Lower Breath Research Articles

Assessment of cerebrovascular reserve impairment using the breath-holding index in patients with leukoaraiosis.

Many studies have demonstrated that leukoaraiosis is associated with impaired cerebrovascular reserve function. However, the definitive hemodynamic changes that occur in leukoaraiosis are not clear, and there are many controversies. This study aimed to investigate hemodynamic changes in symptomatic leukoaraiosis using transcranial Doppler ultrasonography and the breath-holding test in a Chinese Han population, from northern China. A total of 203 patients who were diagnosed with ischemic stroke or clinical chronic progressive ischemic symptoms were enrolled in this study, including 97 males and 106 females, with an age range of 43-93 years. The severity of leukoaraiosis was evaluated according to the Fazekas grading scale, and patients were divided into four groups accordingly. Grade 0 was no leukoaraiosis, and grades I, II, and III were mild, moderate, and severe leukoaraiosis, respectively, with 44, 79, 44, and 36 cases in each group. Transcranial Doppler ultrasonography and the breath-holding test were performed. The mean blood flow velocity of the bilateral middle cerebral artery was measured and the breath-holding index was calculated. The breath holding index was correlated with leukoaraiosis severity and cognitive impairment. Patients with a low breath holding index presented poor performance in the Montreal Cognitive Assessment (MoCA) and executive function tests. That is, the lower the breath holding index, the lower the scores for the MoCA and the higher for the trail-making test Parts A and B. These results indicate that the breath-holding index is a useful parameter for the evaluation of cerebrovascular reserve impairment in patients with leukoaraiosis. In addition, the breath-holding index can reflect cognitive dysfunction, providing a new insight into the pathophysiology of leukoaraiosis. This study was approved by the Ethics Committee of the Fifth People's Hospital of Shenyang, China (approval No. 20160301) and registered in the Chinese Clinical Trial Registry (registration number: ChiCTR1800014421).

Low Cost Alcoholic Breath Sensor Based on SnO2 Modified with CNTs and Graphene

In this work, SnO2 modified with reduced graphene oxide (rGO) and carbon nanotubes (CNTs) separately and combined sensitized by using the co-precipitation method and their sensing behavior toward ethanol vapor at room temperature were investigated. An interdigitated electrode (IDE) gold substrate is very expensive compared to a fluorine doped tin oxide (FTO) substrate; hence, we used the latter to reduce the fabrication cost. The structure and the morphology of the studied materials were characterized by using differential thermal analyses (DTA) and thermogravimetric analysis (TGA), transmission electron microscope (TEM), X-ray diffraction (XRD), Fourier transform infrared (FTIR) spectroscopy, Brunauer-Emmett-Teller surface area and Barrett-Joyner-Halenda (BJH) pore size measurements. The studied composites were subjected to ethanol in its gas phase at concentrations from 10 to 200 ppm. The present composites showed high-performance sensitivity for many reasons: the incorporation of SnO2 and CNTs which prevents the agglomeration of rGO sheets, the formation of a 3D mesopourus structure and an increase in the surface area. The decoration with rGO and CNTs led to more active sites, such as vacancies, which increased the adsorption of ethanol gas. In addition, the mesopore structure and the nano size of the SnO2 particles allowed an efficient diffusion of gases to the active sites. Based on these results, the present composites should be considered as efficient and low-cost sensors for alcohol.

The physiologic and phenotypic significance of variation in human amylase gene copy number

