Radiotherapy uses high-energy X-rays or other particles to destroy cancer cells and medical practitioners have used this approach extensively for cancer treatment (Hachadorian et al., 2020). However, it is accompanied by risks because it seriously harms normal cells while killing cancer cells. The side effects can lower cancer patients' quality of life and are very unpredictable due to individual differences (Bentzen, 2006). Therefore, it is essential to assess a patient's body damage after radiotherapy to formulate an individualized recovery treatment plan. Exhaled volatile organic compounds (VOCs) can be changed by radiotherapy and thus used for medical diagnosis (Vaks et al., 2012). During treatment, high-energy X-rays can induce apoptosis; meanwhile, cell membranes are damaged due to lipid peroxidation, converting unsaturated fatty acids into volatile metabolites (Losada-Barreiro and Bravo-Díaz, 2017). At the same time, radiotherapy oxidizes water, resulting in reactive oxygen species (ROS) that can increase the epithelial permeability of pulmonary alveoli, enabling the respiratory system to exhale volatile metabolites (Davidovich et al., 2013; Popa et al., 2020). These exhaled VOCs can be used to monitor body damage caused by radiotherapy.
Breath Tests/methods* ; Exhalation ; Humans ; Quality of Life ; Respiratory System/chemistry* ; Volatile Organic Compounds/analysis*

OBJECTIVE: To investigate the impact of a history of atopy on the value of fractional exhaled nitric oxide (FENO) for predicting sputum eosinophils in patients with chronic cough. METHODS: A total of 868 patients with persistent cough lasting more than 3 weeks without pulmonary infection were enrolled, including 119 patients with subacute cough (defined as cough lasting 3-8 weeks) and 749 with chronic cough (longer than 8 weeks). The predictive value of FENO level for sputum eosinophilia was analyzed using receiver-operating characteristic (ROC) curve analysis, and the area under the curve (AUC) was calculated. The atopy status of the patients was determined by screening for history of allergy, hay fever, or animal or food allergies. RESULTS: Of the 868 patients enrolled, 173 patients (19.9%) had eosinophilic airway inflammation (EAI). In the overall patients, the median (Q1, Q3) FENO level was 18 (12, 35) ppb, ranging from 5 to 300 ppb. The patients with chronic cough and a positive history of atopy had a higher median FENO level than those without atopy (24 [13, 50] vs 18 [11, 34]; Z=2.25, P= 0.029), and FENO level was significantly correlated with EAI (r=0.281, P < 0.001). The AUCs of FENO for diagnosis of airway eosinophilia in patients with atopy and those without atopy were 0.677 (95% CI: 0.548-0.806) and 0.708 (95% CI: 0.660-0.756), respectively. The optimal cut-off value of FENO for diagnosing EAI was higher in patients with atopy than in those without atopy (72 vs 28.5 ppb). CONCLUSION A history of atopy reduces the predictive value of FENO level for EAI in patients with chronic cough, suggesting the importance of examining the atopic status when interpreting test results of FENO.
Humans ; Cough/diagnosis* ; Exhalation ; Fractional Exhaled Nitric Oxide Testing ; Nitric Oxide/analysis* ; Eosinophilia ; Chronic Disease ; Inflammation

Asthma, Occupational ; Breath Tests ; Exhalation ; Humans ; Lung ; Nitric Oxide ; ROC Curve

OBJECTIVE: To analyze the characteristics of volatile organic compounds (VOCs) in expiratory air components of patients with acute promyelocytic leukemia (APL), and assess the feasibility of VOCs for the diagnosis and prognostic evaluation of APL. METHODS: The VOCs exhaled from the patients with APL and healthy volunteers should be analyzed with SPME-GC/MS, and compared between newly-diagnosed group, relapse group, remission group, and healthy group with Wilcoxon/Kruskal-Wallis one-way analysis of variance and Dunn-Bonferroni test. RESULTS: Dimethyl sulfide, toluene, and dodecane obtained of newly-diagnosed APL patients were significantly higher, while ethanol, n-hexanal, and benzaldehyde were significantly lower than those of healthy people (P<0.05). Compared with the newly-diagnosed group, dimethylsulfide, toluene, and dodecane of the remission group significantly decreased, while ethanol, n-hexanal, and benzaldehyde significantly increased (P<0.05), which was just opposite from the relapse group. CONCLUSION Dimethyl sulfide, toluene, dodecane, ethanol, n-hexanal, and benzaldehyde can be used as biomarkers for the diagnosis and prognosis assessment of APL patients.
Exhalation ; Gas Chromatography-Mass Spectrometry ; Granulocyte Precursor Cells ; Humans ; Leukemia, Promyelocytic, Acute/diagnosis* ; Volatile Organic Compounds/analysis*

