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Introduction: Treatment of fluid overload and anemia remains a challenge in patients undergoing hemodialysis. Hypervolemia can be evaluated using a carbon monoxide (CO) rebreathing method by which blood volume (BV), plasma volume (PV), and red blood cell volumes (RBCV) can be determined. We hypothesized that recurrent hypervolemia would cause hemoglobin (Hb) levels to be in the anemic range without a concurrent reduction in RBCV in patients undergoing hemodialysis. Methods: BV, PV, and RBCV were determined by a CO rebreathing test in 19 patients with type 2 diabetes undergoing chronic hemodialysis. The tests were performed 20 minutes before initiating dialysis, and the measured intravascular volumes were compared with predicted normal intravascular volumes according to Nadler's equation. Before initiating dialysis, Hb and blood pressure were measured, and edema severity was graded. Findings Measured BV was higher in 17 out of the 19 patients with a median of 71.1 (62.4–76.9) mL/kg and higher than the predicted BV of 58.3 (53.5–59.9) mL/kg (P < 0.001). The measured PV was found to be higher in all patients. RBCV was measured as 25.2 (23.4–28.2) mL/kg with a predicted volume of 25.9 (22.4–26.7) mL/kg (P = 0.56). Eighteen patients were anemic as determined by Hb concentrations (defined as Hb < 13 g/dL for men and <12 g/dL for women), and nine were anemic according to RBCV. Discussion: The CO rebreathing test is a new approach to measuring intravascular volumes in hemodialysis patients. Compared with predicted intravascular volumes, the predialysis BV was expanded in the majority with elevated PV as the main cause. No overall difference in RBCV was found between the measured and predicted volumes. According to predialysis Hb levels, all but one patient was anemic, but according to the measured RBCV, only nine were in the anemic range, indicating dilution of Hb. [ABSTRACT FROM AUTHOR]

Acute limb ischemia (ALI) as a complication of acute carbon monoxide (CO) poisoning is rare. Several reports have utilized hyperbaric oxygen therapy (HBO2) as an adjunctive therapy for peripheral arterial diseases. However, no study has yet described the use of HBO2 for ALI precipitated by CO poisoning. Herein we report successful limb salvage achieved with adjunctive HBO2 and conventional therapies in a patient with CO-induced ALI. A 69-year-old man was admitted with acute CO poisoning; ALI of both lower extremities occurred on hospitalization day 3. Pre-existing risk factors for ALI other than CO were not definite. After conventional treatments including catheterdirected thrombolysis and endovascular thrombectomy, the right-side lesion remained and a left-side lesion was newly developed. In addition to prior therapies, 47 sessions of serial HBO2 were administered as adjunctive therapy, resulting in limb salvage. Acute CO poisoning can cause ALI as a rare complication. HBO2 may be utilized as an adjunctive treatment in ALI. [ABSTRACT FROM AUTHOR]

Air pollution by carbon monoxide is a serious problem that affects many cities around the world, and the theory of extreme values has played a crucial role in the study of this issue. In this paper, we proposed a Bayesian hierarchical spatial model of extreme values to evaluate the risk of extreme events of air pollution due to carbon monoxide in the metropolitan area of Mexico City. Spatial trends are modeled through of a Gaussian process for the generalized extreme value (GEV) distribution parameters, and prediction maps are produced for each of these. The results show a marginal spatial behavior for the location, scale, and shape parameters of GEV distribution, which indicate the existence of local variations that would not be possible to model using only stationary models. A return map of the maximum concentrations with a return period of one year is obtained. We found that the return levels for a one-year return period of CO concentration above 8 ppm in the Metropolitan Area of the Valley of Mexico are concentrated in the central part of this region, and the areas with the lowest estimates are distributed in the periphery. In addition, a quantile-quantile (QQ) plot between the theoretical and empirical quantiles was provided, which showed a very good fit of data to the proposed model. [ABSTRACT FROM AUTHOR]

BACKGROUND: Much remains unknown about the consequences of very low birth weight (VLBW) and bronchopulmonary dysplasia (BPD) on adult lungs. We hypothesized that VLBW adults would have impaired lung function compared with controls, and those with a history of BPD would have worse lung function than those without. METHODS: At age 26 to 30 years, 226 VLBW survivors of the New Zealand VLBW cohort and 100 term controls born in 1986 underwent lung function tests including spirometry, plethysmographic lung volumes, diffusing capacity of the lung for carbon monoxide, and single-breath nitrogen washout (SBN2). RESULTS: An obstructive spirometry pattern was identified in 35% VLBW subjects versus 14% controls, with the majority showing mild obstruction. Compared with controls, VLBW survivors demonstrated significantly lower forced expiratory volume in 1 second (FEV1), FEV1 /forced vital capacity (FVC) ratio (FEV1/FVC), forced expiratory flow at 25% to 75% of FVC and higher residual volume (RV), RV/total lung capacity (TLC) ratio (RV/TLC), decreased diffusing capacity of the lung for carbon monoxide, and increased phase III slope for SBN2. The differences persisted after adjustment for sex and smoking status. Within the VLBW group, subjects with BPD showed significant reduction in FEV1, FEV1/FVC, and forced expiratory flow at 25% to 75% of FVC, and increase in RV, RV/TLC, and phase III slope for SBN2, versus subjects without. The differences remained after adjustment for confounders. CONCLUSIONS: Adult VLBW survivors showed a higher incidence of airflow obstruction, gas trapping, reduced gas exchange, and increased ventilatory inhomogeneity versus controls. The findings suggest pulmonary effects due to VLBW persist into adulthood, and BPD is a further insult on small airway function. [ABSTRACT FROM AUTHOR]

Long-term exposure to particulate and gaseous air pollution (AP) may trigger the development of Parkinson disease (PD), but this association remains controversial. The relationship between second-hand smoke (SS) and PD risk is also inconclusive. We aimed to systematically review epidemiological studies investigating the association between these AP exposures and PD risk. This was a systematic review and meta-analysis of studies investigating the relationship of ambient AP and SS with PD risk. PubMed, Embase, Web of Science, Cochrane Library, and Google Scholar databases were searched. We used a random-effects model to derive pooled estimates of relative risk (RR) and corresponding 95% confidence intervals (CIs) per increment in pollutant concentration. The studied AP included particulate matter with aerodynamic diameter <2.5 μm (PM 2.5), <10 μm (PM 10), nitrogen dioxides (NO 2, NO x), ozone (O 3), and carbon monoxide (CO). In total, 21 studies with 222,051 patients with PD were eligible for inclusion. We found marginally significant increased risk of PD with per 10-μg/m3 increase in concentration of PM 2.5 (RR = 1.08, 95% CI = 0.98–1.19), NO 2 (RR = 1.03, 95% CI = 0.99–1.07), and O 3 (RR = 1.01, 95% CI = 1.00–1.02). A positive but non-significant association was also detected for CO (RR = 1.32, 95% CI = 0.82–2.11). Furthermore, an inverse PD-SS relationship was noted irrespective of exposure occasions and timing (at home: RR = 0.73, 95% CI = 0.56–0.95; at work: RR = 0.82, 95% CI = 0.57–1.17; in children: RR = 0.91, 95% CI = 0.76–1.08). Both sensitivity and subgroup analyses generated results comparable with those of the overall analyses. Our study suggested that exposure to PM 2.5 , NO 2 , and O 3 might contribute to higher risk of PD, whereas SS conferring reduced PD risk. Public and environmental health strategies that aim at reducing outdoor AP levels might reduce the burden of PD. More prospective cohort studies with personal exposure measurements are warranted in the future. Image 1 • PM 2.5 , NO 2 , and O 3 may contribute to higher risk of Parkinson disease. • Second-hand smoke conferred reduced risk of Parkinson disease, regardless of exposure occasions and timing. • This is the first meta-analysis on the neuroprotective effect of second-hand smoke. • This is the most comprehensive review on the relationship between outdoor air pollution and Parkinson's disease. [ABSTRACT FROM AUTHOR]

Background and Aims: NicAlert produces semi‐quantitative assessments of cotinine levels in saliva or urine for verification of smoking abstinence. This study aimed to assess the accuracy of NicAlert readings against a liquid chromatography tandem mass spectrometry assay in smokers who had passed expired‐air carbon monoxide (CO) verification but failed NicAlert verification. Design Comparison of NicAlert readings against readings from a reference assay using liquid chromatography tandem mass spectrometry. Setting: Geneva, Switzerland. Participants: Self‐reported non‐smokers (n = 92) who in previous testing had CO of 0–3 parts per million (indicating no recent smoking) and reported not using any nicotine product, but had NicAlert readings ≥ 1 (indicating smoking). Measurements NicAlert produces readings of 0, 1 and 2+, which are reported by the manufacturer to correspond to saliva cotinine concentrations of 0–10 ng/ml (indicating not smoking), 10–30 ng/ml and 30+ ng/ml, respectively. Liquid chromatography tandem mass spectrometry was used as the reference. Findings For 82 participants with a NicAlert reading of 1, only two of the liquid chromatography tandem mass spectrometry values were within the purported range of 10–30 ng/ml; 71 were below 4 ng/ml and half the values were below 0.5 ng/ml. Two of the eight participants with NicAlert readings of 2 had laboratory values within the designated range. Neither of the two participants with NicAlert readings of 3 had a cotinine value within the designated range. Conclusions: In people who had passed carbon monoxide verification, NicAlert readings yielded a very high false‐positive rate in detecting levels of cotinine indicative of smoking. [ABSTRACT FROM AUTHOR]

