Assessing Pulmonary Perfusion in Emphysema Automated Quantification of Perfused Blood Volume in Dual-Energy CTPA

Objectives: The objective of this study was to determine whether automated quantification of lung perfused blood volume (PBV) in dual-energy computed tomographic pulmonary angiography (DE-CTPA) can be used to assess the severity and regional distribution of pulmonary hypoperfusion in emphysema. Materials and Methods: We retrospectively analyzed 40 consecutive patients (mean age, 67 13] years) with pulmonary emphysema, who have no cardiopulmonary comorbidities, and a DE-CTPA negative for pulmonary embolism. Automated quantification of global and regional pulmonary PBV was performed using the syngo Dual Energy application (Siemens Healthcare). Similarly, the global and regional degrees of parenchymal hypodensity were assessed automatically as the percentage of voxels with a computed tomographic density less than -900 Hounsfield unit. Emphysema severity was rated visually, and pulmonary function tests were obtained by chart review, if available. Results: Global PBV generated by automated quantification of pulmonary PBV in the DE-CTPA data sets showed a moderately strong but highly significant negative correlation with residual volume in percentage of the predicted residual volume (r = -0.62; P = 0.002; n = 23) and a positive correlation with forced expiratory volume in 1 second in percentage of the predicted forced expiratory volume in 1 second (r = 0.67; P < 0.001; n = 23). Global PBV values strongly correlated with diffusing lung capacity for carbon monoxide (r = 0.80; P < 0.001; n = 15). Pulmonary PBV values decreased with visual emphysema severity (r = -0.46, P = 0.003, n = 40). Moderate negative correlations were found between global PBV values and parenchymal hypodensity both in a per-patient (r = -0.63; P G 0.001; n = 40) and per-region analyses (r = -0.62; P < 0.001; n = 40). Conclusions: Dual-energy computed tomographic pulmonary angiography allows simultaneous assessment of lung morphology, parenchymal density, and pulmonary PBV. In patients with pulmonary emphysema, automated quantification of pulmonary PBV in DE-CTPA can be used for a quick, reader-independent estimation of global and regional pulmonary perfusion, which correlates with several lung function parameters

Hydrochar from dairy sludge as phosphorus fertiliser affects greenhouse gas emissions and maize yield

Dairy processing sludge is a phosphorus (P) rich waste with a high potential to replace mineral phosphorus fertiliser in crop production, with possible enhancement of greenhouse gas emissions to the environment. Hydrothermal carbonisation is a technology that transforms the sludge into a hydrochar. The objective of this study is examining P availability of two hydrochars produced from Danish and Irish dairy sludge and their influence on greenhouse gas emissions and maize yields. The trial assessed (i) Danish dairy sludge; (ii) hydrochar derived from Danish sludge; (iii) hydrochar made from Irish dairy sludge; (iv) mineral phosphorus fertiliser; and (v) control. Emissions of nitrous oxide and carbon dioxide, soil pH, mineral nitrogen contents and crop yields were measured. Treatment with Danish dairy sludge had significantly higher cumulative nitrous oxide emissions while the emissions from both hydrochars were not significantly different compared to mineral phosphorous fertiliser. Statistical modelling showed that temperature, soil nitrate content, interactions both between temperature and precipitation, and between soil moisture and precipitation were drivers for nitrous oxide emissions. There was no difference in emissions among all treatments when scaled for yield. Hydrochar may alleviate the enhanced nitrous oxide emissions in soil without constraining P availability and maize crop yields

Agents intervening against delirium in the intensive care unit trial-Protocol for a secondary Bayesian analysis

Background Delirium is highly prevalent in the intensive care unit (ICU) and is associated with high morbidity and mortality. The antipsychotic haloperidol is the most frequently used agent to treat delirium although this is not supported by solid evidence. The agents intervening against delirium in the intensive care unit (AID-ICU) trial investigates the effects of haloperidol versus placebo for the treatment of delirium in adult ICU patients. Methods This protocol describes the secondary, pre-planned Bayesian analyses of the primary and secondary outcomes up to day 90 of the AID-ICU trial. We will use Bayesian linear regression models for all count outcomes and Bayesian logistic regression models for all dichotomous outcomes. We will adjust for stratification variables (site and delirium subtype) and use weakly informative priors supplemented with sensitivity analyses using sceptical priors. We will present results as absolute differences (mean differences and risk differences) and relative differences (ratios of means and relative risks). Posteriors will be summarised using median values as point estimates and percentile-based 95% credibility intervals. Probabilities of any benefit/harm, clinically important benefit/harm and clinically unimportant differences will be presented for all outcomes. Discussion The results of this secondary, pre-planned Bayesian analysis will complement the primary frequentist analysis of the AID-ICU trial and facilitate a nuanced and probabilistic interpretation of the trial results.Peer reviewe

