Lower Breath Research Articles

Bronchobiliary fistula after traumatic liver rupture: a case report

IntroductionBronchobiliary fistulas are rare and difficult to treat. Peacock first reported this entity in 1850 while treating a patient with hepatic encopresis.Case presentationA 67-year-old Chinese male patient presented to the outpatient clinic with a complaint of coughing up phlegm with chest tightness for 4 days with symptoms of intermittent bilirubin sputum with a sputum volume of about 500 ml per day but no symptoms of abdominal pain or jaundice and no yellow urine or steatorrhea. The examination revealed cyanosis of the lips and mouth, barrel chest, low breath sounds on the right side, and a large number of wet rales heard in both lungs. The imaging investigations were suggestive of bronchobiliary fistula. Therefore, the patient was operated on and discharged with no perioperative complications.ConclusionBronchobiliary fistula should be considered diagnostically in patients with known liver disease who also experience trauma or medical treatment and cough up bile-colored sputum, regardless of the presence of concurrent infections, and in conjunction with radiological expertise to identify it. Here, we report a case of bronchobiliary fistula and a brief review of the literature on it.

Effect of Volitional Modification of Breath Frequency on Attention and Mood States: An Exploratory Randomized Crossover Study.

Previously, yoga breathing improved mood states and attention but the effect of varying breath frequency on mood and attention was not clear. The objective of this study was to determine the effects of changes in breath frequency on attention, mood, vigor, and affect states. Thirty participants (mean age ± standard deviation, 27.3 ± 4.2 years) were assessed on 2 separate days practicing either high-frequency yoga breathing (HFYB, breath frequency 54.23/min) or bumblebee yoga breathing (BBYB, breath frequency 3.97/min) in random order. Assessments included blood pressure (BP), cancellation test scores, Nijmegen (to check for hyperventilation), respiration (rate, height of the breath wave [depth], and duration of inhalation relative to exhalation), mood states, vigor, and affect states. Diastolic BP increased after HFYB, whereas systolic BP decreased after BBYB, after both sessions scores in a cancellation test increased (changes in cancellation test performance suggest alertness and test-directed attention), also global vigor (signifying mental energy) and global affect (related to being "happy" and "calm") scores increased, whereas negative mood decreased after HFYB session (P < 0.05, Wilcoxon signed-rank test). Both HFYB and BBYB increased attention test scores, possibly due to cortical activation (HFYB) or relaxation (BBYB). In HFYB, breath frequency and inspiration duration increased suggestive of increased sympathetic activity, accounting for increased vigor, positive affect, and diastolic BP. In contrast in BBYB, low breath frequency, higher breath amplitude, and prolonged expiration suggestive of parasympathetic activity may account for the decreased systolic BP after BBYB.

Aluminum Nitride Thin Film Piezoelectric Pressure Sensor for Respiratory Rate Detection.

In this study, we propose a low-cost piezoelectric flexible pressure sensor fabricated on Kapton® (Kapton™ Dupont) substrate by using aluminum nitride (AlN) thin film, designed for the monitoring of the respiration rate for a fast detection of respiratory anomalies. The device was characterized in the range of 15-30 breaths per minute (bpm), to simulate moderate difficult breathing, borderline normal breathing, and normal spontaneous breathing. These three breathing typologies were artificially reproduced by setting the expiratory to inspiratory ratios (E:I) at 1:1, 2:1, 3:1. The prototype was able to accurately recognize the breath states with a low response time (~35 ms), excellent linearity (R2 = 0.997) and low hysteresis. The piezoelectric device was also characterized by placing it in an activated carbon filter mask to evaluate the pressure generated by exhaled air through breathing acts. The results indicate suitability also for the monitoring of very weak breath, exhibiting good linearity, accuracy, and reproducibility, in very low breath pressures, ranging from 0.09 to 0.16 kPa. These preliminary results are very promising for the future development of smart wearable devices able to monitor different patients breathing patterns, also related to breathing diseases, providing a suitable real-time diagnosis in a non-invasive and fast way.

