Breath Levels Research Articles

Abstract 3319: Breath-based detection of lung cancer using exogenous volatile organic compound targeting β-glucuronidase in the tumor microenvironment

Abstract Introduction: Numerous studies have sought potential breath biomarkers for lung cancer and many have promising results but, to date, no validated biomarkers with clear connections to cancer metabolism have been discovered. We aim to show the feasibility of an Exogenous Volatile Organic Compounds (EVOC®) Probe targeting tumor-associated extracellular β-glucuronidase, a glycosidase enzyme that usually resides intracellularly within lysosomes in healthy tissues. Material and Methods: To further assess the suitability of β-glucuronidase as a target for a non-invasive breath test, the enzyme activity was evaluated by enzymatic assay in lung cancer PDX specimens and healthy tissues. In addition, β-glucuronidase was assessed by immunostaining a large panel of primary lung cancers, lymph node metastasis and normal lung tissue, including from smokers and those with chronic obstructive pulmonary disease (COPD). We developed a hydrophilic non-cell permeable substrate probe, D5-ethyl-βD-glucuronide (D5-EtGlu), that upon hydrolysis by the target enzyme releases D5-ethanol, a unique volatile reporter molecule. This provides a readout of tumour-associated enzyme activity using breath analysis. Administering D5-EtGlu to mice resulted in tumour-specific release of D5-Ethanol enabling discrimination between healthy and tumour-bearing animals. D5-EtGlu has been administered intravenously to healthy and lung cancer patients followed by breath analysis. A phase 1a clinical trial administered D5-EtGlu to 21 healthy individuals in a single ascending dose study to establish safety and background D5-ethanol levels in healthy individuals. The phase 1b trial is a proof of mechanism study in humans, in which D5-ethanol breath levels in lung cancer patients will be compared to cancer-free individuals receiving the same D5-EtGlu dose. Results and Discussions: Using ex-vivo specimens, higher β-glucuronidase activity was detected in washouts of PDX specimens compared with healthy tissue samples from mice. Higher β-glucuronidase intracellular and extracellular expression was observed in lung cancers compared with lung normal tissue, with low to moderate expression intracellularly in bronchial tissue and in emphysema and COPD. These results reinforce the presence of β-glucuronidase in the tumour microenvironment and its suitability as a target for a breath-probe. A phase 1a resulted in no adverse events and low/no D5-ethanol signal verifying the inaccessibility of D5-EtGlu to intracellular β-glucuronidase. In the phase 1b study, using the highest probe dose, we have detected a D5-ethanol signal in the majority of the cancer patients. Conclusion: β-glucuronidase can be targeted by the non-cell permeable substrate probe D5-ethyl-βD-glucuronide (D5-EtGlu) with potential to be used as a non-invasive breath test for lung cancer diagnosis including a role in screening. Citation Format: Christiaan Labuschagne, Rob Smith, Neelam Kumar, Max Allsworth, Billy Boyle, Sam Janes, Philip Crosbie, Robert Rintoul. Breath-based detection of lung cancer using exogenous volatile organic compound targeting β-glucuronidase in the tumor microenvironment [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3319.

Evaluation of halitosis in patients with chronic obstructive pulmonary disease, chronic renal failure, and peptic ulcer

Background: Oral breath can be used as a chairside investigation method in the detection of volatile sulfur compounds (VSCs), which can serve as a potential biomarker in the early detection of underlying systemic diseases. Aim: The primary aim was to study the hydrogen sulfide levels in oral breath of patients with chronic obstructive pulmonary disease (COPD), chronic renal failure (CRF), and peptic ulcer disease. Materials and Methods: The study included 100 patients divided into four groups with 25 patients in each group of CRF, COPD, peptic ulcer, and control. The oral breath sample collected from each participant was passed through a sensor in the hydrogen sulfide detector (Tanita, Japan), which registers the level of sulfides. The maximum level attained was determined in parts per billion sulfide equivalents using direct readings from the monitor's digital display. The values obtained were statistically analyzed using statistical tests: Shapiro–Wilk test, analysis of variance, and post hoc analysis. Results: The mean values for the age and hydrogen sulfide scores were as follows: control group (35.16 ± 14.12 and 0.44 ± 1.00), CRF (49.16 ± 13.93 and 2.32 ± 0.98), COPD (48.16 ± 15.58 and 2.40 ± 0.95), and the peptic ulcer (42.36 ± 15.44 and 1.68 ± 1.02). The post hoc analysis for intergroup comparison of mean values reveals that statistically significant (P = 0.001*) differences exist between the control group and the CRF group, the control group and the COPD group, and the control group and the peptic ulcer group. Conclusion: The CRF group had slightly higher hydrogen sulfide measurements among the four groups, indicating the release of more VSCs.

