bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Heat Acclimatization, Heat Acclimation, and Intermittent Exercise Heat Training on Time-Trial Performance
Authors: Sekiguchi Yasuki , Benjamin Courteney L. , Manning Ciara N. , Struder Jeb F. , Armstrong Lawrence E. , Lee Elaine C. , Huggins Robert A. , Stearns Rebecca L. , Distefano Lindsay J. , Casa Douglas J.
Published: October 2021

Background:

The purpose of this study was to investigate effects of heat acclimatization (HAz) followed by heat acclimation (HA), and intermittent heat training (IHT) on time-trial performance.

Hypothesis:

Time-trial performance will improve after HA and will further improve with twice a week of IHT.

Study Design:

Interventional study.

Level of Evidence:

Level 3.

Methods:

A total of 26 male athletes (mean ± SD; age, 35 ± 12 years; body mass, 72.8 ± 8.9 kg; peak oxygen consumption [VO2peak], 57.3 ± 6.7 mL·kg−1·min−1) completed five 4-km time trials (baseline, post-HAz, post-HA, post-IHT4, post-IHT8) in the heat (ambient temperature, 35.4°C ± 0.3°C; relative humidity, 46.7% ± 1.2%) on a motorized treadmill. After baseline time trial, participants performed HAz (109 ± 10 days) followed by post-HAz time trial. Then, participants completed 5 days of HA, which involved exercising to induce hyperthermia (38.50°C-39.75°C) for 60 minutes. Participants were then divided into 3 groups and completed IHT either twice per week (IHTMAX), once per week (IHTMIN), or not at all (IHTCON) over an 8-week period. The exercise used for the IHT matched the HA. Four-kilometer time trials were performed after 4 weeks (post-IHT4) and 8 weeks of IHT (post-IHT8).

Results:

Time trial was faster in post-HA (17.98 ± 2.51 minutes) compared with baseline (18.61 ± 3.06 minutes; P = 0.037) and post-HAz (18.66 ± 3.12 minutes; P = 0.023). Percentage change in time trial was faster in IHTMAX (−3.9% ± 5.2%) compared with IHTCON (11.5% ± 16.9%) ( P = 0.020) and approached statistical significance with large effect (effect size = 0.96) compared with IHTMIN (1.6% ± 6.2%; P = 0.059) at post-IHT8. Additionally, IHTMAX (−2.2% ± 4.2%) was faster than IHTCON (3.6% ± 6.9%) ( P = 0.05) at post-IHT4.

Conclusion:

These results indicate that HA after HAz induces additional improvement in time-trial performance. IHT twice per week shows improvement after 8 weeks, while once per week maintains performance for 8 weeks. No IHT results in a loss of adaptations after 4 weeks and even greater losses after 8 weeks.

Clinical Relevance:

HA after HAz improves time-trial performance, twice a week of IHT improves performance further, and once a week of IHT maintains performance for at least 8 weeks.
Impact of TPOAb-negative maternal subclinical hypothyroidism in early pregnancy on adverse pregnancy outcomes
Authors: Zhu Ping , Chu Ruifeng , Pan Shilei , Lai Xiaolan , Ran Jianmin , Li Xiuhong
Published: October 2021

Purpose:

To investigate the effect of subclinical hypothyroidism on pregnancy outcomes of women early in their pregnancy with different thyroid-stimulating hormone levels and thyroid peroxidase antibody–negative status and to explore reasonable thyroid-stimulating hormone levels for subclinical hypothyroidism in early pregnancy.

Methods:

A total of 2378 women early in their pregnancy were studied retrospectively. The baseline characteristics were collected from medical records. Pregnancy outcomes were compared between the euthyroidism and subclinical hypothyroidism groups that were diagnosed by 2011 or 2017 American Thyroid Association guidelines. In addition, the effect of different maternal thyroid-stimulating hormone levels on adverse pregnancy outcomes was analyzed using binary logistic regression.

Results:

According to the 2011 American Thyroid Association diagnostic criteria of subclinical hypothyroidism, the prevalence of pregnancy outcomes was not significantly higher in the subclinical hypothyroidism group than in the euthyroidism group. However, pregnant women with subclinical hypothyroidism identified by the 2017 American Thyroid Association criteria had a higher risk of premature delivery (odds ratio = 3.93; 95% confidence interval = 1.22–12.64), gestational diabetes mellitus (odds ratio = 2.69; 95% confidence interval = 1.36–5.32), and gestational anemia (odds ratio = 3.28; 95% confidence interval = 1.60–6.75). Moreover, no differences in the prevalence of adverse pregnancy outcomes were observed between the mildly elevated thyroid-stimulating hormone group (2.5 < thyroid-stimulating hormone ⩽4.0 mIU/l) and the normal thyroid-stimulating hormone group (0.27 < thyroid-stimulating hormone ⩽2.5 mIU/l). The significantly elevated thyroid-stimulating hormone group (4.0 < thyroid-stimulating hormone < 10.0 mIU/l) had a higher prevalence of premature delivery, gestational diabetes mellitus, and gestational anemia than the normal thyroid-stimulating hormone group, even after controlling for potential confounding factors.

