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We studied whether in patients with COPD the use of metformin for diabetes treatment was linked to a pattern of lung function decline consistent with the hypothesis of anti-aging effects of metformin. Patients of GOLD grades 1–4 of the COSYCONET cohort with follow-up data of up to 4.5 y were included. The annual decline in lung function (FEV1, FVC) and CO diffusing capacity (KCO, TLCO) in %predicted at baseline was evaluated for associations with age, sex, BMI, pack-years, smoking status, baseline lung function, exacerbation risk, respiratory symptoms, cardiac disease, as well as metformin-containing therapy compared to patients without diabetes and metformin. Among 2741 patients, 1541 (mean age 64.4 y, 601 female) fulfilled the inclusion criteria. In the group with metformin treatment vs. non-diabetes the mean annual decline in KCO and TLCO was significantly lower (0.2 vs 2.3, 0.8 vs. 2.8%predicted, respectively; p 1 and FVC. These results were confirmed using multiple regression and propensity score analyses. Our findings demonstrate an association between the annual decline of lung diffusing capacity and the intake of metformin in patients with COPD consistent with the hypothesis of anti-aging effects of metformin as reflected in a surrogate marker of emphysema.

The aviation industry has committed itself to a scenario of reduction in emissions over the 3 decades ahead, which is especially challenging to fulfil as air traffic is expected to grow in the same time span. On the technical side, this calls for the development of radical aircraft technologies, such as the hybridization of the powertrain, or the use of different energy carriers (battery, hydrogen), which have been increasingly investigated in recent years. To this day however, it is not clear which technology combination could best address a given set of aircraft requirements, how realisable are such prospective aircraft designs within the time frame considered, nor how would those radical vehicle compare against conventional aircraft on the basis of techno-economic performance metrics. The CHYLA project at providing insights on those points, by providing an overview of scaling opportunities, challenges and limitations of key radical technologies where the credibility of underlying technology assumptions is an explicit factor in developing such a landscape. The presentation presents technical progress made in the project scope on three areas. First on energy network, where the behaviour of individual components of the network are modelled rather than assumed to provide a higher-fidelity design. Then on aircraft design, where a range of radical technology combinations, together with their underlying assumptions, can be tested on aircraft of various top-level requirements. Finally on the concept of “credible aircraft design” and its integration within an optimization framework, in order to find the best-performing vehicle that abides by a certain credibility level.

Alterations of cognitive functions have been described in COPD. Our study aimed to disentangle the relationship between the degree of cognitive function and COPD characteristics including quality of life (QoL).Data from 1969 COPD patients of the COSYCONET cohort (GOLD grades 1–4; 1216 male/ 753 female; mean (SD) age 64.9 ± 8.4 years) were analysed using regression and path analysis. The DemTect screening tool was used to measure cognitive function, and the St. George‘s respiratory questionnaire (SGRQ) to assess disease-specific QoL.DemTect scores were =60 years of age. For statistical reasons, we used the average of both algorithms independent of age in all subsequent analyses. The DemTect scores were associated with oxygen content, 6-min-walking distance (6-MWD), C-reactive protein (CRP), modified Medical Research Council dyspnoea scale (mMRC) and the SGRQ impact score. Conversely, the SGRQ impact score was independently associated with 6-MWD, FVC, mMRC and DemTect. These results were combined into a path analysis model to account for direct and indirect effects. The DemTect score had a small, but independent impact on QoL, irrespective of the inclusion of COPD-specific influencing factors or a diagnosis of cognitive impairment.We conclude that in patients with stable COPD lower oxygen content of blood as a measure of peripheral oxygen supply, lower exercise capacity in terms of 6-MWD, and higher CRP levels were associated with reduced cognitive capacity. Furthermore, a reduction in cognitive capacity was associated with reduced disease-specific quality of life. As a potential clinical implication of this work, we suggest to screen especially patients with low oxygen content and low 6-MWD for cognitive impairment.

We studied whether in patients with stable COPD blood gases (BG), especially oxygenated hemoglobin (OxyHem) as a novel biomarker confer information on disease burden and prognosis and how this adds to the information provided by the comorbidity pattern and systemic inflammation. Data from 2137 patients (GOLD grades 1–4) of the baseline dataset of the COSYCONET COPD cohort were used. The associations with dyspnea, exacerbation history, BODE-Index (cut-off ≤2) and all-cause mortality over 3 years of follow-up were determined by logistic and Cox regression analyses, with sex, age, BMI and pack years as covariates. Predictive values were evaluated by ROC curves. Capillary blood gases included SaO2, PaO2, PaCO2, pH, BE and the concentration of OxyHem [haemoglobin (Hb) x fractional SaO2, g/dL] as a simple-to-measure correlate of oxygen content. Inflammatory markers were WBC, CRP, IL-6 and -8, TNF-alpha and fibrinogen, and comorbidities comprised a broad panel including cardiac and metabolic disorders. Among BG, OxyHem was associated with dyspnoea, exacerbation history, BODE-Index and mortality. Among inflammatory markers and comorbidities, only WBC and heart failure were consistently related to all outcomes. ROC analyses indicated that OxyHem provided information of a magnitude comparable to that of WBC, with optimal cut-off values of 12.5 g/dL and 8000/µL, respectively. Regarding mortality, OxyHem also carried independent, additional information, showing a hazard ratio of 2.77 (95% CI: 1.85–4.15, p 8000/µL was 2.33 (95% CI: 1.60–3.39, p 2. It thus appears well suited for clinical use with minimal equipment, especially for GPs.