Comparison of optimization parametrizations for regional lung compliance estimation using personalized pulmonary poromechanical modeling.

Interstitial lung diseases, such as idiopathic pulmonary fibrosis (IPF) or post-COVID-19 pulmonary fibrosis, are progressive and severe diseases characterized by an irreversible scarring of interstitial tissues that affects lung function. Despite many efforts, these diseases remain poorly understood and poorly treated. In this paper, we propose an automated method for the estimation of personalized regional lung compliances based on a poromechanical model of the lung. The model is personalized by integrating routine clinical imaging data - namely computed tomography images taken at two breathing levels in order to reproduce the breathing kinematic-notably through an inverse problem with fully personalized boundary conditions that is solved to estimate patient-specific regional lung compliances. A new parametrization of the inverse problem is introduced in this paper, based on the combined estimation of a personalized breathing pressure in addition to material parameters, improving the robustness and consistency of estimation results. The method is applied to three IPF patients and one post-COVID-19 patient. This personalized model could help better understand the role of mechanics in pulmonary remodeling due to fibrosis; moreover, patient-specific regional lung compliances could be used as an objective and quantitative biomarker for improved diagnosis and treatment follow up for various interstitial lung diseases.

Combination of Mechanical Ventilation and Ceiling Fin to Reduce Airborne Infection Risk

This study evaluated the effects of various combinations of ventilation system and ceiling fin implementations for the prevention of airborne infections. The computational fluid dynamics program, STAR-CCM+, was used to analyze the airborne infection risk. The results indicate that implementation of ceiling fins with conventional mechanical ventilation and with exhaust diffuser at the center of the room reduced airborne infection risk. However, other cases with implementation of ceiling fins showed an increased risk at the breathing level (1.0 m height from the bottom). It is concluded that the application of ceiling fins can be both advantageous and disadvantageous depending on the types of combinations and all aspects should be carefully considered before implementation.

Reproducibility and stability of spirometer-guided deep inspiration breath-hold in left-breast treatments using an optical surface monitoring system.

The aim of this study was to evaluate the reproducibility and stability of left breast positioning during spirometer-guided deep-inspiration breath-hold (DIBH) radiotherapy using an optical surface imaging system (AlignRT). The AlignRT optical tracking system was used to monitor five left-sided breast cancer patients treated using the Active Breathing Coordinator spirometer with DIBH technique. Treatment plans were created using an automated hybrid-VMAT technique on DIBH CTs. A prescribed dose of 60Gy to the tumor bed and 50Gy to the breast in 25 fractions was planned. During each treatment session, the antero-posterior (VRT), superior-inferior (LNG), and lateral (LAT) motion of patients was continuously recorded by AlignRT. The intra-breath-hold stability and the intra- and inter-fraction reproducibility were analyzed for all breath-holds and treatment fractions. The dosimetric impact of the residual motion during DIBH was evaluated from the isocenter shifts amplitudes obtained from the 50%, 90%, and 100% cumulative distribution functions of intra-fractional reproducibility. The positional variations of 590 breath-holds as measured by AlignRT were evaluated. The mean intra-breath-hold stability during DIBH was 1.0±0.4mm, 2.1±1.9mm, and 0.7±0.5mm in the VRT, LNG, and LAT directions, with a maximal value of 8.8mm in LNG direction. Similarly, the mean intra-breath-hold reproducibility was 1.4±0.8mm, 1.7±1.0mm, and 0.8±0.5mm in the VRT, LNG, and LAT directions, with a maximal value of 4.1mm in LNG direction. Inter-fractional reproducibility showed better reliability, with difference in breathing levels in all fractions of 0.3mm on average. Based on tolerance limits corresponding to the 90% cumulative distribution level, gating window widths of 1mm, 2mm, and 5mm in the LAT, VRT, and LNG directions were considered an appropriate choice. In conclusion, despite the use of a dedicated spirometer at constant tidal volume, a non-negligible variability of the breast surface position has been reported during breath-holds. The real-time monitoring of breast surface using surface-guided optical technology is strongly recommended.

