Indirect Measurements of Acceleration Atelectasis and the Role of Inspired Oxygen Concentrations

BACKGROUND: A growing number of symptom reports suggestive of acceleration atelectasis in fast jet aircrew have raised the question as to whether traditional guidelines on inspired gas composition remain valid. The aim of this study was to assess the effects of inspired O2 concentration on the development of acceleration atelectasis when wearing modern anti-G garments. METHODS: There were 14 nonaircrew subjects who completed 5 centrifuge exposures to +5 Gz lasting 90 s. During exposures subjects breathed a gas mixture containing 21, 35, 45, 60, or 75% O2. To assess the extent of atelectasis post-Gz, forced inspiratory vital capacity (FIVC), regional FIVC (EITFIVC), shunt, respiratory resistance, reactance, and compliance and peripheral O2 saturation during a hypoxic exposure were measured. RESULTS: Compared with baseline, FIVC was not statistically significantly altered. EITFIVC was 14.4% lower after the 75% O2 exposure only with a greater symptom reporting with higher FIO2 in some individuals. A significantly greater shunt (3>6%) followed the 60 and 75% O2 exposures. O2 concentration during Gz had no effect on respiratory resistance, reactance, compliance, or hypoxemia. DISCUSSION: There is evidence of mild acceleration atelectasis present when breathing 60% O2, particularly in susceptible individuals, with 75% O2 causing more obvious physiological compromise. An inspired oxygen concentration of <60% will prevent the majority of individuals from developing acceleration atelectasis. Pollock RD, Gates SD, Radcliffe JJ, Stevenson AT. Indirect measurements of acceleration atelectasis and the role of inspired oxygen concentrations. Aerosp Med Hum Perform. 2021; 92(10):780785.

Colonic Volume Changes in Paediatric Constipation Compared to Normal Values Measured Using MRI

Background: Functional constipation in children is common. Management of this condition can be challenging and is often based on symptom reports. Increased, objective knowledge of colonic volume changes in constipation compared to health could provide additional information. However, very little data on paediatric colonic volume is available except from methods that are invasive or require unphysiological colonic preparations. Objectives: (1) To measure volumes of the undisturbed colon in children with functional constipation (FC) using magnetic resonance imaging (MRI) and provide initial normal range values for healthy controls, and (2) to investigate possible correlation of colonic volume with whole gut transit time (WGTT). Methods: Total and regional (ascending, transverse, descending, sigmoid, and rectum) colon volumes were measured from MRI images of 35 participants aged 7–18 years (16 with FC and 19 healthy controls), and corrected for body surface area. Linear regression was used to explore the relationship between total colon volume and WGTT. Results: Total colonic volume was significantly higher, with a median (interquartile range) of 309 mL (243–384 mL) for the FC group than for the healthy controls of 227 mL (180–263 mL). The largest increase between patients and controls was in the sigmoid colon–rectum region. In a linear regression model, there was a positive significant correlation between total colonic volume and WGTT (R = 0.56, p = 0.0005). Conclusions: This initial study shows increased volumes of the colon in children with FC, in a physiological state, without use of any bowel preparation. Increased knowledge of colonic morphology may improve understanding of FC in this age group and help to direct treatment.

Anaphylaxis: subjective symptom reports of patients with a special focus on “near-death” experiences

SummaryAlmost all anaphylactic reactions are associated with subjective symptoms, which are also referred to “prodromi”, and are often not taken seriously. In 100 patients categorized with different severity grades, subjective symptoms were investigated in a personal interview with free/open questions regarding subjective feelings and symptoms (duration 5–90 min). After the interview, the patients were asked to complete a questionnaire about the exact occurrence of the reaction. Special focus was given to near-death experiences in severe reactions. Patients described feelings of “elevation”, “looking at themselves from outside”, “tunnel experiences” and “bright light”. In the kinetics of the anaphylactic reaction, cutaneous symptoms were most often reported as the first or second symptom, while cardiovascular and airway symptoms were also reported as the 3rd, 4th or 5th symptom. In 37% of the patients with severe reactions, everyday life has changed since suffering the anaphylactic episode.

A Placebo-Controlled, Pseudo-Randomized, Crossover Trial of Botanical Agents for Gulf War Illness: Reishi Mushroom (Ganoderma lucidum), Stinging Nettle (Urtica dioica), and Epimedium (Epimedium sagittatum)

