Combining small airway parameters with conventional parameters obtained during spirometry to diagnose airflow obstruction: A cross-sectional study.

BACKGROUND AND OBJECTIVE: The use of small airway parameters generated by spirometry, namely forced expiratory flow between 25% and 75% of forced vital capacity (FVC) (FEF25%-75%) and forced expiratory flow at 50% and 75% of FVC (FEF50% and FEF75%, respectively), is widely discussed. We evaluated the importance of these spirometric parameters in a large Chinese population. METHODS: We conducted a cross-sectional observational study in which spirometry and bronchodilator responsiveness (BDR) data were collected in a healthcare centre from May 2021 to August 2022 and in a tertiary hospital from January 2017 to March 2022. Discordance was assessed between the classification of test results by the large airway parameters of forced expiratory volume in 1 second (FEV1) and FEV1/FVC ratio and by the small airway parameters of FEF25%-75%, FEF75% and FEF50%. The predictive power of Z-scores of spirometric parameters for airflow limitation and BDR was assessed using receiver operating characteristic curves. RESULTS: Our study included 26,658 people. Among people with a normal FVC (n = 14,688), 3.7%, 4.5% and 3.6% of cases exhibited normal FEV1/FVC ratio but impaired FEF25%-75%, FEF75% and FEF50%, respectively, while 6.8%-7.0% of people exhibited normal FEV1 but impaired FEF25%-75%, FEF75% and FEF50%. Using the Z-scores of combining both large and small airway parameters in spirometry showed the best area under the curve for predicting airflow limitation (0.90; 95% CI 0.87-0.94) and predicting BDR (0.72; 95% CI 0.71-0.73). CONCLUSION: It is important to consider both large and small airway parameters in spirometry to avoid missing a diagnosis of airflow obstruction.

Comparative Study on Selected Insulating Materials for Industrial Piping.

This paper describes the results of an experimental assessment of the thermal conductivity of pipe insulation. The need for reducing energy loss in industrial piping systems makes the availability of relevant and reliable insulation materials of special importance. Several specimens of pipe laggings, made of different materials, including mineral wool, polyethylene foam (PEF), expanded polystyrene (EPS), flexible elastomeric foam (FEF) and polyurethane foam (PUR), were tested in accordance with the European standard ISO 8497. The thermal conductivity of the materials was measured for a wide range of temperatures. The results were compared with the values reported in the technical specifications as well as with the literature data. The assessment of measurement uncertainty was also described. The results showed that, in a few cases, thermal conductivity turned out to be greater than that declared by the manufacturer by as much as over 10%.

Role of FEF25-75 in characterizing outpatients with asthma in clinical practice.

BACKGROUND: Asthma is characterized by variable airflow limitation. FEF25-75 has been proposed as a reliable marker for bronchial obstruction, especially when FEV1 and FEV1/FVC are normal. OBJECTIVES: To investigate the role of FEF25-75 in patients with asthma seen in clinical settings. MATERIALS AND METHODS: The cross-sectional study included 439 (181 females and 255 males; mean age 39 years) outpatients with asthma who consecutively visited an allergy clinic for a routine assessment. History, physical examination, asthma control, and spirometry were evaluated. RESULTS: FEF25-75 was impaired (< 65% of predicted) in 136 (31%) outpatients. Considering only subjects with normal FEV1 and FEV1/FVC, FEF25-75 was impaired in 71 (19.6%) subjects. In this subset, impaired FEF25-75 was associated with low FEV1 and FEV1/FVC values (OR 0.91 and 0.85, respectively), and presence of asthma symptoms (OR 2.19). CONCLUSION: FEF25-75 deserves adequate and careful consideration in patients with asthma and normal FEV1 and FEV1/FVC, as the presence of impaired FEF25-75 in this subset suggests a more specific approach.

Enhanced Thermal Stability and Conductivity of FeF3 Using Ni-Coated Carbon Composites: Application as High-Temperature Cathodes in Thermal Batteries.

