Heart And Lung Research Articles

First-in-human controlled inhalation of thin graphene oxide nanosheets to study acute cardiorespiratory responses

Graphene oxide nanomaterials are being developed for wide-ranging applications but are associated with potential safety concerns for human health. We conducted a double-blind randomized controlled study to determine how the inhalation of graphene oxide nanosheets affects acute pulmonary and cardiovascular function. Small and ultrasmall graphene oxide nanosheets at a concentration of 200 μg m−3 or filtered air were inhaled for 2 h by 14 young healthy volunteers in repeated visits. Overall, graphene oxide nanosheet exposure was well tolerated with no adverse effects. Heart rate, blood pressure, lung function and inflammatory markers were unaffected irrespective of graphene oxide particle size. Highly enriched blood proteomics analysis revealed very few differential plasma proteins and thrombus formation was mildly increased in an ex vivo model of arterial injury. Overall, acute inhalation of highly purified and thin nanometre-sized graphene oxide nanosheets was not associated with overt detrimental effects in healthy humans. These findings demonstrate the feasibility of carefully controlled human exposures at a clinical setting for risk assessment of graphene oxide, and lay the foundations for investigating the effects of other two-dimensional nanomaterials in humans. Clinicaltrials.gov ref: NCT03659864.

Risk factors and effect of dyspnea inappropriate treatment in adults' emergency department: a retrospective cohort study.

Dyspnea is a frequent symptom in adults' emergency departments (EDs). Misdiagnosis at initial clinical examination is common, leading to early inappropriate treatment and increased in-hospital mortality. Risk factors of inappropriate treatment assessable at early examination remain undescribed herein. The objective of this study was to identify clinical risk factors of dyspnea and inappropriate treatment in patients admitted to ED. This is an observational retrospective cohort study. Patients over the age of 15 who were admitted to adult EDs of the University Hospital of Toulouse (France) with dyspnea were included from 1 July to 31 December 2019. The primary end-point was dyspnea and inappropriate treatment was initiated at ED. Inappropriate treatment was defined by looking at the final diagnosis of dyspnea at hospital discharge and early treatment provided. Afterward, this early treatment at ED was compared to the recommended treatment defined by the International Guidelines for Acute Heart Failure, bacterial pneumonia, chronic obstructive pulmonary disease, asthma or pulmonary embolism. A total of 2123 patients were analyzed. Of these, 809 (38%) had inappropriate treatment in ED. Independent risk factors of inappropriate treatment were: age over 75 years (OR, 1.46; 95% CI, 1.18-1.81), history of heart disease (OR, 1.32; 95% CI, 1.07-1.62) and lung disease (OR, 1.47; 95% CI, 1.21-1.78), SpO 2 <90% (OR, 1.64; 95% CI, 1.37-2.02), bilateral rale (OR, 1.25; 95% CI, 1.01-1.66), focal cracklings (OR, 1.32; 95% CI, 1.05-1.66) and wheezing (OR, 1.62; 95% CI, 1.31-2.03). In multivariate analysis, under-treatment significantly increased in-hospital mortality (OR, 2.13; 95% CI, 1.29-3.52) compared to appropriate treatment. Over-treatment nonsignificantly increased in-hospital mortality (OR, 1.43; 95% CI, 0.99-2.06). Inappropriate treatment is frequent in patients admitted to ED for dyspnea. Patients older than 75 years, with comorbidities (heart or lung disease), hypoxemia (SpO 2 <90%) or abnormal pulmonary auscultation (especially wheezing) are at risk of inappropriate treatment.

Educational inequalities in all-cause and cause-specific mortality in Japan: national census-linked mortality data for 2010-15.

