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At least 19 records

Development of Sub-optimal Airway Protocols for the International Space Station (ISS) by the Medical Operation Support Team (MOST)

Airway management techniques are necessary to establish and maintain a patent airway while treating a patient undergoing respiratory distress. There are situations where such settings are suboptimal, thus causing the caregiver to adapt to these suboptimal conditions. Such occurrences are no exception aboard the International Space Station (ISS). As a result, the NASA flight surgeon (FS) and NASA astronaut cohorts must be ready to adapt their optimal airway management techniques for suboptimal situations. Based on previous work conducted by the Medical Operation Support Team (MOST) and other investigators, the MOST had members of both the FS and astronaut cohorts evaluate two oral airway insertion techniques for the Intubating Laryngeal Mask Airway (ILMA) to determine whether either technique is sufficient to perform in suboptimal conditions within a microgravity environment. Methods All experiments were conducted in a simulated microgravity environment provided by parabolic flight aboard DC-9 aircraft. Each participant acted as a caregiver and was directed to attempt both suboptimal ILMA insertion techniques following a preflight instruction session on the day of the flight and a demonstration of the technique by an anesthesiologist physician in the simulated microgravity environment aboard the aircraft. Results Fourteen participants conducted 46 trials of the suboptimal ILMA insertion techniques. Overall, 43 of 46 trials (94%) conducted were properly performed based on criteria developed by the MOST and other investigators. Discussion The study demonstrated the use of airway management techniques in suboptimal conditions relating to space flight. Use of these techniques will provide a crew with options for using the ILMA to manage airway issues aboard the ISS. Although it is understood that the optimal method for patient care during space flight is to have both patient and caregiver restrained, these techniques provide a needed backup should conditions not present themselves in an ideal manner.

Polk, James D.↗

MCL1 inhibition enhances the efficacy of docetaxel against airway-derived squamous cell carcinoma cells

Highlights: • Authentic squamous cell carcinoma (SqCC) cell lines of the lung are sparse. • HARA lung SqCC cells depend highly on MCL1 for survival in vitro and in vivo. • MCL1-silenced HARA cells decline in number upon docetaxel (DTX) exposure. • High MCL1 mRNA expression is linked with shorter survival in lung SqCC patients. • MCL1 depletion + DTX is highly effective against Detroit 562 pharyngeal SqCC cells. MCL1 is an anti-apoptotic BCL2 family member that is often overexpressed in various malignant tumors. However, few reports have described the role of MCL1 in squamous cell carcinoma (SqCC) derived from airways including the lung. In this study, we examined whether MCL1 could be a novel druggable target for airway-derived SqCC, for which effective molecular targeted drugs are unavailable. We searched the Kaplan–Meier Plotter database and found that high MCL1 mRNA expression was significantly associated with shorter survival in patients with lower airway (lung) or upper airway (head and neck) derived SqCC. We also explored the Expression Atlas database and learned that authentic lung SqCC cell lines expressing both TP63 and KRT5 mRNA were extremely sparse among the publicly available “lung SqCC cell lines”, with an exception being HARA cells. HARA cells were highly dependent on MCL1 for survival, and MCL1-depleted cells were not able to grow, and even declined in number, upon docetaxel (DTX) exposure in vitro and in vivo. Similar in vitro experimental findings, including those in a 3D culture model, were also obtained using Detroit 562 pharyngeal SqCC cells. These findings suggested that combined treatment with MCL1 silencing plus DTX appears highly effective against airway-derived SqCC.

