Nose Throat Research Articles

Characterization of pediatric extrathoracic aerosol deposition with air-jet dry powder inhalers

The use of air-jet dry powder inhalers (DPIs) offers a number of advantages for the administration of pharmaceutical aerosols, including the ability to achieve highly efficient and potentially targeted aerosol delivery to the lungs of children using the oral or trans-nasal routes of administration. To better plan targeted lung delivery of pharmaceutical aerosols with these inhalers, more information is needed on the extrathoracic (ET) depositional loss in pediatric subjects when using relatively small (e.g., 0.5–2 μm) particles and including oral or nasal device interfaces. The objective of this study was to implement validated computational fluid dynamics (CFD) models to characterize ET depositional loss during mouth-throat (MT) and nose-throat (NT) aerosol administration to pediatric subjects (2–10 years old) using an air-jet DPI platform across a range of initial small-particle aerosol sizes (0.41–13.65 μm) and inhalation flow rates (8–20 L/min).A new CFD model focused on small-particle aerosol depositional loss in existing pediatric airway models was developed and validated with existing in vitro data. The validated CFD model was then used to characterize depositional loss in the MT and NT regions of children using particle sizes, flow rates and interfaces consistent with air-jet DPIs.Successful validation of the CFD model for small-particle aerosol deposition was achieved through enhanced resolution of the near-wall transport conditions. Existing non-dimensional parameters were used to produce high quality single-curve deposition efficiency correlations with r2 values in the range of 0.95–0.97. A new method for predicting realistic polydisperse aerosol deposition using the developed correlations and an equivalent monodisperse particle diameter was also introduced. In conclusion, the newly developed correlations will be useful in planning the lung delivery of next-generation inhaled medications, where achieving both low ET loss and targeted airway deposition, perhaps with excipient enhanced growth technology, are critical factors.

Comparison of king vision video laryngoscope with macintosh laryngoscope for nasotracheal intubation: Randomized control study

Nasotracheal intubation is essential in oro-maxillofacial surgeries to provide a good operational field along with a secured airway. In this study, we aim to compare king vision video laryngoscope with conventional Macintosh laryngoscope for nasotracheal intubation in ear, nose throat and oro-maxillofacial surgeries under general anaesthesia. A total of 102 patients were posted for elective oro-maxillofacial surgeries under general anaesthesia with nasal intubation. Patients were randomized to two different groups. In group K nasotracheal intubation was done with king vision video laryngoscope (KVVL) and in group M with Macintosh laryngoscope. Primary objective was to compare total intubation time and each time intervals (time A: placement of the nasal tube from selected nostril to oropharynx; time B: use of devices to view the glottis, and time C: for nasal tube to be advanced from oropharynx into trachea and removal of the laryngoscope from oral cavity). Secondary objectives were to compare scores of Modified Naso Intubation Difficulty Scale (MNIDS) and haemodynamic responses.The mean total intubation time, and time C interval were noted in King Vision Video Laryngoscope group (37.29±7.83 s and 15.99±8.9 s) and Macintosh laryngoscope group (46.11±10.05 s and 19.86±9.96 s) respectively. There was significant difference between these two groups in terms of mean total intubation time, and time C interval (total time, p=0.001 and time C, p=0.041). The level of difficulty in intubation noted using MNIDS score which is zero in 52.9% patients in King Vision group and 23.5% in Macintosh group (p=0.011).As compared to Macintosh laryngoscope, the king vision laryngoscope requires lesser time for nasotracheal intubation. In addition, Intubation is easier with the king vision laryngoscope than with the Macintosh laryngoscope.