Due to the lack of a national mortality inequality monitoring framework, the overall picture in Japan remains unclear. Here, we investigated educational inequalities in mortality and their cause-specific contribution in Japan. Data were obtained by linking the 2010 Japanese population census and death records between 1 October 2010 and 30 September 2015. We included 7 984 451 Japanese people aged 30-79 years who had a unique 'matching key' generated by sex, birth year/month, address (municipality), marital status and age of spouse (9.9% of the total census population). We computed population-weighted all-cause and cause-specific age-standardized mortality rates (ASMRs) by education level. In addition, we calculated the slope index of inequality (SII), relative index inequality (RII) by education level, and population attributable fraction (PAF) referenced with the highest education (e.g. university graduation). Individuals with less education had higher all-cause and cause-specific ASMRs than highly educated individuals. All-cause SII (per 100 000 person-years) values were 433 (95% CI: 410-457) for men and 235 (95% CI: 217-252) for women. RII values were 1.48 (95% CI: 1.45-1.51) for men and 1.47 (95% CI: 1.43-1.51) for women. Estimated PAFs, excess premature deaths caused by educational inequalities, were 11.6% for men and 16.3% for women, respectively. Cerebrovascular diseases, ischaemic heart diseases and lung cancer were the major contributors to mortality inequalities for both sexes. This first census-based comprehensive report on cause-specific educational mortality inequalities suggested that differences in unfavourable health risk factors by educational background might be associated with these inequalities in Japan.

Estimating the health impact of nicotine exposure by dissecting the effects of nicotine versus non-nicotine constituents of tobacco smoke: A multivariable Mendelian randomisation study.

The detrimental health effects of smoking are well-known, but the impact of regular nicotine use without exposure to the other constituents of tobacco is less clear. Given the increasing daily use of alternative nicotine delivery systems, such as e-cigarettes, it is increasingly important to understand and separate the effects of nicotine use from the impact of tobacco smoke exposure. Using a multivariable Mendelian randomisation framework, we explored the direct effects of nicotine compared with the non-nicotine constituents of tobacco smoke on health outcomes (lung cancer, chronic obstructive pulmonary disease [COPD], forced expiratory volume in one second [FEV-1], forced vital capacity [FVC], coronary heart disease [CHD], and heart rate [HR]). We used Genome-Wide Association Study (GWAS) summary statistics from Buchwald and colleagues, the GWAS and Sequencing Consortium of Alcohol and Nicotine, the International Lung Cancer Consortium, and UK Biobank. Increased nicotine metabolism increased the risk of COPD, lung cancer, and lung function in the univariable analysis. However, when accounting for smoking heaviness in the multivariable analysis, we found that increased nicotine metabolite ratio (indicative of decreased nicotine exposure per cigarette smoked) decreases heart rate (b = -0.30, 95% CI -0.50 to -0.10) and lung function (b = -33.33, 95% CI -41.76 to -24.90). There was no clear evidence of an effect on the remaining outcomes. The results suggest that these smoking-related outcomes are not due to nicotine exposure but are caused by the other components of tobacco smoke; however, there are multiple potential sources of bias, and the results should be triangulated using evidence from a range of methodologies.

Numerical investigation on MHD non-Newtonian pulsating Fe 3 O 4-blood nanofluid flow through vertical channel with nonlinear thermal radiation, entropy generation, and Joule heating

The main aim of the present investigation is to examine the effect of nonlinear thermal radiation, slip, and Joule heating on MHD Pulsatile flow of third-grade ferro-nanofluid via vertical channel with entropy generation. The significance of this study is that it has plenty of physiological applications like cancer treatment, vitamin injections, dialysis, heart–lung machines during surgeries and industrial applications like filtration, pharmaceutical fluid production, and dispensing cosmetic/glue emulsions with no contamination. Furthermore, the ferro-nanoliquid model is the best model for numerous bio/industrial fluids. Therefore, this study explores the entropy analysis of pulsating third-grade ferro-nanoliquid flow between two parallel vertical walls under an applied magnetic field. Blood is taken as a base fluid (third grade), and iron oxide is used as nanoparticles. The governed nonlinear partial differential equations (PDEs) are nondimensionalized, and then the perturbation technique is employed to attain the set of nonlinear ordinary differential equations (ODEs). The bvp4c technique with MATLAB software is utilized to obtain the solutions for the set of ODEs. The deviations in several physical quantities on the flow variables are deployed via graphs. An increment in Eckert number and radiation parameter accelerates the temperature. Entropy generation rate and Bejan number are accelerated for greater values of radiation parameter. The values of the skin friction and Nusselt number against various physical parameters are presented in tables.