Conclusion:

A mildly elevated thyroid-stimulating hormone level or maternal subclinical hypothyroidism diagnosed by 2011 American Thyroid Association guidelines during early pregnancy in thyroid peroxidase antibody–negative women was not associated with adverse pregnancy outcomes. However, maternal subclinical hypothyroidism identified by the 2017 American Thyroid Association guidelines increased the risks of several adverse pregnancy outcomes in women untreated with levothyroxine. The 2017 American Thyroid Association guidelines could be more reasonable for the diagnosis of subclinical hypothyroidism in southern China.
Hepatitis C outreach project and cross-sectional epidemiology in high-risk populations in Trondheim, Norway
Authors: Hannula Raisa , Söderholm Jonas , Svendsen Therese , Skaland Maja , Nordbø Svein A. , Steinum Harald , Damås Jan K.
Published: October 2021

Background:

Hepatitis C is highly prevalent among people who use drugs (PWUD), and the hepatitis C virus (HCV) epidemic is less characterised in Norway. The aims of the study were to assess the prevalence and treatment willingness in high-risk populations by reaching out to frequently visited sites for high-risk populations.

Methods:

Individuals from high-risk populations were included from September 2015 to March 2017. Two dedicated study nurses frequently visited the local opioid substitution clinic, outpatient clinics, PWUD day centres, local prison, and refugee centre in Trondheim, Norway. Demographic data, risk behaviour, and clinical symptoms were obtained by study questionnaire. Subjects with anti-HCV+ rapid test were subsequently tested for HCV RNA and genotyped. Viraemic patients were offered referral for HCV treatment evaluation.

Results:

A total of 381 participants were included in the study: 52 immigrants, 62 prisoners, and 267 PWUD. The anti-HCV prevalence rates were 0% ( n = 0) in immigrants, 40% ( n = 25) in prisoners, and 61% ( n = 164) in PWUD, with 24% ( n = 15) of prisoners and 42% ( n = 108) of PWUD being viraemic. Of those qualifying for treatment ( n = 31), 30 wished to be evaluated.

Conclusion:

This study showed high HCV prevalence in prisoners and PWUD and that infected high-risk patients were interested in treatment evaluation.
Potential and Realized Absorptive Capacity in Colombian Firms: The Mediating Role of the Organizational Climate for Innovation
Authors: Contreras Francoise , Aldeanueva Ignacio , Espinosa Juan C. , Abid Ghulam
Published: October 2021

The absorptive capacity is related to knowledge evaluation and acquisition (Potential Capacity), as well as to the transformation and exploitation of such knowledge (Realized Capacity). This research aims to analyze the absorptive capacity in Colombian companies and to investigate whether the Realized capacity can be predicted from the Potential capacity. Likewise, due to the importance of the context on the absorptive capacity development, the mediating role of the organizational climate for innovation was tested. Through a cross-sectional study, a total of 260 employees from different companies completed the Absorptive Capacity Scale and the Organizational Climate for Innovation Scale. The results showed that Potential absorptive capacity is needed for Realized absorptive capacity, additionally, organizational climate for innovation exerted a mediator role in this transition. These findings highlight that companies should have an organizational climate that allows them to acquire and transform knowledge in order to increase their innovativeness and be more competitive. Further studies should analyze the organizational innovation in relation to the proposed and tested model, while considering employees from different industrial sectors.
Effectiveness, Efficiency and Executive Directors’ Compensation Among Listed Companies in Malaysia
Authors: Ahmed Alarussi Ali Saleh
Published: October 2021

This paper examines whether or not there is any relationship between executive directors’ compensation and the effectiveness and efficiency ratios of non-financial companies in Malaysia. Two variables are used in this study as independent variables (IVs), that is, company effectiveness ratio (return on equity) and company efficiency ratio (asset turnover); and six control variables, that is, firm visibility, liquidity, profitability, working capital, firm net-worth, and leverage. The executive directors’ compensation is the dependent variable (DV). Data are collected from 360 observations (120 companies’ annual reports for 3 years). STATA software analysis is used to examine the collected data. The results show that company effectiveness is one of the determinants of executive directors’ compensation but not company efficiency. Firm visibility, firm net-worth, and profitability also have strong relationships with executive directors’ compensation. However, liquidity and leverage do not show any significant relationship with executive directors’ compensation in Malaysian listed companies. This study focuses on Malaysia during the period of 2012 to 2014 because Malaysia is one of the developing countries in Asia, and in 2010, the Malaysian economy exhibited strong signs of recovery from the global financial crisis. However, the period between 2012 and 2014 was a critical period for the Malaysian economy; the Ringgit experienced depreciation and was devalued by more than 40%, which negatively affected the Malaysian economy as a whole. In addition, this study examines new variables in the Malaysian context, that is, firm efficiency, firm visibility, and firm net-worth.
Generativity and Green Purchasing Behavior: Moderating Role of Man-Nature Orientation and Perceived Behavioral Control
Authors: Afridi Sajjad Ahmad , Khan Wajid , Haider Maqsood , Shahjehan Asad , Afsar Bilal
Published: October 2021

Environment has become a major social problem for a greater number of people than ever before in recent years. As a consequence, in-depth research on green marketing and green purchasing has increased significantly. Although academic researchers have examined antecedents of green purchasing behavior, there still is room for further progress. One such area that needs further investigation is the role of generativity on green purchasing behavior because sustainability requires a long-term perspective that is embedded in the concept of generativity. This study examines the impact of generativity on consumer green purchasing behavior. Generativity refers to individuals’ beliefs that their current behaviors have consequences that extend into future generations. Moreover, the moderating roles of man-nature orientation and perceived behavioral control on generativity-green purchasing behavior link are also examined. Based on moral norm-activation theory, value-belief-norm theory, and theory of planned behavior, hypotheses were developed. Data were collected from a homogenous sample of 416 university students of four faculties through the non-probability sampling technique. Hierarchical regression analysis was used to test the hypotheses. Results show that generative consumers are more likely to show green purchasing behavior. Man-nature orientation and perceived behavioral control positively moderate the relationship between generativity and green purchasing behavior. Findings revealed that consumers who possess a greater concern for future generations, and high on man-nature orientation and perceived behavioral control constitute a segment that will be more likely to engage in green purchasing behavior, enabling effective targeting of marketing communications.
Information Competencies and Information Seeking Behavior in Digital Paradigms: A Case of Urdu Literature
Authors: Khanum Almas , Bashir Faiza
Published: October 2021

