A randomised trial of lung sealant versus medical therapy for advanced emphysema

Uncontrolled pilot studies demonstrated promising results of endoscopic lung volume reduction using emphysematous lung sealant (ELS) in patients with advanced, upper lobe predominant emphysema. We aimed to evaluate the safety and efficacy of ELS in a randomised controlled setting. Patients were randomised to ELS plus medical treatment or medical treatment alone. Despite early termination for business reasons and inability to assess the primary 12-month end-point, 95 out of 300 patients were successfully randomised, providing sufficient data for 3- and 6-month analysis. 57 patients (34 treatment and 23 control) had efficacy results at 3 months; 34 (21 treatment and 13 control) at 6 months. In the treatment group, 3-month lung function, dyspnoea, and quality of life improved significantly from baseline when compared to control. Improvements persisted at 6 months with >50% of treated patients experiencing clinically important improvements, including some whose lung function improved by >100%. 44% of treated patients experienced adverse events requiring hospitalisation (2.5-fold more than control, p=0.01), with two deaths in the treated cohort. Treatment responders tended to be those experiencing respiratory adverse events. Despite early termination, results show that minimally invasive ELS may be efficacious, yet significant risks (probably inflammatory) limit its current utility

The Origin and MgCl2–NaCl Variations in an Athalassic Sag Pond: Insights from Chemical and Isotopic Data

The examination of past and new chemical–isotopic data (2H/1H–18O/16O,11B/10B and87Sr/86Sr ratios) shows the meteoric origin of the Sawa Lake (Muthanna Governorate, Iraq) and its connection with the local aquifers, which feed the lake via the groundwater emerging from its floor through fault systems. The chemical and isotopic evaporation models are traced by geochemical computer codes by using a different composition of some potential inflows to the lake (e.g., the Euphrates River and Dammam aquifer). The main product of the chemical evaporation models is gypsum, as confirmed by the mineralogical examination of the sediment and the surrounding outcrops. A strong18O–2H enrichment is a consequence of the evaporation effect in arid regions; δ18O–Cl models and δ11B = + 23.4‰ exclude the contribution of any seawater-derived fluids. This latter value along with87Sr/86Sr = 0.707989 suggests a mixed origin from the Eocene–Miocene aquifers. The isotope and chemical evaporation paths from the meteorically recharged sources match the lake composition. However, compositional switches from NaCl toward MgCl2occurred in the last decade and are related to post-drought periods, showing that the interaction of the recharging waters with the local soils (Na–Mg exchange and/or the leaching of the top layer salts) have a role in the chemical composition. This demonstrates that the lake is significantly influenced by climatic variations