Male versus female inflammatory response after brain death model followed by ex vivo lung perfusion

BackgroundEx vivo lung perfusion (EVLP) is a useful tool for assessing lung grafts quality before transplantation. Studies indicate that donor sex is as an important factor for transplant outcome, as females present higher inflammatory response to brain death (BD) than males. Here, we investigated sex differences in the lungs of rats subjected to BD followed by EVLP.MethodsMale and female Wistar rats were subjected to BD, and as controls sham animals. Arterial blood was sampled for gas analysis. Heart–lung blocks were kept in cold storage (1 h) and normothermic EVLP carried out (4 h), meanwhile ventilation parameters were recorded. Perfusate was sampled for gas analysis and IL-1β levels. Leukocyte infiltration, myeloperoxidase presence, IL-1β gene expression, and long-term release in lung culture (explant) were evaluated.ResultsBrain dead females presented a low lung function after BD, compared to BD-males; however, at the end of the EVLP period oxygenation capacity decreased in all BD groups. Overall, ventilation parameters were maintained in all groups. After EVLP lung infiltrate was higher in brain dead females, with higher neutrophil content, and accompanied by high IL-1β levels, with increased gene expression and concentration in the culture medium (explant) 24 h after EVLP. Female rats presented higher lung inflammation after BD than male rats. Despite maintaining lung function and ventilation mechanics parameters for 4 h, EVLP was not able to alter this profile.ConclusionIn this context, further studies should focus on therapeutic measures to control inflammation in donor or during EVLP to increase lung quality.

Younger age is associated with cardiovascular pathological phenotype of severe COVID-19 at autopsy.

COVID-19 affects patients of all ages. There are few autopsy studies focusing on the younger population. We assessed an autopsy cohort aiming to understand how age influences pathological outcomes in fatal COVID-19. This study included autopsied patients, aged 6 months to 83 years, with confirmed COVID-19 in 2020-2021. We collected tissue samples from deceased patients using a minimally invasive autopsy protocol and assessed pathological data following a systematic approach. Eighty-six patients were included, with a median age of 55 years (IQR 32.3-66.0). We showed that age was significantly lower in patients with acute heart ischemia (p = 0.004), myocarditis (p = 0.03) and lung angiomatosis (p < 0.001), and significantly higher in patients with exudative diffuse alveolar damage (p = 0.02), proliferative diffuse alveolar damage (p < 0.001), lung squamous metaplasia (p = 0.003) and lung viral atypia (p = 0.03), compared to patients without those findings. We stratified patients by their age and showed that cardiovascular findings were more prevalent in children and young adults. We performed principal component analysis and cluster of pathological variables, and showed that cardiovascular variables clustered and covariated together, and separated from pulmonary variables. We showed that age modulates pathological outcomes in fatal COVID-19. Younger age is associated with cardiovascular abnormalities and older age with pulmonary findings.

An Apriori algorithm-based association rule analysis to identify acupoint combinations for treating uremic pruritus.

Uremic pruritus (UP) is a prevalent and troublesome condition affecting individuals with end-stage renal failure, which results in intense pruritus, depression, as well as poor quality of sleep, significantly impacting their quality of life. According to previous studies, acupuncture and acupoint stimulation have been shown to provide additional benefits in treating UP in dialysis patients. In addition, using acupoints combination may yield superior effectiveness compared to utilizing a singular acupoint. To investigate the potential correlations between acupoint combinations, an association-rule analysis was employed. Apriori algorithms stand out as highly potent techniques for identifying associations in databases; this study utilized an association rule mining to examine the association rules of key acupoint groupings that could be employed for treating UP. The analysis utilized information derived from the meta-analysis encompassing 40 randomized controlled trials that used acupuncture to treat UP. In total, 64 acupoints were analyzed, and 71 association rules were found. The following acupoint combinations: Auricular shenmen (TF4), Quchi (LI11), and Geshu (BL17); Auricular heart (Extra14), Sanyinjiao (SP6), and Auricular lung (CO14); and Auricular heart (Extra14), Xuehai (SP10), and Auricular lung (CO14) showed the strongest associations. Acupoints involving Auricular shenmen (TF4), Quchi (LI11), Geshu (BL17), Auricular heart (Extra14), Sanyinjiao (SP6), Auricular lung (CO14), and Xuehai (SP10) can be regarded as the core combination of acupuncture points for managing UP.

