The postpneumonectomy syndrome: clinical presentation and treatment

Background: Postpneumonectomy syndrome (PPS) is a rare complication after pneumonectomy. It consists of an excessive mediastinal shift resulting in compression and stretching of the tracheobronchial tree and the esophagus. The aim of this study was to give a comprehensive overview of diagnosis, variety of symptoms and evaluation of surgical treatment of PPS. Methods: We retrospectively reviewed the charts of all our patients with PPS since 1994 with respect to symptomatology, treatment and outcome. Our results were compared with case reports and case series in the literature. Results: Six women with a median age of 56.5 years (range 49-65) developed PPS after pneumonectomy for the treatment of lung cancer. Four presented with a right PPS and two with a left PPS, respectively. Symptoms consisted of shortness of breath in all patients and dysphagia as well as heartburn in two patients. Correction of PPS required re-exploration of the pneumonectomy space, reposition of the mediastinum followed by the insertion of single silicone prosthesis in five patients or fixation of the mediastinum with a xenopericardial graft in one patient. We could observe an improvement of the FEV(1)/FVC ratio in all our patients and the clinical improvement of shortness of breath was better than we expected by changes of lung function. Four patients returned to their regular activities with a follow-up of four years. We found 73 cases of PPS in the literature, on the right side in 50 patients (68%) and on the left side in 23 patients (32%). Fifty-nine patients (81%) were treated surgically. Symptoms can be suspicious for cardiogenic origin and vary from heartburn to recurrent syncopes. Conclusion: PPS is rare and not predictable. It can occur after right or left pneumonectomy. Symptoms are manifold and result from a shift, leading to compression and stretching of the two conduits located within the mediastinum, the tracheobronchial tree and the esophagus and consists of shortness of breath, stridor and heartburn. Diagnosis must be made by exclusion. Implantation of prosthesis is the most commonly used and effective treatmen

Different genes interact with particulate matter and tobacco smoke exposure in affecting lung function decline in the general population

BACKGROUND: Oxidative stress related genes modify the effects of ambient air pollution or tobacco smoking on lung function decline. The impact of interactions might be substantial, but previous studies mostly focused on main effects of single genes. OBJECTIVES: We studied the interaction of both exposures with a broad set of oxidative-stress related candidate genes and pathways on lung function decline and contrasted interactions between exposures. METHODS: For 12679 single nucleotide polymorphisms (SNPs), change in forced expiratory volume in one second (FEV(1)), FEV(1) over forced vital capacity (FEV(1)/FVC), and mean forced expiratory flow between 25 and 75% of the FVC (FEF(25-75)) was regressed on interval exposure to particulate matter >10 microm in diameter (PM10) or packyears smoked (a), additive SNP effects (b), and interaction terms between (a) and (b) in 669 adults with GWAS data. Interaction p-values for 152 genes and 14 pathways were calculated by the adaptive rank truncation product (ARTP) method, and compared between exposures. Interaction effect sizes were contrasted for the strongest SNPs of nominally significant genes (p(interaction)>0.05). Replication was attempted for SNPs with MAF<10% in 3320 SAPALDIA participants without GWAS. RESULTS: On the SNP-level, rs2035268 in gene SNCA accelerated FEV(1)/FVC decline by 3.8% (p(interaction) = 2.5x10(-6)), and rs12190800 in PARK2 attenuated FEV1 decline by 95.1 ml p(interaction) = 9.7x10(-8)) over 11 years, while interacting with PM10. Genes and pathways nominally interacting with PM10 and packyears exposure differed substantially. Gene CRISP2 presented a significant interaction with PM10 (p(interaction) = 3.0x10(-4)) on FEV(1)/FVC decline. Pathway interactions were weak. Replications for the strongest SNPs in PARK2 and CRISP2 were not successful. CONCLUSIONS: Consistent with a stratified response to increasing oxidative stress, different genes and pathways potentially mediate PM10 and tobac smoke effects on lung function decline. Ignoring environmental exposures would miss these patterns, but achieving sufficient sample size and comparability across study samples is challengin

Codi-strat - an interdisciplinary network geared towards sustainable management of chronic and infective diseases

A collaborative effort of clinicians, infectologists, molecular biologists, pharmacologists, veterinarians, bioinformaticians, management and education specialists is united in order to develop novel strategies of detecting early stages of chronic and infective diseases, their prevention and therapy. CODI-STRAT integrates 15 centers conducting leading–edge research of chronic inflammatory/infective diseases from seven European (five Mediterranean) countries and the USA, with specific aims to: i) establish long-standing partner center cross-disciplinary collaborations for clinical studies and research, ii) provide young investigators with broad and content-driven training and employability and iii) promote scientists up-skilled in genomics, transcriptomics, tissue expression, human serological and genetic studies, bioinformatics, chip technology, cell cultures and animal models, all directed toward clinical translation and chronic/infective disease management. This manuscript outlines the goals, partner roles and development of CODI-STRAT and its programme.peer-reviewe

Development of DYNAMIX Policy Mixes - Deliverable 4.2, revised version, of the DYNAMIX project