The study investigates the current state of information demands and the information-seeking behavior of Urdu literary students using digital technologies. Another purpose of the study was to determine the level of satisfaction with both the existing facilities and resources. A quantitative survey method of research is used to achieve the study’s objectives. Four major public universities of Lahore were the population. Containing the use of the convenience sample approach, data was obtained using a self-structured questionnaire with open-ended and closed-ended questions. Results show that Urdu literature students were not very familiar and comfortable with using research journals, research reports/theses, and reference works while finding information. There is a need to encourage students the use research journals, research reports/theses. The study focuses solely on Pakistani Urdu literature students. For generalizations, this survey should be reproduced on a larger scale. The findings of the research will contribute to knowledge about Urdu literature students’ information-seeking behavior at the university level in Pakistan, which may be beneficial to ultimately provide better services in the domain of Urdu literature. Universities and libraries need to provide more facilities and electronic resources for the Urdu language and literature students, keeping in mind their trends toward new technologies. University libraries should organize special training programs for literature students.
Individualism, Collectivism, and Well-being Among a Sample of Emerging Adults in the United States
Authors: Nezlek John B. , Humphrey Ashley
Published: October 2021

An increasing body of research suggests that emerging adults living in Western societies are becoming more individualistic and such increases in individualism are associated with reduced well-being. The present study examined relationships between well-being and individualism and collectivism among 1906 emerging adults in the US, aged 18–25. We measured individualism and collectivism distinguishing horizontal and vertical dimensions of these constructs, and we measured well-being in terms of depression, anxiety, self-esteem, interpersonal relationships, and neuroticism. Regression analyses found that individualism was negatively related to well-being, and these relationships varied somewhat between horizontal and vertical individualism. Horizontal collectivism was positively related to all measures of well-being, and vertical collectivism was positively related to three measures. These findings increase our understanding of the roles individualism and collectivism play in the psychological well-being of emerging adults, including the importance of distinguishing horizontal and vertical dimensions of individualism and collectivism.
A bird in the hand is better than two in the bush: Investigating the relationship between financial slack and profitability in business groups
Authors: Lefebvre Vivien
Published: October 2021

Using arguments from the behavioral theory of the firm, agency theory, and the literature on internal capital markets, this article investigates the relationship between financial slack and firms’ profitability in standalone versus business group–affiliated firms. Using a large sample of French privately held firms, we show that there is a quadratic, inverse U-shape relationship between financial slack and profitability for privately held firms. We observe that the relation is steeper for business group affiliated firms than for standalone firms, which is consistent with the idea that firms in business groups are in competition for the business groups resources. Moreover, we explore whether business groups characteristics and position and weight of a given affiliated firm in the business group organization influence the impact of financial slack on profitability. Our results show that for firms that are closest to the business group head firm and that have a higher weight in the business groups, the quadratic, inverse U-shaped relationship is steeper. These findings suggest that the bargaining power that firms have in business groups plays an important role in explaining the relation between financial slack and profitability.

JEL CLASSIFICATION: G32, L22 and L25.
Ambidexterity in micro and small firms: Can competitive intelligence compensate for size constraints?
Authors: Boronat-Navarro Montserrat , Escribá-Esteve Alejandro , Navarro-Campos Jesús
Published: October 2021

Ambidexterity has been linked to firm structures that are typical of organizations with a larger size. However, further research is needed to analyze whether the effect of firm size on ambidexterity is contingent on other aspects. We argue that micro and small firms that have developed some competitive intelligence routines (CIRs) may foster ambidextrous behavior and compensate for the limitations arising from a smaller size and lack of resources. We test our proposal on a sample of 200 firms in the furniture sector. Our results show that CIRs compensate for size constraints in that size is no longer a relevant variable to increase ambidextrous behavior in firms that achieve higher levels in these routines. Our results provide new and important insights into how ambidexterity may be fostered in small firms that lack resource slack or the ability to use separate units to develop knowledge exploration and exploitation activities.

JEL CLASSIFICATION: M10, M21, O3
Breast Core Biopsy Information and Consent: Do we Prepare or do we Scare?
Authors: Pollard Jennifer , Rose Heather , Mullen Russell , Abbott Nick
Published: October 2021

Informed consent has important ethical considerations for invasive procedures. Anecdotal evidence suggests an informed consent policy could heighten anxiety. We evaluated whether detailed information about breast biopsy prior to appointment negatively impacted patient experiences. Phase 1 surveyed patients receiving a standard appointment letter who underwent core biopsy (group A). Phase 2 surveyed two groups receiving standard letter plus biopsy leaflets: those who underwent core biopsy (group B) and those who did not (group C). The analysis included descriptive statistics and qualitative thematic analysis. Hundred percent of group A felt they were given enough information prior to biopsy and 72% felt it would not be helpful having information to read in the clinic beforehand. Hundred percent of group B and 94.1% of group C found it helpful to receive information with their letter. Common themes were good service, verbal explanation, and appreciation of written information. Despite concerns that too much information would heighten anxiety, this has not resulted in negative clinic experiences. Most patients found detailed information included with their appointment letter helpful, regardless of whether they had a biopsy or not.
Subcutaneous calcinosis: Is it different between systemic sclerosis and dermatomyositis?
Authors: Valenzuela Antonia , Chung Lorinda
Published: October 2021

