An efficient and fast multi-band focused bioimpedance solution with EIT-based reconstruction for pulmonary embolism assessment: a simulation study from massive to segmental blockage

Objective: Pulmonary embolism (PE) is an acute condition that blocks the perfusion to the lungs and is a common complication of Covid-19. However, PE is often not diagnosed in time, especially in the pandemic time due to complicated diagnosis protocol. In this study, a non-invasive, fast and efficient bioimpedance method with the EIT-based reconstruction approach is proposed to assess the lung perfusion reliably. Approach: Some proposals are presented to improve the sensitivity and accuracy for the bioimpedance method: (1) a new electrode configuration and focused pattern to help study deep changes caused by PE within each lung field separately, (2) a measurement strategy to compensate the effect of different boundary shapes and varied respiratory conditions on the perfusion signals and (3) an estimator to predict the lung perfusion capacity, from which the severity of PE can be assessed. The proposals were tested on the first-time simulation of PE events at different locations and degrees from segmental blockages to massive blockages. Different object boundary shapes and varied respiratory conditions were included in the simulation to represent for different populations in real measurements. Results: The correlation between the estimator and the perfusion was very promising (R = 0.91, errors < 6%). The measurement strategy with the proposed configuration and pattern has helped stabilize the estimator to non-perfusion factors such as the boundary shapes and varied respiration conditions (3-5% errors). Significance: This promising preliminary result has demonstrated the proposed bioimpedance method’s capability and feasibility, and might start a new direction for this application.

Combination Therapy with Rituximab, Tofacitinib and Pirfenidone in a Patient with Rapid Progressive Interstitial Lung Disease (RP-ILD) Due to MDA5 Antibody-Associated Dermatomyositis: A Case Report

Anti-melanoma differentiation-associated protein 5 (MDA5)-positive rapidly progressive interstitial lung disease (RP-ILD) is associated with poor prognosis, and the most effective therapeutic intervention has not been established. Herein we report a case of a 45-year-old female patient who presented with myalgia, Gottron’s papules with ulceration, and dyspnea on exertion which became aggravated within weeks. Laboratory examination and electromyography confirmed myopathy changes, and a survey of myositis-specific antibodies was strongly positive for anti-MDA5 antibody. High-resolution chest tomography suggested organizing pneumonia with rapidly progressive changes within the first month after diagnosis of the disease. Anti-MDA5-associated dermatomyositis with RP-ILD was diagnosed. Following combination therapy with rituximab, tofacitinib and pirfenidone, clinical symptoms, including cutaneous manifestation, respiratory conditions and radiographic changes, showed significant and sustainable improvement. To our knowledge, this is the first reported case of anti-MDA5-associated dermatomyositis with RP-ILD successfully treated with the combination of rituximab, tofacitinib, and pirfenidone.

Artificial intelligence in functional imaging of the lung

Artificial intelligence (AI) is transforming the way we perform advanced imaging. From high-resolution image reconstruction to predicting functional response from clinically acquired data, AI is promising to revolutionize clinical evaluation of lung performance, pushing the boundary in pulmonary functional imaging for patients suffering from respiratory conditions. In this review, we overview the current developments and expound on some of the encouraging new frontiers. We focus on the recent advances in machine learning and deep learning that enable reconstructing images, quantitating, and predicting functional responses of the lung. Finally, we shed light on the potential opportunities and challenges ahead in adopting AI for functional lung imaging in clinical settings.

Family Perspectives on Continuous Monitor Use in a Children’s Hospital: A Qualitative Study

OBJECTIVES Alarms from continuous cardiorespiratory and pulse oximetry monitors may contribute to parental anxiety and poor sleep during hospitalization, yet families also may find monitoring reassuring. Our objective was to understand how families perceive the utility, benefits, and harms of continuous monitoring. METHODS In this single-center qualitative study, we used semistructured interviews and direct observation. We enrolled families of patients of a variety of ages and clinical diagnoses. We extracted patient demographic information (age, diagnosis) from the health record. Semistructured interviews were recorded and transcribed. Detailed field notes were taken during observations. We used an inductive thematic approach to develop and refine codes that informed the development of themes. RESULTS We recruited 24 families and conducted 23 interviews and 9 observation sessions. Respiratory conditions (eg, bronchiolitis, asthma) were the most common reason for hospitalization. The hospitalized children covered a range of ages: &lt;4 weeks (16%), 4 weeks to 6 months (20%), 7 months to 5 years (44%), and &gt;5 years (20%); 55% had previously been hospitalized. Families expressed varying degrees of understanding the utility of monitors and often conducted their own assessments before notifying staff about alarms. Families expected monitoring, including negative effects like sleep disruption, as part of hospitalization. Families perceived the benefit of monitoring in context of previous hospital experiences, often seeing less benefit and worrying less about alarms in subsequent hospitalizations. CONCLUSIONS Family members continue to find reassurance from cardiorespiratory monitoring despite evidence that it offers limited benefit outside of the ICU setting. Parental perspectives should be addressed in future deimplementation efforts.

