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•Rigid polyurethane foams with different contents of aerogel are prepared.•Cell nucleation is enhanced by the presence of aerogel particles.•Degeneration mechanisms – as observed ...in-situ– are induced by the presence of particles larger than a few microns.•Low contents of aerogel boost polymerization reaction preventing coalescence and drainage.
Water blown rigid polyurethane (RPU) composite foams were produced using different concentrations of nanoporous silica aerogel micrometric powder (0.5, 1 and 3 wt%). The effect of these particles on the foaming kinetics was analysed from a physical and chemical viewpoint. On the physical side, the foaming process was studied by in-situ X-ray radioscopy. The inclusion of aerogel particles in the system delays the foam expansion and enhances the nucleation of cells. However, high amounts of these particles (3 wt%) lead to intense cell coalesce during foam evolution. On the chemical side, the reaction kinetics was investigated by in-situ FTIR spectroscopy and reaction temperature measurements. The addition of low contents of aerogel (below 3 wt%) reduces the conversion of isocyanate while favouring the generation of urethane groups, which explains the higher density of the foams with low aerogel contents. However, the foam with high contents of aerogel (3 wt%) does not change the reaction balance in comparison to the reference. Therefore, this foam presents similar expansion and density to those of the unfilled foam (Reference). Furthermore, higher reaction temperatures were reached by the reference foam during the foaming process, and higher dissipation speeds of these temperatures were detected for the foams containing aerogel with respect to those of the reference foam.
It was as early as 1959 that the report of the CIBA Symposium described the possible coexistence of different obstructive airway diseases, such as asthma, chronic bronchitis and/or emphysema, in the ...same individual. However, because there were no specific therapies for all these different expressions of lung disease, these overlaps were largely ignored by guidelines. In 1995, the American Thoracic Society chronic obstructive pulmonary disease (COPD) statement included a Venn diagram with the different possible overlaps of clinical presentation of obstructive lung diseases 1, but no specific recommendations of treatment were provided for them. It was not until 2007 that the Canadian COPD guidelines specified that: “if the asthma component (in COPD) is prominent, earlier introduction of inhaled corticosteroids (ICS) may be justified” 2. Later, in 2010, the Japanese guidelines for COPD dedicated a chapter to “Treatment of COPD complicated by asthma” 3. To the best of our knowledge, the Spanish guidelines for COPD (GesEPOC) in 2012 were the first to propose specific criteria for the identification of the so-called asthma–COPD overlap (ACO) 4, 5. Because there was no internationally accepted definition of ACO, a group of experts proposed diagnostic criteria for ACO in COPD 6 and these were adopted in the document. The major criteria were as follows: a very positive bronchodilator response (>400 mL and >15% increase in forced expiratory volume in 1 s (FEV1)), sputum eosinophilia or a previous diagnosis of asthma. Minor criteria were an increased total serum IgE, previous history of atopy or a positive bronchodilator test (>200 mL and >12% in FEV1) on at least two occasions 6. To be diagnosed with ACO, a patient must fulfil two major or one major and two minor criteria. Other national guidelines for COPD, such as the Finnish 7 and the Czech guidelines 8, followed this approach and proposed similar criteria for ACO.
The modulus build-up and relative density evolution during the reactive foaming of four standard polyurethane formulations was monitored in-situ by Dynamic Mechanical Analysis (DMA) with a customised ...set-up in parallel plate geometry. The modulus increased from 0.01 MPa in the first minutes to over 1.2 MPa within 20 min. The set-up also enabled the recording of vitrification followed by curing times. These typically occur within 3 min of each other. The results of DMA are corroborated by measurements of the reaction kinetics with Infrared Spectroscopy. This goes to show that the modulus remains nearly unchanged during the stage of swiftest isocyanate conversion, while the point of gel conversion is accompanied by their increase.
•DMA was applied to in-situ measure the modulus development of Rigid Polyurethane foams during foaming.•Employing a customised fixture density evolution was monitored simultaneously during the DMA experiments.•The modulus build-up profiles recorded with DMA were corroborated by measurements of the reaction kinetics.•Vitrification times can be inferred from the temporal evolution of the Loss modulus of the foams.
Introduction
Pregnant women have an increased risk of severe COVID‐19. Evaluation of drugs with a safety reproductive toxicity profile is a priority. At the beginning of the pandemic, ...hydroxychloroquine (HCQ) was recommended for COVID‐19 treatment.
Material and methods
A randomized, double‐blind, placebo‐controlled clinical trial was conducted in eight teaching hospitals in Spain to evaluate the safety and efficacy of HCQ in reducing viral shedding and preventing COVID‐19 progression. Pregnant and postpartum women with a positive SARS‐CoV‐2 PCR (with or without mild COVID‐19 signs/symptoms) and a normal electrocardiogram were randomized to receive either HCQ orally (400 mg/day for 3 days and 200 mg/day for 11 days) or placebo. PCR and electrocardiogram were repeated at day 21 after treatment start. Enrollment was stopped before reaching the target sample due to low recruitment rate. Trial registration EudraCT #: 2020‐001587‐29, on April 2, 2020. Clinical trials.gov # NCT04410562, registered on June 1, 2020.
