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Effect of formoterol/budesonide combination on arterial blood gases in patients with acute exacerbation of COPD.

BACKGROUND: Patients with severe chronic airway obstruction might suffer dangerous hypoxemia after administration of a beta-agonist despite bronchodilation. METHODS: We first compared the acute effects on gas exchange of two doses of formoterol Turbuhaler (9 and 18 microg) in 10 patients with acute exacerbation of COPD. Afterwards, we compared the acute effects of formoterol Turbuhaler 9 microug with those of formoterol/budesonide combination in a single inhaler (Turbuhaler) 9/320 microg in 10 other patients with acute exacerbation of COPD. Finally, we compared the changes in PaO(2) induced by formoterol Turbuhaler 9 microg or formoterol/budesonide combination in a single inhaler (Turbuhaler) 9/320 microg with those in FEV(1) in 10 other patients with acute exacerbation of COPD. Each agent was given on separate days, and the patients' arterial blood gases were measured at baseline and at intervals of 120 min. RESULTS: Small but statistically significant declines in PaO(2) were found after administration of both formoterol 9 and 18 microg. In the second group of patients, formoterol 9 microg alone again induced a significant decrease in PaO(2). However, the simultaneous administration of budesonide 320 microg significantly reduced the acute effect of formoterol on PaO(2). In a third group of 10 patients we confirmed a small but significant decrease in PaO(2) after formoterol alone and the reduction of this effect when budesonide was administered simultaneously. Moreover, we also documented that addition of budesonide amplified the fast onset of action of formoterol. CONCLUSIONS: These results suggest that when treating patients suffering from acute exacerbation of COPD with formoterol, it is prudent to check their arterial blood gases. In any case, combined administration of formoterol and budesonide reduces the potential for acute effects of formoterol on blood-gas tensions.

Acute Disease↗

Effect of nifedipine on fetal and maternal hemodynamics and blood gases in the pregnant ewe.

OBJECTIVE: Our purpose was to determine whether the fetal acidosis and hypoxia previously demonstrated in animal models with maternal nifedipine infusion is the result of a decrease in uteroplacental or fetoplacental blood flow and whether this effect is exacerbated by a higher drug concentration and duration of infusion. STUDY DESIGN: Ten chronically instrumented pregnant ewes (gestational age 0.9 term, term = 145 days) received nifedipine infusions (n = 7) or vehicle (95% ethanol/water, 3:7) (n = 3). Three 90-minute periods were evaluated: 5 microg/kg/min infusion (low-dose nifedipine), no infusion, and 10 microg/kg/min (high-dose nifedipine). Paired maternal and fetal blood gases, glucose, lactate, and nifedipine levels were obtained every 30 minutes while hemodynamic parameters were monitored. We determined maternal and fetal blood flows using the radioactive microsphere technique. RESULTS: Although maternal placental blood flows decreased by 25% during low-dose nifedipine (p < 0.05), this was only transient and there were no other decreases in uteroplacental or fetoplacental blood flow. Fetal blood flow increased to the adrenals and diaphragm with high-dose nifedipine (p < 0.05). Maternal and fetal lactate levels increased with both doses (p < 0.05). In addition, fetuses exhibited significant hypoxia (oxygen content fell 0.46 mmol/L) and acidosis (pH fell 0.06 units) throughout the nifedipine infusion and recovery period. Maternal heart rate increased transiently with both doses (p < 0.05); however, there were no changes in either fetal or maternal mean arterial pressure. Infusion of the vehicle alone did not alter maternal or fetal hemodynamics. Maternal and fetal plasma nifedipine levels reached steady-state by 30 minutes, and maternal/fetal ratios were 0.4 to 0.55. The maternal metabolic clearance rates for low- and high-dose nifedipine were 80.0 and 79.8 ml/min/kg, respectively. Maternal half-life calculation revealed a two-compartment model with a calculated half-life of 2.87 +/- 3.15 and 63.57 +/- 154.03 (+/-SD) minutes for the alpha and beta components, respectively. CONCLUSIONS: Maternal nifedipine infusion is associated with hypoxia and acidosis in the sheep fetus, without persistent decreases in uteroplacental or fetoplacental blood flows or blood pressures. These fetal blood gas changes are more severe with high-dose nifedipine and longer duration of infusion and continue to deteriorate even when recovery is allowed. The deterioration of fetal blood gases is out of proportion to the transient decreases in uteroplacental blood flow and demonstrates that another mechanism for this fetal acidosis and hypoxia exists during nifedipine infusion.