This study conducts a spatio-temporal analysis of tropospheric nitrogen dioxide (NO 2 ) and total carbon monoxide (CO) concentrations in the Punjab and Haryana regions of India and Pakistan, using datasets from the Sentinel 5-Precursor (S5P) satellite. These regions, marked by diverse economic growth factors including population expansion, power generation, transportation, and agricultural practices, face similar challenges in atmospheric pollution, particularly evident in major urban centers like Delhi and Lahore, identified as pollution hotspots. The study also spotlights pollution associated with power plants. In urban areas, tropospheric NO 2 levels are predominantly elevated due to vehicular emissions, whereas residential activities mainly contribute to CO pollution. However, precisely attributing urban CO sources is complex due to its longer atmospheric residence time and intricate circulation patterns. Notably, the burning of rice crop residue in November significantly exacerbates winter pollution episodes and smog, showing a more pronounced correlation with total CO than with tropospheric NO 2 levels. The temporal analysis indicates that the months from October to December witness peak pollution, contrasted with the relatively cleaner period during the monsoon months of July to September. The severe pollution in the OND quarter is attributed to factors such as variations in boundary layer height and depletion of OH radicals. Furthermore, the study highlights the positive impact of the COVID-19 lockdown on air quality, with a significant decrease in NO 2 concentrations during April, 2020 (Delhi: 59%, Lahore: 58%). However, the reduction in total CO columns was less significant. The study also correlates lockdown stringency with tropospheric NO 2 columns (R2: 0.37 for Delhi, 0.25 for Lahore, 0.22 for Rawalpindi/Islamabad), acknowledging the influence of various meteorological and atmospheric variables. The research highlights the significant impact of crop residue burning on winter pollution levels, particularly on total CO concentrations. The study also shows the notable effect of the COVID-19 lockdown on air quality, significantly reducing NO 2 levels. Additionally, it explores the correlation between lockdown stringency and tropospheric NO 2 columns, considering various meteorological factors., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Recent global challenges encompass profound environmental pollution and the depletion of finite fuel resources. In this study, the biodiesel used in the mixture was derived from Azolla pinnata microalgae oil through a trans-esterification reaction chosen for its high oil concentration. During the initial phase of the experiment, varying volumes of biodiesel (5%, 10%, and 15%) and n-heptane (5%, 10%, and 15%) were introduced to diesel to form a ternary fuel blend. The experimental outcome shows that an n-heptane and biodiesel mixture of 10% by volume would produce the best results. Next, experiments were carried out by incorporating 10, 40, and 80 ppm titanium oxide (TiO 2 ) nanoparticles (NPs) in a recommended ternary fuel blend. The experimental investigation showed that D80A10H10TNP40 (diesel 80% + biodiesel 10% + n-heptane 10% + TiO 2 40 ppm) caused a 7.21% increase in brake thermal efficiency (BTE) with a decrease in brake specific fuel consumption (BSFC) and brake specific energy consumption (BSEC) by 9.58% and 10%, respectively, compared to (diesel 80% + biodiesel 20%) D80A20. D80A10H10TNP40 exhibits lower emissions, with a significant reduction of 11.29% and 20.96% in carbon monoxide (CO) and unburnt hydrocarbons (UBHC), respectively. Nitrogen oxide (NO X ) and smoke emissions were reduced by 3.3% and 11.13%, respectively, compared to D80A10H10. Furthermore, D80A10H10TNP40 demonstrated enhanced combustion properties, comprising a significant rise of 4.39% in-cylinder pressure (CP), 35.29% in heat release rate (HRR), and 25.05% in the rate of pressure rise (RPR). The findings of this investigation indicate that D80A10H10TNP40 exhibits enhanced efficiency, emission, and combustion properties compared to the D80A20 fuel., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The number of cars is increasing every year and the environmental aspects of transport are becoming a hot topic. The spatial and temporal patterns of motor vehicle carbon monoxide (CO) emissions are still unclear due to the unbalanced economic development and heterogeneous geographic conditions of China. With the objective of realizing a reduction in motor vehicle CO emissions, his study explores the transport carbon emission reduction pathways of China from motor vehicle CO emission. Firstly, the entropy method is adopted to comprehensively evaluate the CO emissions from motor vehicles in each province; secondly, the development of a Geographically and Temporally Weighted Regression (GTWR) model facilitates the examination of the spatiotemporal dynamics pertaining to the influencing factors of motor vehicle CO emissions within each province.; finally, the characteristics of motor vehicle CO emissions in ETS pilot areas and non-ETS pilot areas are compared. The results show that: (1) After the completion of the six ETS pilot areas in 2011, the CO emission from motor vehicles is reduced by 18% compared with 2010.(2)The entropy method shows that the largest CO emissions from motor vehicles are from Beijing, Shanghai, Guangdong and other provinces with high economic levels.(3) The results of the GTWR model show that the positive effects of economic level, population size, road mileage intensity and motor vehicle intensity on motor vehicle CO emissions are decreasing year by year. The negative effect of metro line intensity on CO emission decreases year by year. This study can help decision makers to identify the high emission areas, understand the influencing factors, and formulate emission reduction measures to achieve the purpose of carbon emission reduction in transport., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Problem: Over 25000 Australian women smoke during pregnancy each year, with risks to mother and baby including miscarriage, pre-eclampsia, placental issues, premature birth, and stillbirth., Background: Carbon Monoxide testing has been introduced in antenatal care settings to help identify smokers and motivate them to quit., Aim: This integrative systematic review aims to take a holistic look at Carbon Monoxide (CO) testing to understand how effective and acceptable this practice is in antenatal care., Methods: PubMed, Scopus and CINAHL were searched for literature relating to pregnant women where CO testing has been used to identify smoking as part of a smoking cessation initiative. The search results were then screened and reviewed independently by two authors. A total of 15 studies were deemed relevant and proceeded to quality appraisal using the Crowe Critical Appraisal Tool. A Narrative Synthesis method was used to present the findings., Discussion: Synthesis resulted in four themes: smoking identification and referral to cessation support, smoking cessation, midwifery usability of CO testing and women's perception of CO testing. Whilst carbon monoxide testing increased the identification and referral to cessation support for pregnant smokers, it did not make an overall difference to smoking cessation rates. Midwives frequently report having too little time to conduct carbon monoxide testing. Findings suggest that women accept the test, but their opinions are under-represented in the existing evidence. Midwives and women report concern for the midwife/woman relationship if testing is not conducted well., Conclusion: Whilst carbon monoxide testing can identify smoking, it does not appear to motivate pregnant smokers to quit., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Environmental epidemiologic studies routinely utilize aggregate health outcomes to estimate effects of short-term (eg, daily) exposures that are available at increasingly fine spatial resolutions. However, areal averages are typically used to derive population-level exposure, which cannot capture the spatial variation and individual heterogeneity in exposures that may occur within the spatial and temporal unit of interest (eg, within a day or ZIP code). We propose a general modeling approach to incorporate within-unit exposure heterogeneity in health analyses via exposure quantile functions. Furthermore, by viewing the exposure quantile function as a functional covariate, our approach provides additional flexibility in characterizing associations at different quantile levels. We apply the proposed approach to an analysis of air pollution and emergency department (ED) visits in Atlanta over 4 years. The analysis utilizes daily ZIP code-level distributions of personal exposures to 4 traffic-related ambient air pollutants simulated from the Stochastic Human Exposure and Dose Simulator. Our analyses find that effects of carbon monoxide on respiratory and cardiovascular disease ED visits are more pronounced with changes in lower quantiles of the population's exposure. Software for implement is provided in the R package nbRegQF., (© The Author(s) 2024. Published by Oxford University Press on behalf of The International Biometric Society.)

Objective: Environmental pollution is an emerging global public health problem across the world and causes serious threats to ecosystems, human health, and the planet. This study is designed to explore the impact of environmental pollution particulate matter PM2.5, PM10, carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), and ozone (O3) on cognitive functions in students from schools located in or away from air-polluted areas., Subjects and Methods: In this study, two schools were selected: one was located near a traffic-polluted area (school #1), and the second was in an area away from the traffic-polluted area (school #2). In this study, a total of 300 students were recruited: 150 (75 male and 75 female) students from school #1 located in a traffic-polluted area, and 150 students (75 male and 75 female) from school #2 located away from a traffic polluted area. The overall average age of students was 13.53±1.20 years. The students were selected based on age, gender, health status, height, weight, BMI, ethnicity, and homogenous socio-economic and educational status. The pollutants PM2.5, PM10, CO, NO2, O3, and SO2 were recorded in the surrounding environment. The overall mean concentration of environmental pollutants in school #1 was 35.00±0.65 and in school #2 was 29.95±0.32. The levels of airborne particles were measured, and the cognitive functions were recorded using the Cambridge Neuropsychological Test Automated Battery (CANTAB). The students performed the cognitive functions tasks, including the attention switching task (AST), choice reaction time (CRT), and motor screening task (MOT)., Results: The results revealed that the AST-Mean 928.34±182.23 vs. 483.79±146.73 (p=0.001), AST-mean congruent 889.12±197.12 vs. 473.30±120.11 (p=0.001), AST-mean in-congruent 988.98±201.27  vs. 483.87±144.57 (p=0.001), CRT-Mean 721.36±251.72  vs. 418.17±89.71 (p=0.001), and MOT-Mean 995.07±394.37 vs. 526.03±57.83 (p=0.001) were significantly delayed among the students who studied in school located in the traffic polluted area compared to students who studied in school which was located away from the traffic-polluted area., Conclusions: Environmental pollution was significantly higher in motor vehicle-congested areas. Cognitive functions were impaired among the students who were studying in a school located in a polluted area. The results further revealed that the students studying in schools located in environmentally polluted areas have attention, thinking, and decision-making abilities related to cognitive function impairment.