Impact of smoking on oral cavity by comparing carbon monoxide and carboxyhemoglobin levels with salivary pH in smokers of Salem district

Objective: Saliva is the first biological fluid exposed to the smoke and other contents of the cigar, which can cause structural and functional changes in saliva. Salivary pH is an important biomarker for detecting oral diseases. Cigarette smoke contains many toxic gases, of which, carbon monoxide (CO), plays a deleterious role in causing systemic illness in a person. As a result, a measure of exhaled CO (eCO), similar to exhaled Nitric Oxide, has been evaluated as a potential breath biomarker to detect smoking status and validate smoking cessation to prevent other systemic defects caused by smoking. The present study would investigate the effect of CO and carboxyhemoglobin (HbCO%) on the pH of the oral cavity of individuals with smoked tobacco habit. Materials and Methods: For this study, 60 male patients aged 18–55 years with smoking habit of a minimum of two cigarettes or beedis per day for a minimum period of one year reporting to the Department of Oral Medicine and Radiology were divided based on their smoking habit and type of smoked tobacco into two groups with each group consisting of 30 participants. To determine the eCO levels and HbCO% levels, a breath analyzer (piCOTM Smokerlyzer®) was used. Patients were asked to hold their breath for 15 s, place their lips tightly around the mouthpiece of the breath analyzer, and gently exhale through the mouthpiece as long as possible. CO levels in exhaled breath (eCO) in parts per million and HbCO% in the percentage of red blood cells carrying CO (HbCO%) were displayed on the display monitor. A digital pH meter was used to calculate the salivary pH from unstimulated saliva samples. The salivary pH readings, along with the eCO and HbCO%, were recorded in the tabular column for each patient. Results: In the present study, the cigarette smokers had a higher mean value of eCO levels. Similarly, cigarette smokers had higher mean HbCo% levels than beedi smokers. It was also observed that salivary pH of smokers was found to be altered when compared to non-smokers. Conclusion: The current study found that the level of CO in exhaled breath correlates with the HbCO% present in the blood, alerting tobacco users to the hidden fatality and therefore serving as an indicator in tobacco cessation programs to raise awareness of the effects of smoking on oral health. Furthermore, along with CO levels the pH of saliva was altered, demonstrating the dangers of tobacco and its products.

Review of Petri Berndtson, Phenomenological Ontology of Breathing

Petri Berndtson’s Phenomenological Ontology of Breathing points to the largely unexplored dimension of our being breathing beings. Berndtson draws upon the ontology of the flesh, as well as several comments of Merleau-Ponty about breathing and Being. The primordial perceptual faith in the being of the world as a field of all fields (the “barbaric conviction”) is seen as a primordial sense of breathing in the world (“respiratory faith”). Drawing upon Merleau-Ponty’s reference to Claudel’s call to listen to the ear of Sigé, the Abyss, Berndtson relates silence in the encounter with Being to an encounter with silence of breath and its abyssal or chasmological (“yawning”) quality. He asserts that this level of breathing is a level of being-in-the-world deeper than the primacy of perception. At this point, the review questions the author’s assertion that this dimension is more primordial than perception, that Merleau-Ponty has a positivistic framing of perception, the author’s literal sense of silence and the lack of appreciation of the power of the poetic in flesh ontology, the role of reversibility and the import of the invisible of the visible. Rather than the ontological primacy of breath, the review suggests that breathing is a way of taking in the world and being open to an aerial dimension of inchoate sense that is equiprimordial with the other avenues of perceiving the world.

