A trait-based investigation into evergreen woody plants for traffic-related air pollution mitigation over time.

This study investigated influences of leaf traits on particulate matter (PM) wash-off and (re)capture (i.e., net removal) over time. Leaf samples were taken before and after three rainfall events from a range of 10 evergreen woody plants (including five different leaf types), which were positioned with an optical particle counter alongside a busy road. Scanning electron microscopy was used to quantify the density (no./mm2), mass (µg/cm2), and elemental composition of deposited particles. To enable leaf area comparison between scale-like leaves and other leaf types, a novel metric (FSA: foliage surface area per unit branch length) was developed, which may be utilised by future research. Vehicle-related particles constituted 15 % of total deposition, and there was a notable 50 % decrease in the proportion of tyre wear particles after rainfall. T. baccata presented the lowest proportion (11.1 %) of vehicle-related particle deposition but the most consistent performance in terms of net PM removal. Only four of the 10 plant specimens (C. japonica, C. lawsoniana, J. chinensis, and T. baccata) presented effective PM wash-off across all particle size fractions and rainfall intensities, with a generally positive relationship observed between rainfall intensity and wash-off. Mass deposition was more significantly determined by particle size than number density. Interestingly, larger particles were also less easily washed off than smaller particles. Some traits typically considered to be advantageous (e.g., greater hairiness) may in fact hinder net removal over time due to retention under rainfall. Small leaf area is one trait that may promote both accumulation and wash-off. However, FSA was found to be the most influential trait, with an inverse relationship between FSA and wash-off efficacy. This finding poses trade-offs and opportunities for green infrastructure design, which are discussed. Finally, numerous areas for future research are recommended, underlining the importance of systems approaches in developing vegetation management frameworks.

The impact of dynamic traffic and wind conditions on green infrastructure performance to improve local air quality.

Road traffic represents the dominant source of air pollution in urban street canyons. Local wind conditions greatly impacts the dispersion of these pollutants, yet street trees complicate ventilation in such settings. This case study adopts a novel modelling framework to account for dynamic traffic and wind conditions to identify the optimal street tree configuration that prevents a deterioration in air quality. Measurement data from a shallow to moderately deep street canyon (average 0.5 H/W aspect ratio and four lanes of 1-way traffic) in Dublin, Ireland was used for model calibration. The computational fluid dynamics (CFD) models were used to examine scenarios of dynamic traffic flows within each traffic lane with respect to its impact on local PM2.5 concentrations on adjacent footpaths, segmenting air quality monitoring results based on different wind conditions for model calibration. The monitoring campaign identified higher PM2.5 concentrations on the leeward (north) footpath, with average differences of 14.1 % (2.15 µg/m3) for early evening peaks. The modelling results demonstrated how street trees negatively impacted air quality on the windward footpath in parallel wind conditions regardless of leaf area density (LAD) or tree spacing, with mixed results observed on the leeward footpath in varying traffic flows and wind speeds. Perpendicular wind direction models and high wind speed exacerbated poor air quality on the windward footpath for all tree spacing models, while improving the air quality on the leeward footpath. The findings advise against planting high-LAD trees in this type of street, with a minimum of 20 m spacing for low-LAD trees to balance reducing local air pollution and ventilation capacity in the street. This study highlights the complexities of those in key decision-marking roles and demonstrates the need to adopt a transparent framework to ensure adequate modelling evidence can inform tree planting in city streets.

A Unique Presentation of Familial Idiopathic Colonic Varices.

Colonic varices typically occur in the setting of portal hypertension, and patients may present with rectal bleeding or occult anemia. Idiopathic colonic varices occur infrequently in the absence of cirrhosis and can involve the entire colon. We present a case of a 54-year-old Eastern European woman who had undergone diagnostic colonoscopy for newly diagnosed sigmoid adenocarcinoma and was incidentally found to have colonic varices with normal portal pressure gradients. Her 38-year-old daughter was found to have similar varices, raising concerns for hereditary etiology.

