bluuebunny/crossref_metadata_2025 huggingface dataset:
The Impact of the Indonesian Chronic Disease Management Program (PROLANIS) on Metabolic Control and Renal Function of Type 2 Diabetes Mellitus Patients in Primary Care Setting
Authors: Alkaff Firas Farisi , Illavi Fauzan , Salamah Sovia , Setiyawati Wiwit , Ramadhani Ristra , Purwantini Elly , Tahapary Dicky L.
Published: January 2021

Background:

Indonesia through its government National Health Insurance System has launched a non-communicable and chronic disease management program named Indonesian Chronic Disease Management Program (PROLANIS), with Type 2 Diabetes Mellitus (T2DM) and hypertension as the main focus. However, study that evaluates the clinical impact of PROLANIS in patients with T2DM is still scarce to this date. This study aims to evaluate the metabolic control and renal function of PROLANIS participants with T2DM every six month within the first 18-months of implementation.

Methods:

This study was a retrospective cohort study conducted at Wates sub-district, East Java using secondary data from PROLANIS group report from April 2018 to October 2019. The study population was T2DM patients who voluntarily joined the PROLANIS group in April 2018. The six-month-evaluation included metabolic parameters [body mass index (BMI), blood pressure, hemoglobin A1C, total cholesterol, high-density lipid, low-density lipid, and triglyceride (TG)] and renal parameters [blood urea nitrogen (BUN), creatinine serum, and urinary microalbumin]. Paired t-test and wilcoxon signed-rank test was used for the analysis, and the P-value was adjusted using Bonferroni correction. A P-value < .0015 was considered statistically significant, while a P-value between .0015 and .003 was considered as marginally significant.

Results:

A total of 30 participants were included in the analysis. Following the PROLANIS implementation, the only parameter of metabolic control that showed significant improvement was TG serum level ( P < .001). Despite the worsening status of other metabolic parameters, the changes were not statistically significant except for BMI that was marginally significant ( P = .002). From renal function, only BUN serum level was significantly deteriorated ( P < .001), while the others did not significantly change.

Conclusion:

PROLANIS implementation in our study population seems to be ineffective. Future study with more primary healthcare centers needs to be done to scrutinize the clinical impact of this program nationwide.
Racism, Interculturality, and Public Policies: An Analysis of the Literature on Migration and the School System in Chile, Argentina, and Spain
Authors: Martínez Rojas David , Muñoz Henríquez Wilson , Mondaca Rojas Carlos
Published: January 2021

In the last decades, Chile has become a receiving society of migrants, and this has overtaxed the social services in this country, among them the school system. According to the literature, the issue is that migration has not been addressed with a proper response from public policies. This article aims to examine recommendations for the development of these policies. To undertake this task, we have conducted a systematic review of the literature on this issue in Chile, Argentina, and Spain (1990–2018). The three cases show the presence of discrimination and racism, with a common response taking the form of intercultural education. In terms of differences, only in Spain there is a consolidated body of research and public policies that focus on migration. That said, although the policies are more robust in Spain, several studies critically assess them. Hence, this country is a good example to know what to do and what to avoid. That information is exactly what is needed in countries like Chile where migration has become pressing issue that demands a proper response.
The Pelvic Incidence Stratified Sagittal Spinopelvic Alignment in Asymptomatic Chinese Population With Different Age Groups
Authors: Zhou Siyu , Sun Zhuoran , Li Wei , Zou Da , Li Weishi
Published: January 2021

Study Design:

Cross-sectional study.

Objective:

To provide the age- and pelvic incidence-related variations of sagittal alignment in asymptomatic Chinese population.

Methods:

This study recruited asymptomatic adult subjects. All subjects undertook the standing whole spinal radiograph and the sagittal parameters were measured: sagittal vertical axis (SVA), T1 pelvic angle (TPA), lumbar lordosis (LL), thoracic kyphosis (TK), pelvic incidence (PI) and pelvic tilt (PT). All subjects were divided into young, middle aged and elderly groups, then each age group was further divided into 5 subgroups (very low, low, average, high and very high) based on PI values. The relations between PI, age and other parameters were evaluated. The differences in sagittal parameters of each PI subgroup were compared.

Results:

546 subjects were included with an average age of 38.6 years (18 to 81). The number of subjects over 70 years and with very low PI was relatively small. The average of PI, TPA, PT and LL were 45.9° ± 8.4°, 6.4° ± 6.2°, 11.9° ± 6.6° and 49.2° ± 10.1°, respectively. SVA, TPA, TK and PT increased with age ( P < 0.05), while SVA, TPA, PT, PI-LL also increased with PI ( P < 0.05). LL, PT, TPA, PI-LL and LL-TK were different among the 5 PI subgroups ( P < 0.05). However, the values of LL in elderly subjects with high and very high PI were similar.

Conclusion:

The age- and PI-related variations in sagittal alignment of Chinese population were provided. The sagittal parameters were significantly influenced by age and PI. The individual pelvic morphology should be carefully considered during the assessment and restoration of sagittal balance.
Evaluation of glenohumeral range of motion and humeral retroversion at ages after major change and differences in wrestlers
Authors: Civan Osman , Civan Adem , Erkan Arda , Ozenci Alpay Merter
Published: January 2021

Purpose:

This study aimed to present the change in humeral retroversion (HR) angle (HRA) that occurs in childhood and young adulthood and the potential developmental difference that is observed in wrestlers.

