Optimal reactive nitrogen control pathways identified for cost-effective PM2.5 mitigation in Europe.

Excess reactive nitrogen (Nr), including nitrogen oxides (NOx) and ammonia (NH3), contributes strongly to fine particulate matter (PM2.5) air pollution in Europe, posing challenges to public health. Designing cost-effective Nr control roadmaps for PM2.5 mitigation requires considering both mitigation efficiencies and implementation costs. Here we identify optimal Nr control pathways for Europe by integrating emission estimations, air quality modeling, exposure-mortality modeling, Nr control experiments and cost data. We find that phasing out Nr emissions would reduce PM2.5 by 2.3 ± 1.2 µg·m-3 in Europe, helping many locations achieve the World Health Organization (WHO) guidelines and reducing PM2.5-related premature deaths by almost 100 thousand in 2015. Low-ambition NH3 controls have similar PM2.5 mitigation efficiencies as NOx in Eastern Europe, but are less effective in Western Europe until reductions exceed 40%. The efficiency for NH3 controls increases at high-ambition reductions while NOx slightly decreases. When costs are considered, strategies for both regions uniformly shift in favor of NH3 controls, as NH3 controls up to 50% remain 5-11 times more cost-effective than NOx per unit PM2.5 reduction, emphasizing the priority of NH3 control policies for Europe.

An analysis of 30 years of surface ozone concentrations in Austria: temporal evolution, changes in precursor emissions and chemical regimes, temperature dependence, and lessons for the future.

Despite substantial reductions in anthropogenic emissions of nitrogen oxides (NO x ) and non-methane volatile organic compounds (NMVOCs) in Austria over the 30 year time period 1990-2019, summertime surface ozone (O3) concentrations still exceed frequently and over wide areas the ozone maximum 8 hour mean target value for the protection of human health. We present a detailed analysis of in situ observations of O3 and NO x to (1) disentangle the main processes propelling O3 formation such as precursor emissions and meteorology and (2) quantify the impact of NO x reductions and (3) estimate the effect of climate warming. The temperature sensitivity of surface O3 production is assessed separately for NO x and VOC limited regimes. The temperature sensitivity of ozone increases with temperature in spring and summer. On average, the evaluated absolute values of the sensitivities are a factor of 2.5 larger in summer than in spring. The analysis of ambient O3 burdens during hot summers indicates that rising temperatures in a warming climate might largely offset the benefit of future emission reductions. MAX-DOAS formaldehyde (HCHO) measurements in Vienna from 2017 to 2019 are used as a proxy for VOC emissions. The seasonal and the temperature dependence of the observed HCHO mixing ratios indicate that biogenic VOCs (BVOCs) are the dominant source of hydrocarbons in the urban setting during the ozone season. The result agrees well with VOC emission estimates that show BVOCs to be the dominant VOC source in Austria since the early 2000s. Accordingly, anthropogenic NO x emission reductions remain, outside of urban cores, the most effective instrument for policymakers to lower surface ozone concentrations in the short term.

Air Pollution Is Associated with COVID-19 Incidence and Mortality in Vienna, Austria.

We determined the impact of air pollution on COVID-19-related mortality and reported-case incidence, analyzing the correlation of infection case numbers and outcomes with previous-year air pollution data from the populations of 23 Viennese districts. Time at risk started in a district when the first COVID-19 case was diagnosed. High exposure levels were defined as living in a district with an average (year 2019) concentration of nitrogen dioxide (NO2) and/or particulate matter (PM10) higher than the upper quartile (30 and 20 µg/m3, respectively) of all districts. The total population of the individual districts was followed until diagnosis of or death from COVID-19, or until 21 April 2020, whichever came first. Cox proportional hazard regression was performed after controlling for percentage of population aged 65 and more, percentage of foreigners and of persons with a university degree, unemployment rate, and population density. PM10 and NO2 were significantly and positively associated with the risk of a COVID-19 diagnosis (hazard ratio (HR) = 1.44 and 1.16, respectively). NO2 was also significantly associated with death from COVID-19 (HR = 1.72). Even within a single city, higher levels of air pollution are associated with an adverse impact on COVID-19 risk.

Efficacy and safety of trimodulin, a novel polyclonal antibody preparation, in patients with severe community-acquired pneumonia: a randomized, placebo-controlled, double-blind, multicenter, phase II trial (CIGMA study).