РАЗВИТИЕ РЕЧЕВОГО ДЫХАНИЯ В КОРРЕКЦИИ ДЕФЕКТОВ ЗВУКОПРОИЗНОШЕНИЯ У СТАРШИХ ДОШКОЛЬНИКОВ С ДИЗАРТРИЕЙ

Introduction: The relevance of our research lies in the search for effective ways of speech therapy through the development of speech breathing in the correction of sound reproduction disorders in preschoolers with dysarthria. There are disagreements in science and practice since the theory recognizes the fundamental importance of speech breathing development in correction of the sound productions defect; whereas speech therapists barely use the corrective possibilities of speech breathing in their practice due to the lack of clearly prescribed consistent recommendations of speech therapy working on the production of speech sounds. The article aims to identify the problems of speech breathing development in the correction of sound reproduction in children with dysarthria, to analyze the state of speech breathing skills important for pronouncing phonemes in 5-6 year-old children with dysarthria, to offer consistent recommendations for speech therapy correction of the defects in working on the production of speech sounds. Materials and methods: The following research methods were used: theoretical, anamnestic consisting in the study of the documentation of preschool educational institution, diagnostic method (diagnosis of speech breathing of senior preschoolers with dysarthria) with screening (study of the speech therapy status of senior preschoolers with dysarthria); methods of quantitative and qualitative processing of the results. Results: We studied the medical records of the preschool educational institution for each child and the speech records of the therapist in order to obtain detailed data on the severity of dysarthria, as well as the intellectual and neurological status, hearing condition of the test subjects in the sample. In order to determine the psychorechological status, the speech therapist reports were later correlated with the speech therapy screening and medical records data. We conducted a study of the state of speech breathing in children with moderate dysarthria and with minimal dysarthric disorders. It was found that in cases of moderate dysarthria, the condition of speech breathing and sound production suffers to a greater extent than in cases of minimal dysarthric disorders. It was revealed that children with dysarthria have the state of speech breathing that correlates with the state of sound reproduction: the more pronunciation defects the child has, the lower the level of speech breathing. Detailed consistent recommendations of correctional work on the development of speech breathing in preschoolers with dysarthria, depending on which speech sound is corrected, are presented.

Effects of single rinse with three different types of mouthwashes on VSCs levels in morning breath: Randomized, double-blind, crossover clinical trial.

Morning breath is a temporary and unpleasant malodour sourced from the mouth, which occurs upon awakening. This double-blind, crossover, randomized clinical trial aimed to evaluate the bad-breath suppression of three commercially available mouthwashes: Mentadent Professional® Chlorhexidine 0.05% with vitamin C (ChxC), Meridol Alito Sicuro® (SnF2 ) and CB12® (ZnChx) compared to a placebo (PbO) on morning halitosis. Thirty-two subjects refraining from oral hygiene practices for 12h before the evaluation, performed a 30-s rinse with 15 ml of mouthwash, followed by a 5-s gargle, in the evening before bedtime. In order to assess morning halitosis, visual inspection (Winkel Tongue Coating Index), organoleptic (Rosenberg index) and chromatographic measurements were used. Gas chromatography was carried out by means of a dedicated device, the Oral Chroma. The recorded measurements have to be considered solely after the rinse since no data about the pre-exposure were available. A washout period of 1 week passed between one administration and the next. The mean value of the organoleptic indices after administration of ChxC mouthwash is similar to ZnChx, SnF2 and PbO values. Thus, no statistically significant differences were recorded among the mouthwashes and PbO. Nevertheless, ChxC seems to be more efficient in comparison with the PbO regarding VSCs levels analysed with Oral Chroma, (CH3 SH; p=0.0081) and [(CH3 )2 S; p=0.0003]. Considering our limited sample, instrumental examination demonstrated that the use of the analysed mouthwashes can result in low VSCs levels after 12h from a single rinse. Furthermore, the highest number of patients (n=14) were proved to be free from bad smell after using a single administration of ChxC with respect to the other commercial products. The other tested mouthwashes did not show better performances with respect to the placebo after a single rinse.

Sleep disordered breathing and haemoglobin A1c levels within or over normal range and ageing or sex differences: the Nagahama study.