Abstract 11820: Importance of Resting Heart Rate Assessment in Autonomic Dysfunction Evaluation in Congestive Heart Failure Patients

Background: Novel treatments in congestive heart failure (CHF) aim at ameliorating autonomic dysfunction. Autonomic dysfunction typically manifests with resting tachycardia and blunted baroreceptor reflex response and been classically described in CHF with reduced LV ejection fraction (EF) but baroreflex function in CHF with preserved EF has not been well investigated. Methods: A single center prospective study was conducted by measuring resting and lowest heart rates (HR) during voluntary breath holding in 118 CHF patients, 68 ± 14 years old, 50 females (42.3%), BMI 30.1 ± 8.5 kg/m 2 , HTN in 97 (82.2%), CAD in 64 (54.2%), diabetes in 49 (41.5%), and chronic lung disease in 39 patients (33.1%). HFrEF less than 40% was found in 41 (34.7%) patients; for the purposes of analysis HRmrEF and HFpEF groups were combined. Beta-blockers were used in 92 (78%) and non-dihydropyridine calcium channel blockers were used in 7 (5.9%) patients. Results: The majority of HFpEF or HFmrEF patients had resting HR less than 80 bpm (55/77 patients, 71.4%), while the majority of HFrEF patients had resting HR more than 70 bpm (32/41 patients, 78%, p=0.015). Furthermore, HFpEF and HFmrEF patients had lower breath holding HR (69.7 ± 14.7 bpm in HFpEF and HFmrEF patients vs. 77.6 ± 13.9 bpm in HFrEF patients, p=0.005). There was a trend of increased resting HR in patients with Class IV CHF (p=0.179). Furthermore, class IV CHF patients manifested with increased breath holding HR (68.9 ± 15.3 bpm in combined NYHA class I-II, 69.9 ± 12.2 bpm in NYHA class III, 79.9 ± 16.1 bpm in NYHA class IV, p=0.02). Regardless of the CHF class (p=0.060) and/or LV EF (p=0.913), increased resting HR was associated with higher breath holding HR. Patients with baseline HR &lt;60 bpm had breath holding HR of 54.6 ± 6.2 bpm, as compared to 94.9 ± 9.0 bpm in patients with baseline HR &gt;90 bpm, p&lt;0.001. Conclusion: In CHF patients, increased resting HR is a strong indicator of abnormal baroreceptor function. HRmrEF and HFpEF patients have lower resting and breath holding HR, suggesting less pronounced autonomic dysfunction, as compared to more pronounced autonomic dysfunction in HFrEF patients. Additional studies are needed to investigate whether autonomic modulation treatment is equally beneficial in patients across the LVEF spectrum.

CLINICO- ELECTROPHYSIOLOGICAL AND CSF PROFILE AND PREDICTORS OF FUNCTIONAL OUTCOME IN GUILLAINE-BARRE SYNDROME- A PROSPECTIVE STUDY

