The effect of bronchial thermoplasty on airway volume measured 12 months post-procedure

Bronchial thermoplasty induces atrophy of the airway smooth muscle layer, but the mechanism whereby this improves patient health is unclear. In this study, we use computed tomography (CT) to evaluate the effects of bronchial thermoplasty on airway volume 12 months post-procedure. 10 consecutive patients with severe asthma were evaluated at baseline by the Asthma Control Questionnaire (ACQ), and high-resolution CT at total lung capacity (TLC) and functional residual capacity (FRC). The CT protocol was repeated 4 weeks after the left lung had been treated by bronchial thermoplasty, but prior to right lung treatment, and then again 12 months after both lungs were treated. The CT data were also used to model the implications of including the right middle lobe (RML) in the treatment field. The mean patient age was 62.7 +/- 7.7 years and forced expiratory volume in 1 s (FEV1) 42.9 +/- 11.5% predicted. 12 months post-bronchial-thermoplasty, the ACQ improved, from 3.4 +/- 1.0 to 1.5 +/- 0.9 (p=0.001), as did the frequency of oral steroid-requiring exacerbations (p=0.008). The total airway volume increased 12 months after bronchial thermoplasty in both the TLC (p=0.03) and the FRC scans (p=0.02). No change in airway volume was observed in the untreated central airways. In the bronchial thermoplasty-treated distal airways, increases in airway volume of 38.4 +/- 31.8% at TLC (p=0.03) and 30.0 +/- 24.8% at FRC (p=0.01) were observed. The change in distal airway volume was correlated with the improvement in ACQ (r=-0.71, p=0.02). Modelling outputs demonstrated that treating the RML conferred no additional benefit. Bronchial thermoplasty induces long-term increases in airway volume, which correlate with symptomatic improvement

Inhibition of Release of Vasoactive and Inflammatory Mediators in Airway and Vascular Tissues and Macrophages By a Chinese Herbal Medicine Formula for Allergic Rhinitis

Herbal therapies are being used increasingly for the treatment of allergic rhinitis. The aim of this study was to investigate the possible pharmacological actions and cellular targets of a Chinese herbal formula (RCM-101), which was previously shown to be effective in reducing seasonal allergic rhinitis symptoms in a randomized, placebo-controlled clinical trial. Rat and guinea pig isolated tissues (trachea and aorta) were used to study the effects of RCM-101 on responses to various mediators. Production of leukotriene B4 in porcine neutrophils and of prostaglandin E2 and nitric oxide (NO) in Raw 264.7 cells were also measured. In rat and guinea pig tracheal preparations, RCM-101 inhibited contractile responses to compound 48/80 but not those to histamine (guinea pig preparations) or serotonin (rat preparations). Contractile responses of guinea pig tracheal preparations to carbachol and leukotriene C4, and relaxant responses to substance P and prostaglandin E2 were not affected by RCM-101. In rat aortic preparations, precontracted with phenylephrine, endothelium-dependent relaxant responses to acetylcholine and endothelium-independent relaxant responses to sodium nitroprusside were not affected by RCM-101. However, RCM-101 inhibited relaxations to l-arginine in endothelium-denuded rat aortic preparations, which had been pre-incubated with lipopolysaccharide. RCM-101 did not affect leukotriene B4 formation in isolated porcine neutrophils, induced by the calcium ionophore A23187; however, it inhibited prostaglandin E2 and NO production in lipopolysaccharide-stimulated murine macrophages (Raw 264.7 cells).The findings indicate that RCM-101 may have multiple inhibitory actions on the release and/or synthesis of inflammatory mediators involved in allergic rhinitis

Oxidative stress precedes skeletal muscle mitochondrial dysfunction during experimental aortic cross-clamping but is not associated with early lung, heart, brain, liver, or kidney mitochondrial impairment

