bluuebunny/crossref_metadata_2025 huggingface dataset:
Tapinarof: A Felicitous Discovery in Psoriasis Treatment
Authors: Prabath Indumathi , Subramanian Subhiksha , Rani Jamuna
Published: November 2022

Tapinarof is a novel topical formulation approved recently, in May 2022, by the United States Food and Drug Administration to treat plaque psoriasis. Existing topical therapies for psoriasis are limited by systemic and local adverse effects, medication cost and repeated administration, thus significantly hampering the compliance of patients to therapy. These limitations can be resolved by tapinarof owing to its better efficacy and favourable safety profile in psoriasis management. Tapinarof was developed with a unique mechanism targeting the aryl hydrocarbon receptor (AhR) involved in inflammation and modulation of skin barrier integrity in inflammatory dermatological disorders such as psoriasis and atopic dermatitis. The efficacy and safety outcomes of tapinarof in psoriasis were justified through the two pivotal clinical trials, namely, PSOARING 1 and PSOARING 2. The common adverse effects observed with tapinarof are folliculitis, contact dermatitis and headache. The literature search was conducted for efficacy and safety of tapinarof in the electronic databases of PubMed and Cochrane using a combination of keywords such as tapinarof, psoriasis and AhR. This review will delineate the molecular mechanisms underlying the action of tapinarof and also summarise the trial data supporting the claim that tapinarof is replacing the existing standard of care in psoriasis management.
Donor Breast Milk Banking: Knowledge and Attitudes of Iranian Mothers
Authors: Hosseinzadeh Mina , Mirghafourvand Mojgan , Sahebihagh Mohammadhassan , Aghajari Parvaneh , Denson Vicki L. , Golsanamloo Sima
Published: November 2022

Introduction:

Milk donation is allowed in Islam and considered a virtue, though according to Islam Sharia, feeding donated milk of other mothers leads to kinship between infants, complicating milk donation programs in Islamic countries. This study aimed to determine the knowledge and attitude of Iranian Muslim mothers regarding milk donation and milk banks.

Methods:

In this cross-sectional descriptive-analytic study, 634 mothers of infants below 1 year of age were recruited using cluster random sampling from health care centers in Tabriz, Iran. Data were collected by questionnaire.

Results:

The findings revealed a low level of knowledge but relatively positive attitudes. Knowledge predictors were education level, income, type of birth, breastfeeding experience, encouragement to donate milk, and hearing about milk donation ( p ≤ .02). Predictors of attitude were knowledge score and encouragement to donate milk ( p ≤ .001).

Discussion:

Comprehensive, culturally congruent education of mothers during pregnancy and post-pregnancy related to milk banks is recommended.
‘Agree to disagree’: Reconciling an English teacher’s identity tensions in negotiating an educational reform through a community of practice perspective
Authors: Gao Yuan , Cui Yaqiong , De Costa Peter I.
Published: November 2022

Educational reforms often precipitate teacher tensions that subsequently impact teacher identity (re)construction. Adopting a community of practice (CoP) framework to examine identity-, belief- and emotion-inflected tensions, and drawing on data from five rounds of interviews, our longitudinal case study traced the identity reformation of an English teacher, Lee, as he negotiated an English for Academic Purposes (EAP) reform in China. We found that Lee’s constant teacher identity conflicts were intertwined with tensions that arose as he negotiated his (1) beliefs about students’ needs and acknowledgment of their language incompetency, and (2) reform-positive emotions and self-negative emotions. Our findings revealed, however, that these tensions were mediated through the assistance afforded by his CoP, which, on the one hand, effectively scaffolded community members’ teaching practices and helped ease the tensions that emerged but, on the other hand, created space for multiple voices to coexist, make adjustments, and thus subsequently achieve reconciliation. Highlighting the role of CoP in teacher development, our findings help advance the teacher identity research agenda by taking a holistic view on work-related tensions, and thus bear implications for educational reformers, teacher educators, and university administrators.
Measuring speaking proficiency growth in the language classroom: An investigation of practical approaches for teachers
Authors: Leeming Paul , Harris Justin
Published: November 2022

Measurement of language learners’ development in speaking proficiency is important for practicing language teachers, not only for assessment purposes, but also for evaluating the effectiveness of materials and approaches used. However, doing so effectively and efficiently presents challenges. Commercial speaking tests are often costly, and beyond the budget of many schools, and the use of frameworks such as Complexity, Accuracy, Lexis, and Fluency place great demand on teachers’ limited time. This article reports on two tests that potentially offer a practical solution to these problems. The speaking proficiency of 75 students in an oral English course at a university in Japan was measured three times over the course of an academic year using short, spoken narratives assessed by human raters with a specially-designed rubric, and a completely automated computer-based test. The many-facet Rasch measurement model was used to analyse the human raters and the rubric, and to provide scores for the subsequent analyses. Mixed-level modeling was used to model growth in speaking proficiency over the academic year, and correlation was used to assess the relationship between the two test types. The results show that both tests were able to measure growth in speaking proficiency, but only in the first half of the year. There was moderate correlation between concurrent administrations of the two tests, suggesting they are measuring the same construct. Results of the narrative test suggest that the rubric was reliable and effective in measuring speaking proficiency in this context, and also provide strong evidence supporting the use of FACETS when human raters are used to evaluate speaking.
Improving the shear design of steel-bar reinforced ultra high performance fibre reinforced concrete beams using mesoscale modelling
Authors: Zhang Yuming , Yang Zhenjun , Zhang Hui , Tsang Neil , Zhang Xiaoxian
Published: November 2022