INTERPROFESSIONAL HEALTH CARE: INTEGRATING AUDIOLOGY AND GERIATRICS IN INTERNATIONAL SETTINGS

Abstract Hearing is fundamental to communication and important for quality of life and overall health of older adults. Despite a potentially large role in how patients engage in healthcare, its importance is underrecognized in healthcare settings. Decreased patient-provider communication and poor treatment understanding may drive decreased satisfaction with healthcare services and avoidance of routine medical care, resulting in poorer health outcomes for older adults with hearing loss. Additionally, despite a high prevalence of hearing loss, less than 20% of those who could potentially benefit from hearing healthcare use hearing aids, potentially exacerbating sequalae of hearing loss in healthcare settings. Amidst growing recognition of the need for inter-professional healthcare collaboration, this session will focus on how audiologists and hearing specialists may partner with other healthcare providers (pharmacists, nurses, physicians) to address hearing needs in primary care, specialty care and hospital settings. We will include perspectives from the United Kingdom, the United States and Canada. We will describe factors that facilitate and impede communication between pharmacists and patients with hearing loss in the community pharmacy. We will also present results of a mixed-methods study from an interdisciplinary team (gerontology, public health, audiology, and otolaryngology/ear nose throat (ENT)) to inform primary care/ENT physicians about preferences for hearing treatment among Black women in the United States. Within a hospital setting, we will present how audiologist-nurse partnerships impact delirium. We will conclude with a discussion of how policy for hearing aid coverage impacts primary care providers recommendations for hearing healthcare in the United States.

The QuantuMDx Q-POC SARS-CoV-2 RT-PCR assay for rapid detection of COVID-19 at point-of-care: preliminary evaluation of a novel technology

Accurate and rapid point-of-care (PoC) diagnostics are critical to the control of the COVID-19 pandemic. The current standard for accurate diagnosis of SARS-CoV-2 is laboratory-based reverse transcription polymerase chain reaction (RT-PCR) assays. Here, a preliminary prospective performance evaluation of the QuantuMDx Q-POC SARS-CoV-2 RT-PCR assay is reported. Between November 2020 and March 2021, 49 longitudinal combined nose/throat (NT) swabs from 29 individuals hospitalised with RT-PCR confirmed COVID-19 were obtained at St George’s Hospital, London. In addition, 101 mid-nasal (MN) swabs were obtained from healthy volunteers in June 2021. These samples were used to evaluate the Q-POC SARS-CoV-2 RT-PCR assay. The primary analysis was to compare the sensitivity and specificity of the Q-POC test against a reference laboratory-based RT-PCR assay. The overall sensitivity of the Q-POC test compared with the reference test was 96.88% (83.78– 99.92% CI) for a cycle threshold (Ct) cut-off value for the reference test of 35 and 80.00% (64.35–90.95% CI) without altering the reference test’s Ct cut-off value of 40. The Q-POC test is a sensitive, specific and rapid PoC test for SARS-CoV-2 at a reference Ct cut-off value of 35. The Q-POC test provides an accurate option for RT-PCR at PoC without the need for sample pre-processing and laboratory handling, enabling rapid diagnosis and clinical triage in acute care and other settings.

Effects of different mesh nebulizer sources on the dispersion of powder formulations produced with a new small-particle spray dryer

The objective of this study was to explore the aerosolization performance of powders produced with different mesh nebulizer sources in the initial design of a new small-particle spray dryer system. An aqueous excipient enhanced growth (EEG) model formulation was spray dried using different mesh sources and the resulting powders were characterized based on (i) laser diffraction, (ii) aerosolization with a new infant air-jet dry powder inhaler, and (iii) aerosol transport through an infant nose-throat (NT) model ending with a tracheal filter. While few differences were observed among the powders, the medical-grade Aerogen Solo (with custom holder) and Aerogen Pro mesh sources were selected as lead candidates that produced mean fine particle fractions <5 µm and <1 µm in ranges of 80.6–77.4% and 13.1–16.0%, respectively. Improved aerosolization performance was achieved at a lower spray drying temperature. Lung delivery efficiencies through the NT model were in the range of 42.5–45.8% for powders from the Aerogen mesh sources, which were very similar to previous results with a commercial spray dryer. Ultimately, a custom spray dryer that can accept meshes with different characteristics (e.g., pore sizes and liquid flow rates) will provide particle engineers greater flexibility in producing highly dispersible powders with unique characteristics.