60 APPLIED LIFE SCIENCES↗

Analysis of a Dynamic Multi-Track Airway Concept for Air Traffic Management

The Dynamic Multi-track Airways (DMA) Concept for Air Traffic Management (ATM) proposes a network of high-altitude airways constructed of multiple, closely spaced, parallel tracks designed to increase en-route capacity in high-demand airspace corridors. Segregated from non-airway operations, these multi-track airways establish high-priority traffic flow corridors along optimal routes between major terminal areas throughout the National Airspace System (NAS). Air traffic controllers transition aircraft equipped for DMA operations to DMA entry points, the aircraft use autonomous control of airspeed to fly the continuous-airspace airway and achieve an economic benefit, and controllers then transition the aircraft from the DMA exit to the terminal area. Aircraft authority within the DMA includes responsibility for spacing and/or separation from other DMA aircraft. The DMA controller is responsible for coordinating the entry and exit of traffic to and from the DMA and for traffic flow management (TFM), including adjusting DMA routing on a daily basis to account for predicted weather and wind patterns and re-routing DMAs in real time to accommodate unpredicted weather changes. However, the DMA controller is not responsible for monitoring the DMA for traffic separation. This report defines the mature state concept, explores its feasibility and performance, and identifies potential benefits. The report also discusses (a) an analysis of a single DMA, which was modeled within the NAS to assess capacity and determine the impact of a single DMA on regional sector loads and conflict potential; (b) a demand analysis, which was conducted to determine likely city-pair candidates for a nationwide DMA network and to determine the expected demand fraction; (c) two track configurations, which were modeled and analyzed for their operational characteristic; (d) software-prototype airborne capabilities developed for DMA operations research; (e) a feasibility analysis of key attributes in the concept design; (f) a near-term, transitional application of the DMA concept as a proving ground for new airborne technologies; and (g) conclusions. The analysis indicates that the operational feasibility of a national DMA network faces significant challenges, especially for interactions between DMAs and between DMA and non-DMA traffic. Provided these issues are resolved, sectors near DMAs could experience significant local capacity benefits.

Wing, David J.↗

Microcystin-LR aerosol induces inflammatory responses in healthy human primary airway epithelium

Harmful algal blooms plague bodies of freshwater globally. These blooms are often composed of outgrowths of cyanobacteria capable of producing the heptapeptide Microcystin-LR (MC-LR) which is a well-known hepatotoxin. Recently, MC-LR has been detected in aerosols generated from lake water. However, the risk for human health effects due to MC-LR inhalation exposure have not been extensively investigated. In this study, we exposed a fully differentiated 3D human airway epithelium derived from 14 healthy donors to MC-LR-containing aerosol for 3 minutes per day for 3 days. Concentrations of MC-LR ranged from 100 pM to 1 µM. Although there were little to no detrimental alterations in measures of the airway epithelial function (i.e. cell survival, tissue integrity, mucociliary clearance, or cilia beating frequency), a distinct shift in the transcriptional activity was found. Genes related to inflammation were found to be upregulated such as C-C motif chemokine 5 (CCL5; log2FC = 0.56 , p = 0.02) and C-C chemokine receptor type 7 (CCR7; log2FC = 0.83, p = 0.03). Functionally, conditioned media from MC-LR exposed airway epithelium was also found to have significant chemo-attractive properties for primary human neutrophils. Additionally, increases were found in the concentration of secreted chemokine proteins in the conditioned media such as CCL1 (log2FC = 5.07 , p = 0.0001) and CCL5 (log2FC = 1.02, p = 0.046). These results suggest that MC-LR exposure to the human airway epithelium is capable of inducing an inflammatory response that may potentiate acute or chronic disease.

3D human airway epithelium↗

Acute Exposure to Aerosolized Nanoplastics Modulates Redox-Linked Immune Responses in Human Airway Epithelium

Micro- and nanoplastics (MPs and NPs) are pervasive environmental pollutants detected in aquatic ecosystems, with emerging evidence suggesting their presence in airborne particles generated by water body motion. Inhalation exposure to airborne MPs and NPs remains understudied despite documented links between occupational exposure to these particles and adverse respiratory outcomes, including airway inflammation, oxidative stress, and chronic respiratory diseases. This study explored the effects of acute NP exposure on a fully differentiated 3D human airway epithelial model derived from 14 healthy donors. Airway epithelium was exposed to aerosolized 50 nm polystyrene NPs at concentrations ranging from 2.5 to 2500 µg/mL for three minutes per day over three days. Functional assays revealed no significant alterations in tissue integrity, cell survival, mucociliary clearance, or cilia beat frequency, suggesting intact epithelial function post-exposure. However, cytokine and chemokine profiling identified a significant five-fold increase in CCL3 (MIP-1α), a neutrophilic chemoattractant, in NP-exposed samples compared to controls. This was corroborated by increased neutrophil chemotaxis in response to conditioned media from NP-exposed tissues, indicating a pro-inflammatory neutrophilic response. Conversely, levels of interleukins (IL-21, IL-2, IL-15), CXCL10, and TGF-β were significantly reduced, suggesting immunomodulatory effects that may impair adaptive immune responses and tissue repair mechanisms. These findings demonstrate that short-term exposure to NP-containing aerosols induces a distinct pro-inflammatory response in airway epithelium, characterized by enhanced neutrophil recruitment and reduced secretion of key immune modulators. These findings underscore the potential for aerosolized NPs to induce oxidative and inflammatory stress, raising concerns about their long-term impact on respiratory health and redox regulation.

