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The E-cigarette market continues to expand at an alarming rate with thousands of flavours available for purchase and continuously evolving devices. Now that it is a multi-billion dollar industry and one without stringent regulation, there is rising concern over the safety of vaping products. Since June 2019, over 2800 cases of E-cigarette-associated acute lung toxicity have been reported in the USA, over 60 of which resulted in death. Many argue that E-cigarettes offer a safer alternative to smoking, but we are evidently far from fully understanding the potential hazards that they pose to respiratory health. Although the risk of an outbreak in the UK has been considered low due to tighter E-cigarette regulations, we cannot fully eliminate the possibility of similar events occurring in the future. With evidence frequently emerging of the harmful effects of E-cigarettes to pulmonary health, there is an urgent need to define the long-term implications of vaping. Studies show that E-cigarette exposure can disrupt pulmonary homeostasis, with reports of gas exchange disturbance, reduced lung function, increased airway inflammation and oxidative stress, downregulation of immunity, and increased risk of respiratory infection. In this review, the latest research on the effect of E-cigarette use on respiratory health will be presented.

Background Stereotactic body radiotherapy (SBRT) is the standard care for inoperable early stage non-small cell lung cancer (NSCLC). The purpose of our study was to investigate whether a prediction model based on cone-beam CT (CBCT) plus pretreatment CT radiomics features could improve the prediction of tumor control and lung toxicity after SBRT in comparison to a model based on pretreatment CT radiomics features alone. Methods A total of 34 cases of stage I NSCLC patients who received SBRT were included in the study. The pretreatment planning CT and serial CBCT radiomics features were analyzed using the imaging biomarker explorer (IBEX) software platform. Multivariate logistic regression was conducted for the association between progression-free survival (PFS), lung toxicity and features. The predictive capabilities of the models based on CBCT and CT features were compared using receiver operating characteristic (ROC) curves. Results Five CBCT features and two planning CT features were correlated with disease progression. Six CBCT features and two planning CT features were related to lung injury. The ROC curves indicated that the model based on the CBCT plus planning CT features might be better than the model based on the planning CT features in predicting lung injury. The other ROC curves indicated that the model based on the planning CT features was similar to the model based on the CBCT plus planning CT features in predicting disease progression. Conclusions Both pretreatment CT and CBCT radiomics features could predict disease progression and lung injury. A model with CBCT plus pretreatment CT radiomics features might improve the prediction of lung toxicity in comparison with a model with pretreatment CT features alone. Key points Significant findings of the study: A model with cone-beam CT radiomics features plus pre-treatment CT radiomics features might improve the prediction of lung toxicity after SBRT in stage I NSCLC patients. What this study adds In the prediction of PFS and lung toxicity in early-stage NSCLC patients treated with SBRT, CBCT radiomics could be another effective method.

Objectives In this study, we focused on the qualitative and quantitative differences of the lung lesions induced by single or multiple intratracheal administration of nickel oxide nanoparticles (NiO). Methods Male rats were randomized into groups receiving intratracheal administrations in a single dose or two to four divided doses of 2 mg/kg/bw. Bronchoalveolar lavage fluid (BALF) analyses were performed at 3 and 28 d post-dose. Histopathological analyses were performed at 28 and 91 d post-dose. Results BALF analyses revealed pulmonary injury, inflammation, and increases in the parameters indicating processing the foreign material in all the NiO-treated groups. Histopathological analyses showed the phagocytosis of NiO by alveolar macrophages, degeneration and necrosis of alveolar macrophages, and inflammatory responses. In the comparison between single and multiple administrations, the trend for stronger toxicity effects was observed after multiple application at 3 d post-dose, while the obvious toxicity effects were also seen in case of single administration. No particular differences of lung lesions depending on the frequency of administration at 28 and 91 d post-dose were evident. Conclusion Intratracheal NiO administration induced strong toxic response thoroughly even by single administration. Therefore, single administration was concluded to be applicable to assess the inhalation toxicity of nanomaterials and can be used in the screening test.

Severe drug-induced lung disease, resistant to steroids, is a dramatic situation due to the absence of therapeutic alternatives. We describe a case of vinorelbine-induced acute respiratory distress syndrome that did not respond to supportive care plus high-dose steroids. Cyclophosphamide pulse therapy was initiated with subsequent clinical and radiological improvement, allowing the patient to be discharged. We suggest that vinorelbine-induced lung toxicity is driven by a primarily immune-mediated mechanism and that it can respond favourably to immunosuppressive therapy.