Methods:

HRA of dominant and non-dominant shoulders (DSHRA and NDSHRA, respectively) were measured using ultrasonography in a group of 30 wrestlers who started wrestling before the age of 13 years (Group 1), a group of 30 young adults, aged between 16–20 years, who were not actively engaged in any branch of overhead sports (Group 2) and a group of children aged between 11–13 years and not actively engaged in any branch of overhead sports (Group 3). Range of motion (ROM) degrees of dominant and non-dominant shoulders in all groups were compared within each group and between the groups.

Results:

DSHRA (mean: 88.73°, 88.93° and 89.40°) values were significantly higher than NDSHRA (mean: 81.13°, 81.83° and 84.37°) values (p < 0.001, p < 0.001 and p < 0,05) in Groups I, II and III, respectively. Internal rotation and total ROM degrees of the dominant shoulder in Group 1 and 3 were higher than those in Group 2.

Conclusion:

There is no significant change in terms of HRA in people aged between 11–13 and 16–20 years because of natural development or wrestling. DSHRA values are higher than NDSHRA ones. In contrast to the shoulders of throwers, the shoulders of wrestlers are characterized by an increase in internal rotation, described as “Wrestler’s shoulder.”

Level of Evidence:

Level III.
Cardiac and Vascular Surgeons for the Treatment of Aortic Disease: A Successful Partnership for Decision-Making and Management of Complex Cases
Authors: Capoccia Massimo , Pal Soumik , Murphy Michael , Mireskandari Maziar , Hoschtitzky Andreas , Nienaber Christoph A. , Cheshire Nicholas J. , Rosendahl Ulrich P.
Published: January 2021

Traditionally, cardiac and vascular surgeons have been treating diseases of the aorta as individual specialists. Neither cardiac nor vascular surgeons have ever considered the aorta as a whole, which can be diseased throughout its length at the same time requiring a more thoughtful and different approach. Aortic dissection and aneurysmal disease may well benefit from a multidisciplinary approach. In the context of this review, we discuss examples of joint operating between cardiac and vascular surgeons that may well become a more routine approach in more units in the future.
Mental Health in Women Living With HIV: The Unique and Unmet Needs
Authors: Waldron Elizabeth M. , Burnett-Zeigler Inger , Wee Victoria , Ng Yiukee Warren , Koenig Linda J. , Pederson Aderonke Bamgbose , Tomaszewski Evelyn , Miller Emily S.
Published: January 2021

Women living with HIV (WLWH) experience depression, anxiety, and posttraumatic stress symptoms at higher rates than their male counterparts and more often than HIV-unaffected women. These mental health issues affect not only the well-being and quality of life of WLWH, but have implications for HIV management and transmission prevention. Despite these ramifications, WLWH are under-treated for mental health concerns and they are underrepresented in the mental health treatment literature. In this review, we illustrate the unique mental health issues faced by WLWH such as a high prevalence of physical and sexual abuse histories, caregiving stress, and elevated internalized stigma as well as myriad barriers to care. We examine the feasibility and outcomes of mental health interventions that have been tested in WLWH including cognitive behavioral therapy, mindfulness-based interventions, and supportive counseling. Future research is required to address individual and systemic barriers to mental health care for WLWH.
Measurements of Tendon Movement Within the Bicipital Groove After Suprapectoral Intra-articular Biceps Tenodesis in a Cadaveric Model
Authors: Kelly Brian J. , Reynolds Alan W. , Schimoler Patrick J. , Kharlamov Alexander , Miller Mark Carl , Akhavan Sam
Published: January 2021

Background:

Lesions of the long head of the biceps can be successfully treated with biceps tenotomy or tenodesis when surgical management is elected. The advantage of a tenodesis is that it prevents the potential development of a cosmetic deformity or cramping muscle pain. Proponents of a subpectoral tenodesis believe that “groove pain” may remain a problem after suprapectoral tenodesis as a result of persistent motion of the tendon within the bicipital groove.

Purpose/Hypothesis:

To evaluate the motion of the biceps tendon within the bicipital groove before and after a suprapectoral intra-articular tenodesis. The hypothesis was that there would be minimal to no motion of the biceps tendon within the bicipital groove after tenodesis.

Study Design:

Controlled laboratory study.

Methods:

Six fresh-frozen cadaveric arms were dissected to expose the long head of the biceps tendon as well as the bicipital groove. Inclinometers and fiducials (optical markers) were used to measure the motions of the scapula, forearm, and biceps tendon through a full range of shoulder and elbow motions. A suprapectoral biceps tenodesis was then performed, and the motions were repeated. The motion of the biceps tendon was quantified as a function of scapular or forearm motion in each plane, both before and after the tenodesis.

Results:

There was minimal motion of the native biceps tendon during elbow flexion and extension but significant motion during all planes of scapular motion before tenodesis, with the most motion occurring during shoulder flexion-extension (20.73 ± 8.21 mm). The motion of the biceps tendon after tenodesis was significantly reduced during every plane of scapular motion compared with the native state ( P < .01 in all planes of motion), with a maximum motion of only 1.57 mm.

Conclusion:

There was a statistically significant reduction in motion of the biceps tendon in all planes of scapular motion after the intra-articular biceps tenodesis. The motion of the biceps tendon within the bicipital groove was essentially eliminated after the suprapectoral biceps tenodesis.