Cathode active materials and conductive additives for thermal batteries operating at high temperatures have attracted research interest, with a particular focus on compounds offering high thermal stability. Recently, FeF3 has been proposed as a candidate for high-voltage cathode materials; however, its commercialization is hindered by its low conductivity. In this study, conductive additives, such as Ni-coated carbon composites (multi-walled carbon nanotubes (MWCNTs) and carbon black (CB)), were utilized to enhance the thermal stability and conductivity of FeF3. The incorporation of metal-carbon conductive additives in the FeF3 composite increased the thermal stability by more than 10 wt.% and ensured high capacity upon conductivity enhancement. The FeF3@Ni/MWCB 15 wt.% composite containing 30 wt.% Ni exhibited a discharge capacity of ∼86% of the theoretical capacity of 712 mAh/g. The use of Ni-coated carbon-based conductive additives will allow the application of FeF3 as an effective high-temperature cathode material for thermal batteries.

Prefrontal activity sharpens spatial sensitivity of extrastriate neurons.

Prefrontal cortex is known to exert its control over representation of visual signals in extrastriate areas such as V4. Frontal Eye Field (FEF) is suggested to be the proxy for the prefrontal control of visual signals. However, it is not known which aspects of sensory representation within extrastriate areas are under the influence of FEF activity. We employed a causal manipulation to examine how FEF activity contributes to spatial sensitivity of extrastriate neurons. Finding FEF and V4 areas with overlapping response field (RF) in two macaque monkeys, we recorded V4 responses before and after inactivation of the overlapping FEF. We assessed spatial sensitivity of V4 neurons in terms of their response gain, RF spread, coding capacity, and spatial discriminability. Unexpectedly, we found that in the absence of FEF activity, spontaneous and visually-evoked activity of V4 neurons both increase and their RFs enlarge. However, assessing the spatial sensitivity within V4, we found that these changes were associated with a reduction in the ability of V4 neurons to represent spatial information: After FEF inactivation, V4 neurons showed a reduced response gain and a decrease in their spatial discriminability and coding capacity. These results show the necessity of FEF activity for shaping spatial responses of extrastriate neurons and indicates the importance of FEF inputs in sharpening the sensitivity of V4 responses.

Presence of variable extrathoracic airflow limitation in patients with a negative methacholine challenge test.

PURPOSE: Determine whether variable extrathoracic airflow limitation (VEAL) is observed in patients with negative methacholine challenge tests (MCT). METHODS: Electronic medical records of patients undergoing MCT at Jesse Brown VA Medical Center between January 2017 and December 2019 were reviewed. Only patients with negative MCT were selected. Pertinent demographic, clinical, and pulmonary function tests (PFT) and MCT data were abstracted from each record. Spirometric flow-volume loops recorded during each test were inspected by one co-author to determine the first inhaled methacholine concentration at which FEF50/FIF50 was either > 1 or further increased if baseline FEF50/FIF50 after nebulized saline (vehicle) already exceeded 1. Student's t-test was used for statistical analysis. P < 0.05 was considered statistically significant. RESULTS: One hundred and twenty-seven consecutive patients with normal baseline PFT and negative MCT were identified. Thirteen patients (10.2%) had negative MCT and FEF50/FIF50 > 1 after testing. They were predominately obese (BMI, 31.3 ± 6.6), non-smoking (10), White (8) males (9) aged 51.3 ± 14.1 years (mean ± SD) referred for symptoms suggestive of asthma (n = 7) or for chronic cough (n = 6). Five had obstructive sleep apnea, three gastroesophageal reflux disease, and two chronic rhinosinusitis. FEF50/FIF50 increased significantly from 0.72 ± 0.21 after nebulized saline (vehicle) to 1.21 ± 0.13 after inhaled methacholine (p < 0.001). Median inhaled methacholine concentration eliciting these responses was 1.0 mg/mL (range, 0.25-16 mg/mL). CONCLUSIONS: VEAL is observed in a subset of patients with a negative MCT. This phenomenon should be recognized and reported to the referring healthcare providers and its clinical significance addressed as indicated.

FeF3/(Acetylene Black and Multi-Walled Carbon Nanotube) Composite for Cathode Active Material of Thermal Battery through Formation of Conductive Network Channels.

