Air Lung Research Articles

Validation of a Monte Carlo-based dose calculation engine including the 1.5T magnetic field for independent dose-check in MRgRT.

Adaptive MRgRT by 1.5T MR-linac requires independent verification of the plan-of-the-day by the primary TPS (MonacoTM) (M). Here we validated a Monte Carlo-based dose-check including the magnetostatic field, SciMoCaTM (S). M and S were validated first in water, by comparison with commissioning-dosimetry. PDD(2x2cm2) through a lung(air)-equivalent virtual-slab was then calculated. Clinical validation retrospectively included 161 SBRT plans, from five patients per-site: Pelvic-Nodes, Prostate, Liver, Pancreas, and Lungs. S-minus-M percentage differences (Δ%) were computed for target- and OARs-related dose-volume metrics. In-phantom dose verification per-patient was performed. γ(2%,1mm)-passing-rates (PR%) of in-water-computed PDD and transverse-dose-profiles vs. commissioning-dosimetry were (99.1±2.0)% for M, and (99.3±1.5)% for S. Calculated output-factors (OF) were typically within 1% from measurements, except for OF(1x1cm2) which was misestimated by -4.4% and+2.2%, by M and S respectively. Dose spikes (valleys) on the PDD(2x2cm2) by S across the lung-equivalent virtual-slab were slightly reduced with respect to M. In clinical plans, S computed higher V95% (p<0.05*, for pancreas and lung) and D2% (p<0.05*, for all sites) for the target, while D%>2% resulted for duodenal D(1cm3), in Pancreas-SBRT, and for mean-lung-dose, in Lung-SBRT. All mostly due to the underestimated OF(1x1cm2) by M. In-phantom dose verifications showed an average 1% increase in PR% by S vs. M. Beam-model quality in S resulted equivalent to M, thus making S useful both for an independent validation of the same beam-model in M, and for a daily validation of the M-based online approval decisions, without significantly delaying the clinical workflow (2-3min).

Optimising CPAP and oxygen levels to support spontaneous breathing in preterm rabbits.

Very preterm infants often require respiratory support after birth with current recommendations suggesting the use of continuous positive airway pressure (CPAP) of 4-8 cmH2O and an initial fraction of inspired oxygen (FiO2) of 0.21-0.3. We have examined the interaction of high and low CPAP and FiO2 levels on breathing rates and lung aeration in preterm rabbits. Prematurely delivered rabbits (29/32 days gestation) received CPAP of either 5cmH2O (5CPAP; n = 12) or 15 cmH2O (15CPAP; n = 14), and a FiO2 of either 0.3 (5CPAP/0.3, n = 6 or 15CPAP/0.3, n = 7) or 0.6 (5CPAP/0.6, n = 6 or 15CPAP/0.6, n = 7). Breathing rates, lung aeration (functional residual capacity; FRC), lung bulging and air accumulation in the stomach were measured using phase-contrast X-ray imaging. Kittens receiving 0.6 FiO2 had higher breathing rates (5CPAP/0.6: 32.6±6.4 breaths/min; p = 0.0064 and 15CPAP/0.6: 36.9±3.5breaths/min; p = 0.0010) than 5CPAP/0.3 kittens (11.8±4.1breaths/min). Kittens receiving 15CPAP/0.6 tended to have higher FRC volumes (34.9±4 mL/kg) than kittens receiving 5 cmH2O CPAP (5CPAP/0.3: 13.1±6mL/kg; p = 0.0675 and 5CPAP/0.6: 13.5±6 mL/kg; p = 0.1720) and 15CPAP/0.3 (22.5 ± 6.6 mL/kg; p = 0.4245). Lung bulging and air accumulation in the stomach were not different between groups. Preterm rabbits supported with both 15 cmH2O CPAP and 0.6 FiO2 increased spontaneous breathing rates and lung aeration without increasing the risk of air in the stomach or lung bulging. While current guidelines recommend the use of low CPAP (4-8 cmH2O) and low FiO2 levels (0.21-0.3 FiO2) to support preterm infants at birth, the optimum levels are unknown. This study has shown that 15 cmH2O of CPAP and FiO2 of 0.6 improved lung aeration and breathing in preterm rabbits, compared with a CPAP of 4 cmH2O and FiO2 of 0.3. These results add to the evidence indicating that initial high CPAP and high FiO2 levels, followed by titration of both, enhance respiratory support for preterm newborns.