Impact of local air quality management policies on emergency hospitalisations for respiratory conditions in the North West Coast region of England: a longitudinal controlled ecological study

Background Air quality is monitored at a local level in the UK as part of the Local Air Quality Management (LAQM) system. If air quality objectives within an area are not achieved an Air Quality Management Area (AQMA) is declared and action plan developed. The efficacy of this system in reducing air pollution has increasingly come into question, however very little is known about its impact on health or health inequalities. We therefore investigated the effect of declaring an AQMA on emergency hospitalisations for respiratory conditions in the North West Coast region of England, and examined whether the effect differed between more compared to less deprived neighbourhoods. Methods This longitudinal controlled ecological study analysed neighbourhoods located within or touching the boundaries of AQMAs declared in the North West Coast region between 2006 and 2016. Each of these intervention neighbourhoods were matched with five control neighbourhoods which had never been located within/touching an AQMA boundary. Difference-in-differences methods were used to compare the change in hospitalisation rates in the intervention neighbourhoods to the change in hospitalisation rates in the matched control neighbourhoods, before and after the declaration of an AQMA. Results In total, 108 intervention neighbourhoods and 540 control neighbourhoods were analysed over the period 2005–2017, giving a total sample size of 8424 neighbourhood-years. Emergency hospitalisations for respiratory conditions decreased in the intervention neighbourhoods by 158 per 100,000 per year [95% CI 90 to 227] after an AQMA was declared relative to the control neighbourhoods. There was a larger decrease in hospitalisation rates following the declaration of an AQMA in more compared to less income deprived neighbourhoods. Conclusions Our results suggest the LAQM system has contributed to a reduction in emergency hospitalisations for respiratory conditions, and may represent an effective strategy to reduce inequalities in health. These findings highlight the importance of measuring the success of air quality policies not just in terms of air pollution but also in terms of population health.

Mitochondrial DNA metabolism is coupled with 20S proteasome function via regulation of deoxyribonucleotide homeostasis in Saccharomyces cerevisiae

The synthesis of mitochondrial DNA (mtDNA) is not coupled with cell cycle. Previous studies have shown that the size of deoxyribonucleoside triphosphate (dNTP) pools plays an important role in regulating mtDNA replication and amplification. In yeast, dNTPs are synthesized by the cytosolic ribonucleotide reductase (RNR). It is currently poorly understood as to how RNR activity is regulated in non-dividing or quiescent cells to finely tune mtDNA metabolism to cope with different metabolic states. Here, we show that defect in the 20S proteasome drastically destabilizes mtDNA. The mtDNA instability phenotype in 20S proteasome mutants is suppressed by overexpression of RNR3 or by the deletion of SML1, encoding a minor catalytic subunit and an intrinsic inhibitor of RNR respectively. We found that Sml1 is stabilized in the 20S proteasomal mutants, suggesting that 20S affects mtDNA stability by stabilizing Sml1. Interestingly, defect in the regulatory 19S proteasomal function has only subtle effect on mtDNA stability, supporting a role of the 20S proteasome in dNTP homeostasis independent of 19S. Finally, we found that when cells are transitioned from glycolytic to oxidative growth, Sml1 level is reduced in a 20S-dependent manner. In summary, our study establishes a link between cellular proteostasis and mtDNA metabolism through the regulation of dNTP homeostasis. We propose that increased degradation of Sml1 by the 20S proteasome under respiratory conditions provides a mechanism to stimulate dNTP synthesis and promote mtDNA amplification.

Relationship between 6-minute walk test and 1-minute sit to stand test in patients with COVID-19: A retrospective analysis

Background: Coronavirus disease (COVID-19) is an infectious disease, causing a range of symptoms such as fever, cough, and dyspnea. 6 Minute walk test (6MWT) is recommended to measure functional capacity in COVID-19. 1- Min sit to stand (STS-1) test has been used as its alternative in various respiratory conditions. This retrospective study aims to explore the relationship between the two tests in patients with COVID-19. Patients and methods: The medical records of COVID-19 patients in a male step down unit, referred for physical therapy between the periods from 5th September, 2020 to 25th September, 2020 were analysed retrospectively. Hemodynamically stable patients who underwent 6MWT and STS-1 prior to discharge, were included in the analysis. SPSS Version 24 was used to find the correlation between 6-min walk distance (6MWD) and number of repetitions in STS-1; and to compare the haemodynamic responses between the two tests. Results: There was a statistically significant positive correlation between the 6MWD and the STS⁻¹ repetitions (r=0.75, p<0.0001). On comparison of the two tests, the change in heart rate (HR) was significantly greater in the STS⁻¹ (p = 0.027). Whereas, the change in dyspnea (modified Borg’s score) and SpO2 was similar in both the groups and was not statistically significant (p= 0.10, p=0.62; respectively). Conclusion: There is a significant correlation between the 6MWT and STS⁻¹ test with similar haemodynamic response and can perhaps be used as an alternative to 6MWT in COVID-19.