Budesonide/Formoterol (Symbicort) combination therapy as both maintenance and reliever treatment (SMART) is a novel approach in asthma management. We examined its 'real-life effectiveness' in treating Malaysian patients with moderate-to-severe asthma in whom despite on combined inhaled corticosteroids and long-acting beta2-agonist, were still inadequately controlled. In a retrospective study, 22 eligible adult patients on SMART [mean (range) age: 49 (36-65) years; FEV1: 41 (21-74)% predicted] were identified from medical records of an urban-based university hospital chest clinic, and their clinical outcomes studied at three months. Another 16 patients [50 (14-66) years; 48 (20-91)% predicted] of similar severity and treatment (i.e. Symbicort maintenance treatment plus short-acting beta2-agonist as reliever), but not on SMART, were used as comparator over the same assessment period. In addition, the patients were separately interviewed with standard questionnaire on their satisfaction and compliance to the SMART approach. In SMART group, rescue treatment requirement (p<0.001) and FEV1 [median difference = 2.5%, p=0.015; mean difference: 90 ml, p=0.013] showed significant improvement while in comparator, there was significant improvement only in the requirement for rescue treatment (p=0.023). Hospital admission rates were significantly reduced in SMART group compared to the other (p=0.039), but not in emergency treatment. Five patients asked to discontinue SMART while all others were satisfied, compliant and perceived improvement of their asthma with SMART. The maximum daily doses of inhaled budesonide and formoterol were 1400 microg and 31.5 microg respectively. Our preliminary findings suggest that SMART approach can be attempted as an effective and safe treatment option for patients with inadequately controlled moderate-to-severe asthma in Malaysian setting.
Study site: Chest clinic, Hospital Tuanku Jaafar, Seremban, Negeri Sembilan, Malaysia
Micro mechanism consideration is critical for gaining a thorough understanding of amorphous shear band behavior in magnetorheological (MR) solids, particularly those with viscoelastic matrices. Heretofore, the characteristics of shear bands in terms of formation, physical evolution, and response to stress distribution at the localized region have gone largely unnoticed and unexplored. Notwithstanding these limitations, atomic force microscopy (AFM) has been used to explore the nature of shear band deformation in MR materials during stress relaxation. Stress relaxation at a constant low strain of 0.01% and an oscillatory shear of defined test duration played a major role in the creation of the shear band. In this analysis, the localized area of the study defined shear bands as varying in size and dominantly deformed in the matrix with no evidence of inhibition by embedded carbonyl iron particles (CIPs). The association between the shear band and the adjacent zone was further studied using in-phase imaging of AFM tapping mode and demonstrated the presence of localized affected zone around the shear band. Taken together, the results provide important insights into the proposed shear band deformation zone (SBDZ). This study sheds a contemporary light on the contentious issue of amorphous shear band deformation behavior and makes several contributions to the current literature.
Polyvinyl alcohol (PVA)-based magnetorheological plastomer (MRP) possesses excellent magnetically dependent mechanical properties such as the magnetorheological effect (MR effect) when exposed to an external magnetic field. PVA-based MRP also shows a shear stiffening (ST) effect, which is very beneficial in fabricating pressure sensor. Thus, it can automatically respond to external stimuli such as shear force without the magnetic field. The dual properties of PVA-based MRP mainly on the ST and MR effect are rarely reported. Therefore, this work empirically investigates the dual properties of this smart material under the influence of different solvent compositions (20:80, 40:60, 60:40, and 80:20) by varying the ratios of binary solvent mixture (dimethyl sulfoxide (DMSO) to water). Upon applying a shear stress with excitation frequencies from 0.01 to 10 Hz, the storage modulus (G') for PVA-based MRP with DMSO to water ratio of 20:40 increases from 6.62 × 10-5 to 0.035 MPa. This result demonstrates an excellent ST effect with the relative shear stiffening effect (RSTE) up to 52,827%. In addition, both the ST and MR effect show a downward trend with increasing DMSO content to water. Notably, the physical state of hydrogel MRP could be changed with different solvent ratios either in the liquid-like or solid-like state. On the other hand, a transient stepwise experiment showed that the solvent's composition had a positive effect on the arrangement of CIPs within the matrix as a function of the external magnetic field. Therefore, the solvent ratio (DMSO/water) can influence both ST and MR effects of hydrogel MRP, which need to be emphasized in the fabrication of hydrogel MRP for appropriate applications primarily with soft sensors and actuators for dynamic motion control.
It is well known in the field of materials science that a substance's longevity is significantly influenced by its environment. Everything begins with the initial contact on a material's surface. This influence will then deteriorate and have an extended negative impact on the strength of the material. In this study, the effect of natural weathering in tropical climates on magnetorheological elastomer (MRE) was investigated through microstructural evaluation to understand the aging behavior of the environmentally exposed MRE. To understand and elucidate the process, MREs made of silicone rubber and 70 wt% micron-sized carbonyl iron particles were prepared and exposed to the natural weathering of a tropical climate for 90 days. The MRE samples were then mechanically tensile tested, which revealed that Young's modulus increased, while elongation at break decreased. Surface degradation due to weathering was suspected to be the primary cause of this condition. Using scanning electron microscopy (SEM), the degradation of MRE was investigated as a function of morphological evidence. Upon examination through SEM, it was noted that the weathering effects on the morphology of the exposed samples showed distinct characteristics on the degraded surfaces of the MRE, including numerous microvoids, cavities, and microcracks. While these features were not prominent for the MRE itself, they bear resemblance to the effects observed in similar materials like rubber and elastomer. An atomic force microscope (AFM) is used to investigate the surface topography and local degradation conditions. This observation revealed a distinctive degradation characteristic of the MRE in connection to natural weathering in tropical climates. The surface damage of the MRE samples became severe and inhomogeneous during the environmental aging process, and degradation began from the exposed MRE surface, causing the mechanical characteristics of the MRE to significantly change.