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Background Although high-frequency percussive ventilation (HFPV) improves gas exchange, concerns remain about tissue overdistension caused by the oscillations and consequent lung damage. We compared a modified percussive ventilation modality created by superimposing high-frequency oscillations to the conventional ventilation waveform during expiration only (eHFPV) with conventional mechanical ventilation (CMV) and standard HFPV. Methods Hypoxia and hypercapnia were induced by decreasing the frequency of CMV in New Zealand White rabbits (n = 10). Following steady-state CMV periods, percussive modalities with oscillations randomly introduced to the entire breathing cycle (HFPV) or to the expiratory phase alone (eHFPV) with varying amplitudes (2 or 4 cmH 2 O) and frequencies were used (5 or 10 Hz). The arterial partial pressures of oxygen (PaO 2 ) and carbon dioxide (PaCO 2 ) were determined. Volumetric capnography was used to evaluate the ventilation dead space fraction, phase 2 slope, and minute elimination of CO 2 . Respiratory mechanics were characterized by forced oscillations. Results The use of eHFPV with 5 Hz superimposed oscillation frequency and an amplitude of 4 cmH 2 O enhanced gas exchange similar to those observed after HFPV. These improvements in PaO 2 (47.3 ± 5.5 vs. 58.6 ± 7.2 mmHg) and PaCO 2 (54.7 ± 2.3 vs. 50.1 ± 2.9 mmHg) were associated with lower ventilation dead space and capnogram phase 2 slope, as well as enhanced minute CO 2 elimination without altering respiratory mechanics. Conclusions These findings demonstrated improved gas exchange using eHFPV as a novel mechanical ventilation modality that combines the benefits of conventional and small-amplitude high-frequency oscillatory ventilation, owing to improved longitudinal gas transport rather than increased lung surface area available for gas exchange.

Background Sarcopenia is defined as an age-related progressive and systemic loss of muscle mass and function. World Health Organization (WHO) definition of health-related quality of life (QoL) states that health is considered “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”, and a decline in QoL is anticipated in individuals with sarcopenia. Beaudart et al. framed the concept of defining QoL in patients suffering from sarcopenia (SarQoL) based on fundamental procedures of QoL questionnaire development, expert recommendations and studies. The aim of the present study is to evaluate the discriminative power, internal consistency and floor and ceiling effects using data available from a sarcopenia study published recently, where the Hungarian version of the SarQoL questionnaire was also administered. Methods In this cross-sectional study, data from SarQoL questionnaire administered to a postmenopausal sarcopenia study cohort (n = 100) was scrutinized for evaluation of psychometric properties of the questionnaire. Our verification of the psychometric properties consisted of discriminative power analysis, assessment of internal consistency, and floor and ceiling effects. The homogeneity of the SarQoL questionnaire, i.e., its internal consistency was measured using Cronbach’s alpha coefficient. Correlation between the overall and domain SarQoL questionnaire scores and appendicular skeletal muscle mass in sarcopenic individuals was assessed. Furthermore, the difference of SarQoL overall and domain scores between sarcopenic and non-sarcopenic patients was also evaluated. Results The median (interquartile range (IQR)) overall SarQoL questionnaire score was 81.5 (67.1–91.5). There was a statistically significant lower overall SarQoL score comparing sarcopenic and non-sarcopenic subjects median (IQR): 75.3 (62.1–86.3) vs. 83.7 (71.4–92.1); p = 0.041). The sarcopenic subjects showed a statistically significant (p = 0.021) correlation between the overall SarQoL score and appendicular skeletal muscle mass (Spearman’s ϱ = 0.412). The overall Cronbach’s alpha of 0.937 indicated a high internal consistency of the Hungarian version of the SarQoL questionnaire. No floor or ceiling effects were noted in the overall SarQoL questionnaire score. Conclusion In our study on community dwelling outpatient postmenopausal Hungarian women, the overall score of the Hungarian version of the SarQoL questionnaire had significant discriminative power to distinguish between sarcopenic and non-sarcopenic patients, had high internal consistency and no floor or ceiling effects.

