miRNA not restricted to, but with known function in muscle) one hour after acute exercise in the quadriceps muscle of COPD patients. However when fold change was calculated for the COPD patients and controls, there was no statistical difference found. There were no detectable miR-181 changes measured in blood. 4. Finally, I used a microarray approach to investigate other circulating microRNA that might to be useful to separate patients based on their lean muscle-mass. COPD patients with a reduced skeletal muscle mass had a reduced number of microRNA associated with growth and cell pluripotency, further studies are required to validate these findings. Taken together, the results from this thesis suggest that the microRNA analysed were detectable in blood, but they could not be usefully used (based on current analysis) as biomarkers of quadriceps dysfunction.
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Taylor, Abigail Elizabeth. "Macrophage phagocytosis in chronic obstructive pulmonary disease." Thesis, Imperial College London, 2009. http://hdl.handle.net/10044/1/7374.
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The hypothesis examined in this thesis stated that macrophages from COPD subjects are defective in their ability to phagocytose. To investigate this hypothesis, engulfment by COPD macrophages was compared to that of cells from controls (smokers without COPD and non-smokers). Phagocytosis of polystyrene beads by monocytes-derived-macrophages (MDM) was comparable to that of alveolar macrophages, thus validating the MDM model. There was no difference in uptake of beads by any subject group, however, COPD MDM phagocytosed significantly less E. coli, H. influenzae and S. pneumoniae than cells from controls. This was not due to current medications as commonly prescribed therapies did not reduce phagocytosis of these bacteria. To identify the mechanism of this defeat, cytoskeletal arrangement was investigated. Actin polymerisation was not altered by disease, but COPD MDM had a greater susceptibility to microtubule disruptors and reduced levels of acetylated tubulin compared to control cells. Increasing microtubule acetylation enhanced uptake of H. influenzae, suggesting that this may be a novel mechanism for improving phagocytosis. Other mechanisms investigated included sphingosine-1-phosphate (S1P) signalling, as production of this molecule was increased by COPD MDM and inhibition of S1P signalling cascade increased uptake of H. influenzae. Microarray analysis demonstrated that following exposure to H. influenzae, COPD MDM expressed significantly more inflammatory genes than control cells, suggesting that these macrophages respond differently to bacteria. These findings suggest that COPD macrophages have a reduced phagocytic ability, which may result in bacterial colonisation, inflammation and exacerbations. Improving this macrophage function would offer therapeutic potential in this disease.
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Minakata, Kenji. "Extended septal myectomy for hypertrophic obstructive cardiomyopathy." Kyoto University, 2009. http://hdl.handle.net/2433/126455.
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Baldrick, Francina Rose. "Diet and chronic obstructive pulmonary disease (COPD)." Thesis, Queen's University Belfast, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.527657.
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Domenech, Pena Arnau. "Dynamics of Streptococcus pneumoniae in patients with Chronic Obstructive Pulmonary Disease." Doctoral thesis, Universitat de Barcelona, 2013. http://hdl.handle.net/10803/134277.
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It is estimated that within a few years chronic obstructive pulmonary disease (COPD) will be the third leading cause of death worldwide. The morbidity and mortality associated with COPD are due, in part to acute exacerbation episodes (AECOPD), mainly caused by microbial pathogens such as Haemophilus influenzae, Streptococcus pneumoniae and Pseudomonas aeruginosa. Moreover, COPD is the main underlying disease associated with pneumococcal pneumonia episodes.
This thesis describes four studies performed to gain insights into the role of pneumococci and their closely-related species S. pseudopneumoniae in causing acute exacerbation and pneumonia episodes in COPD patients.
In the first study, a total of 188 sputum samples were obtained from AECOPD episodes occurring in severe COPD patients during a 1-year period. Samples were quantitatively cultured; of them, S. pneumoniae was isolated in 31 (16.5%) episodes and S. pseudopneumoniae in 9 (4.8%) episodes. S. pneumoniae was the third most frequent cause after Pseudomonas aeruginosa (28.8%) and Haemophilus influenzae (19.7%).
There are major differences in the invasiveness potential of pneumococci, depending on their serotype and genotype. Indeed, in our second study (from 2001 to 2008) we found an association of certain serotypes, and their related genotypes, with different pneumococcal infections. Serotypes 4 (ST2474), 5 (Colombia5-ST289) and 8 (Netherlands8-ST53) were associated with bacteraemic pneumonia, serotypes 1 (Sweden1-ST306) and 3 (Netherlands3-ST180 and ST2603) with bacteraemic and non-bacteraemic pneumonia, and serotypes 16F (ST3016F), 11A and non-typeable pneumococci with AECOPD episodes (P<0.05). Finally, in our experience, serotype 3 pneumococcus was the most frequent cause of pneumonia and acute exacerbations in COPD patients.
