bluuebunny/crossref_metadata_2025 huggingface dataset:
Key Stakeholder Perspectives of Community Engagement Efforts and the Impact of the Covid-19 Pandemic
Authors: Huang Lily , Cleveland Tiera , Clift Kristin , Egginton Jason S. , Pacheco-Spann Laura , Johnson Matthew G. , Albertie Monica , Cardenas Lilliana D. , Phelan Sean M. , Allyse Megan A. , Barwise Amelia K.
Published: November 2022

Introduction:

The COVID-19 pandemic has disproportionally affected historically marginalized populations and their access to resources and healthcare. In times of crisis, authentic community engagement is more important than ever. This study was Phase 1 of a larger 3-phase study to conduct timely community-engaged research with community members to understand the disproportionate impact of COVID-19 on historically underserved communities. The objective of this work was to conduct key informant (KI) interviews (1) to understand community organizations perspectives about the role that large academic health centers play as they interface with community organizations to support their work, (2) to leverage KI’s expertise to identify needs and assets within the community, and (3) to inform both Phase 2 (focus group qualitative research) and Phase 3 (survey) of the broader study.

Methods:

A total of 24 key informants were identified through purposeful sampling and one-on-one semi-structured interviews were conducted across 4 states using video conferencing.

Results:

Barriers to access and lack of transparency were highlighted as major issues requiring reform—in particular, aggressive billing practices and insurance barriers exacerbated local distrust of medical institutions. KIs recognized the health institution’s support for testing and vaccination during the COVID-19 pandemic, but noted other significant gaps in care, especially regarding mental health support. Although communication with the health institution was consistent for some KIs, others experienced unsustained communication efforts that hindered cooperation and relationship building.

Conclusions:

Leaders in the community as key stakeholders can provide unique insights into the challenges and potential solutions required to promote health equity, and foster understanding between local communities and healthcare institutions.
Interrupted Aortic Arch Associated With Aortopulmonary Window: The Role of Multidetector Computed Tomography Angiography
Authors: Brunet-Garcia Laia , Zuccarino Flavio , Moscoso Garrido Bosco Alejandro , Carretero Bellon Juan Manuel
Published: November 2022

We report a case of a 2-day-old male with a diagnosis of interrupted aortic arch combined with aortopulmonary window suspected through echocardiography and confirmed by multidetector computer tomography (MDCT) angiography. Our case highlights how MDCT angiography was a key factor in planning surgical approach as it not only accurately defined aortic arch anatomy but also aortopulmonary window morphology.
To Stay or Leave: A Career Dilemma Faced by Chinese College Counselors
Authors: Chen Jiahua , Muktar Syaharizatul Noorizwan
Published: November 2022

The high turnover rate of Chinese college counselors has become a social issue that is increasingly being concerned about. Many scholars have tried to analyze the reasons for this issue from different perspectives. This study selects a qualitative approach to explore the college counselors’ turnover intention from the perspective of subjective career success while analyzing the relationship between subjective career success and turnover intention. This study finds that the three dimensions of career success criteria could be successfully applied to evaluate counselors’ subjective career success. Career safety and stability can, in combination with the interview results, be incorporated into the measurement of subjective career success under the dimension of external compensation. Meanwhile, college counselors’ subjective career success is correlated with turnover intention. College counselors will evaluate different dimensions of subjective career success and balance the same against their work values. The findings of this study provide empirical support on college counselors’ evaluation of their career status and turnover intention, which helps colleges analyze counselors’ turnover intentions from a new perspective and reduce turnover rate.
Observational study of cenegermin for the treatment of limbal stem cell deficiency associated with neurotrophic keratopathy
Authors: Arboleda Alejandro , Ta Christopher N.
Published: November 2022

Background:

Neurotrophic keratopathy (NK) and limbal stem cell deficiency (LSCD) have high morbidity and require aggressive management to prevent permanent vision loss. Cenegermin, a recombinant human nerve growth factor, was approved by the Federal Drug Administration in 2018 for the treatment of NK.

Objectives:

To determine the efficacy and safety of cenegermin in the treatment of LSCD associated with NK.

Design:

Prospective cohort study

Methods:

Patients diagnosed with LSCD and NK who had failed conventional treatment were enrolled in this prospective open-label study. Patients were treated with cenegermin for 8 weeks. The primary objective was to determine whether the area of abnormal epithelium decreased following treatment. Corneal sensation, visual acuity (VA), and LSCD severity were also evaluated.

Results:

Six eyes of 5 patients were included in the study. Cenegermin significantly improved the area of abnormal corneal epithelium in 5 of 6 eyes, measuring 73% of total corneal area at the initial visit and 48% at the final visit ( P = .036). Corneal sensation improved in all patients, Cochet–Bonnet aesthesiometry measured 14.7 and 26.7 mm at the initial and final visit, respectively ( P = .009). VA improved in 4 out of 6 eyes, with mean initial logMAR VA of 1.67 and final logMAR VA of 1.19 ( P = .045). Finally, LSCD grading improved using the Aravena scoring system; however, this difference was not statistically significant ( P = .14). One patient presented with an epithelial defect at baseline, which resolved following treatment. No patient withdrew from the study due to adverse effects.

