Differences in Respiratory Symptoms and Lung Structure Between Hispanic and Non-Hispanic White Smokers: A Comparative Study

Background: Prior studies have demonstrated that U.S. Hispanic smokers have a lower risk of decline in lung function and chronic obstructive pulmonary disease (COPD) compared with non-Hispanic whites (NHW). This suggests there might be racial-ethnic differences in susceptibility in cigarette smoke-induced respiratory symptoms, lung parenchymal destruction, and airway and vascular disease, as well as in extra-pulmonary manifestations of COPD. Therefore, we aimed to explore respiratory symptoms, lung function, and pulmonary and extra-pulmonary structural changes in Hispanic and NHW smokers. Methods: We compared respiratory symptoms, lung function, and computed tomography (CT) measures of emphysema-like tissue, airway disease, the branching generation number (BGN) to reach a 2-mm-lumen-diameter airway, and vascular pruning as well as muscle and fat mass between 39 Hispanic and 39 sex-, age- and smoking exposure-matched NHW smokers. Results: Hispanic smokers had higher odds of dyspnea than NHW after adjustment for COPD and asthma statuses (odds ratio[OR] = 2.96; 95% confidence interval [CI] 1.09-8.04), but no significant differences were found in lung function and CT measurements. Conclusions: While lung function and CT measures of the lung structure were similar, dyspnea is reported more frequently by Hispanic than matched-NHW smokers. It seems to be an impossible puzzle but it's easy to solve a Rubik' Cube using a few algorithms

Effect of COVID-19 medications on corrected QT interval and induction of torsade de pointes: Results of a multicenter national survey

Background: There are some data showing that repurposed drugs used for the Coronavirus disease-19 (COVID-19) have potential to increase the risk of QTc prolongation and torsade de pointes (TdP), and these arrhythmic side effects have not been adequately addressed in COVID-19 patients treated with these repurposed medications. Methods: This is the prospective study of 2403 patients hospitalised at 13 hospitals within the COVID-19 epicentres of the Iran. These patients were treated with chloroquine, hydroxychloroquine, lopinavir/ritonavir, atazanavir/ritonavir, oseltamivir, favipiravir and remdesivir alone or in combination with azithromycin. The primary outcome of the study was incidence of critical QTc prolongation, and secondary outcomes were incidences of TdP and death. Results: Of the 2403 patients, 2365 met inclusion criteria. The primary outcome of QTc � 500 ms and �QTc � 60 ms was observed in 11.2 and 17.6 of the patients, respectively. The secondary outcomes of TdP and death were reported in 0.38 and 9.8 of the patients, respectively. The risk of critical QT prolongation increased in the presence of female gender, history of heart failure, treatment with hydroxychloroquine, azithromycin combination therapy, simultaneous furosemide or beta-blocker therapy and acute renal or hepatic dysfunction. However, the risk of TdP was predicted by treatment with lopinavir-ritonavir, simultaneous amiodarone or furosemide administration and hypokalaemia during treatment. Conclusion: This cohort showed significant QTc prolongation with all COVID-19 medications studied, however, life-threatening arrhythmia of TdP occurred rarely. Among the repurposed drugs studied, hydroxychloroquine or lopinavir-ritonavir alone or in combination with azithromycin clearly demonstrated to increase the risk of critical QT prolongation and/or TdP. © 2021 John Wiley & Sons Ltd

EXPRESS: Statement on imaging and pulmonary hypertension from the Pulmonary Vascular Research Institute (PVRI)

Pulmonary hypertension is highly heterogeneous and despite treatment advances it remains a life shortening condition. There have been significant advances in imaging technologies, but despite evidence of their potential clinical utility practice remains variable, dependent in part on imaging availability and expertise. This statement summarises current and emerging imaging modalities and their potential role in the diagnosis and assessment of suspected pulmonary hypertension. It also includes a review of commonly encountered clinical and radiological scenarios, and imaging and modeling-based biomarkers. An expert panel was formed including clinicians, radiologists, imaging scientists and computational modelers. Section editors generated a series of summary statements 1based on a review of the literature and professional experience and following consensus review, a diagnostic algorithm and fifty five statements were agreed. The diagnostic algorithm and summary statements, emphasise the key role and added value of imaging in the diagnosis and assessment of pulmonary hypertension and highlight areas requiring further research

Ventricular Geometry From Non-contrast Non-ECG-gated CT Scans:An Imaging Marker of Cardiopulmonary Disease in Smokers

Cardiovascular disease is a major cause of morbidity in smokers, and as much as 50% of the estimated 24 million patients in the United States with chronic obstructive pulmonary disease (COPD) die of cardiovascular causes (1,2). Although echocardiography and cardiac magnetic resonance imaging (MRI) are often used to study cardiac structure and function in COPD (3), these are not routinely deployed in all smokers. Computed tomographic (CT) imaging of the chest is broadly used in clinical care and is increasingly used for lung cancer screening in high-risk smokers (4). Assessment of cardiac structure on those CT scans may help identify patients with COPD at greater risk of developing cardiac dysfunction. Rapid, noninvasive assessments of cardiac morphology and a better understanding of the functional interdependence of heart and lung may improve healthcare outcomes through early detection and initiation of treatment