PURPOSE: The CIGMA study investigated a novel human polyclonal antibody preparation (trimodulin) containing ~ 23% immunoglobulin (Ig) M, ~ 21% IgA, and ~ 56% IgG as add-on therapy for patients with severe community-acquired pneumonia (sCAP). METHODS: In this double-blind, phase II study (NCT01420744), 160 patients with sCAP requiring invasive mechanical ventilation were randomized (1:1) to trimodulin (42 mg IgM/kg/day) or placebo for five consecutive days. Primary endpoint was ventilator-free days (VFDs). Secondary endpoints included 28-day all-cause and pneumonia-related mortality. Safety and tolerability were monitored. Exploratory post hoc analyses were performed in subsets stratified by baseline C-reactive protein (CRP; ≥ 70 mg/L) and/or IgM (≤ 0.8 g/L). RESULTS: Overall, there was no statistically significant difference in VFDs between trimodulin (mean 11.0, median 11 [n = 81]) and placebo (mean 9.6; median 8 [n = 79]; p = 0.173). Twenty-eight-day all-cause mortality was 22.2% vs. 27.8%, respectively (p = 0.465). Time to discharge from intensive care unit and mean duration of hospitalization were comparable between groups. Adverse-event incidences were comparable. Post hoc subset analyses, which included the majority of patients (58-78%), showed significant reductions in all-cause mortality (trimodulin vs. placebo) in patients with high CRP, low IgM, and high CRP/low IgM at baseline. CONCLUSIONS: No significant differences were found in VFDs and mortality between trimodulin and placebo groups. Post hoc analyses supported improved outcome regarding mortality with trimodulin in subsets of patients with elevated CRP, reduced IgM, or both. These findings warrant further investigation. TRIAL REGISTRATION: NCT01420744.

Surgical smoke management for minimally invasive (micro)endoscopy: an experimental study.

BACKGROUND: The aim of this study was to investigate the use of surgical smoke-producing procedures such as laser ablation or electrosurgery in minimally invasive microendoscopic procedures. This study proposes a technical solution to efficiently remove surgical smoke from very small endoscopic cavities using microports as small as 20 G (0.9 mm) in diameter. METHODS: The experimental laboratory study used small, rigid, transparent plastic cavity models connected with tubes and pressure sensors to establish an endoscopic in vitro laboratory model. A Kalium-Titanyl-Phosphate (KTP) laser with a 0.5-mm fiber optic probe was used to produce smoke from bovine scleral tissue in the cavity. Endoscopic gas insufflation into the model was generated by pressurized air and a microvalve. A laboratory vacuum pump provided smoke and gas suction via a microvalve. A self-built control and steering system was utilized to control intracavital pressure during experimental insufflation and suction. RESULTS: Problems related to smoke-generating processes, such as laser vaporization or electrocautery, in small closed cavities were first analyzed. A theoretical and mechatronic laboratory model was established and tested. Intracavital pressure and gas flow were measured first without and then with smoke generation. A new construction design for the suction tube was proposed due to rapid obstruction by smoke particles. CONCLUSIONS: Surgical smoke evacuation from endoscopic cavities that are as small as 2 cm in diameter via minimally invasive ports as small as 20 G (0.9 mm) in diameter may be safe and efficient if sufficient gas exchange is provided during smoke generation by laser or electrosurgical instruments. However, maintaining a low and constant pressure in the cavity during gas exchange and adopting a special construction design for the suction tube are essential to provide an excellent view during the surgical maneuver and to minimize potential toxic side effects of the smoke.

Analysis of inflammation- and atherosclerosis-related gene polymorphisms in branch retinal vein occlusion.

PURPOSE: Branch retinal vein occlusion (BRVO) is a common vision-threatening disease. Compression of the underlying retinal vein due to increased rigidity of the crossing artery has been implicated in the pathogenesis of BRVO. Among others, arterial hypertension and hypercholesterolemia, both of which contribute to atherogenesis, have been identified as risk factors. Atherosclerosis itself is a chronic low-grade inflammatory disease with a distinct pro-inflammatory cytokine pattern. In addition to their role in atherogenesis, some cytokines have been shown to exert procoagulatory effects, and may thus contribute to the development of BRVO by a second mechanism. Gene polymorphisms affecting the expression of inflammation-related cytokines are therefore candidates as potential risk factors for BRVO. The purpose of the present study was to investigate hypothesized associations between cytokine gene polymorphisms and the presence of BRVO. METHODS: The study comprised 398 patients with BRVO and 355 control subjects. Using 5'exonuclease assays (TaqMan), genotypes of the following functional single nucleotide polymorphisms were determined: interleukin 1 beta (IL1B) -511C>T, interleukin 1 receptor antagonist (IL1RN) 1018T>C, interleukin 4 (IL4) -584C>T, interleukin 6 (IL6) -174G>C, interleukin 8 (IL8) -251A>T, interleukin 10 (IL10) -592C>A, interleukin 18 (IL18) 183A>G, tumor necrosis factor (TNF) -308G>A, monocyte chemoattractant protein 1 (CCL2) -2518A>G, and RANTES (CCL5) -403G>A. RESULTS: Neither genotype distributions nor allele frequencies of any of the investigated polymorphisms differed significantly between BRVO patients and controls (p>0.05). Arterial hypertension was found to be significantly more prevalent in BRVO patients than in controls (p<0.001). In a logistic regression analysis presence of arterial hypertension was associated with an odds ratio of 3.33 (95% confidence interval: 2.42-4.57) for BRVO. CONCLUSIONS: As none of the investigated gene variants was significantly more prevalent in BRVO patients than among control subjects, our data suggest that these polymorphisms themselves are unlikely major risk factors for BRVO.