Calcinosis cutis is the deposition of insoluble calcium in the skin and subcutaneous tissues. It is a manifestation of several autoimmune connective tissue diseases, most frequently with systemic sclerosis and juvenile dermatomyositis, followed by adult dermatomyositis. Autoimmune connective tissue disease–associated calcinosis is of the dystrophic subtype, which occurs at sites of damaged tissue in the setting of normal serum calcium and phosphate levels. In juvenile dermatomyositis, calcinosis is considered a marker of ongoing disease activity and possibly inadequate treatment, while in adult dermatomyositis, it is a hallmark of skin damage due to chronic rather than active disease. Calcinosis is associated with long disease duration in systemic sclerosis and dermatomyositis, anti-polymyositis/sclerosis autoantibodies in systemic sclerosis and NXP-2 and melanoma differentiation-associated gene 5 in dermatomyositis. Calcinosis in systemic sclerosis occurs most frequently in the hands, particularly the fingers, whereas in dermatomyositis, it affects mainly the trunk and extremities. The primary mineral component of calcinosis is hydroxyapatite in systemic sclerosis and carbonate apatite in dermatomyositis. Calcinosis in dermatomyositis and systemic sclerosis share some pathogenic mechanisms, but vascular hypoxia seems to play a more important role in systemic sclerosis, whereas the release of calcium from mitochondria in muscle cells damaged by myopathy may be a primary mechanism contributing to dermatomyositis-related calcinosis. Multiple treatment strategies for dermatomyositis and systemic sclerosis-related calcinosis have been used with variable results. Early aggressive treatment of underlying myositis in patients with dermatomyositis may improve long-term outcomes of calcinosis. A better understanding of the pathogenesis of calcinosis is needed to improve treatment options.
Anaphylaxis after Moderna COVID-19 vaccine
Authors: Mayfield Jeremy , Bandi Sumedha , Ganti Latha , Rubero Jose
Published: October 2021

The authors of this article report on a case of a patient who presented to the emergency department (ED) in anaphylaxis after receiving the Moderna® COVID-19 vaccine. The patient was hypoxic, with diffuse wheezing bilaterally to auscultation, flush skin, swollen face, and the feeling of her throat closing. Anaphylaxis can have wide range of presentation, the key is recognizing the symptoms and treating early. The incidence of anaphylaxis from COVID-19 vaccine is not well documented to date.
Repositioning Organizational Failure Through Active Acceptance
Authors: Schwarz Gavin M. , Bouckenooghe Dave
Published: October 2021

This paper considers the way organizations respond to failure by actively repositioning the failed outcome as success. When an organization fails to meet planned goals, they do not necessarily learn from the experience, automatically terminate the plan, or persist with the failing course of action. Instead, another response is to shift original aspirations by recasting what was achieved, acting as if the ensuing failure is positive, despite indicators suggesting otherwise. As a mode of organizational interpretation, this repositioning reformats the criteria for what is success in order to move forward, enabling organizations to continue failed outcomes and their tasks that are well past their use-by date. After detailing this adjustment, we model an active-acceptance protocol on failure, discussing whether organizational effectiveness is predictable from how firms respond to failure in this way. The paper fills a gap in dialogue specific to failing by opening an alternative path to understand how organizations frame failure differently.
Prevalence of Pediatric Periorbital Trauma at a US-Mexico Border Level 1 Trauma Center, 10 Year Retrospective Review
Authors: Skidmore James R. , Kener Kyle , Garcia Jose Castro
Published: October 2021

Introduction: Due to its location in the middle third of the face, the periorbital area is exposed to external forces that may cause blunt and/or penetrating trauma. This anatomical location houses important structures for vision, cosmesis, and upper and lower facial skeletal stability. Trauma in this area puts the patient at risk for injuries to important structures, that, when damaged at early age, may have permanent debilitating consequences. Methods: After obtaining IRB approval, we evaluated ER admissions at a Level 1 Trauma Center located in the US-Mexico border over a 10-year-period. Inclusion criteria included patients younger than 18 years old with diagnosis of trauma to the face involving the periorbital region. Results: From January 2009 to December 2018, 1192 pediatric patients were admitted to the Level 1 Trauma Center with trauma that involved the periorbital area amongst other injuries. Mean age was 8, STD 5.2. 61.4% were male patients. The most common mechanism of injury was fall (365) followed by blunt trauma (305) and motor vehicle accident (MVA) (108). 29.4% of patients required admission, and 18.8% required a surgical intervention. Conclusion: Periorbital trauma in the pediatric population may bring lifelong consequences due to deformity, dysfunction, or loss of the structures that are contained within this anatomical area. Further studies are warranted to assess risk factors and to provide prevention measures to avoid trauma and complications due to injury to these important structures.
CPX-351 induces remission in newly diagnosed pediatric secondary myeloid malignancies
Authors: Hu Yixin , Caldwell Kenneth J. , Onciu Mihaela , Federico Sara M. , Salek Marta , Lewis Sara , Lei Shaohua , Zhang Jinghui , Nichols Kim E. , Takemoto Clifford M. , Triplett Brandon M. , Farrar Jason E. , Rubnitz Jeffrey E. , Ribeiro Raul C. , Wlodarski Marcin W.
Published: October 2021