Recently an association between blood glucose dysregulation and sleep disruption was suggested. The association between sleep disordered breathing, most of which is due to obstructive sleep apnea (OSA) in the general population, and diabetic severity, as well as the impact of antidiabetic treatment, remains unclear. This study aimed to investigate these associations as well as age and sex differences. This cross-sectional study evaluated 7,680 community participants as the main cohort (population-based cohort). OSA was assessed by the 3% oxygen desaturation index from pulse oximetry, which was corrected for sleep duration obtained by wrist actigraphy. For arguing the limitations for using pulse oximetry, 597 hospitalised patients, who were assessed by the apnea-hypopnea index from attended polysomnography, were also evaluated as the validation cohort (hospital-based cohort). Moderate-to-severe OSA was more prevalent as haemoglobin A1c (HbA1c) levels increased (<5.6%/5.6%-<6.5%/6.5%-<7.5%/≥7.5%, respectively) in both cohorts (p < 0.001), but only in those without antidiabetic treatment. The HbA1c level was an independent factor for moderate-to-severe OSA (population-based cohort, odds ratio [OR] 1.26, 95% confidence interval [CI] 1.10-1.45; hospital-based cohort, OR 1.69, 95% CI 1.22-2.33, per 1% increase). These associations were more prominent in the middle-aged (aged <60 years) than in the elderly (aged ≥60 years) and in women than in men in both cohorts. The prevalence of moderate-to-severe OSA in patients with antidiabetic treatment in the hospital-based cohort was ≥75% regardless of HbA1c levels. In conclusion, an association between the prevalence of OSA and HbA1c level even within or over the normal range was found only in patients without antidiabetic treatment and was more prominent in the middle-aged and in women.

RESET-PKD: a pilot trial on short-term ketogenic interventions in autosomal dominant polycystic kidney disease.

Ketogenic dietary interventions (KDI) have been shown to be effective in animal models of polycystic kidney disease (PKD), but data from clinical trials are lacking. Ten autosomal dominant PKD (ADPKD) patients with rapid disease progression were enrolled at visit V1 and initially maintained a carbohydrate-rich diet. At V2, patients entered one of the two KDI arms: a 3-day water fast (WF) or a 14-day ketogenic diet (KD). At V3, they resumed their normal diet for 3-6 weeks until V4. At each visit, magnetic resonance imaging kidney and liver volumetry was performed. Ketone bodies were evaluated to assess metabolic efficacy and questionnaires were used to determine feasibility. All participants [KD n=5, WF n=5; age 39.8±11.6 years; estimated glomerular filtration rate 82±23.5mL/min/1.73 m2; total kidney volume (TKV) 2224 ± 1156mL] were classified as Mayo Class 1C-1E. Acetone levels in breath and beta-hydroxybutyrate (BHB) blood levels increased in both study arms (V1 to V2 average acetone: 2.7±1.2p.p.m., V2 to V3: 22.8±11.9p.p.m., P=.0006; V1 to V2 average BHB: 0.22±0.08mmol/L, V2 to V3: 1.88±0.93mmol/L, P=.0008). Nine of 10 patients reached a ketogenic state and 9/10 evaluated KDIs as feasible. TKV did not change during this trial. However, we found a significant impact on total liver volume (ΔTLV V2 to V3: -7.7%, P=.01), mediated by changes in its non-cystic fraction. RESET-PKD demonstrates that short-term KDIs potently induce ketogenesis and are feasible for ADPKD patients in daily life. While TLV quickly changed upon the onset of ketogenesis, changes in TKV may require longer-term interventions.

The effect of proportional assist ventilation on the electrical activity of the human diaphragm during exercise.

What is the central question of this study? What is the effect of lowering the normally occurring work of breathing on the electrical activity and pressure generated by the diaphragm during submaximal exercise in healthy humans? What is the main finding and its importance? Ventilatory assist during exercise elicits a proportional lowering of both the work performed by the diaphragm and diaphragm electrical activity. These findings have implications for exercise training studies using proportional assist ventilation to reduce diaphragm work in patients with cardiopulmonary disease. We hypothesized that when a proportional assist ventilator (PAV) is applied in order to reduce the pressure generated by the diaphragm, there would be a corresponding reduction in electrical activity of the diaphragm. Healthy participants (five male and four female) completed an incremental cycle exercise test to exhaustion in order to calculate workloads for subsequent trials. On the experimental day, participants performed submaximal cycling, and three levels of assisted ventilation were applied (low, medium and high). Ventilatory parameters, pulmonary pressures and EMG of the diaphragm (EMGdi ) were obtained. To compare the PAV conditions with spontaneous breathing intervals, ANOVA procedures were used, and significant effects were evaluated with a Tukey-Kramer test. Significance was set at P<0.05. The work of breathing was not different between the lowest level of unloading and spontaneous breathing (P=0.151) but was significantly lower during medium (25%, P=0.02) and high (36%, P<0.001) levels of PAV. The pressure-time product of the diaphragm (PTPdi ) was lower across PAV unloading conditions (P<0.05). The EMGdi was significantly lower in medium and high PAV conditions (P=0.035 and P<0.001, respectively). The mean reductions of EMGdi with PAV unloading were 14, 22 and 39%, respectively. The change in EMGdi for a given lowering of PTPdi with the PAV was significantly correlated (r=0.61, P=0.01). Ventilatory assist during exercise elicits a reduction in the electrical activity of the diaphragm, and there is a proportional lowering of the work of breathing. Our findings have implications for exercise training studies using assisted ventilation to reduce diaphragm work in patients with cardiopulmonary disease.

