Volume Reduction Treatment Research Articles

Systemic pro-inflammatory response following bronchoscopic lung volume reduction using endobronchial valves

RationaleBronchoscopic lung volume reduction treatment using endobronchial valves (EBV) is an effective treatment for severe COPD patients by improving lung function and quality of life. However, little is known about its effects on systemic inflammation. Therefore, the aim of our study was to investigate whether EBV treatment impacts the inflammatory cytokine profile.MethodsThis study was a predefined substudy of the SoLVE trial (NCT03474471) that investigated the combination of EBV treatment with pulmonary rehabilitation (PR). The substudy included the collection of blood samples with assessment of 10 inflammatory markers prior to EBV treatment and 6 months after EBV or EBV+PR treatment.ResultsIn 66 patients, six months after treatment a pro-inflammatory cytokine profile was observed, with an increase in all pro-inflammatory markers and a decrease in the anti-inflammatory cytokine IL-10. The changes in plasma cytokine profile were not associated with changes in clinical outcomes such as lung function or exercise capacity.DiscussionIn conclusion, our study demonstrated an elevation in systemic pro-inflammatory cytokine levels following successful EBV-treatment, which was not associated with adverse clinical outcomes. It would be interesting to further explore, whether this increase is attributed to a foreign body response or if other factors contribute to this phenomenon.

Solid waste management and resource recovery during the 4-crew 180-day CELSS integrated experiment

In order to explore the management and treatment methods of solid waste in the Controlled Ecological Life Support System (CELSS) of future lunar bases, during the 4-crew 180-day integrated experiment, the Solid Waste Management and Treatment System (SWMTS) was built, in which the treatment of recyclable solid waste such as inedible plant parts and human excrement was completed through a combination of biological aerobic composting and high-temperature oxidation. Basic data on the types and amounts of solid waste generated during the 4-crew 180-day experiment mission were obtained. There were six types of solid wastes, including the work support wastes, the household support wastes, the plant cultivation wastes, the plant-based wastes, and crew feces. The daily average production was 0.67, 1.4, 0.32, 8.48, 0.534 kg/d, respectively. The proportion of plant-based wastes was high as 74.3 %, indicating that it was the most important part. By closed-loop air drying and graded crushing, all 1526.97 kg of plant-based waste was treated, with water recovery (about 1163.87 kg), as well as volume reduction and stabilization treatment. By incineration and aerobic composting treatment, 67.3 % (244.4 kg) of the plant-based wastes (dry weight) and all of the feces (96.26 kg) were converted, providing 339.54 kg carbon dioxide for plant growth. And 90.6 kg organic fertilizer was obtained. The fertilizer was highly mature, met safety requirements, and effectively improved lettuce yield. The recycling rate of renewable solid waste during the experiment reached 89.8 %. The efficient circulation of solid waste had been achieved during the 4-crew 180-day integrated experiment. The long-time experimental results have shown that the established solid wastes management and treatment system can timely treat biomass solid waste such as inedible parts of plants and crew feces, achieve timely recovery of water in such solid waste, and recycle carbon and other elements, which effectively improved the material closure of the system and ensured the successful 4-crew 180-day experiment. This work also maybe lay the foundation for the construction and operation of an ecological life support system for future lunar bases.

Mass balance and economic analysis of volume reduction treatment for final disposal of radiocesium-contaminated incineration residues

This study evaluates the mass balance and economic feasibility of volume reduction treatment for radiocesium-contaminated incineration residues at the Interim Storage Facility for radioactive waste resulting from the accident at TEPCO’s Fukushima Daiichi Nuclear Power Plant accident in 2011. Operational since March 2020, the Volume Reduction Facility employs thermal melting treatment to concentrate the radiocesium, resulting in the production of 42,000 tons of highly radioactive fly ash. Technologies for further volume reduction of the fly ash have been considered as one possible treatment scenario, but there have been no studies evaluating the optimization of this process. This work focuses on evaluating the feasibility of one promising approach: washing, selective adsorption of radiocesium into an adsorbent, and subsequent adsorbent stabilization. Unit costs were set for each step of the volume reduction process, and mass balance and economic evaluation were conducted. The findings reveal the generation of 390 tons of stabilized waste requiring final disposal, along with 10,000 tons of washing residue and 320,000 tons of wastewater. The subtotal cost of fly ash volume reduction was approximately 38 billion yen, with 61% attributed to adsorption treatment. Sensitivity analysis suggested that adsorbents with an adsorption ratio above 5000 could effectively reduce costs. Notably, the cost of adsorption process significantly influences subtotal costs. These insights enhance understanding of the economic viability and efficiency of volume reduction treatment for radiocesium-contaminated incineration residues, contributing to optimized strategies and technologies for volume reduction prior to final disposal.