Clinical Relevance:

This arthroscopic suprapectoral tenodesis technique can significantly reduce motion of the biceps tendon within the groove in this cadaveric study, possibly reducing the likelihood of groove pain in the clinical setting.
Online or in Person? Examining College Decisions to Reopen during the COVID-19 Pandemic in Fall 2020
Authors: Felson Jacob , Adamczyk Amy
Published: January 2021

When coronavirus disease 2019 (COVID-19) became a major impediment to face-to-face college instruction in spring 2020, most teaching went online. Over the summer, colleges had to make difficult decisions about whether to return to in-person instruction. Although opening campuses could pose a major health risk, keeping instruction online could dissuade students from enrolling. Taking an ecological approach, the authors use mixed modeling techniques and data from 87 percent of two- and four-year public and four-year private U.S. colleges to assess the factors that shaped decisions about fall 2020 instructional modality. Most notably, the authors find that reopening decisions about whether to return to in-person instruction were unrelated to cumulative COVID-19 infection and mortality rates. Politics and budget concerns played the most important roles. Colleges that derived more of their revenue from tuition were more likely to return to classroom instruction, as were institutions in states and counties that supported Donald Trump for president in 2016.
The role of the media in staging air pollution: The controversy on extreme air pollution along Oxford Street and other debates on poor air quality in London
Authors: Kenis Anneleen , Barratt Benjamin
Published: January 2021

Mapping the media frames that have both triggered and articulated the mobilisation around air pollution in London in the period 1997–2017, this paper shows how especially those events that have been framed in agonistic terms have led to a rise of media engagement with the topic. From the controversy around Sahara dust as a so-called ‘natural’ explanation for smog episodes, to the staging of Oxford Street as the most polluted street of the world, from Sadiq Khan's decision to join ClientEarth in its court case against the UK government to the debate on a new runway for Heathrow, from the Volkswagen scandal to the Black Lives Matter blockade of London City Airport: the discursive construction of us/them divides has been crucial in sparking passion, contestation and debate. Empirically, the paper starts from a detailed study of 1594 newspaper articles that appeared on air pollution in five British newspapers, The Guardian, Financial Times, The Independent, The Daily Telegraph and The Times, between January 1997 and March 2017. Theoretically, it combines Chantal Mouffe’s political theory with Anabela Carvalho’s media theory, in particular her diachronic model of circuits of culture. On this basis, the paper distinguishes five critical discourse periods and shows how a number of critical discourse moments, exactly because of their agonising dimension, have been able to spike media attention and shift the terms of the debate. Starting from this observation, the paper argues that media processes should not only be understood in cyclic terms, but can also trigger non-linear iterative dynamics, leading to upward spirals characterised by thresholds and a gradually increasing level of interest overall, in this case raising the profile of London’s poor air.
A multi-dimensional spatial policy model for large-scale multi-municipal Swiss contexts
Authors: Walczak Michael
Published: January 2021

Switzerland’s widely adopted spatial policy rejects the use of new land in favour of promoting the densification of existing buildings or brownfield developments. However, to date there has not been an assessment of the volumetric building reserves that are still available within the current building regulatory framework. This paper addresses this lacuna using a case study of the agglomeration of Lausanne. An automated spatial policy model with particular focus on building density and its volume in residential and mixed-use areas allows for building policy to be quantified, assessed and evaluated on a countrywide scale since it takes the location of the building lot into consideration and cross-references it with the correct building regulation. Three-dimensional comparison allows us to identify whether the maximum volume permitted under the building regulation is greater than the current existing building volume. For the test case, spatial policy model identified 38 hectares of available square metres for densification (‘building surplus’ in the context of existing buildings, either in the form of extending existing buildings or infill development) and 93 hectares of square metres available for new developments (brownfield development of vacant or derelict open land) of residential and mixed-use buildings. At the same time, almost all areas are allocated beyond Lausanne’s inner-city boundaries.
Regional corridor model: Towards a regional corridor model
Authors: Brand André , Drewes J Ernst
Published: January 2021

One of the key concepts underlying the science of spatial planning refers to the role of development corridors as a planning instrument to potentially restructure economic space. Although strong evidence exists that corridors are regarded as important spatial development instruments that channel economic development, counter-arguments indicate the need for more diversified strategies at regional and national levels, as well as a greater awareness of agglomeration economies to allow for the integration of corridors as strategic and supporting networks. Drawing on fundamental literature, a regional corridor model was developed with the aim to establish a spatial framework through which corridor development can be integrated as strategic and supporting networks to support the notion of ‘ sustainable spatial- and settlement planning’, i.e. the appropriate compilation and administration of policies affecting spatial organisation at local, regional and national levels. Based on the empirical research, regional and national governments could, through the RCM, develop a realistic spatial perspective on long-term settlement patterns and investment opportunities which could transform economic space development and seek to connect the potential of urban systems in economic development.
Safety and Efficacy of Apixaban Use in Peritoneal Dialysis: A Review of the Literature
Authors: Amani Armaghan , Fellers Caitlin M. , Eyebe Antoinette , Hall Alyssa , Howard Meredith L.
Published: January 2021

Objective: To review the safety and efficacy of apixaban for the treatment of nonvalvular atrial fibrillation or venous thromboembolism in patients receiving peritoneal dialysis (PD). Data Sources: A PubMed and MEDLINE search was conducted through December 2020 using the following keywords and Medical Subject Headings (MeSH) terms alone or in various combinations: apixaban, peritoneal dialysis, continuous ambulatory peritoneal dialysis, end-stage renal disease, and hemodialysis. Study Selection and Data Extraction: English-language studies evaluating clinical outcomes pertaining to the use of apixaban in end stage renal disease (ESRD), which included patients receiving peritoneal dialysis were eligible for inclusion. Data Synthesis: Four studies were identified that met inclusion for this review, all retrospective in nature. These studies compared the safety and efficacy of apixaban with standard therapy in ESRD included patients on dialysis, with a very limited number of subjects receiving PD. In these studies, apixaban was shown to be potentially safer and more effective than warfarin. Outcomes did not differentiate between patients receiving PD or not. Conclusions: Use of apixaban in patients receiving PD may be safe and effective based on data from limited patients. Pharmacokinetics and pharmacodynamics of apixaban in the PD setting is an important question that clinicians should consider with use of this medication in the ESRD population. More studies focusing on the PD population are needed to better assess the use of apixaban in this understudied population.
How I treat paroxysmal nocturnal hemoglobinuria
Authors: Brodsky Robert A.
Published: January 2021