Conclusions:

Cenegermin effectively improved the cornea epithelium, VA, and corneal sensation in patients with LSCD and NK who had failed prior treatment. Further studies are necessary to better understand the anatomical changes and to confirm our results with a larger randomized control trial.

Registration:

The study was registered at ClinicalTrials.gov with identifier NCT04552730 ( https://clinicaltrials.gov/ct2/show/NCT04552730 ).
Working Together: Peer Interactions to Support Students with Disabilities in the Music Classroom
Authors: Draper Ellary A.
Published: November 2022

There are many models for structuring peer interactions in the music classroom. From peer mentoring to peer tutoring, to other structured interaction models that have emerged from other areas of education, music teachers have many options when considering how to include structured peer interaction activities. This article describes the various models of structured peer interaction activities that can be used in music classrooms and provides strategies for implementing these activities in ways that support students with disabilities.
Mycobacterium avium complex develop resistance to synergistically active drug combinations during infection
Authors: Hoffner SE , Heurlin N , Petrini B , Svenson SB , Kallenius G
Published: November 2022

Isolates of Mycobacterium avium complex from five patients on longterm (3-5 yrs) anti-mycobacterial drug treatment were collected during the early and late phase of disease, and studied in vitro for their susceptibility to anti-mycobacterial drugs and drug-combinations. All isolates were resistant or moderately resistant to ethambutol, rifampicin and streptomycin when given singly; however, all strains isolated early in the disease were susceptible to the combination of ethambutol with either rifampicin or streptomycin. All late isolates had developed resistance to one or both of these combinations. Three of the patients died within a year after the last isolation of M. avium complex, and the two remaining patients still have severe chronic disease. It is concluded that the susceptibility of M. avium strains to combinations of drugs should be monitored during the course of treatment, in order to guide the selection of effective drug-combinations throughout the infection.
Is severe arterial hypoxaemia due to hepatic disease an indication for liver transplantation? A new therapeutic approach
Authors: Rodriguez-Roisin R , Krowka MJ
Published: November 2022

Severe arterial hypoxaemia or deteriorating pulmonary oxygenation due to HPS appears to be reversible within months of orthotopic liver transplantation. Due to the apparently poor prognosis in these patients, such abnormal oxygenation may, indeed, be considered an indication for liver transplantation in selected clinical situations. The pretransplant distinction between HPS and pulmonary hypertension as a reason for arterial hypoxaemia is essential, however, in that different outcomes appear to exist. Further prospective studies of patients with pulmonary vascular complications of liver disease are desperately needed.
Isocapnic and small hypercapnic single-breath stimuli: evidence for an inhibitory inflation reflex in conscious man
Authors: Fernando SS , Saunders KB
Published: November 2022

We wished to find out if a deep inspiration had any influence on subsequent breathing which was mediated by neural rather than chemical stimuli. We therefore compared the effect on ventilation of a deep isocapnic breath with that of a similar breath containing 6% CO2, and with the effect of two successive tidal volume breaths of 6% CO2. We studied five normal subjects, each of whom repeated the three manoeuvres 20 times, and we used ensemble averaging to increase the signal-to-noise ratio. The isocapnic deep inspiration was followed by a significant inhibition of ventilation in the group in the second post-stimulus breath, and in 4 of the 5 subjects in first and second post-stimulus breaths. This was due to an increase in both inspiratory and expiratory time, with a variable effect on tidal volume. A similar initial ventilatory inhibition was seen in the response to a deep breath of 6% CO2. When the isocapnic response was subtracted from the hypercapnic response, the result was similar to that observed from two tidal volume breaths of 6% CO2. We conclude that a single deep inflation of the lungs in awake man inhibits subsequent ventilation by a neural mechanism, and that this may affect the CO2 response measured by single-breath techniques using such manoeuvres.
Experience of a standardised method for assessing respiratory disability
Authors: Cotes JE , Chinn DJ , Reed JW , Hutchinson JE
Published: November 2022

A standardised method of scoring respiratory disability based on measurement and/or estimation of maximal oxygen uptake has recently been developed by the European Society for Clinical Respiratory Physiology. In the present study, we wanted to determine how the results obtained using this objective method compared with those by the more traditional empirical method used in a Medical Boarding Centre (MBC) for Respiratory Diseases. The subjects were 62 men who were claiming industrial injuries benefit on account of prior exposure to a respiratory hazard. The MBC ratings and the disability scores were correlated and, in the case of men with moderate or severe disability, numerically equivalent. The results provided independent confirmation that the MBC ratings were influenced by the forced expiratory volume, radiological category of pneumoconiosis and grade of breathlessness. In subjects in whom the measured and estimated maximal oxygen uptakes were inconsistent, the information obtained during the exercise test could identify which of several factors contributed to the exercise limitation. Since the new method might be expected to reduce the difficulties experienced in assessing respiratory disability, its use is recommended.
Management of occupational asthma
Authors: Hendrick DJ
Published: November 2022