The current research investigates the utilization of spirulina microalgae biodiesel blends in a naturally aspirated constant speed compression ignition engine with Ce 2 O 3 nanoparticles at the concentration of 50 ppm under diverse engine loading conditions. Blends of microalgae dispersed with neat diesel at the volume of 20% and 40%. A series of tests were conducted to evaluate the combined effects of microalgae and nanoparticles on engine performance, combustion efficiency, and emission characteristics. The study revealed that increasing the microalgae concentration in the diesel fuel resulted in reduced brake thermal efficiency due to less effective atomization and lower calorific value. Surprisingly, the 20% biodiesel blend with nanoparticles exhibited the highest brake thermal efficiency across various engine loads, while the 40% blend showed higher brake specific fuel consumption compared to both the 20% blend and neat diesel, primarily because of its lower heating value necessitating increased fuel consumption. Furthermore, the biodiesel blends led to lower in-cylinder pressure than pure diesel, mainly attributable to suboptimal atomization. In terms of emissions, the utilization of microalgae-based fuel led to a significant reduction in NOx, CO, and smoke emissions, attributed to the lower cylinder temperatures associated with these blends. In conclusion, this study underscores the potential of spirulina microalgae, particularly when combined with nanoparticles at an optimal concentration, as a promising and environmentally friendly alternative for compression ignition engines., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

The current study aimed to measure real-world emissions of three-wheeled autorickshaws powered by CNG and parameters (such as speed, acceleration, air-fuel (A/F) ratio, and rpm) influencing 3-wheeler emission rates. Test vehicles manufactured under Bharat Standards BS-III and BS-IV were monitored for exhaust emissions in Delhi city using a portable exhaust emission measurement system (AVL Ditest Gas 1000). The average emission rates of CO, HC, and NO gases for on-road autorickshaws were found to be 0.015 ± 0.017, 0.003 ± 0.0017, and 0.007 ± 0.005 g/s, respectively. Further, the highest emission factor values of 3.98 g/km and 3.93 g/km were estimated for CO and HC+NO gases, respectively. These values were found to be 1.4-3.2 times higher than the respective BS emission norms (BS III-CO =1.25 g/km, HC+NO = 1.25 g/km; BS-IV-CO = 0.94 g/km and HC+NO = 0.94 g/km). In this study, it was observed that the driving pattern and emissions were affected by traffic characteristics, driver behavior (constant acceleration and deceleration), and vehicle characteristics. The air-fuel ratio (A/F) was found to correlate highly with emission rates, followed by acceleration/deceleration and speed. Further analysis found that more than 70% of the aggregated emissions were due to acceleration and deceleration, which contributed to nearly 70% of the travel time. This was followed by the breakdown of speed and emissions into different bins, which found that 20-30 kmph has a higher emission rate and 40-50 kmph bin has a lower emission rate., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Introduction: Improper use of camp stoves in enclosed spaces has resulted in fatalities from carbon monoxide (CO) poisoning. Prior research has focused on the CO output of stoves burning white gas, unleaded gas, or kerosene. Stoves burning an isobutane/propane fuel have not been investigated and are the focus of this study., Methods: Three stoves utilizing isobutane/propane fuel were used to heat a pot of water inside a 3-season tent under controlled settings. Multiple runs with each stove were performed, and CO measurements, in parts per million (ppm), were recorded at 1-min intervals for a total of 15 min using a RAE Systems gas monitor. Data are reported as mean with SD. Repeated measures analysis of variance was utilized to examine changes over time. Statistical significance was set at P<0.05., Results: There was a statistically significant main effect of time and CO level, F (14, 168)=7.6, P<0.001. There was a statistically significant difference between-subjects effect of stove group F (2, 12)=8.6, P=0.005, indicating that CO levels were different depending on the stove. Tukey's post-hoc analyses revealed that stove A had the highest CO levels. The average level of stove A was statistically significantly higher than that of stove B and stove C, with a mean CO level difference of 79 ppm (95% CI, 3-156), P=0.043 and 117 ppm (95% CI, 40-194), P=0.004, respectively., Conclusions: Stoves utilizing isobutane/propane fuel can produce unsafe CO levels and should not be used in enclosed spaces., (Copyright © 2023 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.)

The use of n-pentanol/biodiesel as a diesel engine fuel is one of the important ways to reduce fossil fuel consumption and lower diesel engine emissions. The objective of this work was to investigate the mechanism of the effect of different n-pentanol blending ratios (0%, 10%, 20%, and 30%) on the combustion and emission performance of a common rail diesel engine. Tests were conducted on a four-cylinder supercharged intercooled diesel engine at 1540 r/min with brake mean effective pressures of 0.289, 0.578, and 0.867 MPa. The results showed that with the increase of the n-pentanol blending ratio, the ignition delay was prolonged, the combustion duration was shortened, and the heat release center was shifted forward. The combustion process at medium and high loads was improved. When the blending ratio of n-pentanol reached 20%, the blended fuel showed better combustion characteristics at all three loads, and the peak in-cylinder pressure of the blended fuel increased by 13.74%, 1.95%, and 5.26% at the three loads, respectively, compared with that of pure biodiesel. With the increase of the n-pentanol blending ratio, HC, CH 2 O, CH 4 , and CH 3 CHO emissions increased at all three loads. Soot emission was reduced by 25.86%, 19.71%, and 31.59% at three loads when the n-pentanol blending ratio was 30%. C 2 H 4 emissions increased with the increase of n-pentanol blending ratio at the low-load condition and showed a decreasing tendency at the medium and high loads. At high load conditions, NO x emissions increased with increasing n-pentanol blending ratio, and CO emissions decreased with increasing n-pentanol blending ratio., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The engine tests aimed to produce comparable data for fuel consumption, exhaust emissions, and thermal efficiency. The computational fluid dynamics (CFD) program FLUENT was used to simulate the combustion parameters of a direct injection diesel engine. In-cylinder turbulence is controlled using the RNG k-model. The model's conclusions are validated when the projected p-curve is compared to the observed p-curve. The thermal efficiency of the 50E50B blend (50% ethanol, 50% biofuel) is higher than the other blends as well as diesel. Diesel has lower brake thermal efficiency among the other fuel blends used. The 10E90B mix (10% ethanol, 90% biofuel) has a lower brake-specific fuel consumption (BSFC) than other blends but is slightly higher than diesel. The temperature of the exhaust gas rises for all mixtures as the brake power is increased. CO emissions from 50E50B are lower than diesel at low loads but slightly greater at heavy loads. According to the emission graphs, the 50E50B blend produces less HC than diesel. NOx emission rises with increasing load in the exhaust parameter for all mixes. A 50E50B biofuel-ethanol combination achieves the highest brake thermal efficiency, 33.59%. The BSFC for diesel is 0.254 kg/kW-hr at maximum load, while the BSFC for the 10E90B mix is 0.269 kg/kW-hr, higher than diesel. In comparison to diesel, BSFC has increased by 5.90%., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Nano-additives are being employed in successive generations of biodiesels to increase the performance characteristics and output of diesel engines. In this study, the impact of mixing carbon nanotubes (CNT) with three different generations of biodiesel in a diesel engine is assessed. With 100 ppm of CNT nanoparticles mixed together, pure biodiesels made from first-generation oil (soybean), second-generation oil (neem), and third-generation oil (Nannochloropsis oculata microalgae) are used for the analysis. With an engine load ranging from 0 to 100%, a one-cylinder, four-stroke, direct injection diesel engine is employed. The engine has a water-cooling system, a compression ratio of 17.5:1, and a fuel injection angle of 23° before TDC. The evaluated engines' improved performance and lower emissions serve as proof of the outcomes. The results are evidenced by the lower emissions and higher performance of the tested engines. The biodiesel containing CNT nanoparticles enhanced the cylinder pressure by 0.8-10.69%, the heat release rate (HRR) by 6.38-21.69%, and the brake thermal efficiency (BTE) by 0.32-1.62%. Subsequently, it reduced the brake-specific fuel consumption (BSFC) by 2.53-8.13%, the brake-specific energy consumption (BSEC) by 1.07-3.77%, the smoke opacity (BSN) by 6.26-12.85%, the particulate matter (PM) emissions by 11.04-18.33%, and the carbon dioxide (CO 2 ) emissions by 2.53-8.14% at full engine load. However, an increase in 13.62-18.37% nitrogen emissions (NOx) emissions is also observed with the addition of CNT at 100% load. The investigation supports the use of CNT nano-additives in diesel engines for improved performance and reduced emissions., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The main objective of the present research work is to utilise the produced bio-oil from microwave pyrolysis of Karanja, a non-edible seed, as fuel for diesel engines by increasing some up-gradation in the quality of the fuel. The emulsification process is carried out to improve the stability of the diesel-bio-oil blend using SPAN 80 and TWEEN 80, which lasted for 28 days without any layer separation termed as EKB20. The addition of 5% DEE and 10% DEE into EKB20 is done to enhance the combustion characteristics of the diesel engine. The produced bio-oil fuels were tested in a Kirloskar make, four-stroke, single-cylinder, direct injection diesel engine of 5.2 kW rated power output. The addition of DEE reduces the peak pressure by 4 bar and increases the heat release rate due to the higher volatility of DEE. At full load conditions, the thermal brake efficiency improved by 9.31% and 14.11%, respectively, compared to EKB20. Adding 5% DEE and 10% DEE at the rated power output reduced the smoke density by 18.42% and 60.25%, respectively, compared to EKB20 and 5% and 4% compared to diesel. The addition of 5% DEE and 10% DEE shows a 39% and 51% increase in NO X concentration and a 90% reduction in CO emission at the maximum brake power output. Hence, it is concluded that the fuels EKB20 + 5% DEE and EKB20 + 10% DEE can be used as alternative fuels for diesel engines., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