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, clonal, complement-mediated hemolytic anemia with protean manifestations. PNH can present as a hemolytic anemia, a form of bone marrow failure, a thrombophilia, or any combination of the above. Terminal complement inhibition is highly effective for treating intravascular hemolysis from PNH and virtually eliminates the risk of thrombosis, but is not effective for treating bone marrow failure. Here, I present a variety of clinical vignettes that highlight the clinical heterogeneity of PNH and the attributes and limitations of the 2 US Food and Drug Administration–approved C5 inhibitors (eculizumab and ravulizumab) to treat PNH. I review the concept of pharmacokinetic and pharmacodynamic breakthrough hemolysis and briefly discuss new complement inhibitors upstream of C5 that are in clinical development. Last, I discuss the rare indications for bone marrow transplantation in patients with PNH.
Plasminogen activator inhibitor 1 and venous thrombosis in pancreatic cancer
Authors: Hisada Yohei , Garratt Kenison B. , Maqsood Anaum , Grover Steven P. , Kawano Tomohiro , Cooley Brian C. , Erlich Jonathan , Moik Florian , Flick Matthew J. , Pabinger Ingrid , Mackman Nigel , Ay Cihan
Published: January 2021

Pancreatic cancer patients have a high risk of venous thromboembolism (VTE). Plasminogen activator inhibitor 1 (PAI-1) inhibits plasminogen activators and increases the risk of thrombosis. PAI-1 is expressed by pancreatic tumors and human pancreatic cell lines. However, to date, there are no studies analyzing the association of active PAI-1 and VTE in pancreatic cancer patients. We investigated the association of active PAI-1 in plasma and VTE in pancreatic cancer patients. In addition, we determined if the presence of human pancreatic tumors expressing PAI-1 impairs venous thrombus resolution in mice. Plasma levels of active PAI-1 in patients with pancreatic cancer and mice bearing human tumors were determined by enzyme-linked immunosorbent assay. We measured PAI-1 expression in 5 different human pancreatic cancer cell lines and found that PANC-1 cells expressed the highest level. PANC-1 tumors were grown in nude mice. Venous thrombosis was induced by complete ligation of the inferior vena cava (IVC). Levels of active PAI-1 were independently associated with increased risk of VTE in patients with pancreatic cancer (subdistribution hazard ratio per doubling of levels: 1.39 [95% confidence interval, 1.09-1.78], P = .007). Mice bearing PANC-1 tumors had increased levels of both active human and active mouse PAI-1 and decreased levels of plasmin activity. Importantly, mice bearing PANC-1 tumors exhibited impaired venous thrombus resolution 8 days after IVC stasis compared with nontumor controls. Our results suggest that PAI-1 contributes to VTE in pancreatic cancer.
Topological data analysis reveals genotype–phenotype relationships in primary ciliary dyskinesia
Authors: Shoemark Amelia , Rubbo Bruna , Legendre Marie , Fassad Mahmoud R. , Haarman Eric G. , Best Sunayna , Bon Irma C.M. , Brandsma Joost , Burgel Pierre-Regis , Carlsson Gunnar , Carr Siobhan B. , Carroll Mary , Edwards Matt , Escudier Estelle , Honoré Isabelle , Hunt David , Jouvion Gregory , Loebinger Michel R. , Maitre Bernard , Morris-Rosendahl Deborah , Papon Jean-Francois , Parsons Camille M. , Patel Mitali P. , Thomas N. Simon , Thouvenin Guillaume , Walker Woolf T. , Wilson Robert , Hogg Claire , Mitchison Hannah M. , Lucas Jane S.
Published: January 2021

Background

Primary ciliary dyskinesia (PCD) is a heterogeneous inherited disorder caused by mutations in approximately 50 cilia-related genes. PCD genotype–phenotype relationships have mostly arisen from small case series because existing statistical approaches to investigating relationships have been unsuitable for rare diseases.

Methods

We applied a topological data analysis (TDA) approach to investigate genotype–phenotype relationships in PCD. Data from separate training and validation cohorts included 396 genetically defined individuals carrying pathogenic variants in PCD genes. To develop the TDA models, 12 clinical and diagnostic variables were included. TDA-driven hypotheses were subsequently tested using traditional statistics.

Results

Disease severity at diagnosis, measured by forced expiratory volume in 1 s (FEV1) z-score, was significantly worse in individuals withCCDC39mutations (compared to other gene mutations) and better in those withDNAH11mutations; the latter also reported less neonatal respiratory distress. Patients without neonatal respiratory distress had better preserved FEV1at diagnosis. Individuals withDNAH5mutations were phenotypically diverse. Cilia ultrastructure and beat pattern defects correlated closely to specific causative gene groups, confirming these tests can be used to support a genetic diagnosis.