Results
A total of 116 women (75 pregnant and 41 post‐partum) were enrolled from May 2020 to June 2021. The proportion of women with a positive SARS‐CoV‐2 PCR at day 21 was lower in the HCQ group (21.8%, 12/55) than in the placebo group (31.6%, 18/57), although the difference was not statistically significant (P = 0.499). No differences were observed in COVID‐19 progression, adverse events, median change in QTc, hospital admissions, preeclampsia or poor pregnancy and perinatal outcomes between groups.
Conclusions
HCQ was found to be safe in pregnant and postpartum women with asymptomatic or mild SARS‐CoV‐2 infection. Although the prevalence of infection was decreased in the HCQ group, the statistical power was insufficient to confirm the potential beneficial effect of HCQ for COVID‐19 treatment.
This study is the only completed clinical trial evaluating a drug for COVID‐19 among pregnant women. Prevalence of infection was decreased in the HCQ group, but low recruitment led to insufficient statistical power to confirm the potential beneficial effect of HCQ.
Purpose: The Spanish Activity Questionnaire in COPD (SAQ-COPD) is a short, simple physical activity (PA) measurement instrument for patients with chronic obstructive pulmonary disease (COPD). In this ...study, we analyzed its validity and sensitivity to change. Methods: Prospective scale validation study. An accelerometer (DynaPort MoveMonitorR) and the Yale Physical Activity Survey (YPAS) were used as reference standards. The analyses examined the criterion validity (Spearman correlations), internal consistency (Cronbach's alpha), factorial structure, test-retest reliability (intraclass correlation coefficient, ICC), sensitivity to change and receiver operating characteristic (ROC) curve to classify patients with low PA. Results: A total of 300 patients diagnosed with COPD were analyzed (73% males, mean age 66 + or - 8 years, 40.3% with severe airflow limitation). Cronbach's alpha was 0.60 and Spearman's correlations with accelerometer measurements of PA number of steps, metabolic equivalents (MET), physical activity level (PAL) and YPAS ranged from 0.37 to 0.53 (all p < 0.001). ICC was 0.69 (95% CI 0.61-0.74) and the area under the ROC curve to identify low PA was 0.65 (95% confidence interval: 0.58- 0.73). Significant variations in SAQ-COPD scores were found between groups defined by YPAS for change. Conclusion: The SAQ-COPD questionnaire is a valid instrument for classifying PA in patients with COPD. Correlations with other instruments provide criterion validity and also demonstrate good sensitivity to change. Keywords: physical activity, chronic obstructive pulmonary disease, SAQ-COPD, validity, reliability
•The sedimentary record of La Ballestera playa-lake covers the last ∼11.9 ky.•Siliciclastic sediments registered important runoff in the Early Holocene.•Carbonate content decreased after ∼4.1 ky, ...when aridity conditions enhanced.•Late Holocene arid conditions boosted gypsum precipitation.•The geochemical signature only registered human impact during the last decades.
Evaporitic lakes such as playa-lakes are characteristic of many arid regions and are unique environments with respect to fauna and flora, while being very vulnerable to climate and environmental fluctuations and threatened by the current global change scenario. Water balance oscillations in these systems can trigger the precipitation or dissolution of different evaporitic minerals, negatively impacting local biodiversity and economic activities. Here, we study the sedimentary record of a small saline pond from a playa-lake complex in southwestern Iberia in order to reconstruct the paleohydrological evolution of this area and assess potential anthropogenic disturbances. The different proxies studied in the ∼11.9 ky old sedimentary record of the Laguna de la Ballestera suggest that the greatest lake extension and the highest water levels occurred during the Early Holocene, pointing to the wettest period of the record. Climate transitioned towards more arid conditions during the Middle Holocene, and even more dramatically during the Late Holocene. In this last stage the wetland surface and the water level largely diminished and gypsum precipitation gradually increased pointing towards a negative precipitation/evapotranspiration balance and lowest water levels. Summer desiccation likely occurred under this scenario, especially after ∼1.0–0.9 cal ky BP coeval with the Medieval Climate Anomaly, when gypsum content started to rise abruptly. However, this significant gypsum precipitation was only associated with a massive drop in the siliciclastic content and scarce carbonates (dolomite and calcite) during the last ∼400 years. This evidence suggests a shift from a (semi) permanent to a temporal/seasonal hydrological regime. The environmental evolution of this wetland responded to the general climatic evolution of the western Mediterranean during the Holocene, being mostly controlled by changes in insolation. Our data also show that the environmental response of the studied wetland to natural climate variations was only significantly disturbed by human activities since the 20th century, especially in the second half of the century, deduced by abrupt fluctuations in the siliciclastic, gypsum and organic content in the sediments, as well as by the enhanced sedimentary accumulation rates, probably as a response to changes in the hydroperiod of the lake and in the catchment land use.