The unusual (syn-/anti-)2 conformation of a di-meth-oxy-pyrimidyl-based tennimide.

The tennimide macrocycle, (I) (C52H40N16O16.0.167H2O), was synthesized from 2-amino-4,6-di-meth-oxy-pyrimidine and pyridine-2,6-dicarbonyl dichloride. Compound (I) represents the first tennimide incorporating pyridine rings in the macrocycle scaffold. In the macrocycle ring, the carbonyl groups at each successive dicarbon-yl(pyridine) moiety adopt the (syn/anti)2 conformation. This contrasts with all previously reported tetra-imide macrocycles, which exhibit the (syn)4 conformation. The effect is to close any potential cavity or niche by having two of the central pyridine C5N rings aligned close to each other [with closest pyridine Cg⋯Cg ring centroid separations of 3.5775 (19) Å; closest C⋯C = 3.467 (5) Å]. A partial occupancy water mol-ecule (with s.o.f. = 0.167), resides with its oxygen atom on a twofold axis at hydrogen-bonding distances to the carbonyl O atom, in a mol-ecular niche between two pyridine rings. Macrocyles of (I) have all six C=O groups and all eight meth-oxy O atoms present on the macrocycle surface. However, all twelve N atoms are effectively shielded on steric grounds from any potential inter-molecular inter-actions. The remaining two C=O O atoms inter-act with the partial occupancy water mol-ecule via two O-H⋯O=C hydrogen bonds. Macrocycles of (I) stack as one-dimensional chains along the b-axis direction with primary inter-molecular inter-actions involving weak C-H⋯O=C/OCH3/H2O contacts. Chains inter-lock weakly via meth-oxy-meth-oxy C-H⋯O inter-actions into two-dimensional sheets.

Corrigendum: Impact of adjuvant: trivalent vaccine with quadrivalent-like protection against heterologous Yamagata-lineage influenza B virus.

[This corrects the article DOI: 10.3389/fimmu.2022.1002286.].

Overcoming a stubborn patent foramen ovale.

Transesophageal echocardiography (TEE) with agitated saline contrast ("bubble study") is the gold standard for detection of patent foramen ovale (PFO). Standard provocative maneuvers help facilitate right-to-left shunting necessary for diagnosing PFO but may be difficult to implement during TEE. Hypovolemia related to preprocedural fasting may challenge detection of PFO in TEE, and additional optimization measures such as fluid replenishment with passive leg raise (PLR) can enhance PFO detection. We present a 57-year-old male with history of cryptogenic stroke and stubborn PFO which during TEE bubble study responded only to ample fluid replenishment with PLR following a period of prolonged preprocedural fasting.

Environmental health impacts and inequalities in green space and air pollution in six medium-sized European cities.

BACKGROUND: The GoGreenRoutes project aims to introduce co-created nature-based solutions (NBS) to enhance environmental quality in six medium-sized cities (Burgas, Lahti, Limerick, Tallinn, Umeå, and Versailles). We estimated the mortality and economic impacts attributed to suboptimal exposure to green space and air pollution, economic impacts, and the distribution thereof the adult population by socioeconomic status. METHODS: We retrieved data from publicly accessible databases on green space (NDVI and % Green Area), air pollution (NO2 and PM2.5) and population (≥20 years, n = 804,975) at a 250m × 250m grid-cell level, and mortality for each city for 2015. We compared baseline exposures at the grid-cell to World Health Organization's recommendations and guidelines. We applied a comparative risk assessment to estimate the mortality burden attributable to not achieving the recommendations and guidelines. We estimated attributable mortality distributions and the association with income levels. RESULTS: We found high variability in air pollution and green spaces levels. Around 60% of the population lacked green space and 90% were exposed to harmful air pollution. Overall, we estimated age-standardized mortality rates varying from 10 (Umeå) to 92 (Burgas) deaths per 100,000 persons attributable to low NDVI levels; 3 (Lahti) to 38 (Burgas) per 100,000 persons to lack of % Green Area; 1 (Umeå) to 88 (Tallinn) per 100,000 persons to exceedances of NO2 guidelines; and 1 (Umeå) to 206 (Burgas) per 100,000 persons to exceedances of PM2.5 guidelines. Lower income associated with higher or lower mortality impacts depending on whether deprived populations lived in the densely constructed, highly-trafficked city centre or greener, less polluted outskirts. CONCLUSIONS: We attributed a considerable mortality burden to lack of green spaces and higher air pollution, which was unevenly distributed across different social groups. NBS and health-promoting initiatives should consider socioeconomic aspects to regenerate urban areas while providing equally good environments.

