Relationship between diffusion capacity and small airway abnormality in COPDGene.

Impaired single breath carbon monoxide diffusing capacity (DLCO) is associated with emphysema. Small airways disease (SAD) may be a precursor lesion to emphysema, but the relationship between SAD and DLCO is undescribed. We hypothesized that in mild COPD, functional SAD (fSAD) defined by computed tomography (CT) and Parametric Response Mapping methodology would correlate with impaired DLCO. Using data from ever-smokers in the COPDGene cohort, we established that fSAD correlated significantly with lower DLCO among both non-obstructed and GOLD 1-2 subjects. The relationship between DLCO with CT-defined emphysema was present in all GOLD stages, but most prominent in severe disease. TRIAL REGISTRATION: NCT00608764. Registry: COPDGene. Registered 06 February 2008, retrospectively registered

Túnel de vento do LACAF/FEC/UNICAMP : Instrumento para ensaios de modelos físicos reduzidos e ventilação natural

Este artigo apresenta o Túnel de Vento de Camada Limite Atmosférica do LaCAF/Laboratório de Conforto Ambiental e Física Aplicada da Faculdade de Engenharia Civil, Arquitetura e Urbanismo da Universidade Estadual de Campinas/SP, Brasil. Este instrumento foi desenvolvido e construído por meio de uma pesquisa de Projeto Temático, com apoio FAPESP - Fundação de Amparo à Pesquisa do Estado de São Paulo, que tem como objetivo viabilizar ensaios em modelos reduzidos de ventilação natural para análise do conforto ambiental. A metodologia adotada, para a construção deste, partiu de uma revisão bibliográfica referente a conforto térmico, equipamentos destinados a experimentos de ventilação natural, aerodinâmica aplicada à construção civil e mecânica dos fluidos, além de entrevistas com profissionais da área. A contribuição deste instrumento para a faculdade viabiliza a realização de ensaios de ventilação natural em modelos físicos, na interface dos estudos técnicos sobre desempenho ambiental (ensaios experimentais) e a prática do projeto (urbano e edifício), com as questões relacionadas com a ventilação natural. Diante das pesquisas que foram e estão sendo desenvolvidas na área ambiental no LACAF, este instrumento tem como foco a obtenção de dados qualitativos e quantitativos que poderão subsidiar os procedimentos de avaliação de desempenho ambiental.Laboratorio de Capa Límite y Fluidodinámica AmbientalGrupo Fluidodinámica Computaciona

Túnel de vento do LACAF/FEC/UNICAMP : Instrumento para ensaios de modelos físicos reduzidos e ventilação natural

Este artigo apresenta o Túnel de Vento de Camada Limite Atmosférica do LaCAF/Laboratório de Conforto Ambiental e Física Aplicada da Faculdade de Engenharia Civil, Arquitetura e Urbanismo da Universidade Estadual de Campinas/SP, Brasil. Este instrumento foi desenvolvido e construído por meio de uma pesquisa de Projeto Temático, com apoio FAPESP - Fundação de Amparo à Pesquisa do Estado de São Paulo, que tem como objetivo viabilizar ensaios em modelos reduzidos de ventilação natural para análise do conforto ambiental. A metodologia adotada, para a construção deste, partiu de uma revisão bibliográfica referente a conforto térmico, equipamentos destinados a experimentos de ventilação natural, aerodinâmica aplicada à construção civil e mecânica dos fluidos, além de entrevistas com profissionais da área. A contribuição deste instrumento para a faculdade viabiliza a realização de ensaios de ventilação natural em modelos físicos, na interface dos estudos técnicos sobre desempenho ambiental (ensaios experimentais) e a prática do projeto (urbano e edifício), com as questões relacionadas com a ventilação natural. Diante das pesquisas que foram e estão sendo desenvolvidas na área ambiental no LACAF, este instrumento tem como foco a obtenção de dados qualitativos e quantitativos que poderão subsidiar os procedimentos de avaliação de desempenho ambiental.Laboratorio de Capa Límite y Fluidodinámica AmbientalGrupo Fluidodinámica Computaciona

Túnel de vento do LACAF/FEC/UNICAMP : Instrumento para ensaios de modelos físicos reduzidos e ventilação natural