This report is third in a three-part clinical trial series screening potential treatments for Gulf War Illness (GWI). The goal of the project was to rapidly identify agents to prioritize for further efficacy research. We used a placebo-controlled, pseudo-randomized, crossover design to test the effects of reishi mushroom (Ganoderma lucidum), stinging nettle (Uritca dioica), and epimedium (Epimedium sagittatum) in 29 men with GWI. Participants completed 30 days of symptom reports for baseline, then a botanical line consisting of 30 days of placebo, followed by 30 days each of lower-dose and higher-dose botanical. After completing a botanical line, participants were randomized to complete the protocol with another botanical, until they completed three botanical trials. GWI symptom severity, pain, and fatigue were contrasted between the four conditions (baseline, placebo, lower-dose, higher dose) using linear mixed models. GWI symptom severity was unchanged from placebo in the reishi lower-dose condition (p = 0.603), and was higher in the higher-dose condition (p = 0.012). Symptom severity was not decreased from placebo with lower-dose stinging nettle (p = 0.604), but was significantly decreased with higher-dose stinging nettle (p = 0.048). Epimedium showed no significant decreases of GWI symptoms in the lower (p = 0.936) or higher (p = 0.183) dose conditions. Stinging nettle, especially at higher daily dosages, may help reduce the symptoms of GWI. Epimedium does not appear to beneficially affect GWI symptom severity, and reishi may exaggerate symptoms in some GWI sufferers. These results are in a small sample and are preliminary. Further research is required to determine if stinging nettle is indeed helpful for the treatment of GWI, and what dosage is optimal. This trial was registered on ClinicalTrials.gov (NCT02909686).

A Placebo-Controlled, Pseudo-Randomized, Crossover Trial of Botanical Agents for Gulf War Illness: Resveratrol (Polygonum cuspidatum), Luteolin, and Fisetin (Rhus succedanea)

A chronic multi-symptom illness of unknown etiology, Gulf War Illness (GWI) affects 175,000 to 250,000 veterans of the Gulf War. Because inflammation has suspected involvement in the pathophysiology of GWI, botanical treatments that target inflammation may be beneficial in reducing symptoms. No FDA-approved treatments currently exist for GWI, and rapid prioritization of agents for future efficacy testing is important. This study is part of a larger project that screened nine different botanical compounds with purported anti-inflammatory properties for potential treatment of GWI. We tested three botanicals (resveratrol [Polygonum cuspidatum], luteolin, and fisetin [Rhus succedanea]) on symptom severity of GWI in this placebo-controlled, pseudo-randomized clinical trial. Twenty-one male veterans with GWI completed the study protocol, which consisted of 1 month (30 days ± 3) of baseline symptom reports, 1 month of placebo, 1 month of lower-dose botanical, and 1 month of higher-dose botanical. Participants completed up to 3 different botanicals, repeating the placebo, lower-dose, and higher-dose cycle for each botanical assigned. Linear mixed models were used for analyses. Resveratrol reduced GWI symptom severity significantly more than placebo at both the lower (p = 0.035) and higher (p = 0.004) dosages. Luteolin did not decrease symptom severity more than placebo at either the lower (p = 0.718) or higher dosages (p = 0.492). Similarly, fisetin did not reduce symptom severity at either the lower (p = 0.504) or higher (p = 0.616) dosages. Preliminary findings from this screening study suggest that resveratrol may be beneficial in reducing symptoms of GWI and should be prioritized for future testing. Larger trials are required to determine efficacy, response rates, durability of effects, safety, and optimal dosage. This trial was registered on ClinicalTrials.gov (NCT02909686) on 13 September 2016.

Incidence, healthcare-seeking behaviours, antibiotic use and natural history of common infection syndromes in England: results from the Bug Watch community cohort study

Background Better information on the typical course and management of acute common infections in the community could inform antibiotic stewardship campaigns. We aimed to investigate the incidence, management, and natural history of a range of infection syndromes (respiratory, gastrointestinal, mouth/dental, skin/soft tissue, urinary tract, and eye). Methods Bug Watch was an online prospective community cohort study of the general population in England (2018–2019) with weekly symptom reporting for 6 months. We combined symptom reports into infection syndromes, calculated incidence rates, described the proportion leading to healthcare-seeking behaviours and antibiotic use, and estimated duration and severity. Results The cohort comprised 873 individuals with 23,111 person-weeks follow-up. The mean age was 54 years and 528 (60%) were female. We identified 1422 infection syndromes, comprising 40,590 symptom reports. The incidence of respiratory tract infection syndromes was two per person year; for all other categories it was less than one. 194/1422 (14%) syndromes led to GP (or dentist) consultation and 136/1422 (10%) to antibiotic use. Symptoms usually resolved within a week and the third day was the most severe. Conclusions Most people reported managing their symptoms without medical consultation. Interventions encouraging safe self-management across a range of acute infection syndromes could decrease pressure on primary healthcare services and support targets for reducing antibiotic prescribing.