Acidosis↗

Opposing effects of narcotic gases and pressure on the striatal dopamine release in rats.

Nitrogen-oxygen breathing mixtures, for pressures higher than 0.5 MPa, decrease the release of dopamine in the rat striatum, due to the narcotic potency of nitrogen. In contrast, high pressures of helium-oxygen breathing mixtures of more than 1-2 MPa induce an increase of the striatal dopamine release and an enhancement of motor activity, referred to as the high pressure nervous syndrome (HPNS), and attributed to the effect of pressure per se. It has been demonstrated that the effect of pressure could be antagonized by narcotic gas in a ternary mixture, but most of the narcotic gas studies measuring DA release were executed below the threshold for pressure effect. To examine the effect of narcotic gases at pressure on the rat striatal dopamine release, we have used two gases, with different narcotic potency, at sublethargic pressure, nitrogen at 3 MPa and argon at 2 MPa. In addition, to dissociate the effect of the pressure, we have used nitrous oxide at 0.1 MPa to induce narcosis at very low pressure, and helium at 8 MPa to study the effect of pressure per se. In all the narcotic conditions we have recorded a decrease of the striatal dopamine release. In contrast, helium pressure induced an increase of DA release. For the pressures used, the results suggest that the decrease of dopamine release was independent of such an effect of the pressure. However, for the same narcotic gas, the measurements of the extracellular DA performed in the striatum seem to reflect an opposing effect of pressure, since the decrease in DA release is lower with increasing pressure.

Animals↗

Blood gases and oximetry: calibration-free new dry-chemistry and optical technology for near-patient testing.

The first calibration-free Near-Patient-Testing instrument (NPT7) for blood gases, pH and oximetry has been developed. With cartridges of 30 single-use cuvettes, the NPT7 needs no preparation prior to sample aspiration, no manual calibration, and no maintenance apart from paper and cartridge changes and regulatory quality control. Each cuvette measures pCO2, pO2, pH, total hemoglobin (ctHb), oxygen saturation (sO2), fractions of carboxyhemoglobin (FCOHb) and methemoglobin (FMetHb) on 95 microl whole blood with a 110-s measuring cycle. The measurement principles are as follows: pCO2-three-wavelength infrared spectroscopy of dissolved CO2; pO2-measurement of O2-induced changes in the decay time of phosphorescence; pH-the absorbance spectra change of an azo-dye color indicator; and oximetry is performed with a 128-wavelength spectrophotometer. We determined the within and between instrument variations with tonometered whole blood on seven prototype instruments, using between one and five control levels per analyte. The 95% analytical performance limits: +/-(/Bias/ +2 xS(T)) in the NPT7 instrument matched the analytical performance criteria for the measured quantities as defined by AACC guidelines. The application of these optical measuring methods for blood gases, pH and oximetry in single-use devices introduces a new concept into point-of-care testing (POCT), where preanalytical activities otherwise associated with instrument preparation are eliminated.

Blood Gas Analysis↗

Does pneumoperitoneum with different gases, body positions, and intraperitoneal pressures influence renal and hepatic blood flow?

BACKGROUND: Because of the well-known negative effects of carbon dioxide pneumoperitoneum on the hemodynamic and respiratory system, it was questionable how pneumoperitoneum may affect hepatic and renal blood flow. Therefore the influences of different gases, different intraperitoneal pressures, and different body positions on hepatic and renal blood flow were investigated in a porcine model. METHODS: Cardiac and hemodynamic function were monitored by means of implanted catheters in the pulmonary artery and the femoral vein and artery. Renal and hepatic blood flow were recorded with a transonic volume flow meter placed at the renal and hepatic arteries and the portal vein. Eighteen animals were randomly assigned to receive one of three insufflation gases (carbon dioxide [CO2], argon, or helium. After baseline recording, one of three intraperitoneal pressures (8, 12, or 16 mm Hg) and one of three body positions (supine head up, or head down) were randomly chosen. After an adaptation time of 15 minutes, all data were recorded for 15 minutes. This was repeated until all nine combinations had been investigated. The end points of the study were blood flow in the hepatic and renal arteries and the portal vein, cardial output, systemic vascular resistance, and central venous pressure. RESULTS: Total liver blood flow was reduced on relation to intraabdominal pressure, head-up position, and argon insufflation. Arterial hepatic blood flow was reduced by the head-up position and argon insufflation. Portal venous blood flow decreased with the pig in the head-up position, with increased intraabdominal pressure, and argon insufflation. Renal blood flow was reduced by the head-up position and increased pressure. There was no correlation (p < 0.6) between systemic hemodynamic parameters (cardiac output, central venous pressure, and systemic vascular resistance) and hepatic and renal blood flow. CONCLUSIONS: Head-up position and intraperitoneal pressure greater than 12 mm Hg should be avoided during laparoscopic surgery because they compromise hepatic and renal blood flow. Argon insufflation impairs liver blood flow. However, helium may be advantageous compared with CO2 insufflation.