BACKGROUND Guillain-Barre syndrome (GBS) is a rare, immune mediated disorder which is associated with demyelination of peripheral nervous system and progressive muscle weakness, with an annual global incidence of approximately 1–2 per 100,000 person-years. GBS has an unpredictable clinical course with up to 30% of patients requiring assisted ventilation during the course of their illness. Recent advances in the eld of critical care has successfully improved the outcome of GBS. Successful management mandates anticipation, prompt recognition of modiable risk factors and optimal treatment of neuromuscular respiratory failure in GBS. There is limited Indian data with regards to the early determinants and outcome of severely affected GBS patients. Knowledge of early predictors can substantially improve patient care and provides essential data for triage at an early stage in the course of the illness. OBJECTIVE 1. To study the clinical, electrophysiological prole, progression and outcome of GBS in a tertiary care hospital. 2. To determine the factors associated with the poor functional outcome, including the need for mechanical ventilation. MATERIALS AND METHODS This was a single centre, prospective study with 50 patients with GB syndrome, conducted from from 1st June 2021 to 30th May 2022 for a period of 1 year at Gauhati Medical College and Hospital. Their clinical, electrophysiological, CSF parameters were analysed. Hughes grading, EGRIS, mEGOS, MRC sum score were used. Any clinical deterioration and need for mechanical ventilation were noted carefully. Patients were followed up at 3 months and 6 months at assess their outcome. The mean age of the patients was 30.5 RESULTS years with a male female ratio of 1.3:1. AIDP was the most prevalent subtype found in 23(46%) patients followed by AMAN in 14(28%), AMSAN in 9(18%) and 4(8%) cases were unclassied. 32(64%) had severe disease with Hughes score ≥ 4 and 28(56%) had MRC score &lt;40 at presentation. Respiratory distress was found in 17(34%) of patients, and out of which 10(20%) required mechanical ventilation. During the study 2(4%) patients died of complications. At 3 months, 30(60%) patients had complete recovery, 12(24%) had partial recovery and 6(12%) had poor recovery. At 6 months, 35(70%) had good recovery, 9(18%) had partial recovery and 4(8%) had poor recovery. Delayed CONCLUSION presentation, early peak of illness, prolonged Hospital stay, bulbar weakness, neck exor weakness, bilateral facial weakness, quadriparesis, respiratory distress, need for mechanical ventilation, autonomic dysfunction; high Hughes grading, low average single breath count along with high EGRIS, mEGOS, MRC sum score, high CSF protein, albumin-cytological dissociation, presence of F-wave abnormalities and Non stimulable nerves or Inexcitable nerves on NCS, AMAN subtype and systemic complications are associated with poor outcome. The overall outcome of GBS is favourable.

소매틱 움직임 원리로 본 벽사 정재만류 승무 교육적/치료적 가치

This study is to investigate the educational/therapeutic value by applying the somatic movement breathe(SMB) principle to the Byuksa Jeman Jung’s Seungmu (BJJS) Yeombuljangdan. In the first beat of Yeombuljangdan, the Hangeul Janggo pronunciation “gideng” is the upper breath, the flat breath, and the lower breath in the 3 sobak. The awareness of myeongmunhyeol started the lower respiration from the danjeon and raised it upward, and sutaeyangsojang-gyeong activated it. It is expected that BJJS in the metaverse will become a frame of reference for the principle of SMB. purpose of this research is to consider the meaning of communication process in dance, by applying the concept from Phenomenology of Merleau-Ponty.

Oral microbiota populations of adult dogs consuming wet or dry foods.

Oral microbiota play a prominent role in canine periodontal disease and wet foods are often blamed for poor oral health, but canine oral microbial communities have been poorly studied. We aimed to determine differences in oral health measures, breath odor, and oral microbiota populations of dogs fed wet or dry food. Twelve adult dogs fed either a commercial dry (extruded) or commercial wet (canned) food for 6 wk were studied. Breath samples were measured for sulfur compounds, teeth were scored for plaque, calculus, and gingivitis by a blinded veterinary dentist, salivary pH was measured, and supragingival (SUP) and subgingival (SUB) plaque samples were collected for microbiota analysis. Plaque DNA was extracted and Illumina sequencing was conducted. Phylogenetic data were analyzed using the CosmosID bioinformatics platform and SAS 9.4, with P <0.05 being significant and P <0.10 being trends. Plaque coverage tended to be higher (P < 0.10) in dogs fed wet vs. dry food, but other oral health scores were not different. Dogs fed dry food had higher (P < 0.05) salivary pH and lower (P < 0.05) breath sulfur concentrations than those consuming wet food. Bacterial alpha diversity was higher in SUP than SUB samples, and a clear separation in beta diversity was observed between sample sites on principal coordinates analysis (PCoA) plots. In SUP samples, dogs fed wet food had a higher alpha diversity than dogs fed dry food, with PCoA plots showing a separation between wet and dry food. Relative abundances of Firmicutes, Synergistetes, and 10 bacterial genera were different (P < 0.05) in SUB samples of dogs fed wet vs. dry food. Relative abundances of Fusobacteria and over 20 bacterial genera were different (P < 0.05) in SUP samples of dogs fed wet vs. dry food. In general, oral health-associated bacterial taxa (Pasteurella, Capnocytophaga, Corynebacterium) were higher, while bacteria associated with poor oral health (Fretibacterium fastidiosum, Filifactor alocis, Treponema medium, Tannerella forsythia, Porphyromonas canoris, Porphyromonas gingivalis) were lower in dogs fed dry food. Such shifts in the oral microbiota may impact periodontal disease risk, but longer dietary intervention studies are required to confirm their role in the disease process. Our results suggest that dogs fed dry extruded foods have lower breath odor and tooth plaque buildup and an oral microbiota population more closely associated with oral health than dogs fed wet canned foods.