A Technical Approach to Anesthesia in the Case of Tonsillectomy

&lt;div class="WordSection1"&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Tonsillectomy is the most common surgical procedure performed by an ENT doctor (Throat Nose Ear) in children. This surgery can cause pain, bleeding and swelling in the injured throat. Patient may complain of pain, difficulty swallowing, eating, drinking disorders, nausea and vomiting and fall into a dehydrated state. This can reduce patient satisfaction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion:&lt;/strong&gt; Postoperative pain management of tonsillectomy is a concern both by the ENT doctor and by the anesthesiologist. The high incidence of post-tonsillectomy pain or anxiety increases the risk of secondary post-tonsillectomy bleeding. It is necessary to know the mechanism of post operative pain and the negative impact of pain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; Doctors should give attention to reduce postoperative pain and choose a rational analgesic to overcome post operative tonsillectomy pain.&lt;/p&gt;&lt;/div&gt;

Unusual Presentation of Anca Vasculitis with Otitis Media and CVA

A 42-year-old African female (Kenyan in origin), known to have hypertension that was diagnosed during gestation and persisted; presented with a history of dysphagia for four years. Before her admission, she had presented to the surgical clinic with ear fullness and ear pain with throbbing headaches, and she was diagnosed with bilateral oto-mastoditis. Her symptoms subsequently, progressed to a multisystemic disease involving the lungs, brain, kidneys, and peripheral nerves. ANCA vasculitis is a rare disease, the main target organs in granulomatous polyangiitis include the ear, nose throat, and upper respiratory tract, and glomerulonephritis of the kidney and the lungs. Localized disease manifestation can include the nose (rhinorrhea, nasal crusts, septal perforation) and ear (otitis media, hearing loss, sensorineural deficits). The diagnosis of vasculitis from localized disease manifestation can be difficult to diagnose.

Development of a High-Dose Infant Air-Jet Dry Powder Inhaler (DPI) with Passive Cyclic Loading of the Formulation.

The objective of this study was to incorporate a passive cyclic loading strategy into the infant air-jet dry powder inhaler (DPI) in a manner that provides high efficiency aerosol lung delivery and is insensitive to powder mass loadings and the presence of downstream pulmonary mechanics. Four unique air-jet DPIs were initially compared and the best performing passive design (PD) was selected for sensitivity analyses. A single preterm in vitro nose-throat (NT) model, air source, and nasal interface were utilized throughout. While the majority of analyses were evaluated with a model spray-dried excipient enhanced growth (EEG) formulation, performance of a Surfactant-EEG formulation was also explored for the lead DPI design. Two devices, PD-2 and PD-3, evaluated in the preterm model achieved an estimated lung delivery efficiency of 60% with the model EEG formulation, and were not sensitive to the loaded dose (10-30mg of powder). The PD-3 device was also unaffected by the presence of downstream pulmonary mechanics (infant lung model) and had only a minor sensitivity to tripling the volume of the powder reservoir. When using the Surfactant-EEG formulation, increasing the actuation flow rate from 1.7 to 4.0 L/min improved lung delivery by nearly 10%. The infant air-jet DPI platform was successfully modified with a passive cyclic loading strategy and capable of providing an estimated > 60% lung delivery efficiency of a model spray-dried formulation with negligible sensitivity to powder mass loading in the range of 10-30mg and could be scaled to deliver much higher doses.

Characterizing the Effects of Nasal Prong Interfaces on Aerosol Deposition in a Preterm Infant Nasal Model

The objective of this study was to characterize the effects of multiple nasal prong interface configurations on nasal depositional loss of pharmaceutical aerosols in a preterm infant nose-throat (NT) airway model. Benchmark in vitro experiments were performed in which a spray-dried powder formulation was delivered to a new preterm NT model with a positive-pressure infant air-jet dry powder inhaler using single- and dual-prong interfaces. These results were used to develop and validate a computational fluid dynamics (CFD) model of aerosol transport and deposition in the NT geometry. The validated CFD model was then used to explore the NT depositional characteristic of multiple prong types and configurations. The CFD model highlighted a turbulent jet effect emanating from the prong(s). Analysis of NT aerosol deposition efficiency curves for a characteristic particle size and delivery flowrate (3 µm and 1.4 L/min (LPM)) revealed little difference in NT aerosol deposition fraction (DF) across the prong insertion depths of 2–5 mm (DF = 16–24%) with the exception of a single prong with 5-mm insertion (DF = 36%). Dual prongs provided a modest reduction in deposition vs. a single aerosol delivery prong at the same flow for insertion depths < 5 mm. The presence of the prongs increased nasal depositional loss by absolute differences in the range of 20–70% compared with existing correlations for ambient aerosols. In conclusion, the use of nasal prongs was shown to have a significant impact on infant NT aerosol depositional loss prompting the need for prong design alterations to improve lung delivery efficiency.Graphical