Understanding the failure mechanisms of steel-bar reinforced ultra high performance fibre reinforced concrete (UHPFRC) beams is crucial to improving their design but challenging because of the contrast between beam size and fibre size. We develop a 2D mesoscale finite element model with the fibres explicitly resolved to bridge this gap by simulating the damaging and fracturing processes of the beams. To make fibre distribution in the model mechanically representative, we propose a method to project the fibres from 3D to 2D. The continuum damaged plasticity model is used as the constitutive law for the UHPC matrix, and the zero-thickness cohesive elements with softening constitutive law are used to model the nonlinear bond-slip behaviour of the fibre- and bar-matrix interfaces. The models are validated against experimental data obtained from 3 and 4-point loading tests by comparing the simulated and measured fracturing processes, crack patterns and the load-displacement curves. The validated models are then used to analyse the sensitivity of the shear strength of the beams to fibre content, shear span-to-depth ratio, as well as shear and longitudinal reinforcement ratios in the beam, from which a shear strength equation is proposed to improve the design of reinforced UHPFRC beams. The improvement of the new equation over the AFGC equation is demonstrated against experimental data measured from 32 beams with various material properties.
Development of cross-cultural performance criterion measures: Critical issues and practical solutions
Authors: Kochert Jonathan , Kirshenbaum Jacqueline M , Bigerton Kayla , Scymcyk Jackie , McFerran Michael , Ezzo Chelsea
Published: November 2022

There is a need to carefully evaluate the criteria used to measure cross-cultural performance. Research on criteria measurement development for cross-cultural performance is needed because the current literature lacks clear, well-defined criteria and means to measure it well. This article aims to bridge that gap in three ways. First, we highlight five critical issues that should be considered with regard to cross-cultural performance. These five critical issues include: criterion conceptualization, rater source, standardization, retrospective versus in-situ ratings, and rater usability. Along with a discussion of each issue, techniques are presented to address each issue. Second, to illustrate and improve upon these issues, we present a case study on the development of cross-cultural performance as a criterion concept and corresponding criterion assessment tools in a military context. Specifically, we demonstrate how we defined a cross-cultural performance taxonomy used to develop measurable performance-based criteria. We describe a large-scale criterion development effort conducted to systematically develop and validate two criterion measures of cross-cultural performance used in military training contexts that simulate real-world situations. Third, in an effort to guide and focus how the cross-cultural performance space is defined, we recommend various approaches to future cross-cultural performance criteria development.
Characterizing Intimate Partner Violence in the United States During the COVID-19 Pandemic: A Systematic Review
Authors: Bhuptani Prachi H. , Hunter Julia , Goodwin Caroline , Millman Christopher , Orchowski Lindsay M.
Published: November 2022

Intimate partner violence (IPV) is a significant global health concern. Numerous research studies document increases in IPV since the onset of the COVID-19 pandemic in March 2020. Despite this widespread recognition, research around the nature of this violence is still growing. This systematic review summarizes the existing literature documenting the prevalence and characteristics of IPV during the COVID-19 pandemic. Inclusion criteria are as follows: reported original data empirical study, assessed for IPV among adult population in the United States, and was published in English between December 2019 and March 2022. A total of 53 articles were then independently reviewed and sorted into four thematic subcategories: victimization, perpetration, articles addressing victimization and perpetration, and provider perspectives. Studies document consistent increases in the prevalence of IPV victimization and perpetration. Providers within agencies providing support to individuals impacted by IPV also documented increased strain on the agencies.
The impact of government subsidies on firms’ innovation inputs and outputs in the early stage of the wind industry development
Authors: Gao Xue
Published: November 2022

Government subsidies are necessary to stimulate firms’ private investments and innovation activities. Although many studies have examined the relationship between government subsidies and innovations in developed countries, only a few studies focus on emerging industries in developing countries. This study aims at estimating the impact of government subsidies on firms’ investments and innovation in the early stage of the Chinese wind industry using propensity score matching. The results show that government subsidies have no statistically significant impacts on firms’ innovation outcomes and R&D investments in the early stage of the industry, while both estimates are positive. These policy outcomes might result from the non-R&D use of government subsidies, the uncertainty of market demand, and the insufficient amount and the uncertainty of the durability of government subsidies in 2007. This study provides implications for the design of government subsidy policies to build domestic renewable energy industries in the early development stage.
Hispanic Suicides in Miami-Dade County, Florida, 2008–2018
Authors: Brenes Francisco , Beason Ferrona , Koncsol Stephen , Umadhay Tony , Chin Claudette , Cachon Pedro , Scaccianoce Monica
Published: November 2022