Este artigo apresenta o Túnel de Vento de Camada Limite Atmosférica do LaCAF/Laboratório de Conforto Ambiental e Física Aplicada da Faculdade de Engenharia Civil, Arquitetura e Urbanismo da Universidade Estadual de Campinas/SP, Brasil. Este instrumento foi desenvolvido e construído por meio de uma pesquisa de Projeto Temático, com apoio FAPESP - Fundação de Amparo à Pesquisa do Estado de São Paulo, que tem como objetivo viabilizar ensaios em modelos reduzidos de ventilação natural para análise do conforto ambiental. A metodologia adotada, para a construção deste, partiu de uma revisão bibliográfica referente a conforto térmico, equipamentos destinados a experimentos de ventilação natural, aerodinâmica aplicada à construção civil e mecânica dos fluidos, além de entrevistas com profissionais da área. A contribuição deste instrumento para a faculdade viabiliza a realização de ensaios de ventilação natural em modelos físicos, na interface dos estudos técnicos sobre desempenho ambiental (ensaios experimentais) e a prática do projeto (urbano e edifício), com as questões relacionadas com a ventilação natural. Diante das pesquisas que foram e estão sendo desenvolvidas na área ambiental no LACAF, este instrumento tem como foco a obtenção de dados qualitativos e quantitativos que poderão subsidiar os procedimentos de avaliação de desempenho ambiental.Laboratorio de Capa Límite y Fluidodinámica AmbientalGrupo Fluidodinámica Computaciona

Airway stent complications: the role of follow-up bronchoscopy as a surveillance method.

Background: Airway stenting has become an integral part of the therapeutic endoscopic management of obstructive benign and malignant central airway diseases. Despite increased use of airway stents and frequent stent-associated complications, no clear guidelines for surveillance and maintenance exist. This study aim is to elucidate predictive factors associated with development of stent complications, as well as an optimal surveillance period for follow-up bronchoscopy for early detection and possible prevention of stent-associated complications. Methods: Retrospective cohort study of all patients who underwent airway stent placements at our institution from April 2010 to December 2013 for benign and malignant airway diseases. Metallic, silicone (straight, Y stent, T-tube) and hybrid stents were included in the study. Stent complications were analyzed at the time of follow-up bronchoscopy performed four to six weeks after initial stent placement or earlier if patients became symptomatic. Results: The study included 134 patients of which 147 stents were placed. Follow-up bronchoscopy was performed in 94 patients. Symptomatic status at the time of follow-up bronchoscopy was not associated with stent complications [odds ratio (OR) =1.88; 95% CI: 0.79-4.45; P=0.15]. Patient age, sex, indication for stent placement, and stent location, were not associated with development of complications (all P\u3e0.05). Compared to all other stents, hybrid stents were more likely to migrate (OR =6.60; 95% CI: 2.16-20.2; P=0.001) or obstruct by secretions (OR =2.53; 95% CI: 1.10-5.84; P=0.03). There were no complications associated with surveillance bronchoscopy. Conclusions: Surveillance bronchoscopy within 4 to 6 weeks of stent placement may be useful for early detection of complications and their subsequent management, regardless of symptomatic status and indication for stent placement. Prospective multicenter studies are needed to compare optimal surveillance methods and the impact on patient mortality, morbidity and healthcare costs

Association of immunotherapy and immunosuppression with severe COVID-19 disease in patients with cancer

Background: Cytokine storm due to COVID-19 can cause high morbidity and mortality. Patients with cancer treated with immunotherapy (IO) and those with immunosuppression may have higher rates of cytokine storm due to immune dysregulation. We sought to evaluate the association of IO and immunosuppression with COVID-19 outcomes and cytokine storm occurrence among patients with cancer and COVID-19, based on data from the COVID-19 and Cancer Consortium (CCC19). Methods: A registry-based retrospective cohort study was conducted on patients reported to the CCC19 registry from March 2020 to September 2021. The primary outcome was defined as an ordinal scale of COVID-19 severity. The secondary outcome was the occurrence of a cytokine storm using CCC19 variables, defined as biological and clinical evidence of severe inflammation, with end-organ dysfunction (Fajgenbaum D.C. et al., N Engl J Med., 2020). The association of IO or immunosuppression with the outcomes of interest were evaluated using a multivariable logistic regression balanced for covariate distributions through inverse probability of treatment weighting (IPTW). Results: A total of 10,214 patients were included, among which 482 (4.7%) received IO, 3,715 (36.4%) received non-IO systemic therapies, and 6,017 (58.9%) were untreated in the 3 months prior to COVID-19 diagnosis. No difference in COVID-19 severity or the development of a cytokine storm was found in the IO group compared to the untreated group (aOR: 0.77; 95%CI:0.45-1.32, and aOR: 1.06; 95%CI:0.42-2.67, respectively). On multivariable analysis, baseline immunosuppression was associated with worse outcomes both in relation to COVID-19 severity (aOR: 1.89; 95%CI:1.51-2.35) and the presence of a cytokine storm (aOR: 1.75; 95%CI:1.30-2.35). Conclusions: Administration of IO was not associated with severe outcomes in patients with cancer and COVID-19, whereas pre-existing baseline immunosuppression appears to be independently associated with worse clinical outcomes including cytokine storm

A prognostic model of all-cause mortality at 30 days in patients with cancer and COVID-19