In Vitro Analysis of Nasal Interface Options for High-Efficiency Aerosol Administration to Preterm Infants.

Background: An infant air-jet dry powder inhaler (DPI) platform has recently been developed that in combination with highly dispersible spray-dried powder formulations can achieve high-efficiency aerosolization with low actuation air volumes. The objective of this study was to investigate modifications to the nasal interface section of this platform to improve the aerosol delivery performance through preterm nose-throat (NT) models. Methods: Aerosol delivery performance of multiple nasal interface flow pathways and prong configurations was assessed with two in vitro preterm infant NT models. Two excipient-enhanced growth (EEG) dry powder formulations were explored containing either l-leucine or trileucine as the dispersion enhancer. Performance metrics included aerosol depositional loss in the nasal interface, deposition in the NT models, and tracheal filter deposition, which was used to estimate lung delivery efficiency. Results: The best performing nasal interface replaced the straight flexible prong of the original gradual expansion design with a rigid curved prong (∼20° curvature). The prong modification increased the lung delivery efficiency by 5%-10% (absolute difference) depending on the powder formulation. Adding a metal mesh to the flow pathway, to dissipate the turbulent jet, also improved lung delivery efficiency by ∼5%, while reducing the NT depositional loss by a factor of over twofold compared with the original nasal interface. The platform was also found to perform similarly in two different preterm NT models, with no statistically significant difference between any of the performance metrics. Conclusions: Modifications to the nasal interface of an infant air-jet DPI improved the aerosol delivery through multiple infant NT models, providing up to an additional 10% lung delivery efficiency (absolute difference) with the lead design delivering ∼57% of the loaded dose to the tracheal filter, while performance in two unique preterm airway geometries remained similar.

Pain in Patients with Post Paralytic Hemifacial Spasm: Before, during and after Botulinum Toxin Injections.

It is well-established that botulinum toxin (BT) injections improve quality of life in patients with postparalytic hemifacial spasm. Nevertheless, injection-related pain and contracture-related pain have not yet been studied. The primary objective of our study was to evaluate injection-related pain in patients with facial palsy sequelae, and to compare the standard technique (syringe) with the Juvapen device. The secondary objective was to evaluate the improvement of contracture-related pain one month after BT injection. Methods: We conducted an observational, prospective, monocentric study based on 60 patients with facial palsy sequelae who received BT injections in our university ENT (ear, nose throat) department. There were 30 patients in the Juvapen group (J) and 30 in the standard technique group (ST). All patients completed Numerical Rating Scale (NRS) questionnaires immediately after the injections and one month later. Results: The average NRS score was 1.33/10 with Juvapen and 2.24/10 with the standard technique (p = 0.0058; Z = 2.75). In patients with contracture-related pain, the average NRS score was 3.53 before BT injection, and 0.41 one month after BT injection (p = 0.0001). Conclusions: Juvapen is a less-painful injection technique than the standard one. BT reduces contracture-related pain one month after injection.

