Effect Of Volume Reduction Research Articles

Metabolic Changes After Bronchoscopic Lung Volume Reduction With Endobronchial Valves in COPD Patients

ObjectivesLittle is known about the effect of bronchoscopic lung volume reduction using endobronchial valves (BLVR-EBV) on extrapulmonary manifestations like body composition, muscle function or metabolism. Pulmonary rehabilitation (PR) clearly addresses extrapulmonary manifestations of COPD, including physical inactivity and low muscle mass. However, the added impact of BLVR-EBV+PR remains unknown. Therefore, this study aimed to assess the effect of BLVR-EBV on body composition, muscle function and metabolic markers and whether PR has an additional impact on these outcomes. MethodsSubjects with severe COPD eligible for both PR and BLVR-EBV were randomized into three groups: PR+BLVR-EBV, BLVR-EBV+PR, or only BLVR-EBV (n=97). Assessments included Dual Energy X-ray Absorptiometry, thigh muscle Computed Tomography, muscle strength measurements, accelerometry, and plasma (leptin, adiponectin, insulin, and triglycerides) at baseline and six months after the last intervention. ResultsA total of 74 participants completed the study. At follow-up, there were significant increases in the groups combined and both groups separated in total weight, lean mass, fat mass, muscle strength, daily physical activity, and triglyceride levels while leptin/fat mass ratio levels were significantly reduced. No differences were found between groups who underwent BLVR-EVR alone or BLVR-EBV with PR. ConclusionsBLVR-EBV results in significant increases in body weight, lean and fat mass, muscle strength and daily physical activity level, and impacts on adipokine profile, irrespective of PR. This underscores the systemic benefits of addressing lung hyperinflation in patients with severe COPD.

Clinical Improvements after Endoscopic Lung Volume Reduction with Valves in Patients with advanced Emphysema and a 6-Minute-Walk-Test ≤140 m at Baseline

BackgroundData regarding the effectiveness and safety of endoscopic lung volume reduction with valves (ELVR) in emphysema patients with very low 6-Minute Walk Test (6-MWT) is limited. Patients with severe emphysema and very low exercise capacity, as indicated by a 6-MWT ≤140 m, are often excluded from clinical studies on ELVR, assuming limited therapeutics benefits and increased complication risk.Study Designs and MethodsThis study utilized data from the Lungenemphysemregister e.V., a large German national multi-center prospective open label clinical trial, and aimed to assess the outcomes of ELVR in patients with a baseline 6-MWT ≤140 m and dyspnea primarily attributed to hyperinflation.ResultsFifty-four patients with a baseline 6-MWT ≤140 m and 365 patients with a baseline 6-MWT between 140 m and 450 m were included in the study. Baseline characteristics were representative for patients with advanced lung emphysema. Patients with a 6-MWT ≤140 m at baseline had a lower FEV1, DLCO and higher symptom burden. In the 3-month-follow-up, patients of both groups showed statistically significant improvements in lung function parameters, exercise capacity and quality of life parameters compared to baseline. Patients with a 6-MWT ≤140 m at baseline showed significantly more 6-MWT improvement compared to patients with baseline 6-MWT between 140 m–450 m. Moreover, complication rates were similar in both groups.InterpretationIn summary, the data indicates that ELVR may be an effective and safe treatment for emphysema patients with a very low 6-MWT ≤140 m, if very limited exercise capacity is predominately caused by lung emphysema. Therefore future studies should include emphysema patients with a very low 6-MWT.

The effect of bronchoscopic lung volume reduction on the bronchodilator response.