At present, evidence of the associations between carbon monoxide (CO) and respiratory diseases (RD) in Northwest China is limited and controversial. The aim of this study is to evaluate the impact of ambient CO on outpatient visits for RD in Lanzhou, China. The daily amount of outpatient visits for total and cause-specific RD, air pollutant, and weather variables were collected in Lanzhou, China from 1st January 2013 to 31st December 2019. A generalized additive model and distributed lag nonlinear model were used to assess associations between CO and outpatient visits for RD. During the study period, a total of 1,623,361 RD outpatient visits were recorded. For each interquartile range (IQR) (0.77 mg/m 3 ) increase in CO, the relative risk (RR) was 1.163 (95% CI: 1.138, 1.188) for total RD at lag07, 1.153 (95% CI: 1.128,1.179) for upper respiratory tract infection (URTI) at lag07, 1.379 (95% CI: 1.338,1.422) for pneumonia at lag07, 1.029 (95% CI: 0.997,1.062) for chronic obstructive pulmonary disease (COPD) lag04, 1.068 (95% CI: 1.028,1.110) for asthma lag03, and 1.212 (95% CI: 1.178,1.247) for bronchitis lag07, respectively. In the subgroup analyses, the impacts of CO were more pronounced on total RD, pneumonia, COPD, and bronchitis in males than females, while the opposite was true in URTI and asthma. The impact of CO on RD was the strongest for children under 15 years-of-age. We also found significantly stronger effects during cold seasons compared to warm seasons. In addition, we observed a roughly linear exposure-response curve between CO and RD with no threshold effect. This study in Lanzhou revealed a remarkable association between CO level and an elevated risk of total and cause-specific RD outpatient visits, especially for pneumonia., (© 2023. The Author(s) under exclusive licence to International Society of Biometeorology.)

Because of their adaptability and user-friendliness, internal combustion engines are widely used for a variety of purposes, including the generation of consistent power as well as transportation. As a result, the question of whether or not these engines can make use of bio-oils is an important one today. Bio-oils derived from biomass pyrolysis differ significantly from those derived from petroleum-based fuels and biodiesel. They could, however, be valuable alternatives to fossil fuels in order to attain a carbon-neutral future. Bio-oil obtained from catalytic pyrolysis of Argemone Mexicana seed using titanium oxide (TiO 2 ) nanoparticles was employed in IC engine to check its suitability as an alternative fuel. Engine performance analysis was conducted at B5, B10, B15, B20, B25, and B30 blend for different parameters such as brake thermal efficiency, exhaust gas temperature, and brake-specific fuel consumption with change in engine load. Emission analysis was also carried out for carbon monoxide, hydrocarbon, nitrogen oxides, and carbon dioxide emissions. It was found that B30 blend resembled best performance and the bio-oil produced from catalytic pyrolysis of Argemone mexicana seed can be utilised as a substitute of fossil fuels in IC engine., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Aims: Our aim is to investigate the characterized echocardiographic cardiac measurements of POEMS syndrome and determine its relationship with clinical manifestations. Methods and Results: The cross‐sectional study included 27 treatment‐naïve patients with newly diagnosed POEMS syndrome and 26 age‐ and sex‐matched healthy volunteers. Information of clinical manifestations, serological tests, pulmonary function tests, and both conventional echocardiograph and tissue Doppler imaging (TDI) were collected and analyzed. Pearson's correlation coefficient was used for determining the related clinical and echocardiographic parameters. Compared to healthy people, left ventricular (LV) mass index (LVMI) was elevated in patients with POEMS syndrome (41.3 ± 11.0 g/m2.7, P < .05). LV systolic dysfunction was found by decreased mitral S′ (9.0 ± 2.2 m/sec, P < .01), and diastolic dysfunction by mitral E'/A' (1.10 ± 0.42, P < .05), E/E' (8.69 ± 4.06, P < .001) on lateral, and E/E' (7.90 ± 3.28, P = .133) on septal mitral annulus. The presence of decreased tricuspid annular plane systolic excursion (TAPSE) (22.2 ± 3.5 mm, P < .01) and lateral tricuspid S′ (11.1 ± 1.8 m/sec, P < .05) suggested deterioration of right ventricular (RV) systolic function. Parameters obtained from standard echocardiograph (tricuspid E/A ratio and DT) and TDI ((lateral tricuspid annulus E'/A' and E/E') indicated reduced RV diastolic function. Pulmonary hypertension (PH) was presented in six patients. Correlation analysis suggested that PH was related to total lung capacity (TLC) and diffusion capacity of carbon monoxide (DLCO). Conclusion: Echocardiographic measurements found that there was elevation of LVMI, pulmonary artery hypertension, and subclinical impairment of systolic and diastolic functions of both the right and left heart in patients with POEMS syndrome. [ABSTRACT FROM AUTHOR]

Background and aims: The United Kingdom's National Institute for Health and Care Excellence guidance (NICE PH48) recommends that pharmacotherapy combined with behavioural support be provided for all smokers admitted to hospital; however, relapse to smoking after discharge remains common. This study aimed to assess the effect of adding home support for newly abstinent smokers to conventional NICE‐recommended support in smokers discharged from hospital. Design Individually randomized parallel group trial. Setting: One UK acute hospital. Participants: A total of 404 smokers aged > 18 admitted to acute medical wards between June 2016 and July 2017 were randomized in equal numbers to each treatment group. Interventions and comparators: The intervention provided 12 weeks of at‐home cessation support, which included help in maintaining a smoke‐free home, help in accessing and using medication, further behavioural support and personalized feedback on home air quality. The comparator was NICE PH48 care as usual. Measures: The primary outcome was self‐reported continuous abstinence from smoking validated by an exhaled carbon monoxide level < 6 parts per million 4 weeks after discharge from hospital. Findings In an intention‐to‐treat analysis at the 4‐week primary end‐point, 38 participants (18.8%) in the usual care group and 43 (21.3%) in the intervention group reported continuous abstinence from smoking (odds ratio = 1.17, 95% confidence interval = 0.72 to 1.90, Bayes factor = 0.33). There were no significant differences in any secondary outcomes, including self‐reported cessation at 3 months, having a smoke‐free home or number of cigarettes smoked per day in those who did not quit. Conclusions: Provision of a home visit and continued support to prevent relapse to smoking after hospital discharge did not appear to increase subsequent abstinence rate above usual care in accordance with UK guidance from the National Institute of Health and Care Excellence. [ABSTRACT FROM AUTHOR]

Background: The ILD-GAP model was developed and validated in a Western cohort to predict 1-, 2- and 3-year mortality in chronic interstitial lung disease (ILD). Objectives: We aimed to validate the ILD-GAP model and identify predictors of mortality to derive a nomogram to predict mortality in our local Asian population. Methods: Characteristics of patients on follow-up in a tertiary ILD referral center were retrospectively reviewed. Results: There were 181 patients and 48 mortalities. 29.8% had idiopathic pulmonary fibrosis, 2.8% unclassifiable ILD, 33.1% connective tissue disease-associated interstitial lung disease (CTD-ILD), 28.7% idiopathic nonspecific interstitial pneumonia and 5.5% chronic hypersensitivity pneumonitis. Univariable analysis showed that a higher ILD-GAP index, unclassified ILD, males, older age, higher pulmonary artery systolic pressure, lower forced vital capacity percent predicted and carbon monoxide diffusion capacity (DLCO) correlated with increased mortality, and CTD had lower mortality. Multivariable analysis utilizing Akaike's information criterion stopping rule showed males and a lower DLCO predicted increased mortality, while CTD predicted lower mortality. These were used to generate a nomogram which predicted overall mortality better (C index 0.817, adequacy index 99.5%) than ILD-GAP (C index 0.777, adequacy index 60.7%) and provided superior estimates based on likelihood ratio testing. Calibration plots showed the nomogram predicted 1-year mortality better, whilst the ILD-GAP model predicted 2- and 3-year mortality closer to actual mortality rates but underpredicted 1-year mortality. Conclusion: The nomogram performed better than ILD-GAP in predicting overall mortality and 1-year mortality. Both demonstrated good performance in predicting mortality risk. [ABSTRACT FROM AUTHOR]

Introduction: Interstitial lung disease (ILD) is a serious extraarticular manifestation of rheumatoid arthritis (RA), but no evidence-based therapy exists. Ongoing studies investigate the role of antifibrotic therapies for progressive fibrosing ILD (PF-ILD), including RA-ILD. The aim of the present study was to investigate the frequency of PF-ILD and the clinical characteristics of RA-ILD in a well-characterised, population-based cohort. Methods: We identified patients with RA-ILD diagnosed and followed at the ILD referral centre in Aarhus, Denmark, from 2004 to 2016. Adjusted hazard rate ratios for death were estimated using Cox regression models. The presence of PF-ILD was assessed using recently proposed definitions of relative forced vital capacity (FVC) decline ≥10%, relative diffusion capacity of the lung for carbon monoxide (DLco) decline ≥15% or worsening symptoms or a worsening radiological appearance accompanied by a ≥5 to <10% FVC decline. Results: We identified 102 patients with RA-ILD, and 52% had PF-ILD. Mean follow-up was 3.8 years and median survival was 7.1 years. Thirty-eight patients died during follow-up, and most deaths were from respiratory causes. Predictors of mortality in a multivariate model were DLco and high titres of IgM rheumatoid factor. Conclusion: PF RA-ILD was common and the associated mortality was high. [ABSTRACT FROM AUTHOR]