Biochemistry & Molecular Biology↗

Aerosolized Harmful Algal Bloom Toxin Microcystin-LR Induces Type 1/Type 17 Inflammation of Murine Airways

Harmful algal blooms are increasing globally and pose serious health concerns releasing cyanotoxins. Microcystin-LR (MC-LR), one of the most frequently produced cyanotoxins, has recently been detected in aerosols generated by the normal motions of affected bodies of water. MC-LR aerosol exposure has been linked to a pro-inflammatory influence on the airways of mice; however, little is understood about the underlying mechanism or the potential consequences. This study aimed to investigate the pro-inflammatory effects of aerosolized MC-LR on murine airways. C57BL/6 and BALB/c mice were exposed to MC-LR aerosols, as these strains are predisposed to type 1/type 17 and type 2 immune responses, respectively. Exposure to MC-LR induced granulocytic inflammation in C57BL/6 but not BALB/c mice, as observed by increased expression of cytokines MIP-1α, CXCL1, CCL2, and GM-CSF compared with their respective vehicle controls. Furthermore, the upregulation of interleukins IL-17A and IL-12 is consistent with Th1- and Th17-driven type 1/type 17 inflammation. Histological analysis confirmed inflammation in the C57BL/6 lungs, with elevated neutrophils and macrophages in the bronchoalveolar lavage fluid and increased pro-inflammatory and pro-resolving oxidized lipids. In contrast, BALB/c mice showed no significant airway inflammation. These results highlight the ability of aerosolized MC-LR to trigger harmful airway inflammation, requiring further research, particularly into populations with predispositions to type 1/type 17 inflammation.

60 APPLIED LIFE SCIENCES↗

In-silico quantification of intersubject variability on aerosol deposition in the oral airway

The extrathoracic oral airway I s not only a major mechanical barrier for pharmaceutical aerosols to reach the lung but also a major source of variability in lung deposition. Using computational fluid dynamics, deposition of 1-30 µm particles was predicted in 11 CT-based models of the oral airways of adults (7 healthy subjects and 4 patients with chronic obstructive pulmonary disease). Simulations were performed for mouth breathing during both inspiration and expiration at two steady-state flow rates representative of resting/light activity (18 L/min) and of that typically used during aerosol inhalation from a dry powder inhaler (45 L/min). For each subject, oral deposition increased with increasing particle size and flow rate. When averaged over all subjects, there was no significant difference in oral deposition efficiency between inspiration and expiration, unlike subregional deposition that show significantly different patterns between the two breathing phases. Consistent with previous in-vitro inspiratory studies, our data showed a large intersubject variability in oral deposition. These results highlight the need for incorporating morphological variation of the upper airway in predictive models of aerosol deposition for accurate predictions of particle dosimetry in the intrathoracic region of the lung.

Computational fluid dynamics (CFD), Inertial impac↗

Meteorological conditions along airways

This report is an attempt to show the kind of meteorological information that is needed, and is in part available, for the purpose of determining operating conditions along airways. In general, the same factors affect these operating conditions along all airways though in varying degree, depending upon their topographic, geographic, and other characteristics; but in order to bring out as clearly as possible the nature of the data available, a specific example is taken, that of the Chicago-Dallas airway on which regular flying begins this year (1926).

Gregg, W R↗

Distal airways in humans: dynamic hyperpolarized 3He MR imaging--feasibility

Dynamic hyperpolarized helium 3 (3He) magnetic resonance (MR) imaging of the human airways is achieved by using a fast gradient-echo pulse sequence during inhalation. The resulting dynamic images show differential contrast enhancement of both distal airways and the lung periphery, unlike static hyperpolarized 3He MR images on which only the lung periphery is seen. With this technique, up to seventh-generation airway branching can be visualized. Copyright RSNA, 2003.

NASA Discipline Life Sciences Technologies↗

Simulation Based Training Improves Airway Management for Helicopter EMS Teams

The use of paralytic medications in the performance of RSI intubation is a high risk intervention used by many HEMS crews. There is no margin for error in RSI intubation as the results can be fatal. Operating room access for airway management training has become more difficult, and is not representative of the environment in which HEMS crews typically function. LifeEvac of Virginia designed and implemented an SST airway management program to provide a realistic, consistent training platform. The dynamic program incorporates standardized scenarios, and real life challenging cases that this and other programs have encountered. SST is done in a variety of settings including the helicopter, back of ambulances, staged car crashes and simulation centers. The result has been the indoctrination of a well defined, consistent approach to every airway management intervention. The SST program facillitates enhancement of technical skills. as well as team dynamics and communication.