Bronchoscopic lung volume reduction (BLVR) is a method of achieving lung collapse in severely emphysematous regions. One of the measures of success is the improvement in post-bronchodilator forced expiratory volume in the first second (FEV1). The change in bronchodilator response (BDR) following BLVR is typically not reported, however, the changes in lung physiology that accompany endobronchial valve placement may impact aerosol drug delivery and alter the response to bronchodilators. We compared the BDR before and after BLVR to evaluate this effect. We performed a retrospective study to analyze the change in BDR following BLVR. We included patients who underwent pulmonary function test (PFT) within 6 months of BLVR and confirmed complete lobar atelectasis. The pre-BLVR BDR for each patient served as the control, which was then compared to the post-BLVR BDR. The mean difference in the BDR before and after valve placement was determined. The comparison between pre- and post-BLVR means was performed using a t-test. A total of 35 patients were assessed for the study. Fifteen patients were excluded (due to valve removal, incomplete lobar collapse, and no pre- or post-BLVR PFT available). Of the 20 remaining patients, 14 had a positive BDR at baseline before BLVR. Following BLVR, 13 of the 14 patients demonstrated a non-significant increase in the BDR. The mean BDR for pre- and post-valve was 83.6 vs. 116.3 mL, respectively. The mean absolute increase in BDR following BLVR was 32.7 mL [95% confidence interval (CI): -32.5 to 97.8, P=0.31]. When including all 20 patients, the mean BDR pre- and post-BLVR was 47.5 vs. 86.5 mL, respectively, with a mean increase in BDR by 39 mL (95% CI: 22.3 to 100.3, P=0.21). BLVR may improve the BDR in patients with complete lobar atelectasis.

Lung volume reduction surgery is safe and feasible after initial endobronchial valve treatment for emphysema patients.

Bronchoscopic lung volume reduction with endobronchial valves is a guideline treatment leading to improved pulmonary function, exercise tolerance and quality of life, in patients with advanced emphysema, severe hyperinflation and no collateral ventilation. After valve treatment, loss of the initial lung volume reduction effect can occur, as well as local valve-induced complications such as persistent haemoptysis. In these cases, a surgical lobectomy can be considered to achieve similar efficacy outcomes. We evaluated the safety and feasibility of a video-assisted thoracoscopic surgery lobectomy after valve treatment. This single-centre retrospective study included patients who underwent an elective lobectomy after previous valve treatment. Data were evaluated for safety and efficacy for the additional surgical procedure. Twenty-one patients [73% female, median age 67 (7) years, forced expiratory volume in 1 s 29 (7) %pred, and residual volume 223 (58) %pred] were included. There was no 90-day mortality and there were no postoperative intensive care admissions. Pulmonary infections (14%) and prolonged air leak (14%) were the most common complications. In patients who underwent surgery due to loss or lack of effect of valve treatment, a lobectomy led to a significant improvement in pulmonary function; median forced expiratory volume in 1 s +75 (193) ml (P < 0.013), forced vital capacity +450 (572) ml (P = 0.001), residual volume -665 (715) ml (P = 0.005). In patients who underwent a lobectomy because of complications of valve treatment, all complications were resolved after surgery. We demonstrate that an elective lobectomy after an initial valve treatment is safe and feasible and restores the lung volume reduction effect.

Ultrahigh pressure phase stability of AlB2-type and CaC2-type structures with respect to Fe2P-type and Ni2In-type structures of zirconia

Using density-functional theory, we have performed first-principles calculations to test the phase stability of the hexagonal AlB2-type and tetragonal CaC2-type phases at ultrahigh pressures with respect to the experimentally observed hexagonal Fe2P-type phase and the recently predicted (as post-Fe2P) hexagonal Ni2In-type phase of ZrO2. The phase relations among the four phases have been thoroughly investigated to better understand the high-pressure behavior of ZrO2, especially the upper part of the pressure phase transition sequence. Our enthalpy calculations revealed that the transformation from Ni2In phase to either AlB2 phase or CaC2 phase is unlikely to happen. On the other hand, a direct phase transition from Fe2P phase to Ni2In, CaC2 and AlB2 phases is predicted to occur at 325 GPa, 505 GPa and 1093 GPa, respectively. A deep discussion has been made on the Fe2P → Ni2In and Fe2P → CaC2 transitions in terms of the volume change, the coordination number (CN) change, and the band gap change to obtain a better prediction of the favored post-Fe2P phase of ZrO2. Additionally, the equation of state (EOS) parameters for each phase have been computed using Birch-Murnaghan EOS. To further investigate the phase stability testing, we have studied the components of the enthalpy difference to explore their effect on our findings, and found that all predicted transitions from Fe2P phase are driven by the volume reduction effect when compared to the slight effect of the electronic energy gain.

Contrast media volume reduction with the DyeVertTM system to prevent acute kidney injury in stable patients undergoing coronary procedures.