Conclusions

This large scale, multi-national study presents PCD as a syndrome with overlapping symptoms and variations in phenotype according to genotype. TDA modelling confirmed genotype–phenotype relationships reported by smaller studies (e.g.FEV1worse withCCDC39mutation) and identified new relationships, including FEV1preservation withDNAH11mutations and diversity of severity withDNAH5mutations.
Chronic pulmonary aspergillosis: prevalence, favouring pulmonary diseases and prognosis
Authors: Maitre Thomas , Cottenet Jonathan , Godet Cendrine , Roussot Adrien , Abdoul Carime Nafiz , Ok Vichita , Parrot Antoine , Bonniaud Philippe , Quantin Catherine , Cadranel Jacques
Published: January 2021

Chronic pulmonary aspergillosis (CPA) is an emerging disease in patients with common chronic pulmonary diseases (CPDs). While its prevalence is linked to tuberculosis (TB) in endemic countries, epidemiological and prognostic data are lacking in low TB incidence countries. The aim of this study was to describe these features in CPA patients hospitalised in France between 2009 and 2018.

We estimated the prevalence and mortality of hospitalised CPA patients using the French nationwide administrative hospital database. We also assessed the association with CPD, thoracic interventions and malnutrition.

From 2009 to 2018, 17 290 patients were hospitalised in France for CPA, with an increasing prevalence during this period. Most patients were male (63.5%) with a median age of 65 years at CPA diagnosis, living in farming regions and large cities. The proportion of underlying chronic obstructive pulmonary disease (COPD) and emphysema during the previous 5 years was 44% and 22%, respectively, whereas it was only 3% for both TB and non-TB mycobacterial (NTM) infections. The mortality rates during the first hospitalisation, at 1 year and at 5 years were 17%, 32% and 45%, respectively. In multivariate analysis, mortality rates were increased in patients aged >65 years, male patients and patients with malnutrition, diabetes or lung cancer history. The risk of mortality in patients with COPD or emphysema was higher than in those with previous mycobacterial lung infection.

In France, CPA is an emerging infection commonly associated with non-mycobacterial CPD. This shift in the distribution profile of underlying CPD will likely worsen CPA mortality.
Lung transplantation for sarcoidosis: outcome and prognostic factors
Authors: Le Pavec Jérôme , Valeyre Dominique , Gazengel Pierre , Holm Are M. , Schultz Hans Henrik , Perch Michael , Le Borgne Aurélie , Reynaud-Gaubert Martine , Knoop Christiane , Godinas Laurent , Hirschi Sandrine , Bunel Vincent , Laporta Rosalia , Harari Sergio , Blanchard Elodie , Magnusson Jesper M. , Tissot Adrien , Mornex Jean-François , Picard Clément , Savale Laurent , Bernaudin Jean-François , Brillet Pierre-Yves , Nunes Hilario , Humbert Marc , Fadel Elie , Gottlieb Jens
Published: January 2021

Study question

In patients with sarcoidosis, past and ongoing immunosuppressive regimens, recurrent disease in the transplant and extrapulmonary involvement may affect outcomes of lung transplantation. We asked whether sarcoidosis lung phenotypes can be differentiated and, if so, how they relate to outcomes in patients with pulmonary sarcoidosis treated by lung transplantation.

Patients and methods

We retrospectively reviewed data from 112 patients who met international diagnostic criteria for sarcoidosis and underwent lung or heart–lung transplantation between 2006 and 2019 at 16 European centres.

Results

Patient survival was the main outcome measure. At transplantation, median (interaquartile range (IQR)) age was 52 (46–59) years; 71 (64%) were male. Lung phenotypes were individualised as follows: 1) extended fibrosis only; 2) airflow obstruction; 3) severe pulmonary hypertension (sPH) and airflow obstruction; 4) sPH, airflow obstruction and fibrosis; 5) sPH and fibrosis; 6) airflow obstruction and fibrosis; 7) sPH; and 8) none of these criteria, in 17%, 16%, 17%, 14%, 11%, 9%, 5% and 11% of patients, respectively. Post-transplant survival rates after 1, 3, and 5 years were 86%, 76% and 69%, respectively. During follow-up (median (IQR) 46 (16–89) months), 31% of patients developed chronic lung allograft dysfunction. Age and extended lung fibrosis were associated with increased mortality. Pulmonary fibrosis predominating peripherally was associated with short-term complications.

Answer to the study question

Post-transplant survival in patients with pulmonary sarcoidosis was similar to that in patients with other indications for lung transplantation. The main factors associated with worse survival were older age and extensive pre-operative lung fibrosis.
The Noninvasive Ventilation Outcomes (NIVO) score: prediction of in-hospital mortality in exacerbations of COPD requiring assisted ventilation
Authors: Hartley Tom , Lane Nicholas D. , Steer John , Elliott Mark W. , Sovani Milind P. , Curtis Helen Jane , Fuller Elizabeth R. , Murphy Patrick B. , Shrikrishna Dinesh , Lewis Keir E. , Ward Neil R. , Turnbull Chris D. , Hart Nicholas , Bourke Stephen C.
Published: January 2021

Introduction

Acute exacerbations of COPD (AECOPD) complicated by acute (acidaemic) hypercapnic respiratory failure (AHRF) requiring ventilation are common. When applied appropriately, ventilation substantially reduces mortality. Despite this, there is evidence of poor practice and prognostic pessimism. A clinical prediction tool could improve decision making regarding ventilation, but none is routinely used.