The importance of occupational asthma and its management is usefully set in perspective by considering recent trends of increasing asthma incidence, morbidity and mortality in the population at large. The contribution to incidence made by asthma of occupational origin is of the order 20-100 cases per million workers per year; the individual worker's lifetime risk approaching 5% in some industrial environments. Management of the affected industry inevitably follows different pathways from that of the affected individual, though both need to start from a definitive diagnosis. For the affected industry, managers must identify the causative agent and assess the extent of the problem. Affected workers can then be removed from hazardous settings, and meaningful strategies of prevention can be introduced. The most promising preventive measures involve improvements in industrial hygiene or the substitution of alternative agents in the manufacturing process. The role of worker selection (i.e. the exclusion of applicant workers who may be unduly susceptible because they smoke, or have existing airway hyperresponsiveness or atopy) is small and controversial. More valuable is a strict surveillance programme of workers perceived to be at risk, so that emerging disease is recognized promptly, before it poses any major threat of permanent ill-health. Management choices beyond conventional medication and the avoidance of irritant environmental triggers are greatly limited for the affected individual worker. A change of job environment with complete cessation of exposure to the relevant asthma-inducing agent is to be favoured and offers the best chance of full recovery, but may not be practical if the worker is to avoid permanent unemployment.(ABSTRACT TRUNCATED AT 250 WORDS)
Effect of tidal volume on the output and particle size distribution of hypertonic saline from an ultrasonic nebulizer
Authors: Riedler J , Robertson CF
Published: November 2022

The purpose of the present study was to measure the output and particle size distribution of hypertonic saline from an ultrasonic nebulizer over the range of tidal volumes (VT) used in an epidemiological survey of asthma in children. A Starling pump was used to generate different VTs from 250 to 500 ml, at different respiratory rates of 12 and 20 breaths.min-1, to cover the normal range of respiratory pattern of children aged 7-14 yrs. The Starling pump was connected to a Timeter Compuneb Ultrasonic Nebulizer Model MP 500 with 24 cm of corrugated aerosol tubing, ID 2.2 cm, and a two-way non-rebreathing valve. Nebulizer output was measured by weighing the nebulizer chamber plus tubing and valve before and after each nebulization. To measure particle size distribution, a Malvern Particle Sizer M 3.0 (laser diffraction) was used, with a special adapter attached between valve and Starling pump. Nebulizer output increased linearly from 1.6 to 2.5 ml.min-1 for VT 250 to 500 ml, with little influence by the respiratory frequency. Furthermore, we found that in the range of VT = 300-500 ml the mass median aerodynamic diameter (MMAD) was 2.61 microns, with 100% of the particles less than 5 microns, whereas at VT = 150-250 ml the MMAD was 8.89 microns, with 90% larger than 5 microns. As output from this ultrasonic nebulizer correlates linearly with tidal volumes, size correction may not be necessary in hypertonic saline challenge tests in children. Above a VT of 300 ml, the MMAD is in the respirable range, with 100% of particles less than 5 microns.(ABSTRACT TRUNCATED AT 250 WORDS)
Bronchoalveolar lavage findings in a young adult with idiopathic pulmonary haemosiderosis and coeliac disease
Authors: Bouros D , Panagou P , Rokkas T , Siafakas NM
Published: November 2022

Idiopathic pulmonary haemosiderosis is a rare disease of unknown autoimmune aetiology, mainly affecting children and adolescents. A variety of coexisting autoimmune diseases have been described, including coeliac disease. We describe the case of a man, aged 19 yrs, presenting with a one year history of recurrent haemoptysis. Gluten and gliadin antibodies were positive, and the jejunal biopsy revealed villous atrophy consistent with the diagnosis of coeliac disease. Bronchoalveolar lavage fluid analysis showed a mean haemosiderin score (Golde index) of 240, and a local suppressor/cytotoxic profile on immunocytology. Both clinical and immunological improvement was obtained after a month of gluten-free diet. These immunological findings provide new insight into the pathogenesis of this disease.
Clinical findings and respiratory function in infants following repair of oesophageal atresia and tracheo-oesophageal fistula
Authors: Beardsmore CS , MacFadyen UM , Johnstone MS , Williams A , Simpson H
Published: November 2022

Survival rates for infants undergoing surgical repair of oesophageal atresia with tracheo-oesophageal fistula (OA-TOF) have improved dramatically, but this condition remains associated with substantial morbidity. Most studies of patients following OA-TOF repair have concentrated on school-age and older people; whereas, the most hazardous period is infancy. We aimed to assess respiratory function in a group of infants following primary operative repair, and to relate the results to clinical findings during the first year of life. We studied 16 infants within 3 months of primary repair of OA-TOF. Measurements were made of maximum expiratory flow at functional residual capacity (VmaxFRC), thoracic gas volume (TGV) and airways resistance (Raw). Ten infants had tests repeated, usually to assess progress alongside continuing symptoms, or to ascertain improvement following additional surgery. Seven infants had essentially normal initial respiratory function tests, and six remained either symptom-free or developed only minor clinical problems. One infant subsequently developed stridor, with spontaneous improvement towards the end of the first year. The remaining nine infants had abnormal initial respiratory function tests: one was symptom-free at that time. The remainder developed respiratory and/or gastro-oesophageal symptoms. The functional abnormalities appeared to reflect the severity of the clinical problems encountered. We conclude that respiratory function testing in infants following OA-TOF repair may augment the value of clinical appraisal, help define postoperative respiratory status, and provide a general guide to likely clinical progress.
Occupational exposures estimated by a population specific job exposure matrix and 25 year incidence rate of chronic nonspecific lung disease (CNSLD): the Zutphen Study
Authors: Post WK , Heederik D , Kromhout H , Kromhout D
Published: November 2022