Contrast associated acute kidney injury (CA-AKI) can lead to an increased risk of adverse events. Contrast media (CM) volume reduction has been advocated as a pivotal strategy to prevent CA-AKI in stable patients undergoing percutaneous coronary procedures. To compare the effectiveness of CM volume reduction with the DyeVertTM system versus conventional strategy in reducing the risk of CA-AKI. We prospectively collected data from 136 patients with stable coronary artery disease at high risk of CA-AKI treated with left ventricular end diastolic pressure (LVEDP)- guided hydration and undergoing interventions with the use of the DyeVertTM (Osprey Medical Inc.) system. Patients previously enrolled in the LVEDP-guided hydration arm of the "Renal Insufficiency Following Contrast MEDIA Administration triaL III" (REMEDIAL III) were considered as controls. Propensity score was used to perform 1:1 matching to adjust for major confounders. The primary outcome was the occurrence of CA-AKI, as defined by an absolute increase of creatinine values ≥0.3 mg/dL at 48 h. Patients in the DyeVert group were treated with a significant lower CM volume (median: 47.5 vs. 84.0 mL, p < 0.001). The trend in creatinine increase was lower (p = 0.004) and the Δ of creatinine (0-48 h) showed a higher drop (-0.18 vs. -0.10 mg/dL, p = 0.036) in the DyeVert group. The risk of CA-AKI was significantly lower in DyeVert group compared to control group (5.1% vs. 16.8%; odds ratio 0.27, 95% confidence interval [0.12-0.61]). CM volume reduction with the DyeVertTM system seems to be superior to conventional strategies in reducing the occurrence of CA-AKI.

The Effect of Volume Reduction on Computed Treatment Planning during Head and Neck IMRT and VMAT

The Effect of Volume Reduction on Computed Treatment Planning during Head and Neck IMRT and VMAT

Reducing the dielectric loss of poly(aryl ether)s by grafting

AbstractLimiting molecules' polarized motion effectively reduces the dielectric loss of materials. This article synthesized side chains with different lengths using p‐ethoxyphenol, p‐hydroxybenzoic acid, and long‐chain halohydrins through a two‐step process. These chains' movement was almost unaffected by the main chain of polymers, so they can fill up the free volume of polymers under certain conditions. 1,2‐dihydro‐4‐(4‐hydroxyphenyl)phthalazine‐1‐(2H)‐one(DHPZ), 4,4'‐Difluorophenyl sulfone(DFS), and 4,4‐Bis(4‐hydroxyphenyl) valeric acid(HPV) obtained three polymers with different carboxyl groups (10%, 30%, and 50%) through nucleophilic substitution. They were then grafted and treated with hot‐pressing. The introduction of side chains could reduce the free volume of polymers under hot‐pressing conditions, so further reducing the dielectric loss of materials. Polymer with the shortest and least (10%) side chains showed the most obvious dielectric loss tangent, the reduction rate of the film's dielectric loss tangent was 13.11% (at Tg + 15°C, while the non‐grafted one was only 3.69%) and 20.70% (at Tg + 80°C, while the non‐grafted one was only 8.35%), respectively. In addition, WXRD and DMA tests showed that films' intermolecular chain spacing (“d”) and Tg changed after the hot‐pressing process, respectively. The change law of both was consistent with that of dielectric loss tangent. Confirm that grafting high‐motility side chains can significantly reduce polymer's dielectric loss by enhancing the free volume reduction effect after hot‐pressing.

Impact of pharmacological and non-pharmacological interventions on mortality in chronic obstructive pulmonary disease (COPD) patients

PurposeThis review aimed to summarise evidence about the impact of pharmacological and non-pharmacological interventions on survival in COPD patients. MethodsWe performed a narrative literature review on the effect of pharmacological and non-pharmacological interventions on survival in COPD patients. ResultsInhaled therapies are central to reduce symptoms in COPD. In particular, inhaled steroids seem to have the greatest effect on mortality. Despite the anti-inflammatory effects attributed to statins, their benefit in COPD has been shown only in cases of combined cardiovascular diseases. The use of beta-blockers in COPD has not been associated with increased COPD-related mortality and a beneficial effect on all-cause mortality has even been shown in COPD patients with cardiovascular diseases. Influenza and pneumococcal vaccination reduced the occurrence of exacerbations and mortality due to COPD. In addition, long-term oxygen therapy (LTOT) (≥15h/day) in COPD patients with severe hypoxemia had a positive effect on survival. Regarding non-pharmacological interventions, it has been demonstrated that smoking cessation, treatment compliance and nutritional supplementation for underweight patients also have a positive effect on survival. Non-invasive ventilation results were dependent on patient PaCO2 levels. In patients with advanced COPD, further prospective studies are needed to know the effect of bronchoscopic lung volume reduction and lung transplant on COPD survival. Regarding lung transplant, a survival benefit in patients with a pre-transplant BODE score of ≥7 has been shown in retrospective studies. ConclusionMost of the studies did not evaluate survival as the main criteria and further long-term studies on the global management of COPD are required.