NeoSSNet: Real-Time Neonatal Chest Sound Separation Using Deep Learning.

Goal: Auscultation for neonates is a simple and non-invasive method of diagnosing cardiovascular and respiratory disease. However, obtaining high-quality chest sounds containing only heart or lung sounds is non-trivial. Hence, this study introduces a new deep-learning model named NeoSSNet and evaluates its performance in neonatal chest sound separation with previous methods. Methods: We propose a masked-based architecture similar to Conv-TasNet. The encoder and decoder consist of 1D convolution and 1D transposed convolution, while the mask generator consists of a convolution and transformer architecture. The input chest sounds were first encoded as a sequence of tokens using 1D convolution. The tokens were then passed to the mask generator to generate two masks, one for heart sounds and one for lung sounds. Each mask is then applied to the input token sequence. Lastly, the tokens are converted back to waveforms using 1D transposed convolution. Results: Our proposed model showed superior results compared to the previous methods based on objective distortion measures, ranging from a 2.01 dB improvement to a 5.06 dB improvement. The proposed model is also significantly faster than the previous methods, with at least a 17-time improvement. Conclusions: The proposed model could be a suitable preprocessing step for any health monitoring system where only the heart sound or lung sound is desired.

PAHPhysRAD: A Digital Imaging and Communications in Medicine Research Tool for Segmentation and Radiomic Feature Extraction.

Segmentation and analysis of organs at risks (OARs) and tumor volumes are integral concepts in the development of radiotherapy treatment plans and prediction of patients' treatment outcomes. To develop a research tool, PAHPhysRAD, that can be used to semi- and fully automate segmentation of OARs. In addition, the proposed software seeks to extract 3214 radiomic features from tumor volumes and user-specified dose-volume parameters. Developed within MATLAB, PAHPhysRAD provides a comprehensive suite of segmentation tools, including manual, semi-automatic, and automatic options. For semi-autosegmentation, meta AI's Segment Anything Model was incorporated using the bounding box methods. Autosegmentation of OARs and tumor volume are implemented through a module that enables the addition of models in Open Neural Network Exchange format. To validate the radiomic feature extraction module in PAHPhysRAD, radiomic features extracted from gross tumor volume of 15 non-small cell lung carcinoma patients were compared against the features extracted from 3D Slicer™. The dose-volume parameters extraction module was validated using the dose volume data extracted from 28 tangential field-based breast treatment planning datasets. The volume receiving ≥20 Gy (V20) for ipsilateral lung and the mean doses received by the heart and ipsilateral lung, were compared against the parameters extracted from Eclipse. The Wilcoxon signed-rank test revealed no significant difference between the majority of the radiomic features derived from PAHPhysRAD and 3D Slicer. The average mean lung and heart doses calculated in Eclipse were 5.51 ± 2.28 Gy and 1.64 ± 1.98 Gy, respectively. Similarly, the average mean lung and heart doses calculated in PAHPhysRAD were 5.45 ± 2.89 Gy and 1.67 ± 2.08 Gy, respectively. The MATLAB-based graphical user interface, PAHPhysRAD, offers a user-friendly platform for viewing and analyzing medical scans with options to extract radiomic features and dose-volume parameters. Its versatility, compatibility, and potential for further development make it an asset in medical image analysis.

Comprehensive airway management of ventilator-associated pneumonia in ICU populations.