Effects of long-term vegan diet on breath composition

The composition of exhaled breath derives from an intricate combination of normal and abnormal physiological processes that are modified by the consumption of food and beverages, circadian rhythms, bacterial infections, and genetics as well as exposure to xenobiotics. This complexity, which results wide intra- and inter-individual variability and is further influenced by sampling conditions, hinders the identification of specific biomarkers and makes it difficult to differentiate between pathological and nominally healthy subjects. The identification of a ‘normal’ breath composition and the relative influence of the aforementioned parameters would make breath analyses much faster for diagnostic applications. We thus compared, for the first time, the breath composition of age-matched volunteers following a vegan and a Mediterranean omnivorous diet in order to evaluate the impact of diet on breath composition. Mixed breath was collected from 38 nominally healthy volunteers who were asked to breathe into a 2 l handmade Nalophan bag. Exhalation flow rate and carbon dioxide values were monitored during breath sampling. An aliquot (100 ml) of breath was loaded into a sorbent tube (250 mg of Tenax GR, 60/80 mesh) before being analyzed by thermal desorption-gas chromatography-mass spectrometry (TD-GC-MS). Breath profiling using TD-GC-MS analysis identified five compounds (methanol, 1-propanol, pentane, hexane, and hexanal), thus enabling differentiation between samples collected from the different group members. Principal component analysis showed a clear separation between groups, suggesting that breath analysis could be used to study the influence of dietary habits in the fields of nutrition and metabolism. Surprisingly, one Italian woman and her brother showed extremely low breath isoprene levels (about 5 pbv), despite their normal lipidic profile and respiratory data, such as flow rate and pCO2. Further investigations to reveal the reasons behind low isoprene levels in breath would help reveal the origin of isoprene in breath.

Volatile organic breath components and exercise induced bronchoconstriction in asthmatic children

IntroductionAsthma is one of the most common chronic diseases in childhood and is generally characterized by exercise induced bronchoconstriction (EIB). Assessing EIB is time consuming and expensive as it requires a fully equipped pulmonary function laboratory. Analysis of volatile organic compounds (VOCs) in breath is a novel technique for examining biomarkers which may associate with asthma features. The aim of this pilot study was to identify potential markers in the relationship between EIB and VOCs.MethodsChildren between four and 14 years old were asked to provide a breath sample prior to undergoing an exercise challenge test to assess for EIB.ResultsBreath samples were collected and analyzed in 46 asthmatic children, 21 with EIB and 25 without EIB (NO-EIB). Molecular features (MFs) were not significantly different between EIB and NO-EIB controls. 29 of the 46 children were corticosteroid naïve, 10 with EIB and 13 without. In the corticosteroid naïve group EIB was associated with increased MF23 and MF14 in the lower breath sample (p-value < 0.05).ConclusionThis pilot study shows that EIB was related to an increased MF14 and MF23 in corticosteroid naïve children. The tentative identities of these compounds are octanal and dodecane/tetradecane respectively. These candidate biomarkers have a potential to enable non-invasive diagnosis of EIB in steroid-naïve children.Trial registration This study is registered in the Netherlands trial register (trial no. NL6087) at 14 February 2017.