Research and Engineering Practice Analysis of a New Scheme of Volume Reduction Treatment of Radioactive Waste Based on Waste Incineration Process

Research and Engineering Practice Analysis of a New Scheme of Volume Reduction Treatment of Radioactive Waste Based on Waste Incineration Process

Reduction of tumor volume during radiotherapy in patients with small-cell lung cancer and its prognostic significance.

Several studies have reported the potential prognostic significance of tumor volume reduction ratio (VRR) induced by radiotherapy (RT) in patients with non-small-cell lung cancer. However, there are no data yet on the prognostic significance of volumetric shrinkage in patients with small-cell lung cancer (SCLC). This study aimed to demonstrate the correlation between tumor volume reduction ratio and treatment outcomes. The study included 61 patients with SCLC treated with fractionated RT of the primary tumor at our institution between 2013 and 2020. The relationship between volumetric changes in gross tumor volume (GTV) during radiotherapy and outcomes were analyzed and reported. The median radiation dose was 59.4 Gy (median fraction dose was 1.8 Gy). The median GTV before radiotherapy was 74 cm3, with amedian GTV reduction of 48%. There was ahigher VRR in patients receiving concurrent radiochemotherapy (p = 0.05). No volumetric parameters were identified as relevant predictors of outcome in the entire cohort. In multivariate analysis, only age had an impact on survival, while prophylactic whole-brain radiation influenced the progression-free survival significantly. Concurrent chemotherapy was associated with ahigher VRR than sequential chemotherapy. No significant impact of VRR on patients' outcome or survival was detected.

Complex physical therapy employing self-adjusting garment (ReadyWrap®) in breast cancer-related lymphedema cases in Brazilian women: a protocol for a randomized controlled trial

BackgroundLymphedema is a common complication following breast cancer treatment. The aim of this study is to evaluate the effectiveness of a self-adjusting compression garment (ReadyWrap®) in reducing (phase 1) and maintaining (phase 2) upper limb volume in women presenting breast cancer-related lymphedema.MethodsThis study will comprise a randomized, controlled, single-blind clinical trial concerning women with breast cancer-related lymphedema undergoing treatment at a public cancer treatment reference hospital in the city of Rio de Janeiro, Brazil. The intervention will be carried out by adapting self-dressing versus the standard treatment of compressive bandaging (phase 1) and compressive mesh (phase 2). Both groups will be assessed at the beginning and end of intensive treatment and followed up for up to 12 months to evaluate immediate and late outcomes. Assessments will be carried out by physical upper limb examination (inspection, palpation, volume, dynamometry, and thermography) and questionnaires application to assess patient’s quality of life pertaining to the health, functionality, and symptoms of the affected upper limb, as well adverse effects and adherence to treatment. Data will be analyzed descriptively and analytically through univariate and multiple linear regressions. P values < 0.05 will be considered statistically significant.DiscussionThis study will evaluate the effectiveness of a self-adjustable garment (ReadyWrap®) in the treatment of lymphedema secondary to breast cancer in Brazilian women compared to the gold standard treatment for limb volume reduction (phase 1) and maintenance (phase 2) phases comprising, respectively, a compressive bandaging and a compressive mesh. The outcome results will provide data based on both quantitative responses and self-reported participant outcomes. The study will also assess the cost-effectiveness of the ReadyWrap® treatment versus standard care. Finally, we expect to reaffirm one more product/therapy as a treatment for this extremely complex and impactful condition following the data analysis.Trial registrationNCT04934098 [Clinical trials phase 1]. Registered on June 22, 2021. NCT04881604 [Clinical trials phase 2]. Registered on May 11, 2021.