Moreover, the implementation of pneumococcal conjugate vaccine PCV7 for children in 2001 in Spain has been shown to be highly effective in reducing invasive pneumococcal disease in children, and in adults as well due to the phenomenon of herd protection. This effect was also observed among pneumococci causing acute exacerbations in adults: PCV7 serotypes decreased from 39.4% in the 2001-04 period to 11.2% in the 2009-12 period. In parallel, the prevalence of multi-drug resistant serotypes 15A and 6C has dramatically increased in recent years. For this reason, although the resistance rates of β-lactams decreased over time, macrolides and multi-drug resistance remained stable throughout the study period.
The presence of bacteria colonizing the lower airways of most severe COPD patients results in bronchial epithelial injury and increases morbidity among these patients. In the third study (1995-2010 period), it was found that a third of recurrent pneumococcal acute exacerbations were relapses (caused by a pre-existing strain), mainly associated with serotypes 9V and 19F (P<0.02). This suggests an important role for capsular type in pneumococcal persistence. In view of these results, we analysed the impact of antimicrobial consumption in the development of pneumococcal resistance to β-lactams and fluoroquinolones in 13 patients with a long-time persistence of pneumococci (average time: 582 days, SD ±362). Changes in quinolone-resistant determining regions (QRDR) involved in fluoroquinolone resistance were frequently observed in persistent strains after fluoroquinolone treatment; however, the penicillin-binding protein (PBP) sequences were stable over time, even though all but two patients received multiple courses of β-lactam treatment. These results suggest that an optimal combination of pbp genes is maintained to compensate for the fitness cost imposed by additional changes in these genes.
Despite the genetic stability of these persistent strains, S. pneumoniae is naturally transformable and is able to acquire exogenous DNA, resulting in a dynamic and complex epidemiology of pneumococcal diseases. This genetic diversity was also observed among the 36 S. pseudopneumoniae strains analysed.
Altogether, our studies can help to improve the understanding of the dynamics of S. pneumoniae and S. pseudopneumoniae populations causing disease in COPD patients.En aquesta tesis, es van dur a terme quatre estudis amb l’objectiu d’aprofundir en el paper de S. pneumoniae com a causant d’exacerbacions agudes i pneumònia en pacients amb MPOC. En el primer estudi, es van sembrar quantitativament un total de 188 mostres d’esput obtingudes durant episodis d’EAMPOC en pacients amb MPOC avançat, durant un any d’estudi (febrer 2010 - febrer 2011). S. pneumoniae es va aïllar en 31 (16.5%) episodis i fou la tercera causa d’exacerbació, després de Pseudomonas aeruginosa (28.8%) i Haemophilus influenzae (19.7%). En el segon estudi es va trobar una diferent associació d’alguns serotipus i del seus genotipus relacionats, en pacients amb MPOC amb diferents infeccions pneumocòcciques (període 2001-2008). El serotipus 3 va ser la causa més freqüent de pneumònia i d’EAMPOC, però els serotipus 4 (ST2474), 5 (Colombia5-ST289) i 8 (Netherlands8-ST53) es varen associar amb pneumònia bacterièmica; serotipus 1 (Sweden1-ST306) i 3 (Netherlands3-ST180 i ST2603) es varen associar amb pneumònia tant bacterièmica com no bacterièmica; mentre serotipus 16F (ST3016F), 11A i els pneumococs no-tipificables es varen associar amb EAMPOC (P<0.05). Degut a la implementació de la vacuna conjugada PCV7, els serotipus inclosos en la vacuna han disminuït del 39.4% en el període 2001-2004 a 11.2% en el període 2008-2012. Paral•lelament a aquest descens, els serotipus 15A i 6C han augmentat dramàticament en els últims anys. Per aquesta raó, la multiresistència s’ha mantingut estable durant tot el període d’estudi. En el tercer estudi (1995-2010), es va observar que un terç dels episodis d’EAMPOC recurrents, varen ser causats per una soca preexistent, principalment serotipus 9V i 19F (P<0.05), considerant-se recaigudes. Aquest fet suggereix un paper important del tipus capsular en la persistència. Finalment, es va analitzar l’impacte del consum d’antimicrobians en el desenvolupament de resistència en 13 pacients colonitzats per pneumococc (temps mitjà: 582 dies, DS ±362). Es van observar canvis en les QRDRs de les soques d’aquells pacients que van rebre tractament amb fluoroquinolones. En canvi, les PBPs de les soques persistents van romandre estables tot i els múltiples tractaments amb β-lactàmics que van rebre els pacients. En total, els estudis presentats han millorat el coneixement de la dinàmica de les poblacions de S. pneumoniae i S. pseudopneumoniae en pacients amb MPOC.