Groan

Listen. There’s no introduction to Nina Simone’s rendition of “Strange Fruit,” only a single note. Her voice emerges. Rough. Direct. Accusing. Denouncing. Her entire performance is predicated on the tightly controlled breath: each word bears the weight of her lungs, none left unarticulated or lost among the bitter poignancy of images made into word.Placing Nina Simone’s rendition of “Strange Fruit” is an effort in trying to place breath. Simone’s interpretation is no wail or cry. Hers is a performance steeped in a Black tradition of breathing, born of centuries of fugitivity and bearing the scars of a people trying to live in hostile atmospheres. Her “for the leaves to drop” extends “leaves” for a full seven seconds, voice a decrescendo like the wind wailing before a storm or the scream of a siren. Her guttural energy, baptized in anger and disgust as much as sorrow, reverberates as a groan—that deep, nonlexical sound of despair; that low moaning breath when weight crushes the chest. It’s the breath of a person in pain, an attempt to assuage something they have no remedy for.Her groan is an indictment. It’s an indictment of a world that cuts short the breath of Black people, leaving Black bodies swinging in the trees, or restrained on the side of the road with a knee to the neck. It’s an indictment of the state of Black life, which is always marked by imminent and immanent death. Hers is a groan uttered through tightly clenched teeth.Yes. If singing with Simone, do it with clenched teeth and clenched fist.

Cerebral Vasoreactivity Evaluated by Transcranial Color Doppler and Breath-Holding Test in Patients after SARS-CoV-2 Infection.

From the beginning of the SARS-CoV-2 virus pandemic, it was clear that the virus is highly neurotrophic. Neurological manifestations can range from nonspecific symptoms such as dizziness, headaches and olfactory disturbances to severe forms of neurological dysfunction. Some neurological complication can occur even after mild forms of respiratory disease. This study’s aims were to assess cerebrovascular reactivity in patients with nonspecific neurological symptoms after SARS-CoV-2 infection. A total of 25 patients, aged 33–62 years, who had nonspecific neurological symptoms after SARS-CoV-2 infection, as well as 25 healthy participants in the control group, were assessed for cerebrovascular reactivity according to transcranial color Doppler (TCCD) which we combined with a breath-holding test (BHT). In subjects after SARS-CoV-2 infection, there were statistically significantly lower flow velocities through the middle cerebral artery at rest period, lower maximum velocities at the end of the breath-holding period and lower breath holding index (BHI) in relation to the control group. Changes in cerebral artery flow rate velocities indicate poor cerebral vasoreactivity in the group after SARS-CoV-2 infection in regard to the control group and suggest vascular endothelial damage by the SARS-CoV-2 virus.