Bronchiectasis is a progressive condition characterized by irreversible destruction and dilation of airways generally associated with chronic bacterial infections. Although in Western countries, the morbidity and mortality from bronchiectasis is considered to have declined markedly in the modern era, the condition continues to cause significant morbidity and mortality in the south-west Pacific and probably also in South-East Asia. There is a high prevalence in indigenous populations in the region and factors such as poverty, substandard housing, malnutrition, barriers to medical care and inadequate education are all likely to have a major impact on prevalence and outcome of bronchiectasis. Although bronchiectasis has been viewed as a disease of medium and large airways, there is now increasing evidence of the importance of small airways disease in bronchiectasis and that it may play an integral role in pathogenesis. Chronic inflammation of the bronchial wall by mononuclear cells is common to all types of bronchiectasis. A vicious cycle of bacteria (mediated lung toxicity and bacteria) provoked, host-mediated inflammatory lung damage has been described. If progressive lung damage with its attendant morbidity and mortality is to be prevented, this vicious cycle needs to be broken. The two distinct therapeutic goals in bronchiectasis are to reduce morbidity and to prevent progression of underlying disease. It may be possible to modulate the host response directly and thus reduce tissue damage, but the precise role of immuno-modulatory therapy in bronchiectasis is still unclear. The management of this hitherto neglected disease, which reaches almost epidemic proportions in some ethnic groups and is an ongoing source of considerable morbidity and mortality, requires a comprehensive, multidisciplinary approach, which can be modelled on the successful management of chronic asthma in New Zealand.

The mechanisms involved in bleomycin-induced lung toxicity have not been fully understood to date. This work aimed to compare the proteome profiling of bleomycin-induced lung toxicity by using 2D-nano-LC-MS/MS and spectral counting. By comparing the spectral counts of identified proteins between control and bleomycin-treated groups, we noted that 102 proteins were upregulated and 28 proteins were downregulated in the bleomycin-treated group. Among these differently expressed proteins, five proteins were chosen for validation by Western blot analysis. The levels of these five proteins were consistent with proteomic results. These potential mediators can facilitate the translation of the underlying mechanisms of bleomycin-induced lung toxicity to molecular targets in the clinical arena.

Purpose: The current SBRT treatment techniques include free breathing (FB) SBRT and gated FB SBRT. Gated FB SBRT has smaller target and less lung toxicity with longer treatment time. The recent development of direct connectivity between the ABC and linac allowing for automated beam gating. In this study, we have examined the feasibility of using ABC system to gate the lung SBRT treatment. Methods: A CIRS lung phantom with a 3cm sphere-insert and a moving chest plate was used in this study. Sinusoidal motion was used for the FB pattern. An ABC signal was imported to simulate breath holds. 4D-CT was taken in FB mode and average-intensity-projection (AIP) was used to create FB and 50% gated FB SBRT planning CT. A manually gated 3D CT scan was acquired for ABC gated SBRT planning.An SBRT plan was created for each treatment option. A surface-mapping system was used for 50% gating and ABC system was used for ABC gating. A manually gated CBCT scan was also performed to verify setup. Results: Among three options, the ABC gated plan has the smallest PTV of 35.94cc, which is 35% smaller comparing to that of the FB plan. Consequently, the V20 of the left lungmore » reduced by 15% and 23% comparing to the 50% gated FB and FB plans, respectively. The FB plan took 4.7 minutes to deliver, while the 50% gated FB plan took 18.5 minutes. The ABC gated plan delivery took only 10.6 minutes. A stationary target with 3cm diameter was also obtained from the manually gated CBCT scan. Conclusion: A strategy for ABC gated lung SBRT was developed. ABC gating can significantly reduce the lung toxicity while maintaining the target coverage. Comparing to the 50% gated FB SBRT, ABC gated treatment can also provide less lung toxicity as well as improved delivery efficiency. This research is funded by Elekta.« less