Designed nanoparticles elicit cross-reactive antibody responses to conserved influenza virus hemagglutinin stem epitopes.

Despite the availability of seasonal vaccines and antiviral medications, influenza virus continues to be a major health concern and pandemic threat due to the continually changing antigenic regions of the major surface glycoprotein, hemagglutinin (HA). One emerging strategy for the development of more efficacious seasonal and universal influenza vaccines is structure-guided design of nanoparticles that display conserved regions of HA, such as the stem. Using the H1 HA subtype to establish proof of concept, we found that tandem copies of an alpha-helical fragment from the conserved stem region (helix-A) can be displayed on the protruding spikes structures of a capsid scaffold. The stem region of HA on these designed chimeric nanoparticles is immunogenic and the nanoparticles are biochemically robust in that heat exposure did not destroy the particles and immunogenicity was retained. Furthermore, mice vaccinated with H1-nanoparticles were protected from lethal challenge with H1N1 influenza virus. By using a nanoparticle library approach with this helix-A nanoparticle design, we show that this vaccine nanoparticle construct design could be applicable to different influenza HA subtypes. Importantly, antibodies elicited by H1, H5, and H7 nanoparticles demonstrated homosubtypic and heterosubtypic cross-reactivity binding to different HA subtypes. Also, helix-A nanoparticle immunizations were used to isolate mouse monoclonal antibodies that demonstrated heterosubtypic cross-reactivity and provided protection to mice from viral challenge via passive-transfer. This tandem helix-A nanoparticle construct represents a novel design to display several hundred copies of non-trimeric conserved HA stem epitopes on vaccine nanoparticles. This design concept provides a new approach to universal influenza vaccine development strategies and opens opportunities for the development of nanoparticles with broad coverage over many antigenically diverse influenza HA subtypes.

A Critical Role for ERO1α in Arterial Thrombosis and Ischemic Stroke.

BACKGROUND: Platelet adhesion and aggregation play a crucial role in arterial thrombosis and ischemic stroke. Here, we identify platelet ERO1α (endoplasmic reticulum oxidoreductase 1α) as a novel regulator of Ca2+ signaling and a potential pharmacological target for treating thrombotic diseases. METHODS: Intravital microscopy, animal disease models, and a wide range of cell biological studies were utilized to demonstrate the pathophysiological role of ERO1α in arteriolar and arterial thrombosis and to prove the importance of platelet ERO1α in platelet activation and aggregation. Mass spectrometry, electron microscopy, and biochemical studies were used to investigate the molecular mechanism. We used novel blocking antibodies and small-molecule inhibitors to study whether ERO1α can be targeted to attenuate thrombotic conditions. RESULTS: Megakaryocyte-specific or global deletion of Ero1α in mice similarly reduced platelet thrombus formation in arteriolar and arterial thrombosis without affecting tail bleeding times and blood loss following vascular injury. We observed that platelet ERO1α localized exclusively in the dense tubular system and promoted Ca2+ mobilization, platelet activation, and aggregation. Platelet ERO1α directly interacted with STIM1 (stromal interaction molecule 1) and SERCA2 (sarco/endoplasmic reticulum Ca2+-ATPase 2) and regulated their functions. Such interactions were impaired in mutant STIM1-Cys49/56Ser and mutant SERCA2-Cys875/887Ser. We found that ERO1α modified an allosteric Cys49-Cys56 disulfide bond in STIM1 and a Cys875-Cys887 disulfide bond in SERCA2, contributing to Ca2+ store content and increasing cytosolic Ca2+ levels during platelet activation. Inhibition of Ero1α with small-molecule inhibitors but not blocking antibodies attenuated arteriolar and arterial thrombosis and reduced infarct volume following focal brain ischemia in mice. CONCLUSIONS: Our results suggest that ERO1α acts as a thiol oxidase for Ca2+ signaling molecules, STIM1 and SERCA2, and enhances cytosolic Ca2+ levels, promoting platelet activation and aggregation. Our study provides evidence that ERO1α may be a potential target to reduce thrombotic events.