ObjectiveLower limb ischemia-reperfusion results in skeletal muscle mitochondrial alterations, production of reactive oxygen species (ROS), and remote organ impairments that are largely involved in patient prognosis. However, whether ischemia without reperfusion increases ROS production and precedes mitochondrial alteration and whether mitochondrial dysfunction occurs early in remote organs is unknown. This study determined muscle mitochondrial function and ROS production after ischemia alone, or followed by two periods of reperfusion, and investigated heart, lung, liver, kidney, and brain mitochondrial functions after lower limb ischemia-reperfusion.MethodsWistar rats were randomized into four groups: sham (aortic exposure but no ischemia, n = 9), I3 (ischemia alone induced by aortic cross-clamping for 3 hours, n = 9), I3R10′ and I3R2 (aortic cross-clamping, followed by reperfusion for 10 minutes [n = 8] or 2 hours [n = 9]). Blood lactate, alanine aminotransferase, aspartate aminotransferase, and creatinine were measured. Mitochondrial respiratory chain complexes I, II, III, and IV activities and mitochondrial coupling (acceptor control ratio) were analyzed using a Clark oxygen electrode in skeletal muscle, lung, heart, brain, liver, and kidney. ROS production was determined using dihydroethidium staining in muscle, heart, liver, and kidney. Inflammation was also investigated in remote organs (heart, liver, and kidney) using monocyte-macrophage-2 antibody staining.ResultsLactate level increased after ischemia in all groups. In muscle, ROS increased significantly after ischemia alone (+324% ± 66%; P = .038), normalized after 10 minutes of reperfusion, and increased again at 2 hours of reperfusion (+349.2 ± 67%; P = .024). Interestingly, mitochondrial function was unaffected by ischemia alone or followed by 10 minutes of reperfusion, but maximal mitochondrial oxidative capacity (6.10 ± 0.51 vs 4.24 ± 0.36 μmol/min/g, −30%; P < .05) and mitochondrial coupling decreased after 2 hours of reperfusion (1.93 ± 0.17 vs 1.33 ± 0.07, −45%; P < .01), in sham and I3R2 rats, respectively. Despite increased serum aspartate aminotransferase (×13; P < .0001), alanine aminotransferase (×6; P = .0019), and creatinine (×3; P = .0004), remote organs did not show mitochondrial alteration, inflammation, or ROS production enhancement after 2 hours of reperfusion.ConclusionsOxidative stress precedes skeletal muscle mitochondrial dysfunction during lower limb ischemia. Such a kinetic explains the efficacy of ischemic preconditioning and supports that therapy should be conducted even during ongoing ischemia, suggesting that ischemic preconditioning might be a successful approach.Clinical RelevanceAortic cross-clamping increases reactive oxygen species (ROS) and impairs skeletal muscle and remote organs, which is involved in patient prognosis. However, the temporal relationship between ROS production and mitochondrial dysfunction during lower limb ischemia reperfusion is unknown. This study demonstrates for the first time that ROS production occurs during ischemia alone, without reperfusion, and precedes skeletal muscle mitochondrial impairments. Although involved in multiorgan failure, lung, heart, brain, liver, and kidney mitochondria are not affected early. These results support a need for muscle protection even during lower limb ischemia and that ischemic preconditioning (conditioning performed during ongoing ischemia) might be a successful approach

Carrageenan from Kappaphycus alvarezii (Rhodophyta, Solieriaceae): Metabolism, structure, production, and application

Carrageenan is a polysaccharide derived from red algae (seaweed) with enormous economic potential in a wide range of industries, including pharmaceuticals, food, cosmetics, printing, and textiles. Carrageenan is primarily produced through aquaculture-based seaweed farming, with Eucheuma and Kappaphycus species accounting for more than 90% of global output. There are three major types of carrageenan found in red algae: kappa (κ)-, iota (ι)-, and lambda (λ)-carrageenan. Kappaphycus alvarezii is the most common kappa-carrageenan source, and it is primarily farmed in Asian countries such as Indonesia, the Philippines, Vietnam, and Malaysia. Carrageenan extracted from K. alvarezii has recently received a lot of attention due to its economic potential in a wide range of applications. This review will discuss K. alvarezii carrageenan in terms of metabolic and physicochemical structure, extraction methods and factors affecting production yield, as well as current and future applications