Liudmyla Heorhiivna Tsurkan – personality and pedagogue

The article is devoted to the problems of vocal pedagogics on the example of creative life of outstanding teacher, professor of the Department of solo singing of Kharkiv I. P. Kotlyarevsky National University of Arts Liudmyla Heorhiivna Tsurkan. The goal of an article is to reveal the path of professional growth of L. H. Tsurkan and to systemize her pedagogical principles. The article uses such methods of research as historical, analytical and stylistic. The relevance of the study is due to the lack of generalizing work on the professional development and pedagogical principles of the singer and teacher. Scientific novelty lies in the coverage of previously unknown facts of the biography of L. H. Tsurcan and systematization of its methodological principles. Results for discussion. L. H. Tsurkan is an opera singer who created more than 30 leading images of repertoire for soprano, used her own experience in performance and creative premises in her own pedagogical activity, which she started in 1976 on the Department of Solo signing of Kharkiv I. P. Kotlyarevsky National University of Arts. On several examples, the questions of technology, including methodology of development of vocal apparatus, are researched. She combined fundamental principles of Italian, Russian and Ukrainian schools of singing as well as enriched these methods with new skills and ideas, which help young singers to liberate their creativity, and develop their emotional memory and independence of creative search. On some examples principles of singing are analyzed which were given to the students by L. H. Tsurkan. These are low-rib breath, free state of oropharynx. High position is combined with low breath. The power of voice is coordinated with chest and head resonance or with their combination with dominance of one or another on several parts of the voice. It is stressed that while working on technique and right breath, she always bore music in her mind. A breath is a mean of performers expressiveness. Thus, it has to change according to style of the work. Significant role of diction is stressed, which draw a lot of attention of L. H. Tsurkan. Conclusions. Renowned professor and Master of vocal pedagogics, she created experience and methodical devices which are used not only by her former students, but as well by her colleagues and young pedagogues. These are: relentless and inspired work; indefatigable search for ways and methods of correction of problems, and perfection of already achieved skills; constant development, both cultural and intellectual; ability to play musical instruments and knowledge of theory and history of music; ability to speak foreign languages, which gives an opportunity to learn an incredibly wide variety of musical literature. Not only does this all enrich both spiritually and professionally, but also it is a straightforward path to success and more complete realization of personality. The article uses reminiscences of L. H. Tsurkan’s daughter about life of the pedagogue, video-recordings of master-classes and lessons of the Professor.

Online Real-Time Monitoring of Exhaled Breath Particles Reveals Unnoticed Transport of Nonvolatile Drugs from Blood to Breath

We used online secondary electrospray ionization mass spectrometry to measure venlafaxine (VEN), a nonvolatile drug, in the exhaled air of mice intraperitoneally treated with VEN. The breath pharmacokinetic (PK) profile of VEN was recorded, which was in good agreement with that of the blood. Combined with online collection of exhaled breath particles (EBPs), it was shown that VEN existed as part of EBPs rather than gas molecules in the breath. Linear free-energy relationship analysis confirmed that almost completely ionized VEN at physiological conditions unlikely partition from the lung lining fluid (LLF) into breath air. This implies that the occurrence of VEN in exhaled air accompanies the formation of EBPs from the LLF. By comparison with the low breath signals of VEN metabolites, passive membrane permeability and lung/blood partition coefficient are suggested as the main influencing factors for the levels of drugs in the breath. This study advances our knowledge on the mechanism by which nonvolatile drugs are transferred from blood into exhaled breath, providing guidance for breath test-based therapeutic drug monitoring.

Investigation of low baby's breath (Gypsophila muralis) herb: anatomical structure and chemical composition

Investigation of low baby's breath (Gypsophila muralis) herb: anatomical structure and chemical composition

Metabolomics and a breath sensor identify acetone as a biomarker for heart failure

Abstract Introduction Metabolomics delivers more biological and clinical insight than targeted investigations. We applied metabolomics to patients with heart failure (HF) with reduced ejection fraction (HFrEF). Methods 46 patients with HFrEF and 20 controls underwent metabolomic profiling, including liquid/gas chromatography mass spectrometry (LC-MS/GC-MS), nuclear magnetic resonance (NMR) metabolomics and solid-phase microextraction (SPME) volatilomics in plasma and urine. HFrEF was defined using left ventricular global longitudal strain (GLS) &amp;lt;18%, ejection fraction &amp;lt;50% and NTproBNP ≥35 pmol/L. A low cost consumer breath acetone (BrACE) sensor validated SPME results in 69 patients. Results 34 metabolites were identified by GCMS, 33 by LCMS and 2 volatiles by SPME (acetone, 2-pentanone in plasma and urine). Alanine, aspartate and glutamate, citric acid cycle, arginine biosynthesis, glyoxylate and dicarboxylate metabolism were altered in HFrEF. Plasma acetone correlated with NT-proBNP (r=0.59, 95% CI 0.4 to 0.7), triacylglycerol (55:9), 2-oxovaleric and cis-aconitic acid, involved with ketone metabolism and mitochondrial energetics. BrACE &amp;gt;1.5 ppm discriminated HF from other cardiac pathology (AUC 0.88, 95% CI 0.77 to 0.99, P&amp;lt;0.0001). Conclusion Breath acetone was detectable in HFrEF patients using a consumer sensor ($1/test) and although not cardiac specific, discriminated HF from other cardiac pathology. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Health Research Council of New Zealand