Tracheal, bronchus, and lung cancer mortality and air pollution exposure in Tuscany, Italy: Bayesian Health Impact Assessment and Global Sensitivity Analysis on a sub-regional scale.

Outdoor air pollution is a significant risk factor for tracheal, bronchus, and lung (TBL) cancer. This study employs a Bayesian approach to evaluate TBL cancer mortality due to air pollution in Tuscany, Central Italy, in 2023. Using locally validated data, we assessed the impact of fine particulate matter (PM10 and PM2.5) and nitrogen dioxide (NO2) in terms of attributable deaths and years of life lost (YLL). Our three-step methodology included: (1) Bayesian modeling to derive posterior distributions for life expectancy, pollution levels, mortality rates, and exposure-response functions (inputs); (2) Monte Carlo simulations to propagate uncertainty from the inputs to the impact metrics (outputs); and (3) Global Sensitivity Analysis (GSA) to quantify the influence of each input on the outputs. The largest impact was estimated for PM2.5, with 432 deaths (50% CrI: 174;705) and 6,500 YLL (50% CrI: 2,624;10,613) in the region due to annual average concentrations exceeding the WHO threshold of 5μg/m3. Central districts, with higher exposure levels, were particularly affected, reporting 14 attributable deaths and 207 attributable YLL per 100,000 inhabitants. The GSA indicated that uncertainty in exposure-response functions and annual average concentrations of air pollutants significantly affected outcomes, highlighting the need to strengthen the regional air quality network and conduct local studies to address effects heterogeneity. Our findings highlight the value of high-quality local health assessments for identifying critical areas, setting intervention priorities, and informing context-specific action plans.

GOLD grade-specific characterization of COPD in the COSYCONET multi-center trial: comparison of semiquantitative MRI and quantitative CT.

We hypothesized that semiquantitative visual scoring of lung MRI is suitable for GOLD-grade specific characterization of parenchymal and airway disease in COPD and that MRI scores correlate with quantitative CT (QCT) and pulmonary function test (PFT) parameters. Five hundred ninety-eight subjects from the COSYCONET study (median age = 67 (60-72)) at risk for COPD or with GOLD1-4 underwent PFT, same-day paired inspiratory/expiratory CT, and structural and contrast-enhanced MRI. QCT assessed total lung volume (TLV), emphysema, and air trapping by parametric response mapping (PRMEmph, PRMfSAD) and airway disease by wall percentage (WP). MRI was analyzed using a semiquantitative visual scoring system for parenchymal defects, perfusion defects, and airway abnormalities. Descriptive statistics, Spearman correlations, and ANOVA analyses were performed. TLV, PRMEmph, and MRI scores for parenchymal and perfusion defects were all higher with each GOLD grade, reflecting the extension of emphysema (all p < 0.001). Airway analysis showed the same trends with higher WP and higher MRI large airway disease scores in GOLD3 and lower WP and MRI scores in GOLD4 (p = 0.236 and p < 0.001). Regional heterogeneity was less evident on MRI, while PRMEmph and MRI perfusion defect scores were higher in the upper lobes, and WP and MRI large airway disease scores were higher in the lower lobes. MRI parenchymal and perfusion scores correlated moderately with PRMEmph (r = 0.61 and r = 0.60) and moderately with FEV1/FVC (r = -0.56). Multi-center semiquantitative MRI assessments of parenchymal and airway disease in COPD matched GOLD grade-specific imaging features on QCT and detected regional disease heterogeneity. MRI parenchymal disease scores were correlated with QCT and lung function parameters. Question Do MRI-based scores correlate with QCT and PFT parameters for GOLD-grade specific disease characterization of COPD? Findings MRI can visualize the parenchymal and airway disease features of COPD. Clinical relevance Lung MRI is suitable for GOLD-grade specific disease characterization of COPD and may serve as a radiation-free imaging modality in scientific and clinical settings, given careful consideration of its potential and limitations.

