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BMJ Open May 2024People with mustard gas lung disease experience cough, sputum, breathlessness and exercise limitation. We hypothesised that pulmonary rehabilitation (PR) would be... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
People with mustard gas lung disease experience cough, sputum, breathlessness and exercise limitation. We hypothesised that pulmonary rehabilitation (PR) would be beneficial in this condition.
DESIGN
An assessor-blind, two-armed, parallel-design randomised controlled clinical trial.
SETTING
Secondary care clinics in Iran.
PARTICIPANTS
60 men with breathlessness due to respiratory disease caused by documented mustard gas exposure, mean (SD) age 52.7 (4.36) years, MRC dyspnoea score 3.5 (0.7), St. George's Respiratory Questionnaire (SGRQ) 72.3 (15.2).
INTERVENTIONS
Participants were allocated either to a 6-week course of thrice-weekly PR (n=31) or to usual care (n=29), with 6-week data for 28 and 26, respectively.
OUTCOME MEASURES
Primary endpoint was change in cycle endurance time at 70% baseline exercise capacity at 6 weeks. Secondary endpoints included 6 min walk distance, quadriceps strength and bulk, body composition and health status. For logistical reasons, blood tests that had been originally planned were not performed and 12-month follow-up was available for only a small proportion.
RESULTS
At 6 weeks, cycle endurance time increased from 377 (140) s to 787 (343) s with PR vs 495 (171) s to 479 (159) s for usual care, effect size +383 (231) s (p<0.001). PR also improved 6 min walk distance+103.2 m (63.6-142.9) (p<0.001), MRC dyspnoea score -0.36 (-0.65 to -0.07) (p=0.016) and quality of life; SGRQ -8.43 (-13.38 to -3.48) p<0.001, as well as quadriceps strength+9.28 Nm (1.89 to 16.66) p=0.015.
CONCLUSION
These data suggest that PR can improve exercise capacity and quality of life in people with breathlessness due to mustard gas lung disease and support the wider provision of this form of care.
TRIAL REGISTRATION NUMBER
IRCT2016051127848N1.
Topics: Humans; Male; Iran; Mustard Gas; Middle Aged; Exercise Tolerance; Quality of Life; Dyspnea; Lung Diseases; Adult; Outpatients; Treatment Outcome; Chemical Warfare Agents
PubMed: 38806414
DOI: 10.1136/bmjopen-2023-083085 -
Frontiers in Medicine 2024Sulfur mustard (SM) exposure causes acute and chronic respiratory diseases. The extent of small airway dysfunction (SAD) in individuals exposed to SM is unclear. This...
BACKGROUND
Sulfur mustard (SM) exposure causes acute and chronic respiratory diseases. The extent of small airway dysfunction (SAD) in individuals exposed to SM is unclear. This study evaluated and compared SAD in SM-exposed and SM-unexposed participants using noninvasive lung function tests assessing small airway function.
METHODS
This retrospective cohort study involved SM-exposed ( = 15, mean age: 53 ± 8 years) and SM-unexposed ( = 15, mean age: 53 ± 7 years) Kurdish-Swedish individuals in Sweden. Small airway resistance and reactance were assessed using impulse oscillometry (IOS). Nitrogen (N) multiple breath washout (MBW) was employed to assess lung ventilation heterogeneity. The gas-exchanging capacity of the lungs was assessed using the diffusing capacity of the lungs for the carbon monoxide (DLCO) test. Lung function outcomes were reported as absolute values and -scores. Group comparisons were performed using the Mann-Whitney U test.
RESULTS
No statistically significant differences in age, height, or body mass index were observed between the two groups. IOS showed significantly increased small airway resistance, while NMBW exhibited significantly increased global and acinar ventilation heterogeneity in SM-exposed individuals compared to that in unexposed individuals. SAD was identified in 14 of 15 SM-exposed individuals, defined as at least one abnormal IOS difference between resistance at 5 and 20 Hz (R5-R20) and/or area of reactance (AX) or NMBW lung's acinar zone (S), and DLCO adjusted to the alveolar volume (DLCO/VA) outcome. Of these 14 individuals, only 5 demonstrated concordant findings across the IOS and NMBW tests.