Association between breath methane concentration and visceral fat area: a population-based cross-sectional study

High visceral fat area (VFA) is a stronger predictor of cardiovascular disease and overall mortality, compared with body mass index (BMI) and waist circumference (WC). Recent reports demonstrate that obesity is related to breath gas, which is produced by the intestinal microflora. However, these studies define obesity using BMI, not VFA. In this population-based cross-sectional study, we investigated the relationship between breath gases (methane and hydrogen) and both VFA and BMI. A total of 1033 participants (62% women; age [mean ± standard deviation] 54.4 ± 14.9 years) in the 2015 Iwaki Health Promotion Project in Japan were enrolled in the study. Breath samples were collected using a breath bag and analyzed by gas chromatography. VFA was measured using a visceral fat meter. The proportion of methanogenic bacteria to total intestinal microbiota was measured by polymerase chain reaction and 16S rRNA gene sequencing analysis. Our analysis revealed a significant association between high VFA and low breath methane, even after adjusting for confounding factors (B = −0.024 and P = 0.004). To identify the association between breath methane and VFA in participants with methane-producing bacteria in their intestinal microflora, participants were divided into two groups based on the presence or absence of methanogenic bacteria in their stool. The Methanogen + group was further divided into two subgroups with breath methane higher (Methane-UP) or lower (Methane-LO) than the median breath methane concentration. VFA was significantly lower in the Methane-UP group than in the Methane-LO group. In participants with methanogenic bacteria, breath methane concentration might be an independent biomarker of visceral fat accumulation.

A059 Metabolomics and a Breath Sensor Identify Acetone as a Biomarker for Heart Failure

Metabolomics delivers more biological and clinical insight than targeted investigations. We applied metabolomics to patients with heart failure (HF) with reduced ejection fraction (HFrEF). 46 patients with HFrEF and 20 controls underwent metabolomic profiling, including liquid/gas chromatography mass spectrometry (LC-MS/GC-MS), nuclear magnetic resonance (NMR) metabolomics and solid-phase microextraction (SPME) volatilomics in plasma and urine. HFrEF was defined using left ventricular global longitudal strain (GLS) < 18%, ejection fraction < 50% and NTproBNP ≥ 35 pmol/L. A low cost consumer breath acetone (BrACE) sensor validated SPME results in 69 patients. 34 metabolites were identified by GCMS, 33 by LCMS and 2 volatiles by SPME (acetone, 2-pentanone in plasma and urine). Alanine, aspartate and glutamate, citric acid cycle, arginine biosynthesis, glyoxylate and dicarboxylate metabolism were altered in HFrEF. Plasma acetone correlated with NT-proBNP (r = 0.59, 95% CI 0.4 to 0.7), triacylglycerol (55:9), 2-oxovaleric and cis-aconitic acid, involved with ketone metabolism and mitochondrial energetics. BrACE > 1.5 ppm discriminated HF from other cardiac pathology (AUC 0.88, 95% CI 0.77 to 0.99, P < 0.0001). Breath acetone was detectable in HFrEF patients using a consumer sensor ($1/test) and although not cardiac specific, discriminated HF from other cardiac pathology.

Low Exhaled Breath Droplet Formation May Explain Why Children are Poor SARS-CoV-2 Transmitters

A characteristic of the novel coronavirus disease 2019 (COVID-19) is the few cases of severely affected children. They not only rarely get symptoms but also seem to be poor transmitters. We propose that this may be explained by the mechanism of breath droplet formation, which occur during the re-opening of collapsed terminal bronchioles. Children's lungs are still developing. Compared to adults they have few alveoli and terminal bronchioles, thus less sites of aerosol formation where virus-loaded lung lining liquid can get airborne. In addition, children have a lower respiratory minute volume and tend to have a lower viral load. These points, together with the fact that asymptomatic carriers release less aerosols than symptomatic carriers support the idea that children are indeed poor transmitters of the COVID-19 virus.