Salivary α-amylase gene (AMY1) copy number (CN) correlates with the amount of salivary α-amylase, but beyond this, the physiologic significance is uncertain. We hypothesized that individuals with higher AMY1 CN would digest starchy foods faster and show higher postprandial responses and lower breath hydrogen excretion compared with those with low CN. Four linked studies were conducted. In Study 1, we genotyped 201 healthy subjects with the use of real-time quantitative polymerase chain reaction and determined glucose tolerance, insulin sensitivity, salivary α-amylase activity, body mass index (BMI), and macronutrient intake. In Study 2, a pool of 114 subjects tested 6 starchy foods, 3 sugary foods, 1 mixed meal, and 2 reference glucose solutions, containing either 50 or 25 g of available carbohydrate. In Study 3, we compared glycemic and insulin responses to starchy foods with responses to glucose in 40 individuals at extremes of high and low CN. In Study 4, we compared breath hydrogen and methane responses over 8 h in 30 individuals at extremes of CN. AMY1 CN correlated positively with salivary α-amylase activity (r=0.62, P<0.0001, n=201) but not with BMI, glucose tolerance, or insulin sensitivity. However, CN was strongly correlated with normalized glycemic responses to all starchy foods (explaining 26-61% of interindividual variation), but not to sucrose or fruit. Individuals in the highest compared with the lowest decile of CN produced modestly higher glycemia (+15%, P=0.018), but not insulinemia, after consuming 2 starchy foods. Low-CN individuals displayed >6-fold higher breath methane levels in the fasting state and after starch ingestion than high-CN individuals (P=0.001), whereas hydrogen excretion was similar. Starchy foods are digested faster and produce higher postprandial glycemia in individuals with high AMY1 CN. In contrast, having low CN is associated with colonic methane production. This trial was registered at www.anzctr.org.au as ACTRN12617000670370.

Attitudes about smoking cessation treatment, intention to quit, and cessation treatment utilization among young adult smokers with severe mental illnesses

SignificanceYoung adults with schizophrenia, bipolar disorder and other severe mental illnesses (SMI) have high rates of smoking, but little research has evaluated predictors of cessation activity and treatment utilization in this group. MethodsWe assessed attitudes, beliefs, social norms, perceived behavioral control, intention, quit attempts, treatment utilization, and cessation among 58 smokers with SMI, age 18–30, enrolled in a randomized pilot study comparing a brief interactive/motivational vs. a static/educational computerized intervention. Subjects were assessed at baseline, post intervention, and 3-month follow-up. ResultsOver follow-up, one-third of participants self-reported quit attempts. Baseline measures indicating lower breath CO, greater intention to quit, higher perceptions of stigma, higher perceptions of psychological benefits of smoking, and greater symptom distress were associated with quit attempts, whereas gender, diagnosis, social support, attitudes about smoking, and use of cessation treatment were not. In the multivariate analysis, lower breath CO, higher intention to quit and symptom distress were significantly related to quit attempts.Only 5% of participants utilized verified cessation treatment during follow-up. Consistent with the Theory of Planned Behavior, attitudes, social norms and perceived behavioral control regarding cessation treatments correlated significantly with intention to use treatment. Norms and beliefs about treatment were somewhat positive and some improved after intervention, with a pattern significantly favoring the interactive intervention, but intentions to use treatments remained low, consistent with low treatment utilization. ConclusionsPerceptions of traditional cessation treatments improved somewhat after brief interventions, but most young adult smokers with SMI did not use cessation treatment. Instead, interventions led to quit attempts without treatment.

Avian anthrophobia? Behavioral and physiological responses of house finches (Haemorhous mexicanus) to human and predator threats across an urban gradient

Urban environments present animals with many novel experiences, not the least of which is the physical presence of humans. However, most studies on urban predation do not take human presence into account. We examined behavioral and physiological responses of a songbird species (the house finch, Haemorhous mexicanus) that is abundant in both natural and urban areas to the presence of humans and to a native predator model to distinguish whether urban birds show consistently bolder behavior or if they differentially respond to a threatening native predator versus a potentially more benign human. During three field seasons (winter 2012, summer-fall 2012, and winter 2013), we captured birds at six sites (urban, suburban, and rural) and measured breath rate (an indicator of stress). We then tested behavioral reactions of caged finches to an approaching human and both a hawk (predator) and dove (control-bird) flyover. We found that rural birds had lower breath rates than urban birds, but that urban birds showed fewer activity behaviors (e.g., hops, flights) than rural birds in response to an approaching human. Urban and rural birds did not differ in their behavioral responses to either the hawk or dove mount, though there were seasonal differences. Because house finch behavioral responses varied as a function of type of stimulus presented, our results point to an example of plasticity rather than to a generalized bold urban phenotype and also implicate tolerance of human proximity as a key factor driving urban success in some avian species.

2,5-Dimethylfuran as a Validated Biomarker of Smoking Status.