To evaluate the validity of comprehensive airway management intervention on ventilator-associated pneumonia (VAP) in ICU patients requiring mechanical ventilation. In this retrospective observational study, the clinical data from 120 patients undergoing mechanical ventilation in the ICU of Hebei Chest Hospital from May 2020 to July 2022 were surveyed. Finally, 50 cases of VAP were identified and placed into an observation (n=25) and a control group (n=25) according to the nursing model they received. The control group was treated with routine nursing intervention, and the observation group was given comprehensive airway management intervention based on the control group. After 3 weeks of intervention, the clinical symptom recovery time, treatment-related indexes, nursing quality and nursing satisfaction score, and blood gas indexes and vital signs of the patients in the two groups were examined. The multivariate Logistic regression analysis was performed to identify the risk factors related to the death of critically ill patients. The observation group showed a significant reduction in the recovery time of heart failure, wheezing cough, and lung rales compared with that in the control group. The duration of mechanical ventilation, hospitalization, and antibiotic use in the observation group were appreciably shorter compared with those in the control group (all P<0.05). Additionally, nursing satisfaction and nursing quality scores were higher in the observation group compared to the control group (P<0.05). The contrast of blood gas indexes and vital signs between the two groups before ventilation and 1 hour after evacuation ventilation showed that a statistical significance existed in the interaction between groups (P<0.05). The risk factors related to the death of critically ill patients included D-dimer (OR=1.051, 95% CI: 1.006-1.08, P<0.05) and lactic acid (OR=0.894, 95% CI: 0.923-1.031, P<0.05). Comprehensive airway management mode can reduce the occurrence of VAP in ICU patients requiring mechanical ventilation.

PERIOPERATIVE OUTCOMES OF COMBINED HEART SURGERY AND LUNG TUMOR RESECTION : A SYSTEMATIC REVIEW

Background: Cancer and cardiovascular disease are the leading causes of death in both men and women worldwide. There are concerns regarding the potentially increased mortality and complication rates of simultaneous surgery and the adequacy of lung exposure during heart surgery. Methods: By comparing itself to the standards set by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of cthe requirements. So, the experts were able to make sure that the study was as up-to-date as it was possible to be. For this search approach, publications that came out between 2013 and 2023 were taken into account. Several different online reference sources, like Pubmed and SagePub, were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Result: In the PubMed database, the results of our search brought up 14 articles, whereas the results of our search on SagePub brought up 91 articles. The results of the search conducted for the last year of 2013 yielded a total 9 articles for PubMed and 23 articles for SagePub. In the end, we compiled a total of 5 papers, 4 of which came from PubMed and 1 of which came from SagePub. We included five research that met the criteria. Conclusion: In summary, combined heart surgery and lung tumor resection had a low mortality rate and an acceptable complication rate. Subgroup analyses revealed that most patients with lung cancer underwent uncompromised anatomical resection and mediastinal lymph node sampling or dissection during combined cardiothoracic surgery, and showed off-pump CABG may reduce the complication rate compared with on-pump CABG. Further researches are still needed to verify these findings.

Formation of Health Volunteer for Integrated Non-Communicable Diseases (Posbindu PTM) Services in Geblagan, Tamantiro, Kasihan, Bantul

Integrated Non-Communicable Disease Development Post (POSBINDU PTM) is an activity for monitoring and early detection of integrated PTM risk factors (heart disease, diabetes, lung disease, asthma, and cancer). The target of Posbindu PTM activities is 15-59 years (productive age) with the hope that if they are healthy at productive age, then they can become quality elderly. The problem faced by Indonesian people who are of productive age is that they do not know that they have hypertension or diabetes mellitus, because they are often asymptomatic early in the course of the disease. The service is carried out by identifying the Padukuhan Geblagan community who have the potential to become Posbindu PTM health volunteer. The selected health volunteers are then given training related to Posbindu PTM activities. This training begins with the provision of material related to Posbindu PTM, providing material related to the types of diseases that are included in non-communicable diseases, providing material related to how to identify non-communicable diseases, providing material related to the technical implementation of Posbindu PTM, demonstrating the implementation of Posbindu PTM and redemonstrating the implementation of Posbindu. The result of this activity is that Posbindu PTM health volunteer have been trained with a 5- table system with a total of 20 people. PTM Posbindu health volunteers who have received training can carry out Posbindu PTM activities properly. The health volunteers that were formed consisted of all levels of society, RT administrators, PKK administrators and community leaders. The Padukuhan Geblagan PTM Posbindu has been launched by the Tamantirto Village Government, witnessed by the Kasihan 1 Health Center staff and named the Posbindu PTM SEHAT (Sehat, Enerjik, Hidup, Aman, Tentram).