Efficiency and Reliability of Bronchoscopic Lung Volume Reduction Coil Application in Patients with Severe Emphysema.

In the past years, surgery has been used for the non-medical treatment of severe emphysema. However, in recent years, bronchoscopic lung volume reduction (LVR) treatment has become more preferred because it is less invasive. Bronchoscopic coil treatment is the most frequently applied technique among these methods. The aim of the investigation was to determine the efficacy and safety of bronchoscopic volume reduction coil treatment for patients with severe emphysema. The patients who were performed bronchial volume reduction coil treatment between 2015 and 2017 and were followed in our outpatient clinic were retrospectively examined. They were followed for 1 year at quarterly intervals after the procedure. All the safety and efficacy of the patient's records, including the modified Medical Research Council (MRC) dyspnea score, the St. George's Respiratory Questionnaire (SGRQ) quality of life scale, the 6 min walk distance (6-MWT), pulmonary function tests, and adverse events, were evaluated. Sixteen patients were included in the study. The mean of the preoperative mMRC clinic dyspnea score was 3.38, the mean of the 3rd month's mMRC score was 2.62 (p=0.007), and the mean of the 12th month's mMRC was 2.37 (p=0.003). The preoperative SGRQ quality of life parameter was 71.95±15.7, the 3rd month was 66.7±16.2 (p=0.007), and the 12th month was 62.9±16.4 (p=0.003). Preoperative mean of 6-MWT was 247.25±112.36 m, 3rd month 264.25±95 m (p=0.148), and 12th month 317±122.9 m (p=0.034). Patients' preoperative residual volume was 5.28±1.96 L, 3rd month 4.52±1.35 L (p=0.023), and 12th month 4.545±1.83 L (p=0.163). Patients' preoperative forced expiratory volume in one second, respectively, was 0.79±0.29 L, 3rd month 0.79±0.3 L (p=0.917), and 12th month 0.86±0.3 L (p=0.756). It seems that bronchoscopic LVR coil treatment, which is an effective and reliable procedure that reduces shortness of breath rather than respiratory function test parameters and improves the quality of daily life, will become even more widespread.

Prevalence and Impact of COVID-19 among Severe COPD Patients post Bronchoscopic Lung Volume Reduction Treatment with Endobronchial Valves

Background: The COVID-19 pandemic has a great impact on numberless aspects of our society. In our bronchoscopic lung volume reduction interventional program, we work with severe COPD patients on a daily basis. Objectives: We were interested in the prevalence and outcome of COVID-19, impact of the pandemic on daily life, and the vaccination coverage in our severe COPD patients who have been treated with one-way endobronchial valves. Method: A questionnaire, which consisted of questions related to the infection rate, treatment, and outcome of COVID-19 infections; feelings of anxiety related to the pandemic; adherence to preventive measures; and willingness to be vaccinated; was sent to our patients in June 2021. Results: The questionnaire was sent to 215 patients, and the response rate was 100%. The vaccination rate was 97% in our surveyed population. The majority of patients (63%) indicated that they were quite or very anxious to get infected with COVID-19. Twenty-five (11.5%) patients were diagnosed with COVID-19, with none of these patients having been vaccinated at the time of infection. The infection rate reported in this study is comparable to that of the general Dutch population. However, the hospital admission rate and mortality rates are higher. Conclusions: Our results show that the SARS-CoV-2 infection rate in severe COPD patients treated with endobronchial valves was comparable with the general population; however, the hospital admission and mortality rates were worse.