Exposure biomarkers are required in tobacco use studies to accurately assess smoking status since self-reporting usually results in misclassification estimates. This study uses breath analysis and assesses some volatile organic compounds (VOCs) as potential biomarkers of tobacco smoke exposure. Forced-expiratory breath samples were obtained from 377 volunteers (174 smokers and 203 nonsmokers). Exhaled breath levels of different VOCs previously related to tobacco smoke were evaluated. The toluene-to-benzene ratio was evaluated as this ratio has been found to be different in atmospheric samples and tobacco smoke emissions. Finally, breath analyses from 64 patients attending a clinical practice were evaluated and the results were compared to their self-reporting status. Univariate analysis shows that all compounds evaluated gave significant differences (p < .001). Receiver operating characteristic (ROC) curves suggest that xylenes and toluene are not able to accurately determine smoking status, and benzene and the T/B ratio present potential utility in certain conditions. The highest discriminant capacity was obtained for 2,5-dimethylfuran (AUC = 0.982, 95% confidence interval [CI]: 0.969-0.995), with a cut-off value of 0.016 ppbv (sensibility = 0.965, specificity = 0.896). Drinking coffee was the only confounding parameter that can give low breath levels for this compound. The evaluation of the results obtained from the patients attending a clinical practice showed that 8% of people who claim to be nonsmokers hid their real smoking status. The results obtained confirm that the determination of 2,5-dimethylfuran in breath samples is a good and simpler alternative to conventional blood or urine tests for assessing smoking status. Analysis of 2,5-dimethylfuran in breath samples results in a simple and fast method for the determination of the smoking status of a person. This methodology presents multiple advantages as it is neither invasive nor embarrassing for patients attending clinical practices. Moreover, analysis of biomarkers in breath samples is simpler and faster than using conventional methods based on urine or blood analysis.

Witnesses’ memory for events and faces under elevated levels of intoxication

ABSTRACTResearch on alcohol and witness memory has burgeoned over the last decade. However, most studies have tested participants at relatively low breath alcohol concentration (BAC) levels, unrepresentative of those encountered by officers in the field. To examine how higher intoxication levels might impair witness memory for events and faces, the current research tested participants’ ability to recall a mock crime at elevated BAC levels (>.08%). The BAC levels of bar patrons (N = 138) were recorded before witnessing a video-taped mock crime. Participants were then interviewed using free recall and cued questions and shown a six-person target-present or target-absent lineup. Results show that alcohol negatively affected both the quantity and quality of recall. Regardless of question format, alcohol also reduced the percentage of accurate information elicited from witnesses; however, only cued questions increased the percentage of inaccurate information reported. Intoxication had no effect on identification accuracy. These findings suggest that the encoding and storage systems for faces and events may be impacted differently by alcohol. Our results also highlight the importance of including higher BAC levels when examining the effects of alcohol on witness memory.

Organic Gas Sensor with an Improved Lifetime for Detecting Breath Ammonia in Hemodialysis Patients.

In this work, a TFB (poly[(9,9-dioctylfluorenyl-2,7-diyl)-co-(4,4'-(N-(4-s-butylphenyl)diphenylamine)]) sensor with a cylindrical nanopore structure exhibits a high sensitivity to ammonia in ppb-regime. The lifetime and sensitivity of the TFB sensor were studied and compared to those of P3HT (poly(3-hexylthiophene)), NPB (N,N'-di(1-naphthyl)-N,N'-diphenyl-(1,1'-biphenyl)-4,4'-diamine), and TAPC (4,4'-cyclohexylidenebis[N,N-bis(4-methylphenyl) benzenamine]) sensors with the same cylindrical nanopore structures. The TFB sensor outstands the others in sensitivity and lifetime and it shows a sensing response (current variation ratio) of 13% to 100 ppb ammonia after 64 days of storage in air. A repeated sensing periods testing and a long-term measurement have also been demonstrated for the test of robustness. The performance of the TFB sensor is stable in both tests, which reveals that the TFB sensor can be utilized in our targeting clinical trials. In the last part of this work, we study the change of ammonia concentration in the breath of hemodialysis (HD) patients before and after dialysis. An obvious drop of breath ammonia concentration can be observed after dialysis. The reduction of breath ammonia is also correlated with the reduction of blood urea nitrogen (BUN). A correlation coefficient of 0.82 is achieved. The result implies that TFB sensor may be used as a real-time and low cost breath ammonia sensor for the daily tracking of hemodialysis patients.