Examination of Air Quality of Dr. Sami Yağız Street in Niğde

Air pollution can be defined as the accumulation of gas, air, or particulate matter released as a result of fuel residues and chemical processes in the atmosphere in amounts that harm the lives of living things. Rapid urbanization, industrialization, increase in the number of motor vehicles, meteorological conditions, fuels used for heating, and the spread of industrial establishments and thermal power plants play an important role in the increase in air pollution. Air pollution is a major environmental problem affecting people in both developed and developing countries, and it is estimated that megacities in developing countries, and a quarter of the world's population are exposed to unhealthy concentrations of air pollutants. People living in cities with high outdoor air pollution are more likely to suffer from heart disease, respiratory problems, and lung cancer than those living in urban areas with clean air. In the industrialized western world, urban air pollution is in some respects in its final stages, with a dramatic decline in SO2 and soot levels. The increase in the number of private vehicles is a newly emerging problem. Rapid urbanization in most developing countries has so far led to uncontrolled growth and environmental degradation. Air pollution levels are still rising in many cities. In this study, air quality was tried to be measured along Dr. Sami Yağız Street, which is one of the most heavily used areas of Niğde. H2S, O2 and CO measurements were made at 25 points at equal intervals on both sides of the street. Measurements were made at a total of 4 different time periods per day. The obtained values were transferred to ArcGIS 10.3 software and maps were produced. Measurement of gases other than H2S is not distributed homogeneously along the street, and traffic density and the businesses on the sides of the street cause changes in the rates of the gases.

Risk of Sudden Cardiac Death in Patients Undergoing Cancer Treatment

The risk of sudden cardiac death (SCD) in patients with cancer receiving cancer therapies is not well defined. In this study we aimed to (1) evaluate the risk of SCD during the first 6 months of cancer treatment and (2) identify risk factors (RFs) for SCD in patients who underwent active cancer treatment. The study population comprised 8,356 patients who received any cancer treatment at the University of Rochester Medical Center from 2011 to 2020. The primary end point was the occurrence of SCD within 6 months of cancer treatment. SCD was defined by using the modified Hinkle-Thaler classification. The mean age at the time of cancer treatment was 64 ± 14 years and 49% were women. All-cause mortality occurred in 834 patients (10%), of whom 51 (6%) were identified as SCD. The cumulative probability of SCD at 6 months was 0.6%. Age <74 years (0.042), history of congestive heart failure (0.058) and lung cancer (0.004) were identified as independent RFs for SCD in the multivariate Cox regression models. The cumulative probability of SCD at 6 months from cancer treatment initiation was significantly higher in patients with ≥2 RFs (1.6%) than in patients with 0 or 1 RF (0.5%) (log-rank p <0.001). In conclusion, our findings suggest that active cancer treatment is associated with SCD risk that is more pronounced in younger patients (< 74 years), patients with cancer and a history of heart failure, and those who underwent treatment for lung cancer. Future studies should address appropriate modalities for prevention and protection in this high-risk population.