Purpose: We proposed using relative damaged volume (RDV) models to evaluate lung toxicity in treatment plans for hypofractionated stereotactic body radiotherapy(SBRT) of lungcancer, and performed plan comparisons using RDV with helical tomotherapy (HT), 3‐dimensional conformal radiotherapy (3D‐CRT), and volumetric modulated arc therapy (VMAT) treatment plans for lungcancerSBRTtreatments. Methods: Ten lungcancer patients treated with SBRT were retrospectively selected. Four treatment plans were generated for each patient to deliver 50 Gy in five fractions to the planning target volume (PTV). HT plans were generated using 1.0 cm or 2.5 cm jaw size. 3D‐CRT plans with 6 MV (3D‐6MV) and 10 MV (3D‐10MV) photon energy were generated using 12 non‐coplanar beams. VMAT plans were generated using one single arc field. The dose volume histogram (DVH) for the normal lung was first normalized to the biologic equivalent DVH. The lung RDV was then calculated with both the S‐shaped and logistic function models, respectively. The sensitivity of the RDV to the model parameter of 50% local dose effect level (D_L50) was evaluated. Results: The logistic function model gave higher RDV than the S‐shaped model. With D_L50 increasing from 20 Gy to 30 Gy, the average RDV decreased by 30.1% and 29.4% using the S‐shaped and logistic function models, respectively. The VMAT plans achieved similar average RDV with non‐coplanar 3D‐CRT plans. The HT plans showed the lowest average RDV compared to the other treatment modalities. The average maximum dose to the PTV was 61.3+\−2.2 Gy, 67.0+\−3.7 Gy, 67.1+\−4.4 Gy, and 61.8+\−2.6 Gy in the HT, 3D‐6MV, 3D‐10MV, and VMAT plans, respectively. Conclusions: The lung RDV allowed for efficient lung toxicity evaluation. Based on RDV evaluation, HT treatment plans could provide lower lung toxicity compared to non‐coplanar 3D‐CRT and single‐arc VMAT plans for SBRTtreatment of lungcancer.

The effects of exposure pattern on the toxicity of acetaldehyde vapour were investigated in 4-week inhalation studies. Male rats were exposed to 500 or 150 and 110 ppm for 6 h per day/5 days per week. One group of animals was exposed without interruption, the exposure of a second group was interrupted for 1.5 h between the first and second 3-h periods, the exposure of a third group was similarly interrupted and for six 5 min periods exposure was increased sixfold. Peak exposures of up to 3000 ppm superimposed on 500 ppm acetaldehyde caused irritation and excitation, and reduced body weight gain. No such effects occurred after interrupted or uninterrupted exposure to 500 ppm acetaldehyde without peak loads. A reduced phagocytotic index of lung macrophages was found in each of the groups exposed to 500 ppm acetaldehyde, the effect being most marked in the group with superimposed peaks of 3000 ppm. Degeneration of the nasal olfactory epithelium was observed in rats uninterruptedly exposed to 500 ppm acetaldehyde. Interruption of the exposure or interruption combined with peak exposure did not visibly influence this adverse effect on the nose. No compound-related effects were seen in rats interruptedly or uninterruptedly exposed to 150 ppm acetaldehyde or interruptedly exposed to 110 ppm with peak loads of 660 ppm. As a consequence 150 ppm acetaldehyde can be considered a 'no-toxic-effect level' in male rats exposed for 6 h/day, 5 days/week, during a 4-week period. It was concluded that the interruption of daily exposure by 1.5 h exposure-free period or by the superimposition of six times 5 min peak exposure periods did not appreciably influence the nasocytotoxic potency of acetaldehyde. Furthermore for inhalation toxicity testing of irritants such as acetaldehyde the use of variable exposure patterns does not seem to produce more relevant toxicity data than the use of uninterrupted daily exposure to a fixed concentration. Chemicals/CAS: acetaldehyde, 75-07-0; Acetaldehyde, 75-07-0

Bleomycin given intravenously (i.v.) or intramuscularly (i.m.) in twice-weekly doses of 10 mg/m2 was evaluated for efficacy and toxicity in 382 patients. Responses were observed in 11/27 Hodgkin's diseases, 10/30 lymphomas, 9/22 squamous cell cancers of ectodermal origin, 12/26 germinal cancers, and 3/8 renal adenocarcinomas. The i.m. route is less likely to casue pulmonary toxicity or hypotension than the i.v. route. Advanced age and total doses exceeding 200 mg were associated with a higher risk of lung toxicity. All responders had shown at least improvement upon receiving 200 mg; higher total doses should be used only in responding patients.