OBJECTIVE: To better understand the significance of the pressure-time curve and flow-time curve from the perspective of PB840 ventilator working principle. METHODS: (1) Mechanical principle: flow supply valves (air valve and oxygen valve) and exhalation valve in PB840 ventilator were controlled to achieve the ventilation target (volume or pressure) by the central processing unit according to the monitoring data from pressure sensors (P₁ at the supply side, P₂ at the exhalation side) and flow sensors (Q₁ at the air side, Q₂ at the oxygen side, Q₃ at the exhalation side). (2) The essence of curve: each point means a value of pressure or flow at a certain time measured by the sensors or calculated by the system. (3) The respiratory process could be divided into inspiratory part, expiratory part, and the connection part from expiratory to inspiratory. The air running state and the respiratory mechanics relationship at the three parts could be inferred according to the form of curves. RESULTS: (1) Inspiratory process: at volume-controlled and constant flow ventilation: there should be a relationship "Pc-Pa = XR" between alveolar pressure (Pa) and circuit pressure (Pc) according to Ohm law. So, the Pc curve (pressure-time curve) could indirectly reflect the Pa curve with the flow (X) and resistance (R) being constant. At pressure-set ventilation: it is the goal of ventilator to maintain the Pc at the target level. So, the stability of the target pressure line in pressure-time curve reflects the matching ability of the flow supply valves and the exhalation valve. (2) Expiratory process: it could be divided into pre-expiratory [without basic flow (Ba) or bias flow (Bi)] and post-expiratory (with Ba or Bi), where Ba or Bi is equal to "Q₁+Q₂". So, the mathematical function are "X(t) = Q_3t" in pre-part, and "X(t) = Q_3t-(Q_1t+Q_2t)" in post-part. The relationship between pressure and flow at peak expiratory flow point: it could be found that there is an obvious time span and area formation under the curve from 0 to peak point (Fpeak) after stretching the abscissa axis of flow-time curve. It means that some gas have been discharged from the lung when it arrives at the peak point. So, the alveolar pressure should be lower than the platform pressure at the point (Pplat). The circuit pressure is significantly higher than positive end expiratory pressure (PEEP) at the point in the stretching axis diagram. So, it means that the formula "R_E = (Pplat-PEEP)/Fpeak" to calculate the expiratory resistance (_E) is unreasonable in the angle of Ohm law. (3) The process from exhalation to inspiratory: according to the difference of the starting point of the conversion, it could be divided into two cases: one is that the inspiratory started from the ending of exhalation. Here, the inhaling starting point is lying in the abscissa axis. The other is that the inspiratory started before the ending of exhalation (with endogenous positive end expiratory pressure). Here, the starting point is lying below the abscissa axis, and the slope of the following curve is obviously larger than the slope of natural expiratory curve. According to the difference of results from the starting point to the end of the inhalation triggering effort, it could be divided into two cases: one is that it reach the trigger point. Here, the expiratory curve extends upward from or below the horizontal axis until an effective air supply is triggered. The other is that it could not reach the trigger point. Here, the expiratory curve extends upward from or below the horizontal axis, but then runs downward (meaning exhaling). CONCLUSIONS It is helpful to analyze the ventilation state, ventilation failure, and the causes of man-machine confrontation with understanding the ventilation principle and the air route map of the ventilator.
Exhalation ; Humans ; Positive-Pressure Respiration ; Respiration, Artificial ; Respiratory Insufficiency ; Respiratory Mechanics ; Ventilators, Mechanical