Investigation of Growth Rate and Phycocolloid Content from Kappaphycus alvarezii (Rhodophyta, Solieriaceae) under Different Light Conditions Using Vibrational Spectroscopy

Kappa-carrageenan (K-carrageenan) is an important phycocolloid which is a major constituent of the cell wall of Kappaphycus alvarezii. The chemical structure of K-carrageenan comprises a linear backbone of D-galactose residues linked with alternating α-(1,3) and β-(1,4) linkages which are substituted by one ester-sulphonic group per di-galactose repeating unit. The spectral qualities of light as well as the ambient carbon dioxide concentration, both play an important role in the photosynthetic pathway in plants and this investigation set forth to establish the effect of different wavelengths of light and carbon dioxide supplementation on the chemical structure of K-carrageenan obtained from K. alvarezii. Specimens were cultivated under a range of monochromatic light spectra and assessed for chemical composition using Fourier Transform Infrared (FTIR) spectroscopy.The K. alvarezii control was irradiated with full light spectrum, treatments were carried out using blue (492-455 nm), green (577-492 nm) and red (780-622 nm)light. One experiment was carried out by supplementation with carbon dioxide. Samples were collected after 14 days. The effect of different wavelengths of light on the growth rates of experimental samples was determined. Red light had the most significant impact on the growth rate of K. alvarezii as compared to those treated with blue light. The FTIR fingerprint of the ground seaweed was found to be identical to that of commercial K-carrageenan (Sigma). Special emphasis was given to the 800-1300 cm-1 region, which presents several vibrational modes. All the samples produced similar FTIR spectral profiles, suggesting that genes related to the carrageenan biosynthesis are not affected by different wavelengths of light or CO2. The results obtained from FTIR spectroscopy demonstrated that different wavelengths of light and supplementation with CO2 have no influence to the chemical structure of K-carrageenan in K. alvarezii

Optimizing energy costs in a zinc and lead mine

Boliden Tara Mines Ltd. consumed 184.7 GWh of electricity in 2014, equating to over 1% of the national demand of Ireland or approximately 35,000 homes. Ireland's industrial electricity prices, at an average of 13 c/KWh in 2014, are amongst the most expensive in Europe. Cost effective electricity procurement is ever more pressing for businesses to remain competitive. In parallel, the proliferation of intelligent devices has led to the industrial Internet of Things paradigm becoming mainstream. As more and more devices become equipped with network connectivity, smart metering is fast becoming a means of giving energy users access to a rich array of consumption data. These modern sensor networks have facilitated the development of applications to process, analyse, and react to continuous data streams in real-time. Subsequently, future procurement and consumption decisions can be informed by a highly detailed evaluation of energy usage. With these considerations in mind, this paper uses variable energy prices from Ireland’s Single Electricity Market, along with smart meter sensor data, to simulate the scheduling of an industrial-sized underground pump station in Tara Mines. The objective is to reduce the overall energy costs whilst still functioning within the system's operational constraints. An evaluation using real-world electricity prices and detailed sensor data for 2014 demonstrates significant savings of up to 10.72% over the year compared to the existing control systems

Altered regional cerebral blood flow in idiopathic hypersomnia

Objectives Idiopathic hypersomnia is characterized by excessive daytime sleepiness despite normal or long sleep time. Its pathophysiological mechanisms remain unclear. This pilot study aims at characterizing the neural correlates of idiopathic hypersomnia using single photon emission computed tomography. Methods Thirteen participants with idiopathic hypersomnia and sixteen healthy controls were scanned during resting wakefulness using a high-resolution single photon emission computed tomography scanner with 99mTc-ethyl cysteinate dimer to assess cerebral blood flow. The main analysis compared regional cerebral blood flow distribution between the two groups. Exploratory correlations between regional cerebral blood flow and clinical characteristics evaluated the functional correlates of those brain perfusion patterns. Significance was set at p <0.05 after correction for multiple comparisons. Results Idiopathic hypersomnia participants showed regional cerebral blood flow decreases in medial prefrontal cortex, posterior cingulate cortex and putamen, as well as increases in amygdala and temporo-occipital cortices. Lower regional cerebral blood flow in the medial prefrontal cortex was associated with higher daytime sleepiness. Conclusions These preliminary findings suggest that idiopathic hypersomnia is characterized by functional alterations in brain areas involved in the modulation of vigilance states, which may contribute to the daytime symptoms of this condition. The distribution of regional cerebral blood flow changes was reminiscent of the patterns associated with normal non-rapid-eye-movement sleep, suggesting the possible presence of incomplete sleep-wake transitions. These abnormalities were strikingly distinct from those induced by acute sleep deprivation, suggesting that the patterns seen here might reflect a trait associated with idiopathic hypersomnia rather than a non-specific state of sleepiness