Methods

Consecutive patients admitted with AECOPD and AHRF treated with assisted ventilation (principally noninvasive ventilation) were identified in two hospitals serving differing populations. Known and potential prognostic indices were identifieda priori. A prediction tool for in-hospital death was derived using multivariable regression analysis. Prospective, external validation was performed in a temporally separate, geographically diverse 10-centre study. The trial methodology adhered to TRIPOD (Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis) recommendations.

Results

Derivation cohort: n=489, in-hospital mortality 25.4%; validation cohort: n=733, in-hospital mortality 20.1%. Using six simple categorised variables (extended Medical Research Council Dyspnoea score 1–4/5a/5b, time from admission to acidaemia >12 h, pH <7.25, presence of atrial fibrillation, Glasgow coma scale ≤14 and chest radiograph consolidation), a simple scoring system with strong prediction of in-hospital mortality is achieved. The resultant Noninvasive Ventilation Outcomes (NIVO) score had area under the receiver operating curve of 0.79 and offers good calibration and discrimination across stratified risk groups in its validation cohort.

Discussion

The NIVO score outperformed pre-specified comparator scores. It is validated in a generalisable cohort and works despite the heterogeneity inherent to both this patient group and this intervention. Potential applications include informing discussions with patients and their families, aiding treatment escalation decisions, challenging pessimism and comparing risk-adjusted outcomes across centres.
Bronchodilator reversibility as a diagnostic test for adult asthma: findings from the population-based Tasmanian Longitudinal Health Study
Authors: Tan Daniel J. , Lodge Caroline J. , Lowe Adrian J. , Bui Dinh S. , Bowatte Gayan , Johns David P. , Hamilton Garun S. , Thomas Paul S. , Abramson Michael J. , Walters E. Haydn , Perret Jennifer L. , Dharmage Shyamali C.
Published: January 2021

Bronchodilator reversibility (BDR) is often used as a diagnostic test for adult asthma. However, there has been limited assessment of its diagnostic utility. We aimed to determine the discriminatory accuracy of common BDR cut-offs in the context of current asthma and asthma–COPD overlap (ACO) in a middle-aged community sample.

The Tasmanian Longitudinal Health Study is a population-based cohort first studied in 1968 (n=8583). In 2012, participants completed respiratory questionnaires and spirometry (n=3609; mean age 53 years). Receiver operating characteristic (ROC) curves were fitted for current asthma and ACO using continuous BDR measurements. Diagnostic parameters were calculated for different categorical cut-offs.

Area under the ROC curve (AUC) was highest when BDR was expressed as change in forced expiratory volume in 1 s (FEV1) as a percentage of initial FEV1, as compared with predicted FEV1. The corresponding AUC was 59% (95% CI 54–64%) for current asthma and 87% (95% CI 81–93%) for ACO. Of the categorical cut-offs examined, the European Respiratory Society/American Thoracic Society threshold (≥12% from baseline and ≥200 mL) was assessed as providing the best balance between positive and negative likelihood ratios (LR+ and LR−, respectively), with corresponding sensitivities and specificities of 9% and 97%, respectively, for current asthma (LR+ 3.26, LR− 0.93), and 47% and 97%, respectively, for ACO (LR+ 16.05, LR− 0.55).

With a threshold of ≥12% and ≥200 mL from baseline, a positive BDR test provided a clinically meaningful change in the post-test probability of disease, whereas a negative test did not. BDR was more useful as a diagnostic test in those with co-existent post-bronchodilator airflow obstruction (ACO).
Respiratory subtype of relapsing polychondritis frequently presents as difficult asthma: a descriptive study of respiratory involvement in relapsing polychondritis with 13 patients from a single UK centre
Authors: Dubey Shirish , Gelder Colin , Pink Grace , Ali Asad , Taylor Christopher , Shakespeare Joanna , Townsend Susan , Murphy Patrick , Hart Nicholas , D'Cruz David
Published: January 2021

Introduction

Relapsing polychondritis is a rare multisystem vasculitis characterised by recurrent cartilage inflammation. Respiratory involvement, of which tracheobronchomalacia (TBM) is the commonest form, is difficult to treat and is linked to increased mortality. We describe 13 patients with respiratory involvement.

Methods

This is a retrospective study of all the patients with relapsing polychondritis at University Hospitals Coventry and Warwickshire NHS Trust (UHCW), a secondary care provider for ∼500 000. Only patients with respiratory involvement were included in this study.

Results

We identified 13 patients who fulfilled the inclusion criteria. Most patients were identified from the “difficult asthma” clinic. TBM was seen in 11 patients, whilst two patients had pleural effusions which resolved with immunosuppression and one patient had small airways disease. Computed tomography scans (inspiratory and expiratory) and bronchoscopy findings were useful in diagnosing TBM. Pulmonary function testing revealed significant expiratory flow abnormalities. All patients were treated with corticosteroids/disease-modifying anti-rheumatic drugs (DMARDs) and some were given cyclophosphamide or biological agents, although the response to cyclophosphamide (1 out of 4) or biologicals (2 out of 4) was modest in this cohort. Ambulatory continuous positive airway pressure ventilation was successful in four patients.

Conclusions

Relapsing polychondritis may be overlooked in “difficult asthma” clinics with patients having TBM (not asthma) and other features of relapsing polychondritis. Awareness of this condition is crucial to enable early diagnosis and interventions to reduce the risk of life-threatening airway collapse. A number of patients respond well to DMARDs and are able to minimise corticosteroid use.
Diaphragmatic motion recorded by M-mode ultrasonography: limits of normality
Authors: Boussuges Alain , Finance Julie , Chaumet Guillaume , Brégeon Fabienne
Published: January 2021

Chest ultrasonography has proven to be useful in the diagnosis of diaphragm dysfunction. The aim of the present study was to determine the normal values of the motion of both hemidiaphragms recorded by M-mode ultrasonography.