Acute respiratory infection symptoms and COVID-19 testing behaviour: results based on South Australian health surveys

BackgroundEffective syndromic surveillance alongside COVID-19 testing behaviours in the population including in higher risk and hard to reach subgroups is vital to detect re-emergence of COVID-19 transmission in the community. The aim of this paper was to identify the prevalence of acute respiratory infection symptoms and coronavirus testing behaviour among South Australians using data from a population based survey.MethodsWe used cross-sectional data from the 2020 state-wide population level health survey on 6857 respondents aged 18 years and above. Descriptive statistics were used to explore the risk factors and multivariable logistic regression models were used to assess the factors associated with the acute respiratory infection symptoms and coronavirus testing behaviour after adjusting for gender, age, household size, household income, Aboriginal and/or Torres Strait Islander status, SEIFA, Country of birth, number of chronic diseases, wellbeing, psychological distress, and mental health.ResultsWe found that 19.3% of respondents reported having symptoms of acute respiratory infection and the most commonly reported symptoms were a runny nose (11.2%), coughing (9.9%) and sore throat (6.2%). Fever and cough were reported by 0.8% of participants. Of the symptomatic respondents, 32.6% reported seeking health advice from a nurse, doctor or healthcare provider. Around 18% (n = 130) of symptomatic respondents had sought testing and a further 4.3% (n = 31) reported they intended to get tested. The regression results suggest that older age, larger household size, a higher number of chronic disease, mental health condition, poor wellbeing, and psychological distress were associated with higher odds of ARI symptoms. Higher household income was associated with lower odds of being tested or intending to be tested for coronavirus after adjusting for other explanatory variables.ConclusionsThere were relatively high rates of self-reported acute respiratory infection during a period of very low COVID-19 prevalence and low rate of coronavirus testing among symptomatic respondents. Ongoing monitoring of testing uptake, including in higher-risk groups, and possible interventions to improve testing uptake is key to early detection of disease.

Advancement of the Infant Air-Jet Dry Powder Inhaler (DPI): Evaluation of Different Positive-Pressure Air Sources and Flow Rates.

In order to improve the delivery of dry powder aerosol formulations to the lungs of infants, this study implemented an infant air-jet platform and explored the effects of different air sources, flow rates, and pulmonary mechanics on aerosolization performance and aerosol delivery through a preterm nose-throat (NT) in vitro model. The infant air-jet platform was actuated with a positive-pressure air source that delivered the aerosol and provided a full inhalation breath. Three different air sources were developed to provide highly controllable positive-pressure air actuations (using actuation volumes of ~10mL for the preterm model). While providing different flow waveform shapes, the three air sources were calibrated to produce the same flow rate magnitude (Q90: 90th percentile of flow rate). Multiple air-jet DPI designs were coupled with the air sources and evaluated with a model spray-dried excipient enhanced growth formulation. Compared to other designs, the D1-Single air-jet DPI provided improved performance with low variability across all three air sources. With the tested D1-Single air-jet and Timer air source, reducing the flow rate from 4 to 1.7L/min marginally decreased the aerosol size and significantly increased the lung delivery efficiency above 50% of the loaded dose. These results were not impacted by the presence of downstream pulmonary mechanics (resistance and compliance model). The selected design was capable of providing an estimated >50% lung delivery efficiency of a model spray-dried formulation and was not influenced by the air source, thereby enabling greater flexibility for platform deployment in different environments.

An Approach for Corona Spreads Forecast and Herd Immunity Prediction with the Help of Machine Learning

Corona-virus is the disease caused by the current Covid-19 that emerged in December 2019 in China. A coronavirus is a common virus that causes your nose, sinuses, or upper throat to get infected. Most coronaviruses are not harmful, SARS-CoV-2 disease that causes what physicians term a respiratory tract infection. Using Herd Immunity, we can slow the spread of this (COVID-19) disease Herd immunity occurs when a large part of a population (the herd) becomes immune to this disease, which makes it unlikely that the infection will spread from person to person. As a result, the whole population is not only covered by those who are immune. We can check a person has herd immunity or not to see the spread of this disease with the aid of predictive models. The goal of predictive modeling is to create a way for individuals to be efficient, accurate, and profitable.

Revealing the dilemma in COVID-19 pneumonia: use of the prone thorax CT imaging in differentiation of opacificities due to dependant zone and pneumonic consolidation.