Research initiatives in hybrid-electric/sustainable aviation typically address only a single vehicle or single vehicle class. However, it can be expected that for novel propulsion and energy solutions to reach a sufficient maturity level an approach not too different from the early days of aviation could be followed: starting small to prove a technology and gradually scaling it up to larger and larger classes of vehicles. Therefore, it is important to sketch a landscape of technologies and identify areas suitable for scaling, as well as limitations or challenges for development. The CHYLA project aims to contribute to the overall research and development in sustainable aviation by providing exactly this; an overview of scaling opportunities, challenges and limitations of key radical technologies where the credibility of underlying technology assumptions is an explicit factor in developing such a landscape. In CHYLA we introduce the concept of “credible aircraft design”, which refers to the influence of the uncertainty in the assumptions behind the design to quantify how realisable, or in other words, how credible, is the design. Since technical work on the project has just started, the presentation givesa general overview of the CHYLA scope, approach and objectives.&nbsp

Bronchiectasis (BE) might be frequently present in COPD but masked by COPD symptoms. We studied the relationship of clinical signs of bronchiectasis to the presence and extent of its radiological signs in patients of different COPD severity. Visit 4 data (GOLD grades 1-4) of the COSYCONET cohort was used. Chest CT scans were evaluated for bronchiectasis in 6 lobes using a 3-point scale (0: absence, 1: ≤50%, 2: >50% BE-involvement for each lobe). 1176 patients were included (61%male, age 67.3y), among them 38 (3.2%) with reported physicians' diagnosis of bronchiectasis and 76 (6.5%) with alpha1-antitrypsin deficiency (AA1D). CT scans were obtained in 429 patients. Within this group, any signs of bronchiectasis were found in 46.6% of patients, whereby ≤50% BE occurred in 18.6% in ≤2 lobes, in 10.0% in 3-4 lobes, in 15.9% in 5-6 lobes; >50% bronchiectasis in at least 1 lobe was observed in 2.1%. Scores ≥4 correlated with an elevated ratio FRC/RV. The clinical diagnosis of bronchiectasis correlated with phlegm and cough and with radiological scores of at least 3, optimally ≥5. In COPD patients, clinical diagnosis and radiological signs of BE showed only weak correlations. Correlations became significant with increasing BE-severity implying radiological alterations in several lobes. This indicates the importance of reporting both presence and extent of bronchiectasis on CT. Further research is warranted to refine the criteria for CT scoring of bronchiectasis and to determine the relevance of radiologically but not clinically detectible bronchiectasis and their possible implications for therapy in COPD patients.

The COPD Assessment Test (CAT) is in widespread use for the evaluation of patients with chronic obstructive pulmonary disease (COPD). We assessed whether the CAT items carry additional information beyond the sum score regarding COPD characteristics including emphysema. Patients of GOLD grades 1 to 4 from the COPD cohort COSYCONET (German COPD and Systemic Consequences - Comorbidities Network) with complete CAT data were included (n = 2270), of whom 493 had chest CT evaluated for the presence of emphysema. Comorbidities and lung function were assessed following standardised procedures. Cross-sectional data analysis was based on multiple regression analysis of the single CAT items against a panel of comorbidities, lung function, or CT characteristics (qualitative score, 15th percentile of mean lung density), with age, BMI and gender as covariates. This was supported by exploratory factor analysis. Regarding the relationship to comorbidities and emphysema, there were marked differences between CAT items, especially items 1 and 2 versus 3 to 8. This grouping was basically confirmed by factor analysis. Items 4 and 5, and to a lower degree 1, 2 and 6, appeared to be informative regarding the presence of emphysema, whereas the total score was not or less informative. Regarding comorbidities, similar findings as for the total CAT score were obtained for the modified Medical Research Council scale (mMRC) which was also informative regarding emphysema. Our findings suggest that the usefulness of the CAT can be increased if evaluated on the basis of single items which may be indicating the presence of comorbidities and emphysema.

In recent years the field of soft robotics has gained a lot of interest both in academia and industry. In contrast to rigid robots, which are potentially very powerful and precise, soft robots are composed of compliant materials like gels or elastomers (Rich et al., 2018; Majidi, 2019). Their exclusive composition of nearly entirely soft materials offers the potential to extend the use of robotics to fields like healthcare (Burgner-Kahrs et al., 2015; Banerjee et al., 2018) and advance the emerging domain of cooperative human-machine interaction (Asbeck et al., 2014). One material class used frequently in soft robotics as actuators are electroactive polymers (EAPs). Especially dielectric elastomer actuators (DEAs) consisting of a thin elastomer membrane sandwiched between two compliant electrodes offer promising characteristics for actuator drives (Pelrine et al., 2000). Under an applied electric field, the resulting electrostatic pressure leads to a reduction in thickness and an expansion in the free spatial directions. The resulting expansion can reach strain levels of more than 300% (Bar-Cohen, 2004). This paper presents a bioinspired worm-like crawling robot based on DEAs with additional textile reinforcement in its silicone structures. A special focus is set on the developed cylindrical actuator segments that act as linear actuators.

This paper is aimed at giving an overview of possible cooling technologies for electrical machines and their assessment for aviation applications, e.g., fan or propeller drives. The most important demand for aircraft is the minimization of the drive system weight comprising electrical machine, power electronics, and the cooling system. The potential of aluminum winding an overview about several cooling technologies with the Rankine or Brayton cycle or utilizing the phase change of the cooling fluid is given. As an alternative approach, the cooling structure inside the machine is studied. A very interesting potential was discovered with direct slot cooling (DSC) removing the heat where it is produced and, thus, simplifying the cooling system effort and its weight. Since it is one of the most promising approaches, this cooling method is studied in depth. Furthermore, it can also be combined with one of the cooling technologies discussed above.