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In precapillary pulmonary hypertension (PH), nasal high flow therapy (NHF) may favorably alter sympathovagal balance (SVB) and sleep-related breathing through washout of anatomical dead space and alleviation of obstructive sleep apnea (OSA) due to generation of positive airway pressure.
To investigate the effects of NHF on SVB, sleep, and OSA in patients with PH, and compare them with those of positive airway pressure therapy (PAP).
Twelve patients with PH (Nice class I or IV) and confirmed OSA underwent full polysomnography, and noninvasive monitoring of SVB parameters (spectral analysis of heart rate, diastolic blood pressure variability). Study nights were randomly split into four 2-h segments with no treatment, PAP, NHF 20 L/min, or NHF 50 L/min. In-depth SVB analysis was conducted on 10-min epochs during daytime and stable N2 sleep at nighttime.
At daytime and compared with no treatment, NHF20 and NHF50 were associated with a flow-dependent increase in peripheral oxygen saturation but a shift in SVB towards increased sympathetic drive. At nighttime, NHF20 was associated with increased parasympathetic drive and improvements in sleep efficiency, but did not alter OSA severity. NHF50 was poorly tolerated. PAP therapy improved OSA but had heterogenous effects on SVB and neutral effects on sleep outcomes. Hemodynamic effects were neutral for all interventions.
In sleeping PH patients with OSA NHF20 but not NHF50 leads to decreased sympathetic drive likely due to washout of anatomical dead space. NHF was not effective in lowering the apnea-hypopnoea index and NHF50 was poorly tolerated.
In sleeping PH patients with OSA NHF20 but not NHF50 leads to decreased sympathetic drive likely due to washout of anatomical dead space. NHF was not effective in lowering the apnea-hypopnoea index and NHF50 was poorly tolerated.Multi-stage cascade impactors (CI) are accepted for the determination of metrics of the drug mass aerodynamic particle size distributions (APSD) of aerosols emitted from orally inhaled products (OIPs). This is particularly important for products where the drug to excipient ratio or particle density may not be the same in each aerodynamic size fraction; examples of such products are carrier-containing dry powder inhalers (DPIs) and suspension pressurized metered-dose inhalers (pMDIs). CI measurements have been used as the "gold standard" for acceptance of alternative methods of APSD assessment, such as laser diffraction for nebulized solutions. Although these apparatus are labor-intensive, they are accepted in regulatory submissions and quality control assessments because the mass of active pharmaceutical ingredient(s) in the aerosol can be quantified by chemical assay and measured particle size is based on the aerodynamic diameter scale that is predictive of deposition in the respiratory tract. Two of the most important factors that modify the ideal operation of an impactor are "particle bounce," that is often accompanied by re-entrainment in the air flow passing the stage of interest, and electrostatic charge acquired by the particles during the preparation and aerosolization of the formulation when the inhaler is actuated. This article reviews how both factors can lead to biased APSD measurements, focusing on measurements involving pMDIs and DPIs, where these sources of error are most likely to be encountered. click here Recommendations are provided for the mitigation of both factors to assist the practitioner of these measurements.Biochar (BC) has been widely used to remove heavy metals from wastewater. However, due to the hydrophobicity of BC and the lack of its surface functional groups, the effect of metal ions adsorption onto BC is limited. click here In order to improve the adsorption efficiency, L-cysteine was used to modify biochar derived from pomelo peel (PP) to regulate surface structure. The characteristics of BC and cysteine/biochar composite (cys/BC) were analyzed by various characterization methods. Results showed that the hydrophilicity of biochar was enhanced, and the number of surface functional groups was increased, resulting to strong adsorption ability of Ag(I) (618.9 mg/g), Pb(II) (274.5 mg/g), and As(V) (34.7 mg/g) for cys/BC, which increased approximately by 15%, 35%, and 29% compared with that of BC, respectively. The adsorption process of Pb(II) onto cys/BC was fitted better by the Freundlich isotherm model and for Ag(I) and As(V) by the Langmuir isotherm model. Moreover, the adsorption kinetics followed pseudo-second-order equation and the adsorption process was controlled by the intraparticle diffusion for Ag(I), Pb(II), and As(V) adsorption onto cys/BC. In addition, the adsorption capacities of cys/BC for Ag(I), Pb(II), and As(V) decreased slightly after five adsorption/desorption cycles. Finally, the multiple adsorption mechanisms including functional groups, pore adsorption, surface complexation, and cations-π were analyzed. The paper demonstrated that the cys/BC composite could be reused as effective adsorbents for removing contaminants in the environment.Bulking agents are particularly important for sewage sludge composting. In this study, reusable polypropylene packing (RPP) was mixed with sawdust to improve composting. The effect of the mix ratio of sawdust and RPP on the physicochemical characteristics, nitrogen transformation, and emissions of greenhouse gas (GHG) as well as differences in the germination index values was detected in a lab-scale composting experiment. The results showed that the unique use of RPP as a bulking agent increased the moisture content over 70%, which resulted in poorer porosity and a less efficient O2 utilization environment and thus suppressed the degradation of organic matter. The highest CH4 9275.8 mg and lowest CO2 202.6 g emissions were detected after 25 days of composting in the treatment with RPP used as a bulking agent. When the mixing ratio of sawdust and RPP was 11, the temperature, oxygen supply, and dissolved organic carbon degradation were improved. The NH3, N2O, and CH4 emissions were reduced by 32.2, 18.3, and 90.7% compared with a treatment with RPP as a unique bulking agent. The RPP had no effect on conserving nitrogen during sludge composting; the total nitrogen loss was reduced from 29.3 to 18.2% when sawdust was mixed with RPP in a ratio of 11. Therefore, mixing RPP and sawdust in the dry weight ratio of 11 (sawdust RPP) can be potentially used for reducing composting cost and improving the sewage sludge composting by reducing the amount of sawdust mixed and mitigating GHG and NH3 emissions.