Variations in aggression and activity levels amongst squirrels inhabiting low and high density areas

AbstractVariation in an individual animal's behavioural traits has been observed in a wide range of species and is believed to have important fitness consequences. As part of a larger study, it was observed that squirrels occurred at different densities on a 315 ha island, and this subsequently led to variations in faecal cortisol metabolite levels. This study aimed to examine whether living at different densities would also lead to variations in activity and aggression levels and in their survival probability, breeding and body condition. In order to examine variations in activity and aggression, behavioural tests (open field test, mirror image stimulation, breath rates and struggle rate tests) were conducted on 32 individuals (15♀, 17♂), a total of 69 times. Activity in the wild was investigated through radio tracking. There was a significant correlation between the time a squirrel was active and in their aggressive behaviour during the behavioural tests, with more aggressive individuals also being more active. Squirrels in the low density area spent a greater proportion of time active and engaged in aggressive behaviour in the open field test but also moved further in the wild and had a lower breath rate and higher struggle rates. Squirrels in the high density area were the least aggressive, had a smaller home range and higher breath and lower struggle rates. However, this was found to have no effect on survival probability, breeding or body condition. These variations may be the result of sampling dispersing squirrels.

Gastrointestinal tolerance of low FODMAP oral nutrition supplements in healthy human subjects: a randomized controlled trial

BackgroundThere has been increasing interest in utilizing a diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) for the treatment of irritable bowel syndrome (IBS), a functional gastrointestinal disease. While studies have indicated that this diet can be effective at symptom reduction, it is a restrictive diet and patients may find it challenging to find low FODMAP products to meet their nutrient needs. The primary objective of this study was to assess the gastrointestinal (GI) tolerance of three low FODMAP oral nutrition supplements (ONS) in healthy adults.MethodsA double-blind randomized controlled crossover study was conducted in 21 healthy adults (19–32 years). Fasted subjects consumed one of four treatments at each visit, with a one week wash out period between visits. Each participant received all treatments. Treatments included three low FODMAP ONS formulas (A, B, and C) as well as a positive control consisting of 5 g fructooligosaccharides (FOS) mixed in lactose-free milk. Breath hydrogen was measured at baseline, 1, 2, 3, and 4 h post treatment consumption. Subjective GI symptom questionnaires were completed at baseline, 0.5, 1, 1.5, 2, 3, 4, 12, 24 and 48 h following treatment consumption. Mean breath hydrogen concentrations and baseline corrected area under the curve for both breath hydrogen and GI symptoms were analyzed and compared between treatments. Significance was determined at P < 0.05.ResultsThe positive control resulted in higher breath hydrogen response compared to all three of the low FODMAP ONS beverages at 3 and 4 h after consumption. There were no differences in GI symptom response between treatments.ConclusionsAll treatments were well tolerated in healthy participants. The low FODMAP formulas resulted in a lower breath hydrogen response compared to the positive control, and may be better tolerated in individuals with IBS. More research should be conducted to better understand the GI tolerance of low FODMAP ONS in individuals with IBS.Trial registrationThe protocol for this study was registered on ClinicalTrials.gov in January 2016 (Clinical Trials ID: NCT02667184).

Respiratory Pattern and Tidal Volumes Differ for Pressure Support and Volume-assured Pressure Support in Amyotrophic Lateral Sclerosis.