Background: Patients with cancer are at higher risk of dying of COVID-19. Known risk factors for 30-day all-cause mortality (ACM-30) in patients with cancer are older age, sex, smoking status, performance status, obesity, and co-morbidities. We hypothesized that common clinical and laboratory parameters would be predictive of a higher risk of 30-day ACM, and that a machine learning approach (random forest) could produce high accuracy. Methods: In this multi-institutional COVID-19 and Cancer Consortium (CCC19) registry study, 12,661 patients enrolled between March 17, 2020 and December 31, 2021 were utilized to develop and validate a model of ACM-30. ACM-30 was defined as death from any cause within 30 days of COVID-19 diagnosis. Pre-specified variables were: age, sex, race, smoking status, ECOG performance status (PS), timing of cancer treatment relative to COVID19 diagnosis, severity of COVID19, type of cancer, and other laboratory measurements. Missing variables were imputed using random forest proximity. Random forest was utilized to model ACM-30. The area under the curve (AUC) was computed as a measure of predictive accuracy with out-of-bag prediction. One hundred bootstrapped samples were used to obtain the standard error of the AUC. Results: The median age at COVID-19 diagnosis was 65 years, 53% were female, 18% were Hispanic, and 16.7% were Black. Over half were never smokers and the median body mass index was 28.2. Random forest with under sampling selected 20 factors prognostic of ACM-30. The AUC was 88.9 (95% CI 88.5-89.2). Highly informative parameters included: COVID-19 severity at presentation, cancer status, age, troponin level, ECOG PS and body mass index. Conclusions: This prognostic model based on readily available clinical and laboratory values can be used to estimate individual survival probability within 30-days for COVID-19. In addition, this model can be used to select or classify patients with cancer and COVID-19 into risk groups based on validated cut points, for treatment selection, prophylaxis prioritization, and/or enrollment in clinical trials. Future work includes external validation using other large datasets of patients with COVID-19 and cancer

The role of clothing in thermal comfort: how people dress in a temperate and humid climate in Brazil

Abstract Thermal insulation from clothing is one of the most important input variables used to predict the thermal comfort of a building's occupants. This paper investigates the clothing pattern in buildings with different configurations located in a temperate and humid climate in Brazil. Occupants of two kinds of buildings (three offices and two university classrooms) assessed their thermal environment through 'right-here-right-now' questionnaires, while at the same time indoor climatic measurements were carried out in situ (air temperature and radiant temperature, air speed and humidity). A total of 5,036 votes from 1,161 occupants were collected. Results suggest that the clothing values adopted by occupants inside buildings were influenced by: 1) climate and seasons of the year; 2) different configurations and indoor thermal conditions; and 3) occupants' age and gender. Significant intergenerational and gender differences were found, which might be explained by differences in metabolic rates and fashion. The results also indicate that there is a great opportunity to exceed the clothing interval of the thermal comfort zones proposed by international standards such as ASHRAE 55 (2013) - 0.5 to 1.0 clo - and thereby save energy from cooling and heating systems, without compromising the occupants' indoor thermal comfort

Centrilobular emphysema and coronary artery calcification: mediation analysis in the SPIROMICS cohort

Abstract Background Chronic obstructive pulmonary disease (COPD) is associated with a two-to-five fold increase in the risk of coronary artery disease independent of shared risk factors. This association is hypothesized to be mediated by systemic inflammation but this link has not been established. Methods We included 300 participants enrolled in the SPIROMICS cohort, 75 each of lifetime non-smokers, smokers without airflow obstruction, mild-moderate COPD, and severe-very severe COPD. We quantified emphysema and airway disease on computed tomography, characterized visual emphysema subtypes (centrilobular and paraseptal) and airway disease, and used the Weston visual score to quantify coronary artery calcification (CAC). We used the Sobel test to determine whether markers of systemic inflammation mediated a link between spirometric and radiographic features of COPD and CAC. Results FEV1/FVC but not quantitative emphysema or airway wall thickening was associated with CAC (p = 0.036), after adjustment for demographics, diabetes mellitus, hypertension, statin use, and CT scanner type. To explain this discordance, we examined visual subtypes of emphysema and airway disease, and found that centrilobular emphysema but not paraseptal emphysema or bronchial thickening was independently associated with CAC (p = 0.019). MMP3, VCAM1, CXCL5 and CXCL9 mediated 8, 8, 7 and 16% of the association between FEV1/FVC and CAC, respectively. Similar biomarkers partially mediated the association between centrilobular emphysema and CAC. Conclusions The association between airflow obstruction and coronary calcification is driven primarily by the centrilobular subtype of emphysema, and is linked through bioactive molecules implicated in the pathogenesis of atherosclerosis. Trial Registration ClinicalTrials.gov: Identifier: NCT01969344 .https://deepblue.lib.umich.edu/bitstream/2027.42/146749/1/12931_2018_Article_946.pd