Animals↗

PCDDs and PCDFs concentration in combustion gases and bottom ash from incineration of hospital wastes in Poland.

The result from the determination of polychlorinated dibenzodioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs) in combustion gases and bottom ash from eighteen of Polish hospital waste incinerators is presented. Thirteen of the investigated plants were built between 1994 and 1997. Eight of them shown low PCDDs/Fs concentration in stack gases, below 0.1 ng-TEQ/mn3. For two plants concentrations of PCDDs/Fs in stack gas were above 20 ng-TEQ/mn3. In all of the samples of bottom ash taken from pyrolytic chambers, PCDDs and PCDFs were in the level of 8-45 micrograms TEQ/kg. A method used for sampling and analysis is described.

Air Pollution↗

Effects of endotracheally administered distilled water and normal saline on the arterial blood gases of dogs.

The effects of endotracheally (ET) administered distilled water (DW) and normal saline solution (NSS) on the arterial blood gases of dogs were compared. When distilled water was administered endotracheally, arterial pH was depressed to 99.36% of baseline values within 5 minutes. When compared to pH changes following ET administration of NSS the depression of pH following DW administration was significant (P less than .05). Following ET injection of DW, arterial PO2 was depressed to 61% of baseline values and remained significantly depressed throughout the experiment. In comparison, following ET NSS administration, PO2 was depressed substantially less, and remained at significantly higher levels for the entire experiment. In dogs, administration of NSS by the ET route produces less detrimental effects on arterial blood gases than does the ET administration of DW. This may have implications for the choice of diluent for human drug administration using the ET route.

Analysis of Variance↗

Relationship between arterial blood gases and spirometry in acute exacerbations of chronic obstructive pulmonary disease.

Previous studies have established spirometric criteria for arterial blood gas analysis during acute asthmatic attacks. However, only general guidelines have been available regarding the need for blood gas analysis during an acute exacerbation of chronic obstructive pulmonary disease (COPD). We conducted a study to determine the relationship between arterial blood gases and spirometry in 70 emergency department patients during acute exacerbations of COPD. Arterial blood gas analysis and spirometry were performed on arrival at the emergency department. All of the patients with a pCO2 of more than 45 mm Hg had an FEV1 of less than 35% of the predicted normal. We found patients with a pO2 of less than 60 mm Hg who had an FEV1 as high as 54% of the predicted normal. There was no correlation between the FEV1 and pO2. Because spirometry was not reliable for identifying patients with significant hypoxemia, we conclude that arterial blood gas analysis is indicated for patients presenting to the ED with acute exacerbations of COPD. Spirometric criteria that have been used to eliminate the need for arterial blood gases in asthmatic patients cannot be applied safely to patients with COPD.

Acute Disease↗

The routine use of radiography and arterial blood gases in the evaluation of blunt trauma in children.