Update in association between Lung Cancer and air pollution.

A significant portion of newly diagnosed lung cancer cases occur in populations exposed to air pollution. The World Health Organization has identified air pollution as a human carcinogen, prompting many countries to implement monitoring systems for ambient particulate matter (PM). PM consists of a complex mix of organic and inorganic particles, both solid and liquid, present in the air. Given the carcinogenic properties of PM and the prevalence of lung cancer in exposed populations, it is crucial to explore their connection and clinical implications to effectively prevent lung cancer in this group. This review examines the link between ambient PM and lung cancer. Epidemiological studies have shown a dose-response relationship between PM exposure and lung cancer risk. PM exposure leads to oxidative stress, disrupting the body's redox balance and causing DNA damage, a key factor in cancer development. Recent findings on the strong correlation between ambient PM and adenocarcinoma suggest that understanding the specific molecular and pathological background of pollution-related lung cancer is important. In addition to efforts to control emission sources at the international level, a more individualized approach is necessary to prevent PM-related lung cancer development.

Maximal oxygen uptake, pulmonary function and walking economy are not impaired in patients diagnosed with long COVID.

SARS-CoV-2 may result in the development of new symptoms, known aslong COVID, a few months after the original infection. It is elusive to what extent physical capacity in patients diagnosed with long COVID is impacted. We compared maximal oxygen uptake (V̇O2max), one of the single most important factors for cardiovascular health and mortality, expired lung volumes and air flow, oxygen cost of walking and 6-min-walking-test (6MWT), in 20 patients diagnosed with long COVID (11 males and 9 females; 44 ± 16years (SD); 26.7 ± 3.8BMI, duration of acute phase 1.7 ± 1.2weeks, tested 4 ± 3months after long COVID diagnosis) with 20 healthy age and sex matched controls (11males and 9females; 44 ± 16years; 25.9 ± 4.0BMI). Long COVID patients had a V̇O2max of 41.4 ± 16.2mL∙kg-1∙min-1(men) and 38.2 ± 7.5 (women) and this was not different from controls. Similarly, mean spirometry measures in the patient group (VC; FVC; FEV1; FEV1/FVC) were also not different (85-106%) from predicted healthy values. Finally, inclined treadmill (5%, 4km∙h-1) walking economy was not different between the groups (long COVID: 15.2 ± 1.1mL∙kg-1∙min-1; controls: 15.2 ± 1.2mL∙kg-1∙min-1), while the 6MWT revealed a difference (long COVID: 606 ± 118m; controls: 685 ± 85m; p = 0.036). V̇O2max, oxygen cost of walking, and spirometry measurements did not appear to be impaired in patients diagnosed with long COVID with a prior mild to moderate SARS-CoV-2 infection. The typical outcomes in these essential factors for health and longevity implies that while long COVID can present with a range of symptoms, caution should be made when attributing these symptoms directly to compromised pulmonary function or V̇O2max.

Association of Exercise Tolerance with Respiratory Health Outcomes in Mild-to-Moderate COPD.