Considerable research is being conducted on the use of FeF3 as a cathode replacement for FeS2 in thermal batteries. However, FeF3 alone is inefficient as a cathode active material because of its low electrical conductivity due to its wide bandgap (5.96 eV). Herein, acetylene black and multi-walled carbon nanotubes (MWCNTs) were combined with FeF3, and the ratio was optimized. When acetylene black and MWCNTs were added separately to FeF3, the electrical conductivity increased, but the mechanical strength decreased. When acetylene black and MWCNTs were both added to FeF3, the FeF3/M1AB4 sample (with 1 wt.% MWCNTs and 4% AB) afforded a discharge capacity of approximately 74% of the theoretical capacity (712 mAh/g) of FeF3. Considering the electrical conductivity and mechanical strength, this composition was confirmed to be the most suitable.

Small airways dysfunction: The importance of utilising Z-scores to define MMEF abnormalities in clinical practice.

Background: The small airways comprise the largest cross-sectional area of the lungs, however, assessing and reporting abnormalities for this region of the bronchial tree has been practically and scientifically uncertain. Methods: Using routinely collected spirometry data for patients with either asthma or COPD, the accuracy of % predicted values for defining small airways dysfunction was assessed. A z-score of ≤ -1.645 of the maximal-mid expiratory flow (MMEF) was used as the gold standard for defining abnormality in the small airways. Results: Records of 3396 patients were included in the analysis. The false positive (FP) rates were 24.6 %, 16.1 %, 11.5 %, or 7.9 % when the % predicted value of 80 %, 70 %, 65 %, or 60 % were used, respectively. Sex, age, and BMI were associated with FP rates. Males were more likely to be categorised as FP with odds ratio (OR) between 1.10 and 1.49 across % predicted groups. Age was associated with FP rates with an OR between 1.01 and 1.08. The BMI was also associated with FP rates with an OR of 1.03 across all % predicted groups. Assessing the association of age groups with FP rate showed that those above 60 years old were more likely to be categorised as FP with an OR between 1.23 and 73.2 compared to those less than 30 years old. Conclusion: When assessing the small airways in clinical practice or for scientific purposes, the % predicted values overestimate the actual impairment leading to FP interpretation. Utilising z-score values are recommended to assess the small airways using the spirometric index, MMEF.

Graphitized Carbon-Coated Iron Fluoride Nanocavities for Enhanced Kinetics of Multielectron Cathode Conversion Reactions.

As for the conversion-type iron fluoride (FeF3) cathode material with multielectron reactions for lithium-ion batteries (LIBs), sluggish reaction kinetics and low electrical conductivity pose certain limitations for the long-lasting reversible conversion processes. Herein, the three-dimensional porous nitrogen-doped carbon matrix in situ anchoring FeF3 nanocavities coated by graphitized carbon (FeF3/GC) are rationally prepared. Through the Kirkendall effect, the low-temperature fluorination of NF3 enables the resultant hollow FeF3 nanoparticles to possess a large number of lithium storage cavities and outer graphitized carbon structure, further effectively buffering the expansion of volume. The FeF3/GC cathode delivers a superior discharge capacity of 504.2 mAh g-1 after 1200 cycles at 1000 mA g-1, with a capacity decay rate of only 0.01% per cycle. Even at a rate of 5000 mA g-1, the composite cathode still delivers a discharge capacity of 309.6 mAh g-1. Impressively, the existence of graphitized carbon and the short Li+ diffusion length ensure fast electron/ion transfer, which significantly enhances the conversion reaction kinetics. This study aims to provide a promising strategy for the efficiency enhancement of multielectron cathode conversion reactions for LIBs.

Long-Term Efficacy and Safety Among Patients With Severe Eosinophilic Asthma Treated With Mepolizumab and Its Effect on Small Airways.