Lignin Recovery from Black Liquor Using Integrated UF/NF Processes and Economic Analysis

Lignin is a polyphenolic biopolymer present in large amounts in black liquor (BL). This work investigated the recovery of lignin from BL (pre-filtered by ultrafiltration (UF)) by nanofiltration (NF). For the NF tests, laboratory-made mixed matrix membrane (MMM) prepared with 0.1% activated carbon (AC) nanoparticles were used in crossflow filtration mode. The effect of pressure (6-15 bar) and volume reduction (VR) (~65%) were analyzed, and the filtration performance was evaluated in terms of permeate flux, lignin rejection rate, and flux reduction. The lignin rejection rate varied in the range of 67-80% with the pressure, however, the highest increases in flux and rejection were observed at 12 bar, which was found to be the optimum pressure. At a VR of ~65%, the permeate flux decreased by ~55% and the lignin rejection rate increased from 78% to 86%. In addition, an economic evaluation was performed for the preparation of UF and NF MMM. The minimum-to-maximum price range was estimated considering the costs of the laboratory and commercial grade regents. It showed a difference of ~10-fold and ~14-fold for UF and NF membranes, respectively. The results of the laboratory-scale study were used to evaluate the economic feasibility of the process for recovering lignin- and hemicellulose-rich retentate streams.

UJI EFEK ANTIINFLAMASI EKSTRAK ETANOL DAUN LIDAH MERTUA TERHADAP VOLUME UDEM BUATAN PADA MENCIT

The research of anti-inflammatory effect of ethanolic extract of leaves Sansevieria trifasciata in mice, the aim of this research to determining the extract of leaf at a concentration of carriage provides anti inflammatory effects of optimal. This study used 25 mice divided into 5 groups, each group consisted of 5 mice, group I as a control group given Na.CMC, group II, III, and IV were each given leaf extract ethanolic Sansevieria trifasciata 5% b/v, 10% b/v, and 15% b/v. As group as the diclofenac sodium suspension 0,02% b/v as a comparison. The after at 15 minutes of treatment, and then injected into the egg whites as the induction of oedema. Evalution volume of oedema was done by measuring the volume using pletysmometer of oedema. The results showed than in leaf extract ethanolic Sansevieria trifasciata with concentration 5% b/v, 10% b/v, and 15% b/v can have anti inflammatory effects. Oedema volume reduction effect on leaf extract ethanolic Sansevieria trifasciata 15% b/v, as same as the effects of diclofenac sodium suspension 0,02% b/v

Assessment of inner ear morphology and function in response to local positive pressure for Ménière’s disease: a nonrandomized controlled trial

Ménière’s disease (MD) is an inner ear disorder in which the main pathological feature is endolymphatic hydrops (EH). Positive pressure therapy (PPT) using a portable device is now a second-line therapy for intractable MD when initial medical treatment fails. However, it remains unknown whether PPT causes the morphological and functional changes of inner ear in patients with active MD in accordance with reduction of vertigo attacks. In this nonrandomized controlled trial of 52 patients with MD, the volume of EH significantly decreased with reduction of vertigo attacks during 8 months of PPT combined with medications while the volume of that significantly increased with medications alone. There was no difference between Control group (n = 26) and PPT group (n = 26) regarding the vertigo control, however, PPT group achieved a significant functional improvement of vertical semicircular canals. The effect of volume reduction by PPT has been firstly demonstrated and the functional changes of all semicircular canals during PPT have been firstly examined. Morphological and functional changes in the inner ear by administrating local positive pressure are quite different from those caused by medications alone.Clinical trial registration: UMIN-CTR UMIN000041164 (registered on July 20, 2020).