Introduction: Mobile phone-based messaging support and biomarker feedback independently show evidence of increasing an individual's likelihood of quitting smoking. However, the combination of these two strategies to facilitate smoking cessation has not been adequately explored.Methods: We conducted a randomized controlled trial in Baltimore, Maryland, to assess the efficacy of COach2Quit, a smartphone application that provides exhaled carbon monoxide readings with message support. The primary outcome was self-reported and biochemically verified smoking cessation at 30-day follow-up. Secondary outcomes were reduction in smoking, motivation to quit, and engagement and satisfaction with COach2Quit. An intention-to-treat analysis was conducted.Results: Adult smokers were randomized 1:1 to receive brief advice and COach2Quit (intervention, n = 50) or brief advice only (control, n = 52). Thirteen participants were lost to follow-up. At 30-day follow-up, one participant in each arm quit smoking. Median change in carbon monoxide levels (in parts per million (ppm)) (intervention: -3.0 [interquartile range (IQR) -12.0, 2.0]; control: -2.5 [IQR -9.0, 2.0]) and median change in number of cigarettes smoked per day (intervention: -5.5 [IQR -14.0, -1.0]; control: -6.0 [IQR -10.0, -2.0]) was similar between study arms. There was no significant difference in mean percent change in the Reasons for Quitting scale score (intervention: 6.3 [95% confidence interval = -2.2% to 14.8%]; control: -3.6 [95% confidence interval = -9.2% to 2.1%]). A majority (n = 32, 91%) of participants liked having COach2Quit to help them quit smoking.Conclusions: There were no significant differences in smoking cessation, smoking reduction, and motivation to quit between study arms. However, high satisfaction with the COach2Quit application indicates its feasibility and acceptability as a smoking cessation tool.Implications: Smoking is the leading preventable cause of morbidity and mortality in the United States. Although counseling and pharmacotherapy are efficacious for smoking cessation, they are not easily accessible or desirable to all smokers, highlighting the need for identifying other interventions. There is evidence for the efficacy of mobile phone-based messaging support for smoking cessation. However, there is limited research on the efficacy of biomarker feedback, much less interventions that combine these two approaches. This research contributes to filling this gap and identifying novel interventions to facilitate smoking cessation. [ABSTRACT FROM AUTHOR]

Elective cardiac surgery accounts for a significant proportion of perioperative resource allocation in Australasia. Preoperative pulmonary function testing (PFT) is routinely undertaken in some centres to identify patients who may require prolonged ventilation and intensive care unit (ICU) stay, although there are currently no data supporting this practice. Routine PFT places a burden on respiratory diagnostic laboratories, is inconvenient to patients and may delay surgery.We aimed to identify whether PFT parameters identify patients requiring prolonged mechanical ventilation after elective cardiac surgery. Adult patients admitted to the Royal Adelaide Hospital ICU following elective cardiac surgery between July 2013 and December 2017 were identified retrospectively from the local ICU database. Preoperative PFT and operative and postoperative outcome data were retrieved from local databases, and multivariable logistic regression was undertaken to identify which PFT variables were associated with prolonged mechanical ventilation. PFT data were available for 835/1139 (73%) elective cardiac surgical cases. The best independent predictors of prolonged mechanical ventilation were post-bronchodilator forced vital capacity (FVC) and single-breath diffusing capacity for carbon monoxide (DLCO). Patients with FVC <80% predicted and DLCO <60% predicted had an odds ratio for prolonged postoperative ventilation of 7.5 (95% confidence intervals 3.6-15.6; P<0.001). The area under the receiver operating characteristic curve derived from this model was 0.68. Abnormal PFT results were associated with prolonged postoperative mechanical ventilation. A PFT-based prediction tool does not accurately predict individual patient outcome but identifies a cohort of patients at higher risk of requiring prolonged ventilation, potentially informing ICU resource allocation and surgical planning. [ABSTRACT FROM AUTHOR]

As the prevalence rates of cigarette use have declined over the past decade, use of electronic cigarettes (e-cigarettes) continues to increase, and companies are heavily invested in manufacturing new e-cigarette products. Scientists are therefore studying e-cigarette use at a rapid rate, generally by conceptualizing e-cigarettes as similar to traditional cigarettes in their use and effects. Thinking of e-cigarettes as largely comparable with cigarettes, however, fails to capture the unique e-cigarette capabilities, user experiences, and effects on nicotine dependence and even health. Assuming that e-cigarette users puff on their devices as they do cigarettes to attain doses of nicotine comparable in magnitude and asking questions about e-cigarette use modeled after how smoking behavior has been usually assessed (eg, puff number, duration, number of cigarettes per day) may miss important differences. A greater appreciation of the distinct uniqueness of e-cigarettes, as compared with cigarettes, will help to accelerate innovative research on e-cigarettes and other electronic devices, leading to new theoretical models and behavioral measures.Implications: With research about electronic cigarettes (e-cigarettes) rapidly increasing, this commentary addresses the conceptualization of e-cigarettes as similar to traditional cigarettes. The more we attempt to understand and measure e-cigarettes as equivalent to cigarettes, the more likely research may err in conclusions about these unique devices. Our commentary notes how using unique conceptualizations and measures for e-cigarettes will help accelerate new research. [ABSTRACT FROM AUTHOR]

Introduction: Up to 24% of electronic cigarette (e-cigarette) users are concurrent users of both tobacco and e-cigarettes (dual users). Dual users provide an opportunity to assess key motivational processes supporting e-cigarette use, such as the reward value of e-cigarettes. This study used the Choice Behavior Under Cued Conditions procedure to examine cue-specific reactions to tobacco and e-cigarettes with a primary focus on evaluating the relative reward value of both forms of cigarettes.Methods: Fifty-four dual users were exposed to a lit tobacco cigarette, their own e-cigarette, or a cup of water across multiple trials. On each trial, participants rated their craving for both tobacco and e-cigarettes and indicated the amount of money they would spend to access the cue. Key measures included craving, amount of money spent to access the cue, latency to access the cue, spending choice time, and consumption.Results: Participants reported significantly higher craving and spent significantly more money on tobacco and e-cigarette trials than on water trials. The magnitude of cue-specific craving was comparable across tobacco and e-cigarettes, but participants spent significantly more to access tobacco cigarettes than e-cigarettes.Conclusions: This is the first study to demonstrate cue-specific reactivity to e-cigarettes utilizing a neutral comparison condition and to examine the reward value of e-cigarettes relative to tobacco cigarettes. Overall, the data suggest that e-cigarette puffs are less valued and generate less craving than tobacco cigarette puffs for dual users. The data provide clear support for the utility of Choice Behavior Under Cued Conditions for examining a range of motivational processes supporting e-cigarette use.Implications: The test procedure used in this research generates multiple indices of nicotine and tobacco motivation and allows for an explicit comparison of those variables in people who use both e-cigarettes and tobacco cigarettes. [ABSTRACT FROM AUTHOR]

Introduction: There are fundamental differences between electronic cigarettes (e-cigarettes) and conventional cigarette product categories with regards to potential environmental exposures, notably that e-cigarettes do not contain tobacco or generate side-stream emissions. Here we assess the spatial and temporal patterns of exhaled e-cigarette aerosol at a bystander's position, and compare it with conventional cigarette smoke emissions.Methods: Smokers were asked to use e-cigarettes or smoke conventional cigarettes in a room-simulating chamber. Volunteers used the products at different distances from a heated mannequin, representing a bystander, and under different room ventilation rates. Aerosol particle concentrations and size distributions at the bystander's position were measured.Results: For both product categories, the particle concentrations registered following each puff were in the same order of magnitude. However, for e-cigarettes the particle concentration returned rapidly to background values within seconds; for conventional cigarettes it increased with successive puffs, returning to background levels after 30-45 minutes. Unlike for the e-cigarette devices tested, such temporal variation was dependent on the room ventilation rate. Particle size measurements showed that exhaled e-cigarette particles were smaller than those emitted during smoking conventional cigarettes and evaporated almost immediately after exhalation, thus affecting the removal of particles through evaporation rather than displacement by ventilation.Conclusions: Significant differences between emissions from the tested e- and conventional cigarettes are reported. Exhaled e-cigarette particles are liquid droplets evaporating rapidly; conventional cigarette smoke particles are far more stable and linger.Implications: • Several factors potentially influencing particle behavior after exhalation of e-cigarette aerosols or emitted during smoking conventional cigarettes were studied.• Differences in particle size between those exhaled following use of e-cigarettes and those emitted during smoking of conventional cigarettes were observed.• E-cigarette particle concentrations decreased rapidly following exhalation due to evaporation.• The removal of particles following smoking conventional cigarettes was much slower and was dependent on the room ventilation rate. [ABSTRACT FROM AUTHOR]