In December 2019, a disease called Coronavirus disease 2019 (COVID-19) caused by the novel coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS- COV-2) emerged in Wuhan, China. The disease was declared as a pandemic by the WHO on May 11, 2020. The gold standard to diagnose is a Real-time reverse transcriptase-polymerase chain reaction (RT-PCR) test. Additionally, computed tomography (CT) is also very useful in certain cases. A 62-year-old female patient was admitted to the emergency room with fever and joint pain for five days. She had a history of contact with COVID- 19 (+) patient. Unenhanced lung CT performed in the prone position clearly showed nodular infiltrations in the subpleural/peripheral lower lung areas in the right lung. Another 73-year-old female patient was admitted to the emergency room with tiredness and loss of taste for a few days. She had no history of contact with COVID-19 (+) patients. Unenhanced lung CT performed while the patient was in supine position, diffuse nodular opacities in the lower regions of both lungs could hardly be detected. The combined throat nose swab test was positive in both patients. In conclusion, lung CT in prone position is a very valuable method of imaging to show COVID-19 pneumonia; it can distinguish true COVID-19 pneumonia from dependent lung zones in the supine position.

Timing of onset of symptom for COVID-19 from publicly reported confirmed cases in Uganda.

Introductionincubation period for COVID-19, 2-14 (average 5-6) days. Timing of onset of COVID-19 signs and symptoms amongst cases in Uganda is however not known.Methodswe utilized data on real-time reverse transcription polymerase chain reaction (RT-PCR) confirmed cases to investigate symptom onset timing, from 21st March to 4th September 2020. Since timing of COVID-19 symptom onset is highly likely to be an interval rather than a point estimate, we generated 3-tertile categories: 1st, 2nd and 3rd tertile denoting symptom presentation within 3, 4 to 6 and at least 7 days. We considered all signs and symptoms in the database and analysed using Chi-square test and multinomial logistic regression, controlling for age and sex.Resultswe analysed a total of 420 symptomatic case-patients; 72.0% were males, median age of 33 years. Common symptoms were cough (47.6%), running nose (46.2%), fever (27.4%), headache (26.4%) and sore throat (20.5%). We utilized 293 cases with clinical symptom onset date recorded. Most of the patients, 37.5%, presented symptom within 3 days, 31.4% had symptoms in the 2nd and 31.4% in 3rd tertile, denoting 4 to 6 days and at least 7 days after exposure. Running nose (RRR=0.45, 95%CI: 0.24-0.84) and chest pain (RRR=0.64, 95%CI: 0.09-0.72) were more likely to occur in 3rd tertile than 1st or 2nd tertile. Cases aged ≥20 years were less likely to have symptoms in the 1st and 2nd tertile compared to ≤20 years (p<0.05).Conclusionour study provides empirical evidence for epidemiological characterization of cases by signs and symptoms which complements current proposals for the length of active monitoring of persons exposed to SARS-CoV-2.

Deciphering the Genetic Alterations in SPARC Gene Family and Its Association with HNSCC

The aim of this study is to identify the genetic alteration in SPARC gene family and its association with head and neck squamous cell carcinoma (HNSCC). Head and neck cancer is a set of cancerous lesions arising from the squamous cell of the mucous membrane of the oral cavity, nose throat, larynx and pharynx. SPARC gene encodes for cysteine rich acid matrix metalloprotein, osteonectin whose expression in metastatic OSCC (Oral squamous cell carcinoma) was found to be higher. This expression pattern also correlated with the worst pattern of invasion and differentiation of OSCC tumors. In line with the above facts, the present study was carried out to ascertain the gene alterations and their consequences. Also the putative association of gene alterations with HNSCC was analyzed using computational tools. The Cancer Gene Atlas (TCGA, Firehose Legacy) dataset hosted by the cBioportal server was used in the present study. The non-synonymous variants identified were further assessed for protein stability and pathogenicity employing IMutant and PROVEAN tools. Gene amplification was observed in the FSTL1 gene, which was also shown to present with the highest frequency of gene alterations (5%) among eight genes. Furthermore, the expression of the FSTL1 gene was found to differ significantly among different grades of HNSCC. In conclusion, the study throws light on the possible association of the FSTL1 gene of the SPARC family with HNSCC.