Management of Non-hospitalized patients with Acute SARS-CoV-2 (COVID-19) viral infection in among human adult population

The global corona virus disease outbreak, also known as the COVID-19 pandemic outbreak, caused a major health crisis around the world. The morbidity and mode of transmission of COVID-19 appear to be more severe and uncontrollable. The main pathophysiology of this deadly disease is respiratory failure and subsequent cardiovascular complications. From a pharmacological standpoint, several therapeutic strategies have been proposed for the development of safe and effective treatment against the SARS-CoV-2 virus, but no specific treatment regimen has been developed for this viral infection to date. The current review focuses on the role of herbs and herbs-derived secondary metabolites in inhibiting the SARS-CoV-2 virus as well as in the management of post-COVID-19 complications. This strategy will promote and protect the use of medicinal plant resources to support the healthcare system. Plant-derived phytochemicals have already been shown to prevent viral infection and to alleviate post-COVID complications such as parkinsonism, kidney and heart failure, liver and lung damage, and mental problems. We investigated mechanistic approaches of herbal medicines and their phytochemicals as antiviral and post-COVID complications by modulating immunological and inflammatory states in this review.

Breast Volume Is a Predictor of Higher Heart Dose in Whole-Breast Supine Free-Breathing Volumetric-Modulated Arc Therapy Planning.

In breast cancer volumetric-modulated arc therapy (VMAT) planning, the rotation of the gantry around the target implies a greater dose spreading to the whole heart, compared to tangential-field standard treatment. A consecutive cohort of 121 breast cancer patients treated with the VMAT technique was investigated. The correlation of breast volume, heart volume and lung volume with mean heart dose (mHD) and mean and maximum LAD dose (mLAD dose, MLAD dose) was tested, and a subsequent a linear regression analysis was carried out. VMAT treatment plans from 56 left breast cancer and 65 right breast cancer patients were analyzed. For right-sided patients, breast volume was significantly correlated with mHD, mLAD and MLAD dose, while for left-sided patients, breast volume was significantly correlated with mHD and mLAD, while heart volume and lung volume were correlated with mHD, mLAD and MLAD dose. Breast volume was the only predictor of increased heart and LAD dose (p ≤ 0.001) for right-sided patients. In left-sided patients, heart and lung were also predictors of increased mHD (p = 0.005, p ≤ 0.001) and mean LAD dose (p = 0.009, p ≤ 0.001). In this study, we observed an increase in heart and LAD doses in larger-breasted patients treated with VMAT planning. In right-sided patients, breast volume was shown to be the only predictor of increased heart dose and LAD dose.

Factores pronósticos en el trasplante cardiopulmonar: experiencia a 30 años en un centro de referencia

IntroductionHeart–lung transplantation has shown a progressive decrease in the number of procedures. There is a lack of information about this field in Spain. The main goal of this study is to analyze the experience of a national reference hospital. MethodsWe performed a retrospective study of a historical cohort of heart–lung transplanted patients in a single center, during a 30 years period (from 1990 to 2021). The associations between variables were evaluated using the χ2 test or Fisher's exact test. Survival was analyzed using the Kaplan–Meier method. Differences were evaluated using the log-rank test and multivariate analysis with the Cox method. ResultsA decrease in the number of procedures performed in the last decade was observed [2000–2009: 19 procedures (44.2%); 2010–2021: 15 procedures (34.8%)]. Early postoperative mortality was 23.3%, falling to 13.3% from 2010. In-hospital mortality was 41%, falling to 33% from 2010.Main factors related to higher mortality: previous thoracic surgery, corticosteroid therapy, extracorporeal circulation (ECLS) greater than 200 min, ischemia time greater than 300 min, and tracheal dehiscence (p < 0.005).Overall survival at one, five, and ten years was 58%, 44.7%, and 36.1%, respectively. Factors associated with lower survival rates: previous thoracic surgery, male donor, extracorporeal circulation greater than 200 min, ischemia time greater than 300 min, tracheal dehiscence and weight difference (p < 0.005). ConclusionsThere has been a progressive decrease in the number of heart–lung transplantations, being more evident in the last decade, but showing an improvement in both mortality and survival.