PURPOSE: Few studies have compared fractional exhaled nitric oxide (FeNO) measurement by NIOX VERO® (NOV) and other devices in children. Moreover, there is no agreement between differences in FeNO values obtained using different devices in adults. Here, we compared FeNO values obtained using NOV and NObreath® (NOB) systems to derive a correction equation for children. METHODS: Eighty-eight participants (age 7–15 years) who were diagnosed with atopic bronchial asthma and visited Sagamihara National Hospital as outpatients between January and April of 2017 were included. We measured FeNO values obtained using NOB and NOV, and analyzed them using Wilcoxon tests and Altman-Bland plots. RESULTS: The median age of the participants was 11.5 years, and the scored Asthma Control Test (ACT) or Childhood ACT (C-ACT) was 25 (interquartile range, 24–25) or 26 (24–27). NOB and NOV values were significantly different (31 [14–52] versus 36 [20–59] ppb; P = 0.020) and strongly correlated (r = 0.92). An equation to convert NOB values into NOV values was derived using linear regression as follows: log NOV = 0.7329 × log NOB + 0.4704; NOB for 20, 40, 58, 80 and 100 ppb corresponded to NOV for 27, 44, 59, 73 and 86 ppb. Thus, NOB < 58 ppb suggested NOB < NOV, whereas NOB > 58 ppb suggested NOB > NOV. CONCLUSIONS: NOB and NOV values were strongly correlated. Participants whose FeNO values were relatively low represented NOB < NOV, whereas those whose FeNO values were relatively high represented NOB > NOV.
Adult ; Asthma ; Child* ; Exhalation ; Humans ; Linear Models ; Nitric Oxide* ; Outpatients

Radon, the primary constituent of natural radiation, is the second leading environmental cause of lung cancer after smoking. To confirm a relationship between indoor radon exposure and lung cancer, estimating cumulative levels of exposure to indoor radon for an individual or population is necessary. This study sought to develop a model for estimate indoor radon concentrations in Korea. Especially, our model and method may have wider application to other residences, not to specific site, and can be used in situations where actual measurements for input variables are lacking. In order to develop a model, indoor radon concentrations were measured at 196 ground floor residences using passive alpha-track detectors between January and April 2016. The arithmetic mean (AM) and geometric mean (GM) means of indoor radon concentrations were 117.86±72.03 and 95.13±2.02 Bq/m³, respectively. Questionnaires were administered to assess the characteristics of each residence, the environment around the measuring equipment, and lifestyles of the residents. Also, national data on indoor radon concentrations at 7643 detached houses for 2011-2014 were reviewed to determine radon concentrations in the soil, and meteorological data on temperature and wind speed were utilized to approximate ventilation rates. The estimated ventilation rates and radon exhalation rates from the soil varied from 0.18 to 0.98/hr (AM, 0.59±0.17/hr) and 326.33 to 1392.77 Bq/m²/hr (AM, 777.45±257.39; GM, 735.67±1.40 Bq/m²/hr), respectively. With these results, the developed model was applied to estimate indoor radon concentrations for 157 residences (80% of all 196 residences), which were randomly sampled. The results were in better agreement for Gyeonggi and Seoul than for other regions of Korea. Overall, the actual and estimated radon concentrations were in better agreement, except for a few low-concentration residences.
Background Radiation ; Exhalation ; Gyeonggi-do ; Korea ; Life Style ; Lung Neoplasms ; Methods ; Models, Theoretical ; Radon ; Seoul ; Smoke ; Smoking ; Soil ; Ventilation ; Wind

Radon, the primary constituent of natural radiation, is the second leading environmental cause of lung cancer after smoking. To confirm a relationship between indoor radon exposure and lung cancer, estimating cumulative levels of exposure to indoor radon for an individual or population is necessary. This study sought to develop a model for estimate indoor radon concentrations in Korea. Especially, our model and method may have wider application to other residences, not to specific site, and can be used in situations where actual measurements for input variables are lacking. In order to develop a model, indoor radon concentrations were measured at 196 ground floor residences using passive alpha-track detectors between January and April 2016. The arithmetic mean (AM) and geometric mean (GM) means of indoor radon concentrations were 117.86±72.03 and 95.13±2.02 Bq/m³, respectively. Questionnaires were administered to assess the characteristics of each residence, the environment around the measuring equipment, and lifestyles of the residents. Also, national data on indoor radon concentrations at 7643 detached houses for 2011-2014 were reviewed to determine radon concentrations in the soil, and meteorological data on temperature and wind speed were utilized to approximate ventilation rates. The estimated ventilation rates and radon exhalation rates from the soil varied from 0.18 to 0.98/hr (AM, 0.59±0.17/hr) and 326.33 to 1392.77 Bq/m²/hr (AM, 777.45±257.39; GM, 735.67±1.40 Bq/m²/hr), respectively. With these results, the developed model was applied to estimate indoor radon concentrations for 157 residences (80% of all 196 residences), which were randomly sampled. The results were in better agreement for Gyeonggi and Seoul than for other regions of Korea. Overall, the actual and estimated radon concentrations were in better agreement, except for a few low-concentration residences.
Background Radiation ; Exhalation ; Gyeonggi-do ; Korea ; Life Style ; Lung Neoplasms ; Methods ; Models, Theoretical ; Radon* ; Seoul ; Smoke ; Smoking ; Soil ; Ventilation ; Wind