Amyotrophic lateral sclerosis (ALS) is a progressive neuromuscular disease resulting in respiratory failure and death. Use of noninvasive ventilation (NIV) improves survival. However, use of volume-assured pressure support (VAPS) has not been extensively studied in ALS. To explore the clinical usefulness of a detailed evaluation of device-recorded NIV data in the management of chronic respiratory failure in ALS, and to determine whether there are differences in efficacy between patients using VAPS or PS. We performed a retrospective chart review of 271 patients with ALS using either PS or VAPS, along with an evaluation of device-recorded data to explore differences in attainment of goal tidal volumes (Vt) and ratio of respiratory rate to tidal volume (f/Vt), in addition to triggering and cycling ability. Two hundred and fifteen patients were using PS, while 56 were using VAPS. There were no significant differences in demographic data, symptoms, pulmonary function, or patient compliance. Compared with VAPS, achieved Vt was significantly lower for PS while f/Vt was significantly higher. Percent spontaneous triggering was relatively preserved in both cohorts, whereas percent spontaneous cycling was considerably decreased in both. Furthermore, there was no association found between spontaneous triggering or cycling, and pulmonary function, indicating the presence of low spontaneous breath cycling or triggering ability is difficult to predict. Examination of device data for exhaled tidal volumes and f/Vt may be of use in evaluating efficacy of NIV in ALS. VAPS provides more reliable goal Vt than does PS, and is associated with decreased f/Vt. Spontaneous cycling is decreased in ALS despite preservation of triggering ability. Although a set backup rate may address decreased triggering, perhaps more importantly, setting a sufficient fixed inspiratory time would address the issue of decreased cycling.

White Grape Juice Elicits a Lower Breath Hydrogen Response Compared with Apple Juice in Healthy Human Subjects: A Randomized Controlled Trial

BackgroundDiets low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPS) are used to manage symptoms in individuals with irritable bowel syndrome. Although effective at reducing symptoms, the diet can be complex and restrictive. In addition, there are still large gaps in the literature and many foods with unclear effects in the gastrointestinal (GI) tract, like fruit juice. Although many fruits are allowable on a low-FODMAP diet, consumption of all fruit juice is generally cautioned due to the large fructose load contained in juice, regardless of the glucose concentration. Very little research exists regarding the importance of limiting fructose load during a low-FODMAP diet; therefore, individuals following a low-FODMAP diet may be unnecessarily restricting their diets. ObjectiveTo determine whether there is a difference in GI tolerance between juice from a high-FODMAP fruit (apple juice) and juice from a low-FODMAP fruit (white grape juice) in healthy human subjects. The goal is to provide insight into the role of juice in a low-FODMAP diet. MethodsA double-blind, randomized, controlled crossover study was conducted with 40 healthy adults. Fasted subjects consumed 12 oz of either apple juice or white grape juice. Breath hydrogen measures were taken at baseline, 1, 2, and 3 hours. Subjective GI tolerance surveys were completed at the same time intervals and at 12 and 24 hours. Breath hydrogen and GI symptoms were assessed with area under the curve analysis. Significance was determined with a two-sided t test with a P value <0.05. ResultsConsumption of apple juice resulted in a greater mean breath hydrogen area under the curve at 23.3 ppm/hour (95% CI 13.0 to 33.6) compared with white grape juice at 5.8 ppm/hour (95% CI –4.6 to 16.1) (P<0.001). No differences in reported GI symptoms were seen between treatments. ConclusionsBoth juices were well tolerated and neither produced any severe symptoms in healthy adults. White grape juice consumption resulted in only a small rise in breath hydrogen, which may suggest excluding foods only because of the high fructose load could be unnecessarily restrictive. The results of this study suggest that the fructose-to-glucose ratio is likely more important than the total fructose load of the food when considering the acceptability of a food on a low-FODMAP diet. More research is needed in individuals with irritable bowel syndrome to determine whether white grape juice and other juices from low-FODMAP fruits could be additional beverage options for individuals following a low-FODMAP diet.

The Impact of Common Inhaler Errors on Drug Delivery: Investigating Critical Errors with a Dry Powder Inhaler.