Robustness Evaluation for Proton Therapy with a Spirometry Based Deep Inhalation Breath Hold System

<h3>Purpose/Objective(s)</h3> Deep inhalation breath hold (DIBH) treatment allows for greater sparing of healthy tissue by minimizing target motion due to respiration. However, the breath hold level achieved during simulation and throughout treatment is not perfectly reproducible. DIBH techniques such as spirometry define an allowed variation in the nominal breath hold level to facilitate treatment. This variation represents an uncertainty which must be incorporated into the robust evaluation which is essential in proton therapy treatment planning. The aim of this study is to evaluate the dosimetric impact of this uncertainty for DIBH patients treated with proton therapy using a spirometry system with visual feedback and to determine the ideal clinical workflow to ensure robustness. <h3>Materials/Methods</h3> A dedicated workflow involving simulation, treatment planning and quality assurance was developed and implemented in our clinic to assess the potential dosimetric impact of this uncertainty. The workflow involved a multi-scan simulation procedure in which patients were simulated under their nominal breath hold level and two additional breath hold levels at ± 100 mL tidal lung volume with respect to the nominal. This variation was chosen as it represents twice the allowed variation during treatment in order to be conservative. The additional scans were used to assess motion near the target and to determine the best techniques to be used during plan optimization to ensure robustness. In particular a 5 mm motion threshold was used by physics to recommend the use of simultaneous optimization across all three image sets. The final treatment plan was forward calculated on the additional image sets to guarantee robustness. Patient data, including on-treatment imaging and verification CT scans (QA-CT), were analyzed to assess plan robustness for 30 patients treated under this workflow over two years. <h3>Results</h3> Out of 30 DIBH patients treated under this workflow the simultaneous optimization tool was recommended in three cases but ultimately not utilized in planning at MD/dosimetry discretion balancing dose to OARs and robustness. All thirty patients passed the robust evaluation procedure and there were no cases for which QA-CT indicated a need to revise a treatment plan due to a variation in the breath hold level. <h3>Conclusion</h3> Our initial experience indicates that in proton therapy utilizing spirometry based DIBH with visual feedback the uncertainty associated with the variation in breath hold level does not have a significant dosimetric impact on plan robustness. Given these results, the decision was made to reduce the workload and simplify the workflow by eliminating the additional scans and utilizing a single breath hold level during simulation.

Altered gut microbiota in patients with small intestinal bacterial overgrowth.

Small intestinal bacterial overgrowth (SIBO) is diagnosed by using quantitative culture of duodenal aspirates and/or a hydrogen breath test. However, few studies have analyzed bacterial microbiota in Japanese patients with SIBO. Twenty-four patients with any abdominal symptoms and suspected SIBO were enrolled. Quantitative culture of duodenal aspirates and a glucose hydrogen breath test were performed on the same day. SIBO was diagnosed based on a bacterial count≥103 CFU/mL or a rise in the hydrogen breath level of ≥20ppm. The composition of the duodenal microbiota was analyzed by 16S rRNA gene sequencing. Small intestinal bacterial overgrowth was diagnosed in 17 of the 24 patients (71%). The positive rates for the hydrogen breath test and quantitative culture of duodenal aspirates were 50% and 62%, respectively. Patients with SIBO showed significantly reduced α-diversity compared with non-SIBO patients, and analysis of β-diversity revealed significantly different distributions between SIBO and non-SIBO patients. In addition, the intestinal microbiome in SIBO patients was characterized by increased relative abundance of Streptococcus and decreased relative abundance of Bacteroides compared with non-SIBO patients. Duodenal dysbiosis was identified in patients with SIBO and may play a role in the pathophysiology of SIBO.