OBJECTIVETo evaluate fractional exhaled nitric oxide (FENO) level in patients with subacute cough and its value in predicting the patients' response to inhaled corticosteroids (ICS) treatment.

METHODSA total of 100 patients with persistent cough lasting more than 3 weeks were enrolled, including 52 patients with subacute cough and 48 with chronic cough. FENO, spirometry, and responses to ICS therapy of the patients were evaluated.

RESULTSThe recruited patients had a median (inter-quartile ranges) FENO level of 19 ppb (12-30 ppb). Patients with chronic cough had a significantly higher median FENO level than those with subacute cough (20.5 vs 16 ppb; Z=-2.245, P=0.025). A FENO level ≥25 ppb was recorded in 15 (28.8%) patients with subacute cough, as compared with 20 (41.6%) in patients with chronic cough (χ(2)=1.801, P=0.179). With a FENO ≥25 ppb as the critical value to justify ICS treatment, 15 patients with subacute cough received ICS and 14 (93.3%) of them showed obvious relief of cough after 2 weeks of therapy, a response rate similar to that of 85.0% (17/20) in patients with chronic cough receiving the treatment (χ(2)=0.588, P=0.443). In patients with subacute cough, those with cough variant asthma (CVA) or eosinophilic bronchitis (EB) had a significantly higher median FENO level than those with postinfectious cough [(16 (11-31) ppb vs 11 (8-19) ppb, P<0.01]. In the etiological analysis, CVA or EB was identified in 23 (44.2%) of the patients with subacute cough, as compared 21 (43.8%) in patients with chronic cough (χ(2)=0.002, P=0.961).

CONCLUSIONFENO may be an important indicator for etiological diagnosis of subacute cough and for predicting the response to ICS treatment.

Adrenal Cortex Hormones ; therapeutic use ; Breath Tests ; Chronic Disease ; Cough ; diagnosis ; drug therapy ; Exhalation ; Female ; Humans ; Male ; Nitric Oxide ; analysis

PURPOSE: The purpose of this study was to identify the effects of exhalation breathing exercises using expirometer and that of inhalation breathing exercises using incentive spirometry on pulmonary function and complications in elderly patients with upper-abdominal surgery. METHODS: The research design was a nonequivalent control group non-synchronized design. Participants were 63 patients who underwent upper-abdominal surgery under general anesthesia (32 in experiment group, 31 in control group). They were recruited at P university hospital from August 1 to November 30, 2015. Effects were evaluated by measuring pulmonary functions (Forced Vital Capacity [FVC], Forced Expiratory Volume in 1 second [FEV1]) and pulmonary complications. Data were analyzed using SPSS/WIN 18.0 program. RESULTS: There was no difference in FVC between the experimental group and the control group, but FEV1 in the experimental group increased significantly compared to the control group by time change (p=.001). Also, there were no pulmonary complications in the experimental group but there were 5 cases (16.1%)(p=.018) in the control group. CONCLUSION: Findings indicate that exhalation breathing exercises by elderly patients following upper-abdominal surgery is an effective nursing intervention in enhancing pulmonary function and preventing pulmonary complications.
Aged* ; Anesthesia, General ; Breathing Exercises* ; Exhalation* ; Forced Expiratory Volume ; Humans ; Inhalation* ; Motivation ; Nursing ; Research Design ; Respiration* ; Spirometry ; Vital Capacity