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Lecamwasam, Harish Sanjeev. "An analysis of detrusor dynamics and urethral flow in the canine urinary tract, under obstructive and non-obstructive conditions." Thesis, Massachusetts Institute of Technology, 1995. http://hdl.handle.net/1721.1/36612.
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Batlle, Garcia Jordi de 1981. "Measure and effect of diet in chronic obstructive pulmonary disease." Doctoral thesis, Universitat Pompeu Fabra, 2011. http://hdl.handle.net/10803/52896.
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Background and objectives: Recent research has shown an
association between a healthy diet and reduced chronic obstructive
pulmonary disease (COPD) incidence. However, the potential role
of diet in COPD prognosis is unknown. This thesis aimed to
describe the characteristics of diet in COPD patients and to
estimate its association with the disease evolution, in terms of
pathophysiological impairment and hospitalizations. A secondary
objective was to study the role of diet in asthma, as a COPDrelated
phenotype.
Methods: A dietary ancillary protocol was included in a well
phenotyped cohort of 342 COPD patients recruited during their first
admission for a COPD exacerbation in Spain. Dietary data of the
last 2 years was assessed using a validated food frequency
questionnaire (122 items). Levels of oxidative stress and
inflammatory markers were measured in serum. Hospital
admissions during follow-up were obtained from national datasets.
Additionally, data from the International Study of Asthma and
Allergies in Childhood (ISAAC) in Mexico was used to assess the
effect of diet in childhood asthma.
Results: (i) COPD patients report an adequate intake of the main
food groups and macro- and micro-nutrients according to local
recommendations, excepting vitamin D; (ii) vitamin E and olive oil
intakes are associated with reduced oxidative stress in COPD
active smokers; (iii) intake of _3 and _6 fatty acids is related to the
levels of serum inflammatory markers; (iv) cured meat intake
increases the risk of COPD admission during follow-up; and (v)
children adherence to a Mediterranean dietary pattern relates to
reduced childhood asthma prevalence.
Conclusions: Dietary habits may modify COPD prognosis and
childhood asthma. Therefore, advice on healthy diet should be
considered in chronic respiratory diseases guidelines.Antecedents i objectius: Estudis recents mostren associacions entre una dieta sana i reduccions en la incidència de malaltia pulmonar obstructiva crònica (MPOC). Tanmateix, el possible rol de la dieta en l'evolució de l'MPOC és desconegut. L'objectiu d'aquesta tesi és descriure les característiques de la dieta en pacients amb MPOC i estimar-ne l’associació amb l'evolució de la malaltia en termes d’alteracions fisiopatològiques i hospitalitzacions. Com a objectiu secundari, també es vol estudiar el paper de la dieta en l'asma, com a malaltia estretament relacionada amb l'MPOC. Mètodes: Es va aniuar un protocol d’epidemiologia nutricional en una cohort de 342 malalts d’MPOC, ben fenotipats, reclutats a Espanya durant la seva primera hospitalització per agudització de l'MPOC. Es va administrar un qüestionari de freqüència de consum d'aliments (122 ítems) preguntant per la dieta dels darrers 2 anys. Es van mesurar en sèrum els nivells de marcadors d'estrès oxidatiu i d'inflamació. Les hospitalitzacions durant el temps de seguiment s’obtingueren a partir de registres nacionals. Per últim, s'utilitzaren dades de l'International Study of Asthma and Allergy in Childhood (ISAAC) a Mèxic per a estimar l'efecte de la dieta en l'asma infantil. Resultats: (i) El consum d'aliments i macro- i micro-nutrients fou considerat adient respecte a les recomanacions locals, exceptuant la vitamina D; (ii) la ingesta de vitamina E i oli d’oliva s’associà a menors nivells d’estrès oxidatiu en pacients fumadors actius; (iii) els nivells de ingesta d'àcids grassos _3 i _6 es va relacionar amb els nivells d’inflamació sistèmica; (iv) la ingesta d’embotits i carns curades va incrementar el risc d'hospitalització per MPOC durant el seguiment; i (v) l’adherència a un patró mediterrani d'alimentació s’associà a menor prevalença d'asma infantil. Conclusions: Els hàbits alimentaris poden modificar l'evolució de l'MPOC i el desenvolupament d'asma infantil. Per tant, s’hauria de considerar l’inclusió de consells alimentaris en les guies clíniques per a malalties respiratòries cròniques.