Rationale: Previous studies have identified exercise intolerance in patients with mild-to-moderate chronic obstructive pulmonary disease (COPD). The associations of exercise tolerance with lung function decline and acute exacerbation risk in mild-to-moderate COPD is unclear, especially in the community population. Objectives: We evaluated exercise tolerance in mild-to-moderate COPD and analyzed its associations with respiratory health outcomes. Methods: We analyzed data from the Early Chronic Obstructive Pulmonary Disease community-based study of patients with mild-to-moderate COPD (post- bronchodilator FEV1/FVC <0.70 and FEV1 ≥50% predicted). Patients who completed questionnaires, spirometry, and cardiopulmonary exercise testing at baseline were included. Annual exacerbation assessment and spirometry testing were conducted for 2 years consecutively. Exercise tolerance was defined as the percentage of predicted peak oxygen uptake (VO2peak %predicted). We analyzed the association between exercise tolerance, annual lung function decline, and acute exacerbation risk. Measurements and Main Results: Overall, 338 patients were included in the baseline analysis, and 319 completed the 2-year follow-up. The mean and standard deviation (SD) of VO2peak %predicted was 79.8±13.7. Low VO2peak %predicted was associated with more chronic respiratory symptoms, worse lung function, severe emphysema, and air trapping at baseline. During the 2-year follow-up, a decrease of 13.7% (1-SD) in VO2peak %predicted was associated with a decline in pre-bronchodilator FEV1/FVC (difference=0.4%, 95% CI: 0.1%-0.7%, P= 0.003), and higher total exacerbation risk (relative risk [RR]=1.25, 95% CI: 1.08-1.46, P=0.004) after adjustment. Conclusions: Mild-to-moderate COPD patients with exercise intolerance have worse respiratory health outcomes, for which a low exercise tolerance as a prognostic marker.

Vaping Possible Negative Effects on Lungs: State-of-the-Art From Lung Capacity Alteration to Cancer.

Vaping has emerged as a popular alternative to traditional smoking. It produces smokeless vapour by heating an e-liquid mixture in an atomizer. This paper delves into the current state of knowledge surrounding electronic cigarettes, exploring the gap between the perceived safety of e-liquids and the emerging evidence of their harmful effects when inhaled. As we navigate this intricate landscape, it is crucial to unravel the complexities of vaping and its implications for public health. We conducted a three-layer systematic review of the guidelines set by the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Meta-analyses of Observational Studies in Epidemiology (MOOSE). The search was performed in three layers, including the first layer, the effect of vaping on lung function; the second layer, the effect of vaping on lung structure and inducing lung injury; and the third layer, the physiopathologic effect of vaping on the lung and a possible carcinogenic effect. Exposure to e-cigarette vapour reduced lung ventilation in adult male Long-Evans rats, indicating impaired lung function. In male Wistar rats, vaping was associated with a decrease in lung air volume and denser lung tissue structure. Studies on guinea pigs showed that vaping caused acute bronchoconstriction, contributing to lung function impairment. A case study of a young man with an E-cigarette and vaping-induced lung injury (EVALI) highlighted the detrimental effects of vaping on human lung function. The EVALI outbreak in the USA was linked to harmful substances in vapes, such as vitamin E acetate and THC, leading to serious lung injuries, including pneumonia and bronchiolitis. Vaping poses significant health risks, especially to young adults, and misconceptions regarding its safety persist despite evidence of its potential to cause various lung diseases. While vaping has positioned itself as a smoking cessation aid, the discussion surrounding its impact on lung health requires careful consideration. The lack of conclusive evidence on the long-term effects of vaping underscores the need for further research. However, existing data suggest that vaping is not without risks, and its potential association with respiratory issues and cancer underscores the urgency of public health interventions.

Radiomultiomics: quantitative CT clusters of severe asthma associated with multiomics.

Lung quantitative computed tomography (qCT) severe asthma clusters have been reported, but their replication and underlying disease mechanisms are unknown. We identified and replicated qCT clusters of severe asthma in two independent asthma cohorts and determined their association with molecular pathways, using radiomultiomics, integrating qCT, multiomics and machine learning/artificial intelligence. We used consensus clustering on qCT measurements of airway and lung CT scans, performed in 105 severe asthmatic adults from the U-BIOPRED cohort. The same qCT measurements were used to replicate qCT clusters in a subsample of the ATLANTIS asthma cohort (n=97). We performed integrated enrichment analysis using blood, sputum, bronchial biopsies, bronchial brushings and nasal brushings transcriptomics and blood and sputum proteomics to characterise radiomultiomic-associated clusters (RACs). qCT clusters and clinical features in U-BIOPRED were replicated in the matched ATLANTIS cohort. In the U-BIOPRED cohort, RAC1 (n=30) was predominantly female with elevated body mass index, mild airflow limitation, decreased CT lung volume and increased lung density and upregulation of the complement pathway. RAC2 (n=34) subjects had airway wall thickness and a mild degree of airflow limitation, with upregulation of proliferative pathways including neurotrophic receptor tyrosine kinase 2/tyrosine kinase receptor B, and downregulation of semaphorin pathways. RAC3 (n=41) showed increased lung attenuation area and air trapping, severe airflow limitation, hyperinflation, and upregulation of cytokine signalling and signalling by interleukin pathways, and matrix metallopeptidase 1, 2 and 9. U-BIOPRED severe asthma qCT clusters were replicated in a matched independent asthmatic cohort and associated with specific molecular pathways. Radiomultiomics might represent a novel strategy to identify new molecular pathways in asthma pathobiology.