Secondary myelodysplastic syndromes and acute myeloid leukemia (sMDS/AML) are rare in children and adolescents and have a dismal prognosis. The mainstay therapy is hematopoietic cell transplantation (HCT), but there has been no innovation in cytoreductive regimens. CP X-351, a fixed 5:1 molar ratio of liposomal cytarabine to daunorubicin, has shown favorable safety and efficacy in elderly individuals with secondary AML and children with relapsed de novo AML. We report the outcomes of 7 young patients (6 with newly diagnosed sMDS/AML and 1 with primary MDS/AML) uniformly treated with CP X-351. Five patients had previously received chemotherapy for osteosarcoma, Ewing sarcoma, neuroblastoma, or T-cell acute lymphoblastic leukemia; 1 had predisposing genomic instability disorder (Cornelia de Lange syndrome) and 1 had MDS-related AML and multiorgan failure. The median age at diagnosis of myeloid malignancy was 17 years (range, 13-23 years). Patients received 1 to 3 cycles of CP X-351 (cytarabine 100 mg/m2 plus daunorubicin 44 mg/m2) on days 1, 3, and 5, resulting in complete morphologic remission without overt toxicity or treatment-related mortality. This approach allowed for adding an FLT3 inhibitor as individualized therapy in 1 patient. Six patients were alive and leukemia-free at 0.5 to 3.3 years after HCT. One patient died as a result of disease progression before HCT. To summarize, CP X-351 is an effective and well-tolerated regimen for cytoreduction in pediatric sMDS/AML that warrants prospective studies.
Childhood asthma: pathogenesis and phenotypes
Authors: Pijnenburg Mariëlle W. , Frey Urs , De Jongste Johan C. , Saglani Sejal
Published: October 2021

In the pathogenesis of asthma in children there is a pivotal role for a type 2 inflammatory response to early life exposures or events. Interactions between infections, atopy, genetic susceptibility and environmental exposures (such as farmyard environment, air pollution and tobacco smoke exposure) influence the development of wheezing illness and the risk of progression to asthma. The immune system, lung function and the microbiome in gut and airways develop in parallel, and dysbiosis of the microbiome may be a critical factor in asthma development. Increased infant weight gain and preterm birth are other risk factors for development of asthma and reduced lung function. The complex interplay between these factors explains the heterogeneity of asthma in children. Subgroups of patients can be identified as phenotypes, based on clinical parameters, or endotypes, based on a specific pathophysiological mechanism. Paediatric asthma phenotypes and endotypes may ultimately help to improve diagnosis of asthma, prediction of asthma development and treatment of individual children, based on clinical, temporal, developmental or inflammatory characteristics. Unbiased, data-driven clustering, using a multidimensional or systems biology approach may be needed to better define phenotypes. The present knowledge on inflammatory phenotypes of childhood asthma has now been successfully applied in the treatment with biologicals of children with severe therapy-resistant asthma, and it is to be expected that more personalised treatment options may become available.
Benefits and risks of bronchoalveolar lavage in severe asthma in children
Authors: Ben Tkhayat Raja , Taytard Jessica , Corvol Harriet , Berdah Laura , Prévost Blandine , Just Jocelyne , Nathan Nadia
Published: October 2021

Background

Although bronchoscopy can be part of the exploration of severe asthma in children, the benefit of bronchoalveolar lavage (BAL) is unknown. The present study aimed to decipher whether systematic BAL during a flexible bronchoscopy procedure could better specify the characteristics of severe asthma and improve asthma management.

Material and methods

The study took place in two departments of a university hospital in Paris. Children who underwent flexible bronchoscopy for the exploration of severe asthma between April 2017 and September 2019 were retrospectively included.

Results

In total, 203 children were included, among whom 107 had a BAL. BAL cell count was normal in most cases, with an increasing number of eosinophils with age, independently from the atopic status of the patients. Compared with bronchial aspiration only, BAL increased the rate of identified bacterial infection by 1.5. Nonatopic patients had more bacterial infections (p<0.001). BAL induced a therapeutic modification only for azithromycin and omalizumab prescriptions. The practice of a BAL decreased bronchoscopy tolerance (p=0.037), especially in the presence of tracheobronchial malacia (p<0.01) and when performed in a symptomatic patient (p=0.019).

Discussion and conclusion

Although BAL may provide interesting information in characterising severe asthma, in most cases its impact on the patient's management remains limited. Moreover, BAL can be poorly tolerated and should be avoided in the case of tracheobronchial malacia or current asthma symptoms.
Family planning, pregnancy and birth in women with lung conditions: a worldwide survey
Authors: Williams Clare , Johnson Barbara , Middleton Peter G. , Backer Vibeke , Gibson Peter G. , Hollis Gill , Coleman Courtney
Published: October 2021

Lung diseases can complicate pregnancy, but little is known about the experiences of pregnancy among women living with such diseases. This survey aimed to understand the experiences of women with a lung condition before and during pregnancy, in childbirth and post-partum.

The survey was translated into nine languages and hosted online between March and May 2018. This paper reports on 327 women who had asthma, cystic fibrosis (CF), lymphangioleiomyomatosis (LAM) and sarcoidosis as a sole or primary lung condition.