Suicide is a leading cause of death in Hispanic Americans. Although this population is growing rapidly, particularly in geographic areas such as Miami-Dade County, Florida, few studies have examined suicide in Hispanics. The purpose of this cross-sectional study was to examine associations between suicide and demographic characteristics among Hispanics in Miami-Dade County, Florida, between 2008 and 2018. A total of 1,601 Hispanics died from suicide. Cubans ( n = 1,145) represented nearly three quarters of the suicides, while Central or South Americans ( n = 119), Puerto Ricans ( n = 59), and Mexicans ( n = 29) accounted for lower intentional deaths. Furthermore, although no correlation between suicide and age was found, significantly more than half of the suicides were men, X2 (1, N = 1,600) = 361.894, p < .001 ( p = .000). Hispanic male suicides were 4.52 more frequent than Hispanic female firearm suicides. Men were more likely to use firearms, while women were more likely to choose drugs, substances, or some other form of method. Intentional deaths were unequal across locations, Χ2 (3, N = 1,601) = 603.764, p < .001 ( p = .000), with increased incidence occurring at the Hispanic's home. The second most common suicide location was health care facilities for drugs. Researchers should collaborate with health care providers to increase suicide research and eliminate disparities in at-risk Hispanic Americans.
Effects of flywheel resistance training using horizontal vs vertical exercises
Authors: Asencio Pablo , Hernández-Davó Jose L , García-Valverde Adrián , Sabido Rafael
Published: November 2022

Flywheel resistance training is a very useful method to optimize athletic performance. However, research assessing the different loading conditions hypothesis during flywheel resistance training is scarce. The aim of this study was to assess the influence of the loading conditions used during flywheel resistance exercise on improvements in athletic performance. Twenty nine (29) athletes were randomly assigned to three different flywheel resistance training groups: vertical-directed exercises (VR), horizontal-directed exercises (HR) and a mixed group (MIX). Performance assessment included one repetition maximum (1-RM) in the half-squat exercise, countermovement jump (CMJ) performance and change of direction (COD) ability (5-0-5 agility test). For the 1-RM squat, significant improvements were found in the VR ( p = 0.011) and MIX groups ( p = 0.015). All groups showed significant increases in CMJ height ( p < 0.05), and significant decreases in 5-0-5 time with the non-dominant leg ( p < 0.05). As regards 5-0-5 with the dominant leg, the VR ( p = 0.004) and MIX groups ( p = 0.001) showed significant decreases in 5-0-5 time. Non-significant group × time interactions were noted. In conclusion, all groups showed similar improvements in 1-RM squat, jumping and COD performance. However, the inclusion of vertical-directed exercises seems to optimize increases in 1-RM squat.
Performance improvement of microbial fuel cells through assembling anodes modified with nanoscale materials
Authors: Liang Huanhuan , Han Jiali , Yang Xingai , Qiao Zhixing , Yin Tao
Published: November 2022

In microbial fuel cell (MFC), the anode is the carrier of microbial attachment and growth, and its material and surface structure play a vital role in MFC electricity generation. Therefore, anode surface optimization is an effective way to improve MFC performance. Although the power generation of bacteria has been confirmed and studied as early as the beginning of the 20th century, up to now, MFC still has the extremely challenging problem of low current and low power output in practical application. To improve the performance of MFC, several strategies have been applied to enhance the bacterial extracellular electron transfer. One promising technology is the genetic engineering approach, and some outstanding research results have been obtained. Another effective strategy is to design and fabricate a high-performance electrode because anode material is the essential factor affecting MFC performance, which provides surface active sites for microbial adhesion, reproduction and interfacial electron transfer. At present, the MFC anodes mainly include carbon-based electrodes and a variety of metal electrodes, but untreated anodes have always been unable to overcome the obstacle of low power output. Anode modification, a common and effective method, is employed for improving the power output of MFC. For this reason, this review is primarily focused on the applications of various anode materials and its nanoscale modification in the field of MFC, including the influence of different anode materials on the power output of MFC, and analyzes the reasons why anode modification enhances output performance. Furthermore, the influence of anode research on the practical application of MFC in the future is prospected.
Evaluating a serious game to improve childhood cancer patients' treatment adherence
Authors: Chai Carmen Wang Er , Lau Bee Theng , Tee Mark Kit Tsun , Al Mahmud Abdullah
Published: November 2022

Objective

Childhood cancer patients need to have good treatment adherence. Unfortunately, treatment non-adherence often occurs due to high side-effect burdens of treatment and the lack of knowledge of one's illness and treatment. Therefore, a serious game intervention based on the Protection Motivation Theory (PMT) was designed and developed to motivate childhood cancer patients to undergo treatment, perform daily self-care and educate them about their illness.

Methods

Childhood cancer patients (6–17 years old) and their caregivers were recruited in a multi-centre, single-arm intervention in Malaysia. A total of 24 child-caregiver dyads have completed the study. This study used PMT-based surveys to collect quantitative data regarding children's motivation to adhere to treatment and perform daily self-care. Additionally, a 20-question multiple-choice quiz was used to determine children's knowledge levels. These surveys were conducted pre-test and post-test. Children's and caregivers' feedback were also gathered post-test as qualitative data.

Results

The results showed that overall, the children's intention to undergo cancer treatment had increased significantly. A significant increase in the intention to perform daily self-care was found among younger children, while older children showed significant improvement in their cancer knowledge levels. The post-test feedback suggested that the game was liked by both children and caregivers and it provided various benefits to children with cancer.

Conclusions

Findings suggest that the intervention has the potential to improve childhood cancer patients’ motivation for treatment adherence and daily self-care, in addition to educating them about cancer and treatment.
Preoperative Assessment of Bone Density Using MRI-Based Vertebral Bone Quality Score Modified for Patients Undergoing Cervical Spine Surgery
Authors: Huang Weibo , Gong Zhaoyang , Zheng Chaojun , Chen Yu , Ma Xiaosheng , Wang Hongli , Jiang Jianyuan
Published: November 2022

Study design

Diagnostic accuracy study.