Healthy volunteers were studied while in a seated position. Diaphragmatic excursions and diaphragm profiles were measured during quiet breathing, voluntary sniffing and deep breathing. Diaphragmatic excursions were assessed by M-mode ultrasonography, using an approach perpendicular to the posterior part of the diaphragm. Anatomical M-mode was used for the recording of the complete excursion during deep breathing.

The study included 270 men and 140 women. The diaphragmatic motions during quiet breathing and voluntary sniffing were successfully recorded in all of the participants. The use of anatomical M-mode was particularly suitable for measurement of the entire diaphragmatic excursion during deep breathing. The statistical analysis showed that the diaphragmatic excursions were larger in men compared to women, supporting the determination of normal values based on sex. The lower and upper limits of normal excursion were determined for men and women for both hemidiaphragms during the three manoeuvres that were investigated. The lower limits of normal diaphragmatic excursions during deep breathing should be used to detect diaphragmatic hypokinesia,i.e.3.3 and 3.2 cm in women and 4.1 and 4.2 cm in men for the right and the left sides, respectively.

The normal values of the diaphragmatic motion and the lower and upper limits of normal excursion can be used by clinicians to detect diaphragmatic dysfunction.
Prevalence and characteristics of self-reported hypothyroidism and its association with nonorgan-specific manifestations in US sarcoidosis patients: a nationwide registry study
Authors: Alzghoul Bashar N. , Amer Farah N. , Barb Diana , Innabi Ayoub , Mardini Mamoun T. , Bai Chen , Alzghoul Bara , Al-Hakim Tamara , Singh Noopur , Buchanan Mindy , Serchuck Leslie , Gomez Manjarres Diana , Woodmansee Whitney W. , Maier Lisa A. , Patel Divya C.
Published: January 2021

Little is known about the prevalence, clinical characteristics and impact of hypothyroidism in patients with sarcoidosis. We aimed to determine the prevalence and clinical features of hypothyroidism and its relation to organ involvement and other clinical manifestations in patients with sarcoidosis.

We conducted a national registry-based study investigating 3835 respondents to the Sarcoidosis Advanced Registry for Cures Questionnaire between June 2014 and August 2019. This registry is based on a self-reported, web-based questionnaire that provides data related to demographics, diagnostics, sarcoidosis manifestations and treatment. We compared sarcoidosis patients with and without self-reported hypothyroidism. We used multivariable logistic regression and adjusted for potential confounders to determine the association of hypothyroidism with nonorgan-specific manifestations.

14% of the sarcoidosis patients self-reported hypothyroidism and were generally middle-aged white women. Hypothyroid patients had more comorbid conditions and were more likely to have multiorgan sarcoidosis involvement, especially with cutaneous, ocular, joints, liver and lacrimal gland involvement. Self-reported hypothyroidism was associated with depression (adjusted odds ratio (aOR) 1.3, 95% CI 1.01–1.6), antidepressant use (aOR 1.3, 95% CI 1.1–1.7), obesity (aOR 1.7, 95% CI 1.4–2.1), sleep apnoea (aOR 1.7, 95% CI 1.3–2.2), chronic fatigue syndrome (aOR 1.5, 95% CI 1.2–2) and was borderline associated with fibromyalgia (aOR 1.3, 95% CI 1–1.8). Physical impairment was more common in patients with hypothyroidism.

Hypothyroidism is a frequent comorbidity in sarcoidosis patients that might be a potentially reversible contributor to fatigue, depression and physical impairment in this population. We recommend considering routine screening for hypothyroidism in sarcoidosis patients especially in those with multiorgan sarcoidosis, fatigue and depression.
Is laryngeal hypersensitivity the basis of unexplained or refractory chronic cough?
Authors: Sundar Krishna M. , Stark Amanda Carole , Hu Nan , Barkmeier-Kraemer Julie
Published: January 2021

Refractory chronic cough (RCC) and unexplained chronic cough (UCC) are common problems seen in primary care and subspecialty clinics. The role of cough hypersensitivity and laryngeal dysfunction in contributing to the persistence of cough in RCC/UCC is not well recognised.

Data of patients with RCC and UCC evaluated in 2019 by an interdisciplinary cough clinic led by a pulmonologist and speech–language pathology team was reviewed. Patients completed validated questionnaires including the Leicester cough questionnaire (LCQ), voice handicap index (VHI) and dyspnoea index (DI) questionnaire at initial encounter. Presence of cough hypersensitivity was based upon a history of allotussia and hypertussia. Laryngeal dysfunction was diagnosed in those with a history of laryngeal paresthesias, throat clearing, voice abnormalities, upper airway dyspnoea and documentation of functional or anatomic laryngeal abnormalities on nasoendoscopy.

Of the 60 UCC/RCC patients analysed, 75% of patients were female and 85% were over 40 years of age. Cough hypersensitivity was documented in all patients and multiple cough triggers occurred in 75% of patients. 95%, 50% and 25% of patients reported laryngeal paresthesias, voice abnormalities and upper airway dyspnoea, respectively. Significant associations between LCQ and VHI and DI scores occurred when adjusting for age, sex, ethnicity and body mass index. Laryngeal functional abnormalities were documented on 44 out of 60 patients on nasoendoscopy.

