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Lung Capacity01:47

Lung Capacity

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The air in the lungs is measured in volumes and capacities. Lung volume measures reflect the amount of air taken in, released, or left over after a lung function, like a single inhalation. Lung capacity measures are sums of two or more lung volume measures.
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Treatment for Pulmonary Arterial Hypertension: Phosphodiesterase Inhibitors01:28

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Phosphodiesterase 5 (PDE5) inhibitors are potent enzymes that function to hydrolyze cyclic nucleotides to their corresponding 5' monophosphates. Their unique biochemical properties have been applied in treating Pulmonary Arterial Hypertension (PAH).
Among the PDE5 inhibitors, sildenafil (Revatio) stands out as a competitive and selective inhibitor. It operates by elevating cellular levels of cGMP and augmenting signaling through the cGMP-PKG pathway, promoting vasodilation. Upon oral...
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Treatment for Pulmonary Arterial Hypertension: Endothelin Receptor Antagonists01:18

Treatment for Pulmonary Arterial Hypertension: Endothelin Receptor Antagonists

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Endothelins (ETs) are potent vasoactive peptides critical in the human body's various physiological and pathological processes. One of the most promising therapeutic strategies for treating pulmonary arterial hypertension (PAH) involves counteracting the effects of these endothelins using a class of drugs known as endothelin receptor antagonists.
ETs are synthesized through a complex sequence of enzymatic steps, primarily involving an enzyme referred to as endothelin-converting enzyme...
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Treatment for Pulmonary Arterial Hypertension: Prostacyclin Receptor Agonists01:23

Treatment for Pulmonary Arterial Hypertension: Prostacyclin Receptor Agonists

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Prostacyclin receptor agonists are a class of therapeutic agents integral to managing pulmonary arterial hypertension (PAH). These drugs operate by mimicking the action of prostaglandin I2, or PGI2, a naturally occurring compound in the body.
These agonists bind to the IPR receptor situated on the plasma membrane of the pulmonary artery smooth muscle cells. This binding triggers a cascade of reactions known as the GS-AC-cAMP-PKA pathway. This pathway results in the relaxation of smooth muscle...
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Treatment for Pulmonary Arterial Hypertension: Oxygen Therapy for Respiratory Failure01:16

Treatment for Pulmonary Arterial Hypertension: Oxygen Therapy for Respiratory Failure

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Oxygen therapy has emerged as a significant tool in enhancing the quality of life for patients suffering from pulmonary arterial hypertension (PAH). While this therapy has principally been studied on patients with significant hypoxemia, this therapeutic approach helps prevent potential organ damage and can be administered in the comfort of one's home.
Oxygen therapy is vital in increasing and maintaining blood oxygen levels in PAH patients. As a result, it aids in reducing fatigue,...
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Treatment for Pulmonary Arterial Hypertension: Receptor Tyrosine Kinase Inhibitors and Calcium Channel Blockers01:26

Treatment for Pulmonary Arterial Hypertension: Receptor Tyrosine Kinase Inhibitors and Calcium Channel Blockers

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Receptor tyrosine kinase inhibitors (TKIs) and calcium channel blockers (CCBs) are two critical categories of drugs employed in the treatment of pulmonary artery hypertension (PAH). PAH is a disease that causes high blood pressure in the pulmonary arteries, resulting in chest pain, fatigue, and shortness of breath.
TKIs, such as imatinib (Gleevec), are particularly effective in tackling the growth and mitogenic factors that become upregulated in PAH patients. These factors contribute to the...
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Multifractal Spectrum Analysis for Assessing Pulmonary Nodule Malignancy
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Pulmonary Artery Resection During Lung Resection for Malignancy.

Maria Lucia L Madariaga1, Abraham Geller1, Michael Lanuti1

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Pulmonary artery reconstruction for lung cancer offers a safe alternative to pneumonectomy, with low operative risk for eligible patients. Long-term survival depends on managing distant recurrence, highlighting the need for systemic therapies.

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Area of Science:

  • Thoracic Surgery
  • Surgical Oncology
  • Cardiovascular Surgery

Background:

  • Complete resection of central lung tumors invading the main pulmonary artery (PA) necessitates arterial reconstruction to potentially avoid pneumonectomy.
  • The oncologic equivalence of PA reconstruction versus pneumonectomy remains an area of investigation.
  • This study reviews patient selection and outcomes for PA reconstruction in the context of pneumonectomy candidacy.

Purpose of the Study:

  • To evaluate the safety and efficacy of pulmonary artery reconstruction for central lung tumors.
  • To assess outcomes in patients who are candidates for pneumonectomy.
  • To determine the impact of combined bronchial sleeve resection and PA reconstruction on survival and recurrence.

Main Methods:

  • A retrospective review of 34 pulmonary arterial resections for primary or metastatic lung malignancy performed between 2000 and 2018.
  • Independent assessment of pneumonectomy candidacy and arterioplasty technique by 9 surgeons.
  • Exclusion of patients with limited lateral PA resection or resection for metastasis from survival analysis.

Main Results:

  • No operative mortality was observed; one late death occurred at 47 days. Postoperative complications were noted in 61.8% of patients.
  • Overall 5-year survival was 33%. Patients undergoing bronchial sleeve resection and PA reconstruction demonstrated improved 5-year disease-free survival (50% vs 19%) and lower recurrence rates (8% vs 47%).
  • Distant recurrence accounted for 80% of disease recurrence, underscoring the systemic nature of disease progression.

Conclusions:

  • Pulmonary artery resection and reconstruction for lung malignancy can be performed safely.
  • Arterial resection in pneumonectomy candidates presents a low operative risk.
  • Long-term survival is significantly influenced by distant recurrence, emphasizing the critical role of systemic therapy.