STUDY OBJECTIVE: To evaluate the usefulness of routine radiographs and arterial blood gases in children with blunt trauma. DESIGN: Retrospective chart review. TYPE OF PARTICIPANTS: Ninety patients who met triage criteria for our trauma team evaluation and who were less than 15 years old were evaluated. Patients with a Glasgow Coma Scale score (GCS) of 15 (lie, mild to moderately injured children) were the focus of this study. METHODS: Children seen from May 1991 through August 1992 had charts reviewed systematically and within 24 hours of emergency department evaluation. Standard radiologic evaluation, including cervical-spine, chest, and pelvic radiographs, as well as arterial blood gas analysis, were obtained. The severity of injury was graded according to the Modified Injury Severity Scale. RESULTS: The mean age of patients was 6.4 years, and the injuries observed were exclusively extremity fractures. The correlation between physical examination findings and radiologic evaluation was assessed. Forty-three patients had an abnormal physical examination (ie, gross deformity, limitation of motion, or pain), and 26 had a fracture identified on radiograph. Forty-seven patients had a normal physical examination and none had a fracture identified on radiograph (P < .001; sensitivity of positive signs and symptoms, 100%; false-negative findings, 0%). Four patients with abnormal blood gases are described. No patient had any vascular or solid organ injury identified. CONCLUSION: In children with a GCS score of 15, selected radiologic and laboratory tests based on clinical findings are recommended. Careful observation and repeat examinations by trained clinicians can select a group of children at low risk for occult injury.

Adolescent↗

Evaluation of lethality estimates for combustion gases in military scenarios.

To meet the military objective of determining criteria for incapacitation and lethality from toxic gas exposures, a series of small animal tests and data analyses were conducted. Carbon monoxide (CO), a narcotic gas and nitrogen dioxide (NO2), an irritant gas, along with carbon dioxide (CO2) were tested individually and in the following mixtures: (CO + CO2), (NO2 + CO2) and (NO2 + CO + CO2). A group of six animals was exposed to each of the gases and their combinations, lethality and biophysical data were collected. We conclude that our observations of lethality from single toxic gases can be correlated with a fractional effective dose (FED) description, in which external concentrations are corrected for minute volume changes. Multiple gas exposures clearly demonstrate synergistic effects because lethality rates greatly exceed those expected from statistically independent causes. Simple addition of the FED values, however, overstates the effect and implies a competition between the narcotic and irritant gas effects. The N-Gas model, while being an additive FED model, does not appear to be in a form that could guide the setting of military exposure standards.

Animals↗

Cardiac output, coronary blood flow, and blood gases during open-chest standard and compression-active-decompression cardiopulmonary resuscitation.

OBJECTIVE: To determine whether open-chest compression-active-decompression (CAD) could improve cardiac output, coronary blood flow, blood gases, and resuscitation compared to open-chest manual compression in a porcine model of cardiac arrest. DESIGN: Prospective, randomized laboratory investigation for measurement of cardiac output, coronary blood flow, arterial and mixed venous blood gases and potassium levels, and return of spontaneous circulation. SUBJECTS: Ten pigs each weighing approximately 36.4 kg. INTERVENTIONS: Following preparation of the model and opening of the chest, ultrasonic flow probes were placed on the ascending aorta and left anterior descending artery. Cardiac arrest was induced by epicardial pacing. Subjects received either open-chest CAD or open-chest manual compression. After 10 min of arrest, defibrillation was attempted. MEASUREMENTS AND MAIN RESULTS: Cardiac output fell to 46+/-53% (95% CI: -20 to 112) and 41+/-14% (95% CI: 23-59) (P>0.05) of baseline with CAD and manual methods at 5 min after arrest, respectively. Similarly, coronary blood flow fell to 33+/-14% (95% CI: 16-50) and 42+/-16% (95% CI: 22-62) (P>0.05) of baseline at 5 min. Both groups developed similar levels of metabolic acidosis, mixed venous hypoxemia, and hyperkalemia, with potassium levels: 6.5+/-4.0 meq/l (95% CI: 1.6-11.4) at 5 min and 7.5+/-4.6 meq/l (95% CI: 1.8-13.2) at 10 min in the CAD group and 5.8+/-2.0 meq/l (95% CI: 3.4-8.3) at 5 min and 6.1+/-1.4 meq/l (95% CI: 4.4-7.9) at 10 min in the manual group. Levels of hyperkalemia were inversely proportional to the square of PvO(2). One pig in each group was resuscitated after defibrillation. CONCLUSION: We found no benefit using CAD. Both low coronary blood flow and hyperkalemia may have limited resuscitation.

Animals↗

[Pollution and retro-pollution by the distribution system of medical gases].