Women with CF and LAM were most likely to report that their condition influenced their decision to have children. Those with CF and LAM who did become pregnant reported greater satisfaction with their healthcare during pregnancy and gave more consideration to factors such as location and type of birth; they were also more concerned about the impact of the pregnancy on their health than women with other diseases. Women with sarcoidosis reported receiving conflicting advice as to both the impact of their condition on pregnancy and how becoming pregnant might impact their health. Women with asthma reported not always being able to access the information they needed from healthcare professionals.

The results suggest that healthcare providers should be having dialogues with affected women early on, from before conception, throughout the pregnancy and after giving birth, and training should be provided to healthcare staff to equip them with the information they need to do this.
Factors for severe outcomes following SARS-CoV-2 infection in people with cystic fibrosis in Europe
Authors: Jung Andreas , Orenti Annalisa , Dunlevy Fiona , Aleksejeva Elina , Bakkeheim Egil , Bobrovnichy Vladimir , Carr Siobhán B. , Colombo Carla , Corvol Harriet , Cosgriff Rebecca , Daneau Géraldine , Dogru Deniz , Drevinek Pavel , Vukic Andrea Dugac , Fajac Isabelle , Fox Alice , Fustik Stojka , Gulmans Vincent , Harutyunyan Satenik , Hatziagorou Elpis , Kasmi Irena , Kayserová Hana , Kondratyeva Elena , Krivec Uroš , Makukh Halyna , Malakauskas Kestutis , McKone Edward F. , Mei-Zahav Meir , de Monestrol Isabelle , Olesen Hanne Vebert , Padoan Rita , Parulava Tsitsino , Pastor-Vivero Maria Dolores , Pereira Luísa , Petrova Guergana , Pfleger Andreas , Pop Liviu , van Rens Jacqui G. , Rodic´ Milan , Schlesser Marc , Storms Valérie , Turcu Oxana , Woz´niacki Lukasz , Yiallouros Panayiotis , Zolin Anna , Downey Damian G. , Naehrlich Lutz
Published: October 2021

Background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in people with cystic fibrosis (pwCF) can lead to severe outcomes.

Methods

In this observational study, the European Cystic Fibrosis Society Patient Registry collected data on pwCF and SARS-CoV-2 infection to estimate incidence, describe clinical presentation and investigate factors associated with severe outcomes using multivariable analysis.

Results

Up to December 31, 2020, 26 countries reported information on 828 pwCF and SARS-CoV-2 infection. Incidence was 17.2 per 1000 pwCF (95% CI: 16.0–18.4). Median age was 24 years, 48.4% were male and 9.4% had lung transplants. SARS-CoV-2 incidence was higher in lung-transplanted (28.6; 95% CI: 22.7–35.5)versusnon-lung-transplanted pwCF (16.6; 95% CI: 15.4–17.8) (p≤0.001).

SARS-CoV-2 infection caused symptomatic illness in 75.7%. Factors associated with symptomatic SARS-CoV-2 infection were age >40 years, at least one F508del mutation and pancreatic insufficiency.

Overall, 23.7% of pwCF were admitted to hospital, 2.5% of those to intensive care, and regretfully 11 (1.4%) died. Hospitalisation, oxygen therapy, intensive care, respiratory support and death were 2- to 6-fold more frequent in lung-transplantedversusnon-lung-transplanted pwCF.

Factors associated with hospitalisation and oxygen therapy were lung transplantation, cystic fibrosis-related diabetes (CFRD), moderate or severe lung disease and azithromycin use (often considered a surrogate marker forPseudomonas aeruginosainfection and poorer lung function).

Conclusion

SARS-CoV-2 infection yielded high morbidity and hospitalisation in pwCF. PwCF with forced expiratory volume in 1 s <70% predicted, CFRD and those with lung transplants are at particular risk of more severe outcomes.
Individual trajectory-based care for COPD: getting closer, but not there yet
Authors: Roche Nicolas , Devillier Philippe , Berger Patrick , Bourdin Arnaud , Dusser Daniel , Muir Jean-François , Martinat Yan , Terrioux Philippe , Housset Bruno
Published: October 2021

Chronic obstructive pulmonary disease (COPD) is a main cause of death due to interplaying factors, including comorbidities that interfere with symptoms and response to therapy. It is now admitted that COPD management should be based on clinical symptoms and health status and should consider the heterogeneity of patients’ phenotypes and treatable traits. This precision medicine approach involves a regular assessment of the patient's status and of the expected benefits and risks of therapy. The cornerstone of COPD pharmacological therapy is inhaled long-acting bronchodilation. In patients with persistent or worsened symptoms, factors likely to interfere with treatment efficacy include the patient's non-adherence to therapy, treatment preference, inhaler misuse and/or comorbidities, which should be systematically investigated before escalation is considered. Several comorbidities are known to impact symptoms, physical and social activity and lung function. The possible long-term side-effects of inhaled corticosteroids contrasting with their over-prescription in COPD patients justify the regular assessment of their benefits and risks, and de-escalation under close monitoring after a sufficient period of stability is to be considered. While commonly used in clinical trials, the relevance of routine blood eosinophil counts to guide therapy adjustment is not fully clear. Patients’ characteristics, which define phenotypes and treatable traits and thus guide therapy, often change during life, forming the basis of the concept of clinical trajectory. The application of individual trajectory-based management of COPD in clinical practice therefore implies that the benefit:risk ratio is regularly reviewed according to the evolution of the patient's traits over time to allow optimised therapy adjustments.
Agreement of the modified Medical Research Council and New York Heart Association scales for assessing the impact of self-rated breathlessness in cardiopulmonary disease
Authors: Ahmadi Zainab , Igelström Helena , Sandberg Jacob , Sundh Josefin , Sköld Magnus , Janson Christer , Blomberg Anders , Bornefalk Hans , Bornefalk-Hermansson Anna , Ekström Magnus
Published: October 2021

Background

The functional impact of breathlessness is assessed using the modified Medical Research Council (mMRC) scale for chronic respiratory disease and with the New York Heart Association Functional Classification (NYHA) scale for heart failure. We evaluated agreement between the scales and their concurrent validity with other clinically relevant patient-reported outcomes in cardiorespiratory disease.