Initial Development of an Air-Jet Dry Powder Inhaler for Rapid Delivery of Pharmaceutical Aerosols to Infants.

Background: Positive-pressure dry powder inhalers (DPIs) have recently been developed that in combination with highly dispersible spray-dried powder formulations can achieve high efficiency aerosolization with low actuation air-volumes (AAVs). The objective of this study was to initially develop the positive-pressure air-jet DPI platform for high efficiency aerosol delivery to newborn infants by using the nose-to-lung route. Methods: Aerosolization performance metrics of six air-jet DPIs were first assessed at AAVs that were consistent with full-term (30 mL) and preterm (10 mL) neonates. Designs of the air-jet DPIs varied based on geometry of the inlet and outlet flow passages and shape of the aerosolization chamber. Aerosolization metrics evaluated at the device outlet were emitted dose (ED) and mass median aerodynamic diameter (MMAD). Designs with the best aerosolization performance were connected to a smoothly expanding nasal interface and full-term infant (3550 g) nose-throat (NT) model with tracheal filter. Results: The three best performing devices had characteristics of a cylindrical and horizontal aerosolization chamber with a flush or protruding outlet orifice. Including multiple air inlets resulted in meeting the aerosolization targets of >80% ED (based on loaded dose) and MMAD <1.8 μm. Reducing the AAV by a factor of threefold from 30 to 10 mL had little effect on aerosol formation. The three leading devices all delivered ∼50% of the loaded dose through a full-term NT in vitro model by using an AAV of 30 mL. Conclusion: With careful selection of design attributes, the air-jet DPI platform is capable of high-efficiency aerosolization of a 10 mg powder mass by using AAVs that are consistent with infant inhalation. The associated infant air-jet DPI system, which forms a seal at the nostril(s) and delivers both the aerosol and a complete inhalation, is capable of rapid and efficient aerosol administration to infant lungs, based on initial testing in a full-term in vitro NT model.

Isolation of ultrasmall (filterable) bacteria from patients suffering from ME, and patients and staff of a paediatric hospital

A total of 108 blood samples obtained from 28 male and 80 female patients diagnosed with ME were diluted in sterile, Ringer’s Solution and forced (by suction) through 0.2 µm filters. Of the 28 male samples, 4 yielded filterable bacteria and of the 80 female samples, 18 gave filterable bacteria; as a result, of the total of 124 samples, 22 yielded FB. Filterable (0.4 and 0.2, but not 0.1micron filterable) bacteria were also isolated from the nose throat and skin of paediatric patients and from the throat and skin of staff at an emergency paediatric hospital. The highest percentage of bacterial passage occurred through the largest (0.4 µm) pores. The results show that ultrasmall bacteria occur in ME patients and in paediatric patients and nurses. The potential pathogenic role of such filterable bacteria is briefly discussed.

Clinical features and imaging findings in six coronavirus disease 2019 patients

Objective To summarize the clinical features and imaging findings of six coronavirus disease 2019 (COVID-19) patients, so as to provide evidences for early diagnosis and clinical intervention. Methods Six COVID-19 patients with positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were enrolled from the Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine from Jan. 1 to Feb. 22, 2020. The epidemiological history, clinical manifestations, imaging data and laboratory indicators were retrospectively analyzed. Results All six patients had a clear travel or residence history in Wuhan. Four patients had fever, three had cough, two had upper respiratory tract symptoms such as runny nose and sore throat, and two had systemic symptoms such as headache and muscle ache. Chest computed tomography (CT) showed that all the six patients had abnormal manifestations in bilateral lungs, and the lower lung lesions were more common than the upper lung lesions. The main manifestations were multiple ground-glass opacities, consolidation shadows, crazy paving sign and different degrees of fibrosis in lateral field of bilateral lungs. Chest CT examination later after onset showed lung consolidation and severe fibrosis. Conclusion The imaging of COVID-19 has special characteristics. Combined with the epidemiological history, clinical manifestations and the detection of SARS-CoV-2 nucleic acid, COVID-19 can be effectively diagnosed in the early stage.