The anaesthetic machine, the recovery room or the ICU ventilator as well as any other simple oxygenation device can be accidentally supplied with a "wrong" gas, or a mixture of "wrong" and "true" gases, or a gas containing chemical impurities, as a result of one of the following causes: a) the source of the medical gas pipeline supply contains a "wrong" gas or impurities; b) the gas pipeline is polluted by a "wrong" gas or solvents, introduced during the installation or maintenance of the pipeline; c) the pipeline is polluted by a wrong gas at a point of inter-connection or cross-connection of two pipelines; d) supply of a "wrong" gas through wrong quick couplers connected to the pipeline; e) back flow of a gas in another pipeline supply through a defective gas mixer, which is today the most common cause of pipeline contamination or retropollution. It occurs with some types of mixers in case of absence or malfunction of non-return valves, associated with a pressure difference between the two gas lines. The means of prevention, recognition and emergency treatment of these events include: a) systematic removal of mixers and flowmeter-mixers from supplies when not in use; b) periodical checking of these devices for an accidental communication between the gases to be mixed; c) systematic use of an oxygen analyser for a continuous measurement of FIO2, especially when the machine is connected to the N2O pipeline supply; d) the presence of a reserve cylinder of oxygen connected to every anaesthetic machine.

Air↗

Bronchial healing, lung parenchymal histology, and blood gases one month after transplantation of lungs topically cooled for 2 hours in the non-heart-beating cadaver.

BACKGROUND: The aim of this study was to investigate, in an experimental survival model, the functional and morphologic results of lung transplantation using lungs from non-heart-beating donors. METHODS: Left lungs, topically cooled to 25 degrees C for 2 hours in situ after 5 minutes of circulatory arrest followed by 26 minutes of unsuccessful cardiopulmonary resuscitation, were transplanted into syngeneic rats. Five weeks after the transplantation, right pneumonectomy was performed and blood gases measured after 60 minutes. In a control group, fresh donor lungs were used for transplantation and comparison was made with the cadaver group and a group of normal rats after right pneumonectomy. Morphologic changes were evaluated by semiquantitative scoring of 13 different parameters to obtain a total histologic index for each rat. RESULTS: Computerized tomography scans of the chest made during the third post-operative week showed normal lung parenchyma in both groups, and at 5 weeks there were no significant differences in blood gases. The bronchial anastomoses showed normal healing in all cases. The histologic changes in the lung parenchyma were generally mild and focal, primarily consisting of interstitial and perivascular mononuclear inflammation, bronchial inflammation and athelectasis. Surprisingly, the transplanted controls demonstrated the most pronounced changes, although only the difference in total histologic index between groups was significant. CONCLUSIONS: Lungs from non-heart-beating donors, topically cooled in the cadaver for two hours after failed resuscitation, showed normal bronchial healing and favorable parenchymal histology compared to transplanted control lungs 5 weeks after transplantation.

Animals↗

A death in a stationary vehicle whilst idling: unusual carbon monoxide poisoning by exhaust gases.

In this paper, we describe an autopsy case in which death was due to accidental carbon monoxide poisoning occurring in a stationary vehicle idling in an open space. To investigate the source of the fatal fumes, the death scene situation was reconstructed using the vehicle. Exhaust gases were found to invade the interior through the floor from a defective exhaust system. CO gas was detected while idling and the level in the cabin gradually rose to 1.5% over a 2-h period. Since the 8-year-old motor vehicle seemed to have been defective for some months, it was concluded that stationary idling overnight caused an accumulation of toxic gases in the interior.

Accidents↗

Sulfur species in volcanic gases.