BACKGROUND: The major problem at the Cleveland Allergy and Asthma Center was the need for additional therapy for severe eosinophilic asthma patients who were steroid-dependent or required frequent bursts of prednisone. OBJECTIVES: The objectives of this study were to determine the efficacy of monthly mepolizumab (MP) injections up to 6½ years using Asthma Control Quesitonnaire-7 (ACQ-7), forced expiratory volume in 1 second (FEV1), forced expiratory flow at 25% to 75% (FEF25%-75%) overall and among super-responders, and to understand whether FEF25%-75% is an effective parameter to evaluate MP efficacy. METHODS: We reviewed the charts of 67 patients with severe eosinophilic asthma and compared the results between 47 super-responders and the rest of the cohort regarding ACQ-6, ACQ-7, eosinophils, FEV1, and FEF25%-75%. The groups of super-responders and all other patients were described with respect to initial and current values of the study end points using medians and 25th and 75th percentiles. Changes from the initial to the current values in the study end points were measured using percent changes. The Wilcoxon signed rank test was used within each group to test the null hypothesis of 0 median percent change. RESULTS: After 6½ years, there were no significant changes in FEV1. The FEF25%-75%, had a significant median percent increase of 40% among the super-responders (P < .001), which was substantially higher (P = .026) than the median percent increase of 13.8% observed among all other patients. CONCLUSIONS: The use of MP up to 6½ years was safe and effective, with significant changes to ACQ-7 and FEF25%-75% associated with MP treatment, but not the FEV1. A higher magnitude of changes was observed among super-responders than the rest of the cohort. Changes in FEF25%-75% were more meaningful than changes in FEV1 in evaluating pulmonary function responsiveness of severe eosinophilic asthma to MP.

The Practical Role of FEF25-75 in Young Patients with Allergic Rhinitis.

Allergic rhinitis (AR) is a relevant risk factor asthma as it may frequently precede asthma onset. There is evidence that lung function may be early impaired in AR patients. In this regard, the forced expiratory flow at 25%-75% of vital capacity (FEF25-75) could be a reliable marker of bronchial impairment in AR. Therefore, the present study investigated the practical role of FEF25-75 in young people with AR. The parameters included history, body mass index (BMI), lung function, bronchial hyperresponsiveness (BHR), and fractional exhaled nitric oxide (FeNO). This cross-sectional study included 759 patients (74 females and 685 males, mean age of 29.2 years) suffering from AR. The study demonstrated a significant association between low FEF25-75 values and BMI (OR 0.80), FEV1 (OR 1.29), FEV1/FVC (OR 1.71), and BHR (OR 0.11). Stratifying the patients on the basis of the presence (or absence) of BHR, sensitization to house dust mites (OR 1.81), AR duration (OR 1.08), FEF25-75 (OR 0.94), and FeNO (OR 1.08) were associated with BHR. Stratifying patients based on high FeNO values (>50 ppb), BHR was associated with high FeNO (OR 39). In conclusion, the present study showed that FEF25-75 was associated with low FEV1 and FEV1/FVC and BHR in AR patients. Therefore, spirometry should be considered in the long-term workup of patients with allergic rhinitis as impaired FEF25-75 might suggest an initial progression toward asthma.

The role of small airway function parameters in preschool asthmatic children.