Selective separation and immobilization process of 137Cs from high-level liquid waste based on silicon-based heteropoly salt and natural minerals

• Silicon-based composite adsorbent was effective for 137 Cs removal. • The interaction mechanism of Cs was studied at the molecular level by density functional theory. • A conceptual process for separation and long-term safe disposal of Cs was proposed. A macro porous silica-based ammonium phosphomolybdate (AMP/SiO 2 ) adsorbent was synthesized and tested for separation and recovery of 137 Cs from real radioactive liquid waste. The excellent adsorption ability and high selectivity of AMP/SiO 2 for 137 Cs were confirmed. AMP/SiO 2 had relatively large decontamination efficiency of 137 Cs exceeding 99% in radioactive wastes, and the decontamination factors of 137 Cs were estimated to be 688 and 270 after adsorption in radioactive waste at 1 and 3 mol/L HNO 3 , respectively. In column operation, the separation and recovery of Cs(I) and coexisting ions could be realized using different eluents, and the recovery rate of Cs(I) was more than 90%. The Cs 3d and Mo 3d X-ray photoelectron spectroscopic spectra of AMP/SiO 2 before and after Cs(I) adsorption, suggesting that the ion exchange process of cesium with crystal lattice cations was the governing mechanism, and cesium ions could spontaneously react with approximately two ammonium ions in each AMP lattice by density functional theory simulation. Further, the crystal binding energy of each revised model showed an upward trend with the progress of the adsorption. After sintering at 1200 °C, CsAlSiO 4 , which could stably solidify eluted cesium, was formed in the allophane-based solidified product. The crystalline properties and volume reduction effect of the sintered products were enhanced with the increase in the allophane content. Ba(II) hardly entered the lattice of CsAlSiO 4 and occupied the Cs(I) site, resulting in minor changes in the crystal structure with substitution of Ba(II) for Cs(I).

Cost-effectiveness analysis of surgical lung volume reduction compared with endobronchial valve treatment in patients with severe emphysema

Lung volume reduction, either by surgery or bronchoscopically by endobronchial valve treatment have been shown to be a cost-effective alternative compared with conservative therapy. However, there is no comparative analysis of lung volume reduction by surgery and bronchoscopic lung volume reduction using endobronchial valves. The aim of this retrospective study was to provide a cost-effectiveness analysis of lung volume reduction by surgery compared with bronchoscopic lung volume reduction using endobronchial valves. The effectiveness of lung volume reduction was assessed using forced expiratory volume in the first second (FEV1), residual volume (RV) and 6-minute walking distance (6MWD), measured at baseline and at 4 to 12 weeks. Cost unit accounting derived from SwissDRG was used as a surrogate of the costs from the payer's perspective. In total, 67 patients (37 men and 30 women) with a mean age of 68.3 ± 7.4 years were included. Both clinical effectiveness and costs were comparable between surgical and bronchoscopic lung reduction. The incremental cost-effectiveness ratios (ICERs) for bronchoscopic compared with lung volume reduction by surgery for FEV1, RV and 6MWD were -101, 4 and 58, respectively. For RV and 6MWD, it could be shown that endobronchial valve treatment is justified as a probably cost-effective alternative to lung volume reduction by surgery. Endobronchial valve treatment resulted in an improvement of 0.25 quality-adjusted life years (QALYs) and an ICER of € 7657 per QALY gained. A robust statement on the superiority of one of the two procedures in terms of cost-effectiveness cannot be made from the present study. Therefore, the study is not suitable for resource allocation. Two upcoming trials comparing lung volume reduction surgery and endobronchial valve treatment may be able to answer this question.

