Time filter

Source Type

Austin, TX, United States

Li Z.,International Biomedical
Journal of Bionic Engineering

Considerable progress has been made on modeling particle deposition in the oral-tracheal airway under some normal breathing conditions, . i.e., resting, light activity and moderate exercise. None of these standard breathing patterns correspond to very low inhalation profiles. It is known that particle deposition in the oral-tracheal airway is greatly influenced by flow and particle inlet conditions. In this work, very low inhalation flow rates are considered. Particle deposition is numerically investigated in different oral-tracheal airway models, . i.e., circular, elliptic and realistic oral-tracheal airway models. Both micro- and nano-particles that are normally present in cigarette smoke are considered. Results show that inhalation profiles greatly influence the particle deposition. Due to relatively low flow rate, for ultra-fine particles, the oral deposition is enhanced due to longer residence time in oral cavity and stronger Brownian motion. However, for larger particles, less particles deposit in the oral-tracheal airway due to the weaker impaction. The transition happens when particle size changes from 0.01 μm to 0.1 μm. The influence of the limited entrance area is shown and discussed. Under the low inhalation profiles, the highest deposition fraction could be in either circular or realistic models depending on the particle property and the geometric characteristic of oral cavity. The knowledge obtained in this study may be beneficial for the design of bionic inhaler and understanding of health effect from smoke particle on human being. © 2012 Jilin University. Source

Chronic obstructive pulmonary disease (COPD) is a common disease in the general population and it places a considerable burden on patients, with the disease negatively affecting quality of life. In practice, patients with COPD generally seek medical attention because of symptoms, particularly breathlessness, and the resulting physical limitations, which affect the health-related quality of life (HR-QOL) in patients. The defining feature of COPD is airflow limitation that causes air trapping and increased hyperinflation as the ventilation rate increases during physical effort. Hyperinflation causes or worsens breathlessness as breathing becomes inefficient, with the end result being an avoidance of physical exertion and a cycle of increasing dyspnea caused by inactivity and deconditioning, with deleterious effects on HR-QOL. Current published guidelines for COPD state that the goals of pharmacologic therapy should be to control symptoms, improve health status and exercise tolerance, and reduce the frequency of COPD exacerbations. Effective and sustained bronchodilation has emerged as a key strategy for improving dyspnea and ability to exercise. As there is no cure for COPD, a major goal of treatment and of research into new therapies is to improve HR-QOL in COPD patients. Conclusion: More recently, indacaterol, an inhaled ultra-long-acting β2-agonist (24-hour action), has been approved in many countries at different doses (between 75 and 300 μg once daily) for treatment of patients with stable but symptomatic COPD. The aim of this review was to explore once-daily indacaterol clinical data as related to improvement in HR-QOL in COPD. Indacaterol studies have shown significant improvements in lung function of COPD patients, and these improvements have also translated into clinically meaningful improvements in patient symptoms and HR-QOL. © 2013 Feldman, publisher and licensee Dove Medical Press Ltd. Source

Feldman G.J.,International Biomedical | Edin A.,Alliance Biomedical Russian Group
Therapeutic Advances in Respiratory Disease

The defining feature of chronic obstructive pulmonary disease (COPD) is progressive airflow limitation that causes air trapping and hyperinflation. The increasing hyperinflation results in dyspnea along with associated inability to engage in the activities of daily living. The American Thoracic Society (ATS), European Respiratory Society (ERS) and Global Initiative for Chronic Obstructive Lung Disease (GOLD) treatment guidelines all place bronchodilators as the foundation of pharmacological management of COPD. In patients with moderate-to-very-severe respiratory impairment, adding regular treatment with one or more long-acting bronchodilators is recommended [long-acting β2-agonists (LABAs) or long-acting muscarinic antagonists (LAMAs)]. A growing body of evidence shows that LAMA and LABA co-administration is more effective than either drug class alone in managing stable COPD to improve lung function, symptoms and health status. Recently, new drug applications (NDAs) for a fixed-dose combination (FDC) of umeclidinium (UMEC), a LAMA, and vilanterol (VI), a LABA, at UMEC/VI doses of 125/25 and 62.5/25 μg have been submitted by sponsors to the US Food and Drug Administration (FDA) and to the European Medicines Agency (EMA). Thus, UMEC/VI has become the first FDC LAMA/LABA product that has reached a regulatory approval stage. Other LAMA/LABA once-daily combinations coming through development include FDCs of tiotropium and olodaterol, glycopyrronium and indacaterol, and twice-daily aclidinium and formoterol. The aim of this review is to explore currently available data for once-daily UMEC/VI in the context of the evolving standards of COPD management. © The Author(s), 2013. Source

Grimes D.A.,International Biomedical
Cochrane database of systematic reviews (Online)