POCUS use in the critical care areas: The use of posterior view for heart assessment

AbstractEchocardiography can be quickly deployed for bedside management of critically ill patients, using parasternal, apical, and subxiphoid windows. However, lung air can obstruct these views. As left pleural effusion can cause pulmonary atelectasis, it creates a liquid space that improves ultrasonic transmission when using a postero‐lateral approach. This unconventional view uses a phased array transducer positioned at the posterior axillary line between the fourth and fifth intercostal spaces, enabling four‐chamber heart visualization. Although limited without pleural effusion, this method becomes valuable in the presence of a left‐sided effusion and when conventional views are inadequate.

The Relationship between Lung Cancer Prevalence and Air Quality and Other Factors

The Relationship between Lung Cancer Prevalence and Air Quality and Other Factors

Assessment of spatial variation in lung cancer incidence and air pollutants: spatial regression modeling approach

ABSTRACT A notable finding is that Kerala’s capital Thiruvananthapuram has shown an increasing trend in lung cancer (LC) incidence. Long-term exposure to air pollution is a significant environmental risk factor for LC. This study investigated the spatial association between LC and exposure to air pollutants in Thiruvananthapuram, using Spatial Lag Model (SLM), Spatial Error Model (SEM), and Geographically Weighted Regression (GWR). The results showed that overall LC incidence rate was 111 per 105 males (age >60 years), whereas spatial distribution map revealed that 48% of the area had an incidence rate greater than 150. The results revealed a significant association between PM2.5 and LC. SLM was identified as the best model that predicted 62% variation in LC. GWR model improved model performance and made better local predictions in the southeastern parts of the study area. This study explores the effectiveness of spatial regression techniques for dealing spatial effects and pinpointing high-risk areas.

Lung Cancer and Air Quality in a Large Urban County in the United States.

Lung cancer is the leading cancer-related killer in the United States. The incidence varies geographically and may be affected by environmental pollutants. Our goal was to determine associations within time series for specific air pollutants and lung cancer cases over a 33-year period in Wayne County, Michigan, controlling for population change. Lung cancer data for Wayne County were queried from the Michigan Cancer Registry from 1985 to 2018. Air pollutant data were obtained from the United States Environmental Protection Agency from 1980 to 2018. Autoregressive distributed lag (ARDL) models were estimated to investigate time lags in years between specific air pollution levels and lung cancer development. A total of 58,866 cases of lung cancer were identified. The mean age was 67.8 years. Females accounted for 53 percent of all cases in 2018 compared to 44 percent in 1985. Three major clusters of lung cancer incidence were detected with the most intense clusters in downtown Detroit and the heavily industrialized downriver area. Sulfur dioxide (SO2) had the strongest statistically significant relationship with lung cancer, showing both short- and long-term effects (lag range, 1-15 years). Particulate matter (PM2.5) (lag range, 1-3 years) and nitrogen dioxide (NO2) (lag range, 2-4 years) had more immediate effects on lung cancer development compared to carbon monoxide (CO) (lag range, 5-6 years), hazardous air pollutants (HAPs) (lag range, 9 years) and lead (Pb) (lag range, 10-12 years), which had more long-term effects on lung cancer development. Areas with poor air quality may benefit from targeted interventions for lung cancer screening and reductions in environmental pollution.