A new analytical method for the determination of the sulfur species (SO2, H2S, S8(0)) in volcanic gases is proposed by revising, updating, and improving previous methods. The most significant advantages of the proposed procedure can briefly be summarized, as follows: (i) the reaction among sulfur species stops during the gas sampling by using preevacuated thorion-tapped vials with purified 0.15M Cd(OH)2 in 4 M NaOH to favor the precipitation of H2S as CdS; (ii) all the sulfur species (SO2, H2S, S8(0)) are analyzed by ion chromatography, after conversion to SO4, which allows the detection limit to be lowered significantly with respect to the previous studies; (iii) appropriate aliquots from intermediate steps may be used to determine other species commonly present in volcanic gases such as CO2, HCI, HF, HBr, HI, and so forth; (iv) determination of all the other gas species is not jeopardized by the proposed method, i.e., one single vial can be used for analyzing the full chemical composition of a volcanic gas with the exception of NH3. Statistical parameters calculated from gas sampling data at the F5 crater fumarole in Vulcano Island (Aeolian Islands, southern Italy), suggest that the standard error of mean (s/ root n) is higher for S (0.10), followed by SO2, H2S, and CO2 (0.04, 0.038, and 0.028, respectively). SO2 shows the higher variation coefficient (12.1%) followed by H2S, S, and CO2 (5.7, 1.5, and 0.8%, respectively). Furthermore, if the time dependence of sampling is taken into account, the measured values, instead of fluctuating in a random manner, tend to follow systematic patterns, out of statistical control, possibly suggesting a sort of natural fluctuation of the volcanic system. Other crater fumaroles from volcanic systems located in different geodynamical areas (Hawaii, USA, El Chichon, Mexico, Poas, Costa Rica) have been analyzed as well.

Journal Article↗

Membrane-based parallel plate denuder for the collection and removal of soluble atmospheric gases.

A continuously wetted cellulose acetate membrane-based parallel plate diffusion denuder is described. This is the first membrane-based denuder that has a small enough internal liquid holdup volume to permit reasonably rapid response time (10 --> 90% rise time of approximately 1.2 min for a transient event at a liquid flow rate of 500 microL/min) while permitting quantitative removal of common soluble atmospheric trace gases at flow rates up to 1.7 L/min. The latter attribute permits the use of the device as the first element in a particle sampling and analysis system for the quantitative removal of potentially interfering soluble trace gases. Particle losses in the denuder range from 0.9 to 2.9% over an aerodynamic diameter range of 0.38-3.48 microm, averaging 1.8%. However, only approximately 0.5% of the particles actually appears in the denuder effluent liquid. The relatively compact (300 mm H x 57 mm W x 26 mm D) wet denuder should be attractive in a number of applications. We show excellent agreement for HONO measurements with a conventional larger parallel plate wetted denuder in field measurements.

Journal Article↗

Recognition and discrimination of gases by the oxygen-sensing signal transducer protein HemAT as revealed by FTIR spectroscopy.

The determination of ligand binding properties is a key step in our understanding of gas sensing and discrimination by gas sensory proteins. HemAT is a newly discovered signal transducer heme protein that recognizes O(2) and discriminates against other gases such as CO and NO. We have used FTIR spectroscopy on CO- and NO-bound sensor domain HemAT and sensor domain distal mutants Y70F, T95A, R91A, and L92A to gain insight into the structure of the iron-bound ligand at ambient temperature. These mutations were designed to perturb the electrostatic field near the iron-bound gaseous ligand and also allow us to investigate the communication pathway between the distal residues of the protein and the heme. We show the formation of both H-bonded and non-H-bonded conformations in the CO-bound forms. In addition, we report the presence of multiple conformations in the NO-bound forms. Such distal H-bonding is crucial for ligand binding and activation by the heme. The comparison of the O(2), NO, and CO data demonstrates that Thr95 and Tyr70 are crucial for ligand recognition and discrimination and, thus, for specific sensing of gases, and L92 is crucial for controlling the conformational changes of the Thr95 and Tyr70 residues upon NO binding.

Amino Acid Sequence↗

Integrated system for the treatment of oxides of nitrogen from flue gases.

A novel and effective system was developed for the complete treatment of NOx from flue gases. The system consisted of photocatalytic or ozone oxidation of NOx, followed by scrubbing and biological denitrification. Maximum photocatalytic oxidation of NOx was achieved while using powdered TiO2 at a catalytic loading rate of 10 g/h, relative humidity of 50%, and a space time of 10 s. The used catalyst was regenerated and reused. A total of 72% of oxidized NO was recovered as HNO3/HNO2 in the regeneration process. Stoichiometrically, 10% excess ozone was able to affect 100% oxidation of NO to NO2. Presence of SO2 adversely influenced the oxidation of NO by ozone. The scrubbing of NO was effective with distilled water. Heterotrophic denitrifiers were able to denitrify the leachate with an efficiency of 90%, using sewage (COD 450 mg/L) as electron donor. The new integrated treatment system seems to be a promising alternative for complete treatment of NOx from flue gases.

Air Pollution↗