Researchers, using checklists, have identified that 30%-90% of patients make errors in inhaler use. It is not certain whether these errors affect the delivery of medication. We have developed an electronic monitor (INCA™) that records audio each time an inhaler is used, providing objective information on inhaler technique. The aim of this study was to assess the effect that correctly identified inhaler errors, with the INCA device, have on drug delivery. This was a prospective study of healthy volunteers using a salbutamol Diskus™. The inclusion criteria allowed for the recruitment of healthy participants who were nonfrequent users of Salbutamol. Each participant was assigned to one control "phase" first and two/three subsequent error "phases." Each phase consisted of six doses of the drug taken 6 hours apart, and the participants' blood was drawn before and 25 minutes after doses one and six. This allowed us to sample their trough and peak serum salbutamol levels. Fourteen healthy volunteers were studied. The inhaler technique errors simulated in this study included exhaling into the device after drug priming but before inhalation, low inspiratory flow, multiple inhalations, low breath hold, missed doses, and wrong inhaler position. Only the exhalation error, low inspiratory flow, and missed doses led to a significant reduction in serum salbutamol levels. After six doses of the exhalation error, there was a 62% reduction in peak salbutamol levels. Low inspiratory flow led to a 52% reduction in peak salbutamol levels and a 78% reduction in trough levels. Missed doses led to a 37% reduction in trough salbutamol levels. These findings confirm that technique errors affect drug delivery. Furthermore, we were able to identify that the most critical technique errors with the Diskus inhaler are exhalation into the device before inhalation, poor inspiratory flow, and missing doses.

Abstract 17612: Hypertension Severity is Associated With Impaired Cognitive Performance

B: Hypertension affects the target-organs diversely. Most evidence on target-organ damage in hypertension is related to kidney and heart. The cerebrovascular and cognitive impairment are less studied. O: To study the cognitive function changes in patients with hypertension on different stages compared to the control pairs and their correlation with the arterial stiffness properties assessed by non-invasive methods and cerebral circulation assessed by transcranial Doppler. M: In a cross sectional study 162 patients (42 controls and 120 hypertensive) were comparatively evaluated. Hypertensive patients were divided in three stages according to the blood pressure levels or medication use (HTN-1: BP 140-159/90-99 or use of one antihypertensive drug; HTN-2: BP 160-179/100-109 or use of two drugs and HTN-3: BP ≥180/110 or use of three or more drugs). The following variables were evaluated: pulse wave velocity, intima medial thickness, cerebral blood flow velocities by transcranial Doppler (TD) and cognitive function. Mean velocity of middle cerebral artery was continuously monitored at resting and during the breath holding test (30 seconds) and 3 minutes handgrip maneuver. Cognitive function was assessed by mini mental state examination and Montreal Cognitive Assessment. R: Compared to control group, HTN-3 group was older, had higher BMI, IMT and PWV and lower educational level and family income (Table 1). Interestingly, the higher the hypertension stage the poorer was the performance in cognitive tests even after age correction. There was no difference among the groups related to TD velocities at rest and the hand-grip maneuver. However, it was noted a lower breath holding index in the hypertensive group (HTN-1=0.94±0.56; HTN-3=0.97±0.59 vs Control=1.5±0.68; p=0.002) which could infer less vasomotor reactivity in these patients. C: Cognitive impairment was more frequent in patients with hypertension and this frequency was related to hypertension severity.

肺癌微波消融术后出现气胸1例的护理体会

Objective: To explore nursing experience of pneumothorax in lung cancer after microwave ablation after microwave ablation. Methods: The patient appeared chest congestion, wheezes, low breath sounds in right lung and respiratory degree weakened 1 day after the microwave ablation. Chest radiography suggested right pneumothorax, compression 60%, therefore, pleural puncture gas treatment was given. The patient still complained of chest congestion and difficulty in breathing. Right pleural drainage beside the bed was conducted at 11:30 on November 24, 2014 and intensive care was then given. Results: The patient was discharged on December 6, 2014. Conclusion: Preoperative examination as the doctor instructed is required, and improve the patient's psychological care of patients, preoperative preparation and operative cooperation. Closely observe the patient's vital signs and postoperative complications, and give proper care. The health consciousness of patients’ self-regulation is an important measure to ensure safety and efficacy of surgery.

Optimal Testing for Diagnosis of Fructose Malabsorption: Under-dosage Leads to False Negative Intolerance Test.