The influence of occupational exposures on total mortality and respiratory mortality and morbidity was examined, employing a population specific Job Exposure Matrix (JEM). Moreover, the relationship between time-related variables of exposure to dust and chronic nonspecific lung disease (CNSLD) incidence was analysed, using time since first exposure and duration of exposure. Occupational exposures in the Zutphen cohort were assessed by application of a JEM, arbitrarily considering jobs as exposed when at least 10% of men who had held the job of interest reported an exposure to one or more from a list of 27 chemical agents. None of the exposures was related to mortality due to CNSLD, although results were influenced by the healthy-worker effect and low mortality rates. Exposure to wood dust and a high probability of exposure to dust were associated with total mortality. Exposures to dust and solvents were statistically significantly related to CNSLD incidence. An exposure-response relationship was found for the probability of exposure to dust with CNSLD incidence. Time-related estimates of exposure to dust based on work history were negatively related to CNSLD incidence. The results suggest the presence of a healthy-worker effect, in a general population study, resulting in an underestimation of the relationship between occupational exposures and respiratory diseases based on the evidence published so far. The use of the full work history to determine exposure to dust leads to stronger relationships with CNSLD incidence, compared to conventional analyses using exposure at the start of follow-up.
No effect of the oral neutral endopeptidase inhibitor candoxatril, on bronchomotor tone and histamine reactivity in asthma
Authors: Angus RM , McCallum MJ , Nally JE , Thomson NC
Published: November 2022

Neutral endopeptidase (NEP) is found in many tissues in man, including the lung. Metabolism by NEP is one of the main mechanisms for the clearance of atrial natriuretic peptide (ANP), a hormone that causes bronchodilation and reduces nonspecific bronchial reactivity in man. Candoxatril, an oral NEP inhibitor has been shown to elevate circulating ANP levels. We have sought to determine whether the administration of candoxatril will alter bronchomotor tone (forced expiratory volume in one second (FEV1)) and histamine reactivity. Ten male asthmatic patients with stable asthma were enrolled (mean (SD) age 32 (10) yrs; FEV1 92 (11)% predicted) in a randomized, double-blind, placebo-controlled study. On each study day, after baseline spirometry, patients received 200 mg of candoxatril or placebo. Spirometry was repeated at half hourly intervals. After 2 h a histamine inhalation test was performed. There was no significant difference in FEV1 values at baseline or at 2 h post-dosing between active and placebo study days, with mean (SEM) FEV1 at baseline and 2 h of 3.71 (0.29) l and 3.85 (0.29) l on the placebo day, and 3.89 (0.27) l and 4.05 (0.82) l on the active day, respectively. The geometric mean (range) provocative concentration of histamine producing a 20% fall in FEV1 (PC20) on the placebo day and active day did not differ significantly, being 1.17 (0.25-25.8) and 0.93 (0.13-32) mg.ml-1, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
Glucocorticoids may not inhibit plasma exudation by direct vascular antipermeability effects in human airways
Authors: Greiff L , Andersson M , Svensson C , Alkner U , Persson CG
Published: November 2022

In animal airways, single topical treatment with glucocorticoids produces a prompt vascular anti-permeability effect that may last for several hours. This has been considered a potentially important anti-inflammatory action in human airways. The present study, involving nine healthy subjects, examines whether nasal budesonide application affects histamine-induced mucosal exudation of plasma and plasma-derived mediators in human airways. A selected low concentration (40 micrograms.ml-1) of the vascular permeability-inducing agent histamine was kept in one of the nasal cavities for 10 min, and this challenge was repeated at 50 min intervals over 4 h. Ten minutes after the first histamine-challenge, a clinical dose of budesonide (100 micrograms) was sprayed into the same nasal cavity. Nasal lavage fluid levels of albumin and fibrinogen were measured as indices of mucosal exudation of bulk plasma, and bradykinins were analysed to indicate generation of plasma-derived mediators. The baseline levels of albumin and fibrinogen were evaluated in 24 healthy control subjects by means of a 10 min saline lavage. Histamine produced significant mucosal exudation of albumin and fibrinogen, compared to control subjects. Topical budesonide treatment did not affect the histamine-induced mucosal exudation of albumin or fibrinogen, nor did budesonide affect the mucosal output of bradykinins. The present human airway data do not support the view, based on animal findings, that airway glucocorticoids reduce mucosal exudation of plasma by direct vascular effects. We suggest that anti-exudative effects of topical glucocorticoids in airway diseases indirectly reflect the inhibition of cellular inflammatory processes by these drugs, rather than any direct effects on the airway microcirculation.
Niacin attenuates acute lung injury induced by lipopolysaccharide in the hamster
Authors: Nagai A , Yasui S , Ozawa Y , Uno H , Konno K
Published: November 2022