CONCLUSION
Exposure to SM was positively associated with long-term impairment of respiratory tract function in the small airways in the majority of the previously SM-exposed individuals in the present study. Furthermore, both IOS and NMBW should be employed to detect SAD in SM-exposed survivors as they provide complementary information. Identifying and characterizing the remaining pathology of the small airways in survivors of SM exposure is a first step toward improved treatment and follow-up.
PubMed: 38500955
DOI: 10.3389/fmed.2024.1251500 -
Journal, Physical Therapy Education Sep 2023Full-time clinical education experiences (CEEs) constitute a significant component of entry-level physical therapy education. COVID-19 challenged clinical education...
INTRODUCTION
Full-time clinical education experiences (CEEs) constitute a significant component of entry-level physical therapy education. COVID-19 challenged clinical education throughout the country by affecting the availability of CEEs.
REVIEW OF LITERATURE
Research suggested that the number of clinical education spots available would stay the same. By contrast, the number of students enrolling in physical therapist (PT) and physical therapist assistant (PTA) education programs continues to rise. In response to the COVID-19 pandemic, students and faculty expressed concerns about the lack of student readiness and the availability of CEEs. The purpose of this study was to examine prepandemic factors that influenced the number of CEE slots available in Florida and the impact that the COVID-19 pandemic had on slot availability. Furthermore, researchers sought to identify factors that prevented a return to prepandemic levels of CEE spot offerings and recognize solutions to overcome those barriers. Finally, the researchers aimed to pinpoint suggestions to enhance collaborations between the clinical sites and physical therapy education programs.
SUBJECTS
Forty-eight site coordinators of clinical education (SCCEs) from various settings and regions in Florida completed the survey.
METHODS
An online survey was distributed to Florida SCCEs to ascertain their perceptions on how COVID-19 influenced clinical education. The researchers used descriptive and inferential statistics to analyze the data.
RESULTS
Clinical instructor (CI) volunteerism was the primary determinant of CEE spots available before the COVID-19 pandemic. The number of CEE spots was reduced for both PT and PTA education programs during the COVID-19 pandemic. Although the PTA slots returned to their baseline from 2019, the PT placements remained significantly lower in 2021. Social distancing and CI availability had the most considerable impact on CEE offerings. Site coordinators of clinical education also suggested that the greatest supports needed from the academic institutions were educating students on COVID-19 prevention and providing personal protective equipment (PPE) to students for their CEEs. This article also offers suggested incentives that academic sites can provide their clinical partners, such as in-services earning continuing education units, to enhance their participation in clinical education.
DISCUSSION AND CONCLUSION
All clinical education stakeholders must collaborate to provide students with the required clinical educational opportunities. Academic sites should continue to provide support, training, and incentives to CIs to enhance participation from clinical education sites. Educational programs must add content about COVID-19 to their curriculum and consider providing students with PPE during their rotations to restore the number of CEEs post-COVID-19 pandemic.
Topics: Humans; Florida; Pandemics; COVID-19; Physical Therapy Modalities; Mustard Gas
PubMed: 38478814
DOI: 10.1097/JTE.0000000000000286 -
Journal, Physical Therapy Education Sep 2023The aim of this study was to adapt and validate the Belongingness Scale-Clinical Placement Experience (BES-CPE) for Doctor of Physical Therapy (DPT) students in the...
INTRODUCTION
The aim of this study was to adapt and validate the Belongingness Scale-Clinical Placement Experience (BES-CPE) for Doctor of Physical Therapy (DPT) students in the United States.