Background Ageing is an inherent feature of life and as per the United Nations, in the year 2020, 985 million women were ≥ 50 years of age worldwide, and the figure is expected to rise to 1.65 billion by 2050. Preservation of health and well-being in the elderly are challenging, and on the same note generalized changes in the musculoskeletal system contribute to this scenario. Musculoskeletal changes with ageing are referred to as sarcopenia. Reduced muscle mass and physical performance are hallmarks of sarcopenia, exclaimed with difficulty in independent activity and poor quality of life. Knowing that there is a hiatus in our knowledge as regards to the prevalence of sarcopenia in Hungary, the aim of this study was to determine the prevalence of sarcopenia in a community dwelling outpatient postmenopausal Hungarian cohort using the EWGSOP2 consensus recommendation. Methods In this cross-sectional study, women arriving for routine bone densitometry examination at the Regional Osteoporosis Center, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen were invited to participate in the study. A total of a 100 community-dwelling women were recruited who confirmed to the inclusion criteria of self-reported postmenopausal status, ≥ 50 years of age and gave written informed consent. The study procedures included the self-administered SARC-F questionnaire, followed by assessment of muscle strength, muscle quantity and physical preformance. Muscle strength was determined with the hand grip strength (HGS), appendicular skeletal muscle mass was assessed using dual energy X-ray absorptiometry and physical performance was determined by the gait speed (GS) test. Results As per the EWGSOP2 definition, the percentage of study participants with probable sarcopenia (low muscle strength), sarcopenia (low muscle strength and low muscle quantity) and severe sarcopenia (low muscle strength, muscle quantity and low physical performance) was 36, 31 and 8%, respectively. Multiple linear regression analysis revealed that height, weight, HGS and GS were all independent predictors of appendicular skeletal muscle mass. Conclusion The 31% prevalence of sarcopenia in the studied post-menopausal women highlights the need for adequate assessment of the condition in the elderly. Our findings most probably bear public health implications and may accelerate formulation of policies promoting healthy ageing.

Severe COVID-19-related acute respiratory distress syndrome (C-ARDS) requires mechanical ventilation. While this intervention is often performed in the prone position to improve oxygenation, the underlying mechanisms responsible for the improvement in respiratory function during invasive ventilation and awake prone positioning in C-ARDS have not yet been elucidated. In this prospective observational trial, we evaluated the respiratory function of C-ARDS patients while in the supine and prone positions during invasive (n = 13) or non-invasive ventilation (n = 15). The primary endpoint was the positional change in lung regional aeration, assessed with electrical impedance tomography. Secondary endpoints included parameters of ventilation and oxygenation, volumetric capnography, respiratory system mechanics and intrapulmonary shunt fraction. In comparison to the supine position, the prone position significantly increased ventilation distribution in dorsal lung zones for patients under invasive ventilation (53.3 ± 18.3% vs. 43.8 ± 12.3%, percentage of dorsal lung aeration ± standard deviation in prone and supine positions, respectively; p  = 0.014); whereas, regional aeration in both positions did not change during non-invasive ventilation (36.4 ± 11.4% vs. 33.7 ± 10.1%; p  = 0.43). Prone positioning significantly improved the oxygenation both during invasive and non-invasive ventilation. For invasively ventilated patients reduced intrapulmonary shunt fraction, ventilation dead space and respiratory resistance were observed in the prone position. Oxygenation is improved during non-invasive and invasive ventilation with prone positioning in patients with C-ARDS. Different mechanisms may underly this benefit during these two ventilation modalities, driven by improved distribution of lung regional aeration, intrapulmonary shunt fraction and ventilation-perfusion matching. However, the differences in the severity of C-ARDS may have biased the sensitivity of electrical impedance tomography when comparing positional changes between the protocol groups. Trial registration: ClinicalTrials.gov (NCT04359407) and Registered 24 April 2020, https://clinicaltrials.gov/ct2/show/NCT04359407 .

Severe coronavirus disease 2019 (COVID-19) may require veno-venous extracorporeal membrane oxygenation (V-V ECMO). While V-V ECMO is offered in severe lung injury to COVID-19, long-term respiratory follow-up in these patients is missing. Therefore, we aimed at providing comprehensive data on the long-term respiratory effects of COVID-19 requiring V-V ECMO support during the acute phase of infection. In prospective observational cohort study design, patients with severe COVID-19 receiving invasive mechanical ventilation and V-V ECMO (COVID group, = 9) and healthy matched controls ( = 9) were evaluated 6 months after hospital discharge. Respiratory system resistance at 5 and 19 Hz (R , R ), and the area under the reactance curve (AX ) was evaluated using oscillometry characterizing total and central airway resistances, and tissue elasticity, respectively. R and R difference (R -R ) reflecting small airway function was also calculated. Forced expired volume in seconds (FEV ), forced expiratory vital capacity (FVC), functional residual capacity (FRC), carbon monoxide diffusion capacity (DLCO) and transfer coefficient (KCO) were measured. The COVID group had a higher AX and R -R than the healthy matched control group. However, there was no significant difference in terms of R or R . The COVID group had a lower FEV and FVC on spirometry than the healthy matched control group. Further, the COVID group had a lower FRC on plethysmography than the healthy matched control group. Meanwhile, the COVID group had a lower DLCO than healthy matched control group. Nevertheless, its KCO was within the normal range. Severe acute COVID-19 requiring V-V ECMO persistently impairs small airway function and reduces respiratory tissue elasticity, primarily attributed to lung restriction. These findings also suggest that even severe pulmonary pathologies of acute COVID-19 can manifest in a moderate but still persistent lung function impairment 6 months after hospital discharge. NCT05812196.

