Bronchodilation improves endurance but not muscular efficiency in chronic obstructive pulmonary disease

We hypothesized that bronchodilator treatment not only improves hyperinflation and endurance capacity but also muscular efficiency in stable chronic obstructive pulmonary disease (COPD). We aimed to demonstrate that tiotropium and salmeterol improve muscular efficiency compared with placebo. Twenty-five COPD patients were studied, including 20 males of mean (standard deviation) age 62 years (7 years) with baseline forced expiratory volume in 1 second of 41% (10%) predicted, and maximal workload of 101 Watt (36 Watt). Subjects were randomized for 6-week treatment with tiotropium 18 μg once daily, salmeterol 50 μg twice daily, or placebo using a double-blind, crossover design. Muscular efficiency and endurance time were measured during cycling at 50% of maximal work load. Resting energy expenditure was measured using a ventilated hood. Muscular efficiency after tiotropium, salmeterol, and placebo treatment was 14.6%, 14.4%, and 14.4%, respectively (P > 0.05), and resting energy expenditure was 1485 kcal/24 hours, 1709 kcal/24 hours, and 1472 kcal/24 hours (P > 0.05), respectively. Endurance time after tiotropium treatment was significantly higher than that after placebo (27.0 minutes versus 19.3 minutes [P = 0.02]), whereas endurance time after salmeterol treatment was not higher than that after placebo (23.3 minutes [P = 0.22]). In this small study, we were not able to demonstrate that bronchodilator therapy improved muscular efficiency. Apparently, reduced costs of breathing relative to total energy expenditure were too small to be detected

Relationship between dyspnoea, pulmonry function and exercise capacity in patients with cystic fibrosis

AbstractThe median age of survival in patients with cystic fibrosis (CF) has improved considerably. Despite this improvement, deterioration of pulmonary function and decrease in exercise capacity are still the main problems for many patients. Although dyspnoea is a common complaint in CF patients, relatively little regard has been paid to this symptom. This study examined the relationship between dyspnoea, bicycle exercise capacity and pulmonary function in patients with CF.In 14 patients in a stable clinical condition, pulmonary function [forced expiratory volume in 1 s (FEV1), inspiratory vital capacity (IVC)], bicycle exercise capacity [maximum exercise capacity (Wmax)], subjective degree of dyspnoea during daily living [Medical Research Council (MRC) dyspnoea scale], and during exercise (Borg scale) were assessed.The mean (sd) age of the patients was 25 (6·8) years, FEV1 was 41 (19)% predicted, IVC was 63 (17)% predicted and FEV1IVC ratio was 47 (10)%; median (range) Wmax was 55 (0–79)% predicted. Bicycle exercise test performance appeared to be mainly determined by pulmonary function and MRC dyspnoea grade; multiple regression equation containing FEV1 and dyspnoea accounted for 76% of the variance in Wmax (% predicted) (Wmax= −7·9 dysp+1·1FEV1, +24). Exercise dyspnoea, assessed by the Borg scale, showed a significant linear correlation with minute ventilation. (V̇e), maximal voluntary ventilation (MVV) (%) (r=0·76; P<0·001). Medical Research Council dyspnoea score correlated relatively poorly with FEV1 (% predicted) (r= −0·17; n.s.) and IVC (% predicted) (r= −0·48; n.s.). Borg score at maximal exercise did not correlate with MRC dyspnoea score (r= −0·07). Borg50% score correlated significantly with MRC dyspnoea score (r= 0·61; P<0·05).These results show that dyspnoea has an influence on exercise capacity. Dyspnoea score showed a large inter-individual variation, not strongly related to pulmonary function. It is concluded that dyspnoea deserves more attention in CF patients and needs to be assessed in rehabilitation programmes and other intervention studies in these patients

A Systematic Review of Immunological Studies of Erythema Nodosum Leprosum.