Safety and Considerations of the Anaesthetic Management during Bronchoscopic Lung Volume Reduction Treatments

Background: Different bronchoscopic lung volume reduction approaches are available for a select group of patients with advanced COPD. General anaesthesia is the recommended method of sedation during these procedures. However, this patient population is at an increased risk of anaesthetic complications, and the best approach to general anaesthesia and mechanical ventilation is unknown. Objectives: The aims of this study were to describe the anaesthetic management techniques used during bronchoscopic lung volume reduction procedures and to investigate the number of anaesthesia-related events. Methods: Data were retrospectively collected from all endobronchial valve and lung volume reduction coil procedures performed between January 2018 and March 2020 in our hospital. Primary outcomes measures were anaesthetic technique including airway management; ventilation mode and settings; and the incidence of anaesthesia-related events, classified as catastrophic, severe, significant, or moderate. Results: 202 procedures were included. One procedure was performed under procedural sedation, 198 (98%) under general anaesthesia with endotracheal intubation, and 3 (1.5%) under general anaesthesia with laryngeal mask airway. Volume-controlled ventilation was used in 64% of the procedures and pressure-controlled in 36%. Patients were ventilated with a median respiration rate of 9.9 (IQR: 9.6–10.6) breaths per minute, mean tidal volume of 5.8 ± 1.4 mL/kg, and median inspiratory to expiratory (I:E) ratio of 1:2.8 (IQR: 1:2.1–1:3.2). No catastrophic anaesthesia-related events were observed. Hypotension was the most observed anaesthesia-related event. Conclusions: Despite the presence of advanced COPD, general anaesthesia and mechanical ventilation are well tolerated by patients undergoing endobronchial valve or lung volume reduction coil treatment. This is presumably strongly linked to the strict selection criteria. Other important considerations are using a low respiratory rate, low tidal volume, and high I:E ratio.

Survival in COPD patients treated with bronchoscopic lung volume reduction

Background and objectiveSevere COPD patients can significantly benefit from bronchoscopic lung volume reduction (BLVR) treatments with coils or endobronchial valves. However, the potential impact of BLVR on survival is less understood. Therefore, our aim was to investigate the survival rate in patients who are evaluated for BLVR treatment and whether there is a difference in survival rate between patients who undergo BLVR treatment and patients who do not. MethodsWe included patients with COPD who visited our hospital for a consultation evaluating their eligibility for BLVR treatment and who performed pulmonary function tests during this visit. Furthermore, vital status was verified. ResultsIn total 1471 patients were included (63% female, mean age 61 years). A total of 531 patients (35%) died during follow-up and the median survival time of the total population was 2694 days (95% confidence interval(CI) 2462–2926) which is approximately 7.4 years. The median survival time of patients who were treated with BLVR was significantly longer compared to patients who were not treated with BLVR (3133 days versus 2503 days, p < 0.001), and BLVR was found to be an independent predictor of survival when adjusting for other survival-influencing factors such as age, gender or severity of disease. ConclusionsOur results suggest that bronchoscopically reducing lung volume in patients with severe hyperinflation may lead to a survival benefit for a population with a severely reduced life expectancy.

Bullous Parametric Response Map for Functional Localization of COPD

Advanced bronchoscopic lung volume reduction treatment (BLVR) is now a routine care option for treating patients with severe emphysema. Patterns of low attenuation clusters indicating emphysema and functional small airway disease (fSAD) on paired CT, which may provide additional insights to the target selection of the segmental or subsegmental lobe of the treatments, require further investigation. The low attenuation clusters (LACS) were segmented to identify the scalar and spatial distribution of the lung destructions, in terms of 10 fractions scales of low attenuation density (LAD) located in upper lobes and lower lobes. The LACs of functional small airway disease (fSAD) were delineated by applying the technique of parametric response map (PRM) on the co-registered CT image data. Both emphysematous LACs of inspiratory CT and fSAD LACs on expiratory CT were used to derive the coefficients of the predictive model for estimating the airflow limitation. The voxel-wise severity is then predicted using the regional LACs on the co-registered CT to indicate the functional localization, namely, the bullous parametric response map (BPRM). A total of 100 subjects, 88 patients with mild to very severe COPD and 12 control participants with normal lung functions (FEV1/FVC % > 70%), were evaluated. Pearson’s correlations between FEV1/FVC% and LAV%HU-950 of severe emphysema are − 0.55 comparing to − 0.67 and − 0.62 of LAV%HU-856 of air-trapping and LAV%fSAD respectively. Pearson’s correlation between FEV1/FVC% and FEV1/FVC% predicted by the proposed model using LAD% of HU-950 and fSAD on BPRM is 0.82 (p < 0.01). The result of the Bullous Parametric Response Map (BPRM) is capable of identifying the less functional area of the lung, where the BLVR treatment is aimed at removing from a hyperinflated area of emphysematous regions.