Objectives

Previous studies have reported the clinical application of the Vertebral Bone Quality (VBQ) scores for assessing bone density in operative lumbar spine patients. We aim to explore whether the method could be modified and applicable for patients undergoing cervical spine surgery.

Methods

Adult patients receiving cervical spine surgery for degenerative diseases between September 2020 and March 2022 with non-contrast T1-weighted MRI and DEXA were included. Correlation between cervical VBQ scores and DEXA T-scores was analyzed using Pearson’s correlation. Student’s t test was used to present the discrepancy between the VBQ of patients with normal bone density (T ≥ -1.0) and patients with osteopenia/osteoporosis (T < -1.0). Statistical significance was set at P < .05.

Results

Eighty-three patients (20 patients with T ≥ -1.0 vs 63 patients with T < -1.0 ) were included. Significant difference was found between the cervical VBQ between groups (2.99 ± .79 vs 3.80 ± .81, P < .001). Interclass correlation coefficient for inter-rater reliability was .82 (95% CI: .70-.93) and .91(95% CI: .84-.97) for intra-rater reliability. The area under the ROC curve was .78 (95% CI: .65-.90). The DEXA T-score of the femoral neck, total hip and the lowest DEXA T-score were found to be significantly correlated with the cervical VBQ score according to Pearson correlation analysis ( P < .001).

Conclusions

This is the first study to apply the VBQ method to assess the bone density in preoperative cervical spine patients. Cervical VBQ scores were significantly correlated with DEXA T-score. With an overall accuracy of .78, the radiation-free and cost-effective method could be a potential tool for screening patients with osteopenia and osteoporosis before surgery.
My Enemy’s Enemy: Iran’s Approach to the Re-emergence of the Taliban
Authors: Abbasian Parisa
Published: November 2022

Over the years, Iran’s approach to the Taliban has had ups and downs. Iran welcomed the United States’ 2001 invasion of Afghanistan and worked with the American forces to overthrow the Taliban. Nevertheless, it was not long before Iran adopted an utterly opposite policy by compromising with the Taliban and supplying it with political and military support. This article examines domestic and regional factors contributing to this dramatic change in Iran’s behaviour toward the Taliban. It provides an assessment of how Tehran’s threat perception of the US military presence across its borders, the rise of the Islamic State in Khorasan Province, the increasing Afghan drug trafficking, and the influx of refugees from Afghanistan to Iranian territory have prompted Tehran to pursue a different approach toward the Taliban. It also explains how Iran’s intention to sustain water supply from Afghanistan’s rivers to the eastern provinces of Iran and resume profitable trade with Afghanistan has acted as a catalyst in expanding Iran–Taliban relations. This article argues that Iran sees the Taliban as an agent to weaken the United States, prevent the spread of ISIS in Khorasan, and strengthen Iran’s influence in Central Asia. The article concludes that although the Taliban’s rise to power in Afghanistan poses challenges for Iran, the benefits it brings are such that it prevents Tehran from relinquishing ties with the Taliban.
Bispecific antibodies for the treatment of B-cell lymphoma: promises, unknowns, and opportunities
Authors: Falchi Lorenzo , Vardhana Santosha A. , Salles Gilles A.
Published: November 2022

Treatment paradigms for B-cell non-Hodgkin lymphomas (B-NHL) have shifted dramatically in the last 2 decades following the introduction of highly active immunotherapies such as rituximab. Since then, the field has continued to witness tremendous progress with the introduction of newer, more potent immunotherapeutics, including chimeric antigen receptor T-cell therapy, which have received regulatory approval for and currently play a significant role in the treatment of these diseases. Bispecific antibodies (BsAb) are a novel class of off-the-shelf T-cell redirecting drugs and are among the most promising immunotherapeutics for lymphoma today. BsAb may target various cell-surface antigens and exist in different formats. Anti-CD20xCD3 BsAb have demonstrated remarkable single-agent activity in patients with heavily pretreated B-NHL with a manageable toxicity profile dominated by T-cell overactivation syndromes. Much work remains to be done to define the optimal setting in which to deploy these drugs for B-NHL treatment, their ideal combination partners, strategies to minimize toxicity, and, perhaps most importantly, pharmacodynamic biomarkers of response and resistance. In this review, we provide an update on BsAb development in B-NHL, from discovery to clinical applications, highlighting the achievements, limitations, and future directions of the field.
Accurate measurement of intrinsic positive end-expiratory pressure: how to detect and correct for expiratory muscle activity
Authors: Zakynthinos SG , Vassilakopoulos T , Zakynthinos E , Roussos C
Published: November 2022