Smart mattress integrated with pressure sensor and IoT functions for sleep apnea detection

Obstructive Sleep Apnea (OSA) is the main reason for sleep-associated respiration disorders, wherein respiration stops and begins evolved again and again at some pointing sleep. Sleep-disordered respiration can affect our common health protection and quality of life. This look targets at detecting sleep posture and sleep-disordered respiration through measuring the sensory reaction of a pressure sensor and respiration microphone sensor set up with mattresses, pillowcases, and positional sleep apnea. Three positions use of pressure sensors were used to analyze. The respiration microphone sensor is used for the duration of sleep and to measure breathing levels. In this work, we have got an advanced sleep monitoring system based on an inattentive method. Internet of Things (IoT) is used to transmit information saved in sensors and displayed in internet applications. Helps us without problems displaying gold coins and gold time periods.

Simple algorithm to narrow down the candidates to receive echocardiography in patients with chronic liver disease for suspected pulmonary hypertension.

Portopulmonary hypertension (PoPH) is a subtype of pulmonary arterial hypertension related to portal hypertension. The definitive diagnosis of PoPH is made by invasive right heart catheterization. Alternatively, pulmonary arterial hypertension may be recognized noninvasively from the tricuspid regurgitant pressure gradient (TRPG), measured by echocardiography. In this study, we aimed to establish a simple algorithm to identify chronic liver disease patients with a high TRPG value in order to narrow down the candidates to receive echocardiography. TRPG was measured by echocardiography in 152 patients with chronic liver disease. Factors predictive of TRPG >30 mmHg were investigated. There were 28 (18%) cases with TRPG >30 mmHg. Independent factors associated with a high TRPG were the presence of shortness of breath, high serum brain natriuretic peptide (BNP), and low serum albumin. Child-Pugh class or the presence of ascites, varices, or encephalopathy was not associated with TRPG. There was a correlation between the serum BNP and TRPG, and the optimal cutoff value of BNP by the Youden index was 122 pg/mL, and by 100% sensitivity was 50 pg/mL. A combination of these factors identified patients with a high probability of TRPG >30 mmHg (n=12, positive predictive value [PPV] of 83%), no probability (n=80, PPV 0%), and intermediate probability (n=60, PPV 25-34%). This algorithm has reduced the number of patients needing echocardiography by 53%. A simple algorithm using the presence of shortness of breath, serum BNP, and albumin levels can narrow down the candidates to receive echocardiography.

Stratified micro-environments using a sidewall air supply: An experimental and simulation study

The idea of providing stratified micro-environments in a shared environment by utilizing a sidewall air supply is proposed, to provide different thermal comfort and air quality levels to satisfy individual needs at different occupied positions. Experimental cases with various supply air parameters and room layouts are conducted in a mock consultation room consisting of two face-to-face occupants. Further, parametric studies using computational fluid dynamics (CFD) are performed. Overall thermal sensation and local thermal comfort are both evaluated. Tracer gas (i.e., CO2) concentration distributions are investigated experimentally, while the air age is used as an indicator in CFD simulations. The results show that the proposed strategy simultaneously provides displacement ventilation (DV) and stratum ventilation (SV) in a shared environment, satisfying individual preferences and needs. The demarcation thermal length of the supply air jet between DV and SV is around 0.8 m. The normalized contaminant concentration at the breathing level is 0.00–0.30 with both table and floor contaminant sources. Better air quality is achieved in the area served by a higher thermal length. The local discomfort and “lock-up” effect under DV is reduced, by the interaction between the supply air jets, which is validated, as the partition impeding the interaction brings a significant influence. Short jet spacing of 0.75 m implies that multiple stratified micro-environments can be provided in a medium room, while a medium distance between the occupant and the supply air terminal (i.e., 1.7 m) is the most efficient in cooling and renewing the air age.