Comparison of algorithm-based versus single-item phenotyping measures of depression and anxiety disorders in the GLAD Study cohort

Background: Research to understand the complex aetiology of depressive and anxiety disorders often requires large sample sizes, but this comes at a cost. Large-scale studies are typically unable to utilise "gold standard" phenotyping methods, instead relying on remote, self-report measures to ascertain phenotypes. Aims: To assess the comparability of two commonly used phenotyping methods for depression and anxiety disorders. Method: Participants from the Genetic Links to Anxiety and Depression (GLAD) Study (N = 37,419) completed an online questionnaire including detailed symptom reports. They received a lifetime algorithm-based diagnosis based on DSM-5 criteria for major depressive disorder (MDD), generalised anxiety disorder (GAD), specific phobia, social anxiety disorder, panic disorder, and agoraphobia. Any anxiety disorder included participants with at least one anxiety disorder. Participants also responded to single-item questions asking whether they had ever been diagnosed with these disorders by health professionals. Results: Agreement for algorithm-based and single-item diagnoses was high for MDD and any anxiety disorder but low for the individual anxiety disorders. For GAD, many participants with a single-item diagnosis did not receive an algorithm-based diagnosis. In contrast, algorithm-based diagnoses of the other anxiety disorders were more common than the single-item diagnoses. Conclusions: The two phenotyping methods were comparable for MDD and any anxiety disorder cases. However, frequencies of specific anxiety disorders varied depending on the method. Single-item diagnoses classified most participants as having GAD whereas algorithm-based diagnoses were more evenly distributed across the anxiety disorders. Future investigations of specific anxiety disorders should use algorithm-based or other robust phenotyping methods.

Pain symptoms are reported earlier than quantitative measures of low back pain during prolonged standing

BACKGROUND: Along with quantitative measures, pain symptoms may help inform early interventions to prevent prolonged standing induced low back pain (LBP); however, the relationship between quantitative and qualitative measures has not been assessed. OBJECTIVE: Determine the relationship between qualitative and quantitative measures of pain development during prolonged standing induced LBP development. METHODS: Thirty-five participants performed two-hours of standing. A visual analog scale (VAS) and the Short-Form McGill Pain Questionnaire were used to assess the participant’s LBP every 7.5-minutes. Participants were classified as a pain developer (PD) based on VAS scores or three consecutive pain symptom reports. RESULTS: Pain symptom reports occurred 31.3 (±24.8) minutes earlier than the VAS reports. Eight participants (44%) were non-PDs with the VAS and PDs with the symptom method (p = 0.0047). CONCLUSIONS: A subset of participants who were not categorized as LBP developers during prolonged standing using the VAS method still report LBP symptoms. The inclusion of pain symptom reporting could provide additional information for practitioners when identifying individuals who would benefit from early interventions for standing induced LBP.

Interventional multicenter study to assess the feasibility of an e-health system (ZEMY) designed to manage symptoms and treatment-related toxicities in patients with breast cancer.

e14107 Background: There is increasing interest in using e-health systems for symptom monitoring and alert triggering. ZEMY, a new software medical device, was developed to improve symptom management and enhance patient and health care team interactions. Methods: This was a three-month open-label, interventional, single arm study conducted at five French sites. Adult women with breast cancer (BC) initiating oral and/or parenteral cancer treatment received a smartphone with ZEMY installed and verbal training. Patients started cancer treatment on Day 1 and were followed for three months. Patients entered data for ten prespecified symptoms. The ZEMY software made recommendations to patients on the self-management of symptoms and transmitted automatic messages to the health care team. Primary outcome was patient feasibility response at 3 months (completion of ≥3 symptom reports and a report completion rate of ≥60% per patient). Secondary objectives included ZEMY symptom management, usability and satisfaction, and device deficiencies (DDs). Results: Overall, 54 patients were enrolled (Jun 2018 to Jan 2019) and 52 (96.3%) completed the study. Thirty-one (57.4%) patients were responders; this was not significantly higher than the predefined cut-off and ZEMY feasibility was not demonstrated. Forty-seven (87.0%) patients had ≥3 completed symptom reports and 33 (66.0%) patients had a report completion rate of ≥60% (missing: n = 4). In subgroup analyses, 22/30 (73.3%) patients with locally advanced BC and 24/36 (66.7%) patients aged 40–60 years were responders. ZEMY patient recommendations and health care team automatic messages were considered relevant at least once in > 74% of cases for five of the six symptoms that were reported at least once by more than 1/3 of patients (diarrhea, nausea, fatigue, cutaneous and mucosal toxicities, and anxiety/depression). Using a 0–10 visual analogue scale, mean ZEMY satisfaction score was higher for patients than investigators (6.3 ±2.9 vs 4.4 ±1.5). Overall, 95 DDs were reported in 37 (68.5%) patients. Main reasons for DDs were inappropriate recommendations (n = 51) and device malfunction (n = 36). Conclusions: The primary endpoint of the study was not reached; however, higher response rates were observed in subgroups versus the overall population, indicating that ZEMY may be useful in symptom management in these patients. Generally, patients had a favorable opinion of ZEMY. The DD rate observed indicates the need for better user support in the future. Clinical trial information: NCT03558490.