Dhindsa, Harinder S.↗

Naphthalene-DNA Adduct Formation in a Lung Airway Explant Model: The Role of Bioactivation and Naphthalene Metabolites

Humans are widely exposed to naphthalene. Once inhaled or ingested, naphthalene is metabolized by cytochrome P450 and other enzymes to form toxic metabolites known to harm lung epithelial cells. Naphthalene metabolites circulate in the blood. Chronic naphthalene inhalation promotes lesions in the epithelium of the mouse lung and rat nose. Oral naphthalene exposure leads to DNA adduct formation in mouse lung, but the contributions of different enzymatic pathways and the metabolites they generate are not fully understood. This study explores the influence of naphthalene metabolites on DNA adduct formation in the lungs of two species (mice and primates). To isolate the lung response, conducting airway explants containing Club cells, a target for pulmonary naphthalene toxicity, were microdissected from live lung tissue and incubated with 14 C-naphthalene or its metabolites: 14 C-1,2-naphthoquinone or 14 C-naphthalene-1,2-dihydrodiol. Explants were incubated for 1 h, then processed immediately (T1), or were transferred to clean media for the remainder of the 24 h (T24), to monitor 14 C in DNA over time. Accelerator mass spectrometry analysis revealed the formation of DNA adducts by all three radiolabeled compounds by T24. Our results support the notion that P450 enzymes of the Cyp2abfgs subfamily contribute to naphthalene-induced DNA adduct formation (approximately 4-fold reduction in male mice lacking the Cyp2abfgs genes, P < 0.01). The finding that naphthalene-1,2-dihydrodiol, a stable metabolite, formed DNA adducts (102–117 adducts/10 8 nucleotides) at 24 h following addition to the culture media validates the concern that circulating naphthalene metabolites can contribute to DNA adduct formation in the lung. DNA adducts persisted to 24 h after exposure in both mouse and primate airways and at comparable levels between species (77.8 vs 129 adducts/10 8 nucleotides, respectively). Together, these results support the importance of a potential genotoxic mechanism of naphthalene and its metabolites in vivo in both mice and nonhuman primates, and possibly also in humans.

Biological and medical sciences↗

Investigation of inter-subject variation in ultrafine particle deposition across human nasal airways: A study involving children, adults, and the elderly

Occupational and environmental exposure to toxic nanoparticles, driven by the rapid expansion of nanotechnology, raises significant respiratory health concern. Numerous studies have explored airflow and particle dynamics in adult nasal airways, but understanding the impact of age-related anatomical changes in children and the elderly remains limited. This study systematically investigates age-related anatomical variations and associated influence on nasal airflow dynamics and ultrafine particle deposition characteristics. Using Computational Fluid-Particle Dynamics (CFPD) method, simulation was conducted under diverse inhalation conditions spanning a wide age range, including: two children (5 years old), two young adults (in their twenties), and two elderly (over 77 years old). Our results reveal distinctive variations across age groups in anatomical dimensions, which affect distribution of wall shear stress where the elderly and children display unique patterns distinct from the young adults. While total deposition efficiency differs significantly between children and adults, filtration efficiency in the subregion with most deposition, main respiratory, remains consistent. However, inter-subject differences are observed in the vestibular and olfactory regions,emphasizing nuanced impact of age-related anatomical variations. Overall and subregional empirical equations for deposition efficiency were developed by incorporating the combined diffusion parameter, Sc a Δ b , corroborating the use of geometrical characteristic parameters for each specific subject in predicting nasal deposition efficiency across age groups. Our findings contribute to predictive nanoparticle exposure analysis in nasal airways across different age groups, thereby enhancing respiratory healthcare for individuals across the life span.

60 APPLIED LIFE SCIENCES↗

A reevaluation of the interrupter technique for airway resistance measurement

An attempt was made to obtain a better insight into the actual transient response of airway opening pressure (Pao) following rapid occlusion. With this knowledge it was hoped to be able to clarify the reason for the overestimations found by other investigators, and possibly to obtain a more accurate method of estimating alveolar pressure just prior to interruption. This would result in an improved method for estimating airway resistance. Use of an extrapolation method was found to provide an improved correlation between resistances determined by the interruptor technique and those found by the plethysmograph in normal subjects.