TO THE EDITOR: With great interest we have been following the discussion about our study published in Journal of Neurogastroenterology and Motility.1 We highly estimate the recent constructive comments expressed by the authors Erdogan and colleagues2 and would like to make some conclusive remarks. We fully agree with the authors that all patients with irritable bowel syndrome (IBS)-like symptoms should undergo breath testing and have specifically stated this in our manuscript. Thus, we are not sure where Erdogan et al2 got the notion that such tests should only be performed for research purposes. We furthermore agree with Erdogan et al2 that 2 consecutive breath tests are impractical, especially considering the bothersome symptoms that patients experience during and after testing. Therefore, we favor the breath test with 50 g fructose. From our yet unpublished data we know that H2 breath tests with 50 g fructose identify patients with IBS-like symptoms who will benefit from a fructose-reduced diet. If only 25 g tests were performed, an important subgroup (the ones with symptomatic 50 g breath test) would be missed although they greatly benefit from a detailed dietary counseling, while patients with positive 25 g breath test already benefit from brief dietary advice as shown by a decline in gastrointestinal (GI) symptoms, improved quality of life and state of health. In patients with severe fructose malabsorption only the detailed dietary advice regimen resulted in improvement of GI symptoms and perceived state of health. This is our rationale to perform a breath test with 50 g of fructose. The German consensus paper on clinically relevant breath tests in gastroenterological diagnostics does not always recommend a test with 50 g. It points out that in case of highly suspected fructose malabsorption, the high dose test should be performed first and in case of a positive outcome, an additional 25 g test enhances specificity.3 On the other hand, the rationale to start with the low dose is that healthy volunteers almost never malabsorb 25 g. Thus, the test has an excellent specificity because, according to test criteria, there are rarely false positives. However, we feel that the low dose test lacks sensitivity because a proportion of negative low dose breath testers will still respond to a fructose elimination diet. To deal with the lower specificity in the high dose test, observing symptoms during the test can help: increased H2 excretion combined with typical symptoms triggered by the high dose challenge is a good criterion to distinguish between true and false positive patients, and healthy volunteers barely report symptoms even though they may have elevated H2 excretion.4 Some healthy subjects and patients with IBS-like symptoms are able to fully absorb 50 g of fructose because otherwise, every test person would have significant H2 excretion and symptoms. In our study 64% were symptomatic fructose malabsorbers with a 50 g test dose, which in reverse implies that 36% of patients with unclear abdominal discomfort were able to absorb 50 g of fructose without clinical symptoms. We disagree with the authors that amounts > 25 g of fructose are nowadays not consumed at once. As recently outlined, a 16-oz bottle of apple juice may contain > 30 g fructose and a 22-oz soft drink could contain approximately 30 g to 40 g depending on the percent fructose in the corn syrup sweetener,5,6 both representing liquids regularly consumed by a large proportion of the population. As clinicians we will accept false positives. They may undergo a 4–6 weeks dietary trial and not respond. But it is unpleasant to exclude patients, in whom most of the treatments have failed, from a fructose elimination diet that works most of the time in these patients because their diagnosis was missed. Thus, we find it more appropriate to use the high dose test with 50 g because we feel that it is clinically more relevant.

Pulmonary manifestation in children with systemic lupus erythematosus

Objective To observe the incidence, clinical types, and prognosis of pulmonary involvement in children with systemic lupus erythematosus(SLE), and to probe the relationship between the relative factors. Methods The clinical data of 61 children with SLE, who treated in Children's Hospital of Shanghai from Jan.2006 to Dec.2011 were analyzed retrospectively.The lung manifestations of the patients were classified according to their clinical symptoms and signs, and lung imaging examination(chest X-ray and CT). Other data of the SLE patients with lung injury or without lung injury were collected, including the course of the disease, activity index[SLE disease activity index(SLEDAI) scoring 0-4 was divided into no activity, 5-9 was divided into low activity, 10-14 was divided into moderate activity, and more than 15 as severe activity], blood sedimentation, the values of serum complement and the positive rate of dsDNA in autoantibody, and a comparison was made and statistical analysis was performed. Results Pulmonary injury occurred in 17 cases with an incidence rate of 27.9%(17/61 cases), and the average course of the disease was (8.76±6.96) months.The clinical manifestations of 17 cases included fever, cough, dyspnea, hypoxemia, chest pain, lower breath sound, and lung rale, which were not non-specificity.According to imageological examination, in 17 cases there were 2 cases with pulmonary hypertension (the incidence rate was 11.8%), 4 cases with acute lupus pneumonitis (the incidence rate was 23.5%), 6 cases with interstitial pneumonia (the incidence rate was 35.3%), 7 cases with lesion of pleura (the incidence rate was 41.2%), 10 cases with pulmonary infection(the incidence rate was 58.8%). There were no statistical differences between patients with and without lung injury(infectious and non-infectious)in the course, the values of serum complement, the positive rate of dsDNA and activity index.Lung lesions of the 17 patients recovered quickly after early diagnosis and active treatment. Conclusions Pulmonary manifestation in children with SLE is not uncommon, and it can happen at any stage of the disease, not just on the stage of lupus activity, but it usually indicates disease was not controlled.Pulmonary manifestation of SLE in children involve many parts of lung, including pulmonary parenchyma, interstitial, blood vessels, pleura, etc.Early diagnosis and active treatment can improve the short-term prognosis of lung injury with lupus, and long-term outcome remains to be observed. Key words: Systemic lupus erythematosus; Pulmonary injury; Child