Background Crystalloids are first line in fluid resuscitation therapy, however there is a lack of evidence-based recommendations on the volume to be administered. Therefore, we aimed at comparing the systemic hemodynamic and respiratory effects of volume replacement therapy with a 1:1 ratio to the historical 1:3 ratio. Methods Anesthetized, ventilated rats randomly included in 3 groups: blood withdrawal and replacement with crystalloid in 1:1 ratio (Group 1, n  = 11), traditional 1:3 ratio (Group 3, n  = 12) and a control group with no interventions (Group C, n  = 9). Arterial blood of 5% of the total blood volume was withdrawn 7 times, and replaced stepwise with different volume rations of Ringer’s acetate, according to group assignments. Airway resistance (Raw), respiratory tissue damping (G) and tissue elastance (H), mean arterial pressure (MAP) and heart rate (HR) were assessed following each step of fluid replacement with a crystalloid (CR1-CR6). Lung edema index was measured from histological samples. Results Raw decreased in Groups 1 and 3 following CR3 ( p  < 0.02) without differences between the groups. H elevated in all groups ( p  < 0.02), with significantly higher changes in Group 3 compared to Groups C and 1 (both p  = 0.03). No differences in MAP or HR were present between Groups 1 and 3. Lung edema was noted in Group 3 ( p  < 0.05). Conclusions Fluid resuscitation therapy by administering a 1:1 blood replacement ratio revealed adequate compensation capacity and physiological homeostasis similar with no lung stiffening and pulmonary edema. Therefore, considering this ratio promotes the restrictive fluid administration in the presence of continuous and occult bleeding.

Inkjet printing of metal nanoparticles allows for design flexibility, rapid processing and enables the 3D printing of functional electronic devices through co-deposition of multiple materials. However, the performance of printed devices, especially their electrical conductivity, is lower than those made by traditional manufacturing methods and is not fully understood. Here, we reveal that anisotropic electrical conductivity of printed metal nanoparticles is caused by organic residuals from their inks. We employ a combination of electrical resistivity tests, morphological analysis and 3D nanoscale chemical analysis of printed devices using silver nanoparticles to show that the polymer stabiliser polyvinylpyrrolidone tends to concentrate between vertically stacked nanoparticle layers as well as at dielectric/conductive interfaces. Understanding the behaviour of organic residues in printed nanoparticles reveals potential new strategies to improve nanomaterial ink formulations for functional printed electronics. Inkjet printed metal nanoparticles are known to have lower electrical conductivity than those produced by traditional approaches. Here, anisotropic electrical conductivity is attributed to organic residuals from the metal nanoparticle ink, reducing conductivity.

Background Skeletal manifestations are predominant in psoriatic arthritis (PsA). The aim of this cross-sectional, case-control study is the complex assessment of areal and volumetric bone mineral density (BMD), fracture risk, vitamin D status and bone turnover markers, and its association with disease-related variables. Methods Lumbar spine (L1-L4) and femoral neck (FN) areal, and distal radius (DR) volumetric BMD, 10-year probability of major and hip osteoporotic fracture as assessed by the fracture risk assessment (FRAX) tool, markers of bone metabolism and disease activity were assessed. Results Upon comparison of the disease and age- and sex-matched control groups, there was a statistically significant difference in FN areal (0.952 (0.607–1.292) g/cm 2 vs. 1.016 (0.760–1.550) g/cm 2 ; p  = 0.001) and DR total volumetric (284.3 (138.9–470.3) mg/cm 3 vs. 367.0 (287.0–412.0) mg/cm 3 ; p  < 0.001) BMD, 10 year probability for major osteoporotic (3.7% (0.7–32%) vs. 2.6% (0–17.5%); p  = 0.003) and hip (0.4% (0–16%) vs. 0.05% (0–6.1%); p  = 0.002) fracture and 25-hydroxyvitamin D status (47.5 (10–120) nmol/L vs. 64 (10–137; p  < 0.001) nmol/L). As compared to areal assessment, volumetric BMD measurements identified a significantly higher number of patients with low bone mineral density (T-Score ≤ − 1.00) (34% vs. 88%, p  < 0.001). Upon multiple linear regression analysis, disease activity score, as determined by DAS28 assessment, was an independent predictor of 10-year probability for major osteoporotic fracture ( B (95%CI) = 1.351 (0.379–2.323); p  = 0.007). Conclusion In the studied PsA cohort, disease activity was an independent predictor of 10-year probability for a major osteoporotic fracture, and complemented assessment of volumetric and areal BMD assured better efficacy at identifying those with low bone mineral density.