Lipopolysaccharide plays a major role in the development of lung injury induced by Gram-negative bacteria, but a protective agent to attenuate the LPS-induced lung injury has not been found. The aim of this study was to examine the effects of niacin on LPS-induced acute lung injury. We administered LPS (Escherichia coli) 0.01 mg.100 g-1 body weight, transtracheally into the lungs of hamsters. Niacin (250 or 500 mg.kg-1 body weight) was injected intraperitoneally 24 h before, and 1 h after the LPS administration. LPS treatment increased wet/dry lung weight, albumin content and neutrophil counts in bronchoalveolar lavage fluid. In hamsters treated with niacin, wet/dry lung weight, albumin content and intra-alveolar cell counts were normal. Nicotinamide adenine dinucleotide (NAD) was significantly decreased in lung tissue of hamsters treated with LPS alone, but was increased in hamsters treated with LPS and niacin. Histopathological examination revealed that niacin-treated LPS-administered hamsters had lungs with no or occasional inflammatory cell infiltration in alveolar spaces, in contrast to the lungs of LPS-treated hamsters, which were infiltrated with numerous inflammatory cells. We conclude that niacin attenuates LPS-induced acute lung injury, probably, in part, by preventing the depletion of NAD.
Leukotriene receptor antagonism prevents lung protein leakage and hypoxaemia in a septic cat model
Authors: Schutzer KM , Larsson A , Risberg B , Falk A
Published: November 2022

Products of the arachidonic acid cascade have been found to play an important role in the pathophysiology in experimental shock and in ARDS. The effect of cysteinyl-leukotriene (cLT) blockade on the development of respiratory failure during septic shock was examined. Ventilated cats received an infusion of Escherichia coli bacteria. Pretreatment was given with diethylcarbamazine (DEC), a leukotriene synthetase inhibitor, or a new potent cLT receptor antagonist, ICI 198,615. With a gamma camera, the distributions of plasmatransferrin radiolabelled with indium-113m chloride (113mIn) and erythrocytes radiolabelled with technetium-99m (99mTc) were measured over the lungs. A normalized slope index (NSI) reflecting protein leakage, based on the transferrin extravasation, was calculated. In the nonseptic control group (n = 7) NSI was 4.4 x 10(-4) +/- 0.7 x 10(-4).min-1 (mean +/- SEM). Unpretreated septic animals (n = 7) showed a protein leakage after bacterial infusion, with a NSI of 34 +/- 3.5 x 10(-4).min-1. Pretreatment with DEC (n = 6) significantly reduced NSI to 16 +/- 1.5 x 10(-4).min-1. In the group pretreated with ICI 198,615 (n = 8), NSI was 9 +/- 1.2 x 10(-4).min-1. Arterial oxygen tension (PaO2) remained at baseline level of 20 +/- 1.0 kPa during the experimental period in both the nonseptic control group and the ICI 198,615 pretreated group. In the unpretreated septic group, PaO2 fell progressively from a preseptic value of 21 +/- 0.9 to 12 +/- 1.5 kPa after 3 h.(ABSTRACT TRUNCATED AT 250 WORDS)
Pulmonary immune cells in health and disease: platelets
Authors: Herd CM , Page CP
Published: November 2022

The platelet has traditionally been associated with disorders of the cardiovascular system; a well-recognized cell type actively involved in the maintenance of haemostasis and the initiation of repair following tissue injury. It has been accepted that the primary function of platelets is their adhesion to the endothelium or to other components at sites of the injured vessel wall in the initiation of haemostasis. However, it has been suggested that the fundamental physiological role of the platelet within the mammalian circulation is in the defence of the host against invasion by foreign organisms. Studies from several groups suggest an important role of the platelet in allergic processes and immunological mechanisms. In this review, we have summarized the origin, physiology, activation and function of the platelet, in addition to both experimental and clinical evidence implicating the involvement of this cell type in certain human lung diseases.
Efficient drug delivery to the lungs from a continuously operated open-vent nebulizer and low pressure compressor system
Authors: Newman SP , Pitcairn GR , Hooper G , Knoch M
Published: November 2022

A comparison of aerosol delivery has been made between two open-vent Pari jet nebulizers. Intermittent and continuous delivery were compared for one of the nebulizers. Ten healthy volunteers inhaled 99mTc-labelled diethylenetriamine penta-acetic acid (DTPA) aerosols on three occasions. The Pari LC device was operated both intermittently (by a manual interrupter that generated aerosol only in synchrony with inhalation) and continuously. The Pari LL nebulizer was operated only in the intermittent mode. A system of inspiratory and expiratory valves was fitted to each nebulizer in order to direct airflow. Both nebulizers were powered by Pari Boy compressors. The mean (SD) whole lung deposition for the LL nebulizer was 11.1 (4.0)% of the nominal dose, compared to 15.3 (12.8)% and 12.8 (7.9)% for the LC used with intermittent and continuous operation, respectively. These differences were not statistically significant. Regional deposition patterns within the lungs were similar for the three nebulizer systems. These data show that efficient nebulizer systems using relatively low power compressors are possible, and suggest that continuously operated open-vent nebulizers may be designed to give lung deposition comparable to that achieved by nebulizers fitted with manual interrupters.
Herpes simplex pneumonia in a young immunocompetent man
Authors: Martinez E , de Diego A , Paradis A , Perpina M , Hernandez M
Published: November 2022

We report the case of a 33 year old man with herpetic bronchitis and bilateral pneumonitis. He presented without mucocutaneous lesions, and his cellular and humoral immunity were not compromised. Diagnosis was established on histological and cytological findings and confirmed by serology. Acyclovir treatment led to a favourable outcome.
Small cell lung cancer with paraneoplastic nephrotic syndrome
Authors: Boon ES , Vrij AA , Nieuwhof C , van Noord JA , Zeppenfeldt E
Published: November 2022