Development of Wet Treatment Process for Volume Reduction, Detoxification and Recycling of Low-grade Aluminum Dross

For the purpose of volume reduction and detoxification of the low-grade aluminum dross (abbreviated as L-dross) with low content of metallic Al, the leaching behavior of two kinds of L-dross was investigated using 2 mol/dm3 H2SO4 and 2 mol/dm3 NaOH with or without heating operation. Ettringite with an anion removal ability was synthesized from the L-dross leachate generated after the volume reduction and detoxification treatment. A series of wet treatment process composed of L-dross leaching and ettringite synthesis was tried to develop in this study.

Crosslink bio-adhesives for bronchoscopic lung volume reduction: current status and future direction.

Several bronchoscopic lung volume reduction (BLVR) treatments have been developed to reduce hyperinflation in emphysema patients. Lung bio-adhesives are among the most promising new BLVR treatment options, as they potentially provide a permanent solution for emphysematous patients after only a single application. To date, bio-adhesives have mainly been used as haemostats and tissue sealants, while their application in permanently contracting and sealing hyperinflated lung tissue has recently been identified as a novel and enticing opportunity. However, a major drawback of the current adhesive technology is the induction of severe inflammatory responses and adverse events upon administration. In our review, we distinguish between and discuss various natural, semi-synthetic and synthetic tissue haemostats and sealants that have been used for pulmonary applications such as sealing air/fluid leaks. Furthermore, we present an overview of the different materials including AeriSeal and autologous blood that have been used to achieve lung volume reduction and discuss their respective advantages and drawbacks. In conclusion, we describe the key biological (therapeutic benefit and biocompatibility) and biomechanical (degradability, adhesive strength, stiffness, viscoelasticity, tunability and self-healing capacity) characteristics that are essential for an ideal lung bio-adhesive material with the potential to overcome the concerns related to current adhesives.

HRCT characteristics of severe emphysema patients: Interobserver variability among expert readers and comparison with quantitative software

PurposeFor a successful bronchoscopic lung volume reduction coil treatment it is important to place the coils in the most emphysematous lobes. Therefore assessment of the lobe with greatest destruction is essential. Our aims were to investigate the level of agreement among expert reviewers of HRCT-scans in emphysema patients and the comparison with QCT (quantitative computed tomography) software. MethodFive experienced CT-assessors, conducted a visual assessment of the baseline HRCT-scans of emphysema patients who participated in the RENEW bronchoscopic lung volume reduction coil study. On the same HRCT-scans, a QCT analysis was performed. ResultsIn total 134 HRCT-scans were rated by all 5 experts. All 5 CT-assessors agreed on which was the most destructed lobe in 61 % of the left lungs (ƙ:0.459) and 60 % of the right lungs (ƙ:0.370). The consensus of the 5 assessors matched the QCT in the left lung for 77 % of the patients (ƙ:0.425) and in the right lung for 82 % (ƙ:0.524). ConclusionsOur results show that the interobserver agreement between five expert CT-assessors was only fair to moderate when evaluating the most destructed lobe. CT-assessor consensus improved matching with QCT determination of lobar destruction compared to individual assessor determinations. Because some CT-features are associated with treatment outcomes and important for optimal patient selection of bronchoscopic lung volume reduction treatment, we recommend including more than one CT-reviewer and supported by QCT measurements.

Surgical Interventions for COPD.

Chronic obstructive pulmonary disease (COPD) treatment is aimed at managing the disease rather than cure, with a focus on improving quality of life and decreasing exacerbations. Interventional therapies, including lung volume reduction surgery, bullectomy, lung transplantation, and bronchoscopic lung volume reduction treatment using endobronchial valves, are treatment options for patients with COPD who are symptomatic due to hyperinflation despite optimal medical management. We will review the current literature to provide a comprehensive summary of the currently available scientific data, discuss typical treatment-related side effects, and evidence-based management approach and recommendations for patient selection in clinical practice.