Background and Aims: Due to concerns about increased exposure to nicotine, pregnant women using nicotine replacement therapy (NRT) to stop smoking are usually advised to stop using NRT if they relapse to smoking. This study investigated whether this is justified. We compared changes in saliva cotinine from baseline to 2 weeks post‐target quit date pregnant smokers who relapsed to smoking and continued to use their patches having been assigned to use nicotine patches or placebo. Design and Setting: Controlled pre–post design stratified by intervention condition from the 'Study of Nicotine Patch in Pregnancy', a randomized, placebo‐controlled trial. Participants: A sample of 268 pregnant women, assigned placebo (n = 122) or nicotine (n = 146) patches, who returned for further supplies of patches and who reported any smoking in the week prior to a visit at 2 weeks after their target quit date. Measurements Saliva cotinine concentrations were measured at baseline and 2 weeks after participants' target quit dates. Any smoking in the previous week was assessed by self‐report, validated by expired air carbon monoxide (CO). Findings There was no change in saliva cotinine concentrations between baseline and 2 weeks post‐target quit date in saliva cotinine concentration in the nicotine patch group [ratio of geometric means = 0.94, 95% confidence interval (CI) = 0.83 to 1.07; P = 0.37, Bayes factor = 0.15]. However, there was a reduction in reported number of cigarettes smoked/day (mean difference −6, 95% CIs −7 to −5, P < 0.001) and in CO concentrations (mean difference −3.0 parts per million, 95% CIs −4.2 to −1.9, P < 0.001). These changes were not significantly different from changes in the placebo group except for cigarette consumption, which reduced more in the nicotine group (P = 0.046). Conclusions: In women trying to stop smoking with the aid of a nicotine patch but having smoked at 2 weeks post‐target quit, their nicotine concentration did not change from baseline, but they reported smoking fewer cigarettes and had lower carbon monoxide concentrations. [ABSTRACT FROM AUTHOR]

Background: Chronic hypersensitivity pneumonitis (CHP) is characterized by lymphocytic inflammation and progressive fibrosis of the lung caused by a variety of inhaled antigens. Due to the difficulty of accurately diagnosing CHP, and the poor prognosis associated with the condition, a novel clinical biomarker is urgently needed. Objective: To investigate the usefulness of C-C motif chemokine ligand 15 (CCL15), which had been demonstrated to highly express in the lungs of CHP patients, as a clinical biomarker for CHP. Method: Immunohistochemical investigations were performed on lung tissue from CHP patients, and CCL15 levels in serum and bronchoalveolar lavage fluid (BALF) were measured via the enzyme-linked immunosorbent assay. Results: Immunohistochemistry investigations revealed high CCL15 expression in the lungs of CHP patients. Serum CCL15 levels in CHP patients (29.1 ± 2.1 μg/mL) were significantly higher than those of idiopathic pulmonary fibrosis patients (19.7 ± 1.3 μg/mL, p = 0.01) and healthy subjects (19.5 ± 1.7 μg/mL, p = 0.003). When BALF CCL15 level was divided by BALF albumin (Alb) level (BALF CCL15/Alb), it was significantly inversely correlated with forced vital capacity (β = –0.47, p = 0.0006), percentage of predicted carbon monoxide diffusion capacity of the lung (β = –0.41, p = 0.0048), and BALF lymphocyte count (β = –0.34, p = 0.01) in CHP patients. Multivariate Cox proportional hazards analysis revealed that high BALF CCL15/Alb and poor prognosis were statistically significantly independently correlated in CHP patients (HR 1.1, 95% CI 1.03–1.18, p = 0.004). Conclusion: The results of the current study suggest that CCL15 may be a useful prognostic biomarker for CHP. CCL15 was highly expressed in the lung tissue of CHP patients, and BALF CCL15/Alb was significantly associated with CHP prognosis. [ABSTRACT FROM AUTHOR]

Study Question: What is the functional relevance of decreased pulmonary vascular distensibility in adolescents conceived by IVF?Summary Answer: Children born by IVF have a slight decrease in pulmonary vascular distensibility observed during normoxic exercise that is not associated with altered right ventricular function and aerobic exercise capacity.What Is Known Already: General vascular dysfunction and increased hypoxic pulmonary hypertension have been reported in ART children as compared to controls. Pulmonary hypertension or decreased pulmonary vascular distensibility may affect right ventricular function and thereby possibly limit maximal cardiac output and aerobic exercise capacity.Study Design, Size, Duration: This prospective case-control study enrolled 15 apparently healthy adolescents conceived by IVF/ICSI after fresh embryo transfer paired in a 2 to 1 ratio to 30 naturally conceived adolescents between March 2015 and May 2018.Participants/materials, Setting, Methods: Fifteen IVF/ICSI adolescents and 30 controls from singleton gestations matched by age, gender, weight, height and physical activity underwent exercise echocardiography, lung diffusion capacity measurements and a cycloergometer cardiopulmonary exercise test. A pulmonary vascular distensibility coefficient α was determined from the pulmonary arterial pressure (PAP) versus cardiac output (Q) relationships. Pulmonary capillary volume (Vc) was calculated from single breath nitric oxide and carbon monoxide lung diffusion capacity measurements (DLCO and DLNO) at rest and during exercise (100 W). Eight of the IVF subjects and eight controls underwent a 30 min hypoxic challenge at rest with a fraction of inspired oxygen of 0.12 to assess hypoxic pulmonary vasoconstriction.Main Results and the Role Of Chance: In normoxia, oxygen uptake (VO2), blood pressure, DLCO, DLNO, echocardiographic indices of right ventricular function, Q and PAP at rest and during exercise were similar in both groups. However, IVF children had a lower pulmonary vascular distensibility coefficient α (1.2 ± 0.3 versus 1.5 ± 0.3%/mmHg, P = 0.02) and a blunted exercise-induced increase in Vc (24 versus 32%, P < 0.05). Hypoxic-induced increase in pulmonary vascular resistance in eight IVF subjects versus eight controls was similar.Limitations, Reasons For Caution: The IVF cohort was small, and thus type I or II errors could have occurred in spite of careful matching of each case with two controls. ART evolved over the years, so that it is not certain that the presently reported subtle changes will be reproducible in the future. As the study was limited to singletons born after fresh embryo transfers, our observations cannot be extrapolated to singletons born after frozen embryo transfer.Wider Implications Of the Findings: The present study suggests that adolescents conceived by IVF have preserved right ventricular function and aerobic exercise capacity despite a slight alteration in pulmonary vascular distensibility as assessed by two entirely different methods, i.e. exercise echocardiography and lung diffusing capacity measurements. However, the long-term prognostic relevance of this slight decrease in pulmonary vascular distensibility needs to be evaluated in prospective large scale and long-term outcome studies.Study Funding/competing Interest(s): Dr Caravita was supported by an ERS PAH short term research training fellowship (STRTF2014-5264). Dr Pezzuto was funded by an Italian Society of cardiology grant. Dr Motoji was supported by a grant from the Cardiac Surgery Funds, Belgium. All authors have no conflicts of interests to declare. [ABSTRACT FROM AUTHOR]

Introduction: Roles for pharmacists in general practice are developing in Australia. It is known that pharmacists can provide effective smoking cessation services in other settings but evidence in general practice is lacking. Aim: To determine whether a pharmacist can provide effective smoking cessation services within general practice. Method: Data from smoking cessation consultations were obtained for 66 consecutive patients seen by one practice pharmacist. The pharmacist tailored interventions to the individual. Medication was offered in collaboration with community pharmacists and general practitioners. Quit coaching, based on motivational interviewing, was conducted. Smoking status was ascertained at least 6 months after the intended quit date and verified by a carbon monoxide breath test where possible. Results: The patients' median age was 43 years (range 19–74 years); 42 were females (64%). At baseline, the median (i) number of pack years smoked was 20 (range: 1–75); (ii) Fagerstrom Test of dependence score was 6 (1–10); and (iii) number of previous quit attempts was 3 (0–10). Follow-up after at least 6 months determined a self-reported point prevalence abstinence rate of 30% (20/66). Of all patients who reported to be abstinent, 65% (13/20) were tested for carbon monoxide breath levels and were all below 7 ppm. The biochemically verified smoking abstinence rate was therefore 20% overall (13/66). Successful quit attempts were associated with varenicline recommendation (69% v 25%), increased median number of practice pharmacist consultations (4 v 2 per patient) and mental health diagnosis (85% v 51%). Conclusion: Our observed abstinence rate was comparable or better than those obtained by practice nurses, community pharmacists and outpatient pharmacists, indicating the general practice pharmacist provided an effective smoking cessation intervention. A larger randomised trial is warranted. [ABSTRACT FROM AUTHOR]

Spatial and temporal variations in the Martian carbon monoxide (CO) cycle have been investigated through combining Compact Reconnaissance Imaging Spectrometer for Mars (CRISM) retrievals of carbon monoxide mixing ratio and Mars Climate Sounder (MCS) temperature profiles with a Martian global circulation model (GCM) to produce the first global reanalysis of the Martian CO cycle. The reanalysis reduces the root mean square error between the forecast and CRISM CO retrievals by a factor of 2–4, dependent on the time of year. Forecasts initiated from the reanalysis show an improved match to standalone CRISM CO retrievals from northern winter solstice to northern summer solstice, indicating the benefit of data assimilation in simulating the CO abundance. The northern summer solstice CO minimum between 10∘S – 50∘S in the CRISM CO retrievals is found to be caused by a suppression of CO-enriched air leaking from the Hellas and Argyre basins, and is also strongly influenced by the amount of carbon dioxide condensing at the time. The GCM is the first reported to simulate the local CO minimum however it is weaker in strength, as CO-enriched air is also released northward in the area of Argyre basin in the GCM because of a shifted boundary between the southern polar vortex and mid-latitudes. The reanalysis, as a result of the assimilation of MCS temperature profiles, indicates that the polar vortex boundary is northward of Argyre basin and hence no northerly transport of CO-enriched air should be present over this location. Differences in local CO abundance between the reanalysis and GCM are also evident in spatio-temporal regions where no nearby CRISM CO retrievals are available as a result of alterations in local circulation and the sublimation/condensation of carbon dioxide through the combined assimilation of CRISM CO retrievals alongside MCS temperature profiles, illustrating how constraints can be imposed indirectly on the CO cycle through the powerful technique of data assimilation. • The annual cycle of atmospheric CO is analysed by combining MRO datasets with a global model. • Local circulation patterns explain the observed CO northern summer solstice minimum. • Forecasts of CO abundance from reanalysis show improved match to CRISM CO retrievals. [ABSTRACT FROM AUTHOR]