Methods

Outpatients with stable chronic respiratory disease or heart failure were recruited. Agreement between the mMRC and NYHA scales was analysed using Cramér's V and Kendall's tau B tests. Concurrent validity was evaluated using correlations with clinically relevant measures of breathlessness, anxiety, depression, and health-related quality of life. Analyses were conducted for all participants and separately in chronic obstructive pulmonary disease (COPD) and heart failure.

Results

In a total of 182 participants with cardiorespiratory disease, the agreement between the mMRC and NYHA scales was moderate (Cramér's V: 0.46; Kendall's tau B: 0.57) with similar results for COPD (Cramér's V: 0.46; Kendall's tau B: 0.66) and heart failure (Cramér's V: 0.46; Kendall's tau B: 0.67). In the total population, the scales correlated in similar ways to other patient-reported outcomes.

Conclusion

In outpatients with cardiorespiratory disease, the mMRC and NYHA scales show moderate to strong correlations and similar associations with other patient-reported outcomes. This supports that the scales are comparable when assessing the impact of breathlessness on function and patient-reported outcomes.
Working memory training efficacy in COPD: the randomised, double-blind, placebo-controlled Cogtrain trial
Authors: van Beers Martijn , Mount Sarah W. , Houben Katrijn , Gosker Harry R. , Schuurman Lisanne , Franssen Frits M.E. , Janssen Daisy J.A. , Schols Annemie M.W.J.
Published: October 2021

Background

Cognitive impairment is highly prevalent in COPD and is associated with a sedentary lifestyle, unhealthy diet and increased cognitive stress susceptibility. Enhancement of cognitive performance by working memory training (WMT) may reverse these effects. Therefore, this study aimed to investigate the efficacy of WMT in COPD on cognitive performance, healthy lifestyle behaviours and cognitive stress susceptibility.

Methods

The double-blind randomised, placebo-controlled Cogtrain trial consisted of a 12-week training phase comprising 30 active or sham WMT sessions, followed by a second 12-week maintenance phase with 12 sessions. Measurements took place at baseline and after the first and second phases. The primary outcome was cognitive performance. Secondary outcomes were the recall of prespecified healthy lifestyle goals, physical capacity and activity, dietary quality and cognitive stress susceptibility. Motivation towards exercising and healthy eating and psychological wellbeing were exploratory outcomes.

Results

Sixty-four patients with moderate COPD (45% male, aged 66.2±7.2 years, median forced expiratory volume in 1 s 60.6% predicted) were randomised. WMT significantly increased patients’ performance on the trained tasks in the first phase, which remained stable in the second phase. Of the 17 cognitive outcome measures, only one measure of memory improved after the first phase and one measure of reaction time after the second phase. This intervention did not influence physical capacity and activity, recall of prespecified healthy lifestyle goals, psychological wellbeing or cognitive stress susceptibility.

Conclusion

WMT improved performance on the trained tasks but not overall cognitive performance, healthy lifestyle behaviours or cognitive stress susceptibility in patients with COPD.
Regional homogeneity alterations in multi-frequency bands in tension-type headache: a resting-state fMRI study
Authors: Zhang Shuxian , Li Huayun , Xu Qinyan , Wang Chao , Li Xue , Sun Jiawei , Wang Yaqi , Sun Tong , Wang Qianqian , Zhang Chengcheng , Wang Jili , Jia Xize , Sun Xihe
Published: October 2021

Objectives

In this study, we aimed to investigate the spontaneous neural activity in the conventional frequency band (0.01−0.08 Hz) and two sub-frequency bands (slow-4: 0.027–0.073 Hz, and slow-5: 0.01–0.027 Hz) in tension-type headache (TTH) patients with regional homogeneity (ReHo) analyses.

Methods

Thirty-eight TTH patients and thirty-eight healthy controls (HCs) underwent resting-state functional magnetic resonance imaging (RS-fMRI) scanning to investigate abnormal spontaneous neural activity using ReHo analysis in conventional frequency band (0.01−0.08 Hz) and two sub-frequency bands (slow-4: 0.027–0.073 Hz and slow-5: 0.01–0.027 Hz).

Results

In comparison with the HC group, patients with TTH exhibited ReHo increases in the right medial superior frontal gyrus in the conventional frequency band (0.01−0.08 Hz). The between group differences in the slow-5 band (0.01–0.027 Hz) highly resembled the differences in the conventional frequency band (0.01−0.08 Hz); even the voxels with increased ReHo were spatially more extensive, including the right medial superior frontal gyrus and the middle frontal gyrus. In contrast, no region showed significant between-group differences in the slow-4 band (0.027–0.073 Hz). The correlation analyses showed no correlation between the ReHo values in TTH patients and VAS scores, course of disease and number of seizures per month in conventional band (0.01−0.08 Hz), slow-4 band (0.027–0.073 Hz), as well as in slow-5 band (0.01–0.027 Hz).

