Recommendations for the use of endoscopic lung volume reduction in South Africa: Role in the treatment of emphysema

Emphysema is a very common cause of morbidity and mortality in South Africa (SA). Therapeutic options in severe emphysema are limited. Endoscopic lung volume reduction (ELVR) is increasingly being used internationally for the treatment of advanced emphysema in a subset of patients with advanced disease, aiming to obtain the same functional advantages as surgical lung volume reduction while reducing risks and costs. In addition to endobronchial valves, ELVR using endobronchial coils is now available in SA. The high cost of these interventions underscores the need for careful patient selection to best identify those who may or may not benefit from ELVR-related procedures. The Assembly on Interventional Pulmonology of the South African Thoracic Society appointed a committee comprising both local and international experts to extensively review all relevant evidence and provide advice on the use of ELVR in SA based on published evidence, expert opinion and local access to the various devices

Bronchoscopic lung volume reduction with endobronchial valves for patients with heterogeneous emphysema and intact interlobar fissures (The BeLieVeR-HIFi trial): study design and rationale

Although lung volume reduction surgery improves survival in selected patients with emphysema, there has been ongoing interest in developing and evaluating bronchoscopic approaches to try to reduce lung volumes with less morbidity and mortality. The placement of endobronchial valves is one such technique, and although some patients have had a significant improvement, responses have been inconsistent because collateral ventilation prevents lobar atelectasis. We describe the protocol of a trial (ISRCTN04761234) aimed to show that a responder phenotype, patients with heterogeneous emphysema and intact interlobar fissures on CT scanning, can be identified prospectively, leading to a consistent benefit in clinical practice

A biomarker panel (Bioscore) incorporating monocytic surface and soluble TREM-1 has high discriminative value for ventilator-associated pneumonia: a prospective observational study

Ventilator-associated pneumonia (VAP) increases mortality in critical illness. However, clinical diagnostic uncertainty persists. We hypothesised that measuring cell-surface and soluble inflammatory markers, incorporating Triggering Receptor Expressed by Myeloid cells (TREM)-1, would improve diagnostic accuracy.A single centre prospective observational study, set in a University Hospital medical-surgical intensive Care unit, recruited 91 patients into 3 groups: 27 patients with VAP, 33 ventilated controls without evidence of pulmonary sepsis (non-VAP), and 31 non-ventilated controls (NVC), without clinical infection, attending for bronchoscopy. Paired samples of Bronchiolo-alveolar lavage fluid (BALF) and blood from each subject were analysed for putative biomarkers of infection: Cellular (TREM-1, CD11b and CD62L) and soluble (IL-1β, IL-6, IL-8, sTREM-1, Procalcitonin). Expression of cellular markers on monocytes and neutrophils were measured by flow cytometry. Soluble inflammatory markers were determined by ELISA. A biomarker panel ('Bioscore'), was constructed, tested and validated, using Fisher's discriminant function analysis, to assess its value in distinguishing VAP from non VAP.The expression of TREM-1 on monocytes (mTREM-1) and neutrophils (nTREM-1) and concentrations of IL-1β, IL-8, and sTREM-1 in BALF were significantly higher in VAP compared with non-VAP and NVC (p<0.001). The BALF/blood mTREM-1 was significantly higher in VAP patients compared to non-VAP and NVC (0.8 v 0.4 v 0.3 p<0.001). A seven marker Bioscore (BALF/blood ratio mTREM-1 and mCD11b, BALF sTREM-1, IL-8 and IL-1β, and serum CRP and IL-6) correctly identified 88.9% of VAP cases and 100% of non-VAP cases.A 7-marker bioscore, incorporating cellular and soluble TREM-1, accurately discriminates VAP from non-pulmonary infection

A new high: Cannabis as a budding source of carbon-based materials for electrochemical power sources

Cannabis sativa L., a low-cost, fast-growing herbaceous plant, is seeing a resurgence in widespread cultivation as a result of new policies and product drive. Its biodegradable and environmentally benign nature coupled with its high specific surface area and three-dimensional hierarchal structure makes it an excellent candidate for use as a biomass-derived carbon material for electrochemical power sources. It is proposed that this ‘wonder crop’ could have an important role in the energy transition by providing high-functioning carbon-based materials for electrochemistry. In this article, all instances of C. sativa usage in batteries, fuel cells and supercapacitors are discussed with a focus on highlighting the high capacity, rate capability, capacitance, current density and half-wave potential that can be achieved with its utilisation in the field

Design and rationale of a multi-center, pragmatic, open-label randomized trial of antimicrobial therapy - the study of clinical efficacy of antimicrobial therapy strategy using pragmatic design in Idiopathic Pulmonary Fibrosis (CleanUP-IPF) clinical trial