Regional Pulmonary Ventilation Assessment Method and System Based on Impedance Sensing Information from the Pentapulmonary Lobes

Regional lung ventilation assessment is a critical tool for the early detection of lung diseases and postoperative evaluation. Biosensor-based impedance measurements, known for their non-invasive nature, among other benefits, have garnered significant attention compared to traditional detection methods that utilize pressure sensors. However, solely utilizing overall thoracic impedance fails to accurately capture changes in regional lung air volume. This study introduces an assessment method for lung ventilation that utilizes impedance data from the five lobes, develops a nonlinear model correlating regional impedance with lung air volume, and formulates an approach to identify regional ventilation obstructions based on impedance variations in affected areas. The electrode configuration for the five lung lobes was established through numerical simulations, revealing a power–function nonlinear relationship between regional impedance and air volume changes. An analysis of 389 pulmonary function tests refined the equations for calculating pulmonary function parameters, taking into account individual differences. Validation tests on 30 cases indicated maximum relative errors of 0.82% for FVC and 0.98% for FEV1, all within the 95% confidence intervals. The index for assessing regional ventilation impairment was corroborated by CT scans in 50 critical care cases, with 10 validation trials showing agreement with CT lesion localization results.

A Novel Ultrasound Imaging Assistance UI: Using Marker‐Based Coordinate System for Real‐Time Breathing Monitoring and Probe Positioning

Ultrasound is widely employed in medical examinations due to its noninvasive, radiation‐free, and convenient features. However, the quality of acquired ultrasound images is highly dependent on the skill of the operator and experience, which significantly limits the use of ultrasound. In this study, we propose a new user interface (UI) designed to assist novices in independently acquiring accurate ultrasound images. The operator can complete image acquisition by adjusting the position and angle of the actual probe to align the projected probe on the UI screen to a specific position, while simultaneously observing the breath state of the subject to capture ultrasound images at the appropriate position and moment. We compare our UI with a previous UI in an experiment. The results demonstrate that novice operators can acquire more accurate ultrasound images using our UI compared to the previous UI, indicating that our UI offers improved guidance. Regarding breath state observation, the experiment reveals a strong association between changes in lung air volume of a subject and respiratory level changes measured by our system. © 2024 Institute of Electrical Engineers of Japan. Published by Wiley Periodicals LLC.

Lung function in children residents in the largest coal region in Brazil.

Coal mining activities release harmful air pollutants, which affect children's health, particularly the lung function. Brazil has a large coal reserve in the southern region, where a coal-fired power plant and two coal mines are located. The study aimed to evaluate the prevalence of altered respiratory function and associated factors in children living in this region. A cross-sectional study was conducted in seven cities. It collected socioeconomic and demographic, prenatal and postnatal care, neonatal outcomes, child health information as well as lung function and air quality. The study included 396 children who lived in a high socio-environmental vulnerability due to low education levels and family income, high percentage of unemployed and families with a high bedroom density. There was a high prevalence of preterm birth, low birth weight and long-term exposure to environmental conditions. The most common respiratory problem in the parents was rhinitis, while in the children was wheezing and pneumonia. The prevalence of respiratory function alteration in the region was 7.78%. Variables associated with altered respiratory function were passive smoking, low birth weight, history of wheezing. The concentration of pollutants was equivalent when comparing stations within the coal mining host town (Candiota) and surrounding towns.

Successful coronary artery bypass surgery in an elderly patient with giant air cyst in the left lung

Lung air cysts and bullae are airborne cavities larger than 1 cm in diameter, surrounded by a thin wall, localized within the lung tissue. The bullae are often located apically in the lung. They are usually asymptomatic unless they are very large in size and are detected on chest X-ray or lung tomography. In this article, we present an asymptomatic 79-year-old male patient who was randomly detected as having an air cyst in the anterior segment of the upper lobe of the left lung during the preparation for coronary bypass. We did not find similar cases in PUBMED literature review.