BACKGROUND: Small airways are the major sites of inflammation and airway remodeling in all severities of asthma patients. However, whether small airway function parameters could reflect the airway dysfunction feature in preschool asthmatic children remain unclear. We aim to investigate the role of small airway function parameters in evaluating airway dysfunction, airflow limitation and airway hyperresponsiveness (AHR). METHODS: Eight hundred and fifty-one preschool children diagnosed with asthma were enrolled retrospectively to investigate the characteristics of small airway function parameters. Curve estimation analysis was applied to clarify the correlation between small and large airway dysfunction. Spearman's correlation and receiver-operating characteristic (ROC) curves were employed to evaluate the relationship between small airway dysfunction (SAD) and AHR. RESULTS: The prevalence of SAD was 19.5% (166 of 851) in this cross-sectional cohort study. Small airway function parameters (FEF25-75%, FEF50%, FEF75%) showed strong correlations with FEV1% (r = 0.670, 0.658, 0.609, p<0.001, respectively), FEV1/FVC% (r = 0.812, 0.751, 0.871, p<0.001, respectively) and PEF% (r = 0.626, 0.635, 0.530, p<0.01, respectively). Moreover, small airway function parameters and large airway function parameters (FEV1%, FEV1/FVC%, PEF%) were curve-associated rather than linear-related (p<0.001). FEF25-75%, FEF50%, FEF75% and FEV1% demonstrated a positive correlation with PC20 (r = 0.282, 0.291, 0.251, 0.224, p<0.001, respectively). Interestingly, FEF25-75% and FEF50% exhibited a higher correlation coefficient with PC20 than FEV1% (0.282 vs. 0.224, p = 0.031 and 0.291 vs. 0.224, p = 0.014, respectively). ROC curve analysis for predicting moderate to severe AHR showed that the area under the curve (AUC) was 0.796, 0.783, 0.738, and 0.802 for FEF25-75%, FEF50%, FEF75%, and the combination of FEF25-75% and FEF75%, respectively. When Compared to children with normal lung function, patients with SAD were slightly older, more likely to have a family history of asthma and airflow obstruction with lower FEV1% and FEV1/FVC%, lower PEF% and more severe AHR with lower PC20 ( all p<0.05). CONCLUSION: Small airway dysfunction is highly correlated with large airway function impairment, severe airflow obstruction and AHR in preschool asthmatic children. Small airway function parameters should be utilized in the management of preschool asthma.

Spike rates of frontal eye field neurons predict reaction times in a spatial attention task.

Which neuronal signal(s) predict reaction times when subjects respond to a target at covertly attended locations? Although recent studies showed that spike rates are not predictive, it remains a highly contested question. Therefore, we record single-unit activity from frontal eye field (FEF) neurons while macaques are performing a covert spatial attention task. We find that the attentional modulation of spike rates of FEF neurons is strongly correlated with behavioral reaction times. Moreover, this correlation already emerges 1 s before target dimming, which triggers the behavioral responses. This prediction of reaction times by spike rates is found in neurons showing attention-dependent enhanced and suppressed activity for targets and distractors, respectively, yet in varying degrees across subjects. Thus, spike rates of FEF neurons can predict reaction times persistently and well before the operant behavior during selective attention tasks. Such long prediction windows will be useful for developing spike-based brain-machine interfaces.

Early COPD diagnosis and treatment: A case report.

Chronic obstructive pulmonary disease (COPD) refers to a group of widely diffuse diseases that cause airflow blockage characterized by persistent respiratory symptoms such as dyspnea, chronic cough, recurrent wheezing, chronic sputum production, and progressive restricted airflow associated with exacerbations. COPD is the third leading cause of death worldwide and can only be treated not cured. Pulmonary function tests do not permit the identification of initial obstructive airways disease. Forced expiratory flow (FEF25-75), which calculates obstruction severity at small and medium bronchial airways levels, allows an early COPD diagnosis. We report a 72-year-old ex-smoker male not exposed to occupational risk with symptoms suggesting early COPD. Baseline pulmonary function tests were normal, except FEF25-75. The patient did not respond to the first 6 months of treatment with long-acting muscarinic antagonist (LAMA), whereas he showed a clear clinical and FEF25-75 response to 1-year treatment with LAMA associated with long-acting ß2 agonist (LABA). This clinical case report highlights the usefulness of FEF25-75 evaluation in early COPD diagnosis and monitoring and confirms the efficacy of LAMA-LABA association for small airways obstruction treatment.

Thermodynamically Stable Dual-Modified LiF&FeF3 layer Empowering Ni-Rich Cathodes with Superior Cyclabilities.