Chronic obstructive pulmonary disease (COPD) is currently a leading cause of death worldwide, and its burden is expected to rise in the coming years. Common COPD symptoms include dyspnea, cough ...and/or sputum production. Some patients may experience acute worsening of symptoms (known as an exacerbation), and therefore require additional therapy. Exacerbations are mainly triggered by respiratory infections and environmental factors. Healthcare professionals face many challenges in COPD management, including the heterogeneity of the disease and under-reporting of symptoms. The authors review these challenges and provide recommendations for the best methods to assess COPD. The goals of COPD treatment include recognising the impact that both symptoms and exacerbations have on patients’ lives when considering optimal patient-focused management. The review discusses the need for COPD management strategies to include both pharmacologic and non-pharmacologic approaches and provides recommendations for monitoring treatment outcomes and adjusting management strategies accordingly. Novel treatment strategies including precision medicine and point-of-care testing are also discussed.
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•Challenges of COPD management include disease heterogeneity and under-diagnosis.•The best available tools should be used for COPD diagnosis and assessment.•Optimal management of COPD includes recognizing both symptoms and exacerbations.•Both pharmacologic and non-pharmacologic treatment strategies should be considered.•Novel strategies (e.g. precision medicine, point-of-care testing) may be of value.
Polyphenols are bioactive compounds with several anticarcinogenic activities; however, human data regarding associations with thyroid cancer (TC) is still negligible. Our aim was to evaluate the ...association between intakes of total, classes and subclasses of polyphenols and risk of differentiated TC and its main subtypes, papillary and follicular, in a European population. The European Prospective Investigation into Cancer and Nutrition cohort included 476,108 men and women from 10 European countries. During a mean follow‐up of 14 years, there were 748 incident differentiated TC cases, including 601 papillary and 109 follicular tumors. Polyphenol intake was estimated at baseline using validated center/country‐specific dietary questionnaires and the Phenol‐Explorer database. In multivariable‐adjusted Cox regression models, no association between total polyphenol and the risks of overall differentiated TC (HRQ4 vs. Q1 = 0.99, 95% confidence interval CI 0.77–1.29), papillary (HRQ4 vs. Q1 = 1.06, 95% CI 0.80–1.41) or follicular TC (HRQ4 vs. Q1 = 1.10, 95% CI 0.55–2.22) were found. No associations were observed either for flavonoids, phenolic acids or the rest of classes and subclasses of polyphenols. After stratification by body mass index (BMI), an inverse association between the intake of polyphenols (p‐trend = 0.019) and phenolic acids (p‐trend = 0.007) and differentiated TC risk in subjects with BMI ≥ 25 was observed. In conclusion, our study showed no associations between dietary polyphenol intake and differentiated TC risk; although further studies are warranted to investigate the potential protective associations in overweight and obese individuals.
What's new?
Polyphenols are secondary plant metabolites with health protective properties but whether a diet rich in polyphenols protects from thyroid cancer has not been conclusively explored. In this large prospective study, no associations were observed between dietary polyphenol intake and differentiated thyroid cancer risk. The authors recommend further studies to investigate potential associations specifically in overweight and obese individuals.
There is a dearth of research regarding the prevalence and nature of patient-reported rhinitis and its relationship with risk of asthma exacerbations. The aim of this study was to (i) determine the ...prevalence, severity and treatment of self-reported rhinitis symptoms among adults aged ≥18 years with asthma treated at Global Initiative for Asthma (GINA) Step 3 and above and (ii) compare the demographics, clinical characteristics, medication use, side-effects and healthcare practitioner review between patients who report rhinitis symptoms and those who do not and (iii) determine whether patient-reported rhinitis is associated with risk of asthma exacerbations in the total patient sample.
This analysis used data from the iHARP (Initiative Helping Asthma in Real-life Patients) asthma review service - a cross-sectional observational study (2011 and 2014) in seven countries that captured data on patient demographics, rhinitis symptoms, asthma symptoms, indicators of exacerbations, medication use, oropharyngeal effects and side-effects, using practitioner- and patient-reported questionnaires. Comparisons between patients with and without rhinitis were tested. Univariate logistic regression was used to identify variables associated with risk of exacerbations for entry into multivariable logistic regression.
This report contains data from 4274 patients: 67.4% (2881/4274) reported rhinitis symptoms and of which 65.7% (1894/2881) had not received a doctor diagnosis; 36.5% (1052/2881) had moderate-severe rhinitis, 12.4% (358/2881) had used intranasal corticosteroids and 19.8% (569/2881) oral antihistamines. Patients with coexisting moderate-severe rhinitis were more likely to have GINA-defined uncontrolled asthma than those with mild rhinitis or no rhinitis. Moderate-severe rhinitis was associated with 40% increased risk of asthma exacerbations (OR=1.40, 95% CI: 1.02-1.90).
This study identified a major gap in the diagnosis and management of rhinitis in a cohort of people with asthma treated at GINA Step 3 and above who are managed in general practice. It highlights the need for practitioners to identify, evaluate and optimally treat rhinitis in adults with asthma, which is a significant factor associated with exacerbation risk.
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