Combination therapy with oral treprostinil for pulmonary arterial hypertension. A double-blind placebo-controlled clinical trial

Rationale: Oral treprostinil improves exercise capacity in patients with pulmonary arterial hypertension (PAH), but the effect on clinical outcomes was unknown. Objectives: To evaluate the effect of oral treprostinil compared with placebo on time to first adjudicated clinical worsening event in participants with PAH who recently began approved oral monotherapy. Methods: In this event-driven, double-blind study, we randomly allocated 690 participants (1:1 ratio) with PAH to receive placebo or oral treprostinil extended-release tablets three times daily. Eligible participants were using approved oral monotherapy for over 30 days before randomization and had a 6-minute-walk distance 150 m or greater. The primary endpoint was the time to first adjudicated clinical worsening event: death; hospitalization due to worsening PAH; initiation of inhaled or parenteral prostacyclin therapy; disease progression; or unsatisfactory long-term clinical response. Measurements and Main Results: Clinical worsening occurred in 26% of the oral treprostinil group compared with 36% of placebo participants (hazard ratio, 0.74; 95% confidence interval, 0.56–0.97; P = 0.028). Key measures of disease status, including functional class, Borg dyspnea score, and N-terminal pro–brain natriuretic peptide, all favored oral treprostinil treatment at Week 24 and beyond. A noninvasive risk stratification analysis demonstrated that oral treprostinil–assigned participants had a substantially higher mortality risk at baseline but achieved a lower risk profile from Study Weeks 12–60. The most common adverse events in the oral treprostinil group were headache, diarrhea, flushing, nausea, and vomiting. Conclusions: In participants with PAH, addition of oral treprostinil to approved oral monotherapy reduced the risk of clinical worsening. Clinical trial registered with www.clinicaltrials.gov (NCT01560624)

Effect of meso-scale surface water temperature heterogeneity on surface cooling estimates of a large lake: Airborne remote sensing results from Lake Geneva

Satellite thermal images are frequently used in the study of surface heat exchange dynamics over lakes. Such investigations can depict large-scale thermal patterns with a resolution of O(1 km2), but not meso- or small-scale processes, requiring O(1 m) and O(1 cm) resolution. Using an airborne platform, the effect of meso-scale spatial heterogeneity of Lake Surface Water Temperature (LSWT) on the surface cooling estimation at the sub-pixel satellite scale O(1 km2) was investigated in Lake Geneva. The measurement system consists of a tethered balloon launched imaging and monitoring platform, equipped with an uncooled infrared camera that records the LSWT, and an autonomous catamaran that simultaneously measures in situ surface/near surface temperatures. Cold season data did not show significant LSWT heterogeneity, and hence surface cooling spatial variability. However, based on three selected daytime meso-scale maps, a LSWT contrast of > 2°C in spring and > 3.5°C in summer is observed, corresponding to the spatial surface cooling range of > 20 Wm-2 and > 40 Wm-2, respectively. Due to the nonlinear relationship between turbulent surface heat fluxes and LSWT, negatively skewed LSWT spatial distributions resulted in negatively skewed surface cooling patterns under very stable or predominantly unstable Atmospheric Boundary Layer (ABL) conditions and positively skewed surface cooling patterns under predominantly stable ABL conditions. Implementing a mean spatial filter, the effect of the area-averaged LSWT on the surface cooling estimation of a typical satellite pixel was assessed. The effect of the averaging filter size on the mean spatial surface cooling values was negligible, except for the predominantly stable ABL conditions when a reduction of ~3.5 Wm-2 from high O(1 m) to low O(1 km) pixel resolution was obtained. The results revealed that the bias in the sampling of meteorological parameters, particularly wind speed, could affect both the mean and the range of spatial surface cooling. Errors in air temperature may also alter the surface cooling distribution from negatively to positively skewed, and hence affect the area-averaged estimates

A mobile measurement platform and an image processing procedure for high-resolution aerial thermal imagery of lake surface water temperatures

A mobile platform for carrying out Lake Surface Water Temperature (LSWT) thermography with O(1 m) pixel resolution is presented. It consists of (i) a small balloon carrying a thermal and RGB imagery package tethered to a winch on a boat, and (ii) an autonomous catamaran that measures in situ surface/near surface temperatures, both communicating with the boat in real time. The image processing procedure includes non-uniformity correction (spatial noise) by a pixelwise two-point linear correction; drift correction (temporal noise) by probability density function matching in regions of overlap between sequential images; and creation of composite thermal images by a feature matching-based algorithm. A high overlapping field of view (~95%) is essential for optimizing image fusion and noise reduction of lake aerial thermography to resolve the small LSWT gradients. Catamaran-measured in situ temperatures were used for the radiometric calibration. The resultant high-resolution meso-scale LSWT maps show various cold-warm patches and streak-like structures with a temperature contrast of > 2°C over areas covering less than a typical satellite pixel (1 km2). They were verified by catamaran measurements. The results demonstrate the capability of this mobile platform system and the proposed image processing procedure to determine meso-scale LSWT patterns with unprecedented detail