BACKGROUND: Insertion of an intrauterine device (IUD) immediately after an abortion has several advantages. The woman is known not to be pregnant. Many clinicians refuse to insert an IUD in a woman who is not menstruating. After induced abortion, a woman's motivation to use contraception may be high. However, insertion of an IUD immediately after a pregnancy ends carries risks, such as spontaneous expulsion due to recent cervical dilation. OBJECTIVES: To assess the safety and efficacy of IUD insertion immediately after spontaneous or induced abortion. SEARCH STRATEGY: We searched MEDLINE, CENTRAL, POPLINE, EMBASE, ClinicalTrials.gov, and ICTRP. We also contacted investigators to identify other trials. SELECTION CRITERIA: We sought all randomized controlled trials with at least one treatment arm that involved IUD insertion immediately after an induced abortion or after curettage for spontaneous abortion. We identified 11 trials which described random assignment. DATA COLLECTION AND ANALYSIS: We evaluated the methodological quality of each report and abstracted the data. We focused on discontinuation rates for accidental pregnancy, perforation, expulsion, and pelvic inflammatory disease. We computed the weighted average of the rate ratios. We computed relative risks (RR) with 95% Confidence Intervals (CI). MAIN RESULTS: Three trials randomized to immediate or delayed insertion. One showed no significant differences. Meta-analysis of two showed use of levonorgestrel-releasing intrauterine system or CuT380A was more likely for immediate versus delayed insertion (RR 1.18; 95% CI 1.08 to 1.28). Another trial randomized to the levonorgestrel IUD or Nova T; discontinuation rates due to pregnancy were 0.8 and 9.5, respectively. Sub-analysis showed higher expulsion rates for postabortal than interval insertions (levonorgestrel: 2.8 versus 6.8; Nova T: 3.0 versus 8.3).Seven trials examined immediate insertion. From meta-analysis of two multicenter trials, pregnancy was less likely for the TCu 220C versus the Lippes Loop (RR 0.38; 95% CI 0.20 to 0.72) as was expulsion (RR 0.51; 95% CI 0.30 to 0.88). Estimates for the TCu 220 versus the Copper 7 were 0.52 (95% CI 0.36 to 0.77) and 0.58 (95% CI 0.39 to 0.87), respectively. In other work, adding copper sleeves to the Lippes Loop improved efficacy (RR 3.82; 95% CI 1.41 to 10.36) and reduced expulsion (RR 3.37; 95% CI 1.65 to 6.90). AUTHORS' CONCLUSIONS: Insertion of an IUD immediately after abortion is safe and practical. IUD expulsion rates appear higher than after interval insertions. However, IUD use is higher at six months with immediate than with interval insertion. Source

Grimes D.A.,International Biomedical
Cochrane database of systematic reviews (Online)

BACKGROUND: Insertion of an intrauterine device (IUD) immediately after delivery is appealing for several reasons. The woman is known not to be pregnant, her motivation for contraception may be high, and the setting may be convenient for both the woman and her provider. However, the risk of spontaneous expulsion may be unacceptably high. OBJECTIVES: To assess the efficacy and feasibility of IUD insertion immediately after expulsion of the placenta. Our a priori hypothesis was that this practice is safe but associated with higher expulsion rates than interval IUD insertion. SEARCH STRATEGY: We searched MEDLINE, CENTRAL, POPLINE, EMBASE, ClinicalTrials.gov, and ICTRP. We also contacted investigators to identify other trials. SELECTION CRITERIA: We sought all randomized controlled trials (RCTs) with at least one treatment arm that involved immediate post-partum (within 10 minutes of placental expulsion) insertion of an IUD. Comparisons could include different IUDs, different insertion techniques, immediate versus delayed post-partum insertion, or immediate versus interval insertion (unrelated to pregnancy). Studies could include either vaginal or cesarean deliveries. DATA COLLECTION AND ANALYSIS: We evaluated the methodological quality of each report and sought to identify duplicate reporting of data from multicenter trials. Two authors abstracted the data. Principal outcome measures were pregnancy, expulsion, and continuation rates. Because the trials did not have uniform interventions, we were unable to aggregate them in a meta-analysis. MAIN RESULTS: We found nine RCTs; one directly compared immediate post-partum insertion with delayed insertion. Expulsion by six months was more likely for the immediate group than the delayed insertion group (OR 6.77; 95% CI 1.43 to 32.14). In trials of immediate insertion alone, modifications of existing devices, such as adding absorbable sutures or additional appendages, did not appear beneficial. Most studies showed no important differences between insertions done by hand or by instruments. Lippes Loop and Progestasert devices did not perform as well as did copper devices. AUTHORS' CONCLUSIONS: Immediate post-partum insertion of IUDs appeared safe and effective, though direct comparisons with other insertion times were limited. Expulsion rates appear to be higher than with interval insertion. Advantages of immediate post-partum insertion include high motivation, assurance that the woman is not pregnant, and convenience. The popularity of immediate post-partum IUD insertion in countries as diverse as China, Mexico, and Egypt support the feasibility of this approach. Early follow up may be important in identifying spontaneous IUD expulsions. Source

Discover hidden collaborations