Commercial influenza vaccines vary in HA-complex structure and in induction of cross-reactive HA antibodies.

Influenza virus infects millions of people annually and can cause global pandemics. Hemagglutinin (HA) is the primary component of commercial influenza vaccines (CIV), and antibody titer to HA is a primary correlate of protection. Continual antigenic variation of HA requires that CIVs are reformulated yearly. Structural organization of HA complexes have not previously been correlated with induction of broadly reactive antibodies, yet CIV formulations vary in how HA is organized. Using electron microscopy to study four current CIVs, we find structures including: individual HAs, starfish structures with up to 12 HA molecules, and novel spiked-nanodisc structures that display over 50 HA molecules along the complex's perimeter. CIV containing these spiked nanodiscs elicit the highest levels of heterosubtypic cross-reactive antibodies in female mice. Here, we report that HA structural organization can be an important CIV parameter and can be associated with the induction of cross-reactive antibodies to conserved HA epitopes.

Learning abnormal physical examination signs: an introductory course.

CONTEXT: The acquisition of clinical skills is an essential part of the osteopathic medical school curriculum. Preclinical medical students, especially at osteopathic medical schools, have limited exposure to abnormal physical examination (PE) findings that are not typically seen in a student's peers or in a standardized patient (SP). The early exposure of first-year medical students (MS1s) to normal and abnormal findings in the simulation settings better equips them to identify abnormalities when they encounter them in a clinical setting. OBJECTIVES: The aim of this project was to develop and implement the introductory course on learning abnormal PE signs and pathophysiology of abnormal clinical findings to address the educational needs of MS1s. METHODS: The didactic part of the course consisted of PowerPoint presentations and lecture on the topics related to the simulation. The practical skill session was 60 min, during which time students first practiced PE signs and then were assessed on their ability to accurately identify abnormal PE signs on a high-fidelity (HF) mannequin. Faculty instructors guided students through clinical cases and challenged them with probing questions in clinically relevant content. Before- and after-simulation evaluations were created to assess students' skills and confidence. Student satisfaction levels after the training course were also assessed. RESULTS: This study demonstrated significant improvements in five PE skills (p<0.0001) after the introductory course of abnormal PE clinical signs. The average score for five clinical skills increased from 63.1 to 88.74% (before to after simulation). The confidence of students in performing clinical skills and their understanding of the pathophysiology of abnormal clinical findings also increased significantly (p<0.0001) after simulation activity and educational instruction. The average confidence score increased from 3.3 to 4.5% (before to after simulation) on a 5-point Likert scale. Survey results demonstrated high satisfaction with the course among learners with mean satisfaction score 4.7 ± 0.4 on 5-point Likert scale. The introductory course was well received by MS1s and they left positive feedback. CONCLUSIONS: This introductory course offered MS1s with novice PE skills the ability to learn a variety of abnormal PE signs, including heart murmurs and rhythms, lung sounds, measurement of blood pressure (BP), and palpation of the femoral pulse. This course also allowed abnormal PE findings to be taught in a time-efficient and faculty-resource-efficient manner.

Prehospital Hemorrhage Control and Treatment by Clinicians: A Joint Position Statement.

Exsanguination remains the leading cause of preventable death among victims of trauma. For adult and pediatric trauma patients in the prehospital phase of care, methods to control hemorrhage and hemostatic resuscitation are described in this joint consensus opinion by the American College of Surgeons Committee on Trauma, the American College of Emergency Physicians, and the National Association of EMS Physicians.