Substance flow analysis on the leachate DOM molecules along five typical membrane advanced treatment processes

The processes combining biological treatment with membrane separation technologies have been widely adopted for leachate treatment. However, dissolved organic matter (DOM) of leachate membrane concentrates generated from various membrane separation technologies has not been systematically investigated in field scale. Therefore, substance flow analysis based on DOM molecular information of leachate membrane concentrates from primary membrane systems (i.e. nanofiltration (NF) and reverse osmosis (RO)) and secondary membrane systems (i.e. disk-tube reverse osmosis (DTRO) and humic substance filtration system (HSF)) in five engineering-scale leachate treatment facilities, obtained via ultra-performance liquid chromatography coupled with hybrid quadrupole Orbitrap mass spectrometry, was given and simultaneously compared. In NF concentrates (NFC), 45.1–98.5% of DOM originated from raw leachate (L-DOM) was concentrated, showing poor biodegradability. The L-DOM interception characteristics of NFC-fed HSF were mainly based on volume reduction but concentration effect. L-DOM in RO concentrates (ROC) showed a higher proportion of peak intensity reduced components, accounting for 50.3–96.8%, and organic composition changes were more dependent on water quality characteristics than membrane types. ROC-fed DTRO intercepted 49.3–72.6% of L-DOM, but DTRO may be less effective at intercepting DOM molecules in landfill leachate with higher oxidation levels. Considering risks from feasible treatment technologies, the difficulty for the treatment of leachate membrane concentrates followed the order of DTRO concentrates > ROC > NFC. This study suggests that ROC-fed DTRO need to be controlled to avoid amplifying the treatment difficulty. Besides, treatment technologies for RO and DTRO concentrates with low-concentrated but refractory DOM and high salts should be explored.

Clinical significance of prostate volume and testosterone reduction on lower urinary tract symptoms in patients with prostate cancer undergoing androgen deprivation therapy

To investigate the effect of both prostate volume and serum testosterone changes on lower urinary tract symptoms in patients with prostate cancer undergoing androgen deprivation therapy. A total of 167 patients who received androgen deprivation therapy for prostate cancer treatment from January 2010 to August 2020 were enrolled in this retrospective study. Changes in the International Prostate Symptom Score (IPSS) in the patient groups stratified by prostate volume and the amount of testosterone reduction were assessed every 4 weeks until 12 weeks after androgen deprivation therapy initiation. Longitudinal mixed models were used to assess the adjusted effects of prostate volume and testosterone reduction on IPSS change. All mean values of IPSS-total score (IPSS-total), voiding subscore (IPSS-vs), and storage subscore (IPSS-ss) significantly decreased from baseline to week 12 in both patients with small (< 33 mL) and large (≥ 33 mL) prostates. The mean values of IPSS-total, IPSS-vs, and IPSS-ss similarly decreased in patients with large prostate with a baseline IPSS-total of ≥ 13. However, in those with small prostate, IPSS-ss specifically remained unchanged, while IPSS-total and IPSS-vs significantly decreased. In addition, only in patients with small prostate (< 33 mL), patients with lesser testosterone reduction (< Δ400 ng/dL) showed greater improvement in IPSS-ss by 7.5% compared with those with greater testosterone reduction (≥ Δ400 ng/dL). In conclusion, although androgen deprivation therapy generally improves lower urinary tract symptoms, it may worsen specifically storage symptoms in patients with relatively small prostate and greater testosterone reduction. Our finding suggests that testosterone may influence lower urinary tract symptoms in these patients.

Clinical Impact of Compensatory Hyperinflation of the Nontreated Adjacent Lobe After Bronchoscopic Lung Volume Reduction with Valves.

BackgroundBronchoscopic lung volume reduction (BLVR) with endobronchial valves (EBV) can be a successful treatment for end-stage emphysema patients. The reduction of hyperinflation enhances ventilatory mechanics and diaphragm function. Understanding predictors for treatment success is crucial for further improvements.PurposeThe aim of this study was to assess the effect of the target lobe volume reduction (TLVR) in relation to the ipsilateral lung volume reduction (ILVR), affected by the compensatory expansion of the adjacent lobe, on the outcome after BLVR with valves.Patients and MethodsThe volumetric relationship of ILVR% to TLVR%, addressed as Reduction Ratio (R), was recorded in 82 patients and compared to changes in lung function, physical performance and quality of life. A small value for R implies a relatively low volume reduction of the ipsilateral lung (ILVR) compared to the volume reduction of the target lobe (TLVR). Additionally, the minimal clinically important difference (MCID) for R was calculated.ResultsPatients with a smaller Reduction Ratio (R <0.2) showed minor improvements at the 3 months follow-up compared to patients with R ≥0.2 (mean changes of 39 mL (5.8%), –395 mL (–4.9%) and 96 mL (7.1%) versus 231 mL (33%), –1235 mL (–20%) and 425 mL (29%) in the forced expiratory volume in 1s (FEV1), residual volume (RV) and inspiratory vital capacity (IVC), respectively, and –3 m and 0 points versus 20.4 m and –3.4 points in the 6-minute-walking-distance (6MWD) and COPD assessment test (CAT) score respectively). With a combined value of 0.185, a MCID for R was calculated with established anchors (FEV1, RV, and 6MWD) for emphysema patients.ConclusionExtensive compensatory hyperinflation of the adjacent non-treated lobe after BLVR results in decreased ILVR, which is responsible for a lack of meaningful improvements in ventilatory mechanics and clinical outcome, despite technically successful lobe volume reduction.