It has been shown that expiratory muscle contraction leads to an overestimation of intrinsic positive end-expiratory pressure (PEEPi). To quantify this overestimation, we compared PEEPi, measured during spontaneous breathing (SB) by the end-expiratory airway occlusion technique (PEEPi,occl) with static PEEPi (PEEPi,st). PEEPi,st was measured using end-expiratory airway occlusion during simulation of SB by the ventilator with the patient relaxed, and was considered to represent the "gold standard" for PEEPi,occl. Twelve ventilator-dependent patients were studied during SB (pressure support 5-7 cmH2O). Full mechanical ventilation was resumed when they were unable to sustain SB. Subsequently, by manipulating the variables of the ventilator, we simulated the pattern of SB and measured PEEPi,st, corresponding to PEEPi,occl. On the basis of the presence or absence of expiratory rise in gastric pressure (Pga) (rapid drop of end-expiratory Pga at the beginning of inspiration, Pga,exp,rise), and abdominal muscle electromyographic (EMG) activity, patients were subdivided into those either actively (Group 1) or passively expiring (Group 2). In Group 1 (8 patients), PEEPi,occl was higher than PEEPi,st (13.3+/-2.0 vs 6.8+/-1.1 cmH2O; p<0.01). PEEPi,occl-Pga,exp,rise (6.9+/-1.1 cmH2O) was quite similar to PEEPi,st; their mean difference was 0.03 cmH2O with limits of agreement -0.48 to +0.53 cmH2O. In Group 2, PEEPi,occl was similar to PEEPi,st. We conclude that, in actively expiring patients, an accurate estimation of the actual PEEPi,st can be obtained by subtracting Pga,exp,rise from PEEPi,occl.
Relationship between transdiaphragmatic and mouth twitch pressures at functional residual capacity
Authors: Laghi F , Tobin MJ
Published: November 2022

The clinical application of transdiaphragmatic twitch pressure (Pdi,tw) response to phrenic nerve stimulation has been hindered by the requirement for placement of oesophageal and gastric balloons. Investigators have reported that mouth twitch pressure (Pmo,tw) estimates Pdi,tw accurately at lung volumes above and below functional residual capacity (FRC). However, it is not known whether Pmo,tw estimates Pdi,tw accurately when stimulation is performed at FRC during relaxed conditions. The aim of this study was to develop a simple method whereby measurements of Pmo could be used to predict oesophageal twitch pressure (Poes,tw) and possibly Pdi,tw at FRC. The study was performed in 11 healthy volunteers during phrenic nerve stimulation. At FRC, 9 of the 11 subjects showed a poor correlation between Pmo,tw and Poes,tw, and between Pmo,tw and Pdi,tw, probably due to varying degrees of glottic closure. Stimulations performed while subjects maintained an inspiratory flow of approximately 50 mL x s(-1), or at the point of reattaining FRC during an inspiration preceded by a limited exhalation, produced good correlations between Pmo,tw and Poes,tw (r=0.97 in both instances) and Pmo,tw and Pdi,tw (r=0.96 and r=0.95, respectively), with a steep slope. The respective slopes for the Pmo,tw Poes,tw relationship were 0.88 and 0.94, and for the Pmo,tw Pdi,tw relationship, 0.59 and 0.54. Unfortunately, these manoeuvres produced a significant increase in transpulmonary pressure (3.6+/-0.6 (SE) and 5.6+/-1.4 cmH2O, respectively), suggesting change in diaphragmatic length. Stimulations delivered while subjects performed an inspiratory effort or during exhalation against a high resistance preceded by a limited inhalation could not be used to predict Poes,tw and Pdi,tw from Pmo,tw. In conclusion, although transdiaphragmatic and oesophageal twitch pressure could be predicted from mouth twitch pressure during some inspiratory manoeuvres mouth twitch pressure was not reliable for the prediction of the oesophageal and transdiaphragmatic twitch pressure at functional residual capacity during relaxed conditions in healthy volunteers.
Breathing pattern during sleep disruptive snoring
Authors: Bloch KE , Li Y , Sackner MA , Russi EW
Published: November 2022

Breathing disturbances during snoring have been quantified by face mask pneumotachography and oesophageal catheters. In order to nonobtrusively investigate respiratory mechanics during nonapnoeic snoring in relation to sleep disturbances, we employed calibrated respiratory inductive plethysmography (RIP). In 10 snorers, RIP recordings were studied during nonapnoeic snoring without arousals in non-rapid eye movement (NREM) sleep, nonapnoeic snoring with repetitive arousals in NREM sleep and wakefulness. Results were compared to RIP recordings in undisturbed NREM sleep and wakefulness in seven healthy nonsnorers. Compared to wakefulness and undisturbed NREM sleep in nonsnorers, snoring was associated with predominant thoracic breathing, ribcage/abdominal asynchrony, and increased fractional inspiratory time. Preceding arousals during snoring, inspiratory flattening of time-derivatives of RIP volume signals, and marked ribcage/abdominal asynchrony indicated pronounced flow limitation. Low variation coefficients of respiratory cycle time (<10%) and tidal volume (<20%) discriminated snoring periods without arousals from snoring periods with arousals and from wakefulness periods, with a sensitivity of 100% and a specificity of 99%. Snoring periods with arousals were identified by the presence of snoring combined with high coefficients of variation of cycle time (> or =10%) and tidal volume (> or =20%), with a sensitivity of 96% and a specificity of 100%. Thus, characteristic patterns of ribcage/abdominal motion recorded by respiratory inductive plethysmography differentiated breathing in sleep disruptive snoring from simple snoring.
Persistence of airway hyperresponsiveness and viral antigen following respiratory syncytial virus bronchiolitis in young guinea-pigs
Authors: Riedel F , Oberdieck B , Streckert HJ , Philippou S , Krusat T , Marek W
Published: November 2022