Plastic packaging waste in Europe: Addressing methodological challenges in recording and reporting.

A reliable comparison of European Union (EU) Member States' reporting of statistics on plastic packaging waste generation, recycling and recovery is necessary if there is to be a fair transition to a circular economy across the EU. It is a priority for there to be an improvement in the quality and validity of these statistics to assess each Member State's performance in relation to EU targets. This article explores the quality of national reporting based on the two main approaches which are used to calculate packaging waste generation, namely 'placed on the market' and 'waste analysis'. The findings outline how Member States apply a variety of approaches leading to different packaging waste statistics which makes reported data difficult to compare. Often, it is not clear what approach is applied in different counties. Factors such as freeriding, non-compliance and de minimis have represented the primary weaknesses in evaluating and reporting packaging waste statistics as producers have financial incentives for under-reporting. This article highlights the need to inform circular economy strategies by addressing the challenge of comparing data on packaging and plastic packaging waste generation across the EU.

Understanding (un)grammaticality in context: Evidence from young Spanish-English bilinguals over time.

PURPOSE: Percent grammatical utterances (PGU) provides clinicians and researchers with meaningful information on young children's grammatical abilities (Eisenberg & Guo, 2016). However, work is still needed to place PGU within the context of conventional language sample measures and understand how PGU reflects grammatical development in bilingual populations. The current study focuses on Spanish-English bilingual preschoolers to examine: 1) change in Spanish and English PGU over one year of preschool English instruction, 2) associations between PGU and other language sample measures within each language and across time, and 3) the types and frequency of error patterns in each language. METHOD: Play-based language samples were elicited in English and Spanish from bilingual children (n = 19) at the beginning and end of an instructional preschool year in English. PGU was derived from each sample along with other language sample measures (e.g., mean length of utterance). We examined change in PGU from Time 1 to Time 2, and correlations between Time 1 PGU and Time 2 PGU for each language. Specific grammatical errors were described in terms of their frequency in each language and stability across time. RESULTS: Average English PGU increased from Time 1 to Time 2, and correlated with other language sample measures. Conversely, average Spanish PGU did not increase from Time 1 to Time 2, nor did PGU correlate with any other Spanish measure. Error patterns in each language reflected grammatical differences across English and Spanish. CONCLUSIONS: Our results revealed distinct developmental patterns in bilingual children's first and second languages. Associations between time points and measures in English contrasted with disassociations in Spanish. Error patterns revealed more detailed information as to how bilingual children begin to acquire grammatical structures in each of their languages. We provide a case example to illustrate how grammaticality and error patterns can be used to characterize children's language abilities. We conclude with clinical implications of grammaticality in Spanish-English bilingual children.

Tourette's Syndrome cervical dystonia induced occipital neuralgia remedied by peripheral nerve stimulation: A case report / Síndrome de Tourette, distonia cervical induzida por neuralgia occipital remediada por estimulação nervosa periférica: relato de caso

BACKGROUND: Dystonia is uncommon in Tourette's syndrome, and occipital neuralgia secondary to Tourette's dystonia is more rare, affecting quality of life. Occipital peripheral nerve stimulation (PNS) is an excellent alternative by being adjustable and minimally invasive. Our case demonstrates occipital PNS as an effective option for refractory Tourette's dystonia. CASE PRESENTATION: A thirty-four-year-old male with poorly controlled Tourette's cervical dystonia presented with severe occipital neuralgia. Various medications were prescribed including propranolol and amitriptyline, and bilateral third-occipital nerve rhizotomies and occipital nerve blocks were trialed. Distal nerve blocks at the occipital protuberance were most effective. Therefore, an occipital PNS trial was done, and a PNS was implanted with no complications. Upon follow-up, the patient reported drastic pain reduction. CONCLUSION: Our case illustrates neuromodulation benefits for a rare presentation of refractory occipital neuralgia secondary to Tourette's-related dystonia. Occipital PNS should be considered for refractory cases because it is safe, easy to implant, and effective.