This report documents the development of the initial dynamic policy mixes that were developed for assessment in the DYNAMIX project. The policy mixes were designed within three different policy areas: overarching policy, land-use and food, and metals and other materials. The policy areas were selected to address absolute decoupling in general and, specifically, the DYNAMIX targets related to the use of virgin metals, the use of arable land and freshwater, the input of the nutrients nitrogen and phosphorus, and emissions of greenhouse gases. Each policy mix was developed within a separate author team, using a common methodological framework that utilize previous findings in the project. Specific drivers and barriers for resource use and resource efficiency are discussed in each policy area. Specific policy objectives and targets are also discussed before the actual policy mix is presented. Each policy mix includes a set of key instruments, which can be embedded in a wider set of supporting and complementary policy instruments. All key instruments are described in the report through responses to a set of predefined questions. The overarching mix includes a broad variety of key instruments. The land-use policy mix emphasizes five instruments to improve food production through, for example, revisions of already existing policy documents. It also includes three instruments to influence the food consumption and food waste. The policy mix on metals and other materials primarily aims at reducing the use of virgin metals through increased recycling, increased material efficiency and environmentally justified material substitution. To avoid simply shifting of burdens, it includes several instruments of an overarching character

Adult Learning Sign Language by combining video, interactivity and play in a 3D game platform

One in every six persons in the UK suffers a hearing loss, either as a condition they have been born with or a disorder they acquired during their life. 900,000 people in the UK are severely or profoundly deaf and based on a study by Action On Hearing Loss UK in 2013 only 17 percent of this population, can use the British Sign Language (BSL). That leaves a massive proportion of people with a hearing impediment who do not use sign language struggling in social interaction and suffering from emotional distress, and an even larger proportion of Hearing people who cannot communicate with those of the deaf community. This paper presents a theoretical framework for the design of interactive games to support learning BSL supporting the entire learning cycle, instruction, practice and assessment. It then describes the proposed design of a game based on this framework aiming to close the communication gap between able hearing people and people with a hearing impediment, by providing a tool that facilitates BSL learning targeting adult population. The paper concludes with the planning of a large scale study and directions for further development of this educational resource

Integration of social aspects in decision support, based on life cycle thinking

Recently increasing attention has been paid to complementing environmental Life Cycle Assessment (LCA) with social aspects. The paper discusses the selection of social impacts and indicators from existing frameworks like Social Life Cycle Assessment (SLCA) and Social Impact Assessment (SIA). Two ongoing case studies, addressing sustainability assessment within decision support, were considered: (1) Integrated Water Resources Management (IWRM) in Indonesia; and (2) Integrated Packaging Waste Management in Spain and Portugal (FENIX). The focus was put on social impacts occurring due to decisions within these systems, such as choice of technologies, practices or suppliers. Thus, decision makers—here understood as intended users of the studies’ results—are not consumers that buy (or do not buy) a product, such as in recent SLCA case-studies, but mainly institutions that decide about the design of the water or packaging waste management system. Therefore, in the FENIX project, a list of social impacts identified from literature was sent to the intended users to be ranked according to their priorities. Finally, the paper discusses to what extent the entire life cycle is reflected in SLCA impact categories and indicators, and explains how both life-cycle and on-site-related social impacts were chosen to be assessed. However, not all indicators in the two projects will assess all stages of the life cycle, because of their varying relevance in the different stages, data availability and practical interest of decision makers

Air Quality and Comfort Characterisation within an Electric Vehicle Cabin in Heating and Cooling Operations†

This work is aimed at the experimental characterisation of air quality and thermal profile within an electric vehicle cabin, measuring at the same time the HVAC system energy consumption. Pollutant concentrations in the vehicle cabin are measured by means of a low-cost system of sensors. The effects of the HVAC system configuration, such as fresh-air and recirculation mode, on cabin air quality, are discussed. It is shown that the PM concentrations observed in recirculation mode are lower than those in fresh-air mode, while VOC concentrations are generally higher in recirculation than in fresh-air mode. The energy consumption is compared in different configurations of the HVAC system. The novelty of this work is the combined measurement of important comfort parameters such as air temperature distribution and air quality within the vehicle, together with the real time energy consumption of the HVAC system. A wider concept of comfort is enabled, based on the use of low-cost sensors in the automotive field

One transition, many transitions? A corpus-based study of societal sustainability transition discourses in four civil society’s proposals

When the civil society makes ‘transition’ its label, it cannot be assumed that different civil society actors share compatible varieties of localist or radical transformationists discourses. This study has comparatively analyzed the discourses in four civil society sustainability transition proposals using a corpus-based methodology. We found that the proposals are similar as they identify the economy as an object and an entry point for transition, frame the economy as embedded in the socio–ecological system, ascribe agency to grassroots movements for transitions from the bottom–up. We also found crucial differences among the discourses regarding the role of the State, the degree of reform or radical innovation, the degree of imaginative character of the sustainability vision, the degree of opposition to capitalism. We suggest that insights on how the civil society employs notions of transition with respect to the themes of politics, emotions and place can help advance theorizations and practices of societal sustainability transitions led by the civil society