Asthma and dietary intake: an overview of systematic reviews

Epidemiological research on the relationship between diet and asthma has increased in the last decade. Several components found in foods have been proposed to have a series of antioxidant, anti-allergic and anti-inflammatory properties, which can have a protective effect against asthma risk. Several literature reviews and critical appraisals have been published to summarise the existing evidence in this field. In the context of this EAACI Lifestyle and asthma Task Force, we summarise the evidence from existing systematic reviews on dietary intake and asthma, using the PRISMA guidelines. We therefore report the quality of eligible systematic reviews and summarise the results of those with an AMSTAR score ≥32. The GRADE approach is used to assess the overall quality of the existing evidence. This overview is centred on systematic reviews of nutritional components provided in the diet only, as a way to establish what type of advice can be given in clinical practice and to the general population on dietary habits and asthma. This article is protected by copyright. All rights reserved

Clinical Outcomes and Predictors of Improved Left Ventricular Ejection Fraction in Heart Failure with Reduced Ejection Fraction due to Non-Ischemic Cardiomyopathy

Background: Left ventricular ejection fraction (LVEF) improvement is the cornerstone of LV reverse remodelling. It prognosticates heart failure with reduced ejection fraction (HFrEF). There is limited data on the clinical factors that predict LVEF improvement among non-ischemic cardiomyopathy (NICM) patients in Malaysia. Objective: To determine the 3-year outcomes and predictors of LVEF improvement in patients with (NICM) and HFrEF. Materials &amp; Methods: We recruited patients with NICM and HFrEF (LVEF &lt;40%) between 2016 and 2018. NICM was defined as HF with 1) normal coronary arteries or 2) any coronary artery stenosis not involving the proximal left anterior descending artery (LAD) and without transmural fibrosis in the LAD territory from cardiac magnetic resonance (CMR) imaging to account for the impaired LVEF. Clinical and imaging parameters were assessed using logistic regression statistics to determine the predictors of LVEF improvement. LVEF improvement is defined as a recovery of EF to &gt; 40% with at least a 10-point increment from baseline. The clinical outcomes at three year were 1) change in NYHA class and 2) composite of all-cause mortality, unscheduled clinic or emergency department visits, readmission and/or ventricular arrhythmia. Results: 43 patients were recruited. The mean duration of follow-up and echocardiographic assessment interval were 46 and 23 months, respectively. The cohort had a mean age of 46±13 years, and were mostly male (72%). More patients had NYHA 1 at the end of the study (37% vs 86%). 11 patients (25%) recorded composite outcomes. 62.8% had LVEF improvement. Patients with LVEF improvement had a lower incidence of late gadolinium enhancement (51.7% vs 85.7%, odds 5.6 ,p=0.045) and midwall fibrosis on CMR (18.5% vs 62.5%, odds 7.3, p=0.003). LVEF improvement did not affect the functional NYHA recovery (92% vs 81%, p=0.28). Patients with less LVEF improvement had higher incidence of composite outcome (18.5% vs 37.5%, p=0.168). Other characteristics were not significantly different between the groups. Conclusion: Patients with NICM and LVEF improvement had lower composite outcome. Absence of late gadolinium enhancement, particularly midwall fibrosis was an independant predictor of LVEF improvement. This underscores the importance of CMR tissue characterisation to refine the prognostication of NICM patients