FUNDAMENTO: A distonia é incomum na síndrome de Tourette, e a neuralgia occipital secundária à distonia de Tourette é mais rara, afetando a qualidade de vida. A estimulação do nervo periférico occipital (SNP) é uma excelente alternativa por ser ajustável e minimamente invasiva. Nosso caso demonstra o SNP occipital como uma opção eficaz para a distonia de Tourette refratária. APRESENTAÇÃO DO CASO: Um homem de 34 anos com distonia cervical de Tourette mal controlada apresentou neuralgia occipital grave. Vários medicamentos foram prescritos, incluindo propranolol e amitriptilina, e foram testadas rizotomias bilaterais do nervo terceiro-occipital e bloqueios do nervo occipital. Os bloqueios dos nervos distais na protuberância occipital foram mais eficazes. Portanto, foi feito um ensaio de PNS occipital e um PNS foi implantado sem complicações. Após o acompanhamento, o paciente relatou redução drástica da dor. CONCLUSÃO: Nosso caso ilustra os benefícios da neuromodulação para uma apresentação rara de neuralgia occipital refratária secundária à distonia relacionada a Tourette. O PNS occipital deve ser considerado para casos refratários porque é seguro, fácil de implantar e eficaz.

Co-immunization with hemagglutinin stem immunogens elicits cross-group neutralizing antibodies and broad protection against influenza A viruses.

Current influenza vaccines predominantly induce immunity to the hypervariable hemagglutinin (HA) head, requiring frequent vaccine reformulation. Conversely, the immunosubdominant yet conserved HA stem harbors a supersite that is targeted by broadly neutralizing antibodies (bnAbs), representing a prime target for universal vaccines. Here, we showed that the co-immunization of two HA stem immunogens derived from group 1 and 2 influenza A viruses elicits cross-group protective immunity and neutralizing antibody responses in mice, ferrets, and nonhuman primates (NHPs). Immunized mice were protected from multiple group 1 and 2 viruses, and all animal models showed broad serum-neutralizing activity. A bnAb isolated from an immunized NHP broadly neutralized and protected against diverse viruses, including H5N1 and H7N9. Genetic and structural analyses revealed strong homology between macaque and human bnAbs, illustrating common biophysical constraints for acquiring cross-group specificity. Vaccine elicitation of stem-directed cross-group-protective immunity represents a step toward the development of broadly protective influenza vaccines.

Ascitic calprotectin and lactoferrin for detection of spontaneous bacterial peritonitis: a systematic review and meta-analysis.

Background: Spontaneous bacterial peritonitis (SBP) is a common bacterial infection in cirrhotic patients associated with a high mortality rate. Prompt diagnosis and early antibiotic administration are crucial in minimizing adverse outcomes. Although detection of ≥250 polymorphonuclear leukocytes (PMN) in ascitic fluid is the current gold standard to diagnose SBP, consideration for rapid detection with biomarkers is warranted. Methods: A literature search for studies evaluating ascitic calprotectin and lactoferrin for detection of SBP was performed using PubMed, Embase, Scopus, Google Scholar, Cochrane library, and Clinical Trial Registries. Summary sensitivity, specificity, log diagnostic odds ratio (LDOR), and area under the summary receiver operating curve (AUC) were calculated. Results: In total, 12 and 13 studies evaluated ascitic calprotectin and lactoferrin, respectively, for detection of SBP. Summary sensitivity, specificity, and LDOR for calprotectin were 0.942 (95% CI, 0.916, 0.967), 0.860 (95% CI, 0.799, 0.935), and 4.250 (95% CI, 3.504, 4.990), respectively. AUC for calprotectin was 0.91. Summary sensitivity, specificity, and LDOR for lactoferrin were 0.954 (95% CI, 0.930, 0.979), 0.890 (95% CI, 0.836, 0.945), and 4.630 (95% CI, 3.800, 5.452), respectively. AUC for lactoferrin was 0.958. Conclusions: The overall performance of ascitic calprotectin and lactoferrin was substantial, potentially serving as a screening tool or an alternative to manual cell count. However, a variety of manufacturers, cut-off values, and significant heterogeneity between studies should be noted. Point-of-care testing for calprotectin and lactoferrin may resolve disadvantages associated with the current methods. Future studies on this topic are, therefore, needed.