Background The aim of the present study is to evaluate serum osteoprotegerin (OPG) and soluble receptor activator of nuclear factor κB ligand (sRANKL) levels in a randomly selected male cohort over 50 years of age and its association with cystatin C, a cysteine proteinase inhibitor that decreases formation of osteoclasts by interfering at a late stage of pre-osteoclast differentiation, apart from being a marker of renal function independent of gender, muscle mass and age; in addition to known predictors such as age, sex hormones, vitamin D, bone mineral density (BMD) and biochemical markers of bone turnover. Methods We determined serum OPG and sRANKL levels and examined its relationship with cystatin C, age, osteocalcin, C-terminal telopeptides of type-I collagen, procollagen type 1 amino-terminal propeptide, 25-hydroxyvitamin D, parathyroid hormone, total 17β-estradiol (E2), total testosterone and L1–L4 (LS) and femur neck (FN) BMD data available from 194 (age, range: 51–81 years) randomly selected ambulatory men belonging to the HunMen cohort. Results OPG correlated significantly with age (Spearman’s rho (r) = 0.359, p  < 0.001), cystatin C ( r  = 0.298, p  < 0.001), E2 ( r  = 0.160, p  = 0.028) and free testosterone index (FTI) ( r  = −0.230, p  = 0.001). Compared to the middle-aged (age: ≤ 59 years, n  = 98), older men (age > 59 years, n  = 96) had significantly higher serum OPG (4.6 pmol/L vs. 5.4 pmol/L; p  < 0.001), and lower sRANKL (0.226 pmol/L vs. 0.167 pmol/L; p  = 0.048) levels. The older men showed a significant correlation between serum OPG levels and cystatin C (Spearman’s rho = 0.322, p  = 0.002), and E2 (Spearman’s rho = 0.211, p  = 0.043). Including cystatin C and E2 in a regression model showed that cystatin C (standard regression coefficient (β) = 0.345; p  = 0.002) was the only significant predictor of serum OPG levels in the older men. Conclusions The results of this study demonstrated that in addition to age (which was the stronger predictor), other modifiable factors such as cystatin C, FTI and E2 were also significant predictors of OPG, and that the association between cystatin C and OPG was more evident with increased age (older age group). As such, cystatin C is a significant predictor of OPG independently of age, FTI and E2.

The aim of this study is to evaluate the relationship of serum sclerostin levels with age, cystatin C, bone mineral density (BMD) and biochemical markers of bone turnover in healthy Hungarian men >50 years of age. We determined serum levels of sclerostin and examined its relationship to age, cystatin C, osteocalcin, C-terminal telopeptides of type-I collagen, procollagen type 1 amino-terminal propeptide, 25-hydroxyvitamin D, parathyroid hormone, and L1–L4 (LS) and femur neck (FN) BMD data available from 194 randomly selected ambulatory men belonging to the HunMen cohort. In the study population as a whole [ n  = 194; age (median, range) 59 (51–81) years], statistically significant correlation was found between sclerostin and age ( r  = 0.211; p  = 0.003), cystatin C ( r  = 0.246; p  = 0.001), FN BMD ( r  = 0.147; p  = 0.041) and LS BMD ( r  = 0.169; p  = 0.019). Compared to middle-aged men (age ≤59 years, n  = 98), elderly men (age >59 years, n  = 96) had significantly higher serum sclerostin levels (67.8 ± 15.9 vs 63.5 ± 14 pmol/L; p  = 0.047). Among men with normal ( T score >−1.0) FN BMD, the elderly had significantly higher serum sclerostin levels compared to the middle-aged men (70.4 ± 17 vs 63.9 ± 11.5 pmol/L; p  = 0.019). Furthermore, among the elderly men cystatin C was the only significant predictor of serum sclerostin levels (standardized regression coefficient ( β ) = 0.487; p  < 0.001). In the studied healthy elderly cohort, this study reports a significant increase in sclerostin levels with increasing age and deteriorating kidney function as determined by plasma cystatin C levels.