The effects of percentile versus fixed criterion schedules on smoking with equal incentive magnitude for initial abstinence.

Incentives have been successfully used to reduce smoking in hard-to-treat (HTT) smokers by progressively reinforcing lower levels of breath carbon monoxide (CO). When compared with schedules only providing incentives for smoking abstinence, using a progressive (percentile) criterion facilitates longer periods of smoking abstinence. However, participants receiving incentives for lower breath CO levels on percentile schedules typically earn more for their first abstinent breath CO sample relative to participants receiving incentives only for smoking abstinence. Many studies show that larger incentive magnitude increases abstinence rates. The present study tested the effects of different incentive schedules on rates of abstinence maintenance while holding the initial incentive magnitude constant for 93 HTT smokers to eliminate initial abstinence incentive magnitude as a potential confound. Smokers were randomized to percentile, fixed criterion, or random incentive schedules. The incentive magnitude for the first abstinent breath CO sample (<3 ppm) was $5 for percentile and fixed criterion incentive participants, and then increased by $0.50 for each consecutive abstinent breath CO sample. All groups had similar patterns of meeting the abstinence criterion for at least 1 visit. However, once this abstinence criterion was met, abstinence was more likely to be maintained by fixed criterion incentive participants. Unlike previous studies comparing percentile and fixed criterion schedules, percentile incentive schedules were not associated with longer periods of abstinence relative to fixed criterion incentive schedules. Further studies that manipulate initial incentive magnitude are needed to test whether the difference between the current and previous studies was due to initial incentive magnitude.

A case of recurrent malignant fibrous histiocytoma with marked response to combined chemotherapy with gemcitabine and carboplatin.

A case of recurrent malignant fibrous histiocytoma with marked response to combined chemotherapy with gemcitabine and carboplatin.

Determination of breath isoprene allows the identification of the expiratory fraction of the propofol breath signal during real-time propofol breath monitoring

Real-time measurement of propofol in the breath may be used for routine clinical monitoring. However, this requires unequivocal identification of the expiratory phase of the respiratory propofol signal as only expiratory propofol reflects propofol blood concentrations. Determination of CO2 breath concentrations is the current gold standard for the identification of expiratory gas but usually requires additional equipment. Human breath also contains isoprene, a volatile organic compound with low inspiratory breath concentration and an expiratory concentration plateau. We investigated whether breath isoprene could be used similarly to CO2 to identify the expiratory fraction of the propofol breath signal. We investigated real-time breath data obtained from 40study subjects during routine anesthesia. Propofol, isoprene, and CO2 breath concentrations were determined by a combined ion molecule reaction/electron impact mass spectrometry system. The expiratory propofol signal was identified according to breath CO2 and isoprene concentrations and presented as median of intervals of 30s duration. Bland-Altman analysis was applied to detect differences (bias) in the expiratory propofol signal extracted by the two identification methods. We investigated propofol signals in a total of 3,590 observation intervals of 30s duration in the 40 study subjects. In 51.4% of the intervals (1,844/3,590) both methods extracted the same results for expiratory propofol signal. Overall bias between the two data extraction methods was -0.12ppb. The lower and the upper limits of the 95% CI were -0.69 and 0.45ppb. Determination of isoprene breath concentrations allows the identification of the expiratory propofol signal during real-time breath monitoring.