We present a case of nephrotic syndrome, associated with small cell lung carcinoma. Renal biopsy revealed membranous glomerulonephritis, probably due to immune complex deposition with tumour antigen. Complete remission of the small cell lung carcinoma after chemotherapy was followed by regression of the nephrotic syndrome. This regression persisted even when brain metastases developed, without simultaneous relapse of tumour outside the central nervous system.
Cardiac angiosarcoma revealed by lung metastases
Authors: Bic JF , Fade-Schneller O , Marie B , Neimann JL , Anthoine D , Martinet Y
Published: November 2022

Cardiac angiosarcoma is a rare tumour with very poor prognosis especially in patients with metastatic disease. We present the case of a 43 year old patient with angiosarcoma revealed by open lung biopsy for multiple pulmonary metastases. Cardiac symptoms were limited to a moderate pericarditis and no echocardiographic sign of heart tumour was observed. The clinical outcome was rapidly fatal despite chemotherapy. The cardiac primary tumour was diagnosed at autopsy. We emphasize the difficulties of diagnosing cardiac angiosarcoma and confirm the limited value of echocardiography for this diagnosis.
Early decrease of serum Clara cell protein in silica-exposed workers
Authors: Bernard AM , Gonzalez-Lorenzo JM , Siles E , Trujillano G , Lauwerys R
Published: November 2022

Clara cell protein (CC16) is a 16 kDa protein secreted by nonciliated cells of the tracheobronchial tree; it has recently been proposed as a peripheral marker of respiratory epithelial injury. The concentration of CC16 was measured in the serum and, when available, in the sputum of 86 miners exposed to silica and of 86 control subjects matched for age, body mass index and smoking status (26 lifelong nonsmokers and 60 current smokers in both groups). Workers were exposed to silica-rich dust in a quarry for 15.2 months on average. No difference between exposed and control workers could be detected with regard to respiratory symptoms, chest radiographs or lung function tests. By contrast, the concentration of CC16 in serum was decreased in silica-exposed workers (geometric mean 12.3 micrograms.l-1) compared to controls (16.3 micrograms.l-1). The decrease was found both in lifelong nonsmokers (14.7 vs 21.9) and current smokers (11.3 vs 14.5). In the latter, tobacco smoking caused a decrease of serum CC16 that was additional to that associated with silica exposure. The determination of CC16 in sputum samples, judged to be reliable on the basis of the CC16/alpha-amylase concentration ratio (mostly from smokers), also revealed a reduction of CC16 following silica exposure (46.2 vs 106 mg.l-1). We conclude that alterations in the serum concentrations of CC16 probably reflect very early toxic effects of silica particles on the respiratory epithelium. This reinforces the view that serum CC16 is a sensitive marker, which might improve our ability to detect exposure to chemicals potentially harmful to the respiratory tract.
No effect of histamine on human bronchial epithelial cell permeability and tight junctional integrity in vitro
Authors: Devalia JL , Godfrey RW , Sapsford RJ , Severs NJ , Jeffery PK , Davies RJ
Published: November 2022

Both animal and human studies have suggested that histamine increases airway epithelial cell permeability in vivo. In order to study the effect of histamine on paracellular epithelial permeability and tight junctional integrity, we have cultured human bronchial epithelial cells to confluency and investigated the effect of topically applied 0.1-20.0 microM histamine. Cultures were established on microporous membranes of tissue culture cell inserts and used for the assessment of: 1) transepithelial movement of radiolabelled mannitol (14C-mannitol) and bovine serum albumin (14C-BSA), in the luminal to serosal direction and 2) changes in electrical resistance of the cultures. Epithelial cell cultures were also established on plastic coverslips, in order to determine tight junction morphology by freeze-fracture electron microscopy, and to assess junctional integrity by lanthanum penetration, using thin sections. Compared with untreated control cultures, 0.1-10 microM histamine did not significantly alter the movement of either 14C-mannitol or 14C-BSA across the epithelial cultures at any time during incubation, but caused an increase in the electrical resistance of the cultures, which was maximal by 6 h of incubation. The morphology of the tight junctions revealed by freeze-fracture and junctional integrity (the latter determined by the degree of lanthanum penetration) were similar in untreated control cultures and cultures incubated with histamine. These studies indicate that histamine does not have a direct effect on paracellular bronchial epithelial permeability in vitro.
Does single dose salmeterol affect exercise capacity in asthmatic men?
Authors: Robertson W , Simkins J , O'Hickey SP , Freeman S , Cayton RM
Published: November 2022