REVIEW OF LITERATURE
Belongingness is vital to one's mental, emotional, and physical health. Research has shown that belongingness is positively correlated with students' academic performance and achievement. An absence of belongingness may hinder students' full participation in clinical experiences and compromise clinical achievement.
SUBJECTS
Respondents were current or former DPT students at least 18 years of age who had either completed the midterm evaluation of their final terminal full-time clinical education experience (TCE) in their DPT program or were no more than 1 year from the completion of their final TCE.
METHODS
The BES-CPE was adapted for DPT students, and the scale was completed electronically by those who met the inclusion criteria. Principal component analysis with promax rotation and Cronbach's α were used to determine construct validity and reliability.
RESULTS
One hundred fifty-nine respondents completed all items on the BES-CPE and demographic survey. A 3-component structure was identified (esteem, connectedness, and efficacy), which was aligned to the original BES-CPE scale. One item was discarded, and the final version of the BES-CPE for DPT students is a 33-item scale with satisfactory internal consistency.
DISCUSSION AND CONCLUSION
This study adapted and provided evidence for validity of the first known scale to measure belongingness in DPT students during their clinical education experiences (CEEs) in the United States. The 33-item BES-CPE provided valid and reliable measures of belongingness in DPT students during CEEs that can be used to provide a better understanding of the student experience in the clinical learning environment.
Topics: Humans; United States; Reproducibility of Results; Students; Physical Therapy Modalities; Mustard Gas; Alkanesulfonic Acids
PubMed: 38478813
DOI: 10.1097/JTE.0000000000000292 -
RSC Advances Feb 2024Chemical warfare agents (CWAs) pose a persistent threat to human safety, and bis(2-chloroethyl) sulfide, or sulfur mustard (SM) is one of the most dangerous substances...
Chemical warfare agents (CWAs) pose a persistent threat to human safety, and bis(2-chloroethyl) sulfide, or sulfur mustard (SM) is one of the most dangerous substances and is able to cause serious harm. Detecting SM gas is vital, but current methods have high-temperature requirements and limited selectivity, mainly because of the lack of CWA receptor development, and this makes them challenging to use. To address this issue, we present a trisaryl phosphoric triamide-based resin receptor that preferentially interacts with a SM simulant 2-chloroethyl ethyl sulfide (2-CEES) through dipole interactions. The receptor was synthesized through a facile process using an amine and a triethyl phosphate and the properties of its coating were enhanced using epoxy chemistry. The receptor's superior triamide structure was evaluated using a quartz crystal microbalance and reactivity was confirmed by observing the variations in reactivity according to the number of phosphoramides. The receptor showed better reactivity to 2-CEES vapor than to the known poly(epichlorohydrin) and showed selectivity to other volatile organic compounds. Moreover, its durability was evident even 30 days post-coating. The applicability of this receptor extends to array sensors, sound acoustic wave sensors, and chemo-resistive and chemo-capacitive sensors, and it promises advances in chemical warfare agent detection.
PubMed: 38449823
DOI: 10.1039/d3ra08852a -
Science and Technology of Advanced... 2024A series of porous organic polymers based on a singlet oxygen generating oxoporphyinogen ('') has been successfully prepared from a pseudotetrahedral -tetraamine...