Inhaled Steroids, Sex and Emphysema Index - Clinical Parameters with Impact on the Effectiveness of Valve Implantation in Patients with Severe Emphysema.

Aims and ObjectivesMany patients with chronic obstructive lung disease suffer from emphysema. Valve implantation may be a reasonable method in patients presenting advanced emphysema and absent interlobar collateral ventilation (CV). However, other clinical parameters influencing the effectiveness of endoscopic lung volume reduction (ELVR) are not well known.MethodsCOPD patients with advanced emphysema who received valve implantation in 2016 were retrospectively analyzed. The following characteristics were collected prior to valve implantation: age, sex, body mass index, presence of allergies, use of inhaled corticosteroids (ICS), lung function parameters, diffusion capacity, 6-minute walk distance (6-MWD), blood gases, COHb, smoking history, and emphysema index (quantitative multi-detector computed tomography). Three months following valve implantation, lung function parameters, diffusion capacity, 6-MWD and blood gases were measured. In this analysis, we evaluated the impact of these variables on an increase in FEV1 and 6-MWT as well as a decrease in RV three months after valve implantation.ResultsOverall, 77 COPD patients (57% male, mean age 66, mean FEV1 32%, mean RV 259%) who underwent valve therapy were enrolled. At 3-month follow-up, patients experienced a mean FEV1 increase of 0.09 ± 0.21 L, a mean RV decrease of 0.42 ± 1.80 L and a mean improvement of 8.3 ± 57 m in the 6-MWT. Overall, ICS, sex and emphysema index had an impact on the outcome following ELVR: ICS medication was associated with inferior FEV1 outcome. The higher the emphysema index, the less the RV reduction. Sex was a predictor for change of FEV1 (%), RV (L), and 6-MWT: male patients seem to benefit less than female patients from valve implantation.ConclusionThese findings suggest that ICS, emphysema index and sex are clinical parameters that may be associated with inferior outcome following ELVR. Further studies have to confirm these results to improve patient selection and clinical outcome of ELVR.

Cardiopulmonary Effects of Bronchoscopic Left Lung Volume Reduction in the Native Emphysematous Lung Following a Right Lung Transplant Complicated by Main Stem Narrowing.

Cardiopulmonary Effects of Bronchoscopic Left Lung Volume Reduction in the Native Emphysematous Lung Following a Right Lung Transplant Complicated by Main Stem Narrowing.

Study on Nursing Effects of Liposuction and Volume Reduction Surgery for Lymphedema Perioperative Nursing Care

Objective: To study the nursing effect of liposuction and volume reduction in the treatment of lymphedema during the perioperative period. Method: A total of 68 patients treated with liposuction volume reduction surgery for pseudo-lymphedema of lower limbs admitted from May 2019 to May 2020 in a tertiary hospital in Xi’an, Shaanxi Province were selected, and they were divided into observation group and control group by random grouping method. There were 34 cases in each group. The control group took routine care during the perioperative period, while the observation group performed full care during the perioperative period. The complication rate and pain degree of the two groups were compared. Results: The complication rate of the study group was 5.88%, while that of the control group was 26.67%. Compared with the study group, the complication rate was significantly higher than that of the control group, and the gap was statistically significant (P&gt;0.05). The pain scores of patients in the study group were significantly lower than those in the control group at 3 and 6 days after surgery, and the gap was statistically significant (P&gt;0.05). Conclusion: Lymphedema should be taken care of during the perioperative period of liposuction and volume reduction, which can effectively reduce the occurrence of pain and complications. It is worthy of extensive clinical promotion.