The aim of this study was to investigate whether the long-acting beta-agonist salmeterol affects athletic performance in patients with asthma. The effect of 50 micrograms salmeterol on the cardiorespiratory responses to a progressive maximal cycle exercise test and on endurance capacity (defined as the exercise duration at 70% maximum oxygen uptake), was compared with 200 micrograms salbutamol and a matched placebo in eight asthmatic men. Both salmeterol and salbutamol improved pre- and postexercise forced expiratory volume in one second (FEV1) for maximal and endurance exercise. Following active treatment, patients exercised from a significantly high baseline FEV1, with both salmeterol (3.58(1.16)l) (mean (SD)) and salbutamol (3.55(1.24)l) compared with placebo (3.29(1.35)l). Similar improvements preceded endurance exercise. Cardiorespiratory, haemodynamic or subjective responses to the progressive maximum exercise tests were not different with salmeterol, salbutamol or placebo, nor did endurance capacity change with any treatment modality. Blood lactate levels, after 15 min exercise, were significantly higher with salbutamol (3.64 (1.83) mM), but not with salmeterol (3.03 (1.64) mM), compared with placebo (2.95 (1.69) mM). These results demonstrate the absence of significant cardiorespiratory or metabolic effects during exercise after a single dose of salmeterol, together with a lack-of ergogenic effect, as measured by maximal or endurance exercise performance, in patients with asthma.
Lung volume measurements in wheezy infants: comparison of plethysmography and gas dilution
Authors: Eber E , Steinbrugger B , Modl M , Weinhandl E , Zach MS
Published: November 2022

The accuracy both of plethysmographic measurements of thoracic gas volume (TGV) and determinations of functional residual capacity (FRC) by gas dilution techniques in infants with obstructive lung disease is subject to continued dispute. We studied 25 wheezy infants and compared TGV derived from end-expiratory airway occlusions (TGVEE), corrected TGV after end-inspiratory airway occlusions (TGVEI), and FRC determined by nitrogen wash-out (FRCN2). Group mean TGVEE and TGVEI differed significantly (25.8 +/- 8.4 versus 24.6 +/- 7.1 ml.kg-1). TGVEE and FRCN2 did not differ significantly. TGVEE and TGVEI, as well as TGVEE and FRCN2, and TGVEI and FRCN2 data, respectively, showed lack of agreement. Based on 95% confidence intervals, calculated from TGVEE data, 14 of the 25 infants showed a significantly higher TGVEI than TGVEE; only one patient had a significantly lower TGVEI. Compared to FRCN1 data, TGVEE and TGVEI measurements yielded lower values in at least one third of our patients. The present study illustrates, that there is no gold standard for the measurement of lung volume in infants with airway obstruction.
Effect of nasal CPAP on ventilatory drive in normocapnic and hypercapnic patients with obstructive sleep apnoea syndrome
Authors: Lin CC
Published: November 2022

The purpose of this study was to evaluate the effect of nasal continuous positive airway pressure (CPAP) on the abnormal ventilatory drive in hypercapnic patients with the obstructive sleep apnoea syndrome (OSAS). Six patients with hypercapnic OSAS (Group I) and 24 patients with eucapnic OSAS (Group II) were studied. All patients had arterial blood gas analysis, overnight sleep studies, and an assessment of ventilatory drive (progressive hyperoxic hypercapnic response and progressive isocapnic hypoxic ventilatory response) prior to and during nasal CPAP therapy (at 2 weeks and 1 month of treatment). Nasal CPAP effectively improved the hypopnoea/apnoea index in both groups (Group I: 87 +/- 14 vs 8 +/- 4; Group II: 63 +/- 17 vs 6 +/- 3). Both hypercapnic and hypoxic ventilatory drive before treatment were significantly impaired in Group I as compared to Group II. Both the slope and baseline level of the ventilatory response and the mouth occlusion pressure (P0.1) improved significantly after 2 weeks of nasal CPAP therapy in Group I, with normalization of arterial carbon dioxide tension (PaCO2) (6.3 +/- 0.2 to 5.2 +/- 0.4 kPa). We conclude that it is possible to completely correct the abnormal ventilatory drive in hypercapnic OSAS patients within 14 days of initiating nasal CPAP therapy.
Comparison of oxygen uptake during a conventional treadmill test and the shuttle walking test in chronic airflow limitation
Authors: Singh SJ , Morgan MD , Hardman AE , Rowe C , Bardsley PA
Published: November 2022

The purpose of this study was to investigate the relationship between performance on the shuttle walking test and maximal oxygen uptake (VO2max) during a conventional treadmill test in patients with chronic airflow limitation. Two different techniques were used to measure oxygen consumption, i.e. conventional Douglas bag techniques (treadmill test) and a portable oxygen consumption meter (shuttle test). Initially, 19 patients performed a shuttle walking test (after one practice walk) and a maximal treadmill walking test, in a randomized, balanced design. Subsequently, 10 patients, (after one practice) completed an unencumbered shuttle walking test and one supporting the portable oxygen consumption meter, in random order. The results of the first experiment revealed a strong relationship between performance during the shuttle walking test and VO2max during the treadmill walking test (r = 0.88). The results of the second experiment consistently demonstrated an incremental increase in oxygen consumption and ventilation in response to the increasing intensity of the shuttle walking test. Again, a strong relationship between VO2max and performance on the shuttle test was demonstrated (r = 0.81). We concluded that the shuttle walking test is a valid field exercise test of functional capacity. Performance on the test relates strongly to VO2max, the traditional indicator of cardiorespiratory capacity.
Survey on domiciliary oxygen by concentrator in England and Wales
Authors: Waterhouse JC , Nichol J , Howard P
Published: November 2022