Respiratory syncytial virus (RSV) bronchiolitis in infancy is known to be followed by chronic respiratory symptoms and airway hyperresponsiveness in a subgroup of patients. To further investigate the pathogenesis of RSV-induced chronic airway pathology, we infected young guinea-pigs at 4 weeks of age with RSV applied as an aerosol (n=30), and control guinea-pigs with virus-free culture medium (n=24). Infection was confirmed by positive antibody titre to RSV after 6 weeks, and by typical pathological changes of bronchiolitis after 1 week in six animals from each group. Airway hyperresponsiveness was measured weekly for 5 weeks by histamine challenge, using body-plethysmographic measurement of compressed air (CA). The provocative concentration of histamine producing significant airway obstruction (i.e. CA = 0.1 mL) (PC0.1 mL CA in mg x mL(-1)) was calculated from dose-response curves. Six weeks postinfection, the lungs were investigated for the presence of inflammation and of viral antigen by immunofluorescence and immunohistochemistry using a rabbit hyperimmune serum and monoclonal antibodies. Airway responsiveness was increased in the RSV group 1 week postinfection compared to the control group (PC0.1 mL CA median 2.50 vs >10 mg x mL(-1); p<0.001) and this persisted up to 5 weeks postinfection (PC0.1 mL CA median 1.61 vs >10 mg x mL(-1); p<0.001). During the same period, viral antigen persisted in the lungs of infected animals, although there was less inflammation at 6 weeks postinfection than at 1 week postinfection. In guinea-pigs, respiratory syncytial virus infection of the airways causes persistent airway hyperresponsiveness over a period of at least 5 weeks. During this time, viral antigen, but not inflammation, remains detectable in the lungs and might be responsible for ongoing airway hyperresponsiveness.
Assessment of xanthine oxidase in human lung and lung transplantation
Authors: Kinnula VL , Sarnesto A , Heikkila L , Toivonen H , Mattila S , Raivio KO
Published: November 2022

Oxygen free radical generation by xanthine oxidase (XO) is a possible mechanism in the injury following reperfusion of transplanted organs. This study was undertaken to investigate XO in human lung, and to investigate whether XO is released into the blood stream during the immediate postoperative period after lung transplantation. XO activity was measured in healthy human lung tissue, and XO protein and the adenine nucleotide catabolic products hypoxanthine, xanthine and uric acid were analysed in the plasma samples collected during human heart-lung transplantation (n=4), double lung transplantation (n=2), and single lung transplantation (n=1). Neutrophil degranulation was assessed by plasma lactoferrin measurements. The results indicated that XO activity (detection limit 5 pmol x min(-1) x mg(-1) protein) and protein (detection limit 5 ng x mg-1 protein) were undetectable in the lungs of five healthy individuals. Similarly, no XO protein could be found in the plasma samples from the right ventricle or left atrium during and after the transplantation in any of the cases. Plasma xanthine and hypoxanthine concentrations were elevated 2-10 fold immediately after the reperfusion of the transplant, indicating washout of high-energy phosphate degradation products from the ischaemic lung. Plasma uric acid decreased rather than increased immediately after the surgery and during the following 24 h. Lactoferrin was elevated during the surgery. In conclusion, these results show that XO activity in human lung is low, it is not released into the blood stream during human heart-lung transplantation, and it is unlikely to contribute to postoperative complications in these patients.
The impact of inspiratory effort on inspiratory flow through Turbuhaler in asthmatic patients
Authors: Persson G , Olsson B , Soliman S
Published: November 2022

To investigate the impact of the inhalation effort on the peak inspiratory flow through Turbuhaler, 100 asthmatics having a wide range of asthma severity (baseline forced expiratory volume in one second 28-127% of predicted normal) were studied. Each patient inhaled through four modifications of empty Turbuhaler inhalers, using first a "deep" inhalation and then a "forceful and deep" inhalation manoeuvre. Peak inspiratory flow increased by an average of 20% using a "forceful and deep" as compared to a "deep" inhalation, with a markedly higher increase for the patients who had a low peak inspiratory flow using the deep inhalation. Virtually all patients (97-100%) attained a peak inspiratory flow > or = 40 L x min(-1) after a "forceful and deep" inhalation. This study demonstrates that instructing the patient to take a "forceful and deep" inhalation optimizes the use of Turbuhaler. Irrespective of asthma severity, the vast majority of patients could attain a sufficiently high peak inspiratory flow with a "forceful and deep" inhalation.
The binding of surface proteins from Staphylococcus aureus to human bronchial mucins
Authors: Trivier D , Houdret N , Courcol RJ , Lamblin G , Roussel P , Davril M
Published: November 2022

Colonization by Staphylococcus aureus is frequently observed in obstructive lung diseases, particularly in cystic fibrosis. It has been shown that the bacteria bind to mucins, the main constituent of bronchial secretions. The binding mechanism, however, remains unclear. We have investigated the interactions of two strains of S. aureus, one mucoid and one nonmucoid, with human bronchial mucins. Using a solution phase assay, the binding capacity of the two strains to radiolabelled bronchial mucins was assessed. The bacterial constituents were released by lysostaphin lysis and the surface components of the nonmucoid strain were extracted with the use of a detergent (3-([3-cholamidopropyl] dimethylammonio)-1-propane sulphonate (CHAPS)). All were analysed for mucin-binding using an overlay assay. The amount of mucins bound to the nonmucoid strain was threefold greater than that of the mucoid strain. In the lysostaphin extract from the mucoid strain, only a 57 kDa protein faintly bound 125I-labelled mucins, whereas three mucin-binding proteins (52, 57 and 71 kDa) were identified from the nonmucoid strain. Two surface proteins, one major at 60 kDa and one minor at 71 kDa, bound radiolabelled bronchial mucins and their binding was almost completely inhibited by ovine submaxillary mucin. These results indicate: 1) differences in the mucin-binding capacity from one strain of S. aureus to another; and 2) the presence of external and internal adhesins binding to human respiratory mucins in the nonmucoid strain.
Value of fibreoptic bronchoscopy in the diagnosis of complicated pulmonary unilocular cystic hydatidosis
Authors: Saygi A , Oztek I , Guder M , Sungun F , Arman B
Published: November 2022