Compelling data have linked disease progression in patients with idiopathic pulmonary fibrosis (IPF) with lung dysbiosis and the resulting dysregulated local and systemic immune response. Moreover, prior therapeutic trials have suggested improved outcomes in these patients treated with either sulfamethoxazole/ trimethoprim or doxycycline. These trials have been limited by methodological concerns. This trial addresses the primary hypothesis that long-term treatment with antimicrobial therapy increases the time-to-event endpoint of respiratory hospitalization or all-cause mortality compared to usual care treatment in patients with IPF. We invoke numerous innovative features to achieve this goal, including: 1) utilizing a pragmatic randomized trial design; 2) collecting targeted biological samples to allow future exploration of 'personalized' therapy; and 3) developing a strong partnership between the NHLBI, a broad range of investigators, industry, and philanthropic organizations. The trial will randomize approximately 500 individuals in a 1:1 ratio to either antimicrobial therapy or usual care. The site principal investigator will declare their preferred initial antimicrobial treatment strategy (trimethoprim 160 mg/ sulfamethoxazole 800 mg twice a day plus folic acid 5 mg daily or doxycycline 100 mg once daily if body weight is < 50 kg or 100 mg twice daily if ≥50 kg) for the participant prior to randomization. Participants randomized to antimicrobial therapy will receive a voucher to help cover the additional prescription drug costs. Additionally, those participants will have 4-5 scheduled blood draws over the initial 24 months of therapy for safety monitoring. Blood sampling for DNA sequencing and genome wide transcriptomics will be collected before therapy. Blood sampling for transcriptomics and oral and fecal swabs for determination of the microbiome communities will be collected before and after study completion. As a pragmatic study, participants in both treatment arms will have limited in-person visits with the enrolling clinical center. Visits are limited to assessments of lung function and other clinical parameters at time points prior to randomization and at months 12, 24, and 36. All participants will be followed until the study completion for the assessment of clinical endpoints related to hospitalization and mortality events. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT02759120

Neutron studies of Na-ion battery materials

The relative vast abundance and more equitable global distribution of terrestrial sodium makes sodium-ion batteries (NIBs) potentially cheaper and more sustainable alternatives to commercial lithium-ion batteries (LIBs). However, the practical capacities and cycle lives of NIBs at present do not match those of LIBs and have therefore hindered their progress to commercialisation. The present drawback of NIB technology stems largely from the electrode materials and their associated Na+ion storage mechanisms. Increased understanding of the electrochemical storage mechanisms and kinetics is therefore vital for the development of current and novel materials to realise the commercial NIB. In contrast to x-ray techniques, the non-dependency of neutron scattering on the atomic number of elements (Z) can substantially increase the scattering contrast of small elements such as sodium and carbon, making neutron techniques powerful for the investigation of NIB electrode materials. Moreover, neutrons are far more penetrating which enables more complex sample environments including in situ and operando studies. Here, we introduce the theory of, and review the use of, neutron diffraction and quasi-elastic neutron scattering, to investigate the structural and dynamic properties of electrode and electrolyte materials for NIBs. To improve our understanding of the actual sodium storage mechanisms and identify intermediate stages during charge/discharge, ex situ, in situ, and operando neutron experiments are required. However, to date there are few studies where operando experiments are conducted during electrochemical cycling. This highlights an opportunity for research to elucidate the operating mechanisms within NIB materials that are under much debate at present

Neutron studies of Na-ion battery materials

The relative vast abundance and more equitable global distribution of terrestrial sodium makes sodium-ion batteries (NIBs) potentially cheaper and more sustainable alternatives to commercial lithium-ion batteries (LIBs). However, the practical capacities and cycle lives of NIBs at present do not match those of LIBs and have therefore hindered their progress to commercialisation. The present drawback of NIB technology stems largely from the electrode materials and their associated Na+ion storage mechanisms. Increased understanding of the electrochemical storage mechanisms and kinetics is therefore vital for the development of current and novel materials to realise the commercial NIB. In contrast to x-ray techniques, the non-dependency of neutron scattering on the atomic number of elements (Z) can substantially increase the scattering contrast of small elements such as sodium and carbon, making neutron techniques powerful for the investigation of NIB electrode materials. Moreover, neutrons are far more penetrating which enables more complex sample environments including in situ and operando studies. Here, we introduce the theory of, and review the use of, neutron diffraction and quasi-elastic neutron scattering, to investigate the structural and dynamic properties of electrode and electrolyte materials for NIBs. To improve our understanding of the actual sodium storage mechanisms and identify intermediate stages during charge/discharge, ex situ, in situ, and operando neutron experiments are required. However, to date there are few studies where operando experiments are conducted during electrochemical cycling. This highlights an opportunity for research to elucidate the operating mechanisms within NIB materials that are under much debate at present