Hypertussia, allotussia and laryngeal dysfunction are common in patients with RCC and UCC. Evaluation of UCC and RCC can delineate laryngeal hypersensitivity and allows appropriate treatment to be directed at this phenotype.
Predicting mortality during long-term follow-up in pulmonary arterial hypertension
Authors: Kylhammar David , Hjalmarsson Clara , Hesselstrand Roger , Jansson Kjell , Kavianipour Mohammad , Kjellström Barbro , Nisell Magnus , Söderberg Stefan , Rådegran Göran
Published: January 2021

The European Society of Cardiology (ESC) and European Respiratory Society (ERS) guideline recommendation of comprehensive risk assessments, which classify patients with pulmonary arterial hypertension (PAH) as having low, intermediate or high mortality risk, has not been evaluated during long-term follow-up in a “real-life” clinical setting. We therefore aimed to investigate the utility of risk assessment in a clinical setting for up to 5 years post diagnosis.

386 patients with PAH from the Swedish PAH Registry were included. Risk group (low/intermediate/high) and proportion of low-risk variables were investigated at 3-, 4- and 5-year follow-ups after time of diagnosis. In an exploratory analysis, survival rates of patients with low-intermediate or high-intermediate risk scores were compared.

A low-risk profile was in multivariate Cox proportional hazards regressions found to be a strong, independent predictor of longer transplant-free survival (p<0.001) at the 3-, 4- and 5-year follow-ups. Also, for the 3-, 4- and 5-year follow-ups, survival rates significantly differed (p<0.001) between the three risk groups. Patients with a greater proportion of low-risk variables had better (p<0.001) survival rates. Patients with a high-intermediate risk score had worse survival rates (p<0.001) than those with a low-intermediate risk score. Results were similar when excluding patients with ≥3 risk factors for heart failure with preserved ejection fraction, atrial fibrillation and/or age >75 years at diagnosis.

Our findings suggest that the ESC/ERS guideline strategy for comprehensive risk assessments in PAH is valid also during long-term follow-up in a “real-life” clinical setting.
Dyspnoea and symptom burden in mild–moderate COPD: the Canadian Cohort Obstructive Lung Disease Study
Authors: Cherian Mathew , Jensen Dennis , Tan Wan C. , Mursleen Sara , Goodall Emma C. , Nadeau Gilbert A. , Awan Amnah M. , Marciniuk Darcy D. , Walker Brandie L. , Aaron Shawn D. , O'Donnell Denis E. , Chapman Kenneth R. , Maltais François , Hernandez Paul , Sin Don D. , Benedetti Andrea , Bourbeau Jean
Published: January 2021

Studies assessing dyspnoea and health-related quality of life (HRQoL) in chronic obstructive pulmonary disease (COPD) have focussed on patients in clinical settings, not the general population.

The aim of this analysis was to compare the prevalence and severity of dyspnoea and impaired HRQoL in individuals with and without COPD from the general population, focussing on mild–moderate COPD.

Analysis of the 3-year Canadian Cohort Obstructive Lung Disease (CanCOLD) study included four subgroups: mild COPD (Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1); moderate COPD (GOLD 2); non-COPD smokers; and non-COPD never-smokers. The primary outcome was dyspnoea (Medical Research Council (MRC) scale), and the secondary outcome was HRQoL (COPD Assessment Test (CAT) score; Saint George's Respiratory Questionnaire (SGRQ) score). Subgroups were analysed by sex, physician-diagnosed COPD status and exacerbations.

1443 participants (mild COPD (n=397); moderate COPD (n=262(; smokers (n=449) and never-smokers (n=335)) were studied. People with mild COPD were more likely to report more severe dyspnoea (MRC 2versus1) than those without COPD (OR (95% CI) 1.42 (1.05–1.91)), and non-COPD never-smokers (OR (95%CI) 1.64 (1.07–2.52)). Among people with mild COPD, more severe dyspnoea was reported in womenversusmen (MRC2versus1; OR (95% CI) 3.70 (2.23–6.14)); people with,versuswithout, physician-diagnosed COPD (MRC2versus1; OR (95% CI) 3.27 (1.71–6.23)), and people withversuswithout recent exacerbations (MRC2versus1; ≥2versus0 exacerbations: OR (95% CI) 3.62 (1.02–12.86); MRC ≥3versus1; 1versus0 exacerbation: OR (95% CI): 9.24 (2.01–42.42)). Similar between-group differences were obtained for CAT and SGRQ scores.

Careful assessment of dyspnoea and HRQoL could help identify individuals for earlier diagnosis and treatment.
Research Status, Critical Technologies, and Development Trends of Hydraulic Pressure Pulsation Attenuator
Authors: Wang Yan , Shen Tongsheng , Tan Chunsen , Fu Jian , Guo Shengrong
Published: January 2021

Hydraulic pumps are a positive displacement pump whose working principle causes inherent output flow pulsation. Flow pulsation produces pressure pulsation when encountering liquid resistance. Pressure pulsation spreads in the pipeline and causes vibration, noise, damage, and even pipeline rupture and major safety accidents. With the development of airborne hydraulic systems with high pressure, power, and flow rate, the hazards of vibration and noise caused by pressure pulsation are also amplified, severely restricting the application and development of hydraulic systems. In this review paper, the mechanism, harm, and suppression method of pressure pulsation in hydraulic systems are analyzed. Then, the classification and characteristics of pulsation attenuators according to different working principles are described. Furthermore, the critical technology of simulation design, matching method with airborne piston pumps, and preliminary design method of pulsation attenuators are proposed. Finally, the development trend of pulsation attenuators is prospected. This paper provides a reference for the research and application of pressure pulsation attenuators.