Study on indoor pollutants emission in Akure, Ondo State, Nigeria

PurposeThis study aimed to characterize the concentrations of indoor pollutants (such as carbon dioxide (CO2), ozone (O3), nitrogen dioxide (NO2) and sulfur dioxide (SO2), as well as particulate matter (PM) (PM1, PM2.5 and PM10) in Akure, Nigeria, as well as the relationship between the parameters’ concentrations.Design/methodology/approachThe evaluation, which lasted four months, used a low-cost air sensor that was positioned two meters above the ground. All sensor procedures were correctly carried out.FindingsCO2 (430.34 ppm), NO2 (93.31 ppb), O3 (19.94 ppb), SO2 (40.87 ppb), PM1 (29.31 µg/m3), PM2.5 (43.56 µg/m3), PM10 (50.70 µg/m3), temperature (32.4°C) and relative humidity (50.53%) were the average values obtained. The Pearson correlation depicted the relationships between the pollutants and weather factors. With the exception of April, which had significant SO2 (18%) and low PM10 (49%) contributions, NO2 and PM10 were the most common pollutants in all of the months. The mean air quality index (AQI) for NO2 indicated that the AQI was “moderate” (51–100). In contrast to SO2, whose AQI ranged from “moderate” to “very unhealthy,” O3's AQI ranged from “good” (50) to “unhealthy” (151–200). Since PM1, PM2.5 and PM10 made up the majority of PC1’s contribution, both PM2.5 and PM10 were deemed “hazardous.”Practical implicationsThe practical implication of indoor air pollution is long-term health effects, including heart disease, lung cancer and respiratory diseases such as emphysema. Indoor air pollution can also cause long-term damage to people’s nerves, brain, kidneys, liver and other organs.Originality/valueLack of literature in terms of indoor air quality (IAQ) in Akure, Ondo State. With this work, the information obtained will assist all stakeholders in policy formulation and implementation. Again, the low-cost sensor used is new to this part of the world.

Comparing breath hold versus free breathing irradiation for left-sided breast radiotherapy by PlanIQ™

BackgroundBreast cancer is the most widespread cancer in women and young women worldwide. Moving towards customised radiotherapy, balancing the use of the available technology with the best treatment modality may not be an easy task in the daily routine. This study aims to evaluate the effectiveness of introducing IQ-feasibility into clinical practice to support the decision of free-breathing (FB) versus breath-hold (BH) left-sided breast irradiations, in order to optimise the technology available and the effectiveness of the treatment.MethodsThirty-five patients who received 3D radiotherapy treatment of the left breast in deep-inspiration BH were included in this retrospective study. Computed tomography scans in FB and BH were acquired for each patient; targets contoured in both imaging datasets by an experienced radiation oncologist, and organs at risk delineated using automatic segmentation software were exported to PlanIQ™ (Sun Nuclear Corp.) to generate feasibility dose volume histogram (FDVHs). The dosimetric parameter of BH versus FB FDVH, and BH clinical dataset versus BH FDVH were compared.ResultsA total of 30 patients out of 35 patients analysed, presented for the BH treatments a significant reduction (p < 0.05) in the heart mean dose (Dm\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${{\ ext{D}}}_{{\ ext{m}}}$$\\end{document}), volume receiving 5 Gy (V5Gy\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${{\ ext{V}}}_{5{\ ext{Gy}}}$$\\end{document}) and 20 Gy (V20Gy\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${{\ ext{V}}}_{20{\ ext{Gy}}}$$\\end{document}), of 35.7%, 54.5%, and 2.1%, respectively; for the left lung, a lower reduction was registered and significant only for V5Gy\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${{\ ext{V}}}_{5{\ ext{Gy}}}$$\\end{document} (21.4%, p = 0.046). For the remaining five patients, the FDVH cut-off points of heart and lung were superimposable with differences of less than 1%. Heart and left lung dosimetric parameters of the BH clinical plans are located in the difficult zone of the FDVH and differ significantly (p < 0.05) from the corresponding parameters of the FDVH curves delimiting this buffer area between the impossible and feasible zones, respectively.ConclusionThe use of PlanIQTM as a decision-support tool for the FB versus BH treatment delivery modality allows customisation of the treatment technique using the most appropriate technology for each patient enabling accurate management of available technologies.