Cumulative occupational exposure to gases and fumes is associated with impairment in lung function and disease-related quality of life in a German COPD patient cohort

ObjectivesThe impact of occupational exposures on lung function impairments and quality of life (QoL) in patients with chronic obstructive pulmonary disease (COPD) was analysed and compared with that of smoking.MethodsData...

Advancing homogeneous networking principles for the development of fatigue-resistant, low-swelling and sprayable hydrogels for sealing wet, dynamic and concealed wounds in vivo

Effective sealing of wet, dynamic and concealed wounds remains a formidable challenge in clinical practice. Sprayable hydrogel sealants are promising due to their ability to cover a wide area rapidly, but they face limitations in dynamic and moist environments. To address this issue, we have employed the principle of a homogeneous network to design a sprayable hydrogel sealant with enhanced fatigue resistance and reduced swelling. This network is formed by combining the spherical structure of lysozyme (LZM) with the orthotetrahedral structure of 4-arm-polyethylene glycol (4-arm-PEG). We have achieved exceptional sprayability by controlling the pH of the precursor solution. The homogeneous network, constructed through uniform cross-linking of amino groups in protein and 4-arm-PEG-NHS, provides the hydrogel with outstanding fatigue resistance, low swelling and sustained adhesion. In vitro testing demonstrated that it could endure 2000 cycles of underwater shearing, while in vivo experiments showed adhesion maintenance exceeding 24 h. Furthermore, the hydrogel excelled in sealing leaks and promoting ulcer healing in models including porcine cardiac hemorrhage, lung air leakage and rat oral ulcers, surpassing commonly used clinical materials. Therefore, our research presents an advanced biomaterial strategy with the potential to advance the clinical management of wet, dynamic and concealed wounds.

The impact of the synergistic effect of SO2 and PM2.5/PM10 on obstructive lung disease in subtropical Taiwan.

Chronic Obstructive lung diseases (COPD) are complex conditions influenced by various environmental, lifestyle, and genetic factors. Ambient air pollution has been identified as a potential risk factor, causing 4.2 million deaths worldwide in 2016, accounting for 25% of all COPD-related deaths and 26% of all respiratory infection-related deaths. This study aims to evaluate the associations among chronic lung diseases, air pollution, and meteorological factors. This cross-sectional study obtained data from the Taiwan Biobank and Taiwan Air Quality Monitoring Database. We defined obstructive lung disease as patients with FEV1/FVC < 70%. Descriptive analysis between spirometry groups was performed using one-way ANOVA and the chi-square or Fisher's exact test. A generalized additive model (GAM) was used to evaluate the relationship between SO2 and PM2.5/PM10 through equations and splines fitting. A total of 2,635 participants were enrolled. Regarding environmental factors, higher temperature, higher relative humidity, and lower rainfall were risk factors for obstructive lung disease. SO2 was positively correlated with PM10 and PM2.5, with correlation coefficients of 0.53 (p < 0.0001) and 0.52 (p < 0.0001), respectively. Additionally, SO2 modified the relative risk of obstructive impairment for both PM10 [β coefficient (β) = 0.01, p = 0.0052] and PM2.5 (β = 0.01, p = 0.0155). Further analysis per standard deviation (per SD) increase revealed that SO2 also modified the relationship for both PM10 (β = 0.11, p = 0.0052) and PM2.5 (β = 0.09, p = 0.0155). Our GAM analysis showed a quadratic pattern for SO2 (per SD) and PM10 (per SD) in model 1, and a quadratic pattern for SO2 (per SD) in model 2. Moreover, our findings confirmed synergistic effects among temperature, SO2 and PM2.5/PM10, as demonstrated by the significant associations of bivariate (SO2 vs. PM10, SO2 vs. PM2.5) thin-plate smoothing splines in models 1 and 2 with obstructive impairment (p < 0.0001). Our study showed high temperature, humidity, and low rainfall increased the risk of obstructive lung disease. Synergistic effects were observed among temperature, SO2, and PM2.5/PM10. The impact of air pollutants on obstructive lung disease should consider these interactions.