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Batlle, Garcia Jordi de. "Measure and effect of diet in chronic obstructive pulmonary disease." Doctoral thesis, Universitat Pompeu Fabra, 2011. http://hdl.handle.net/10803/52896.
Full textAbstract:
Background and objectives: Recent research has shown an
association between a healthy diet and reduced chronic obstructive
pulmonary disease (COPD) incidence. However, the potential role
of diet in COPD prognosis is unknown. This thesis aimed to
describe the characteristics of diet in COPD patients and to
estimate its association with the disease evolution, in terms of
pathophysiological impairment and hospitalizations. A secondary
objective was to study the role of diet in asthma, as a COPDrelated
phenotype.
Methods: A dietary ancillary protocol was included in a well
phenotyped cohort of 342 COPD patients recruited during their first
admission for a COPD exacerbation in Spain. Dietary data of the
last 2 years was assessed using a validated food frequency
questionnaire (122 items). Levels of oxidative stress and
inflammatory markers were measured in serum. Hospital
admissions during follow-up were obtained from national datasets.
Additionally, data from the International Study of Asthma and
Allergies in Childhood (ISAAC) in Mexico was used to assess the
effect of diet in childhood asthma.
Results: (i) COPD patients report an adequate intake of the main
food groups and macro- and micro-nutrients according to local
recommendations, excepting vitamin D; (ii) vitamin E and olive oil
intakes are associated with reduced oxidative stress in COPD
active smokers; (iii) intake of _3 and _6 fatty acids is related to the
levels of serum inflammatory markers; (iv) cured meat intake
increases the risk of COPD admission during follow-up; and (v)
children adherence to a Mediterranean dietary pattern relates to
reduced childhood asthma prevalence.
Conclusions: Dietary habits may modify COPD prognosis and
childhood asthma. Therefore, advice on healthy diet should be
considered in chronic respiratory diseases guidelines.Antecedents i objectius: Estudis recents mostren associacions entre una dieta sana i reduccions en la incidència de malaltia pulmonar obstructiva crònica (MPOC). Tanmateix, el possible rol de la dieta en l'evolució de l'MPOC és desconegut. L'objectiu d'aquesta tesi és descriure les característiques de la dieta en pacients amb MPOC i estimar-ne l’associació amb l'evolució de la malaltia en termes d’alteracions fisiopatològiques i hospitalitzacions. Com a objectiu secundari, també es vol estudiar el paper de la dieta en l'asma, com a malaltia estretament relacionada amb l'MPOC. Mètodes: Es va aniuar un protocol d’epidemiologia nutricional en una cohort de 342 malalts d’MPOC, ben fenotipats, reclutats a Espanya durant la seva primera hospitalització per agudització de l'MPOC. Es va administrar un qüestionari de freqüència de consum d'aliments (122 ítems) preguntant per la dieta dels darrers 2 anys. Es van mesurar en sèrum els nivells de marcadors d'estrès oxidatiu i d'inflamació. Les hospitalitzacions durant el temps de seguiment s’obtingueren a partir de registres nacionals. Per últim, s'utilitzaren dades de l'International Study of Asthma and Allergy in Childhood (ISAAC) a Mèxic per a estimar l'efecte de la dieta en l'asma infantil. Resultats: (i) El consum d'aliments i macro- i micro-nutrients fou considerat adient respecte a les recomanacions locals, exceptuant la vitamina D; (ii) la ingesta de vitamina E i oli d’oliva s’associà a menors nivells d’estrès oxidatiu en pacients fumadors actius; (iii) els nivells de ingesta d'àcids grassos _3 i _6 es va relacionar amb els nivells d’inflamació sistèmica; (iv) la ingesta d’embotits i carns curades va incrementar el risc d'hospitalització per MPOC durant el seguiment; i (v) l’adherència a un patró mediterrani d'alimentació s’associà a menor prevalença d'asma infantil. Conclusions: Els hàbits alimentaris poden modificar l'evolució de l'MPOC i el desenvolupament d'asma infantil. Per tant, s’hauria de considerar l’inclusió de consells alimentaris en les guies clíniques per a malalties respiratòries cròniques.
50
Mayet, Thierry. "Influence du débit cardiaque sur les échanges gazeux dans la bronchopathie chronique obstructive." Bordeaux 2, 1996. http://www.theses.fr/1996BOR23016.
Full text