Long-term oxygen therapy is initiated in England and Wales by the patient's family doctor, sometimes at the request of a hospital consultant. Guidelines for therapy exist but are not mandatory. We wish to investigate the numbers and types of patients being treated under this regimen, the method of treatment and how they responded to their oxygen dose. We therefore interviewed and tested patients at the inception of therapy in six of the nine prescribing areas of the whole country, during August 1990 and February 1991. Main outcome measures were diagnoses, daily duration and flow prescribed, arterial oxygen saturation (SaO2) breathing air and improvement in arterial oxygen saturation on prescribed oxygen. Most patients both in summer and winter reported diagnoses of chronic bronchitis (45%) or emphysema (50%), in addition to other conditions. Most were male (58%), and most (72%) were over retirement age. Roughly half (45%) were house-bound, but only 28 (6%) were totally bedridden. Three quarters (77%) reported that a hospital consultant had told them how much oxygen to use, and in all diagnostic groups mean prescriptions exceeded 15 h.day-1 and 2 l.min-1. However, only half (54%) of the patients with complete measurements had basal arterial oxygen saturation of 90% or less at the start of treatment, together with a satisfactory improvement in arterial oxygen saturation on the prescribed flow of oxygen. In conclusion, patients are usually prescribed adequate regimens but little attempt is made to ensure that prescription is appropriate or response satisfactory. Resources continue to be used for treating patients without ensuring that they benefit.(ABSTRACT TRUNCATED AT 250 WORDS)
Three years experience with a new balloon catheter for the management of haemoptysis
Authors: Freitag L , Tekolf E , Stamatis G , Montag M , Greschuchna D
Published: November 2022

For the management of severe haemoptysis we have developed a double-lumen, bronchus-blocking catheter that can be introduced through the working channel of a standard fibrebronchoscope. We wondered whether this catheter would be suitable to control pulmonary haemorrhage in clinical practice. Over a period of 36 months, 30 of these catheters were used in 27 patients with moderate and massive pulmonary bleeding from various lesions. Underlying diseases were: malignancies (11), vascular deformities (5), tuberculosis (4), silicosis (2), carcinoids (2), silicosis (2), endometriosis (1), bronchiectasis (1). In 26 cases, the transbronchoscopic balloon tamponade was successful. In one patient, tumour growth close to the carina prevented securing of the balloon and double-lumen tube intubation was required. There were only minor complications attributable to the balloon. With the catheter in place for up to seven days, patients underwent surgery, received radiation, chemotherapy, drug treatment or bronchial arterial embolization. In conclusion, we found this double-lumen, bronchus-blocking device safe and the technique practicable to control pulmonary haemorrhage.
Theoretical and experimental basis for the development of a dynamic airway stent
Authors: Freitag L , Eicker R , Linz B , Greschuchna D
Published: November 2022

Three major problems are currently associated with airway stents: mucostasis, formation of granulation tissue, and migration. We wanted to determine whether these problems could be solved by a different stent design. Based on theoretical considerations of an idealized trachea, we developed a dynamic bifurcation stent made of silicone which incorporates horseshoe-shaped steel struts. A flexible posterior membrane enables dynamic compression during cough, whilst the clasps maintain the airway lumen in the face of external compression. The design of the stent cast was based upon computed tomographic (CT)-scan studies of the central airways. Its complex shape provides a smoother distribution of pressure on the mucosa; thereby, lowering the stimulus for granulation formation. The bronchial limbs saddle on the carina, preventing displacement. The mechanical behaviours of the new stent and two commercially available stents were compared in an ex-vivo model, utilizing freshly excised tracheae and new visualization techniques. Dynamic (artificial coughs) and static loads (simulating tumour compression or pleural pressures) were applied on excised human tracheae with different stents. Our dynamic stent preserved effective compression of the posterior membrane in response to cough, and also provided lumen stability against extrinsic compression. In comparison, the two commercially available stents did not provide both functions equally well. In conclusion, our newly designed dynamic bifurcation stent shows characteristics which should prove useful in avoiding problems currently associated with airway stents.
The role of matrix metalloproteases and their inhibitors in tumour invasion, metastasis and angiogenesis
Authors: Ray JM , Stetler-Stevenson WG
Published: November 2022

One critical event of tumour invasion that signals the initiation of the metastatic cascade is thought to be interaction of the tumour cell with the basement membrane. Basement membranes may also pose as barriers to tumour cell invasion at multiple points later in the metastatic cascade, including during the processes of vascular infiltration and extravasation. Thus, an important proteolytic event in the metastatic cascade, and also angiogenesis, appears to be degradation of basement membrane components. A specific class of extracellular matrix degrading metalloenzymes, the matrix metalloproteases, and their endogenous inhibitors, the tissue inhibitors of metalloproteases, are thought to have a role in the creation of the proteolytic defect in basement membrane type IV collagen. We will review the evidence which indicates that matrix metalloproteases and tissue inhibitors of metalloproteases are essential for tumour cell invasion and angiogenesis. The regulation of matrix metalloproteases will be discussed, including gene activation and transcription, messenger ribonucleic acid (mRNA) stability, binding of proenzymes to cell membranes and/or matrix components, proenzyme activation, and inactivation by endogenous inhibitors. We will also discuss the mechanism for tissue inhibitor of metalloproteases-mediated inhibition of tumour invasion and angiogenesis. This appears, at least in part, to be through inhibition of protease activity required for cellular invasion, although recent observations suggest that tissue inhibitors of metalloproteases affect other distinct groups of biological activities through mechanisms other than matrix metalloprotease inhibition.