A series of porous organic polymers based on a singlet oxygen generating oxoporphyinogen ('') has been successfully prepared from a pseudotetrahedral -tetraamine precursor () by its reaction with tetracarboxylic acid dianhydrides under suitable conditions. Of the compounds studied, those containing naphthalene () and perylene () spacers, respectively, have large surface areas (~530 m g). On the other hand, the derivative with a simple benzene spacer () exhibits the best O generating capability. Although the starting -tetraamine precursor is a poor O generator, its incorporation into POPs leads to a significant enhancement of O productivity, which is largely due to the transformation of NH groups to electron-withdrawing diimides. Overall O production efficacy of s under irradiation by visible light is significantly improved over the common reference material . All the materials , and promote oxidation of thioanisole involving conversion of ambient triplet state oxygen to singlet oxygen under visible light irradiation and its reaction with the sulfide. Although the reaction rate of the oxidation promoted by POPs is generally lower than for conventional materials (such as ) or previously studied derivatives, undesired overoxidation of the substrate to methyl phenyl sulfone is suppressed. For organic sulfides, selectivity of oxidation is especially important for detoxification of mustard gas (bis(2-chloroethyl)sulfide) or similarly toxic compounds since controlled oxidation leads to the low toxicity bis(2-chloroethyl)sulfoxide while overoxidation leads to intoxification (since bis(2-chloroethyl)sulfone presents greater toxicity to humans than the sulfide substrate). Therefore, POPs capable of promoting selective oxidation of sulfides to sulfoxides have excellent potential to be used as mild and selective detoxification agents.
PubMed: 38440402
DOI: 10.1080/14686996.2024.2322458 -
Polymers Feb 2024There have been many studies on surface acoustic wave (SAW) sensors for detecting sulfur-containing toxic or harmful gases. This paper aims to give an overview of the... (Review)
Review
There have been many studies on surface acoustic wave (SAW) sensors for detecting sulfur-containing toxic or harmful gases. This paper aims to give an overview of the current state of polymer films used in SAW sensors for detecting deleterious gases. By covering most of the important polymer materials, the structures and types of polymers are summarized, and a variety of devices with different frequencies, such as delay lines and array sensors for detecting mustard gas, hydrogen sulfide, and sulfur dioxide, are introduced. The preparation method of polymer films, the sensitivity of the SAW gas sensor, the limit of detection, the influence of temperature and humidity, and the anti-interference ability are discussed in detail. The advantages and disadvantages of the films are analyzed, and the potential application of polymer films in the future is also forecasted.
PubMed: 38399835
DOI: 10.3390/polym16040457 -
Heliyon Jan 2024The primary objective of this study was to analyze the long-term survival of 48,067 chemical warfare survivors who suffered from pulmonary, cutaneous, and ocular lesions...
BACKGROUND
The primary objective of this study was to analyze the long-term survival of 48,067 chemical warfare survivors who suffered from pulmonary, cutaneous, and ocular lesions in the decades following the Iran-Iraq war.
METHODS
The data for this study were obtained from the Veterans and Martyr Affair Foundation (VMAF) database. The survivors were divided into two groups based on whether they were evacuated/admitted (EA) to a hospital or not evacuated/admitted (NEA) to a hospital. The proportional hazard (PH) assumption for age categories, gender, exposure statuses, and eye severity was not satisfied. Therefore, we used a Generalized Gamma (GG) distribution with an Accelerated Failure Time (AFT) model for analysis.
RESULTS
The study included a total of 48,067 observations, and among them, 4342 (9.03 %) died during the study period. The mean (SD) age of the survivors was 55.99 (7.9) years. The mortality rate increased with age, and higher rates were observed in males. Survival probabilities differed significantly among age categories, provinces, lung severity, and eye severity based on log-rank tests (p-value<0.05 for all). The GG model results showed that higher age and being male were associated with a shorter time to death. The study also found that the mortality rate was significantly higher in the EA group compared to the NEA group.
CONCLUSION
The present study showed no significant difference in survival time between the EA and NEA groups. The findings suggest that pulmonary lesions caused by mustard gas are more likely to be fatal compared to skin and eye lesions. The results also indicate a potential association between survival time and the severity of lung damage.
PubMed: 38312548
DOI: 10.1016/j.heliyon.2024.e24535 -
International Journal of Molecular... Jan 2024Vesicating chemicals like sulfur mustard (SM) or nitrogen mustard (NM) can cause devastating damage to the eyes, skin, and lungs. Eyes, being the most sensitive, have...