Pushing the limit of cutoff potentials allows nickel-rich layered oxides to provide greater energy density and specific capacity whereas reducing thermodynamic and kinetic stability. Herein, a one-step dual-modified method is proposed for in situ synthesizing thermodynamically stable LiF&FeF3 coating on LiNi0.8 Co0.1 Mn0.1 O2 surfaces by capturing lithium impurity on the surface to overcome the challenges suffered. The thermodynamically stabilized LiF&FeF3 coating can effectively suppress the nanoscale structural degradation and the intergranular cracks. Meanwhile, the LiF&FeF3 coating alleviates the outward migration of Oα- (α<2), increases oxygen vacancy formation energies, and accelerates interfacial Li+ diffusion. Benefited from these, the electrochemical performance of LiF&FeF3 modified materials is improved (83.1% capacity retention after 1000 cycles at 1C), even under exertive operational conditions of elevated temperature (91.3% capacity retention after 150 cycles at 1C). This work demonstrates that the dual-modified strategy can simultaneously address the problems of interfacial instability and bulk structural degradation and represents significant progress in developing high-performance lithium-ion batteries (LIBs).

A Novel Sugar-Assisted Solvothermal Method for FeF2 Nanomaterial and Its Application in LIBs.

Due to its quite high theoretical specific-energy density, FeF2 nanomaterial is a good candidate for the cathode material of high-energy lithium-ion batteries. The preparation of FeF2 nanomaterial is very important for its application. At present, the preparation process mostly involves high temperature and an inert atmosphere, which need special or expensive devices. It is very important to seek a low-temperature and mild method, without the need for high temperature and inert atmosphere, for the preparation and following application of FeF2 nanomaterial. This article reports a novel sugar-assisted solvothermal method in which the FeF3∙3H2O precursor is reduced into FeF2 nanomaterial by carbon derived from the dehydration and condensation of sugar. The obtained FeF2 nanomaterials are irregular granules of about 30 nm, with inner pores inside each granule. Electrochemical tests show the FeF2 nanomaterial's potential as a lithium-ion battery cathode material.

The impact of occupational exposure to crystalline silica dust on respiratory function (airway obstruction and FEF25-75) in the French general population.

INTRODUCTION: Although several studies have studied the relationship between occupational exposure to crystalline silica dust and respiratory mortality, few have examined the relationship with impairments in respiratory function and the exposure threshold triggering spirometric monitoring in exposed workers. The objective of the present study was to evaluate the impact of exposure to crystalline silica dust on respiratory function. METHODS: We included 1428 male participants (aged 40 to 65) recruited from the French general population, at random from electoral rolls, in the cross-sectional ELISABET study and for whom data on forced expiratory flow-volume curve indices z-scores (calculated using the Global Lung Function Initiative 2012 equations) and exposure (via a questionnaire) were available. A cumulative exposure index (CEI) for crystalline silica dust (CEIsilica, expressed in mg.m-3.year) was calculated using the Matgéné occupational exposure matrix. RESULTS: 293 of the 1428 participants (20.52%) reported exposure to silica dust. We found that the adjusted z-scores for the forced expiratory volume in the first second/forced vital capacity (FEV1/FVC) ratio decreased significantly as CEIsilica increased. After adjustment, the adjusted z-scores for FEV1/FVC (ß: -0.426 (95% confidence interval (CI): -0.792, -0.060) per 1 mg m-3.year increment) and the mean forced expiratory flow between 25 and 75% of the forced vital capacity (FEF25-75) (ß: -0.552 (95% CI: -0.947, -0.157)) were significantly lower in the participants with CEIsilica ≥1 mg m-3.year than in non-exposed participants. The likelihoods of having airway obstruction (odds ratio (OR): 3.056 (95% CI: 1.107, 7.626)) or having an impaired FEF25-75 (OR: 4.305 (95% CI: 1.393, 11.79)) were also significantly higher in participants with CEIsilica ≥1 mg m-3.year. CONCLUSION: Our results emphasize the importance of spirometry-based monitoring in workers exposed to more than 1 mg m-3.year of crystalline silica dust, in order to identify small airway obstruction or airway obstruction as early as possible.

Pulmonary Function Tests in Childhood Asthma: Which indices are Better for Assessment of Severity?