Computational modeling method to estimate secondhand exposure potential from exhalations during e-vapor product use under various real-world scenarios

Potential secondhand exposure of exhaled constituents from e-vapor product (EVP) use is a public health concern. We present a computational modeling method to predict air levels of exhaled constituents from EVP use. We measured select constituent levels in exhaled breath from adult e-vapor product users, then used a validated computational model to predict constituent levels under three scenarios (car, office, and restaurant) to estimate likely secondhand exposure to non-users. The model was based on physical/thermodynamic interactions between air, vapor, and particulate phase of the aerosol. Input variables included space setting, ventilation rate, total aerosol amount exhaled, and aerosol composition. Exhaled breath samples were analyzed after the use of four different e-liquids in a cartridge-based EVP. Nicotine, propylene glycol, glycerin, menthol, formaldehyde, acetaldehyde, and acrolein levels were measured and reported based on a linear mixed model for analysis of covariance. The ranges of nicotine, propylene glycol, glycerin, and formaldehyde in exhaled breath were 89.44–195.70 µg, 1199.7–3354.5 µg, 5366.8–6484.7 µg, and 0.25–0.34 µg, respectively. Acetaldehyde and acrolein were below detectable limits; thus, no estimated exposure to non-EVP users is reported. The model predicted that nicotine and formaldehyde exposure to non-users was substantially lower during EVPs use compared to cigarettes. The model also predicted that exposure to propylene glycol, glycerin, nicotine and formaldehyde among non-users was below permissible exposure limits.

Health risk assessment using chemical signatures of fine and coarse particles collected at breathing level height during firework display in New Delhi, India

Sporadic emissions of fine (PM2.5) and coarse (PM2.5-10) particles at breathing level height (BLH) during Diwali, before Diwali and after Diwali (DD, BD and AD) in fireworks ban and no-ban years (2017 and 2018) were studied for water-soluble inorganic ions (WSII), organic and elemental carbon (OC and EC), metals and health risk. Average PM2.5 level at BLH exceeded Air Quality Standard (60 µgm−3) by 7.6, 3.7 and 3.2 times during BD, DD and AD, respectively, in 2017 while impulsive increase was observed in 2018 during DD (26 times) followed by AD and BD (5.2 and 4.7 times). Al, K, Sr, Ba, NO3 -, OC, Cl- in PM2.5 showed sudden increase during DD compared to BD and AD in non-Ban year (2018) and can be considered as markers of firework display. OC was more than EC in PM2.5 and was highest during BD and AD, as compare to DD. Dry deposition of emissions and re-suspension of residual ash/unburnt mass could be a reason for poor air quality at BLH. High Hazardous Index (HI) values in both size particles indicated that children were more vulnerable to exposure and were at high risk compared to adults. Cr followed by Cd and Ni in particles posed carcinogenic risk to children and adults. More such studies shall be conducted at BLH to improve human health risk assessment due to PM2.5 exposure.

Correlation of serum HDL level with HRV indices using multiple linear regression analysis in patients with type 2 diabetes mellitus

Aims/objectivesTo determine the correlation between serum HDL levels with HRV indices in patients with T2DM. Materials and methodsThe study included 120 type 2 DM patients aged 35–65 years of either sex by simple random sampling. One-minute HRV was analyzed during deep breathing and fasting serum HDL levels was estimated in all patients. Data were analyzed using SPSS 20.0. Karl Pearson's correlation coefficient for relationship and Multiple linear regression analysis was applied for assessment of the influence of independent variables (HRV Indices) on a dependent variable (serum HDL levels). P < 0.05 was considered statistically significant. ResultsSignificant negative correlation was observed between serum HDL levels with Mean HR (r = 0.7422, p < 0.001)), LFnu (r = −0.6172, p < 0.001) and ratio of LF/HF (r = 0.5333, p < 0.001). But significant positive correlation was observed between serum HDL levels with HFnu (r = 0.6438, p < 0.001), SDNN, (r = 0.7495, p < 0.001)), RMSSD (r = 0.6348, p < 0.001) and pNN50 % (r = 0.8187, p < 0.001). ConclusionsOur findings suggest that HDL-C level and all other HRV indices are dependent on each other in patients with T2DM. Most of these patients with low HDL-C level might be associated with autonomic imbalance; this in turn is detected by a simple bedside test of 1-minute HRV during deep breathing.