Jackson, A. C.↗

The Role of Capital Productivity in British Airways' Financial Recovery

British Airways (BA) was privatised in 1987, but its financial recovery occurred a number of years earlier. This recovery was sustained throughout the early 1990s economic recession, a period when few major airlines were operating profitably. This paper examines the role of productivity developments at British Airways from the early 1980s through 1996. The emphasis is on capital productivity and investment, but changes in capital intensity and labour productivity are also evaluated. Various measures are considered for both capital and labour productivity: outputs are measured in available tonne-kms (ATKS) and revenue tonne-kms (RTKs), with the former preferred over the latter two measures, after adjustment for work performed by BA for others. Capital inputs are measured in equivalent lease costs adjusted to constant prices with a different treatment of flight and ground equipment or assets. Labour inputs are derived from total payroll costs deflated by a UK wage price index. The airline made considerable capital investments over the period and at the same time went through two major processes of labour restructuring. This resulted in a gradual increase in capital intensity, relative high labour productivity growth, but poor capital productivity performance. However, capital investment played an important role in the airline's sustained labour and total factor productivity over the whole period.

Morrell, Peter↗

The Role of Capital Productivity in British Airways' Financial Recovery

British Airways (BA) was privatized in 1987, but its financial recovery occurred a number of years earlier, This recovery was sustained throughout the early 1990s economic recession, a period when few major airlines were operating profitably. This paper examines the role of productivity developments at British Airways from the early 1980s through 1996. The emphasis is on capital productivity and investment, but changes in capital intensity and labour productivity are also evaluated. Various measures are considered for both capital and labour productivity: outputs are measured in available tonne-kms (ATKs) and revenue tonne-kms (RTKs), with the former preferred over the latter two measures, after adjustment for work performed by BA for others. Capital inputs are measured in equivalent lease costs adjusted to constant prices with a different treatment of flight and ground equipment or assets. Labour inputs are derived from total payroll costs deflated by a UK wage price index. The airline made considerable capital investments over the period and at the same time went through two major processes of labour restructuring. This resulted in a gradual increase in capital intensity, relative high labour productivity growth, but poor capital productivity performance, However, capital investment played an important role in the airline's sustained labour and total factor productivity over the whole period.

Morrell, Peter↗

Galectin-1 secreted by bone marrow-derived mesenchymal stem cells mediates anti-inflammatory responses in acute airway disease

The hallmarks of allergic airway disease (AAD) include infiltration of inflammatory cells into the bronchoalveolar space. Bone marrow derived mesenchymal stem cells (BMSCs) show anti-inflammatory properties in AAD. In addition, galectin-1 (Gal-1) is a lectin significantly upregulated upon inflammation and is also known to mediate potential anti-inflammatory responses. We hypothesized that BMSCs regulated inflammatory responses by secretion of Gal-1 during AAD pathogenesis. BMSCs were isolated from murine femurs and tibiae and adoptively transferred into an ovalbumin-induced AAD mouse model. Knockdown of Gal-1 in BMSCs was performed using shRNA. Flow cytometry, ELISAs, and immunohistology were performed to analyze inflammatory responses in mice, and a Transwell system was used to establish an in vitro co-culture system of lung epithelial cells (MLE-12) and BMSCs. Administration of BMSCs significantly upregulated Gal-1 expression upon inflammation and decreased infiltration of inflammatory cells and secretion of proinflammatory cytokines in vivo. In addition, we showed that this function was mediated by reduced activation of the MAPK p38 signaling pathway. Similar observations were found using an in vitro lipopolysaccharide-induced model when MLE-12 cells were co-cultured with BMSCs. Gal-1 secretion by BMSCs alleviated inflammatory responses observed in AAD and hence provides a promising therapeutic alternative to AAD patients insensitive to conventional drug treatments.

60 APPLIED LIFE SCIENCES↗

Human Primary Airway Epithelium +/- Macrophages Response to HCoV-229E Infection Transcriptomics (ACS-DP3)

The purpose of this experiment was to evaluate the human host cellular response to wild-type Human coronavirus strain 229E (HCoV-299E) infection. Sample data was obtained for mock and infected (MOI 3) primary human airway epithelial cells with and without macrophages and grown in air-liquid interface conditions. Sample data was acquired using an Illumina Hi-Seq 4000 sequencer system and further processed for RNA sequencing (RNA-Seq) expression analysis.

59 BASIC BIOLOGICAL SCIENCES↗