Complicated pulmonary unilocular cystic hydatidosis (CPUCH) is a serious condition, which requires immediate treatment. The aim of the present study was to evaluate the efficacy of fibreoptic bronchoscopy (FOB) in the final diagnosis of CPUCH. Of 1,726 cases, who underwent FOB evaluation between 1990 and 1994 in our centre, 24 patients (17 females and 7 males), who had proven CPUCH after thoracotomy, were included in this study. Fourteen of the 24 cases were diagnosed in the preoperative period by cytological and histopathological evaluation of FOB material, whereas the remaining 10 cases with presumed CPUCH underwent thoracotomy for final diagnosis. Of the 14 cases diagnosed by FOB (11 females and 3 males); none had concomitant extrapulmonary hydatid disease. Whitish-yellow membranes were seen in 12 of the cases during FOB. Whilst cuticular particles, degenerated scoleces, and hooklets were seen in 14 cases in bronchial lavage, these elements were identified in brushing material in only seven. In 10 of the 14 cases, cytological diagnosis was confirmed by FOB biopsies before thoracotomy. It is concluded that whilst the clinical, radiological and laboratory findings are presumptive, fibreoptic bronchoscopic examination and the cytological and histopathological examination of material obtained during that procedure are conclusive for the diagnosis of complicated pulmonary unilocular cystic hydatidosis.
Gender difference in smoking effects on lung function and risk of hospitalization for COPD: results from a Danish longitudinal population study
Authors: Prescott E , Bjerg AM , Andersen PK , Lange P , Vestbo J
Published: November 2022

Recent findings suggest that females may be more susceptible than males to the deleterious influence of tobacco smoking in developing chronic obstructive pulmonary disease (COPD). This paper studies the interaction of gender and smoking on development of COPD as assessed by lung function and hospital admission. A total of 13,897 subjects, born after 1920, from two population studies, 9,083 from the Copenhagen City Heart Study (CCHS) and 4,814 from the Glostrup Population Studies (GPS), were followed for 7-16 yrs. Data were linked with information on hospital admissions caused by COPD. Based on cross-sectional data, in the CCHS the estimated excess loss of forced expiratory volume in one second (FEV1) per pack-year of smoking was 7.4 mL in female smokers who inhaled and 6.3 mL in male smokers who inhaled. In the GPS, the corresponding excess loss of FEV1 was 10.5 and 8.4 mL in females and males, respectively. Two hundred and eighteen subjects in the CCHS and 23 in the GPS were hospitalized during follow-up. Risk associated with pack-years was higher in females than in males (relative risks (RRs) for 1-20, 20-40 and >40 pack-years were 7.0 (3.5-14.1), 9.8 (4.9-19.6) and 23.3 (10.7-50.9) in females, and 3.2 (1.1-9.1), 5.7 (2.2-14.3) and 8.4 (3.3-21.6) in males) but the interaction term gender x pack-years did not reach significance (p=0.08). Results were similar in the GPS. After adjusting for smoking in more detail, females in both cohorts had an increased risk of hospitalization for COPD compared to males with a RR of 1.5 (1.2-2.1) in the CCHS and 3.6 (1.4-9.0) in the GPS. This was not likely to be caused by a generally increased rate of hospital admission for females. Results were similar when including deaths from COPD as endpoint. In two independent population samples, smoking had greater impact on the lung function of females than males, and after adjusting for smoking females subsequently suffered a higher risk of being admitted to hospital for COPD. Results suggest that adverse effects of smoking on lung function may be greater in females than in males.
Increased bronchoalveolar granulocytes and granulocyte/macrophage colony-stimulating factor during exacerbations of chronic bronchitis
Authors: Balbi B , Bason C , Balleari E , Fiasella F , Pesci A , Ghio R , Fabiano F
Published: November 2022