Erythema nodosum leprosum (ENL) is a painful inflammatory complication of leprosy occurring in 50% of lepromatous leprosy patients and 5-10% of borderline lepromatous patients. It is a significant cause of economic hardship, morbidity and mortality in leprosy patients. Our understanding of the causes of ENL is limited. We performed a systematic review of the published literature and critically evaluated the evidence for the role of neutrophils, immune complexes (ICs), T-cells, cytokines, and other immunological factors that could contribute to the development of ENL. Searches of the literature were performed in PubMed. Studies, independent of published date, using samples from patients with ENL were included. The search revealed more than 20,000 articles of which 146 eligible studies were included in this systematic review. The studies demonstrate that ENL may be associated with a neutrophilic infiltrate, but it is not clear whether it is an IC-mediated process or that the presence of ICs is an epiphenomenon. Increased levels of tumor necrosis factor-α and other pro-inflammatory cytokines support the role of this cytokine in the inflammatory phase of ENL but not necessarily the initiation. T-cell subsets appear to be important in ENL since multiple studies report an increased CD4+/CD8+ ratio in both skin and peripheral blood of patients with ENL. Microarray data have identified new molecules and whole pathophysiological pathways associated with ENL and provides new insights into the pathogenesis of ENL. Studies of ENL are often difficult to compare due to a lack of case definitions, treatment status, and timing of sampling as well as the use of different laboratory techniques. A standardized approach to some of these issues would be useful. ENL appears to be a complex interaction of various aspects of the immune system. Rigorous clinical descriptions of well-defined cohorts of patients and a systems biology approach using available technologies such as genomics, epigenomics, transcriptomics, and proteomics could yield greater understanding of the condition

IPC and NACE classification of patents. A comparison between data on U.S. and on French, German and U.K. patents

This article is a review of the principal results of a statistical study of the US-patented applications filed during the period 1969 to 1974. The study itself will be published as EUR-Report No 6575. The US data are classified according to the IPC and are compared with those of the Federal Republic of Germany, France and the United Kingdom, with regard to their quantitative distribution over selected technological classes. Further, the technological trends within selected classes are highlighted. An attempt has also been made to link the patent statistical data to the industrial branches classified according to the NACE.

Towards Living with Water: In search of new perspectives towards living with the increasing risk of flooding in the densifying outer dike area of the urban center of Rotterdam

As a result of global warming sea levels have recently started to rise and pose threatening scenarios to increasingly densifying urban areas worldwide. As the low-lying Netherlands will be one of the first to witness the consequenses of rising sea levelsa and increasing river water discharge, alternatives for its built environment will have to be explored in order to be able to adapt in time. As the Netherlands has been successfully holding off the water for decades, the country is globally seen as a pioneer in water management solutions. Therefore the Dutch are in the position to lead by example. However, the phenomenon of rapidly accellerating sea level rise is something Dutch water management has never dealt with before. Uncertainty and rapidly changing predictions make it difficult to decide on drastic and costly measures in time. In order to facilitate a transition from the established defensive landscape towards living with water instead, a new flood resilient building type can facilitate in adapting to near future predictions, while also raising awareness for the urgency of rising water levels and contributing to the current housing shortage. In order to achieve this it is necessary to step away from the defensive landscape and outdated water management strategies. This research will elaborate on predictions regarding sea level rise and changing weather conditions in the densifying outer dike area of the urban center of Rotterdam. Contemporary approaches towards building dikes, the importance of engaging private parties in generating flood resilient solutions and the possibility to utilize water and flood defence barriers as a flexible building ground in densifying urban areas will be discussed. Ultimately leading to a novel mixed-use housing typology with the overarching goal to reduce the flood risk in densifying outer dike areas and contribute to a changing mindset towards living with the increasing risk of flooding.Architecture, Urbanism and Building Science

Trends in the inventive activity of private applicants for patents in Germany, France and the United Kingdom

Presented are the main results of a study made on the trend of private inventive activity in Germany, France and the United Kingdom. Besides an overall trend for the years 1910-1980, a presentation is given of the distribution of this activity amongst different technical subject areas for the year 1980, with distinction made between domestic and foreign applications.