Objectives: Marketing of the Natural American Spirit (NAS) cigarettes implies reduced risk of toxic exposures. We aimed to provide a comprehensive chemical characterization of these cigarettes. Methods: We analyzed 13 varieties of NAS for a range of tobacco- and combustionderived constituents. Cigarettes were smoked by 2 standard regimens and analyzed using our routine analytical procedures. We also analyzed tobacco filler and physical cigarette characteristics. Results: Under intense smoking conditions, nicotine in smoke of NAS cigarettes averaged 3.3(±0.7) mg/cigarette, compared to 2.4(±0.4) in other brands. The levels of carcinogenic nitrosamines NNN and NNK varied extensively across NAS varieties, their sum ranging from 71 to 443 ng/cigarette. Levels of volatile toxicants were generally similar to, or higher than those found in other commercial US cigarettes. Conclusions: High nicotine content suggests that NAS cigarettes may be more addictive than many other brands. Similarly low TSNA levels were measured in some NAS varieties, independent of whether or not they were labeled as organic. Levels of other toxicants were similar to other brands. Consumer education and additional regulatory measures are needed to address the misperceptions that NAS cigarettes are safer than other commercial cigarette brands. [ABSTRACT FROM AUTHOR]

Purpose: Preoperative pulmonary dysfunction has been associated with increased operative mortality and morbidity after cardiac surgery. This study aimed to determine whether values for the diffusing capacity of the lung for carbon monoxide (DLCO) could predict postoperative complications after cardiac surgery. Methods: This study included 408 consecutive patients who underwent cardiac surgery between June 2008 and December 2015. DLCO was routinely determined in all patients. A reduced DLCO was clinically defined as %DLCO < 70%. %DLCO was calculated as DLCO divided by the predicted DLCO. The association between %DLCO and in-hospital mortality was assessed, and independent predictors of complications were identified by a logistic regression analysis. Results: Among the 408 patients, 338 and 70 had %DLCO values of ≥ 70% and < 70%, respectively. Complications were associated with in-hospital mortality (P < 0.001), but not %DLCO (P = 0.275). A multivariate logistic regression analysis with propensity score matching identified reduced DLCO as an independent predictor of complications (OR, 3.270; 95%CI, 1.356–7.882; P = 0.008). Conclusions: %DLCO is a powerful predictor of postoperative complications. The preoperative DLCO values might provide information that can be used to accurately predict the prognosis after cardiac surgery. Clinical trial registration number: UMIN000029985. [ABSTRACT FROM AUTHOR]

Molecular dynamics simulation was used to characterise the dynamical injection behaviour of CO through a gold nano-injector with a Gr coating. We also varied the nozzle outlet size, system temperature, and extrusion velocity to elucidate their influence on the flow patterns, injection pressure, and flow rate of the CO nano-jets. Simulation results revealed the following important findings. (1) At 100 K, the liquefaction of a CO jet led to a wider spray angle (øs = 84∼96°) and allowed molecules to attach to the Gr layer, resulting in agglomeration at the orifice. (2) At 500 K and 55.824 m/s, the nebulisation of the CO nano-jet was induced, which produced a narrower spray angle (øs = 47°). (3) The flow rate of CO molecules was essentially linear under the following conditions: low extrusion velocity (≤13.956 m/s), large orifice (d = 1.5 nm), and high system temperature (≥300 K). (4) Due to the compressibility of CO molecules, the pressure inside the chamber under a high extrusion speed (≥27.912 m/s) presented a sharp increase in the middle and final extrusion stages. A delay in the pressure increase enabled the liquefaction of the extruded CO molecules, resulting in an unstable flow rate. [ABSTRACT FROM AUTHOR]

First-generation Chinese and Korean male immigrants in the United States are at high risk for tobacco use. This study pilot-tested a graphic, native-language text-messaging intervention to promote smoking cessation among these groups. First-generation Chinese and Korean male immigrant smokers (N = 71) were recruited from the Washington DC area. Participants were randomly assigned to one of four conditions based on a between-subjects 2 (graphic plus text or text-only messages) × 2 (quitline information or quitting tips) design. The text-messaging intervention included 30 text messages in total and lasted one month. Participants completed an expired air carbon monoxide (CO) assessment and self-reported measures at both baseline and follow-up. Results show that, from baseline to follow-up, participants' expired air CO levels decreased significantly (P = 0.001). Attitude toward quitting also became more positive (P = 0.028). Compared with text-only messages, graphic text messages produced greater positive changes in quitting attitudes (P = 0.039) and elicited greater fear response (P = 0.005). Compared with quitting tip messages, quitline information resulted in greater regret (P = 0.016) and fear (P = 0.051). These findings suggest that graphic text-messaging can be an effective method to promote smoking cessation among first-generation Chinese and Korean male immigrants. [ABSTRACT FROM AUTHOR]

Smoking is frequently presented as being particularly problematic when the smoker is a pregnant woman because of the potential harm to the future child. This premise is used to justify targeting pregnant women with a unique approach to smoking cessation including policies such as the routine testing of all pregnant women for carbon monoxide at every antenatal appointment. This paper examines the evidence that such policies are justified by the aim of harm prevention and argues that targeting pregnant women in this way is likely to do more harm than good. Routine carbon monoxide testing is particularly problematic as it sends a message to pregnant women that they cannot be trusted either to truthfully answer questions as to whether or not they smoke, or to make decisions in the best interests of themselves and their future children in the way that non-pregnant individuals are. Further, if the aim is to reduce rates of prenatal harm, the evidence suggests that adopting a supportive and empowering approach to prenatal care is the most effective way to achieve this, something that the current policies aimed at pregnant women are in conflict with. [ABSTRACT FROM AUTHOR]

Tobacco smoking with a water pipe or hookah is increasing globally. There are millions of water pipe tobacco smokers worldwide, and in the United States, water pipe use is more common among youth and young adults than among adults. The spread of water pipe tobacco smoking has been abetted by the marketing of flavored tobacco, a social media environment that promotes water pipe smoking, and misperceptions about the addictive potential and potential adverse health effects of this form of tobacco use. There is growing evidence that water pipe tobacco smoking affects heart rate, blood pressure regulation, baroreflex sensitivity, tissue oxygenation, and vascular function over the short term. Long-term water pipe use is associated with increased risk of coronary artery disease. Several harmful or potentially harmful substances present in cigarette smoke are also present in water pipe smoke, often at levels exceeding those found in cigarette smoke. Water pipe tobacco smokers have a higher risk of initiation of cigarette smoking than never smokers. Future studies that focus on the long-term adverse health effects of intermittent water pipe tobacco use are critical to strengthen the evidence base and to inform the regulation of water pipe products and use. The objectives of this statement are to describe the design and operation of water pipes and their use patterns, to identify harmful and potentially harmful constituents in water pipe smoke, to document the cardiovascular risks of water pipe use, to review current approaches to water pipe smoking cessation, and to offer guidance to healthcare providers for the identification and treatment of individuals who smoke tobacco using water pipes. [ABSTRACT FROM AUTHOR]

INTRODUCTION The 2016 US Surgeon General's Report suggests that the use of electronic nicotine delivery systems (ENDS) is a fetal risk factor. However, no previous study has estimated their effect on adverse pregnancy outcomes. We assessed the prevalence of current ENDS use in pregnant women and explored the effect on birth weight and smallness-for-gestational-age (SGA), correcting for misclassification from nondisclosure of smoking status. METHODS We conducted a cohort study with 248 pregnant women using questionnaire data and biomarkers (salivary cotinine, exhaled carbon monoxide, and hair nicotine). We evaluated the association between birth weight and the risk of SGA by applying multivariate linear and logbinomial regression to reproductive outcome data for 232 participants. Participants who did not disclose their smoking status were excluded from the referent group. Sensitivity analysis corrected for misclassification of smoking/ENDS use status. RESULTS The prevalence of current ENDS use among pregnant women was 6.8% (95% CI: 4.4-10.2%); most of these (75%) were concurrent smokers. Using self-reports, the estimated risk ratio of SGA for ENDS users was nearly two times the risk in the unexposed (RR=1.9, 95% CI: 0.6-5.5), and over three times that for ENDS-only users versus the unexposed (RR=3.1, 95% CI: 0.8-11.7). Excluding from the referent group smokers who did not disclose their smoking status, the risk of SGA for ENDS-only use was 5 times the risk in the unexposed (RR=5.1, 95% CI: 1.1-22.2), and almost four times for all types of ENDS users (RR=3.8, 95% CI: 1.3-11.2). SGA risk ratios for ENDS users, corrected for misclassification due to self-report, were 6.5-8.5 times that of the unexposed. CONCLUSIONS Our data suggest that ENDS use is associated with an increased risk of SGA. [ABSTRACT FROM AUTHOR]