Although inflammatory changes are found throughout the airways of patients with chronic bronchitis, the mechanisms of the pathogenesis of chronic bronchitis are still unclear. The aim of this study was to investigate airways inflammation in patients with and without an exacerbation of bronchitis. Thirteen chronic bronchitic patients and nine normal subjects were studied. Eight of the patients were studied under baseline conditions (B), and five during an exacerbation of bronchitis (E). Bronchoscopy and bronchoalveolar lavage (BAL) with cytological analysis were performed, and the levels of granulocyte/macrophage colony-stimulating factor (GM-CSF) were determined in sera and in BAL supernatants by a solid phase enzyme immunoassay. Compared with patients under baseline conditions, chronic bronchitic patients with an exacerbation had increased numbers of BAL neutrophils (10+/-3 and 83+/-18x10(3) cells x mL(-1), respectively; p<0.0001) and of BAL eosinophils (1.9+/-0.5 and 6.7/-1.9x10(3) cells x mL(-1), respectively; p=0.014). Patients with chronic bronchitis, as a whole, had significantly increased levels of BAL GM-CSF compared to control subjects (36+/-5 and 19+/-4 pg x mL(-1), respectively; p=0.035), and similar levels of serum GM-CSF. Serum levels of GM-CSF were markedly increased in chronic bronchitic patients with an exacerbation, as compared with patients under baseline conditions (1.4+/-0.4 and 13+/-1 pg x mL(-1), respectively; p <0.0001). BAL levels of GM-CSF were also increased in chronic bronchitic patients with an exacerbation (25+/-5 and 54+/-8 pg x mL(-1), respectively; p=0.009). During exacerbations of chronic bronchitis there are changes in the cell populations in bronchoalveolar lavage of patients consistent with a recruitment of polymorphonuclear leucocytes in the airway lumen. The increased levels of granulocyte/macrophage colony-stimulating factor might suggest a role for this cytokine in the inflammatory processes of chronic bronchitis.
Allergic alveolitis following exposure to epoxy polyester powder paint containing low amounts (<1%) of acid anhydrides
Authors: Piirila P , Keskinen H , Anttila S , Hyvonen M , Pfaffli P , Tuomi T , Tupasela O , Tuppurainen M , Nordman H
Published: November 2022

Only one case report concerning allergic alveolitis caused by polyester powder paint has been published previously. The aim of this study was to determine whether phthalic anhydride (PA) or trimellitic anhydride (TMA) is the alveolitis-causing agent in such paint. A 61 year old woman showed recurrent symptoms of chills, cough, and fever whilst at work. She was working in a plant where epoxy polyester powder paints were used to paint metal. The paint was found to contain low (<1%) amounts of TMA and PA. The patient showed shadowing on chest radiographs. In bronchoalveolar lavage, lymphocytosis (67%) and a low T-helper/T-suppressor ratio (0.2) were found. Transfer factor was within normal limits, but a slight reduction was verified after re-exposure to the paint. The symptoms, exposure, reduction in transfer factor, findings on chest radiographs and bronchoalveolar lavage were consistent with allergic alveolitis. In conclusion, the polyester powder paint used in the plant caused allergic alve olitis in this patient. Of the constituents in the paint, trimellitic anhydride and phthalic anhydride were the possible causative agents.
Atypical mycobacteriosis in a lung transplant recipient
Authors: Baldi S , Rapellino M , Ruffini E , Cavallo A , Mancuso M
Published: November 2022

Although mycobacterial infections are more frequent in lung transplant recipients than in other solid organ recipients only occasional reports of infection from atypical Mycobacteria have been reported in patients receiving lung transplantation. We present a case of pleural and cutaneous infection due to Mycobacterium fortuitum in a double-lung transplant recipient. The infection was rapidly responsive to therapy with a two drug regimen and no reduction of immunosuppression was necessary.
Diffuse pulmonary calcinosis without calcium metabolism abnormalities in a renal transplant recipient
Authors: Romagnoli M , Mourad G , Serre I , Senac JP , Paradis L , Godard P , Chanez P
Published: November 2022

Eighteen years after an uneventful renal transplantation, the chest radiograph of an asymptomatic 50 year old man showed diffuse bilateral infiltrations, predominately at the right apex. Computed tomography (CT) scan demonstrated a diffuse alveolar pattern, the alveoli being filled with a very dense material, with some tracheal calcifications. Bronchoalveolar lavage fluid analysis was normal, but bronchial and transbronchial biopsies revealed calcium deposits in the bronchial mucosa and in the alveolar septa. The diagnosis of diffuse pulmonary calcinosis was established, despite normal blood calcium, phosphorus and magnesium levels, based upon computed tomography scan and pathological findings at fibreoptic bronchoscopy, without the need for an open lung biopsy.
Individual lung blood flow during unilateral hypoxia: effects of inhaled nitric oxide
Authors: Hambraeus-Jonzon K , Bindslev L , Frostell C , Hedenstierna G
Published: November 2022

We hypothesized that the diversion of blood away from a hypoxic lung to the opposite oxygenated lung can be enhanced by inhaling nitric oxide (NO) into the oxygenated lung. We measured individual lung blood flow when 50 ppm NO was selectively inhaled to: a hyperoxic lung during contralateral hypoxia; a normoxic lung during bilateral normoxia; and a hyperoxic lung during bilateral hyperoxia. Twenty two patients with healthy lungs were studied during intravenous anaesthesia. The lungs were separately and synchronously ventilated. The relative perfusion of each lung was assessed by the inert gas elimination technique. Unilateral hypoxic (inspiratory oxygen fraction (FI,O2) 0.05) ventilation during contralateral hyperoxia reduced the perfusion of the hypoxic lung from a mean (SD) of 47 (9)% of cardiac output (Q'), to 30 (7)% (p<0.001) of Q'. NO inhalation to the hyperoxic lung increased its blood flow from 70 (7)% to 75 (6)% (p<0.05) of Q', and reduced the blood flow to the hypoxic lung to 25 (6)% (p<0.05). Unilateral NO inhalation during bilateral normoxia or hyperoxia had no effect on pulmonary blood flow distribution. Nitric oxide inhalation to a hyperoxic lung increases the perfusion to this lung by redistribution of blood flow if the opposite lung is hypoxic.