Effects of 6-Week Use of Very Low Nicotine Content Cigarettes in Smokers With Serious Mental Illness.

IntroductionThe US Food and Drug Administration is considering implementing a reduced-nicotine standard for cigarettes. Given the high rate of smoking among people with serious mental illness (SMI), it is important to examine the responses of these smokers to very low nicotine content (VLNC) cigarettes.MethodsThis trial compared the effects of VLNC (0.4 mg nicotine/g tobacco) and normal nicotine content cigarettes (15.8 mg/g) over a 6-week period in non-treatment-seeking smokers with schizophrenia, schizoaffective disorder, or bipolar disorder (n = 58). Linear regression was used to examine the effects of cigarette condition on cigarettes per day, subjective responses, nicotine and tobacco toxicant exposure, craving, withdrawal symptoms, and psychiatric symptoms.ResultsAt week 6, participants in the VLNC condition smoked fewer cigarettes per day, had lower breath carbon monoxide levels, lower craving scores, and rated their study cigarettes lower in satisfaction, reward, enjoyment, and craving reduction than those in the normal nicotine content condition (ps < .05). Week 6 psychiatric and extrapyramidal symptoms did not differ by condition, except for scores on a measure of parkinsonism, which were lower in the VLNC condition (p < .05). There were no differences across conditions on total nicotine exposure, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol, withdrawal symptoms, or responses to abstinence.ConclusionsThese results suggest that a reduced-nicotine standard for cigarettes would reduce smoking among smokers with SMI. However, the lack of effect on total nicotine exposure indicates VLNC noncompliance, suggesting that smokers with SMI may respond to a reduced-nicotine standard by substituting alternative forms of nicotine.ImplicationsResults from this trial suggest that a reduced-nicotine standard for cigarettes would reduce smoking rates and smoke exposure in smokers with SMI, without increasing psychiatric symptoms. However, noncompliance with VLNC cigarettes was observed, suggesting that these smokers might respond to a reduced-nicotine standard by substituting alternative forms of nicotine.

Assessment of Skin Blood Flow Following Acute Intravenous Alcohol, and Association with Subjective Perceptions, in Social Drinkers.

The objective of this study was to determine the effect of acute intravenous (IV) alcohol infusion on skin blood flow (SBF) response, measured at fingertip and earlobe, and subjective responses associated with SBF in social drinkers. Twenty-four social drinkers underwent a computer-assisted alcohol self-infusion study. SBF was measured continuously using laser Doppler flow meter, with the probe placed on the fingertip or earlobe. Perfusion recordings were collected at baseline, and at 0-minute (0 to 5minutes), 10-minute (10 to 15minutes), and 20-minute (20 to 25minutes) time points during the priming phase of IV alcohol self-administration paradigm at low breath alcohol levels of approximately 30mg%. Subjective response was measured using the Drug Effects Questionnaire (DEQ) and Biphasic Alcohol Effects Scale. Overall SBF (collective data from both fingertip and earlobe) and SBF by each site showed significant drop at 0minutes and then subsequent significant elevation with alcohol self-administration. Males showed higher overall SBF at baseline and 0minutes than the females. At fingertip site, lowering in 0-minute SBF compared to baseline, and subsequent significant increase at the 10- and 20-minute SBF recordings were observed. DEQ measures of "like" and "want more" alcohol were significantly associated with 10- and 20-minute SBF recordings collected at fingertip site. The changes in SBF following acute IV alcohol exposure are consistent with the sympathetic response of alcohol on the cardiovascular system. This acute hemodynamic effect characterizes differences in blood flow that are sensitive to relatively low levels of acute alcohol exposure. The association of subjective perceptions with the SBF response provides evidence of the psychophysiological effects of alcohol at low levels of exposure.