Objective: Forming implementation intentions (if-then plans) about how to refuse cigarette offers plus antismoking messages was tested for reducing adolescent smoking. Method: Cluster randomized controlled trial with schools randomized (1:1) to receive implementation intention intervention and messages targeting not smoking (intervention) or completing homework (control). Adolescents (11-12 years at baseline) formed implementation intentions and read messages on 8 occasions over 4 years meaning masking treatment allocation was not possible. Outcomes were: follow-up (48 months) ever smoking, any smoking in last 30 days, regular smoking, and breath carbon monoxide levels. Analyses excluded baseline ever smokers, controlled for clustering by schools and examined effects of controlling for demographic variables. Economic evaluation (incremental cost effectiveness ratio; ICER) was conducted. Trial is registered (ISRCTN27596806). Results: Schools were randomly allocated (September- October 2012) to intervention (n= 25) or control (n= 23). At follow-up, among 6,155 baseline never smokers from 45 retained schools, ever smoking was significantly lower (RR= 0.83, 95% CI [0.71, 0.97], p= .016) in intervention (29.3%) compared with control (35.8%) and remained so controlling for demographics. Similar patterns observed for any smoking in last 30 days. Less consistent effects were observed for regular smoking and breath carbon monoxide levels. Economic analysis yielded an ICER of $134 per ever smoker avoided at age 15-16 years. Conclusions: This pragmatic trial supports the use of repeated implementation intentions about how to refuse the offer of a cigarette plus antismoking messages as an effective and cost-effective intervention to reduce smoking initiation in adolescents. [ABSTRACT FROM AUTHOR]

Introduction: Compared to the general population, smoking rates are 2-4 times higher among individuals with opioid use disorders (OUDs). These smokers also have poor long-term cessation rates, even with pharmacotherapy or other interventions. Low success rates with traditional approaches may prompt smokers with OUDs to try more novel products like electronic cigarettes (ECIGs). This pilot study was designed to examine the feasibility, acceptability, and effect of ECIGs on smoking behavior among smokers with OUD.Methods: Participants (N = 25) were daily smokers receiving buprenorphine/naloxone for OUD at an outpatient clinic. They were randomized to use a second-generation ECIG (0 or 18 ng/ml nicotine) ad libitum for two weeks while completing assessments via text messaging daily, and also via in-person visits at baseline, end of the two-week intervention, and a 4-week follow-up.Results: Feasibility was evidenced by high enrollment (93.9%) and retention (70.9%) rates. ECIG adherence was relatively high as measured by self-report (80.6% active, 91.7% placebo), while the average volume of liquid used per week was low (~3 ml). Both ECIG doses produced reductions in self-reported cigarettes per day that were not supported by average carbon monoxide levels. Biologically-confirmed smoking abstinence was observed in 8% of participants.Conclusions: Preliminary results suggest that smokers with OUD are interested in using ECIGs, but their adherence may be less than ideal. Poor medication adherence rates are often observed in this disparate population, and future work should consider the use of other ECIG device types and a combination of methods to verify and quantify ECIG use. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to examine the implications of increased maternal Breath Carbon Monoxide (BCO) levels at the first antenatal visit for subsequent birthweight (BW) and neonatal outcomes.Study Design: Secondary analysis of a prospective, observational study. Pregnant women aged ≥18years who understood English were recruited (n=250). However, only women who delivered a normally formed baby weighing ≥500g were analysed (n=234). At the first antenatal visit, a research questionnaire was completed and a BCO test was performed. Obstetric and neonatal data computerised by midwives at the first antenatal visit and updated after delivery were also analysed.Results: Results from the receiver operating characteristic (ROC) curve indicated the highest combined sensitivity and specificity for smoking was observed at a BCO cut-off level of 3ppm (sensitivity 85%, specificity 90%). Of the 234 women, 53 (22.6%) had a BCO ≥3ppm but only 36 (15.4%) disclosed smoking to the midwife on routine questioning. A further 23 (9.8%) were classified as non-disclosers based on a research questionnaire and/or a BCO measurement ≥3ppm. No relationship was found between the self-reported number of cigarettes daily in early pregnancy and BW (r=0.05, p=0.78). However, an inverse relationship was found between maternal BCO levels and BW (r=-0.31, p<0.001). BCO levels ≥3ppm in early pregnancy were associated with an increased risk of emergency caesarean section, low birth weight, BW <25th centile, fetal distress and having two or more adverse pregnancy events (all p<0.05). Smoking non-disclosers had babies with decreased BWs (-400.1g, 95% CI 141.1-659.0g, p<0.001), and higher rates of BW <25th centile (56.5% versus 25.3%, p<0.001), small-for-gestational-age (21.7% versus 9.1%, p<0.001) and fetal distress (39.1% versus 16.0%, p<0.01) compared to non-smokers Non-disclosers at the first antenatal visit also had a 22% higher rate of having two or more adverse pregnancy events (p<0.05).Conclusion: The results showed that an increased BCO level was associated with a lower BW and increased risk of adverse pregnancy and neonatal outcomes. This strengthens the case for universal BCO screening at the first antenatal visit. A high BCO reading should be an indication for referral to stop smoking services referral and close fetal surveillance. [ABSTRACT FROM AUTHOR]

Highlights • Dielectric permittivities of CO + CO 2 mixtures measured with a re-entrant cavity resonator. • Measurements were made at temperatures from (255.05 to 313.28) K and pressures to 8 MPa. • The permittivity data allowed a 15-fold reduction in the mixtures' composition uncertainties. • Harvey-Prausnitz mixing rule used to extract densities from permittivities to 0.5% uncertainty. Abstract A microwave re-entrant cavity resonator apparatus was used for the determination of dielectric permittivity, mole fraction composition and molar density of two binary (CO + CO 2) mixtures, with CO 2 mole fractions of approximately 0.25 and 0.50. The dielectric permittivity was measured with a relative combined expanded uncertainty (k = 2) less than or equal to 0.13% over the temperature range from T = (255.05 to 313.28) K at pressures up to 8 MPa. The new dielectric permittivity data were used together with the pure fluid polarizability correlations to reduce the uncertainty in the mixture's mole fraction composition by factor of 15 relative to that provided by the supplier. Moreover, by applying the Harvey-Prausnitz mixing rule, we determined the mixture molar densities from measured permittivities to within 0.53% (k = 2) in a previously unstudied region. The new mixture density data near 6 MPa agree within 1.4% of predictions made with the multi-parameter equation of state optimized for combustion gases (EOS-CG). Comparison of these data with the EOS-CG and literature density values show that mixture density determinations based on dielectric permittivity measurements and the Harvey-Prausnitz mixing rule can also be accurate for gas mixtures containing appreciable amounts of a polar substance. [ABSTRACT FROM AUTHOR]

Abstract The higher level ab initio methods are performed to reduce an accuracy of three-dimensional adiabatic potential energies. And the accurate numerically fitted method, 3D-spline method, is used to get an accuracy adiabatic potential energy surfaces for the three lowest states of CCO molecule. Starting from reactants, the title reaction through the first two lowest states have no reaction barrier should be very fast. The title reaction pathways should be different depending on the angles that the oxygen atom O(3P) attacked the C 2 ( a 3 Π u ) molecule. If the angles less than 60 ° , the reaction pathway should be O(3P) + C 2 ( 3 Π u ) → CCO( C ∞ ) → CO( X 1 Σ) + C(1D); On the other hand, if the angles great than 65°the transition state should be take into account, the reaction pathway is O(3P) + C 2 ( 3 Π u ) → CCO( C 2 v ) → TS → CCO( C ∞ ) → CO( X 1 Σ) + C(1D). [ABSTRACT FROM AUTHOR]

Objective: To assess survival and identify predictors of survival in patients with systemic sclerosis-interstitial lung disease (SSc-ILD) who participated in the Scleroderma Lung Studies (SLS) I and II.Methods: SLS I randomised 158 patients with SSc-ILD to 1  year of oral cyclophosphamide (CYC) vs placebo. SLS II randomised 142 patients to 1 year of oral CYC followed by 1 year of placebo vs 2 years of mycophenolate mofetil. Counting process Cox proportional hazard modelling identified variables associated with long-term mortality in SLS I and II. Internal validation was performed using joint modelling.Results: After a median follow-up of 8 years, 42% of SLS I patients died, and when known the cause of death was most often attributable to SSc. There was no significant difference in the time to death between treatment arms in SLS I or II. Higher baseline skin score, older age, and a decline in the forced vital capacity (FVC) and the diffusing capacity for carbon monoxide (DLCO) over 2 years were independently associated with an increased risk of mortality in SLS I. The Cox model identified the same mortality predictor variables using the SLS II data.Conclusion: In addition to identifying traditional mortality risk factors in SSc (skin score, age), this study demonstrated that a decline in FVC and DLCO over 2 years was a better predictor of mortality than baseline FVC and DLCO. These findings suggest that short-term changes in surrogate measures of SSc-ILD progression may have important effects on long-term outcomes. [ABSTRACT FROM AUTHOR]

The article reports that cigarette smoking in pregnancy is the most significant modifiable risk factor associated with wide-ranging adverse maternal, fetal and neonatal outcomes. It mentions that breath carbon monoxide screening using a hand-held carboxymeter is a valuable tool for detecting active and passive smoking during pregnancy.