Impact of adjuvant: Trivalent vaccine with quadrivalent-like protection against heterologous Yamagata-lineage influenza B virus.

As new vaccine technologies and platforms, such as nanoparticles and novel adjuvants, are developed to aid in the establishment of a universal influenza vaccine, studying traditional influenza split/subunit vaccines should not be overlooked. Commercially available vaccines are typically studied in terms of influenza A H1 and H3 viruses but influenza B viruses need to be examined as well. Thus, there is a need to both understand the limitations of split/subunit vaccines and develop strategies to overcome those limitations, particularly their ability to elicit cross-reactive antibodies to the co-circulating Victoria (B-V) and Yamagata (B-Y) lineages of human influenza B viruses. In this study, we compared three commercial influenza hemagglutinin (HA) split/subunit vaccines, one quadrivalent (H1, H3, B-V, B-Y HAs) and two trivalent (H1, H3, B-V HAs), to characterize potential differences in their antibody responses and protection against a B-Y challenge. We found that the trivalent adjuvanted vaccine Fluad, formulated without B-Y HA, was able to produce antibodies to B-Y (cross-lineage) on a similar level to those elicited from a quadrivalent vaccine (Flucelvax) containing both B-V and B-Y HAs. Interestingly, Fluad protected mice from a lethal cross-lineage B-Y viral challenge, while another trivalent vaccine, Fluzone HD, failed to elicit antibodies or full protection following challenge. Fluad immunization also diminished viral burden in the lungs compared to Fluzone and saline groups. The success of a trivalent vaccine to provide protection from a cross-lineage influenza B challenge, similar to a quadrivalent vaccine, suggests that further analysis of different split/subunit vaccine formulations could identify mechanisms for vaccines to target antigenically different viruses. Understanding how to increase the breadth of the immune response following immunization will be needed for universal influenza vaccine development.

Investigating the diagnostic utility of high-resolution oesophageal manometry in patients with refractory respiratory symptoms.

BACKGROUND: The interaction between the respiratory and gastrointestinal systems, and the role of the latter in the development of respiratory pathology, has been examined with a focus on gastro-oesophageal reflux disease (GORD). However, little data exists examining the link between oesophageal motility and respiratory disease. AIMS AND OBJECTIVES: In this study, we examined patterns in oesophageal motility using high-resolution oesophageal manometry (HROM) in patients with refractory respiratory symptoms. METHODS: Data were collected retrospectively for all patients that were investigated using HROM at a single centre for refractory respiratory symptoms between January 1st, 2011-December 1st, 2021. Patients were selected for investigation based on airway reflux symptoms, measured by the Hull Airways Reflux Questionnaire (HARQ). RESULTS: 441 patients were investigated with HROM (64% female, mean age = 56.5 [SD = 13.9]). The commonest diagnoses of these patients were Chronic Cough (77%, n = 339), Asthma (10%, n = 44), and Interstitial Lung Disease (7%, n = 29). The prevalence of oesophageal dysmotility was 66% in our cohort. Those with oesophageal dysmotility had significantly higher HARQ scores than those with normal motility (40.6 vs 35.3, p < 0.001) and there was a significant inverse correlation between HARQ scores and distal contractile integral (DCI), a measure of oesophageal contractility. CONCLUSIONS: Two-thirds of patients with refractory respiratory symptoms were found to have oesophageal dysmotility on HROM. These findings suggest motility disorders of the oesophagus may contribute to the development and progression of respiratory disease. This study highlights the need for further prospective study of the relationship between oesophageal dysmotility and respiratory disease.