Vesicating chemicals like sulfur mustard (SM) or nitrogen mustard (NM) can cause devastating damage to the eyes, skin, and lungs. Eyes, being the most sensitive, have complicated pathologies that can manifest immediately after exposure (acute) and last for years (chronic). No FDA-approved drug is available to be used as medical counter measures (MCMs) against such injuries. Understanding the pathological mechanisms in acute and chronic response of the eye is essential for developing effective MCMs. Here, we report the clinical and histopathological characterization of a mouse model of NM-induced ocular surface injury (entire surface) developed by treating the eye with 2% (/) NM solution for 5 min. Unlike the existing models of specific injury, our model showed severe ocular inflammation, including the eyelids, structural deformity of the corneal epithelium and stroma, and diminished visual and retinal functions. We also observed alterations of the inflammatory markers and their expression at different phases of the injury, along with an activation of acidic sphingomyelinase (aSMase), causing an increase in bioactive sphingolipid ceramide and a reduction in sphingomyelin levels. This novel ocular surface mouse model recapitulated the injuries reported in human, rabbit, and murine SM or NM injury models. NM exposure of the entire ocular surface in mice, which is similar to accidental or deliberate exposure in humans, showed severe ocular inflammation and caused irreversible alterations to the corneal structure and significant vision loss. It also showed an intricate interplay between inflammatory markers over the injury period and alteration in sphingolipid homeostasis in the early acute phase.
Topics: Humans; Animals; Mice; Rabbits; Mechlorethamine; Eye Injuries; Eyelids; Disease Models, Animal; Mustard Gas; Sphingolipids; Inflammation
PubMed: 38255815
DOI: 10.3390/ijms25020742 -
Microbial Cell Factories Jan 2024Pickled mustard, the largest cultivated vegetable in China, generates substantial waste annually, leading to significant environmental pollution due to challenges in...
BACKGROUND
Pickled mustard, the largest cultivated vegetable in China, generates substantial waste annually, leading to significant environmental pollution due to challenges in timely disposal, leading to decomposition and sewage issues. Consequently, the imperative to address this concern centers on the reduction and comprehensive resource utilization of raw mustard waste (RMW). To achieve complete and quantitative resource utilization of RMW, this study employs novel technology integration for optimizing its higher-value applications.
RESULTS
Initially, subcritical hydrothermal technology was applied for rapid decomposition, with subsequent ammonia nitrogen removal via zeolite. Thereafter, photosynthetic bacteria, Rhodopseudomonas palustris, were employed to maximize hydrogen and methane gas production using various fermentation enhancement agents. Subsequent solid-liquid separation yielded liquid fertilizer from the fermented liquid and soil amendment from solid fermentation remnants. Results indicate that the highest glucose yield (29.6 ± 0.14) was achieved at 165-173℃, with a total sugar content of 50.2 g/L and 64% glucose proportion. Optimal ammonia nitrogen removal occurred with 8 g/L zeolite and strain stable growth at 32℃, with the highest OD reaching 2.7. Several fermentation promoters, including FeSO, Neutral red, NaS, flavin mononucleotide, Nickel titanate, Nickel oxide, and Mixture C, were evaluated for hydrogen production. Notably, Mixture C resulted in the maximum hydrogen production (756 mL), a production rate of 14 mL/h, and a 5-day stable hydrogen production period. Composting experiments enhanced humic acid content and organic matter (OM) by 17% and 15%, respectively.
CONCLUSIONS
This innovative technology not only expedites RMW treatment and hydrogen yield but also substantially enriches soil fertility. Consequently, it offers a novel approach for low-carbon, zero-pollution RMW management. The study's double outcomes extend to large-scale RMW treatment based on the aim of full quantitative resource utilization of RMW. Our method provides a valuable reference for waste management in similar perishable vegetable plantations.
Topics: Soil; Hydrogen; Ammonia; Mustard Plant; Zeolites; Nitrogen; Glucose
PubMed: 38238808
DOI: 10.1186/s12934-023-02293-x