OBJECTIVE: To study pulmonary function tests in childhood asthma and to determine which indices are better for assessment of severity. METHODS: This was a hospital-based, cross-sectional study. All consecutive children aged between 5 and 15 y with mild and severe persistent asthma were enrolled. Children in whom diagnosis of asthma was doubtful and those with chronic lung disease or suppurative lung disease were excluded. Diagnosis and classification was based on GINA guidelines. Age-/sex-matched controls who did not have history of wheezing any time in the past were selected. Detailed spirometry was performed on all children enrolled using RMS HELIOS 401. RESULTS: A total of 144 children were enrolled in the study (48 children in each group, i.e., control, mild and severe). Mean age of the study population was 9.06 ± 2.604 y with M:F ratio of 1.9:1. Mean percent of predicted values of FEV1, FVC, FEV1/FVC, FEF25-75, and PEFR in the control group was 94.83, 92.63, 103.25, 73.90, and 93.60; in the mild group was 90.58, 83.52, 111.10, 76.50, and 92.00; and in the severe group 57.56, 62.83, 92.85, 40.15, and 62.12, respectively. Values of all the indices decreased with increase in severity. FEV1 (95% CI: 0.884 to 0.971) having the highest correlation coefficient (-0.652) with respect to severity of asthma and FEV1/FVC having the least (-0.202). FEF25-75 (95% CI: 0.652 to 0.803) having a higher area under the curve, was a better spirometric parameter in predicting mild asthma. CONCLUSION: FEV1 was better index for assessing severity of asthma and FEF25-75 better in predicting mild asthma.

Impact of Biologic Therapy on the Small Airways Asthma Phenotype.

The small airways dysfunction (SAD) asthma phenotype is characterised by narrowing of airways < 2 mm in diameter between generations 8 and 23 of the bronchial tree. Recently, this has become particularly relevant as measurements of small airways using airway oscillometry for example, are strong determinants of asthma control and exacerbations in moderate-to-severe asthma. The small airways can be assessed using spirometry as forced expiratory flow rate between 25 and 75% of forced vital capacity (FEF25-75) and has been deemed more accurate in detecting small airways dysfunction than forced expiratory volume in 1 s (FEV1). Oscillometry as the heterogeneity in resistance between 5 and 20 Hz (R5-R20), low frequency reactance at 5 Hz (X5) or area under the reactance curve between 5 Hz and the resonant frequency can also be used to assess the small airways. The small airways can also be assessed using the multiple breath nitrogen washout (MBNW) test giving rise to values including functional residual capacity, lung clearance index and ventilation distribution heterogeneity in the conducting (Scond) and the acinar (Sacin) airways. The ATLANTIS group showed that the prevalence of small airways disease in asthma defined on FEF25-75, oscillometry and MBNW all increased with progressive GINA asthma disease stages. As opposed to topical inhaler therapy that might not adequately penetrate the small airways, it is perhaps more intuitive that systemic anti-inflammatory therapy with biologics targeting downstream cytokines and upstream epithelial anti-alarmins may offer a promising solution to SAD. Here we therefore aim to appraise the available evidence for the effect of anti-IgE, anti-IL5 (Rα), anti-IL4Rα, anti-TSLP and anti-IL33 biologics on small airways disease in patients with severe asthma.

Exploiting the Iron Difluoride Electrochemistry by Constructing Hierarchical Electron Pathways and Cathode Electrolyte Interface.

Conversion-type cathodes such as metal fluorides, especially FeF2 and FeF3 , are potential candidates to replace intercalation cathodes for the next generation of lithium ion batteries. However, the application of iron fluorides is impeded by their poor electronic conductivity, iron/fluorine dissolution, and unstable cathode electrolyte interfaces (CEIs). A facile route to fabricate a mechanical strong electrode with hierarchical electron pathways for FeF2 nanoparticles is reported here. The FeF2 /Li cell demonstrates remarkable cycle performances with a capacity of 300 mAh g-1 after a record long 4500 cycles at 1C. Meanwhile, a record stable high area capacity of over 6 mAh cm-2 is achieved. Furthermore, ultra-high rate capabilities at 20C and 6C for electrodes with low and high mass loading, respectively, are attained. Advanced electron microscopy reveals the formation of stable CEIs. The results demonstrate that the construction of viable electronic connections and favorable CEIs are the key to boost the electrochemical performances of FeF2 cathode.