A retrospective evaluation of the pulmonary function tests and quality of life assessment surveys of emphysema patients subject to coil treatment.

Bronchoscopic volume reduction treatments are among the important alternatives for selected emphysema patients with a dyspneic course despite optimal medical treatment. Our aim was to carry out a retrospective scan of the data for COPD patients subject to coil treatment at our center for assessing whether coil procedure has an impact on the respiratory symptom and pulmonary function tests in COPD patients. The data of 41 patients with severe emphysema and treated with coils between 2017-2020 were evaluated retrospectively. Cardiopulmonary rehabilitation programs were completed for all patients prior to the procedure and they were assessed with pulmonary function test (PFT), diffusing capacity for carbonmonoxide test (DLCO), body plethysmography, 6-minute walk test, ventilation/perfusion scintigraphy, St. George's Respiratory Questionnaire (SGRQ). Data acquired prior to the procedure and 3rd month control data after the procedure were recorded and SGRQ was applied via face-to-face interviews during the controls by doctors working on Pulmonary Diseases as was the case before the procedure. SGRQ questionnaires of 32 patients were evaluated. Statistically significant changes were observed after the procedure in symptom, activity, impact score and total score which were calculated prior to the procedure. Pre and post procedure FEV1, FVC, FEV1/FVC, PEF, FEF25/75 parameters were used for the comparison made via SFT. Statistically significant changes were observed in FEV1, FVC, FEF25/75 when the pre and post-procedure SFT parameters of the 32 patients included in the study were compared. A statistically significant improvement was observed in the PFT parameters and quality of life questionnaires following the coil procedure which is a bronchoscopic volume reduction procedure.

The effects of lung volume reduction treatment on diffusing capacity and gas exchange.

Lung volume reduction (LVR) treatment in patients with severe emphysema has been shown to have a positive effect on hyperinflation, expiratory flow, exercise capacity and quality of life. However, the effects on diffusing capacity of the lungs and gas exchange are less clear. In this review, the possible mechanisms by which LVR treatment can affect diffusing capacity of the lung for carbon monoxide (D LCO) and arterial gas parameters are discussed, the use of D LCO in LVR treatment is evaluated and other diagnostic techniques reflecting diffusing capacity and regional ventilation (V')/perfusion (Q') mismatch are considered.A systematic review of the literature was performed for studies reporting on D LCO and arterial blood gas parameters before and after LVR surgery or endoscopic LVR with endobronchial valves (EBV). D LCO after these LVR treatments improved (40 studies, n=1855) and the mean absolute change from baseline in % predicted D LCO was +5.7% (range -4.6% to +29%), with no real change in blood gas parameters. Improvement in V' inhomogeneity and V'/Q' mismatch are plausible explanations for the improvement in D LCO after LVR treatment.

Who Should be Referred for Lung Volume Reduction Treatment?

Lung volume reduction treatment can be beneficial for some COPD patients. Jayne Sharman, Kudzayi Kutywayo, Inger Oey and Sridhar Rathinam discuss the process of making the referral

A New Model of Vegetable Waste Resource Treatment Combining Rapid Volume Reduction and Biochemical Technology

In the process of planting, selling and processing vegetables, a large number of wastes will be produced. If these wastes are used as resources for secondary use, they will produce great value. At present, the utilization rate of vegetable waste is very low, and the related technology research is also lagging behind. At present, China actively advocates the development of green economy, energy conservation and emission reduction, and improve the utilization rate of resources. As an important available resource, vegetable waste has received great attention. Therefore, the research on vegetable waste recycling technology is deepening. Based on the analysis of the current situation of vegetable waste recycling treatment, this paper proposes a new model of vegetable waste treatment, which combines rapid volume reduction treatment with biochemical technology to produce organic fertilizer, in order to provide a reference for the reuse of vegetable waste.

Early complications of endobronchial lung volume reduction treatment with endobronchial valves

Early complications of endobronchial lung volume reduction treatment with endobronchial valves