IL-4 Deficiency Is Associated with Mechanical Hypersensitivity in Mice

Interleukin-4 (IL-4) is an anti-inflammatory and analgesic cytokine that induces opioid receptor transcription. We investigated IL-4 knockout (ko) mice to characterize their pain behavior before and after chronic constriction injury (CCI) of the sciatic nerve as a model for neuropathic pain. We investigated opioid responsivity and measured cytokine and opioid receptor gene expression in the peripheral and central nervous system (PNS, CNS) of IL-4 ko mice in comparison with wildtype (wt) mice. Naïve IL-4 ko mice displayed tactile allodynia (wt: 0.45 g; ko: 0.18 g; p<0.001), while responses to heat and cold stimuli and to muscle pressure were not different. No compensatory changes in the gene expression of tumor necrosis factor-alpha (TNF), IL-1β, IL-10, and IL-13 were found in the PNS and CNS of naïve IL-4 ko mice. However, IL-1β gene expression was stronger in the sciatic nerve of IL-4 ko mice (p<0.001) 28 days after CCI and only IL-4 ko mice had elevated IL-10 gene expression (p = 0.014). Remarkably, CCI induced TNF (p<0.01), IL-1β (p<0.05), IL-10 (p<0.05), and IL-13 (p<0.001) gene expression exclusively in the ipsilateral spinal cord of IL-4 ko mice. The compensatory overexpression of the anti-inflammatory and analgesic cytokines IL-10 and IL-13 in the spinal cord of IL-4 ko mice may explain the lack of genotype differences for pain behavior after CCI. Additionally, CCI induced gene expression of μ, κ, and δ opioid receptors in the contralateral cortex and thalamus of IL-4 ko mice, paralleled by fast onset of morphine analgesia, but not in wt mice. We conclude that a lack of IL-4 leads to mechanical sensitivity; the compensatory hyperexpression of analgesic cytokines and opioid receptors after CCI, in turn, protects IL-4 ko mice from enhanced pain behavior after nerve lesion

The ALFAM2 database on ammonia emission from field-applied manure: Description and illustrative analysis

peer-reviewedAmmonia (NH3) emission from animal manure contributes to air pollution and ecosystem degradation, and the loss of reactive nitrogen (N) from agricultural systems. Estimates of NH3 emission are necessary for national inventories and nutrient management, and NH3 emission from field-applied manure has been measured in many studies over the past few decades. In this work, we facilitate the use of these data by collecting and organizing them in the ALFAM2 database. In this paper we describe the development of the database and summarise its contents, quantify effects of application methods and other variables on emission using a data subset, and discuss challenges for data analysis and model development. The database contains measurements of emission, manure and soil properties, weather, application technique, and other variables for 1895 plots from 22 research institutes in 12 countries. Data on five manure types (cattle, pig, mink, poultry, mixed, as well as sludge and “other”) applied to three types of crops (grass, small grains, maize, as well as stubble and bare soil) are included. Application methods represented in the database include broadcast, trailing hose, trailing shoe (narrow band application), and open slot injection. Cattle manure application to grassland was the most common combination, and analysis of this subset (with dry matter (DM) limited to <15%) was carried out using mixed- and fixed-effects models in order to quantify effects of management and environment on ammonia emission, and to highlight challenges for use of the database. Measured emission in this subset ranged from <1% to 130% of applied ammonia after 48 h. Results showed clear, albeit variable, reductions in NH3 emission due to trailing hose, trailing shoe, and open slot injection of slurry compared to broadcast application. There was evidence of positive effects of air temperature and wind speed on NH3 emission, and limited evidence of effects of slurry DM. However, random-effects coefficients for differences among research institutes were among the largest model coefficients, and showed a deviation from the mean response by more than 100% in some cases. The source of these institute differences could not be determined with certainty, but there is some evidence that they are related to differences in soils, or differences in application or measurement methods. The ALFAM2 database should be useful for development and evaluation of both emission factors and emission models, but users need to recognize the limitations caused by confounding variables, imbalance in the dataset, and dependence among observations from the same institute. Variation among measurements and in reported variables highlights the importance of international agreement on how NH3 emission should be measured, along with necessary types of supporting data and standard protocols for their measurement. Both are needed in order to produce more accurate and useful ammonia emission measurements. Expansion of the ALFAM2 database will continue, and readers are invited to contact the corresponding author for information on data submission. The latest version of the database is available at http://www.alfam.dk