Conclusions

The results showed that the superior frontal gyrus and middle frontal gyrus were involved in the integration and processing of pain signals. In addition, the abnormal spontaneous neural activity in TTH patients was frequency-specific. Namely, slow-5 band (0.01–0.027 Hz) might contain additional useful information in comparison to slow-4 band (0.027−0.073 Hz). This preliminary exploration might provide an objective imaging basis for the understanding of the pathophysiological mechanism of TTH.
Clinical utility of aVR lead T-wave in electrocardiogram of patients with ST-elevation myocardial infarction
Authors: Kazemi Babak , Sadat-Ebrahimi Seyyed-Reza , Ranjbar Abdolmohammad , Akbarzadeh Fariborz , Sadaie M. Reza , Safaei Naser , Esmaeil zadeh-Saboor Mehdi , Sohrabi Bahram , Ghaffari Samad
Published: October 2021

Background

aVR lead is often neglected in routine clinical practice largely because of its undefined clinical utility specifications. Nevertheless, positive T-wave in aVR lead has been reported to be associated with poor clinical outcomes in some cardiovascular diseases. This study aimed to prospectively investigate the prognostic value and clinical utility of T-wave amplitude in aVR lead in patients with acute ST-elevation myocardial infarction (STEMI).

Methods

A total of 340 STEMI patients admitted to a tertiary heart center were consecutively included. Patients were categorized into four strata, based on T wave amplitude in aVR lead in their admission ECG (i.e. < − 2, − 1 to − 2, − 1 to 0, and ≥ 0 mV). Patients’ clinical outcomes were also recorded and statistically analyzed.

Results

In-hospital mortality, re-hospitalization, and six-month-mortality significantly varied among four T wave strata and were higher in patients with a T wave amplitude of ≥ 0 mV (p 0.001–0.002). The groups of patients with higher T wave amplitude in aVR, had progressively increased relative risk (RR) of in-hospital mortality (RRs ≤ 0.01, 0.07, 1.00, 2.30 in four T wave strata, respectively). T wave amplitude in the cutoff point of − 1 mV exhibited a sensitivity and specificity of 95.83 (95% CI 78.88–99.89) and 49.68 (95% CI 44.04–55.33).

Conclusion

Our study demonstrated a significant association of positive T wave in aVR lead and adverse clinical outcomes in STEMI patients. Nevertheless, the clinical utility of T-wave amplitude at aVR lead is limited by its low discriminative potential toward prognosis of STEMI.
The relationship between glomerular IgG staining and poor prognostic findings in patients with IgA nephropathy: the data from TSN-GOLD working group
Authors: Turgutalp Kenan , Cebeci Egemen , Turkmen Aydin , Derici Ulver , Seyahi Nurhan , Eren Necmi , Dede Fatih , Gullulu Mustafa , Basturk Taner , Sahin Gulizar Manga , Yilmaz Murvet , Sipahi Savas , Sahin Garip , Ulu Sena , Tatar Erhan , Gundogdu Ali , Kazancioglu Rumeyza Turan , Sevinc Can , Gungor Ozkan , Sahin İdris , Kutlay Sim , Kurultak Ilhan , Aydin Zeki , Altun Bulent , Dursun Belda , Yilmaz Zulfikar , Uzun Ozcan , Suleymanlar Gultekin , Candan Ferhan , Sezer Siren , Tanburoglu Derya Basak , Bahcebasi Zerrin Bicik , Taymez Dilek , Akcali Esra , Oygar Deren , Istemihan Zulal , Bardak Simge , Akcay Omer Faruk , Dincer Mevlut Tamer , Dervisoglu Erkan , Yenigun Ezgi , Turkmen Kultigin , Ozturk Savas
Published: October 2021

Background

Galactose-deficient IgA1 (Gd-IgA1) has an increased tendency to form immunocomplexes with IgG in the serum, contributing to IgAN pathogenesis by accumulating in the glomerular mesangium. Several studies showed that glomerular IgG deposition in IgAN is an important cause of mesangial proliferation and glomerular damage. This study aims to determine the association of the positivity of IgG and the intensity of IgG staining with a poor renal prognosis.

Methods

A total of 943 IgAN patients were included in the study. Glomerular IgG staining negative and positive patients were compared using Oxford classification scores, histopathological evaluations, proteinuria, eGFR, albumin, blood pressures. IgG positive patients were classified as (+), (++), (+++) based on their staining intensity, and the association with the prognostic criteria was also evaluated.

Results

81% (n = 764) of the patients were detected as IgG negative, while 19% (n = 179) were positive. Age, gender, body mass index, blood pressure, proteinuria, eGFR, uric acid values were similar in IgG positive and negative patients who underwent biopsy (p > 0.05). Intensity of glomerular IgG positivity was not found to be associated with diastolic and systolic blood pressure, urea, uric acid, age, eGFR, albumin, proteinuria (p > 0.05 for all, r = − 0.084, r = − 0.102, r = − 0.006, r = 0.062, r = 0.014, r = − 0.044, r = − 0.061, r = − 0.066, r = 0.150, respectively). There was no difference for histopathological findings between IgG (+), IgG (++), IgG (+++) groups (for all, p > 0.05).

Conclusion

Glomerular IgG negativity and positivity detected by routine IFM in IgAN patients is not associated with poor renal prognostic risk factors.